Schizophrenia is a condition of the mind that has consequent effects on the body. Perceptions and awareness are altered with the person often hearing voices, feeling persecuted and becoming suicidal. The cause is still a controversial issue. Cultural perceptions in different countries affect the incidence, treatment and possible outcomes for sufferers. Yoga has been shown to give many positive benefits to people with the disease for maintaining balance and harmony in their lives. However, there needs to be a lot of further research and verification of the effects and benefits of yoga for this condition.
In my personal experience, I have seen many changes in the physical, emotional, mental and spiritual well-being of students with schizophrenia. The classes should be adapted to cater for the individual's needs, focusing on practices that will be grounding, extroverting, balancing and increase awareness. It has been said that people with schizophrenia are accessing a level of higher vibration and some of the great creative minds have been diagnosed schizophrenic. With proper support and understanding, people with this disease could function in society to their fullest potential.
Schizophrenia is a group of symptoms commonly seen in people during an acute attack. The indications are changes in mood, thought, feeling and perception with the person experiencing hallucinations, delusions, mania, paranoia, inability to experience emotion, withdrawal and depression. Sometimes, sufferers will hear voices, feel persecuted and believe that special messages are being sent to them via the media, through messengers or God. Some people have believed that a radio transmitter has been implanted in their body. Others hear and believe commands that they must kill or harm either themselves or someone else. It is a very serious disease. What the disease is and what are the secondary effects of living with schizophrenia is often hard to determine. Sufferers will often swing in mood from the extremes of rajasic, chaotic energy to the dull inertia of a tamasic state. They may feel apathetic, low in motivation and be affected in speech, movement and thinking.
The cause of the disease is still in question. Physiologically, it seems that there is an overreaction of the neurotransmitters in the brain at the synapes, highlighted by an imbalance of chemicals (mostly hormones in the blood – adrenalin, leucine, serotonin and catecholin are possibly four such chemicals). On an energetic level, there appears to be an imbalance in the ida and pingala nadis, causing some of the bizarre reactions. Whether this is a cause or effect of the disease is unsure. At this time, there is little known about yoga and schizophrenia and much research needs to be done.
Incidence varies between cultures, with the trends suggesting a combination of genetic and environmental factors. Some areas of high heavy metal content correlate with an increase in incidence. In countries where there is a strong family or community emphasis, the incidence is usually lower than those where people are trained to be more individualistic or self-reliant. In most western countries, the disease appears in approximately one per 1000 people. In some African countries, the rate has been one per 2,000 people. This discrepancy is probably due to the fact that environmental factors are more supportive and also that the definition of 'normal' is different in the African countries.
Drug treatment for the majority of people suffering from schizophrenia means tranquillizers on a long-term basis. De-institutionalization has led to a greater quality of life for many people. However, social isolation has been a problem for those not served by adequate support services. For many, the solution to living in an institution is to stay with ageing parents and few social outlets. Where funding is available, residential group housing with supporting staff has benefited some people with schizophrenia. Yoga, in this setting, makes a great adjunct therapy to other traditional and wholistic therapies. Community-based programs, local mental health services and community health centres are ideal meeting points and venues for yoga classes in the public domain, for sufferers of schizophrenia.
Many people with schizophrenia have been the great creative geniuses of their time. Charles Darwin, Isaac Newton and Mendel are a few thought to have been schizophrenic. It has been theorized that these people have a highly developed consciousness and heightened sensitivity to vibrations or astral energies. Most modern societies have little regard for those sensitive enough to be in contact with more subtle energies or dimensions, particularly if their behaviour is 'different'. Human worth is usually measured by achievements, wealth and intellect. There are strong societal pressures to conform, support the status quo and not 'rock the boat'.
If it is true that a person with schizophrenia is able to access an advanced consciousness, is there anything to distinguish them from the truly evolved beings in the yogic traditions? Both are able to experience detachment from their bodies, both can have visions of mandalas and yantras and enter a blissful state. The difference is that the person with schizophrenia can change in a moment to a state of dullness and depression. Their actions are actually reactions and the ability to witness and integrate is not present. A person truly in the disembodied state, or videha mukti, has worked out his karmas and transcended his desires. This is the final state before death and merging with the cosmic consciousness. A person with schizophrenia may indeed have an advanced mind, but also has to cope with much confusion and conflict.
