Yoga as therapy

I have cut and pasted below an introduction from the results of a study published April 2012 in Acta Neuropsychiatrica. I’m posting this as sort of a placeholder on my blog, so that I can refer back to it for a good description of what yoga does to improve cognition. (Thanks to MIA for alerting me to this study.)

Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomised trial
Bhatia, T., Agarwal, A., Shah, G., Wood, J., Richard, J., Gur, R. E., Gur, R. C., Nimgaonkar, V. L., Mazumdar, S. and Deshpande, S. N. (2012), Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomised trial. Acta Neuropsychiatrica, 24: 91–100. doi: 10.1111/j.1601-5215.2011.00587.x

Cognitive impairment represents a prominent feature of several psychiatric illnesses, including schizophrenia (SZ), major depressive disorder (MDD) and bipolar disorder (1–3). Deficits in long-term memory, working verbal memory, executive functioning and vigilance have been consistently associated with poor functional outcome in persons with SZ (4–8). As pharmacological treatment is not routinely efficacious (9), there is ongoing interest in adjunctive non-pharmacological interventions for ameliorating cognitive deficits (10–12).

In comparison with conventional therapies, yoga represents a different approach. It is a set of mental and physical practices that have been evolving in India for several millennia. Yoga is viewed by many practitioners as a systematic process designed to purify the body and the mind from toxins accumulated due to improper lifestyle choices and negative thinking patterns. Yoga includes components centred on meditation, breathing and activity or postures designed to balance the body’s ‘energy centres’ (13). Intensive yoga exercises may improve the cognitive function among psychiatrically ill and healthy adults (14–20). There are several mechanisms by which the practice of yoga may improve the cognitive function. Yoga emphasises body awareness and involves focusing one’s attention on breathing or specific muscles or parts of body, so yoga may improve more general as well as focused attention. Yoga practice also influences perception by increasing perceptual sensitivity, by selectively ‘shutting out’ undesirable stimuli and by changing distorted perception. Practising yoga improved auditory and visual perception, by increasing sensitivity to various characteristics of the stimuli (e.g. intensity and frequency) (21). A recent study (20) observed that memory functions of male volunteers improved after yoga. In an open trial of yoga (n = 21) versus physical therapy (n = 20) among patients with SZ in India, greater improvement in psychopathology BP1 was reported with yoga therapy (YT) compared with physical therapy. Improvement in clinical severity was noted following 3 weeks of YT, but cognitive function was not evaluated (22). In another study (23), yoga was found to improve facial emotion recognition deficits. The precise physiological basis for the beneficial effects of yoga is unknown and continues to be investigated. Selvamurthy et al. (24) have found that yoga helps achieve a stable autonomic balance. Others have reported that the practice of yoga reduces autonomic arousal (25,26). Because increased physical activity reduces autonomic reactivity to mental stressors (27), it is possible that some of the beneficial effects of yoga are related to stabilisation/normalisation of autonomic function.

The studies reviewed above were conducted by highly trained therapists or clinicians in structured academic centres. Their utility in routine clinical practice is uncertain. Moreover, YT has typically not been used as a cognitive remediation strategy for individuals with impaired cognition. In the present pilot study, we evaluated the impact of YT among individuals with severe psychiatric illnesses. Cognitive domains known to be impaired in these disorders were assessed.

Psychiatry’s poker hand

A few weeks ago Chris stopped by a display in a hotel lobby and purchased a copy of the following DVD entitled “Un Documentaire: Manuel Diagnostique et Statistique. Le coup de poker le plus funeste de la psychiatrie.” (The Diagnostic and Statistical Manual: Psychiatry’s biggest gamble).

You may have seen clips of this DVD posted on YouTube. As it happens, the Citizen’s Commission on Human Rights (CCHR) owns the video rights. The English title of the DVD is The Diagnostic and Statistical Manual: Psychiatry’s Deadliest Scam. The CCHR was founded in 1969 by the Church of Scientology and Dr. Thomas Szasz. The extent of the financial relationship now between Scientology and CCHR is unclear from the CCHR website.

I don’t really care about the relationship between these two organizations. Whatever CCHR is, it one one of only about two organizations critical of psychiatry and pharma (the other being the Church of Scientology) that has deep enough pockets to get the message out to the greatest number of people. Disclaimer: I am not a member of, nor have I ever been a member of, or contributor to, the Church of Scientology or CCHR, nor do I intend to be.

