Swamiji: You have done a thesis on the role of the Bhagavad Gita in psychotherapy, Dr Parikh?
Dr Parikh: Yes, psychotherapy and psychology have various therapies for helping an individual in distress to face the stresses of life. Most of the therapies are Western. I have tried to use the principles of the Bhagavad Gita in the same way.
Swamiji: Dr Shrikrishna, at Kaivalyadhama you have done research on psychotherapy based on the Yoga Vashishtha?
Dr Shrikrishna: Actually, the type of work done at Kaivalyadhama or at the Bihar School of Yoga has two sides. One is the clinical aspect and the other is how to make these concepts from the scriptures understandable in modern language. Although we may understand these concepts, we may not be able to explain them to the world at large. A real problem exists of definition or clarification and how best to present our interpretations. Which interpretation will be applicable in our everyday life, one from the literary point of view, one from the scientific point of view, or both? How can we incorporate these various concepts so that they do not remain only in the world of Sanskrit terminology, but are directly accessible to ordinary people at the applied level?
When people are suffering from various dysfunctional diseases, especially psychosomatic diseases, we find that an approach is useful in which to some extent they can become the master and can participate in the process of getting better. They realise that they do not have to rely all the time on an external agency in the form of medicine or therapists, and that they can bring about some changes themselves. Some of these concepts we find to be very useful from the applied point of view, and so that is our main thrust.
Dr Lakadawala: Twenty years ago in psychiatry we used to get mainly circumscribed cases, mostly insane people, but currently, a vast number of people come with minor problems. However, their suffering is great; they cannot relate to people, they cannot bear emotional stress and they have to compete in this world. Something has to be done for them. We can treat very disturbed cases with medicine, with shock treatment, but we probably need to be able to offer a large number of our patients something other than conventional treatment.
Dr Parikh: Does conventional treatment mean psychotropic medicine or does it include psychotherapy?
Dr Lakadawala: They are all in the same field so for minor disturbances we give medication for anxiety and depression. Maybe the patient is very tense and after ten days on medication he seems completely alright. However, the basic problem still remains and in six months time it recurs. We must be able to offer patients treatment which is acceptable to them, because many may not come from a highly intellectual sphere. They come to us with the expectation that we can treat them. We know yoga can help.
Dr Mrs Dhavale: We refer our patients with minor psychosomatic disorders to a yoga teacher who gives a class for one hour a week, and tells them to practise at home. But she teaches only asana and pranayama, nothing in detail, and on top of that the patients expect medicine We wanted to have two control groups, one treated only with yoga, and the other with anti-anxiety drugs. But the patients were not happy because they seem to feel that when they go to the doctor they must get some medicine.
Dr Parikh: You could give a placebo.
Dr Mrs Dhavale: We give placebos but they wanted something else.
Dr Parikh: Once you have carried out this experiment and shown that yoga gives better or equal results then they will not want medicine. Their frame of mind is so set that a doctor means medicine. That frame of mind can only change if we demonstrate to them that their problems can be helped without medicine.
Dr Lakadawala: Something has to evolve. Thirty or forty years ago psychiatry was not accepted. Now it is accepted and people come for treatment. We can treat the major crisis, but we have nothing for the minor crisis.
Swamiji: Recently you had a very positive response from the prisoners in Tihar Jail, New Delhi. From your assessment and analysis, what changes did you see happening in the mentality of the prisoners when you took them through the various stages of Vipassana?
Dr Chokhani: Actually the first such opportunity came in 1975 at the Central Jail of Jaipur. The Department of Sociology, University of Rajasthan, became involved in evaluating the prisoners before and after, most of whom were life convicts or had committed grave offences. A sociological evaluation was done from the self-reports of the prisoners, but unfortunately there was no long term follow-up because of the transient political leadership.
In the 1990's we got another boost from the Central Jail, Jaipur which was followed by Sabarmati Jail at Ahmedabad in 1991, and Yaravada jail in 1992. Three courses were organised at Yaravada Jail, guided by the Department of Psychology, Gujarat Vidyapith. But again from a scientific perspective, a lot of questions were raised.
The Tihar Jail programme was very systematically designed. A multi-disciplinary research team was constituted by the All India Institute of Medical Sciences (AIIMS). The Department of Psychiatry took responsibility. We were fortunate to have guidance from Professor Wing, a very senior psychiatrist who has worked with WHO and other organisations, and Professor Parekh who is a management expert from Jaipur. They are very research-oriented people. The research team had a psychologist from the Post-Graduate Institute of Medical Science, Chandigarh and the Indian Institute of Technology, Department of Management, Delhi. The preliminary results have started coming in and they are fascinating. However, the difficulty is how to validate them, what scales do we have?
