|
 
 |
| REVIEW ARTICLE |
|
| Year : 2021 | Volume
: 22
| Issue : 1 | Page : 74-79 |
|
Yoga therapy in psychiatry: Myths and misconceptions
Rama Reddy Karri1, Ananda Balayogi Bhavanani2, Meena Ramanathan3, Vijaya Gopal Mopidevi4
1 Research Scholar, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Puducherry, India
2 Director, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Puducherry, India
3 Deputy Director, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Puducherry, India
4 Professor, Department of Psychiatry, G.S.L. Medical College, Rajamahendravaram, Andhra Pradesh, India
| Date of Submission | 05-May-2021 |
| Date of Acceptance | 08-May-2021 |
| Date of Web Publication | 01-Jun-2021 |
Correspondence Address:
Dr. Rama Reddy Karri
Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Puducherry
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/amh.amh_64_21
Yoga is a philosophy, a science, and an art, the value of which is underrecognized. Many myths and misconceptions are prevailing among the common people as well as mental health professionals, resulting in an underutilization of this effective tool that has the potential for health promotion and disease prevention. It has been established to be an effective adjunct in treating many psychiatric and psychosomatic problems. Scientific, evidence.based data are accumulating from global research institutions. Salutogenesis or wellness concept with a holistic approach is the hallmark of the yoga. This article is a review attempting to dispel some of the popular myths and misconceptions.
Keywords: Integrative medicine, misconceptions, myths, salutogenesis, yoga
How to cite this article:
Karri RR, Bhavanani AB, Ramanathan M, Mopidevi VG. Yoga therapy in psychiatry: Myths and misconceptions. Arch Ment Health 2021;22:74-9 |
No other therapy than yoga has evoked so many myths in the minds of lay people and professionals alike. There is a pressing need to demystify the same, keeping the utility and popularity in view. To proceed further, it is necessary to appreciate the concept of the term “Yoga.” The Sanskrit root of the term Yoga is “yuj,” meaning union or communion. This is understood as the union of body, mind, and soul with each other, and all together. When all these three aspects of a person are integrated cohesively, true human nature emerges. Ultimately, it is understood as the realization of the communion with the universal consciousness or the union of one’s individual consciousness with cosmic consciousness. Yoga helps the progression from “I” to “We” from a limited specific human being to the universal entity. The concepts of disintegration of various components of the psyche, i.e. cognition, affect, and conation as illness, and the idea of their reintegration as the remedy and concepts like Jungian collective unconscious are well familiar to psychiatrists.
Myths are long-standing popular false beliefs that are widely held, and misconceptions are errors of understanding the concepts in proper perspective. A few common misconceptions and myths about yoga are described below.
| Yoga Belongs to a Particular Religion | |  |
As yoga has been given the status of being one among the six authentic sacred perspectives of Sanatan Dharma (Shad-darshanas) and includes certain techniques such as Pranava (Omkara) Pranayama, meditation, or chanting, and sun salutations, it is likely to be misconceived as a system of Hindu religious rituals.
Although yoga has its origins in India as part of Sanatan Dharma, it has universal appeal. Body–mind together with soul exists in all human beings irrespective of religious beliefs. Yoga helps one bring these aspects together and does not bother itself with the tags of any type, be it faith or any such shallow difference in people. Yoga requires practice with absolute devotion and uniformity and not one’s membership to a particular belief system.
Syed and Prakash[1] observed that yoga procedures with Islamic prayers had been made to alleviate emotional problems. The authors suggested that mental health professionals include these two in their treatment programs, at least for Muslim patients, for beneficial results.
