Illness (vyadhi) is as old as humankind, but as we evolve as a species and our lives grow in complexity, ill health is proliferating in spite of advancements in medical science and technology. According to Patanjali, for an aspirant seeking to understand the highest Truth, illness is the first obstacle (Yoga Sutra 1.30). For the same reason, a yogi also has to be a healer—or perhaps a healer has to be a yogi! Unless one knows how to deal with vyadhi, one cannot progress on the path of yoga.
When we look at yoga therapy as a system of healing and as a profession, perhaps we are not thinking of the “ultimate Truth” or “absolute freedom from suffering.” These ideas may even be beyond the scope of our discussion. As Thich Nhat Hanh said, although moving in the direction of the North Star does not mean we have to reach the North Star, the “moving in the direction of” is important. This article focuses on the direction for yoga therapy, particularly for a yoga therapist dedicated to helping people heal. Understanding the roots of yoga—and therefore the roots of yoga therapy—is essential for navigating toward healing and holistic well-being that aligns with the larger goal and purpose of yoga.
Illness: The First—Inevitable—Obstacle
Our quest begins with illness, which brings with it immense anxiety, fear of debility and death, and a highly fragmented mind! We keep searching for solutions outside ourselves and get temporarily satisfied by symptom pacification. Rarely, one is forced to look inward to ask, “How am I creating illness and suffering from within?” When such an involution is possible for the mind, one is ready for yoga and yoga therapy. Otherwise even yoga therapy remains a symptom-pacifying technology, and a yoga therapist, a technician. Not to deprecate technology or technical skills, yoga is simply much more than that. It is the means for reaching the highest goal for each human being: knowing one’s true nature and freedom from suffering. Only when the understanding and application of yoga therapy takes us in this direction can we truly call our practices Yoga!
So, yoga therapy uses a person-oriented approach that shows us the way from the inside out rather than from the outside in. The benefit of such an understanding can revolutionize our approach to health and illness. Healing through yoga is not just the absence of disease, but a journey toward finding wholeness and harmony within and without. Illness then transforms from an obstacle into an opportunity for inner growth and transformation.
I experienced a glimpse of this possibility when I was battling with a severe skin condition for many years that disfigured my face and caused a lot of burning and pain at all levels. And you know how it feels when you are also a yoga teacher and therapist: People wonder what you are “doing wrong,” and you start questioning your own practice and authority to teach! I had to look deeply into three levels of identifications (my asmita [ego] patterns), two of which were my physical appearance and being a yoga therapist. The most important identification, of course, was with illness itself, especially as I had been conditioned and seen as “weak and sickly” from an early age. Acceptance, many times, was not easy, as the flareups were unpredictable and sudden and negatively affected my commitments to travel and work. One morning, just after arriving at a retreat center in Australia, I sat down for my practice having just had a sudden skin flareup, the worst I had ever experienced! I had a teaching commitment from that afternoon for the next 3 weeks. My skin was burning and my tears were streaming down, further intensifying the burning! I was sitting in front of a huge window overlooking a beautiful valley, facing the rising sun. For a few moments the beauty of nature in its raw, pristine splendor mesmerized me. I realized my body is also made up of the same five elements; it is not different or separate from what lay in front of me! Nature just is, shining in all its glory: rugged barks, twisted branches, shriveling leaves, still so perfect!
In retrospect, I think this gift of a momentary samadhi experience (intense absorption) expanded my awareness and provided a powerful insight into the nature of my illness. I could see myself and my pain from a deeper location. Everything changed that moment! There was immense relief and gratitude for nature and for illness itself. I could accept the reality without fighting with it, like I always did. I got in touch with a few strong patterns of belief I was holding about myself and illness. I realized I could be at peace even with all the symptoms flared up—I didn’t need to suffer! Throughout the rest of the trip, with all its ups and downs, this realization kept me in a state of inner balance, and my illness did not impact what I had to do. A sense of ease and effortlessness kept me focused and relaxed at the same time. This, I felt, is true healing: what yoga offers every human being!
Tracing the Path of Illness: Suffering IS the Path to Self-Discovery!