Here’s the take home message from the DVD, as you would expect

  • mental illness has no diagnostic test
  • psychiatry can’t agree on what defines mental illness
  • DSM needs a diagnosis in order to bill insurance

There are some clever illustrations of how there is little agreement on what mental illness is. In one scene, a fictitious group of psychiatrists are the celebrity guests in an updated version of the 1950s television game show, “What’s My Line?”  The psychiatrists try to guess what diagnosis the contestants were previously given, and they all get it wrong, all the time.  In another, patients brought hidden cameras into their therapy sessions and tried to get the psychiatrists to explain what their diagnosis really meant. The wobbly and convoluted answers were hilarious.

There is an expensive French language voice-over that adds a bit of unnecessary, but comic Gallic emphasis  to what is already explained. “Non, c’est ridicule!” says a male voice in response to something the female French voice is explaining. He also responds with “C’est tellement incroyable!” (That’s truly unbelievable!)

A problem with the DVD is that it hardly mentions schizophrenia. I ‘m pretty sure I understand why. It’s because the public still believes that there is this horrible mental illness called schizophrenia that is a “true” mental illness. Schizophrenia still persists in being the one diagnosis where psychiatry and pharma hasn’t inflated the numbers by widening the catchment area, as it has done with bipolar, ADD, autism, and depression. There has been no Joe Biederman popularizing the schizophrenic child – the bipolar child is as close as psychiatry has gone so far.  Let’s assume CCHR, in the DVD at least, doesn’t mention that schizophrenia is manageable without drugs and not a real illness to begin with, because if it did, the public wouldn’t buy the rest of what it is saying. CCHR would prefer to work with the diagnoses that are becoming heavily criticized as being over-diagnosed. A rising tide lifts all boats, so any challenging of the the current treatment paradigm for depression and bipolar, with carry schizophrenia with it. There is a slight problem with my logic of a happy ending for all, and that is that psychiatry won’t give up schizophrenia without a fight.

Splitting, not cracking up

Dear Rossa and Ian,

Just to let you know that Chris and I have had four lessons in May and will then have 3 in June. I will then be away for a few weeks and back in mid-July. I have been very worried about him for the past few weeks. He seems to be drifting again, and in lessons I’m not able to get through to him and to communicate in the way we were able at the start of the year.

To me it feels very like the last time his condition deteriorated, and I’m concerned that he might not be taking his medication or that the balance isn’t right.

I’m sure you are aware of this as well, but I wanted to pass on my concerns. Please don’t hesitate to ring.

Yours sincerely,

Chris’s voice teacher
This well-meaning message that I received yesterday is a prime example of a good reason not to divulge your relative’s diagnosis to other people almost EVER, and a reminder of how the public has internalized pharma’s message. I think I know what’s going on, and I’m doubtful that it’s relapse (although, once again, it has all the hallmarks), but I certainly can see where his teacher is coming from. I phoned her immediately and explained the way I see it. Chris is tired of voice lessons, doesn’t feel like he’s progressing, and has found musical theatre and a small job to be a welcome change of pace. But Chris doesn’t yet have a firm foundation of self, and allows his conflicted self to act like he’s splitting apart. “Normal” people expect a person to show a consistent face across different spheres of activity. Chris hasn’t mastered this technique.

In March, he took a month off from voice lessons and I encouraged him not to go back for a while because, from what he was telling me, he needed a break Apparently, he resumed his lessons in May, probably out of some misguided sense of selflessness and fear of disappointing his teacher. CHRIS – THIS DOESN’T WORK! You are either there and fully participating or you are physcially not there. But take a stand! Don’t be there but be mentally vacant! Stop being all over the map!

(N.B. Chris’s psychiatrist tells me she’s pleased with his recent progress. Go figure.)

One person’s opinion of the lasting effect of maternal deprivation

Today’s New York Times Opiniator was written by a man who suffered extensive maternal deprivation at a very early age. Read the entire piece here.

May 31, 2012, 12:00 pm

Fortunate Son


But after I was attacked, when she fought for me in the emergency room and then nursed me back to health in her home, that finally changed. Psychologists typically believed that the most important bond between a mother and child occurred during the first three years of life. If a child suffered maternal deprivation, he would be emotionally damaged for life. I don’t think that’s true. Getting mugged was a blessing in disguise. It let my mom and me make up for the time we’d lost. It took 14 months of living with her, but I’d finally come home.