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Introduction
This article explores the overlapping territories of Iyengar Yoga
and Medicine. It has been written from my perspective as both a
teacher of Iyengar Yoga and general medical practitioner. Although
I try to practise Medicine as a doctor, and to teach yoga as an
Iyengar Yoga teacher, I find it is neither possible nor desirable
to completely separate these: as a yoga teacher I cannot shut out,
or turn off, my medical background, and some yoga students also
have, on occasion, recourse to consult me as a medical practitioner.
This article looks at some of the instances of these intersections,
and I hope it will provide some useful stimulus for reflection and
constructive thought, not just on the interrelations between Iyengar
Yoga teachers and health professionals, but also for Iyengar Yoga
teachers in their interactions with their students.
I graduated
with a basic medical degree from Sydney University in 1987 (MBBS
Hons1) and, after completing 4 years of postgraduate training, became
a Fellow of the Royal Australian College of General Practitioners
in 1996. I was awarded an Introductory Iyengar Yoga teaching certificate
in 1992 and a Junior Intermediate (Level 3) teaching certificate
in 2000.
Being
awarded a degree or certificate does not necessarily mean that anything
more than a certain minimum standard has been reached, and detailing
my formal qualifications is certainly not meant to imply that I
consider myself as anything of an "expert" in either Medicine
or Iyengar Yoga. Rather, I see myself as having a relationship -
more accurately an apprenticeship - to each of these disciplines,
and possibly, therefore, an unusual vantage point from where observations
regarding the intersection of these fields can be made.
At
the time of writing this I have been working in General Practice
for around 10 years. The Clinic is sited in a dual industrial and
residential area and so the field of medicine practised covers both
the traditional "Family Medicine" of general practice,
as well as Occupational Health. I am thus consulted by a wide spectrum
of patients in which all age ranges are represented. The Clinic
also includes opportunities to teach medical students and has a
complement of General Practice Registrars in training.
Charged
Encounters
There are many issues that can arise when the worlds of Medicine
and Yoga meet. Their complexities, subtleties and potential complications
are perhaps best illustrated through the use of short examples and
case histories. These are incorporated into the discussion which
follows. Some of these examples might also serve as "cautionary
tales", and it may be fruitful for other Iyengar Yoga teachers
to extrapolate from these into parallel situations which might arise
in the course of their own teaching. To preserve the anonymity of
individual patients and students, identifying details have been
omitted.
1.Yoga,
Medicine and Language
It is crucially important to realise that although there exist areas
of overlap between Yoga and Medicine - and these will be elaborated
on later - there are also fundamental differences between these
systems rooted at the level of language.
Each
patient, whether yoga student or not, arrives at the medical consultation
within their own conceptual world. Into this fits their ideas of
normal function, health and disease. These formulations may not
necessarily be either coherent or consciously articulated. It may
be assumed - by either patient or doctor - that the language used
in their mutual interaction carries the same meaning for both parties,
and this assumption increases the potential for skewed communication
and misunderstandings. An example is the use of the term "chronic".
In medical parlance this refers to the duration of a complaint,
though many patients use this term as an index of severity.
Different
paradigms underlie the various ways of viewing the human individual
and health. Each health modality has a language and vocabulary unique
to itself. The way in which a traditional practitioner of Chinese
medicine, or teacher of Iyengar Yoga, formulates an understanding
of a complaint may make little sense to an orthodox allopathic doctor,
unless that doctor shares not just a common vocabulary, but also
a common meaning which might be attributed to that vocabulary. The
word "spleen", for example, conveys quite different meanings
in traditional Chinese medicine compared with allopathic medicine.
It is thus possible for a diagnostic formulation to be dismissed
as nonsensical (e.g. "deficient spleen") if the words
which are common to each system are endowed with radically different
meanings for each practitioner.