Social isolation is a major factor affecting quality of life for many sufferers of this disease. A regular yoga group outside the home or boarding house establishes a social contact and focal point of regularity. The person with schizophrenia will often feel low in self-esteem, confidence, motivation and energy. A yoga class needs to be well within their capabilities, energizing for the body, mind and emotions, and supportive and encouraging. The person's competence can vary from week to week so the teacher needs to be adaptable and encouraging, no matter what happens.
During times of extra stress, sufferers can become extremely introverted, their thinking and movement become slow and erratic, and actions can be irrational. Students need to be encouraged to extrovert themselves but not to the extent where they withdraw completely. If a practice is too confronting, they may just walk away.
It is imperative for the teacher to create a safe environment with very clear boundaries. It is important for the class to be punctual, preferably at the same time every week, and to have an ongoing plan with continuity of practices. Studies show that a significant number of people with schizophrenia come from dysfunctional families that are either extremely over-protective or neglectful.
The teacher should be reliable but aware of not filling a parental role. Another aspect of creating a safe environment is giving the student complete control of what they attempt or don't attempt. This encourages self-responsibility, as well as freedom of expression. At the same time, however, the student needs to have very clear and direct guidance and lots of positive feedback.
All people benefit from stress reduction through yoga. People with schizophrenia are often under an increased stress of coping with their condition and the secondary effects. Acute psychotic episodes are often triggered by stressful events. If a person can learn to reduce feelings of anxiety through yoga, the general level of background stress is reduced also.
The person with schizophrenia often exhibits the extreme example of a rajasic state, being agitated, restless and disturbed. A very grounding and centring yoga sadhana could channel these energies towards a calmer and more controlled mood. At times, the person can also swing into a very tamasic state of depression, passivity and lethargy. Practices that are extroverting and energizing could lighten this mental and physical sluggishness.
Many people are initially attracted to yoga classes as a social outlet. For a person who is introverted and shy, it is important to consider that this may be one of their motivations. Although yoga is generally considered a practice of self-observation and self-awareness, by encouraging conversation and student input, where appropriate, the very withdrawn student can be encouraged more.
It is important in the class to direct the students' awareness to how they feel and what are the effects experienced. A person will often experience his body as alien or out of his control. Incorporating slow, steady joint movements with touch and sight can increase awareness and coordination. It is important not to spend too long a time on this as the person can become fixated on a repetitious movement. In the right setting, partner work in yoga can be beneficial for encouraging cooperation and an extroverted attitude. This needs to be handled very sensitively with the teacher maintaining the safe boundaries of every individual.
Karma yoga, if introduced in the right setting, can help the student to be grounded and channel energies into productive work. Karma yoga is about awareness in every movement and being detached from the fruits of one's labours. In this context, however, the work must be meaningful to the person so that in the beginning stages, self-confidence and motivation in taking action are encouraged.
Kirtan is a very powerful way to focus attention, and develop rhythm and perceptions of the subtle nature of sounds. Care must be taken to keep it very grounded. Naturally, the other benefit of kirtan is that it can be an enjoyable, positive experience, increasing the students' feeling of well-being.
Given that practices need to be grounded, positive, and extroverting, there are some practices to be cautious with. It is important to avoid visualizations, mental activity, practices beyond the students' abilities and those of an introverting nature. Meditation should only be attempted under experienced guidance. The hatha yoga cleansing practices can be stressful if the student does not feel comfortable with them. Any practice of an advanced nature should only be attempted when the student is ready.
As with any class, it is vital to teach to the least competent student's level as well as to the most competent. In fact, it is often appropriate to teach the whole class at the less technically advanced standard and emphasize individual awareness. In a public class, with a student known to have schizophrenia, the teacher must pay attention to that student's individual needs. The person's ability may fluctuate from week to week, seemingly forgetting practices previously learnt. In a class where all students are schizophrenic, the session should be structured appropriately. The class needs to be dynamic, focusing awareness on the physical body, with the student feeling accepted and comfortable.