Salutations, prayers, chanting, and meditating on deities are accompaniments of some yoga techniques. However, these are only paraphernalia and not sine qua non of yoga practice.[2] Atheists or followers of any faith can follow yoga without compromise or embarrassment.
| Yoga is Philosophy, But Not Science | | |
Patanjali was not only a philosopher and linguist but a psychologist and therapist. Patanjali[3] described in detail the psychopathology of mental whirlpools (Chittavrittis) and various afflictions (kleshas) and their symptoms. He also portrayed the ways through which one can transcend them. The descriptions are very systematic, elucidating the nature of the disorder, the reason, the goal of remedy, the path, and the obstacles faced in the process. Yoga resembles psychotherapy in its approach. This may seem surprising; psychiatrists or psychologists think of psychotherapy as a form of science, somewhat practical and materialistic in attitude, and yoga or Vedanta as extremely esoteric and religious concerned with regions of the spirit entirely out of this mundane world.[4] This is due to the unfamiliarity of the westerners with Eastern cultures and, on the other hand, the prejudice of the natives against their own culture.[5]
| Yoga Lacks Evidence, Mostly Anecdotal | | |
Yoga is primarily a lifestyle practice with spiritual content. Nevertheless, the components of yoga have demonstrated various health enhancing physiological as well as therapeutic effects.[6] There is evidence for yoga as being a powerful antidepressant that is comparable with drugs. In depression, yoga deals with underlying cognitive physiology.[7]
Schizophrenia, yoga proves to be add-on intervention in pharmacologically stabilized subjects. The benefits are particularly noteworthy on negative signs and symptoms. Yoga aids in correcting both neuro- and social cognition. Yoga therapy can be introduced early in the treatment of psychosis with some advantages. Elevation of oxytocin and parasympathetic excitement may be the mechanisms of yoga effects in schizophrenia. Neurobiological benefits are such that psychiatrists may utilize yoga for comprehensive care in their patients.[8]
Research suggests that anxiety symptoms appearing during withdrawal states in alcohol-dependent subjects are minimized if yoga practice is included during such detoxification program.[9]
Children with intellectual deficit disorder, attention deficit hyperactive disorder (ADHD), and autistic disorder benefit from adding yoga to their regimens.[10],[11] In psychophysiological conditions such as psoriasis and irritable bowel syndrome, the adjunct role of yoga is well established.[12]
| Yoga is Just Another Form of Exercise | | |
Is yoga just another exercise? If no, what other great qualities has it got? If yes, has it possessed even the essential attributes of a perfect exercise? The answer could be that it has got perfect characteristics of an exercise and has features beyond any exercise.[13] Irrespective of age and health status, anybody can practice it. Yoga has a variety of techniques to suit the needy. Yoga can be learned quickly, and anybody can swiftly grab the basics and witness the benefits early. To be an ideal type of exercise workout, it would require to keep the body and mind healthy, and yoga fulfills that and capable of keeping both the body and the mind healthy all by itself. Yoga, unlike popular forms of gym exercises, does not need any costly tools. Yoga can be practiced almost at any place, individually, or in a group. Occasionally props, as well as supports, are utilized to help the body in attaining and holding a specific position. The poses can differ substantially in their degree of difficulty, and even the same posture can have various stages or degrees or variants.
In contrast to exercise, yoga is more anabolic, more relaxing, more mindful, and aimed more at the developing the individuals holistic potentials.
| Yoga Induces Paranormal or Psychotic Symptoms | | |
Yoga is intended to correct the turbulences of the mind like illusions (Vikalpa) and hallucinations (Viparyaya). Patanjali also cautioned about the obstacles like visual hallucinations (Bhranti Darshana) in the path of yoga. He also warned about the experiencing of paranormal powers (Siddhis). A true yogi would not get distracted by the temptations and does not deviate from the path of self-realization.[14]
Black sheep do exist in all professions. Some charlatans induce delusions of knowledge of past life and regression into it or coenesthetic hallucinations of movement of Kundalini in gullible, highly suggestible individuals. Some offer salvation in the name of shakti path for a hefty price.
