Soulful Healing

In a relatively recent post, I wrote about the signs and symptoms of two common depression diagnoses.  So now I’d like to approach the treatment of depression from a yoga and mental health perspective.  In Ayurveda (the sister science of yoga), we would most likely describe depression symptoms as excess kapha, the energy of earth and water that gets stuck and stagnant when out of balance.  Depending on the situation, I could also foresee a depressed individual being someone with an imbalance in another dosha (DOE-shuh) or sub-dosha, but whose primary guna (GOO-nuh) is tamasic (tah-MAH-sick):  slow, lethargic, inactive, stagnant, heavy, and dark.  I know, I know, I’m throwing a lot of Sanskrit words at you today, but stay with me    Think about that last one for a bit…  Slow, lethargic, inactive, stagnant, heavy, and dark.  If you or anyone you love has ever been depressed, I’m sure those words ring true for you.

Ayurveda is a complex and detailed approach to health and wellness.  As such, it is far too intricate for me to go into detail here (naturally, if you’d like to learn more about your dosha, or constitution, contact me to schedule your Professional Yoga Therapy^TM evaluation today).  I will say that the Ayurvedic yoga approach to depression, or any mental health imbalance, is one that is very individualized.  It is worlds apart from the “take two pills and call me in the morning” approach to health that Western medicine often takes.  That said, a variety of Western research studies have shown that yoga-based interventions are effective in reducing depressive symptoms (Wolf, 2000; Lavey, et al., 2005; Zerka Yoo, 2008).  I enjoy reading yoga therapy research, as I’m hopeful that this adds credibility to yoga therapy and reduces some of the “airy fairy” concerns that people have about using yoga in the health and mental health care fields.  Credibility is also one reason I like referring to the Sanskrit terms behind these concepts.  This isn’t a bunch of gibberish I just made up (I swear!), but a systematic and individualized approach to wellness that’s been around far longer than our current medical systems.  Consequently, taking an Ayurvedic yoga approach to address depressive symptoms could look something like this:

1. Energetic and cleansing breathwork – In yoga, we call breathwork “pranayama” (prahn-uh-YAHM).  For a depressed individual, I would recommend breathing strategies that energize, cleanse, or even bring balance to a person’s energy (again, depending on a variety of specific factors).  These could include Victorious Breath (aka “Ujjayi”, oo-JAI-ee), Sun Breath, and Alternate Nostril Breathing.  There is also the use of Bee Breath (a sighing exhalation) for the clearing out of physical and emotional pain brought on by depression.
2. Mudra (MOO-drah) – These are hand positions intended to focus or channel the flow of energy within the body.  Abhaya (ahb-HA-ya) Mudra builds inner strength and create a protective barrier against negative energy.  Jnana (ny-AH-nah) Mudra reminds us of our unity with all things (depression can make you feel alone and isolated, after all) and helps to focus the mind.  This is great for addressing the lack of concentration that is often present with depression.  Two more favorite mudras for depression include Pushpaputa Mudra, used to recognize the abundance that awaits us, and Rudra (ROO-druh) Mudra, which decreases heaviness and lethargy, increasing energy flow to the entire body.
3. Asana (AH-suhn) – This is the Sanskrit term for yoga’s physical postures.  To address depressive symptoms, I would focus my client on utilizing the energizing and balancing poses.  Again, specific recommendations must always take into consideration the severity and type of symptoms present, as well as the client’s physical abilities.  There are a wide range of energizing and balancing poses that can be used here.  These include everything from gentle, supported backbends on the floor to powerful standing poses and challenging one-legged balance poses.  Even if yoga isn’t quite your style, Zerka Yoo (2008) found that both hapkido and yoga were effective in reducing depressive symptoms.  So increasing your physical activity in general could be helpful.
   Walk around the house/yard and slowly graduate to walking to the corner and back, if you’re thinking a whole exercise plan is too much.

As I said in my last post on this topic:  Please consult with a qualified mental health professional, if you think you or a loved one are experiencing depressive symptoms.  You can also take this online Depression Screening Test to help you determine whether your feelings & behaviors match up with depressive symptoms.  Psych Central hosts this screening test and has an amazing collection of resources on the depression and its treatment.  If you do seek out yoga and Ayurveda to help treat what you think are depressive symptoms, please choose your practitioner wisely.  Professional Yoga Therapists are the most highly qualified yoga practitioners trained in the use of medical, research-based yoga therapy to treat health and mental health diagnoses within their specialties.  To find an Ayurvedic medical practitioner near you, visit the National Ayurvedic Medical Association or the California Association of Ayurvedic Medicine.

