SRI BALAJI VIDYAPEETH ACADEMY OF HEALTH PROFESSIONS EDUCATION AND ACADEMIC DEVELOPMENT
ANNALS OF SBV Volume 2 Issue 2 July - Dec 2013
theme
Complementary & Alternative Medicine
A Publication of
SRI BALAJI VIDYAPEETH
Annals of SBV
Editorial Advisor K R. Sethuraman
Editor-in-Chief N.Ananthakrishnan
Core Committee T.R. Gopalan
V.N. Mahalakshmi
K.A. Narayan
Seetesh Ghose
Usha Carounanidy
Karthiga Jayakumar
S. Kamalam
R. Pajanivel
M. Ravishankar
R. Jagan Mohan Issue Editors Balanehru Subramanian Ananda Balayogi Bhavanani A.N. Uma Satistical Consultant G.Ezhumalai
Editorial and Production Consultant A.N. Uma Editorial Assistance M. Shivasakthy
A. Kripa Angeline Technical Assistance George Fernandez
Published, Produced and Distributed by
Sri Balaji Vidyapeeth Editorial correspondence to Editorial and Production Consultant
Annals of SBV Sri Balaji Vidyapeeth
(Deemed to be University, Declared Under Section 3 of the UGC Act, 1956) Mahatma Gandhi Medical College & Research Institute Campus Pillaiyarkupam, Puduchery - 607 402 INDIA E.mail:annals@sbvu.ac.in | Phone : +91 413 2615449 to 58 | Fax : +91 413 2615457 Visit Annals of SBV Online at http://www.annals.sbvu.ac.in
From The Editor’s Desk Balanehru Subramanian * The future of country’s knowledge power is at crossroads. Universities, regarded to be centers of learning, have lately turned out to become production factories undermining civic service motive and the intellectual future of the country. Resistance to system change, power struggle, inter-personal egotism, jealousy and competition between departments and laboratories, commercialization of education, revenue priorities have all contributed to confrontation and road blocks. Who do we ask for solutions or where do we search for answers? Answers are not sold on the shelves but a fundamental transformation process must encompass every aspect of the mission of the University. A transformation process from discord to harmony is stimulated not just by deliberated set of goals reflecting students’ aptitude, publication, loss of revenue or other. Can a pianist justify he has harmonized music by just playing the white or black keys alone? Transformation is not just achieving a set of goals but, as said, a process of change at every level of functioning to build capacity for the university’s future. Generally, administration slithers into operations by usually keeping subjects, departments and faculty separate. May be it is done for certain reasons. Nevertheless, opportunities created at every door-step university-wide would not only pave way for re-examination of but validation of individual’s knowledge power only to consolidate them to advance higher learning. Is this possible to happen in Indian Universities? Some may cry ‘No’ and some ‘Yes’. People, who cry no, do not carry the mission of a university but worry about their own accomplishments. These people may be productive in terms of teaching, publications, patient care etc., yet loose university’s core value in due process (black keys). On the other hand, people who say yes are not totally opposite but share different ideology beyond their self (white keys). Simply put, it is the attitude of “Why should I?” or lack of it. This is much evident in healthcare universities and institutions where integrated system of patient care and research is prejudicated. In modern world, both of these are obligatory not only for their very own existence but creating a knowledge wealth for the future generations and articulate a system of quality healthcare where a patient is put forward and not his disease or condition. Now, the challenge is who can make this happen? This brings to the ring, academic administrators, faculty, physicians and surgeons, research scientists, students and healthcare providers to do a self-study of their potential, put forward their interests and enrich core values of their self and that of the university. An interdisciplinary effort is needed to connect the disconnected and move from discord to harmony. How do we make this happen? First let us review the integrated system of healthcare. It starts with prejudice carried by a patient, the doctor and the society. A sick patient, who lives a chaotic lifestyle, wants to get well quickly, turns to modern medicine to help him. He loses his core value of quality healthy life. The doctor shifts priority to treat symptoms only. The patient recovers, the society endorses the process. So it seems that all is well. On the other hand, traditional systems of healthcare like AYUSH, music therapy, acupuncture etc., also have an equal claim in disease and healthcare management. There are strengths and weakness in modern medicine as there are in above mentioned systems of healthcare practices. One system can be complimentary to other. However, in reality, we have lost the articulation of life process and healthy living by disconnecting ourselves from an integrated system of medicine. This is like the black and white keys of a piano. You take the right combinations, it is a musical harmony and so is one’s health. If so, why is this not happening...…? Truly, not to the extent expected because of rigidity in the beliefs and undue haste carried by the practitioners and the public, lack of scientific understanding and publicity. When one can complement the other system, let us accept it. What is a magnet without opposite poles? We need to connect the disconnected systems of healthcare. One best way to do is to scientifically generate an “Evidence-based Complimentary System of Healthcare”. A system of healthcare complimented by evidence-based clinical practice and research will help us move from discord to harmony. Second, research in a healthcare scenario is again prejudiced as a ‘not me’ or ‘why should I’ category. It is not just about a physician or surgeon or a scientist but disciplines in healthcare. A virologist doesn’t care about music therapy or a surgeon has ‘nothing to do’ with what a chemist does. It has nothing to do with the spirit of the faculty but isolationism and priorities. The message that a university cannot be fit without innovative research is lost. What the university can do
is to create a microenvironment to reflect scientism intellectualism and the philosophy of evidence based complimentary system of healthcare. How can this be done? Again connect the disconnected departments, disciplines by a common mechanism to focus on sustaining the core values of the university and thereby the society. Let us move from discord to harmony. This would unveil the ‘wholeness’ behind the university’s mission. Sri Balaji Vidyapeeth is committed to achieve this goal. In this effort, SBV has already made landmarks in a unique and innovative way. This issue of Annals of SBV publishes its achievements in integrating allopathy and traditional system of medicine. Sanjeevita 2013, is an innovative effort by Sri Balaji Vidyapeeth and Central Inter-Disciplinary Research Facility promoting ‘Current Concepts in Integrative Medicine’ that brought together all disciplines and systems of medicine together with one common focus – ‘Patient First: Quality Health for All.’ This issue also covers SBV’s achievements in bringing yoga and music therapy as integral part of patient care and well being. All put together, one can experience this innovative concept of modern and traditional healthcare services provided to the public by Sri Balaji Vidyapeeth based on evidence-based research and practice. The editors thank the Chancellor Shri M.K.Rajagopalan for promoting integrative medicine and his unconditional support towards organizing Sanjeevita 2013, supporting evidence-based research in Central Inter-Disciplinary Research Facility and Center for Yoga Therapy, Education and Research.. Our sincere thanks to the Vice-Chancellor Prof.K.R.Sethuraman and Dean (Research) Prof.N.Ananthakrishnan for their encouragement and cooperation in making this happen.