Each
conceptual framework can thus be seen as having a unique language
within which its meaning is articulated. This means that as a medical
practitioner and an Iyengar Yoga teacher, I have two languages operating
in parallel - that of Iyengar Yoga, and that of Medicine. It is
not always possible to translate easily or fully from one to the
other, and learning the vocabulary of Iyengar Yoga means not just
expanding one's word count, but acquiring a different understanding.
In Light on Yoga, where Yogacharya Sri BKS Iyengar explicates the
meaning behind the name "Paschimottonasana", he uses a
conceptual understanding which has no correspondence in orthodox
medical anatomy:
Paschima literally means the west. It implies the back of the
whole body from the head to the heels. The anterior or eastern
aspect is the front of the body from the face down to the toes.
The crown of the head is the upper or northern aspect while the
soles and heels of the feet form the lower or southern aspect
of the body. In this asana the back of the whole body is intensely
stretched, hence the name 
(p.130).1
He
then goes on to explain the derivation of an alternate name for
this asana "Brahmacharyasana":
Due to the extra stretch
given to the pelvic region more oxygenated blood is brought there
and the gonad glands absorb the required nutrition from the blood.
This increases vitality, helps to cure impotency and leads to
sex control. Hence, this asana was called Brahmacharyasana. Brahmacharya
means celibacy and a Brahmachari is one who has controlled the
sex appetite
(p.134).1
These
understandings are therefore based not just on the asana's anatomical
shape, but also upon its subjectively experienced physiologic and
mental effects.
The
definition of anatomical function, as attributed to single muscles
(as is seen in standard anatomy textbooks) reflects a vocabulary
which is simultaneously too simplistic and too compartmentalised
to adequately reflect the experience of asana. Individual muscles
do not work in isolation, and the complexity of their functions
in asana means that the language of standard anatomy is intrinsically
inadequate to express the functional relationships which occur within
asana. The teacher of Iyengar Yoga not only has to subjectively
understand this, but has to expand the understanding and vocabulary
of their yoga students so that the terms used in their interaction
then share a common meaning.
It
is, in fact, where there might be a superficially shared vocabulary,
but not shared meaning, where the potential confusions increase
most. For example, in physiotherapeutic terms the phrase "extend
the spine" would refer to a back bending movement, whereas
to an Iyengar Yoga practitioner this conveys the meaning of lengthening
the spine. The level of confusion can multiply if several practitioners
operating within very different conceptual frameworks are being
accessed by the one person at the same time.
As
an example of this, a young man, A., enquired about using Iyengar
Yoga to help his back problems. It transpired that not only was
he intending to investigate Iyengar Yoga, but was concurrently seeing
his general medical practitioner, a specialist surgeon, a physiotherapist,
a chiropractor and an osteopath for this same problem! He had thus
been presented with a variety of diagnostic labels and therapeutic
avenues, and was (understandably) becoming quite confused by the
differences in approach each of these practitioners had to his problem.
His solution was to consider adding Iyengar Yoga into this equation.
He was not willing to investigate Iyengar Yoga by itself, being
convinced - despite the evidence to the contrary - that more was
better. Rather than increase his confusion - and risk presenting
Iyengar Yoga in a situation where the benefits might be undone by
another modality - it was agreed that he defer his exploration of
Iyengar Yoga until he was satisfied that these other approaches
had been exhausted.
The
understanding that yoga has its own unique language, based within
the experiential and conceptual framework of yoga, is traditional.
In his commentary on Yoga Sutra 3:6, Sri BKS Iyengar quotes Vyasa:
Yoga
is to be known by yoga.
Yoga is the teacher of yoga.
The power of yoga manifests through yoga alone
(173).2
2.