As always, thanks for reading and take good care of your Self!
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References

Lavey, R.; Sherman, T., Mueser, K.T.; Osborne, D.D.; Currier, M., and Wolfe, R. (2005). The effects of yoga on mood in psychiatric inpatients. Psychiatric Rehabilitation Journal, 28, 399–402.

Wolf, D.B. (2000).  Effects of the hare krsna maha mantra on stress, depression, and the three gunas.  Dissertation Abstracts International: Section B: The Sciences and Engineering, 60(7-B), 3584.

Zerka Yoo, Christine (2008).  Hapkido vs. yoga: Analysis of choice, persistence and psychological benefits.  Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(12-B), 8441.

I have found myself having a lot of conversations about depression lately.  From clients to friends to colleagues, sadness and disappointment have many people in their grasp these days.  I imagine that local, national, and global events are major contributing factors.  Whether you call recent U.S. economic challenges the Great Recession or the 2^nd Great Depression (hmmm, there’s that word again), unemployment & stagnant wages & cuts to services to our most vulnerable are crippling the nation.  Then there’s the Haiti earthquake, the BP Oil Spill, the Japan earthquake, tsunami, and nuclear crisis, and the various wars the U.S. is participating in.  Lots of reasons to be bummed, especially if you watch mainstream news on a regular basis.

Sadness is a normal human emotion and while it may not be pleasant to feel, it is an essential part of our experience.  I think it is important to be sad about the above laundry list of alarming events…  Sadness — like all our other emotions — can be a messenger, if we let it.  Sadness alerts us that something important, significant, meaningful is happening.  Whether sad at the end of a fun experience or about living far from family or about the loss of a job or loved one, sadness is part of our collective story.  In addition, one cannot be happy all the time.  In fact, we call it mania when someone’s mood is excessively positive for too long.  Think about the cycles of nature…  There is birth, growth, death.  Plants require both sunshine and rain to grow, so how can we expect only sunshine in our own lives?  As the book of Ecclesiastes notes, “To everything there is a season and a time to every purpose under heaven.”

While personal challenges and socio-political factors have a huge impact on a person’s mood, there is a significant difference between general sadness and clinical depression.  True clinical depression is deeply painful (both emotionally & physically) and makes it difficult for a person to function normally.  The disorder takes over a person’s thoughts, turning them almost exclusively to the negative (or at least making it really hard to think anything positive).  There is huge body of research on what is happening in the brain on a neurochemical level in a depressed person, but that’s beyond my purpose here in this article.  I’ll focus instead of the different types of depression, their symptoms, and some resources for more information. 

There are different types of depression, but when most people use the word they are probably referring to Major Depressive Disorder.  From the Diagnostic & Statistical Manual of Mental Disorders, the symptoms of Major Depressive Disorder include:

• Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful).  Children and adolescents may present with irritable mood.
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day
• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite.
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

As you read through this list, you may have found yourself thinking, “I’ve felt that way before!”  It’s true, many of us have had these signs or symptoms at one point or another for a short time.  It is important to note that a person with true major depression will have at least five of these symptoms and experience them nearly every day for at least two weeks.   In addition, the above symptoms must be significantly impairing a person’s daily functioning.  This means that the person’s behaviors are causing them to have significant difficulties at work (e.g., can’t complete important tasks), school (e.g., sudden drop in grades), or in personal relationships (e.g., emotional withdrawal from or frequent arguments with one’s partner).

Another form of depression is called Dysthymic Disorder (from Greek, quite literally “bad mood”).  This is more of a low-grade depression that lasts for an extended period of time.  Two or more of the following symptoms must be present for at least two years in adults and one year in children (with no more than two months being symptom-free).

• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

Due to the training & experience required to properly diagnose a depressive disorder, I encourage you to refrain from diagnosing yourself based on the information presented here.  If you suspect that you or a loved one are experiencing depressive symptoms, please consult with a qualified mental health professional.  You can also take this online Depression Screening Test to help you determine whether your feelings & behaviors match up with depressive symptoms.  Psych Central hosts this screening test and has an amazing collection of resources on depression and its treatment.

In my next post, I’ll be exploring various treatments for depression, with an emphasis on how mindfulness, meditation, and movement can be used in depression recovery.  Be well and stay tuned!