* * Dr. Balanehru Subramanian MSc.,Phd., Deputy Director, CIRDF, MGMCRI Campus, Pondicherry
From The Editor’s Desk Ananda Balayogi Bhavanani * We are today faced with numerous debilitating chronic illnesses related to aging, environment, and unhealthy lifestyle, such as cancer, diabetes, osteoporosis, and cardiovascular diseases as well as many incurable diseases such as AIDS. Modern medical advancements provide the rationale for the integration of various traditional healing techniques including Yoga to promote healing, health, and longevity. It is imperative that advances in medicine include the wholistic approach of Yoga to face the current challenges in health care. The antiquity of Yoga must be united with the innovations of modern medicine to improve quality of life throughout the world. While modern medicine has a lot to offer humankind in its treatment and management of acute illness, accidents and communicable diseases. No wonder that Dr. Dean Ornish, the eminent American doctor who has shown that Yogic lifestyle can reverse heart disease says, “Yoga is a system of perfect tools for achieving union as well as healing”. According to Dr. B Ramamurthy, eminent neurosurgeon, Yoga re-orients the functional hierarchy of the entire nervous system. He has noted that Yoga not only benefits the nervous system but also the cardiovascular, respiratory, digestive, endocrine systems in addition to bringing about general biochemistry changes in the Yoga practitioners. Yoga has a lot to offer in terms of preventive, promotive and rehabilitative methods in addition to many management methods to tackle modern illnesses. While modern science looks outward for the cause of all ills, the Yogi searches the depth of his own self. This two way search can lead us to many answers for the troubles that plague modern man. Numerous studies have been done in the past few decades on psycho-physiological and biochemical changes occurring following practice of Yoga. A few clinical trials have also been done that have shown promise despite Yoga not being ideally suited for the scientific gold standard of ‘double-blind’ clinical trials. Sri Balaji Vidyapeeth University has been in the forefront of this integration of modern medicine with Yoga and has established the Centre for Yoga Therapy, Education and Research (CYTER) in its MGMC & RI in Nov 2010. CYTER is now functioning in 1st floor, I block, adjacent to the main Hospital block, MGMCRI since December 2013. A scientifically sound Yoga therapy programme is offered through the Yoga Therapy OPD in from 9 am to 1.30 pm daily. Individualised and group Yoga therapy sessions are being conducted for various medical conditions such as diabetes, hypertension, as well as musculoskeletal and psychiatric disorders with excellent feedback from more than 3500 patients who have benefited till date. Numerous pilot studies have been completed and 4 major collaborative research studies are being undertaken under guidance of Dr. Madanmohan, Director CYTER and Professor and Head, Department of Physiology, at MGMC&RI. CYTER has in the past years published 8 papers and 6 abstracts in National and International journals while another 6 are in press. A CME-cum-Workshop on “Yoga and Lifestyle Disorders” was organized by Department of Physiology and CYTER at MGMC&RI, Pondicherry on 22 November 2013. More than 250 medical and paramedical professionals and students as well as Yoga practitioners and enthusiasts from India and abroad took part in the one day CME that gave participants an overview of the role Yoga can play in lifestyle disorders by inculcating a healthy lifestyle. The CME-cum-workshop and Phase II of CYTER was inaugurated by Prof K.R. Sethuraman, Vice-Chancellor, Sri Balaji Vidyapeeth in the presence of Dr. S Krishnan, Dean (Administration) and Yogacharya S Sridharan and Dr. Latha Satish of the Krishnamacharya Yoga Mandriam, Chennai and Yogacharini Cathy Davis of the UK. The following were the recommendations of the workshop: 1. The workshop puts on record its appreciation for the visionary efforts of the Chairman, management and authorities of Sri Balaji Vidyapeeth for their foresightedness in creating a Centre for Yoga Therapy, Education and Research (CYTER) at Mahatma Gandhi Medical College & Research Institute. This is truly innovative and is applauded by all concerned. 2. Scientific studies provide evidence of the preventive, rehabilitative and complementary role of Yoga in management of lifestyle disorders and hence it should be introduced in all medical institutions as part of an integrative approach for the benefit of patients.
3. It is desirable that modern medical professionals be exposed to the scientific and therapeutic aspects of Yoga and this may be done by awareness programmes, workshops and seminars. 4. Yoga should be introduced to undergraduate medical and paramedical students as recommended by MCI and this should be done in the first year itself. 5. A post graduate course in Yoga therapy may be introduced at the earliest for medical professionals to create resources for the delivery of yoga therapy as a health care modality. We are happy to bring out the deliberations and the write ups submitted for the event as a special issue for the ‘Annals of SBVU’ for wider dissemination and readership. We hope that this will motivate more medical professionals to take up the practice of Yoga for their health and the health of their patients. It also may stimulate many to dwell into the psycho-somatic and somato-psychic mechanisms through which Yoga produces its beneficial physiological, biochemical and psychological effects. Wishing you happy reading and a healthy life through Yoga.
“Yoga is probably the most effective way to deal with various psychosomatic disabilities along the same, time-honored, lines of treatment that contemporary medicine has just rediscovered and tested. Asanas are probably the best tool to disrupt any learned patterns of wrong muscular efforts. Pranayama and Pratyahara are extremely efficient techniques to divert the individual’s attention from the objects of the outer environment, to increase every person’s energy potentials and ‘interiorize’ them, to achieve control of one’s inner functioning. Moreover, in restoring human unity, the Yoga discipline is always increasing awareness and understanding of ourselves, adjusting our emotions, expanding our intellect, and enabling us not only to function better in any given situation, but to perform as spiritual beings with universal values.” - Dr Steven F Brena
*
* Dr. Ananda Balayogi Bhavanani, MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD (Alt.Med) Deputy Director, CYTER, MGMCRI, SBVU, Pondicherry
From The Editor’s Desk A.N.Uma * The Music Medicine Unit (MMU) in MGMC&RI was inaugurated in November, 2010, with the blessings of our Hon’ble Chairman and under the headship of Prof. P.Bharathi. Utmost dedication to patient care is our motto. Since its inception, the MMU has been involved in research along with patient care, and several research publications have been documented in international journals. The MMU focuses on undertaking case studies, which bring an important facet to clinical research-that of personal application. Single cases are special examples drawing attention to anomalies in practice, alerting practitioners to matters of urgent attention. Music Therapy in India is now fast developing from its rudimentary stage in the 90s. Each and every one of us is subject to the limitations of human perceptions. But the power of music transcends all human perceptions, and in those who are endowed with appropriate musical intelligence, emotional responsiveness and receptivity, it does not fail to elicit miraculous healing effects. Music’s emotional effect, which is people’s primary motivation for listening, may prepare them to attain or maintain a state of well-being. Be it in any of its many forms, music can evoke powerful emotional reactions in people. Listening to music affects the emotional and cognitive experience of an individual as well as physiological arousal. A couple of articles, illustrated here in the Annals of SBV are on the theme ‘Music Therapy Interventions’ performed in the Music Medicine Unit, MGMC&RI. Affect has been equated with emotion, but in the research literature, it is used to refer to expression of emotional states. Affective modification by music has been extensively studied by Sutherland et.al, who have stated that music has the capacity of modifying the negative affect aroused during anxiety- provoking situations, since it stimulates affective schemes that undo or cancel the experience of anxiety. Music also stimulates positive affect which will boost cognitive- congruent schemes, and generation of positive cognitions is effective in reducing anxiety. The articles in the section of The Harmony also highlight the mechanisms behind sleeping pill addiction, and how music therapy can help in relieving such addictions. Sleeping Pills may be prescribed by physicians for use over a short period of time in the treatment of insomnia. It is however, a known fact that many patients become addicted to sleeping pills. Addiction is not a character defect or a moral deficiency, it’s an illness. Cognitive Behavioral Therapy (CBT) is a better, long-term solution for sleeping problems than medications. Apart from CBT, music therapy employing sedative Indian ragas have proved efficacious in reducing the dosage of sleeping pills in those with addiction. At this very moment, in homes, offices, cars, restaurants, and clubs around the world, people are listening to music. Why do people listen to music? Although the answer to this question is undoubtedly complex, we can attempt to shed some light on the issue by examining music preferences. Just as individuals shape their social and physical environments to reinforce their dispositions and self-view, the music they select can serve a similar function. A couple of articles on biological rhythm and how it impacts the mood have also been given in this Annals of SBV. This is a relatively new field and there is still not an extensive amount of research regarding the importance of biological rhythms. It has not been established whether changes in sleep patterns are a cause of mood disorders, or whether the change in sleep patterns is a result of some other factor such as an anxiety or mood disorder. Most people hear some form of music every day, and music affects people in many ways from emotion regulation to cognitive development, along with providing a means for self-expression. Music training has been shown to help improve intellectual development and ability, though no connection has been found as to how it affects emotion regulation. In general, the plasticity traits (openness to experience and extraversion) affect music preference more than the stability traits (agreeableness, neuroticism). Gender is another factor that affects music preference. Men tend to use music for more cognitive reasons, while women tend to use music for more emotional reasons. Also, men tend to exclude musical genres from one another more than women do. Active mood is another factor that affects music preference. Aggression has been shown to improve creativity and emotional intensity derived from music. People with aggressive disorders find music to be a powerful emotional outlet. Younger people tend to place much more significance on music and also use background music more. Nostalgia is the most important feeling that affects music preference here. Music producing nostalgia effects have been shown to
have large predictive effects on people of all ages. A research study carried out on hypertensives, using Rag Ahir Bhairav is also presented. The articles in this issue under the section ‘THE HARMONY’ has been presented as a special issue for the ‘Annals of SBV’ for wider dissemination and readership.