The doctor-patient and teacher-student relationships
There are similarities between the teacher-student and doctor-patient
relationships. Both relationships should be free from exploitation
and, ideally, both are informed by the attitudes espoused in Yoga
Sutra 1:33: friendliness, compassion, gladness, and, where warranted,
indifference. Nonetheless, when attending a doctor, the scope of
the doctor-patient relationship differs from that between yoga teacher
and student. The boundaries change, sometimes dramatically, and
unless the patient (and doctor) are emotionally prepared for this,
difficulties are magnified from the start. Though both relationships
are necessarily intimate, the type and degree of intimacy differs
severally. As a medical practitioner being consulted by a yoga student
it is often relevant to be aware of personal details which the student
might not wish me as their teacher to know. It may be necessary
to ask for details of past medical health, family history, psychosocial
history, habits (dietary, drug etc), sexual history, financial situation
and so on. Whilst clearly not all of this information is required
all of the time, it is occasionally relevant. I also need to feel
unconstrained to conduct whatever physical examination is warranted
- this may involve intimate examinations.
In
contrast, Yoga teachers do not usually need to know this degree
of personal detail concerning their students. In fact, such knowledge
can sometimes prove prejudicial - for example, a teacher may incorrectly
assume that a student with a detailed objective knowledge of anatomy
(such as a physiotherapist) would have a corresponding subjective
understanding of their own anatomy. If I am appraised of a yoga
student's intention to consult me in my capacity as a medical practitioner,
I try to go over these differences with them beforehand so that
they are clear as to what might be involved.
The
necessity for trust is as paramount in the doctor-patient relationship
as it is in the student-teacher one. However, a proportion of yoga
students hold attitudes which I might loosely term "anti-doctor".
Sometimes these are based on actual experience. Sometimes, however,
these reflect an unexamined polarisation between yoga (& other
natural healing methods) and whatever is conceptualised as allopathic
or "western medicine". If such an attitude is held, consciously
or not, it definitely complicates the subsequent interaction. It
may mean that on the one hand I'm considered acceptable (because
I'm a yoga teacher), but might also mean I'm simultaneously regarded
with a degree of reluctance or suspicion (because I'm a doctor).
The resulting ambivalence has the potential to undermine any therapeutic
benefit. This can be illustrated by the following case history.
B.'s
enthusiasm for Iyengar Yoga was highly infectious: she had encouraged
several others into classes. She was a positive, vibrant and humorous,
though slightly scatty presence who could always be relied upon
to be a spruiker for yoga. Not that this was just hot air - she
had found that Iyengar Yoga classes eliminated the need for her
to visit her osteopath and the need for anti-arthritis medication.
She had always demonstrated a somewhat cavalier attitude to her
body, and often required a modicum of restraint in classes.
Arriving
one afternoon in class she airily mentioned that she had some days
previously "sprained" her wrist, but quickly added that
it had been Xrayed and was OK, and that she would take care of it.
Knowing her somewhat dismissive attitude, and the doctor in me flashing
his little red light on & off, I grilled B. for more details.
She illustrated how, while cavorting around a swimming pool, she
had slipped on the pool cover and landed heavily on her outstretched
hand. Despite her stated aversion to doctors, a friend had persuaded
her to see one, and she was sent for an Xray immediately after the
injury. This had apparently disclosed no fracture. She was advised
that she just had a sprain. The treatment provided was a bandage.
No follow up was suggested.
Recognising
that there was a definite possibility that B. had sustained a scaphoid
bone fracture (one of those wrist bone fractures notorious at declaring
themselves on Xray only some 10 days after the initial event), I
asked her if I could examine her wrist. She was extremely tender
at the base of the thumb in her "anatomical snuff box",
a site often tender in scaphoid fractures. Indeed, so suggestive
is the presence of pain here that orthodox medical opinion mandates
treating this with plaster immobilisation on the assumption that
a fracture is present until the opportunity of reXray can occur
10-14 days after the initial trauma. As J.C.Adams writes in Outline
of Fractures:
Fractures
of the scaphoid are often overlooked ... In many cases the pain
from the initial injury is slight and the patient can continue
to use the hand. Thus he may regard the injury as a sprain and
may not even consult his doctor ... When the clinical features
suggest fracture of the scaphoid but the initial radiographs give
no confirmation of it the radiographic examination should be repeated
after an interval of two weeks....Fractures of the scaphoid are
potentially troublesome and the incidence of complications is
high - the most important complications are: 1) delayed union;
2) non-union; 3) avascular necrosis; and 4) osteoarthritis.
