Harvard University Welcomes Yoga Therapy Lead players within Harvard University’s Cambridge Health Alliance (CHA) invited Kausthub Desikachar, guest yoga therapist, to discuss yoga’s therapeutic approach to healing. Psychiatrist Dr. Chris Bullock, Harvard Medical School Faculty member and co-director of the Division of Integrative Therapies (DIT), organized a three day long series of lectures, round-table discussions, and therapeutic application sessions during December 5-7, 2005, which culminated with Kausthub’s presentation on Yoga and the Mind at the Psychiatric Grand Rounds.

Newly formed and multidisciplinary, the DIT will emphasize yoga as the core discipline, while also offering other complementary modalities such as acupuncture and massage therapy. It will generate a nucleus of therapeutically trained yoga clinicians to provide safe, individual-based yoga counseling to patients within the CHA. These clinicians will function on staff, facilitating an easy access, in-house referral system in which doctors can refer patients directly to therapists. Each yoga clinician will have a mentor, a senior yoga therapist to whom they’ll report regularly, just as within medical mentorship programs. Organized in this way, the DIT will create an easy link between patients who are interested in yoga and well-suited therapists. This environment will be optimal for evidence-based research into the effects of yoga therapy.

 The therapeutic approach, CHA members learned, contrasts with the projected image of yoga in the west, which is primarily taught in groups and aimed at mastering physical postures. The physical postures should function along with the myriad of other tools available to initiate and sustain a healing reaction in the entire system.

Dr. Bullock's reference point for yoga therapy is the Krishnamacharya Yoga Mandiram, a non-profit, non-secular, public charitable trust he visited in Chennai, South India in 2005. Bullock refers to the KYM, created in 1976 by TKV Desikachar to proliferate the healing work of his father and teacher, T Krishnamacharya, as “a yoga clinic.” This “clinic” model parallels the medical system in that providers see patients individually, maintain detailed patient records, and, “like in an alliance, collaborate with other medical professionals.”

The CHA, a community based health initiative of Harvard University, treats staff, students, as well as local residents, including the disturbed and destitute. Encompassing three hospitals, Cambridge Hospital, the Whidden Hospital, and the Sommerville Hospital, along with a multitude of clinics, the CHA exists to support the physical and mental health of local residents. Bullock’s enthusiasm for the KYM’s healing work and functional familiarity to the CHA invited his colleagues’ support. Finding the model palatable, Jay Burke, Chairman of the Department of Psychiatry, Dr. Kerry Bernstein, neurologist and co-coordinator of the DIT, Janna Smith, LICSW, Perry Shtasel MD, clinical Director of the Department of Psychiatry, and Bruce Solomon, Chief operating officer of the CHA, rendered possible this three day long symposium and Psychiatric Grand Rounds.

“The emphasis,” Kausthub accentuates, “is on the patient, not the system.” This vital theme of the yoga of T Krishnamacharya and lifework of TKV Desikachar pervaded throughout these preliminary groundwork discussions. Recognizing a flaw in modern medicine, CHA Dr. Rich Balaban acknowledges that this ideology can complement “our system [which] conspires against relationships.” Echoing his dismay, Diedre Allesio, nurse practitioner specializing in HIV, women’s health, and diabetes care, wonders how patients and providers can cope, asking, “How does one manage it?” With so many patients and so little time, Balaban and Allesio welcome a modality which simultaneously removes some of their burden and empowers the patient. Allesio offers, “Our patients are so excited. I hate to see that potential wasted.” Physicians, nurse practitioners, social workers and patients met the idea of an in hospital yoga therapy division with uniform enthusiasm and commitment, especially after sitting in on the practical application sessions. Pivotal figures, including the Director of the Department of Family Practice, Dr. Randy Wertheimer agreed, “We’re in!”

To witness this approach in action, doctors, nurse practitioners, and residents offered some of their most difficult, yet enthusiastic patients for review. The primary consultation begins with a patient interview, proceeds with a physical examination, continues with a diagnosis, and concludes with the formulation of an individualized personal practice which prioritizes the patient’s issues. This practice is taught to the patient by a teacher who seems to be well-matched to the individual. The underlying idea in yoga therapy, that all physical, mental, and emotional suffering is absolutely real but also subject to change, provides the foundation for this work. Through discriminative application of the tools of yoga, along with cooperation from the patient, positive change can ensue.