Over the past few weeks, my motivation to write has been low.  First, there was Thanksgiving.  I had a wonderful time celebrating with my family & friends.  One of the side effects of feasting, though, is a sleepy lethargy!  So I gave myself permission to just enjoy the relaxation that I don’t usually make time for.   Then in the week after Thanksgiving, one of my friends passed away.  She was about a month younger than me and her death was entirely unexpected and shocking.  I think I spent that first week feeling numb and in complete denial.  As the most basic defense mechanism, denial comes in very handy.  Information that our minds cannot process is blocked out because to take in that information might require a complete reorganization of thoughts, feelings, and information that we currently have.  If you think organizing your desk is challenging, try reorganizing your mind!  About a week after I got the news, I was able to really feel the sadness my defenses had blocked out.

Dealing with this sadness got me to thinking about how the holidays are not always “happy”.  With smiles on our faces, we encourage one another to have “Happy Holidays!”  And while Halloween through Christmas is easily my favorite time of year, it carries with it reminders of both past joys and past sorrows.  Then, there are the current joys and sorrows.  I was reminded of this recently while watching the movie Parenthood, where one of the characters gives an apt description of life as a rollercoaster, noting that she prefers the rollercoaster to the merry-go-round.  Whether we like it or not, life is rollercoaster… a sometimes intense series of ups and downs and all-arounds, with (hopefully) moments of rest in between.  I don’t know about you, but I am looking back on a year that zoomed by in true rollercoaster fashion.  There were a whole lot of amazing times and a whole lot of hard times.  There were times when I thought I couldn’t be happier.  There were times when I couldn’t imagine how I would get through the day.  Here I am…  sad, content, worried, joyful, eager…  all of the feelings that make up this life.  But most of all, I feel lucky to just be sitting here writing about it.

Still, at this time of year, we can sometimes feel pressured to be happy.  As if, when we are not happy, we are somehow upsetting the natural order.  Sometimes, we might even actively become angry with each other because someone wants to honestly express their discomfort or discontent.  When we are the accusers, it’s usually a sign that we are denying, ignoring, or avoiding our own difficult feelings.  It’s far simpler to blame others, versus doing the hard work of looking inward and coming to terms with the stuff we’ve been ignoring.  While denial and avoidance are great forms of self-protection in the short-term, they don’t tend to serve us well in the long haul.  What we deny or avoid comes back to haunt us in strange ways.  Just because we choose not to be conscious of something does not mean it just goes away.  It can come to settle in the subconscious, from which we act out our fears & desires without conscious awareness.  Have you ever been completely shocked by an observation that someone else has made of you, only to later realize they were right?  It’s rarely pretty, but try saying hello to the junk buried in your subconscious with gentleness and curiosity.  Remember that self-blame only creates stagnation and keeps us repeating the patterns we don’t like.

If you are one of the people for whom the holidays are not so happy (or are perhaps a mix of happy & sad & other stuff), know that you are not alone.  I also hope that, as you experience the wide range of human emotion during this holiday time, you can honestly share that with someone who is willing to listen.  Whether you are grieving a recent loss or a more distant one, many people are feeling exactly the same.  Maybe it’s time to reach out for a little social contact, maybe it’s time to stay home and rest, or maybe you need a smidge of both.  Only you can figure that out for your Self.  Denying your Self the right to feel what you feel can have all kinds of negative effects.  So pick your favorite self-care strategy or engage in some self-reflection to get you back to your Soul center.  It’s right there waiting patiently for you to return.  While we struggle with our losses, let us also call to mind the people still here to walk through this life with us.  Whatever your Soul is handling right now, I’m wishing you the  grace to let yourself heal and let others in your life know what you need.  Be well!

If you are just tuning in to this five part series on the different aspects of human experience, you can click accordingly to read Part One and Part Two.  We are slowly making our way from the physical realm to the spiritual realm, exploring how we bridge the disconnect between the two.

Manomayakosha

Manomayakosha (MAH-nuh-MAI-uh-KOH-shuh) is the mental or emotional body.  This layer governs consciousness, memory, ego, perception, and emotions.   It is distinct from intelligence and discernment, which is the next layer.  Have you ever observed your mind to be like a hamster running in a wheel?  Welcome to your manomayakosha.  In exploring this layer of experience, we might first look at some of its challenges.  The ego-mind is impulsive and desires immediate gratification.  It resists things that require time and effort to achieve.  This is also sometimes called the small “s” self.  By that I mean that we often identify very strongly with our thoughts and feelings.  Consider Descartes’ famous statement, “I think, therefore I am.”  Yet we are so much more than the incessant thoughts and fluctuating emotions that pass through our soul-body each day.  The self is different from the Self…  The former being more ego-driven, the latter being Spirit-driven.

