emotional and psychological issues that are the primary cause of the problem in so many of their patients? The concept of psychosomatics in modern medicine is no older than a hundred years and few doctors think about how the mind induces disease in the body.
When today we find our yoga therapists making the same mistake in merely treating manifesting symptoms without remedying the “real” cause, Dr Bhavanani prefers to call this yogopathy! It may be useful in some cases, but it misses the true strength of yoga therapy—the opportunity to address the root cause of the problem.
An example of this yogopathy trend is when we use shavasana (Corpse Pose) to manage patients with hypertension, quoting research that has shown that it reduces blood pressure. We seem happy just to bring the blood pressure down for the time being! The transformative yoga therapy would first assess the primary cause of the patient’s hypertension. Based on such an assessment, it would recommend multilevel solutions suitable for this particular client, choosing from lifestyle changes, and yogic techniques to move and cleanse the body and manage the mind and thought processes, for the client to practice over time. Without an attempt to find and deal with the root cause, it remains merely yogopathy.
Another common example is using left nostril (chandra nadi) pranayama to lower blood sugar or right nostril (surya nadi) pranayama to relieve bronchospasm without looking for the real cause of the patient’s diabetes or asthma. When we do this, how are we any different from the modern doctors who prescribe anti-diabetic and sympathomimetic agents for these patients? Where is the true potential of yoga therapy in this type of approach? Where is the effort to find and deal with the primary cause? Without a transformation of attitude or lifestyle, can it be yoga therapy?
Sometimes inexperienced yoga therapists are so taken by the available tools—from asanas, pranayama, chanting, meditation, mudras, etc.—that they lose the view of the person in front of them and get lost in choosing the best “option for the given disease/or symptom.” This was very apparent in my discussions with yoga therapy students where I had to repeatedly steer them towards the client as a person rather than the condition the client suffered from.
If we want to use the transformative potential of yoga therapy, we need to shift our paradigm from a focus on disease to health promotion, from pathogenesis to salutogenesis. Salus (Latin) means health and genesis (Greek) means source, hence salutogenesis means the source of health. In order to move our habitual pathogenic orientation as yoga teachers, therapists, and at the same time as clients, to a salutogenic orientation, we need awareness to change:
• The goal, from better medical intervention to improvement of our natural and created environment.
• Focus, from curing chronic disease to client ownership, to act in a way helps cause health.
• Norms, from paternalism and entitlement, to empowering clients to cultivate health.
• Orientation, from fixing parts of the system, to healing by bringing all systems into harmonious coherence.
According to Antonovsky,23 at the heart of salutogenesis lies a sense of coherence (SOC), “a pervasive, long lasting and dynamic feeling of confidence” that:
• One’s internal and external environments are predictable.
• There is a high probability that things will work out as well as can be expected.
SOC has a strong positive correlation to perceived physical and mental health and quality of life. It has three main components:
• Cognition—“my world is understandable.”
• Coping skills—“my world is manageable.”
• Motivation—“my world has meaning.”
Salutogenesis, as the health-promoting approach, lies at the core of yoga therapy. When we do an initial assessment of the client, we focus on multilevel functioning in harmony. We identify disharmony at each level of functioning (according to pancha kosha, doshas, gunas, and vayus), and create a protocol specific to this client’s goals to help them move from disharmony to harmony, from disease to health. Together with the client we keep evaluating the progress towards reaching their potential. We facilitate a proactive stance in the client—where they take ownership and responsibility to move forward to grow on a wellness continuum. This helps the client to discover how to live fully.
Yoga has a term for such a dynamic state of wellness—swastha—defined by Sushrut24 as: “a dynamic balance of the elements and humors, normal metabolic activity and efficient elimination coupled with a tranquil mind, senses and contented soul.”
Unless we aim to treat the whole individual on all levels, as per pancha kosha, doshas, and vayus, including underlying psychosomatic disassociation and ignorant perception of reality, we are not practicing real yoga therapy. Therefore, in the application of yoga therapy it is vital that we take into consideration all the following aspects that are part of an integrated approach to the problem. These include the code of personal and social ethics (yamas and niyamas), diet, environment, attitude, lifestyle, bodywork through asanas, mudras, and kriyas, breath work through the use of pranayama, and the management of a healthy thought process and attitudes through the higher practices of yoga nidra, chanting, and meditation.
However, we must remember to look for and assess the root cause of the problem because if not, we are practicing yogopathy, and not yoga therapy!
Contemporary trends and thoughts on the future
The limitation of modern medicine in managing stress-induced psychosomatic, chronic illnesses is the strength of yoga therapy. Hence a holistic integration of both systems enables the best quality of care for clients. It is imperative that advances in medicine include the holistic approach of yoga to face the current challenges in healthcare. The antiquity of yoga must be united with the innovations of modern medicine to improve quality of life throughout the world. This approach is becoming more acceptable with time, and a great proponent of such a method is Dr Dean Ornish, who has just published, with his wife Anne, UnDo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases.25 They describe in detail lifestyle medicine that they have been practicing and researching for the last 40 years, which is based on such an integrated approach, and has successfully reversed cardiovascular disorders and other NCDs.
Lately, Dr Bhavanani has actually begun to question the very scientific research itself that makes up the foundation of “evidence-based” yoga therapy. Many excellent scientists are researching yoga and its effects on different populations and in different conditions, yet their understanding of yoga is too limited to produce meaningful results. This is because they try to fit the grand design of yoga into the limited box of scientific methodology, and end up not studying “yoga” at all. The research that is published is excellent from a scientific perspective, but truly very limited from a yogic perspective. We need to continue working on keeping the yoga in yoga therapy, and especially in yoga research, where it tends to get lost in the tight limitations of “standardization” and “study protocols.” Yoga therapy, by its definition, cannot be standardized or limited, as it is carefully crafted to the need of each client.
A brief qualitative survey on the utilization of yoga research resources by yoga teachers found a general lack of awareness of yoga research among practicing yoga teachers and therapists.26 Although a majority of respondents agreed that research was important, few were seriously updating themselves on such research