- Plato
“Music is a therapy. It is a communication far more powerful than words, far more immediate, far more efficient.” - Yehudi Menuhin “The good thing about music is when it hits you, you feel no pain”. W- Bob Marley
* * Mrs. A.N.Uma. MSc.,MPhil.,Phd.,MA.,BEd Asst. Prof., Anatomy Dept. Executive Editor, THE HARMONY, MGMCRI, Pondicherry
Index Sanjeevita 1. Intergrated Medicine: Current Concept 2. Holistic Healing and Medical Pluralism 3. Physico-chemical Nurturing of the ‘Cell’- A Tool for Rejuvenation 4. Research in Integrative Medicine : Opportunities & Challenges 5. A Comparative Analysis of Modern and Traditional Medicine 6. Homoeopathy – Utilise to its Fullest Potential 7. Integrating Yoga and Modern Medicine : Opportunities and Challenges 8. Traditional Systems of Medicine 9. Potentials of Ayurveda and Medical Pluralism 10. Rasayana (Rejuvenation) in Tradition and in Recent Studies 11. Empowering Innovation in Medical Research: Research Clusters as Functional Approach to Inter-Disciplinary Research
- N. Balaji - K. R. Sethuraman - Samuel JK Abraham - S. P. Thyagarajan - M. Prakash Rao - B.D.Patel - Madan Mohan - G.Ganapathy - P.Murali krishna - M.V.Sankaran Valiathan
1 2 3 4 5 6 7 8 9 10
- Balanehru S & Subramanian G
11
Yoga and Lifestyle Disorders 12. Holistic Healing & Yoga Therapy - K. R. Sethuraman 13. Yog for Healthy Lifestyle - Madanmohan 14. Yogic Lifestyle - S Sridharan 15. Yoga : The Original Mind Body Medicine - Latha Satish 16. Psychosomatic Mechanisms of Yoga - Ananda Balayogi Bhavanani 17. Yoga Practices for Prevention and Management of Lifestyle Disorders
- Ananda Balayogi Bhavanani
18 20 24 26 27 32
18. Activites at CYTER 41
Music Therapy 19. Music Therapy or Music Medicine ? - P .Barathi 20. Indian Music Reorganizes Time and Establishes Homeostasis - P .Barathi 21. Effect of Rag Bowli (early morning raga) on a Case of Monosymptomatic Nocturnal EnuresisAssociated with Nocturnal Polyuria - P .Barathi 22. Sound Doc’s Panel - P .Barathi 23. Responders vs Non-Responders to Music Therapy - P .Barathi 24. The “ Right” Music for the “Right” Situation - P .Barathi 25. Prognosis in Music Therapy Interventions is Associated with the Emotional Intelligence-Alexithymia Spectrum - P .Barathi 26. Indian Music Therapy Sedative Ragas can Relieve Addiction to Sleeping Pills - P .Barathi 27. Rag Bilaskhani Todi Relieves Psychological Distress in Adolescents with Increased Neuroticism and Decreased Agreeableness - P .Barathi 28. Rag Hamsadvani Relieves Fatigue and Elevates the Mood of Listeners - P .Barathi 29. Ragas can Modulate Circadian Rhythms
- P .Barathi
45 47 50 53 54 57 61 65 69 72
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Sanjeevita Intergrated Medicine : Current Concept N.Balaji * ‘Integrated Medicine’ is an approach to care that can be easily incorporated by all Medical Specialties, Professional Disciplines, And By All Health Care Systems Which Addresses The Full Range Of Physical, Emotional, Mental, Social, Spiritual And Environmental Influences That Affect A Person’s Health. The Integrative Approach Emphasizes Prevention, Health Maintenance, Early Intervention, Utilizes All Appropriate, Evidenced-Based and Personalized Therapeutic Approaches To Achieve Optimal Health And Wellbeing In One’s Lifespan. AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha And Homoeopath), the Major Therapeutic Systems Of Traditional Medicine Play A Major Role In Integrative Medicine. With An Increase Life Style Disorders, There Is A Worldwide Interest In Holistic Systems Of Health Care, Particularly With Respect To The Prevention & Management Of Chronic, Non Communicable And Systemic Diseases. It Is Understood That No Single Health Care System Can Provide Satisfactory Answers To All The Health Needs Of Modem Society. Evidently There Is A Need For A New Inclusive And Integrated Health Care That Should Guide Health Policies And Programmes In Future. Medical Pluralism Is Here To Stay And The AYUSH Sector Has A Pivotal Role To Play In New And Emerging Situation. Traditional Medicine Is A Revival. Many People Around The World Would Have Healed The Sick With Herbal Or Animal Derived Remedies Handed Down Through Generation. In Africa And Asia, 80% Of Population Still Uses Traditional Medicines Rather Than Modem Medicine For Primary Health Care. In Developed Nations Traditional Medicine Is Rapidly Gaining Appeal. A Quarter Of Modem Medicines Are Derived From Natural Products. Many Of Which Were First Used In Traditional Medicine. The Drug Resistance Caused By Misuse Of Medication Has Rendered Several Antibiotics, And Life Saving Drugs Useless, Which Leads To Urgently Looking For Alternative Medicine. Across The Globe, Researches, Policy Makers, Pharmaceutical Companies And Traditional Healers Are Joining Forces To Bring Integrated Medicine Into 21st Century. The Important Concepts That Make Integrated Medicine Effective In Patient’s Care Are Physicians Should Be Supportive In The Patient’s Care, Health Is Seen As A Vital State Of Physical, Mental, Emotional, Social And Spiritual Wellbeing, The Interventions Are Designed Accordingly. Patients Are Taught How To Recognize, Manage And Decrease The Stress. Nutritional Counseling, Individualized Health Plan Based On The Patient’s Need, Apart From Conventional Interventions. All Other Appropriate Therapeutic Approaches are To Be Followed.