Although many people discontinue yoga therapy once they are symptom-free, some are able to see that yoga can offer more than pain relief and keep practicing. Slowly many layers get revealed, taking one on the exciting journey of self-discovery. As a therapist, I am not here to fix clients’ problems, but to bear witness to their increasing ability to understand the nature of reality, the body-mind complex, illness, and the path to healing. The practice and self-reflection facilitated by a good yoga therapist can help one progress from identifying with and being consumed by problems to an inner location of stability and clarity from which they learn to deal with challenges with inner strength and resilience. Yoga therapy should make a client less and less dependent on the therapist, true to the definition of yoga given by T. Krishnamacharya: svatantra (independence).
I am not talking about some abstract, esoteric process. Simple practices done every day at a designated time and in a quiet space can build a new rhythm for the body, prana, and senses, making the mind quiet and restful. One naturally becomes reflective, makes better choices, sleeps better, eats consciously, and enjoys the new routine and the space that has been created. Is this happening with the practices we do and teach?
The Healing Process
The second chapter of the Yoga Sutras offers a powerful framework for healing: vyuham, (an arrangement, akin to the formation of an army in war tactics). Many yoga therapists also integrate important diagnostic steps from ayurveda to explore these different steps in the vyuham.
The first step of the vyuham framework is to know the heyam (recognition of pain that is avoidable). There may be many symptoms that bother the individual. The person needs to understand the manifested problems, their intensity and impact on all aspects of their life, and above all how they are experiencing the problem. This is what my teacher, T. K. V. Desikachar, called “the problem of the problem.”
The second step in healing is to understand the hetu: the underlying causes. There can be an immediate identifiable cause that produces a particular set of results/ manifestations (nimitta karana); environmental and contextual factors that contribute to the problem (sahakara karana); and inherent causes (upadana karana) that relate to the person’s nature, constitution, etc. Understanding hetu is fundamental to healing. There is no one cause or one effect; the problem is a combination of many causes and effects, known and unknown. This makes the healing process very complex.
The third step is hanam: setting up goals for the short and long term. The immediate hanam is the pacifying of the dominant symptoms (samanam), like pain reduction, calming the mind, improving sleep, energy levels, etc. As we work on samanam, we are also exploring the immediate contributing factors, such as diet, lifestyle, and any apparent habit patterns that may be triggering or exacerbating the issues. This step is called nidana (cause) parivarjanam (avoid/ remove). Most illnesses are due to vitiation of vata, the most unstable of the doshas, so working with the prana—which is in the form of air (vayu)—and using the breath is one of the most powerful yoga therapy tools available. Facilitating the flow of prana in the right direction—vata anulomanam—is therefore an important step to healing that we can facilitate by the right application of asana and breathing, diet, and balancing activity. Deeper cleansing— sodhanam—deals with replacing unwholesome habit patterns and healing deeper hurt and trauma to release the trapped prana and clear the way for healing. Then the person can get to arogyam—a state where one is reasonably free from illness and the propensity to fall ill. From there they can move on to svasthyam—being deeply established in one’s true nature, free from duhkham.
The fourth step—hanopayam—addresses each step of the hanam with the appropriate tools that facilitate healing by drawing from the rich repertoire of possibilities yoga offers: asana, pranayama, pratyahara (directing the senses inward, away from exterior distractions), dharana (concentration of the mind), chanting, study and self-inquiry, yamas and niyamas (codes of right conduct), and food and lifestyle changes, to name just some of the possibilities. Through a systematic process of observation (darsanam), dialoguing (prasnam), and advanced techniques such as palpation (sparsanam) and examination of the nadis (energy channels) through nadi pariksa (sensing pulses and assessing doshas), we arrive at the vyuham: heyam, hetu, hanam, and upayam. We revisit this framework periodically to steer the direction of intervention based on observation and feedback from the client.
Gathering all the information and designing appropriate practices that take into account all these aspects is by itself a mammoth task that can only be refined and perfected through many years of practice. I have witnessed my teacher develop simple practices that bring miraculous healing within a few weeks. I don’t think we can do this just with information and logic. It is an art that demands a strong conviction; a deep desire to help; a quiet, observant, listening mind; and of course, years and years of study and practice. Krishnamacharya called yoga therapy ashastra shastra cikitsa (surgery without instruments); like a skilled surgeon, a yoga therapist can carefully design appropriate practices to facilitate healing.