Yogis do not use so-called research instruments, they use their intuition, their own vibes. They can evaluate where a person stands, how much sadhana he has done, whether he has been systematic in his training, what his achievements are in this life, the past life and so on. They have their unique way of evaluating a person's background and potential. However, we scientists are trained people, and in some ways this training becomes a limitation, because we see things from our limited perspective. So, our difficulty is how to identify proper research scales, how to evaluate the changes that occurred. The end result was very positive and the final result should be ready in a month or so.
In January we started evaluating a core group of 300 prisoners from Tihar Jail. There was another course in April for over 1,000 prisoners. The study is titled 'A Study of Mental Health in Tihar Jail.' Now we have a training centre at Tihar Jail itself where every month regular courses are organised and there are facilities for meditation for all the prisoners who have done courses. By the end of 1994 we should have a final report ready.
Swamiji: I think that is a good area for a proper experiment.
Dr Chokhani: Tihar Jail provided a good opportunity for prisoners serving long term sentences, but unfortunately 70% of these 1,000 people are behind bars for years. They have a lot of frustration. At least here they can practise some techniques, get rid of some of their frustrations, If we can follow them up over a long period of time that should be sufficient for them to receive the benefits. On the other hand, there are prisoners who are not benefited, who are not comfortable.
Another problem is that we do not know if the people taking part in the test are actually practising meditation regularly, and also some are afraid about what the test means and what it will show about them. So there were drop-outs during the follow-up period. We could be selective and choose people who have done advanced meditation courses, but then we would be testing people who are at an advanced stage, and the results would not reflect the psychological benefits derived by the general population as such. These are the difficulties.
Dr Iyer: As scientists, as medical people, we are trained to be sceptical. We need some concrete proof. One problem is the language. Although people claim they know English, the language of the tests is difficult to understand; for example, there may be double negatives and people's answers may not actually reflect what they mean. To translate the test and have it validated in the regional languages is a lengthy process. So, there is the problem of validation, cross-validation, whether the test actually reflects what it should.
Swamiji: Although we are talking about psychology and psychiatry, I think a lot of the knowledge derived is very subjective. I do not think there are any defined parameters as yet from which we can draw conclusions.
Dr Chokhani: These tests need to be devised.
Dr Iyer: The physiological effects of yoga have been well-researched starting with Swami Rama in the USA - EEG changes, carbon dioxide production etc., but the general public has no access to this literature.
Dr Parikh: In terms of research methodology for studying the benefits derived from such practices, we have scales, but most of them are for use in major psychotherapy, with schizophrenics, depressives, etc. There is very little for people who are just disturbed by facing the ordinary problems of life.
Dr Chokhani: We need two scales actually: one to know whether or not the situation is stressful to a person, and if it is stressful, another to see how the person reacts. The ideal improvement would be a reduction in reaction to the stress. Stress is bound to reduce as a benefit of the treatment. These dichotomous evaluations are never carried out.
Swamiji: We are dealing with two mentalities. If you explain to one group, the patients, that these changes happen and that these are the parameters, it is beyond their comprehension. They want to feel better, to get well according to their concept of becoming well and becoming normal. The other group, your group, can understand the changes that are happening and can devise a method or a language to express those achievements in layman's language to motivate them.
This is one of the major problems that we are facing in BSY. We are establishing a Yoga University in Munger with three faculties. The first faculty is Yoga Philosophy which is very straight forward and covers the yogic tradition the scriptures, references, etc. The second faculty is Yoga Psychology which in my opinion is one of the most complex subjects that we can deal with, because we have not yet been able to define the nature of the mind.
So, we have to create a structure which can be used by a layman who has some knowledge of the mind, a recognition of the present mental state, and an understanding of the adjustment of the mental state to actions being performed, either individually or in social interaction. We have drawn up a syllabus and we are thinking about it.
The third faculty is Applied Yoga which will involve research into therapy, and medical studies which will involve research into asanas, pranayamas and even mental states. This will involve field work, using that knowledge and implementing it in the social context. The physical parameters are known quite well today; these are the parameters which can be monitored and observed. But the mental parameters are difficult because the concept of being normal differs from person to person. It is in this context that I am quite keen to have your opinions.
Dr Shrikrishna: I find it hard to talk about scientific research in the field of yoga. I look at this whole process of education from a different point of view. We are using scientific terminology which should be more definite, precise and concrete. We are talking about a field which is subjective through and through, and it often becomes very difficult to standardise the so-called physical and physiological parameters.