* * Dr. N. Balaji. MD (HOMEO) Director, ISM&H Directorate of Indian Systems of Medicine & Homoeopathy Govt. of Pondicherry, Pondicherry. Page 1
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Holistic Healing and Medical Pluralism K. R. Sethuraman * Holistic healing is rarely discussed in “Western Medicine” unlike other disciplines like Medical Sociology, Medical Anthropology and traditional systems of Medicine (AYUSH disciplines). Holistic Healing is “ to achieve or acquire wholeness as a person. The wholeness involves physical, emotional, intellectual, social, and spiritual aspects of human experience.” (TR Egnew. MD) The types of Healing include, Spontaneous (natural) healing, Technological healing (based on active medications or procedures) and Interpersonal (faith-based) healing. Wickenburg Consensus in 1988 has estimated that rational therapy accounted for only 20% of healing process; the remainder comes from Placebo effect, Hawthorne effect and Spiritual factor. I. Placebo & Nocebo effects are two sides of a coin. Placebo is “I shall please” in Latin. Nocebo is “I shall harm” in Latin. Placebo response rate is from 15% to 58% with a mean of 35% (Prof Beecher of Harvard in 1955). Prof HM Spiro of Yale (1986) has said, “In clinical trials of duodenal ulcer, the placebo benefit was up to 70% and a mean of 50%”. Ted Kaptchuk (1998) a Harvard Professor says, “It is undoubtedly time that the powerful placebo be examined in all its myriad facets; otherwise medicine will always have a limited perception of healing.” Post Modern Voices say, “Patients could benefit from clinicians maximising the potential of placebo effects associated with effective therapies.” (Ernst, 2007) II. Hawthorne effect: (‘caring’ as a beneficial force) A classic Harvard study in Western Electric’s factory at Hawthorne during 1927–37 proved that when employees perceived that the employer “cared”, productivity always improved. Hawthorne effect is relevant to all “caring” enterprises including health care. Patients “feel better” after deciding to put themselves under the care of a physician, a nurse, or a hospital. The attitudes of the management and supervisors influenced the length of hospital stay: the more supportive the management, the shorter the hospital stay. “Unfortunately, the healthcare providers and managers have, until recently, ignored these seminal ideas” (Dr Kerr White, 1996). III. Spiritual factor and Health: The WHO definition of health was revised in 1984 by SEARO: “Health is a dynamic state of complete physical, mental, spiritual and social well-being.” (Khayat, 1998). A WHO study on Quality of Life, Spirituality, Religion & Personal Beliefs (SRPB) involved 5087 subjects in 18 countries. SRPB factors correlated with all the Quality of Life domains. Women reported greater feelings of spiritual connection and faith than men. Less educated reported greater faith but was less hopeful. We need to assess our patients’ Spirituality, Religion & Personal Beliefs as they affect the perceived quality of life Association of American Medical Colleges adopted Spirituality in 1999 and announced, “Spirituality is an individual’s search for the ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism, and the arts. These factors influence how patients and health care professionals perceive health & illness and how they interact with one another.” Post Modern Views on Spirituality: Prayer is not a substitute for rational medical treatment but it is an important element in the way patients cope with chronic illness, suffering, and loss. Physicians need to address and be attentive to all suffering of their patients – be it physical, emotional, or spiritual.
* * Prof. .Sethuraman MD, Vice-Chancellor, Sri Balaji Vidyapeeth, Puducherry Annals of SBV
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Physico-chemical nurturing of the ‘Cell’- A tool for Rejuvenation Samuel JK Abraham * The microenvironment within the body where stem cells reside and are nurtured (the stem cell niche) in various organs including that of Hematopoietic stem cells (HSCs) in the bone marrow (BM) has always been a challenge when it comes to understanding their intricacies. But, as we travel back in time to that of unicellular organisms in evolution, the nature per se was the niche for those unicellular organisms, where they were in direct contact with naturally occurring substances like rocks, soil, water etc. In the process of evolution, as unicellular organisms evolved to become multicellular, the term niche became a separate entity, internally specific to each organ within that organism (1). Cells in the unicellular organisms were directly exposed to physical and chemical influences of the nature and after developing into multicellular organisms with specific organs, the influence of physico-chemical factors became indirect. Nevertheless, physical forces and chemical moieties do play a role either directly or indirectly in every organism and their internal niche. In vitro cell or tissue culture in the earliest recorded history was done using simple chemical solutions, mainly balanced salt solutions (2) which were later modified to include biological components as well (3,4). In recent times as more evidences have started gathering, chemically defined synthetic media is used for the cell culture (5) and the influence of physical forces on the cell culture has also started becoming more evident (6). Our experience till date proves that chemically synthesised polymers and nanomaterial based scaffolds could allow an in vitro expansion of the cells such as corneal limbal stem cells (7), corneal endothelial precursors (8) and chondrocytes (9) in the laboratory, which not only avoids potential threat of biological material based contamination but also ensures reproducibility as well as simplicity. The process of rejuvenation using in vitro expanded cells has been our major area of interest, having been equipped with contamination free, easily reproducible cell culture methodologies of different types of cells. While in vitro expanded autologous fibroblast replenishment (10) has been able to bring back a youthful facial skin, cellular senescence under various physical and chemical environments is an important area for future research. In vitro expansion of immune cells such as Natural Killer (NK) cells and T cells without animal derived feeder layers is a proven procedure for treating cancer (11) and studies have been reported wherein such immune cells could bring down the viral load (12). The hematopoietic stem cells with known age related damages when could be cultured in vitro and be cryopreserved without the damages that are inflicted during the process of aging in vivo, may open new avenues for total rejuvenation of the human body.
References: http://www.metaniche.org/ Miller DJ. J Physiol. 2004; 555:585-7 Harrison R. Anat Rec. 1907 1:116-128. Harrison R. J Exp Zool. 1910; 9:787-846. Ham RG. Proc Natl Acad Sci U S A. 1965; 53:288-93. Engler AJ et al. Cell. 2006;126:677-89. Sitalakshmi G et al. Tissue Eng Part A. 2009;15:407-15. Rao S et al. Indian Journal of Ophthalmology (In print) Arumugam S et al. J.Orthopaedics 2011; 8(3)e5. http://www.miawmi.com/ Takada M et al. Breast Cancer. 2011;18:64-7. Zhang T et al. Antiviral Res. 2007;73:132-9.