Asanas that are excellent in the beginning stages are the pawanmuktasana series, relaxation poses, simple standing asanas, marjariasana, and dynamic shashankasana. With some experience, the student could move on to more challenging asanas such as the shakti bandhas, vajrasana series, and standing and bending asanas. The trikonasana series is particularly good for building confidence and a positive attitude. Doing surya namaskara in progressive stages can slowly build up a group's ability to practise the series.
Once students feel more confident, the extroverting postures such as simhasana, backward bending and easy matsyasana could be incorporated. If it is appropriate to have students working in pairs, asanas such as eka pada pranamasana, trikonasana and mudrasana are a few practices that can be adapted for this purpose. Exercises which are light-hearted and dynamic are useful: crow walking and chopping wood are two examples.
Pranayama practices have an introverting effect. However, they can also be calming and centring. These practices should not be done for long periods of time, and the teacher needs to be very aware to balance them with something dynamic. Yogic breathing is a good practice for encouraging relaxed respiration. The breath is often short and shallow during states of dissipated energy and psychosis. Bhramari is useful for reducing anxiety, anger and tension. Kapalbhati allows the mind to rest from thoughts and visions. Ujjayi and the cooling practices encourage tranquility.
Nadi shodhana is an excellent practice for calming chaotic emotions and is also useful to balance ida and pingala nadis. As mentioned before, it seems there is a link between this disease and the imbalance of ida and pingala nadis. Whether the imbalance is a cause or effect of the schizophrenic symptoms is not clear. Regardless of this fact, it will be helpful for integrating the disharmony, balancing the nadis and then the emotions, thoughts and actions also.
Yoga nidra needs to be kept very solidly in the body sensations, inducing relaxation and awareness without stimulating visualizations or excessive mental activity. The teacher needs to be aware of any movements the student is making during class. Any repetitious movement or flickering of the eyes under the closed eye lids can be a sign that the student is off in his own world. The teacher should be aware if the student has his eyes open and is staring. If these things happen, by changing the voice tone, the speed of talking, or bringing the session back to external awareness, the student can be directed out of his own thoughts and imaginings.
Practices that are unsuitable for people with schizophrenia are those of a very introverting nature. Eye exercises, forward bending asanas without backward bending counterposes, pranayama, and prana vidya are examples of practices that are introverting. Visualizations should be avoided and also the students' capabilities should not be exceeded. Programs in Bihar School of Yoga, Munger, have used combinations of karma, hatha and kriya yoga for people with schizophrenia. Swami Satyananda Saraswati spent 15 days in a Danish asylum in 1968 teaching neti, kunjal, shankhaprakshalana, surya namaskara and bhastrika to the residents, with fantastic results. These are definitely practices best taught by the guru or a very experienced teacher for people with special conditions.
For the past 12 months, I have taught a yoga class of people aged between 25 and 35 years old in a residential support house. All are on maintenance medication and relatively stable with an acute episode happening only every few months. Of the 12 residents, four came to every session and the other eight came intermittently. Some of the students became adept at the physical postures but found focusing and concentration more difficult. One student was able to accomplish chakrasana and another sirshasana. These two were the exceptions rather than the rule.
Most students had some difficulty in locating body parts unless I had them touch or look at the area first. Many of the students were physically able to practise the asanas but lacked confidence in their abilities. When a new posture was learnt, the sense of achievement and joy was worth all the time it took the student to get there.
All the students enjoyed yoga nidra and when they requested an extended relaxation, the challenge for me was to keep it physical and grounded. I found the best combination to be a few minutes of yogic breathing in the beginning, 30-35 minutes of asanas, a pranayama practice, followed by 10-15 minutes of relaxation. I found it fruitful to use an exercise of observing the features of the room in detail between pranayama and relaxation. Sometimes I also had them do simple movements again and then at the end asked for feedback about how they felt. This not only heightened their awareness but also helped me in planning further classes.
I learnt that it is essential to go with no expectations and a lot of flexibility. Week by week both the individual's and the group's needs would change. I also followed a general plan of continuity of practices but chose the easier or harder variation depending on need. This has been a very rich and useful learning experience for me as a relatively new yoga teacher and I feel very grateful to have had the experience of working with these people.