3
I
advised B. - not as her yoga teacher, but as a doctor - to at least
get her hand reXrayed, knowing there was a distinct possibility
of a hitherto undisclosed fracture. I was summarily dismissed: "I
don't like doctors, and I don't like Xrays" she said.
After
missing a few classes, she turned up several weeks later still nursing
a sore wrist. She had got a second opinion - this time from her
osteopath. He had, apparently, pummelled her lightly with a rubber
mallet and reassured her that her bones were fine. Again, she had
(doctors' fingers easily find painful spots) an exquisitely tender
scaphoid region. I advised her, in much more directive terms, that
again I would recommend reXray. She was silent.
She
reappeared 2 weeks later sporting a fibreglass cast on her forearm.
It transpired she had seen a friend - a radiographer - who not only
provided the Xray that confirmed her ununited scaphoid fracture,
but also persuaded her to urgently see an orthopaedic surgeon. The
surgeon informed her that she now had a 40% chance of this fracture
remaining persistently ununited, in which case, surgery would have
to be seriously considered.
Thankfully,
she was by now rattled and so complied with her surgeon's advice
and also with my advice regarding yoga. She regained her previous
strength and mobility in her wrist, and is now back to her usual
effervescent enthusiasm. Incidentally, she told her surgeon that
she was finding Iyengar Yoga useful for her arthritis, and despite
the fact that she had an impressive and pain free range of movement
in her joints, he was dismissive. She continues to spruik for yoga.
As
already mentioned, B.'s case is cited here because it illustrates
the potential hazard of holding an unexamined polarisation between
"western medicine" and other health modalities. Her mistrust
of doctors contributed to a delay in correct diagnosis and appropriate
treatment. Interestingly, a similarly unexamined polarisation between
"western medicine" and other health modalities is also
demonstrated by the orthopaedic surgeon whom B. consulted: he dismissed
an entire field of knowledge (Iyengar Yoga) out of hand.
This
case is also a good example of where my dual training as both a
doctor and an Iyengar Yoga teacher proved useful. Had I not also
been a doctor, it is unlikely that I would have known about the
peculiarity of scaphoid fractures, and thus been able to question
the advice given - incorrectly, as it turns out - by both the initial
doctor and osteopath.
3.
Referrals
As a doctor one of my medical responsibilities is to refer patients
appropriately. Referral is warranted when I feel the patient's management
would be optimised by the input of another health professional.
This does not imply that I think Iyengar Yoga might not be able
to help with a particular complaint, but that the person concerned
may not be ready to take on active management of their problem.
For example, simple muscle-tension headaches almost invariably respond
favourably to Iyengar Yoga, but many of those afflicted also have
an intercurrent depression which saps their motivation to start
anything new, and a more useful and realistic therapeutic approach
for them at this time might be massage. I may mention Iyengar Yoga
in passing, but won't push it.
It
can sometimes be problematic when I'm faced with a patient who requests
referral to another health professional, or who self-refers to another
practitioner during the course of their treatment. Firstly, there
may be the assumption on their part that as an Iyengar Yoga teacher
I will unquestioningly endorse all "natural" health practitioners
and "alternative" practices. This is not always the case.
Secondly, some health practitioners - and medical practitioners
are not excepted - cross the boundaries of their own expertise,
and begin to advise in areas in which they are not appropriately
trained. As a result, these practitioners will sometimes impose
their own inadequate understanding of, or ideas about yoga onto
patients. It is extremely common, for example, to hear of yoga being
circumscribed by the simplistic notions of "stretching"
or "exercises" or "relaxation", and not uncommon
for fears (for example regarding inverted postures) to be transmitted
to patients. I have therefore now learned to be explicit when referring
patients: if I think there is any likelihood of them receiving gratuitous
and ignorant advice regarding yoga, I'll warn them of this beforehand
and ask them to filter it out.