* * Dr. Samuel JK Abraham, Nichi-In Centre for Regenerative Medicine (NCRM), India & Yamanashi University Hospital, Japan Page 3
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Research in Integrative medicine : Opportunities & Challenges S.P. Thyagarajan * Integrative Medicine (IM) refers to a healthcare system that is prospective and holistic, while patient centered and personalized at the same time, focusing on health and wellbeing of the people in addition to disease management. It is not to be equated with Complementary and Alternative Medicine (CAM) or the spectrum of Traditional Systems of Medicine. Integrative medicine researchers have broadly adopted the paradigm of evidence based medicine (EBM) which includes randomized controlled clinical trials (RCT). Conducting IM research continues to be challenging for the IM researchers (i) in areas of evaluating IM using existing models of scientific research, (ii) difficulty in obtaining the required proportion of grants for in-depth studies, (iii) to find internationally acclaimed journals to accept IM research outputs and (iv) the legal challenges in the practice of IM in medical institutions and hospitals. Despite all of these challenges, there have been many research teams at major universities in the world, who have made significant inroads into delineating the science of IM using traditional RCT study designs. For example, Taichi’s effectiveness in treating headache; “Whole Systems Research (WSR)” in Ayurveda or Chinese medicine and “Health Services Research (HSR)” to demonstrate the validity of alternative forms of research in CAM/IM. A similar attempt successfully made by our group for a period spanning over 25 years to validate the use of a medicinal plant, Phyllanthus amarus-based drug for the treatment of chronic carriers of Hepatitis B which finally received patents and international acclaim would be included in the presentation. Thus, in order to systematize successful conduct of research in Integrative Medicine, the following strategies would be of great value: 1.Identify the prime areas of research in integrative medicine and define the level of evidence required for their clinical applications. 2.Establish a consortium of integrative medicine researchers to form consensus on how to implement the research priorities. 3.Build an international information technology platform which standardizes and facilitates data acquisition, data banking, and communication between researchers to achieve synergy of productivity. 4.Demonstrate the value of integrative medicine in health maintenance and disease prevention to policy making bodies including legal bodies, especially in light of the current economic setting of burdoning health care cost to society, so that more resources can be allocated to integrative medicine research.
* * Prof. S. P. Thyagarajan , Pro Chancellor (Research), Sri Ramachandra Medical University, Chennai Annals of SBV
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A comparative analysis of modern and traditional medicine M. Prakash Rao * The term “traditional medicine” (TM) refers to ways of protecting and restoring health that existed before the arrival of modern medicine. As the term implies, these approaches to health belong to the traditions of each country, and have been handed down from generation to generation. Traditional medicines (TM) have met needs of the local communities for centuries. Now the terms such as alternative medicine complimentary medicine are used interchangeably to refer the traditional medicine all over the world. Despite derived from diverse cultures, Languages, Geographical locations and health beliefs of people all over the world , the common specialty and peculiarity that unites all types of alternate systems is “Holistic approach” In 21st millennium, medical science has developed in a rapid manner particularly in the field of evidence based research. At the same time a genuine interest in various traditional practices subsists among practitioners of modern medicine along with the growing numbers of practitioners of traditional systems, acquainted with the modern technology. This kind of integration facilitates and fosters teamwork among all categories of medical professional to cater the requirements in primary health and promotes research in diverse facets for nerve-racking medical problems. In developing countries including India, the work force represented by practitioners of traditional medicine is a potentially important resource for the delivery of health care. The World Health organization (WHO) supported every effort to formulate national policies, potential usefulness of traditional medicine as well as to evaluate the safety and efficacy of remedies to study and upgrade the knowledge of traditional medicines among modern health practitioners. Traditional medicines, despite their limitations, are addressing health needs of millions of people worldwide. It is estimated that about 65-85% of the world population uses traditional medicines for their primary health care. It is also estimated that about 39% of all 520 newly approved drugs in 1983-1994 were natural products and out of that 74% were discovered as a result of bio-prospecting from plants used in traditional medicines. Traditional medicines are increasingly getting more popular mainly because (a) it is holistic system with fewer side effects (b) it is evolving as an evidencebased medicine and (c) its ethno-medical knowledge is applicable to modern drug discovery programs. It is found that there are many diseases that cannot be cured by the existing drugs and the incidence of drug resistance is increasing, consequently there is urgent need for drugs that are effective against these pathogens. Probably, traditional medicines can provide a solution in fighting them as a health care delivery mechanism as well as in exploring the medical research. As the emergence and resurgence of Traditional medicines (TM) in health care is evident worldwide. This paper attempts to make a comparative analysis to find out the current state of traditional medicine in India with respect to infrastructure development such as educational institutes, organizations, practices and therapeutic scope attitude towards alternate medicine with its limitation and implications in the field of health and medicine.
Keywords : World health organization (WHO), Traditional medicine (TM), Complimentary medicine (CAM) Holistic System,
* * Prof. M. Prakash Rao, Scientist IV, Central Council for Research in Homeopathy, New Delhi Page 5
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Homoeopathy – utilise to its fullest potential B.D.Patel * Homeopathy is a natural pharmaceutical science that utilizes extremely small doses of substances to stimulate a person’s immune and defence systems. It considers the mind and body are inter-dependent in Health – Disease – Cure Basically it is individualistic medical system rather than generalised – hence there are no specific Medicines for specific Diseases. Each medicine is individually prescribed according to the “Law of Similars” that is, a substance which is capable of evoking a certain set of symptoms in an essentially healthy person under controlled research procedures, may become a potential effective therapeutic agent when prepared according to the specifications of the Homeopathic Pharmacopoeia and prescribed in accordance with Homeopathic standards.It uses medicines qualities rather than quantity. Believes in minimum medication for any number of diseases or disease conditions.The Homeopathic medicines work so effectively because they work with nature, rather than against, the body’s inherent immune system. There are no additives, fillers, etcIt is neither habit forming nor fattening. Has no known side effects. Homeopathy considers the body to be the best healing system around, and the symptoms are the body’s effort to heal. Homeopathic medicines stimulate the body’s natural ability to heal itself. A dose is considered as the number of times a remedy is taken, not the number of pellets or squirts. Homeopathy is safe during pregnancy, with babies, and animals. The treatment need not wait for the final diagnosis (of course diagnosis may help in treating the case) It can reach more where other systems do not have Penetration. It treats the Person with the Disease rather than Disease in the Person Homoeopathy adopts all the diagnostic measures to diagnose- treat- and monitor the treatment so that there is no mere removing of the symptoms but also annihilating the disease, specially life style changing healthy vegetarian food and of course Ashtanga Yoga. Apart from general ailments, it can treat advantageously treat Asthma, sinusitis, Tuberculosis, allergic rhinitis etc. Depression, bedwetting, IBS, amoebiasis, Hemorrhoids, Fistula in Ano, Fissures, corns, warts, polyps, cysts, pre &Psot menopausal Syndrome, irritable children Autism, ADHD etc, above all Viral diseases like Swine flu, Dengue, chikungunya, Herpes Zoster etc. The practioners need to be open minded &accept the wholisticapproach, look into other options like AYUSH while treating patients. Monitoring can be with the modern gadgets. There is saying “ Success is easy if you do not bother who takes the Credit “ Ultimately patient is not bothered about the type of treatment he is concerned with relief. Hence let the patient be the aim and not the type of Medical system.