That is not the end of the story! The qualities of the student, their conviction, faith in the teacher and yoga, consistency with practice, and intense desire to heal all are important. Much of this process is subtle and cannot be replicated through scientific research. It is a lifelong quest! How do we integrate this into our training?
Venturing Deep, from the Gross to the Subtle
When we look at the vyuham model superficially, we work with it at the gross level, identifying symptoms and causes, setting goals, and designing appropriate practices. But when we start observing more deeply, we see that the actual cause for illness comes from the mind, from our own attachment and aversion patterns, as rightly presented in the first sutra of Ashtanga Hridaya: Sutra-Sthana (the third major text of ayurveda):
Salutations to the Unique and Rare Physician, who has destroyed, without any residue, all the diseases like Raga (lust, anger, greed, arrogance, jealousy, selfishness, ego), which are constantly associated with the body, which is spread all over the body, giving rise to disease, delusion and restlessness.
How succinctly stated! While we continue to address manifestations and causes at the gross level, we realize the subtle levels of manifestation of illness triggered and kept alive by our habit patterns (samskara), which are imbued with raga (attachment to pleasure/ comfort), dvesha (aversion to pain), asmita (identification with the problem/who I am, who I want to be seen as, etc.), and abhinivesha (clinging to the form of the self). Although we are born with latent impressions (vasana) of these habit patterns, every experience— from conception, life in the womb, the process of delivery, and all life events—shapes the individual into the person we become. And although we are changing constantly at all levels, the ahamkara (individuating) principle recreates us in the same form over and over. All aspects of our being, starting from the gross body to the prana, senses, mind, and deeper intelligence, get shaped by these samskara. The Yoga Sutras say that we carry innumerable vasanas that are kept alive through samskara: Our thinking, feeling, actions, choices—even our perception of ourselves and the world around us—are shaped by our samskara! This process keeps us trapped in the cycle of duhkham.
When illness strikes, it brings with it many vyadhi-samskara (minor disease patterns) that are colored by raga and dvesha and that keep the illness strong and resistant to healing. Unless we begin exploration at this level, much of the intervention remains symptom pacification.
But illness can always take a different form! The goal is not to cure a problem but to cleanse our system of these samskara and vasanas that recreate duhkham in many forms. Slowly, with the right kind of daily practice of asana, pranayama, meditation, etc., and direction from the yoga therapist, one begins to understand oneself better. Without self-blame, one is able to recognize habit patterns and, through deeper reflection and meditation, maybe even arrive at acknowledging two or three of the vasanas that have given rise to all the samskara that bind us. Then, practice becomes a beautiful inner journey of attentive observation, listening, and quiet witnessing that generates heat and burns the seeds of the vasana, releasing trapped prana and rendering the samskara ineffective, so that just vestiges of the memory remain. This is the process of tapas (cleansing fire) that the Yoga Sutras talk about as part of kriya (actions for a specific result) yoga (YS 2.1) and niyama (YS 2.43). My experience with healing that I shared in the beginning of this article was one such process.
Balancing the Gunas (Personal Qualities)
Please note that there is one more layer to unravel: the gunas—sattva, rajas, and tamas—the fundamental building blocks of our being that make up our body-mind complex. When rajas dominates, we experience restlessness, distractions, and fragmentation. When tamas dominates, we experience it as illness of the body (as the physical body is primarily made up of tamas), heaviness, and dullness. Only when the proportion of sattva rises can we experience lightness and clarity. The gunas impact and are impacted by everything: our food, activity, sensorial engagements, sleep, work, thinking, past memories, imagination of the future, and any kind of imbalance arising from within or from outside influences. Through the right kind of practice and engagement, we are carefully learning to titrate the right proportion of sattva, rajas, and tamas so that we can make rajas and tamas subservient to sattva.