After my medical training I did a Ph.D. on research into the effects of pranayama on the general body system and brain function, and it raised questions which I have not yet solved. If I teach the practice of kapalbhati to 10 people, what is the standardised way of looking at it? That everyone should do about 120 strokes per minute? Is that a standardised technique? For me each individual is different, each lung capacity is different, each vital capacity is different. Do I adjust the technique to that person's capacity?
If I ask a person with a normal basal breathing rate of about 20 to breathe about 10 times a minute, it is 50% less than normal for him. But for those whose basal breathing rate is about 15 or 14 or even 12, for them to breathe to times per minute is not much less. So, we can say that everyone should do about 120 strokes per minute and then measure the effect, but it puts a different load on different people and, therefore, the effects are going to be different. So, which way should I look at it? Should I look at it from the standardised point of view? If a person has a basal. heart rate of about 70, it should increase to about 100, that is an acceptable limit. But if a person with a heart rate of 80 also reaches too, then are they in the same category?
We are talking in terms of statistical analysis which means standardisation. In standardisation the main problem is that all the phenomenon are subjective. When we talk about lung capacity or blood gas analysis or blood pressure, it is still within our reach, but when we talk about pratyahara or concentration, questions arise. What is attention? What is awareness? What is concentration? How can we say that concentration or attention are different from awareness? We have to be precise and precision in that kind of activity becomes extremely difficult.
So, Swamiji, I have been struggling with this question for the last 15 years. All the literature on scientific research into yoga is a little bit schizophrenic, neither here nor there because it tries to describe the effects in a very concrete, statistical form. For example, I have too patients with diabetes and I give them a certain group of practices, then check their blood glucose levels, insulin levels, insulin receptors, etc. About 50 have shown a reduction in blood glucose levels so I conclude that they have benefited from the yoga practices. Maybe this clarifies the idea to some extent.
However, if I talk about pratyahara and dharana and dhyana then it becomes much more difficult, because even here at the fundamental, primary level, I have doubts. During the last 15 years, since I have been in the field of yoga therapy, I might have seen more than 50,000 people, and the more I know the less I am sure about the whole situation. You can treat 100 diabetic patients and each one is different. Quite often people come to us in twos, maybe a husband and wife, and ask why they have been given the same programme when they are suffering from different problems, or they may both have heart problems and have been given different programmes. So, even at that level I find it very difficult to standardise the process.
There are three basic points which are very important in this discussion about yoga and scientific research. Firstly, practising asana, pranayama or dharana techniques for an hour a day does not usually help people if they are not ready to change the other 23 hours, if they remain tensed up for the rest of the day. If 100 people do the same yoga practices for one hour a day, but interact in different ways in the other 23 hours, then different results will occur. This is the important point. When we talk about yoga we do not only mean the practice of asana and pranayama or dhyana, but the whole 24 hours. So this is another complication in standardisation.
Secondly, we put animals into different categories such as vertebrates and invertebrates, primates and higher primates, but we say that human beings are the same. However, at the psychological level or at the spiritual level or even at the physiological level to some extent, there are individual differences. So, if I give a treatment such as a meditation practice or an asana or even neti kriya, people will interact with the treatment at different levels depending on where they are at.
The third hurdle is that quite often we are so involved with the statistical analysis that we try to prove something statistically by bringing it to the level of a norm, when actually there is no norm there. So, these are the three fundamental problems which I find in scientific research in the field of yoga. That does not mean that the research has not clarified many concepts. It has done so, but at the fundamental level it has not helped.
Dr Parikh: We have to define the differences, and for that we have to go to the basics. If research can be done defining the basic parameters which make for individual differences, then the full process of standardisation will become very easy. That is the starting point.
Dr Shrikrishna: In Swara Yoga there are certain cycles and rhythms which are interrelated and interacting. Some may be working as the main pacemaker or as some type of mediator. If I teach a person anuloma viloma pranayama, will it only influence his nasal function, or will it not also influence to some extent his brain function, his left/right synchronisation? Is it not possible that his whole internal physiological rhythm will also be changed? This is important from the chronological point of view. We know that sometimes people feel more comfortable doing meditation at one time of the day rather than another. In the Psychotherapeutic situation, the time of the appointment will affect the interaction between the patient and the therapist. In pharmacology, research also indicates that the time of the day at which medication is taken into the body will affect the result.
So, there are many factors which need to be incorporated before we can talk in terms of research in the field of yoga. Ultimately, in the tradition, yoga is not just asana or meditation, it is not something we just do for one hour a day. We cannot remove one factor from the total, and draw certain conclusions or extrapolate from that, saying that yoga does this or does not. These are the sort of problems we must look at.