* * Prof. B.D.Patel , Former Director & Dean, V.M.Homoeo Medical College, Salem , Former.Principal, Govt. Homoeo Medical College, Bangalore &Chandigarh(U.T),Former. Chairman Board Of Studies (homoeo) Bang.University. Annals of SBV
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Integrating Yoga and Modern Medicine : Opportunities and Challenges Madan Mohan * “Health for all by 2000 AD” has remained a pipedream. And can we achieve health for all even by 3000 AD? Unlikely. Unless we adopt an effective and integrative approach to the problem. The present health scenario is dismal. With increasing elderly population, the incidence of already prevalent chronic lifestyle disorders is on a steady rise. Antibiotic resistance is staring us in the face. Expensive high-tech modern medicine is beyond the reach of even the upper middle class. Public hospitals are over-crowded, under-staffed and fund-starved. Millions die of chronic diseases while they are on life-long drug treatment. It is clear that allopathy does not have all the answers and there is an urgent need to adopt an integrative and holistic approach to the problem. There are gems in “alternative” treatment modalities which are simple, bio-eco-friendly and inexpensive. We need to shed our ego and get rid of “holier-than-thou” attitude.
Yoga can effectively augment modern medicine. Being holistic, it is ideal for integrated development of our body, mind as well as soul. Mind, body and soul are intricately inter-related and mind-body dichotomy is at the root of our problems and disease. Health as well as ill health have physical, mental-emotional as well as spiritual dimensions. Elderly persons are more happy and healthy if spiritually active. However, spiritual domain has been outside the scope of modern medicine. Yoga can effectively fill this lacuna. Yoga has promotive and preventive potential and can play an important role before the disease manifests itself. Yoga has many advantages. Being non-pharmacological, it is free from negative, harmful side effects of drugs. In contrast, it has positive, “side benefits” in terms of improvement of psychosomatic health of the patient. Even if drugs have to be given along with yoga therapy, decrease in drug dosage will bring down the cost of medicare & limit the side effects of drugs. Another advantage of yoga therapy is that treatment of one disease is associated with simultaneous benefit in other diseases as well as improvement in quality of life. Yogic relaxation and breathing techniques can be of immense value in pre-operative relaxation and post-operative recovery. It is clear that inexpensive and holistic yoga therapy can be great boost to our health care delivery system.
Great ventures are bound to face great challenges. The principle of duality (dvand) is inherent in our world. Change is always resisted due to uncertainty, even fear of unknown. We have to deal with status quo-ists who lack motivation and love laziness. Who has time? Well meaning professionals are busy in administrative work or private practice. The curriculum is already loaded, how to add new content? Another challenge is to identify and exclude unscientific, untested and potentially harmful methods. Powerful drug companies have vested interest in tutoring and pleasing physicians. They are quite smart in modulating even the research findings! The task is stupendous, but worthy and achievable. We need to rope in competent, authentic and well meaning persons. We need visionaries who are scientists by training and action-oriented karmayogis. Use of internet will make the effort more effective, open and respectable. And Divine Grace will make the whole effort fruitful and enjoyable.
* * Prof. Madan Mohan ,Director, Center for Yoga Therapy, Education and Research, Puducherry Page 7
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Traditional systems of Medicine G.Ganapathy * Traditional systems of Medicine especially Siddha system of Medicine in Southern parts of India is becoming much popular for its unique value in treating and preventing ailments of mankind. Infection causes diseases and malnutrition causes diseases were more prominent in the beginning of the last century, but it was controlled in wealthy countries after introducing preventive measures like vaccines and nutritional food programs. Recent problems affecting mankind are malignancy, degenerative disorders, biochemical disturbances, mental illness and immunological disorders mainly genetic in origin. Chromosomal damages are due to radiation used in therapy, environmental pollution by drugs reactions and immoral behaviors. Siddha system treats both body and mind, prevents diseases and helps for longevity of life. Kaayakalpam is the main strength of the system. It helps for longevity of life by preventing diseases. It is not only by drugs, but by practices also. Apart from this, choice of drugs for anemia, arthritis, and skin disorders are more. Treating HIV and malignancy is possible. Drugs were tried for HIV in MMC, Chennai and Thoracic medicine hospital, Tambaram Sanatorium. During Chemotherapy supportive treatment can be provided to treat anemia, loss of appetite, etc. In drug resistant Tuberculosis, drugs in Siddha system is the best of choice. It was tried in Thoracic medicine hospital. Long back it was expected to know the antibiotic available in Siddha medicine and treatment for Asthma. In recent period, drugs for treating viral infections and malignancies are mainly expected. There is more research scope for many diseases available in Siddha system. For successful achievements, support from Advance medical system is very much needed which will be discussed in detail during panel discussion.
* * Prof. ( Dr. ) G.Ganapathy , Joint Director (Retd) Former Professor and HOD, National Institute of Siddha, Tambaram Annals of SBV
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Potentials of Ayurveda and medical pluralism P.Murali Krishna AYURVEDA an indigenous medical wisdom has its roots in Vedas and taking care of health needs of Indian society from time immemorial. It is a comprehensive health care system with well construed basic tenets, time tested formulary and unique Bio-purification technique (Pancha karma). This indigenous medical system literally called as ‘Science of Life’ give due importance to positive health care of individual by advocating special diet regimens, lifestyle regulations and drug administration suite to person, place and seasons. Its unique approach of treating the patients is individualized with threefold schedule of drug, diet and lifestyle to mitigate the entire disease process, thus restore the health. The potential areas of Ayurveda in health and medical care management are as follows 1.’ Rasayana’, a class of drugs having the quality of slowdown the biological aging, and immuno-modulator effect. 2. Panchakarma, five types of Biopurificatory measures to eliminate the pathogens from the body through natural orifices and also to sensitize the body for subsequent drug therapies. 3. ‘Kshara sutra’ a para surgical technique of applying medicated thread in ano-rectal fistulae is well appreciated for its efficacy in healing the tracks and preventing the recurrence. 4. time tested and effective herbal and herbo-mineral formulae in the management of allergic skin & respiratory diseases, acid-peptic disorders, IBS, Psoriasis, Auto-immune diseases, selective neurological disorders, Rhumatological diseases, Genito-urinary disease, male and female infertilities, Neuro-degenerative disorders, refractive errors of eye and migraine. Ayurveda has unique role in offering safe and effective remedies in management of above short listed conditions. In the era of medical pluralism no system is absolute in catering the health needs of society. Openness, acceptability, honesty and patient oriented outlook which are very essential for any physician who has sole responsibility of safe guarding the health and life of patient. The physicians of Ayurveda, though they have special approach in diagnostics but depend on investigative procedures of contemporary modern medicine to have precision in diagnosis. In specific infective conditions like tuberculosis, intensive care, medical and surgical emergencies the patients are referred to specialists of modern medicine where an effective and life saving management can be expected. In growth disorders Homoeopathy has safe and cheap remedies. In specific skin disesases like vitiligo, Unani system has effective treatments. Siddha system has its unique role in offering quick and effective remedies with herbo- mineral combinations. All these medical system have their own way of medical care, which are unapproachable and incomprehensible to physicians of other systems. There is a need of openness and transparency of thought in exchanging the views among the physicians to offer most effective, safe and economy remedies for simple to fatal ailments. Carak Samhita, an Ayurvedic classic of Ancient India quotes that ‘a team of doctors are best to evolve an undoubted remedies’. Every system has its own potential area and unique role in health and medical management. The greatness of these systems is segregated and pocketed. There is need to bring these potentials of various systems in to a common flat form and used for social application. The main short comings achieving medical pluralism in India are undue claims, lack of concern over patient, myopic thinking, commercialization and lack of class professionalism in practitioners. If we overcome these dark areas of thinking, medical pluralism and integrative approaches are going to offer safe, cheap and effective remedies to the needy.