Sure, our thoughts and feelings are very real to us.  Sometimes they are so real that it is hard to know what is true and what is simply the hamster running in its wheel.  Our ego-mind is frequently occupied with the pain from the past or worries about the future.  Despite our best efforts, these ramblings take us away from the present moment.  And it is in the present moment where true contentment can be found.  The beauty of this interplay between body, breath, mind, intellect, and spirit is that we get to decide which of our thoughts and feelings have merit, which to set aside, and which to act upon.  Granted, this is typically easier said than done!  In yoga, we emphasize how consistent asana practice and breathwork help us to better manage the fleeting emotions that swirl through us in each moment.  Have you ever noticed how you when you get a good workout, you breathe more fluidly and your thoughts/emotions settle down?  One of my colleagues notes that when she has particularly stressful days, she sets aside time to practice Muay Thai to help slough off the stress (momentary tanget — Interestingly enough, Wikipedia taught me that “muay thai” is called the “Art of Limbs”.  Yoga also has eight limbs, which I’ll review in future posts!).

Consider in the coming week what role your ego-mind plays in how you care for your energetic and physical body.  Are you taking good care of your body, breath/energy, and emotions?  Do you give too much of your Self?  Or perhaps too little?  And how do you know the difference?  Also, what messages is your ego-mind sending your Self?  Nurturing and gentle; or harsh and critical?  Yes, many questions and not so many clear answers.  But this is the process of personal growth and self-awareness.  One awakening, followed by trial and error with our new knowledge, then further consciousness.  One foot in front of the other…  Inhale…  Exhale…  Inhale…  Exhale…

Last week, I began a 5-part series discussing the koshas.   This is the yogic term for the layers of our being:  body, breath, mind/emotions, intellect, and spirit.  This week, let’s take a closer look at how our breath affects our ability to connect body and soul.

Pranamayakosha

Pranamayakosha (PRAH- nah-MAI-uh-KOH-shuh) is the breath or energetic body.  In yoga, prana means life energy.  Other familiar terms for this concept include chi or life force.  In Christian traditions, it is called the Holy Spirit.  To grasp this concept, consider how we don’t usually see electricity, but we know it is there; same thing with our life energy.  The yogis understand that we can increase or decrease or balance our energy levels through the use of various breathing practices called pranayama.  If you are a regular yoga practitioner, you may be familiar with one of form of pranayama called ujjayi (oo-jy-ee).  Translated as Victorious Breath, Conqueror Breath, or Ocean-Sounding Breath, it is a common staple in yoga classes because this breath technique helps us to steady our breathing and match the flow of breath to the movement of the body.

Breathing is something we usually do unconsciously and yet it is the most important life-sustaining activity we can do.  According to one article at eHow.com, “brain cells are destroyed after 4 to 6 minutes without oxygen”.  Beyond issues of life and death, mere shallow breathing contributes to anxiety, stress, and physical tension.  In my work in mental health, I have come to understand that attention to and mastery of the breath is the single most effective strategy we have for regulating our emotions.  Consider this:  when our emotions become worried or stressed, our breath becomes shallow and rapid, then the body develops physical tension.  Utilizing the breath, we can calm the nervous system, balance the emotions, and relieve our physical tension.  I frequently find myself watching others’ breathing patterns and wanting to reach out to them to share some deep breathing techniques.  Granted, I probably ought to stay focused on my own breath patterns, but we’re all works in progress right?

Initially, the practice of attending to our breath patterns can be disconcerting because when the body and breath become still, we must listen to the ridiculous chatter of our feelings and thoughts.  Yet with consistent practice, it becomes easier to recognize when our body or or thoughts have become constricted and how to use our breath to bring some ease back into our experience.  So the practice of breathwork, however you approach it, can bring you physical relaxation, mental clarity, emotional steadiness, and spiritual connectedness.  I can’t think of any other activity that can bring one a greater sense of true joy!  As you journey through the week ahead, try noticing how your breath connects your body, mind, and soul.  Consider trying some of the deep breathing strategies you may have heard about, whether in this blog, in your yoga class, or somewhere else out there in cyberspace.  In closing, I’ll leave you with a Bible verse that speaks to this concept of breath as life-giving energy:  “The Spirit of God has made me; the breath of the Almighty gives me life.”  – Job 33:4.  Thank you for reading and have a joyful week!