Relapse of psychotic symptoms does occur when some overconfident yoga practitioners advise stopping psychotropic medications.
| Yoga is Harmful | | |
Attempt to attain anything in a hurry is dangerous, which holds true even with yoga. Any therapy with beneficial effects would not be free from adverse effects like musculoskeletal injuries. The benefit–hazard ratio for results with yoga would always be highly favorable. Adverse effects of yoga are less intense compared to any exercise or sport. Attempting Asanas without proper supervision, using props, and meditation without appropriate guidance may lead to ill effects like injuries due to faulty postures.[15]
| Yoga is Just Some Contortionist Postures Called “Asanas” | | |
Yoga is not magic entertaining with something like a great Indian rope trick. Yoga is not performing physical exercises in the name of Asanas. Indeed, Asanas are not “doing” ones, but “being” ones. Asanas are just a minute drop in the ocean of yogic life. Asanas are elementary steps, which may or may not be necessary for the journey of yogic life. Hence, asanas are not sine qua non of yoga. In Patanjali Yoga Sutra, the magnum opus, which is considered the bible of yoga, out of one hundred and ninety-six sutras just three are allotted for Asanas. Patanjali advocates the technique of eight distinct branches called Ashtanga Yoga to unfold one’s true character. It involves the practice of particular principles enumerated as Yama and Niyama (do’s and don’ts), Asana, Pranayama (breathing methods for energy understanding), Pratyahara (withdrawal from sensory attraction), Dharana (process of concentration), Dhyana (state of meditation), and Samadhi (communion). It is not practicing the external physical postures thoughtlessly, but it is about discovering the inner world and getting in touch with it. The method must start with the body; however, the ultimate goal should be to go deep within and discover the real self. Patanjali recommended Ashtanga, including asanas for some, but Kriya yoga recommended for others, does not include asanas.[16]
| Yoga is a Breathing Trainer With the Fancy Name of “Pranayama” | | |
Respiratory training is the physical or physiological phenomenon to improve lung function. Although the yoga technique of Pranayama is based on breathing, it has the primary aim of expansion and regulation of vital energy (Prana Shakti).[17] The conscious control of breathing in particular patterns is proved to benefit many psychosomatic illnesses like irritable bowel syndrome.[18]
| Yoga is Outdated | | |
Yoga explains the wellness concept in the most modern fashion.[19] The wellness is explained as the “Integration” of the five sheaths or the koshas. Disintegration or dissociation or dis-association of the proper alignment of the sheaths leads to illness.[20]
- Psychic phase – disorder with the manomaya sheath
- Psychosomatic phase – malalignment between the manomaya and the pranamaya sheaths
- Somatic phase – malalignment between the pranamaya and the annamaya sheaths
- Organic phase – disorder with the annamaya sheath.
The concept fits perfectly with the modern concept of Psychosomatic medicine. Modern scientific techniques well establish the changes associated with Yoga in the hypothalamo–pituitary–adrenal axis.[21]
| Yoga is Incompatible With Modern Medicine | | |
Under different proprietary names, the techniques ranging from yoga asanas, pranayama, meditation, or combinations are studied. Comprehensive investigations have been done regarding such practices, and their outcomes consistently showed results in favor of their utility.
Not only the predominantly psychologically oriented neurotic disorders like obsessive–compulsive disorder or generalized anxiety disorder but also the biologically oriented psychotic disorders and psychobiological problems like depression are also all benefitted with evidence.
There are centers in India like NIMHANS, S-VYASA (Bengaluru), and CYTER of Sri Balaji Vidyapeeth known for integrating yoga therapy with modern medicine and scientifically researching its outcomes.
| Yoga Therapy is a Panacea Encashing the Deficits in Modern Medicine | | |
Modern medicine is evolving. For the present, there are certain illnesses, which have no remedy and some which can be treated and managed but cannot be cured. Side effects of the treatments are another issue of concern. People resort to alternative medical systems when there is dissatisfaction with modern medicine. Some “pathies” (systems of medicine) offer a cure for every ailment on earth. Some enthusiasts promote yoga as a panacea, but it is the stooping down of the higher lifestyle principles to “yogopathy,” which is not appreciated by masters of yoga.[22] Yoga therapy is only a subsection of yoga, and the illness remission is only a by-product of the transformation. Integrative medicine bridging the best of both traditional and modern systems is the medicine of the future. This is termed traditional, complementary, and integrative medicine by the World Health Organization that even has a Collaborative Centre in Traditional Medicine (Yoga) functioning at MDNIY, New Delhi.