* * Dr P.Murali Krishna, M.D(Ay), Ph.D , Reader, PG Department of Panchakarma, TTD’s S.V.Ayurvedic College, Tirupati-517507(AP) Page 9
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Rasayana (Rejuvenation) in Tradition and in Recent Studies Marthanda Varma Sankaran Valiathan *
Rasayana is one of the eight branches of Ayurveda and has been in vogue for over two thousand years. It remains popular even today and drugs for rasayana are among the top selling products in Ayurvedic formulary. While ageing is a natural process which cannot be prevented, rejuvenant therapy is based on the concept that the infirmities associated with ageing could be prevented. The key principle of rejuvenant therapy is to smoothen the pathway of nutrients to replenish body tissues which are always depleting and degrading. Rejuvenant therapy was carried out in two modes – intramural and extramural. As the intramural method called for indoor facilities and involved many restrictions, the extramural method – simpler and hassle free – has been more popular. There have been studies of rejuvenant procedures in the past, which looked at gross effects such as “feel good factor” etc., which provided little evidence of rejuvenation at the biological level. Recently two published studies have shown that Amalaki Rasayana significantly reduces breaks of single and double strand DNA in the neurons and astrocytes of rats (Subba Rao); and confirm that it enhances the life span, fecundity, thermal tolerance, starvation tolerance and other biological markers in drosophila (Lakhotia). These studies form part of a new initiative – Ayurvedic Biology – which consists of rigorous studies in modern science based on cues from Ayurveda.
* * Marthanda Varma Sankaran Valiathan, Ch.M, FRCS, FRCS (C), FRCP, D.Sc (h.c) , “Rasayana (rejuvenation) in tradition and in recent studies” Prof. M.S. Valiathan, National Research Professor, Manipal University, Manipal, Karnataka
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Empowering Innovation in medical research: Research Clusters as Functional Approach to Inter - Disciplinary Research Balanehru Subramanian * and Subramanian Gopalakrishnan ** Introduction : Inter-disciplinary medical research is a complex and dynamic process. In modern healthcare, a standalone research may not be able to deliver the needs of the society. The end-point validation is how well the research output connects with the needs of the society in terms of diagnosis, management, and prevention of disease. If not, the research unit is like a dead space in a shopping mall where nothing is sold. Bridging science to the society or bench to bed side research or translational research as it is called in recent times requires more than a good research infrastructure and qualified research personnel. A strong inter-disciplinary research team is proposed involving basic research scientists and clinical investigators with fields of expertise ranging from cellular biology to clinical pharmacology to pathology to biomedical engineering. However, shortage of translational researchers, productivity demand with limited funds, lack of proper mechanisms to facilitate translational research and institutional mindset restricted to teaching or patient care are unfavorable to inter-disciplinary research. Unbound by some of these shortcomings, a university structure is an ideal ground for encouraging inter-disciplinary research. Here we hypothesize that an involvement-based clustering of expertise in multi-specialty, multi-institutional university will create a microenvironment to motivate both clinicians and scientists to effectively deliver the healthcare needs of the society. In this article, for the first time in the history of medical institutions, we discuss our experience in successfully establishing 18 need-based research clusters within Sri Balaji Vidyapeeth. Strategic guidelines: To improvise a cluster model, the following guidelines were followed: • Identify and invest in thrust areas of research that make best use of university and regional resources to promote human health and well-being. • Advance research capacity in translational research. • Promote research excellence through effective organizational systems and infrastructure. • Enhance training, career development and mentoring opportunities for the next generation of biomedical researchers. • Promote, nurture and support a professionally rewarding culture for researchers at institutional level. • Increase awareness, appreciation and understanding of the value of in-house research to both internal and external stakeholders and the public. Cluster Initiative: During the process of establishing research clusters, the challenge of consolidating a value added healthcare ecosystem centered on patients’ medical needs was taken as the central dogma. Five broad areas of healthcare, necessary to live a quality healthy life, were identified as the foundation to foster specialized research clusters. These areas were identified by raising five pertinent questions that an informed care seeker or provider would ask in common: Question 1. How does information technology relate to and can assist society in addressing pressing individual and public health problems? This will generate ‘Community Health Informatics’ to address personalized health data management and predictive healthcare, genetic/immune-profiling of individuals to wellness and predisposition to diseases for eg., genetic screening, pharmacovigilence, allergies etc. Question 2. How will new research help us make important decisions to distinguish normal from disease-related aging to use appropriate therapeutic and intervention programs? This will result in ‘Longevity enhancing Clinical Practice’ to address for example, deficits in hearing, vision, coordination, cognition, allergies with special importance to Geriatric care.
* * Dr. Balanehru Subramanian Depute Director, ** Dr. Subramanian Gopalakrishnan, Director In-Charge, Central Inter-Disciplinary Research Facility, Email: bsubram@cidrf.res.in, MGMCRI Campus, Pillayarkuppam, Puducherry
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Question 3. While there is a very strong base in the use and practice of traditional medicine in India, can new evidence of scientific research enhance the acceptability and validate them for worldwide recognition? This will generate an ‘Evidence-based system of traditional medicine’. Traditional medicine is more a personalized medicine, a concept that has embraced the modern medicine. Validation of Ayurveda, Unani, Siddha, Homeopathy, Yoga, Music therapy etc. will consolidate the strengths of each resulting in an ‘Integrative system of healthcare’. Question 4. Will cutting edge technologies provide translational inter-disciplinary research to understand the nature, development and quality of human life? This will engage ‘Need-based research’ looking for innovative ways to use available scientific knowledge to solve problems of people and to improve the well-being of people of all ages. Question 5. New generations in modern world are crippled by a wave of preventable healthcare problems. How can an integrated research help develop mechanisms to manage such issues? This will result in scientifically defined ‘Wellness therapeutic programs’ such as Stress management, weight management, cardiovascular health, diabetic management, arthritis management, asthma management, de-addiction program, therapeutic skin care etc. Brain storming: A bottom-up instead of a top-down management strategy was used to carve out research clusters. A customized template (Figure 1) was provided as a guide to all faculty and researchers in Sri Balaji Vidyapeeth. Multispeciality faculty involvement was sought out in a brain storming session to establish research leading to establishment of a Center of Excellence in Rejuvenation. Research Clusters: Voluntary involvement of faculty resulted in identification of areas of interest that resulted in the following theme-based research clusters:
Figure 1 An overview of the template used in the research cluster brain storming session
1. 2. 3.
Twelve medical research clusters (List 1) Five dental research cluster (List 2) One ‘Health professions education’ research cluster.
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List 1. Medical research clusters established in Mahatma Gandhi Medical College and Research Institute affiliated to Sri Balaji Vidyapeeth.
List 2. Dental research clusters established in Indira Gandhi Institute of Dental Sciences affiliated to Sri Balaji Vidyapeeth. Cluster Coordinates : Each research cluster was then consolidated by a team of faculty coordinated by a cluster leader. The cluster leader is a voluntary commitment by a faculty to share additional responsibilities. The inclusion criteria involved the following: 1. Research involvement is the major criteria 2. Clusters are not specialty-based 3. Clusters to involve both senior and junior faculty 4. Cluster research activity is team work 5. Cluster members to take up theme based research Page 13
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6. Promote inter-cluster team work Though the clusters are carved based on guidelines defined above, isomerization of clusters and its members are encouraged to advance in new areas of need-based research. Cluster Vision: Bound by the concepts of integrative medicine, each cluster is required to generate a central theme or vision to focus their research interest. Members brainstorm their interests to outline their vision. Based on this exercise, each cluster arrived at a core theme or vision for each cluster as listed in Figure 2, 3 and 4.