Please note: While I am most familiar with Christianity, I welcome you to share quotes or verses from your own religious, spiritual, or secular explorations by leaving a comment below.

Last week, I started this three-part series on self-reflection.   I discussed some of the reasons taking the time to reflect on our thoughts, feelings, and actions can be helpful to our growth and development.   In today’s second installment on the reflective learning process, I’ll share my thoughts on strategies for turning your attention inward, as well as using that opportunity to strengthen your self-acceptance and reach your personal goals.

How to Self-Reflect
There are numerous ways to engage in self-reflection!  Potentially as many ways as there are people on this planet.  So when it comes to self-reflection, there really are no rules.  You can choose to reflect in a “stream of consciousness” approach, writing/drawing/recording whatever comes to mind.  You can also direct the process by answering questions about yourself.  Good questions to ask yourself when sitting down to self-reflect are:  What am I thinking?  What am I feeling? (yes, thoughts and feelings are different and I’ll be writing about that in a few weeks!)  What situations prompted these thoughts and feelings?  How did I respond?  Was my response consistent with who I want to be?  If the answer to that last question is a “yes”, great!  Give your yourself the credit you deserve.  If the answer is “no”, you may think of ways you might respond differently next time and decide when to implement that plan.  Remember through all of this that self-acceptance is key and sometimes it’s more important to rest than to do more self-improving.

Journaling
Writing in a journal is an excellent way of recording your thoughts, feelings, and actions throughout the day or week.  Why?  Because in order to write your thoughts in coherent sentences, you have to slow down and organize those thoughts.  This helps to get the mind out of its autopilot chatter and figure out exactly what you are thinking.  Recording your thoughts doesn’t have to be done in a traditional book of lined paper.  I have one journal for writing — well, several actually, as I’ve kept journals for years –and one that is more art and poetry oriented (more on that below!).  For the more techy types out there, there are numerous computer programs and websites that can help you keep an electronic journal.  I suggest doing a web search with the following keywords to get more info…  “free private online journal”  or “journal software”.

Artistic Expression
Engaging in something art-full is another way to express yourself and give some order to your thoughts and feelings.  As I mentioned above, I have a journal that I reserve for poetry and artwork (by “artwork”, I mean doodling!).  I have several half-formed poems that I’ve written in response to various life events, everything from restful winter holidays with my family to challenging career experiences.   Journals with unlined pages are available for these kinds of free-form artistic musings.  You can also use large pieces of paper, tiny little scraps, backs of receipts, sticky notes, crayons, markers, colored pencils, paints (tempera, watercolor, acrylic, oh my!), modeling clay, song-writing, singing, playing an instrument, dancing…  If the activity helps get your experiences out of the endless mind-chattering loop and brings you into a space where you can reflect, then it’s self-reflection.  Easy Peasy Lemon Squeezy    I have also heard wonderful things about The Artist’s Way, a book and online community about the creative process.  While I’ve never read it myself, others have spoken highly of it.  And there are probably many more resources out there on this subject!

Therapy
You had to know this one was coming, right?  I mean, I am a mental health therapist, after all.  Participating in therapy is a great way to self-reflect and can get you past any stuck points you find in your thought process.  Sometimes our mind-chatter just won’t let things be, we beat ourselves up incessantly and can’t figure out how to stop, or we have self-destructive behavior patterns that don’t change despite our best efforts.  These are times when it may be good to seek out the guidance of a mental health clinician.  Unfortunately, there still exists a hefty amount of stigma around going to therapy.  I am on a personal and professional quest to let people know that going to therapy is not about being “crazy” and needing a “shrink”.  There is an ever-growing body of research on evidence-based practices that point to the effectiveness of goal-directed and structured therapy sessions that can help you overcome the barriers to your emotional and interpersonal goals.  For more information on my holistic mental health practice, visit my Specialties page.  To find a therapist in your area, visit my friend and colleague’s great search site, Therapy4Help.  You can also read more about questions to ask a potential therapist and therapy services in general at PsychCentral.

As with everything, balance is essential.  You don’t want to get too caught up in your own inner workings.  Next week, I’ll conclude this series with a discussion about when self-reflection becomes too much of a good thing.  Between now and then, have an inspired week!  Thanks for reading and be well!