| Yoga Can Be Learned From Books or Youtube | | |
People assume that yoga is as easy as flipping through some e-books or internet articles or watching YouTube channels. It is not that simple. Such practices may lead to physical injuries and result in a half-baked understanding of the nature of yoga and underestimating its utility. It is a systematic process to be gained from an able master. There must be a complete understanding of what one needs to do and the benefits and ill-effects of particular practices. Books or videos might inspire and kindle the interest, but self-practice without a mentor is likely to lead to a bad trip.
| YOGA is a SPORT and is the Indian Name for Gymnastics | | |
Many yogis on social media seem to be gymnasts or acrobats and contortionists, but real yoga is not about that all.[23] Unfortunately, any person who twists his body utmost is considered a yoga champion. The development of yoga asana as a sport in India by the Sports Ministry has kindled interest among many, but on the other hand, if one is not careful real yoga is displaced by gymnastics.
| Yoga Promoters Have No Consensus of Concepts and Procedures | | |
As with many therapies and philosophies, yoga has acquired different shades and propagated as different schools under the guidance of masters.[24] The ancient teachings of the Yoga Darshana, the Yoga Vasishta, or the Bhagavadgita may be understood as generic texts. Various modern variants with the names like Iyengar Yoga, Himalayan Yoga, Power Yoga, Viniyoga, Bihar School, and Rishiculture of Gitananda tradition are popular. However, the root is the same.
| Yoga Discourages Productivity and Encourages Sluggishness | | |
Yoga is always action oriented and discourages sloth and inaction. The whole text of Bhagavadgita is based on energizing and motivating the individual, who is trying to shun his responsibilities.[25] By calming down the mind with yoga, concentration improves, resulting in better efficiency.
| Yoga is Suitable Only For People of a Certain Age | | |
A misconception about yoga is that there would be an age restriction. However, yoga is for everyone, irrespective of age and gender. It only requires dedication and regular practice. Anybody can start practicing at any age under the able guidance of a supervisor. It has been known that older people can be taught to perform complex asanas with ease and perfection.[26],[27] Young children too can be easily taught various techniques. It is the “practice” that makes the learner “perfect.”
| Yoga Needs the Flexibility of the Body | | |
As age advances, mobility of the body reduces, and joints become more rigid. It is not mandatory that to start with the practice of Asanas, one’s body must be adaptable. Every person has some degree of flexibility. One might begin yoga technique at any time. There are easy asanas that will undoubtedly help the body become more adaptable and adjust to the situation. The method ought to be with a combination of stamina, equilibrium, versatility, as well as concentration.
| Yogic Principles are Irrational | | |
Modern medicine has considered the human being as just a complex of several systems. With its microscopic view, modern medicine breaks down the supersystem right into systems and many more subsystems for comprehending. We must bear in mind that the whole is always larger than the total of its components. From the yoga perspective, the person is not just the body, the annamaya kosha, the anatomical level of existence. A person has the energy of life, which is prana existing in pranamaya kosha. The manomaya, the psychological level of the person, and higher intellectual capability is the vijnanamaya kosha. As we understand our relation to the universes, we stay in the anandamaya kosha, experiencing our global level of presence. The explanations are perfectly logical when considered at an abstract, functional level.[28]
For instance, the meridians described by acupuncture/acupressure therapists seem so non-sensical for a person who is trained in modern anatomy and physiology. However, practically, those systems work in some cases, where modern medicine fails. The abstract principles like naadis, the carriers of vital energy and chakras, the energy transformers, may seem incompatible with modern medicine as they are indeed more abstract. However, with time, science has started to understand the intricacies of the manifest universe better and many of these concepts are now being explained in more relevant modern terms.