Easier said than done! This lifelong work requires very subtle levels of observation and understanding. All the practices of yoga are designed to bring the gunas into the right proportion for a yogi to advance on the path of yoga toward self-realization. Only a mind full of sattva can reflect the true nature to oneself: “Tada drastuh svarupe avasthanam” (YS 1.3). Coming back to yoga therapy, healing also requires that we facilitate for the client the process of bringing the gunas into the right proportion for them. Some people are by nature more rajasic, tamasic, or sattvic. It is not simplistic, as the gunas consort with one another and work together (Samkhya Karika 12).
A restless student (high rajas) might find chanting in asana (static postures) stabilizing. Someone who is habitually lazy and prone to procrastinating (high tamas) may find the same chants combined with movement invigorating. Practices that engage visualization (bhavana) using an uplifting focus can make the practice joyful and develop a positive disposition (sattva).
The Yoga Sutras offer many practices (working with the body, breath, senses, mind, chanting, and attitudes) that help to cleanse our system of excess rajas and tamas, allowing sattva to dominate. Food, speech, and lifestyle choices also affect the gunas. When sattva dominates, our attachment and aversion patterns are starved, keeping the ego and fears relatively quiet and the field of avidya latent. The body heals, and the mind is unaffected by pain or any extreme conditions within or without. This makes a yogi!
What Does this Mean to a Yoga Therapist? And a Yogi?
Is this peaceful state something each client who comes to us has to achieve? That is almost impossible! But if we do not understand this process well, know what the ultimate goal of yoga is, and strive for it with all our might, we will only be technicians! The aspiration of a yoga teacher/ therapist is to become a vitaraga visayam (YS 1.37) for clients: a mind that is clear and transparent, free from the coloring of raga, dvesha, asmita, and abhinivesha, where one can see oneself, understand, and act in a dharmic (right) manner. Our own practice has to be strong, working toward a clear, meditative mind and progressively moving toward inner quietness and outer actions that reflect the clarity and harmony within.
But all this seems like hard work! And how long will it take, we wonder. It requires a great deal of commitment and immense faith in the process and the goal one is seeking: ultimate freedom from suffering! Although the ultimate goal can appear too far and unimaginable, even small steps bring much relief and clarity, increase our vitality (as more and more prana is released for positive action), and take us further on our path. Every step forward is yoga, as the definition goes: “apraptasya praptih yogah”—to achieve what was so far not possible, to move from one step to a higher step (from Shankara’s commentary on the Bhagavad Gita). Every step will also reveal the next step to us (based on Vyasa’s commentary on YS 3.6).
A yogi understands that illness is the nature of the body and cannot be prevented, like aging and death. So the goal is to transcend illness, go beyond identification with the body and bodily functions (annamaya and pranamaya); transcend the plane of the mind, knowledge, and mental formations (manomaya); access the deeper intelligence (vijnanamaya); and be rooted in the experience of deep inner peace, joy, and contentment (anandamaya). When one is located there, the light from within shines forth and guides the being. “Duhkha samyoga viyogam yogasamjnitam”: delinking from the assumed association with suffering is yoga (BG 6.23).
Even a glimpse of such a possibility can change our relationship with illness. Healing, therefore, is about deeper integration and the harmonizing of all forces within and without in service of the true purpose of our existence.
Every therapist needs a good teacher to guide and support our personal and professional journey. We also need the support of a practicing sangha, a community committed to healing and reducing suffering within and without. And, the texts say it again and again, nothing is possible without Grace!
With the right kind of guidance, study, and self-reflection, we progress on the spiritual path, learning to go beyond identification with what is changing all the time—moving from the body-mind complex to identifying with that Principle that is pure and unchanging. Nothing is impossible, and no effort is wasted! Like small drops of water gathering into a mighty river, once we know our destination, we can move together, merrily, joyfully, inspired by and inspiring each other. There is only one destination for all humankind: freedom from suffering and becoming one with the Ultimate Truth, the mighty ocean where every drop merges.
-- Saraswathi Vasudevan
Originally published in Yoga Therapy Today, a publication of the International Association of Yoga Therapists (www.iayt.org). Shared with permission.
Download the pdf here.