Then
there are the ethical issues surrounding the practice of referral.
I am aware, for example, that the perception might arise that by
my recommending Iyengar Yoga I am inappropriately self-referring,
possibly for financial gain. But how, when I know personally the
efficacy of Iyengar Yoga in managing many problems (and have seen
many students reconfirm this), can I not recommend it? Ethically,
should I keep silent about a modality which I know to be extremely
effective?
4.
Diagnosis: What's in a Label?
Students frequently arrive at classes with what are essentially
muskuloskeletal complaints. These usually improve over time through
the use of appropriate yoga. However, on occasion, a student will
present with what appears at first to be a muskuloskeletal problem
but which has, in fact, a more serious and sinister aetiology, and
which may require a different therapeutic intervention (e.g. surgery).
On such occasions, yoga teachers should be prepared to refer students
to someone with different expertise (e.g. a medical practitioner)
for investigation.
For
example, C., a beginner yoga student, complained that her arms "felt
weak" and that she had difficulty maintaining them at or above
chest height. She told me she was seeing her doctor about this and
I gave my usual response: let me know if there is a diagnosis. A
diagnosis might mean that what was taught to her would require further
modification. But in the absence of a specific diagnosis I was happy
to work from how the asanas influenced her symptoms, an empirical
adjustment based on her subjective response. Thus, when doing the
standing postures, she was asked to use the support of the trestle,
or work with her hands on her hips.
The
classes did not irritate or worsen her condition. She seemed strong
and capable in class, though sometimes could not hold the postures
for as long as the other students. However, she informed me that
outside the classes she had begun to experience sudden and unpredictable
collapses - her legs would just seem to give way. Her doctor referred
her to a rheumatologist (joint specialist) who checked her knees
and arms and found nothing structurally wrong. She also had Xrays
and other tests to exclude cervical ribs (a congenital condition
where extra ribs can compress the nerves and blood vessels to the
arms when the arms are raised) and these too had come back negative.
I
was concerned that I might be seeing the start of a scenario familiar
to many doctors, where a patient with an ill-defined complaint embarks
on a round of medical consultation. In the subsequent diagnostic
process, they are sometimes subjected to multiple and increasingly
invasive tests, potentially toxic pharmacological remedies of dubious
benefit, and occasionally even surgery in a bid to reach a diagnosis.
C.
returned to the classes after a short absence. A neurologist had
diagnosed her with myasthenia gravis. In this condition the immune
system generates an antibody to the nerve-muscle junction. The result
is an abnormal fatigable weakness of muscles. It is certainly not
common, though definitely not rare (1/10,000). The condition is
much more common in women than in men, and is classified as an auto
immune process. What triggers the immune system to generate the
auto antibodies is unknown. As in C.'s case, many of those affected
have abnormalities of the thymus gland - either tumours or overgrowth.
In this condition, voluntary muscular movements may start strongly
but cannot be sustained. Though any muscle group can be affected,
those most commonly involved are above the shoulder girdle. Importantly,
if the respiratory muscles become involved, myasthenia gravis can
be fatal.
C.'s
complaints were classical. Indeed, hers was a "textbook case"
of myasthenia gravis. Nevertheless I and two other doctors - one
a specialist - had missed it completely. In my own case, I believe
that had she presented as a patient at the Clinic, I would almost
certainly have considered it as a possibility which needed active
exclusion. However, because I was being consulted - not as a doctor
- but as her yoga teacher, I was not in the position to take a full
medical history, conduct the requisite physical examination, or
order the appropriate diagnostic tests.
In
this instance, identifying the disease process (i.e. making the
correct diagnosis) had important therapeutic implications. Having
an abnormality of the thymus gland, C. belonged to that group of
patients most likely to benefit from surgery. In such individuals,
removal of the thymus gland (located within the chest cavity) is
generally followed by long lasting remission.
5.
Remedial Yoga
Yoga students sometimes attend the Clinic because they hope that
I'll be able to dispense "yoga advice" to them there.