| Yoga Requires a Lot of Time | | |
One does not need to spend a great deal of time on yoga. There are reports of beneficial effects resulting just after one single session of pranayama.[29] It has also been so well known that once a yogic lifestyle is adopted, it is likely that the person would continue to remain a yogi. On average, spending thirty minutes a day for yoga practice assists in defeating stress and helps relaxation. A little time invested for yoga yields manifold returns.
| Yoga Expects Total Lifestyle Change | | |
Yoga requires a modification in one’s way of living. Nevertheless, yoga does not need to alter one’s lifestyle entirely. There must be small amounts of changes. It does not mean that one ought to give up many habits like diet and compromise all material, personal belongings, and comforts. For instance, a vegetarian diet regimen and abstinence are recommended but not decreed total taboo. More than just physical adjustments, the attitudes, emotions, and behavioral changes are more expected from a yogi.[30]
| Anybody Can Be a Yoga Therapist | | |
In modern medicine, we find a range of practitioners, from quacks, who meddle with every medical issue in the villages to superspecialists in tertiary care hospitals. Yoga has no exception. Self-styled yoga therapists without experience and theoretical background often bring ill-reputation for yoga. The ancient knowledge may be either acquired from acharyas, who gained the knowledge through parampara, or through systematic study at academic institutions.
| Yoga is Just a Placebo | | |
Randomized controlled studies are conducted in many areas of health research, and in most of the studies, it has been proved to be better than placebo. Very few studies equated it with a placebo. It has, however, never showed the nocebo effect!
In conclusion, yoga, unfortunately, has been relegated into backyards both by Western and Indian modern physicians underestimating its value. Incessant efforts to get its scientific status by rigorous research at premier institutions have been frustrated by poor recognition and underutilization. Since the political jolt of international recognition of yoga with a special day, interest is revitalized. Pubmed indexed 692 articles on yoga in the current year. This indicates tremendous research going on. Yoga is health and wellness oriented.
Yoga emphasizes the wellness concept of “salutogenesis,” but not the illness concept of “pathogenesis.”[31] This is relevant when we realize that health is a state of well-being at the physical, mental/emotional, social, and spiritual levels. However, one must admit that it is an ideological goal challenging to reach current modern medical practice standards.
Swasth is the ancient Indian concept which looks at health and wellness as a balance and harmony, with a sense of well-being in all levels of existence. This is what is expected of yoga. Modern medicine thinks in terms of pathogenesis with disease orientation. However, yoga considers salutogenesis, promotion of well-being as its goal.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Sayeed SA, Prakash A. The Islamic prayer (Salah/Namaaz) and yoga togetherness in mental health. Indian J Psychiatry 2013;55:S224-30.  |
| 2. | Bhavanani MD. A yogic perspective on health and disease. Annals of SBV 2014;3:42-6. |
| 3. | Gokhale PP. On Meditative Absorption (Samādhipādaḥ). In: The Yogasūtra of Patañjali. Routledge India; 2020. p. 19-67. |
| 4. | Shamasundar C. Relevance of ancient Indian wisdom to modern mental health-A few examples. Indian J Psychiatry 2008;50:138-43. [ PUBMED] [Full text] |
| 5. | |
| 6. | Hemant B, Arasappa R, Inbaraj, Udupa K, Varambally S. Yoga for mental health disorders: Research and practice. In: Handbook of Research on Evidence-Based Perspectives on the Psychophysiology of Yoga and Its Applications. Hershey, PA,USA. IGI Global; 2021. p. 179-98. |