Dr Shrikrishna: Three points emerge here. The first point concerns the general education of the public and schools. The knowledge should be accessible to anyone who is interested. For example, today preventative and social medicine is being taught even to school children. However, the education system is not teaching them how to live peaceful lives. In a general education it should be made clear why they should do yoga, why they should do asana and pranayama, why they should do meditation.
The second point concerns the applied aspect. There needs to be more precise and definite information about the effects of the practices for the purpose of therapy. There is a need to know exactly how the different asanas will affect muscle tone, ESR, etc.
The third point is that people who are spiritually inclined, or want to do yoga more seriously, can go to BSY or Kaivalyadhama or to a place which is not just concerned with therapy. So, all three have different needs, and the information level for each one will also be different.
Swamiji: I think I should tell you that in Bihar, at the request of the State Government, we are to conduct yoga therapy training in all medical colleges for the new doctors, so that. they are exposed to this idea.
Secondly, the Government is quite keen on making yoga compulsory in medical treatment. They have written to all the government doctors in Bihar, about 16,000 in number, asking them to take yoga therapy training, and then to apply it with their patients.
We began this project this year. There are nine medical colleges in Bihar, and we have covered three. It is an ongoing programme and the result has been such that these three colleges have made a recommendation to the State Government, which has sent an application to the Indian Medical Council, New Delhi, to include yoga in the national MBBS syllabus.
So, I think as a means to generate awareness, this kind of approach is also quite relevant. Even if out of 16,000 doctors only 20% do it, then actually it is a great number, because each doctor will come into contact with a minimum of 3,000 to 4,000 patients per year.
Dr Lakadawala: Swamiji, what has been the response from the medical students? Some time ago I was with a psychiatric team and the students thought that because it was not for passing exams, it was not an important subject.
Swamiji: It is still too early to say. I think what is happening now is the initial euphoria about something new. This trend can go both ways. It can increase in momentum and reach a high level of acceptance or the interest may settle and only a few who are sincerely interested will take it up, and for the others it will have been a good experience.
Dr Parikh: Will you have psychiatrists and psychologists in the teaching faculties?
Swamiji: We have a team of 700 MDs, psychologists and psychiatrists both in India and abroad, internationally, most of whom will be contributing, some as visiting professors. So, there is no shortage of teachers, but people like you who have been involved in both professions, who know what the requirements are, what the parameters are and what protocol has to be maintained in education, are welcome.
Dr Lakadawala: Swamiji, what do you expect from psychiatrists like us, and what should psychiatrists expect from yoga therapy?
Swamiji: In one short simple sentence: provide yoga with your know-how and let yoga provide you with its know-how. That is what we expect from you and what you should expect from us, because as has rightly been said by all of us in our own ways, one of the attractions for people coming to yoga is healing, let us not use the word therapy, whether it is healing the body or healing the mind. I feel it is the doctors who have to have that knowledge and understanding of what help yoga can provide, so that they can treat the total person, not just the symptom of the disease.
Our aim in starting this yoga training programme in medical colleges was to facilitate yoga education for the masses by the professionals who are dealing with the masses. If we have the tradition that allows for healing of the body and at the same time, generation of faculties of the mind and body, then why not know about it and use it. So, in other words, become a yogi so that you can convey the idea to others. That is what the ultimate aim would be.
A yogi is not a renunciate; a yogi is a knower of yoga. In ancient times people would go to a saintly person for treatment of not only their physical, but also their spiritual disorders. Those saintly persons would treat the person by whatever method they chose. Charaka was a sage, Sushrut was a sage, Gherand was a sage, Patanjali was a sage. I do not really think there is any difference between a yogi, a scientist and a doctor, to be very frank, because we have to deal with healing of the human personality, not only the body, but the generation and utilisation of the faculties that lie dormant within the human personality, whether it is the faculty of willpower, auto-suggestion intuitive ability or even siddhis for that matter.
In the course of time, physical treatment became a separate science, the treatment of the mind became a separate science, and spiritual treatment remained in the background. Spiritual treatment is also necessary. You can treat the body, you can treat disorders of the mind, but in the absence of spiritual treatment these two remain partial, incomplete. We talk of attitudes and other things, but we rarely talk of samskaras, and samskaras play a vital role in the growth of human nature and human personality.
So, to have this total vision is the aim of yoga, and this is what it tries to provide people with. I am speaking as a sannyasin here. There are many things that we do not understand because we do not have the scientific background or language which you do. But there are many things which we do have, such as intuitive understanding, which work and which you can translate into your language and understand the whole science. For example, two heart patients may be given different programmes or the same programme. How was that conclusion reached? Nothing was written down, but something was intuitively known to be true. Now, as a yogi, the doctor can understand this faculty, but as a scientist he cannot. The level of understanding changes and I think a good combination of the two skills can go a long way.