This is nearly always inappropriate: the Clinic is an unsuitable
environment in which to teach Iyengar Yoga as I do not have the
time, space or facilities there. I also believe it is unethical
to expect Medicare to subsidise a non-medical consultation. I have
thus learned that it is important to define what the issue is with
the student/patient early on and to clarify whether it is as a doctor
or as a yoga teacher I am being consulted. If the issues clearly
fall into the domain of yoga, I advise them to make a time to see
me in the yoga school. If the problem is clearly a medical one (e.g.
pre-travel immunisation advice) then I deal with this at the Clinic.
Many times, however, it is not clear-cut. For example, the student
may have back pain and be anxious to rule out a serious medical
problem (such as cancer), but willing to use yoga for their management
of this once serious disorders have been excluded. Most of the time,
it is easiest and best to ignore the fact of their being a student
of yoga until the issue of the management of their problem arises,
as it is only at the time of management of the particular problem
that the question arises as to whether as a yoga student they have
the commitment as well as the desire to use Iyengar Yoga therapeutically.
Even
when a patient has an established yoga practice, it does not automatically
follow that remedial yoga will be used optimally. Patient D., for
example, attended the Clinic with a complaint which was indicative
of a serious underlying disorder. Although D. had a commitment to
an asana practice, it was my opinion that the type of practice he
was doing (both in the actual asanas practised and their sequencing)
was not optimal, and quite possibly even aggravating his condition.
However, as I was being consulted specifically as a doctor - and
not as his yoga teacher - my advice in this area was not solicited,
and when proffered, unheeded. The potential therapeutic use of Iyengar
Yoga in this situation remained, therefore, unexplored. Ironically,
I believe the reason he chose to consult me as a doctor was because
he knew I was also a yoga teacher. Unfortunately, in this instance,
I could do no more than voice my opinion as to the possibility of
more helpful yoga, and then provide what support I could through
the course of his illness in my allotted role as general practitioner.
Many
patients would like their doctor to simply "fix" their
problem, often with a prescription. In this exchange not only might
the patient's subjective understanding of their problem be non-existent,
but their own responsibility for managing their problem is minimised.
Although yoga cannot prevent the arising of all future difficulties,
an experienced Iyengar Yoga practitioner has a potentially vast
repertoire of tools in the practices of asana and pranayama, not
only to help understand and manage their difficulties, but where
possible to prevent these from returning (Yoga Sutra 2:16). To use
yoga therapeutically, however, requires the student ultimately to
take on the responsibility for managing their own problem. Yoga
practice requires, and develops, the cycle of trust, fortitude,
accurate memory, absorption and insight (Yoga Sutra 1:20). Therefore,
if a student proclaims a keenness to use Iyengar Yoga therapeutically,
but has little actual commitment to it, it is predictable that its
use in this context can only be suboptimal. This means that before
committing to use Iyengar Yoga therapeutically for a yoga student,
I have to be sure they're not after a "quick fix", and
preferably not simultaneously consulting a multiplicity of health
practitioners.
In
practice, each individual's suitability needs to be assessed. If
they seem genuinely interested in obtaining relief from their problem,
and other modalities do not interest them (or have already been
exhausted), I'll mention Iyengar Yoga earlier and with more vigour.
If, however, they seem to have an investment in maintaining their
problem - and this is commoner than might be thought - I won't.
For example, E.'s initial reason for attending a remedial yoga class
was to address the problem of pain in her forearms and lower back.
This had developed at work and been resistant to many interventions
(medication, physiotherapy, modification of work duties). Over several
months these symptoms were addressed successfully in the class,
only to be supplanted by a complaint of shoulder blade area pain.
This too was brought under control through the use of yoga, but
was then replaced quickly by kneecap pains. The development of these
complaints was puzzling, especially as she had mobility disproportionate
to her level of complaint and also a level of function outside the
classes which did not equate with her stated level of incapacity
(she was a keen and able gardener, for example). In order to clarify
the situation I asked E. if she found the classes at all helpful.