Ed, an inquisitive construction worker, in chronic pain and on disability after a job site injury to the head, uses the forum to reveal his desperation to get better. Tossed from specialist to specialist with increasing pain and no relief, yoga is his last resort. This holistic approach respects the patient’s unique personality and physical, mental, and emotional requirements rather than standardizing his problem. This ambiance transformed a medical system slanderer into a quiet, calmer, and more optimistic believer within minutes. Gina, a scholar undergoing psychiatric treatment for anxiety, reduced attention span, and depression related to past and recent trauma, currently takes medication to increase focus and elevate her mood. A physical exam reveals tight shoulders and neck, for which some abstentions from asanas which aggravate this condition are recommended. A pulse diagnosis reveals much deeper chronic emotional pain, accompanied by a rock hard physical knot in the abdomen, which lay hidden from the doctors and the patient herself. Under the observing eyes of strangers, and guided by Kausthub, Gina does some simple breathing. Like Ed, she noticeably relaxes within minutes, her knot loosens, she commits to some suggestions, and even makes one of her own, asking Kausthub to move to Cambridge.

Others, while open to the DIT, were skeptical about yoga itself. This ancient healing system revealed itself as misunderstood by a few, including an outpatient psychiatric clinic staff member. “I can’t do yoga. My orthopedist recommended I try it for a knee problem, and it got worse.” An outpatient addiction services associate inquired, “Why can’t we just meditate instead?” Kausthub explains that yoga is not synonymous with asana. The most authoritative reference book on yoga, the Yoga Sutras of Patanjali, mentions asana three times only, pranayama eight times, and meditation about 120. It offers a model for healing which is central to yoga therapy. The appropriate tools are implemented only after establishing a reasonable goal. That goal, to move the patient out of suffering, is primarily reached by pacifying symptoms while simultaneously addressing their primary cause. After learning that “the perfect posture is useless if it doesn’t help the person,” the knee-pained protester, who relinquished yoga for Tai Chi, shifts her opinion. “Well I’m glad you came to rectify this!” The same woman wondered why she hadn’t heard about this before. Kausthub used an analogy. Suppose Dr. Bullock recommends walking to a psychiatric patient, and it works. That patient consequently suggests walking to everyone, and now walking itself becomes synonymous with psychiatry. Many influential teachers learned an active yoga early in life, based upon their youthfulness. These challenging physical practices caught on and were popularized in the west, where the values uphold physical perfection and prowess. And they look more stimulating than just sitting there with your eyes closed. Kausthub jokes, “After all, would you buy a poster of someone with their fingers on their nose?”

The idea is to generate yoga teachers in Boston who are familiar with the interrelating aspects of the human system, the mind, breath, body, personal affectations, and emotions, and who trust the mind over body approach. They will use the full spectrum of yoga tools, including postures, breathing, visualization, sound, meditation, and food and lifestyle alterations, with discrimination, to bring about this healing from within. Tantamount to the success of this program will be the therapists’ understanding that deep healing comes through sustained relationship, practice, and conviction on both sides of the therapist/patient team.

Dr. Michael Wertheimer, M.D., head of the Breast Cancer Center, sees the challenge of integrating this into his practice when even in cultures which taught traditional medicine, like China, “Doctors and (alternative) TCM practitioners roll their eyes back at each other.” Kausthub, recognizing the same clash in India, notes that the KYM doesn’t experience this clash. “They both come to us.” Why? “It happens because we are open to them. “50-60% of people visit our center by recommendation from their physicians.” The presenter and the participants agree: curing and healing can happen side by side. Collaboration between the medical system, which handles the curing, and the yoga system, which handles the healing, expedites movement towards a common goal, to improve the patient’s overall health. The first of its kind in the U.S., the CHA’s DIT can serve as a model of a unified pool of caretakers in the medical and yoga fields which hails the patient as #1. Written by Danielle Tarantola 12/05

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Mary KEIZER 08-JAN-2007 I fully back this move towards gaining professional ground in the departments of education. We are doing our best here in Queensland Australia to bring it to the notice of openminded university courses and collages. mary keizer. Felicia Mcgilchrist 18-OCT-2006 Thankyou Danielle, I really appreciated reading this informative and timely article. This link between the medical system and Yoga's holistic approach, is definately a movement in the right direction. As a registered nurse and Yoga teacher I myself have just started approaching various departments within the medical system to see if Yoga can be incorporated into the rehabilitation programs that are currently being setup by the hospital.I have had postive feedback, but as it is very new, nothing solid as yet, although a am very confident that it is only a matter of time. Thankyou again it has provided me with feedback that will help with my presentation. felicia