| 7. | Rao NP, Varambally S, Gangadhar BN. Yoga school of thought and psychiatry: Therapeutic potential. Indian J Psychiatry 2013;55:S145-9. |
| 8. | Varambally S, Gangadhar BN. Current status of yoga in mental health servces. Int Rev Psychiatry 2016;28:233-5. |
| 9. | Sarkar S, Ramanathan M, Gupta K, Rajasekar B, Dayanidy G, Bhavanani A. Effect of adjuvant yoga therapy on craving in participants of an alcohol DE-addiction program: A pilot study. SBV J Basic Clin App Health Sci 2020;2:138-41. |
| 10. | Artchoudane S, Ramanathan M, Bhavanani AB, Muruganandam P, Jatiya L. Effect of yoga therapy on neuromuscular function and reduction of autism severity in children with autism spectrum disorder: A pilot study. Int J Health Syst Translat Med 2021;1:76-85. |
| 11. | Bhavanani A, Artchoudane S, Ramanathan M, Mariangela A. Yoga as a therapeutic tool in autism: A detailed review. Yoga-Mimamsa 2019;51:3. |
| 12. | Bhavanani AB. Psychosomatic mechanisms of yoga. Ann SBV 2013;2:27-31. |
| 13. | Vhavle SP, Rao RM, Manjunath NK. Comparison of yoga versus physical exercise on executive function, attention, and working memory in adolescent schoolchildren: A randomized controlled trial. Int J Yoga 2019;12:172-3. [ PUBMED] [Full text] |
| 14. | LePage J. Patanjali’s Yoga Sutras as a model for psycho-spiritual evolution. Int J Yoga Ther 1995;6:23-6. |
| 15. | Cramer H, Quinker D, Schumann D, Wardle J, Dobos G, Lauche R. Adverse effects of yoga: A national cross-sectional survey. BMC Complement Altern Med 2019;19:190. |
| 16. | Bhavanani A. Diverse dimensions of yoga. Yoga-Mimamsa 2014;46:3. |
| 17. | GitanandaGiri S. Pranayama in the tradition of rishiculture ashtanga yoga. Pondicherry, India: Satya Press; 2008. |
| 18. | Gangadhar BN. Integration of yoga in clinical psychiatric practice. Telangana J Psychiatry 2021;6:110-2. |
| 19. | Swanson A. Science of yoga: Understand the anatomy and physiology to perfect your practice. London, England: DK; 2019. |
| 20. | Bhagat OL. Yogic concepts of holistic health and wellness. J Adv Res Ayurveda Yoga Unani Sidhha Homeopathy 2018;05:15-8. |
| 21. | Sneha M. Effect of yoga on parasympathetic nervous system of human body. Indian J Clin Anat Physiol 2019;6:492-6. |
| 22. | Bhavanani AB. Yoga is not an intervention but may be yogopathy is. Int J Yoga 2012;5:157-8. [ PUBMED] [Full text] |
| 23. | |
| 24. | |
| 25. | Turci R. The yoga of the Bhagavad Gita: Spirituality, meditation, and the rise of a new scientific paradigm. In: Handbook of Research on Evidence-Based Perspectives on the Psychophysiology of Yoga and Its Applications. Hershey, PA,USA: IGI Global; 2021. p. 85-102. |
| 26. | Chobe S, Chobe M, Metri K, Patra SK, Nagaratna R. Impact of Yoga on cognition and mental health among elderly: A systematic review. Complement Ther Med 2020;52:102421. |
| 27. | Ramanathan M, Bhavanani AB, Trakroo M. Effect of a 12-week yoga therapy program on mental health status in elderly women inmates of a hospice. Int J Yoga 2017;10:24-8. [ PUBMED] [Full text] |
| 28. | Davies A. Caring science and yoga: The human caring science Kosha model. In: A Handbook for Caring Science. New York, NY: Springer Publishing Company; 2018. |
| 29. | Bhavanani A, Ramanathan M and Madanmohan. Immediate cardiovascular effects of a single yoga session in different conditions. Altern Integr Med 2013;2:1-5. |
| 30. | Bhavanani A. Role of yoga in prevention and management of lifestyle disorders. Yoga Mimamsa 2017;49:42. [Full text] |
| 31. | Bhavanani AB. Salutogenesis Approach to Communication. In: Effective Medical Communication. Singapore: Springer Singapore; 2020. p. 235-45. |
|
Search Pubmed for