When she answered with an emphatic no, I decided to discontinue
her classes since there seemed to be no valid reason for her continued
attendance. E. was not entirely happy with this decision and even
volunteered belatedly that the classes had in fact been of some
benefit.
In
retrospect, I believe she had an investment (emotional and financial)
in maintaining her complaints which sabotaged their resolution in
this context. She was, after all, receiving financial compensation
for her inability to maintain her usual work hours and had, on more
than one occasion, expressed dissatisfaction with her job. It is
interesting to note that she intended to use the money obtained
by way of settlement to start a business in which the expected physical
demands would be considerable.
Yoga
may be more a field for understanding a problem than necessarily
eliminating it. As Sri Prashant Iyengar has stated: "Yoga cures
what cannot be endured, and endures what cannot be cured".4
In Yoga Sutra 2:4 afflictions are seen as potentially existing in
4 states: active, interrupted, mild and dormant. Like a dormant
volcano, the potential for re-emergence of a problem always exists
if circumstances are adverse. Thus, I do not think it is wise to
promise "cures" through yoga even though many students
have experienced long-lasting relief.
The
greater the commitment of the student to yoga, the greater the likelihood
of a good outcome. This may at best be the acceptance of a problem
that is chronic. Patient F., for example, has been subjected to
three progressively more disabling spinal operations for low back
pain. He unfortunately now has a spinal nerve root so entrapped
by dense surgical scarring that even slight over-stretching confines
him to bed for several days with extremely severe back pain, and
an inability to use his left leg. F. is dependent on a high daily
dose of narcotic to help manage his pain. Nonetheless, he credits
his Iyengar Yoga practice (which is currently confined mainly to
forms of supported lying, sitting and standing) to staving off suicide,
exerting significant antidepressant and analgesic effects, and helping
with insomnia. Although I could wish - and have wished - for more
in terms of his mobility, both he and I have had to accept the limitations
he currently has, especially in relation to his repertoire of asana.
As
a doctor and Iyengar Yoga teacher I have to resist the temptation
to step outside my own sphere of knowledge. This might mean refusing
to take someone for remedial yoga- not out of meanness - but rather
from an acknowledgement that in this field I definitely have my
limitations. As an example of this, I was asked by a yoga student,
G., if I could devise a yoga programme for his wife who was 20 weeks
pregnant. His enthusiasm was understandable (Iyengar Yoga had helped
him with his back pain), but dangerously flattering. His wife had
an "incompetent cervix" which threatened miscarriage.
Her cervix had therefore been recently stitched, and she had then
been advised complete rest by her obstetrician. Not only was I not
confident or competent in this area, who was I to countermand the
instructions of her specialist? What would have happened had she
miscarried? I therefore declined, with relief I suspect not only
on my part, but also on hers. I had, however, been tempted.
In
this context, when yoga teachers encounter something entirely outside
the range of their understanding and experience, it is apt to recall
what Sri BKS Iyengar has written in The Tree of Yoga:
You can only give what
you yourself have experienced. If you wish to help others through
the healing power of yoga, you have to put yourself at the service
of the art and through experience gain understanding. Do not imagine
that you already understand and impose your imperfect understanding
on those who come to you for help.
Remember that the experience and knowledge born of subjective
experience are a million times superior to accumulated and acquired
knowledge. Experienced knowledge is subjective, and it is factual,
whereas acquired knowledge, being objective, may leave the stain
of doubts. So learn, do, relearn, experience, and you will be
able to teach with confidence, courage and clarity
(p.111-112).5
6.
Common Ground
Yoga and Medicine share the dual intentions of alleviating
suffering and promoting optimal health. As Sri BKS Iyengar comments
on Yoga Sutra 2:16:
yoga is a preventive healing
art, science and philosophy by which we build up robust health
in mind and body and construct a defensive strength with which
to deflect or counteract afflictions that are as yet unperceived
afflictions
(p.117).2
Although
medicine is often used when prevention has failed and disease is
well-established, contemporary medicine does recognise and practise
three levels of prevention: primary prevention which reduces the
likelihood of diseases occurring (e.g. immunisation); secondary
prevention which is aimed at the early detection of disease before
it becomes symptomatic (e.g. Pap smears and checking blood pressure);
and tertiary prevention which is the attempt to prevent the complications
or disability associated with already established disease.
Another
area of commonality is that both medical practitioners and Iyengar
Yoga teachers might be seen as Apprentices in their chosen fields
- that is, accepting that their understanding is never definitive,
and that, over time, application to their subject will yield a deeper
and more comprehensive knowledge. Yoga, however, stresses the importance
of subjective understanding wrested through personal practice. This
means assuming self-responsibility if one is to rely on yoga for
a therapeutic effect, whereas in many medical interventions the
patient's self-responsibility is minimised.
It
is important to recognise that the medical profession have a tendency
to colonise "alternative" health fields, often with scanty
training: for example, any general practitioner in Australia could,
until 2003, with no or minimal training, practise acupuncture (and
receive a government rebate for doing so!). But more importantly,
the medical profession sometimes set themselves up as the arbiters
of how such therapies should be used. While it is true that doctors
study for long periods in order to practise medicine, this is certainly
inadequate in developing expertise in Iyengar Yoga, and does not
render them sensibly capable of either prescribing or proscribing
it.
Finally,
whilst it is indisputably true that the student who is impelled
to start Iyengar Yoga for a reason (e.g. back pain) - and who finds
relief through its practice - often becomes a committed and long
term practitioner, it is important not to restrict the purpose of
yoga only to a therapy. The Sanskrit term samadhi bhavanarthah (Yoga
Sutra 2:2) implies a state beyond the absence of afflictions. It
is thus reminiscent of the WHO definition of health formulated in
1947: "a state of complete physical, mental and social well
being and not merely the absence of disease or infirmity".6
Even though a yoga student may see me as a patient in the Clinic,
if they are to fully engage with Iyengar Yoga, it is my responsibility
as their teacher, where possible, to expand their view of yoga beyond
the elimination of disease. As Yogacharya Sri BKS Iyengar points
out in The Tree of Yoga:
In the first instance,
yoga is not a therapeutic science at all. Yoga is a science for
liberating the soul by bringing the consciousness, the mind and
body to a state of integration. But when a factory is constructed
to produce a certain product for marketing, fortunately or unfortunately
many other products may incidentally be produced, and may also
have market value. So it is possible to forget the original purpose
for which the factory was built, and produce only the by-products
to sell on the market. Similarly, yoga has several facets, and
though the aim and culmination of yoga is the sight of the soul,
it has lots of beneficial side-effects, among which are health,
happiness, peace and poise. As every industrial process has certain
by-products, so health, happiness and healing are all by-products
of yoga, and yoga can be seen to some extent as a medical science
(p.86).5
Note
The accompanying illustration juxtaposes the images
of Patanjali and a modern version of the traditional Caduceus, the
latter reprinted (with permission) from:
Talley N. and O'Connor S. Clinical Examination: A guide to Physical
Diagnosis. MacLennan and Petty, 1989; Front cover illustration
Acknowledgements
Special thanks to Naomi Cameron for her assistance
in writing this article.
References
1. Iyengar B K S. Light on Yoga. Thorsons, 2001
2. Iyengar B K S. Light on the Yoga Sutras of Patanjali. The Aquarian
Press, 1993
3. Adams J C. Outline of Fractures. 8th ed. Churchill Livingstone,
1983; 175-177
4. Motiwala S, Mehta R H. Treating Chronic Ailments with Yoga: Lower
Back Pain. Yoga Vaani. 1997; Vol XIII, No. 3: 46
5. Iyengar B K S. The Tree of Yoga. Shambhala Publications, 1988
6. Hetzel B S. Health and Australian Society. 3rd ed. Penguin, 1980;
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