Figure 2. Medical Research Clusters and their vision
Figure 3 Dental Research Clusters and their vision Annals of SBV
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Figure 4 Health Profession Education Research Cluster and its vision
Cluster challenges : With enthusiasm and encouragement at the forefront, potential challenges that the clusters could face were identified: 1. Research laboratory space 2. Research infrastructure 3. Access to skilled workforce 4. Scientific writing 5. Protected research time 6. Seed money support 7. Incentives for research publications Resolution to challenges: One of the major innovations of Sri Balaji Vidyapeeth in medical education and research is the establishment of a multi-crore, modern, state of art center for research in medical and allied healthcare areas, named ‘Central Inter-Disciplinary Research Facility’ (CIDRF). This research facility which is unique in a Medical University in this country has been approved by the Department of Scientific and Industrial Research, Government of India. CIDRF is staffed to carry out cutting edge research in molecular medicine in an attempt to take medical education and patient care to new heights. Faculty has been chosen to represent different emerging areas of medical research. This facility is housed in about 10,000 sq feet of laboratories furnished to international standards and equipped with best in class and latest instruments to carry out work in identified emerging research areas. Research development management etiquette practiced by the Chancellor Shri.M.K.Rajagopalan, Vice-Chancellor Prof.K.R.Sethuraman and Dean of Research Prof.N.Ananthakrishnan has resulted in creation of a research fund. Secondly, research clusters meet at predetermined time without interrupting clinical hours, to discuss research projects. Third, in addition to encouraging publication of research articles in national and international peer reviewed journals, Sri Balaji Vidyapeeth publishes ‘Annals of SBV’ a biannual journal to advance knowledge sharing. Cluster mentorship: To foster post-graduate and under-graduate medical research in campus, research clusters in collaboration with CIDRF are actively involved in mentoring post-graduate research as well as providing preceptorship to under-graduate research. The ‘Medical Student Research Preceptorship’ program is conducted by CIDRF to foster research even at the under-graduate level. Cluster Endorsement: The outcome of these research clusters and their value addition to healthcare cannot be undermined even though healthcare providers have rigid beliefs of their practice that is many decades old. The question is will these clusters, emerging from an institution that practices modern medicine, lead the way into an avenue of integrated healthcare practices and how well will these be accepted by other systems of healthcare practice. To address this, leading experts from all major systems of healthcare practice, from modern medicine to Ayurvedha, Yoga, Unani, Siddha and Homeopathy congregated to review this cluster initiative. These experts endorsed the vision nurtured by these clusters in a unique Research Cluster Inaugural ceremony named Sanjeevita 2013, organized on September 6, 2013 (Table 1)
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Cluster SWOT analysis:
  Conclusion : Our attempt is first of its kind in India intended to take healthcare research beyond borders with resources and opportunities available locally. The research cluster model has overcome prejudication that clinical specialists are not interested in research. Research clusters provide level playing field that advances on each other’s expertise, strength and knowledge. Activity of these research clusters so far has had impressive progress in terms of in inter-disciplinary integrative medicine project developments. While other medical institutions could commence on such a model system, we conclude, based on our success that translational inter-disciplinary research in emerging areas of integrative medicine is effective in a University microenvironment. This integrated system of fostering research will effectively contribute to the healthcare needs of the society. Acknowledgement : The authors thank the Chancellor Shri.M.K.Rajagopalan, Vice-Chancellor Prof.K.R.Sethuraman and Dean of Research Prof.N.Ananthakrishnan for their enticing support in creating an international research microenvironment in Sri Balaji Vidyapeeth. The authors also thank Dean, Principal, faculty and students of constituent colleges of SBV for their active participation and interest in research.
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Yoga and Lifestyle Disorders Holistic Healing & Yoga Therapy K.R. Sethuraman * Holistic Medicine is similar to Integrative Medicine in its approach. It focuses on the ‘Preventive and therapeutic approach which sees the person as a whole being, including mind, body, & spirit, and not as a patient with an isolated malfunction of a particular system or organ.” Integrative medicine (IM) is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. Holistic Healing is very much a part of family medicine. “To heal is to achieve or acquire wholeness as a person; the wholeness involves physical, emotional, intellectual, social, and spiritual aspects of human experience” says Dr TR Egnew, a Chief of Family Medicine in Washington DC. There are three types of Healing: Spontaneous natural healing, Technological healing (based on active medications or procedures) and Inter-personal healing (induced by Provider-Client relationship). Wickenburg consensus statement of 1988 has looked at various Factors in Healing and it estimated that Rational (Pharmacological or technological) factors only accounted for 20% of healing and the remainder resulted from Placebo effect (35%), Hawthorne effect (30) and Spiritual factor (15%) Complementary & Alternative Medicine use among 1,055 patients of Mayo Heart Clinic in USA revealed that 82% reported use of CAM therapies, which included 24% mind-body therapies like Yoga& meditation, stress management, and other relaxation techniques. However, only 1 in 7 discussed it with their physicians for fear of refutation or ridicule. A similar study in Australia among 19209 women found that 1-in-3 used yoga and meditation as adjunct therapies. Therefore Yoga-therapy is currently a very active area of research and include the following conditions: • Psychological symptoms and disorders • Mindfulness and job stress • Anxiety • Depression • Sleep • Pain syndromes • Low back pain • Headaches • Osteoarthritis • Rheumatoid arthritis • Cardiovascular conditions o Coronary artery disease o Hypertension • • • • • • •
Yoga In Recent Research Autoimmune conditions Asthma Ashtanga yoga & Smoking Diabetes Multiple Sclerosis Lymphoma
*
* Prof. K. R. Sethuraman MD, Vice-Chancellor, Sri Balaji Vidyapeeth, Puducherry Annals of SBV
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• Breast Cancer • Physical effects o Weight loss o Leg strength • Pregnancy conditions o Hypertension and preterm labor o Stress and vagal activity o Labor pain • Physiological effects o Heart rate and blood pressure o Pulmonary measures • Ashtanga yoga & Smoking
Some of the recent evidences of Yoga therapy: Ashtanga yoga for weight loss and well being in the Young: Ashtanga yoga is often referred to as ‘‘power yoga’’ as it is more aerobic in nature. Participants lost 2 kg on average after a 12-week program.
Yoga during pregnancy - Effects on maternal comfort, labour pain & outcomes: 74-primigravid Thai women
were equally divided into experimental and control groups. yoga program involved six, 1-hr sessions at prescribed weeks of gestation. The Yoga-group had i) higher levels of maternal comfort during labour and 2 hour post-labour and ii) had experienced less labour pain
Yoga on Balance & Gait : A study of 27 women with musculoskeletal problems (osteoarthritis and low-back pain) who underwent 8 sessions (twice weekly x 4 weeks) of yoga therapy of asanas, stretching exercises and breathing techniques revealed that yoga had a positive effect on balance and gait of women with musculoskeletal problems. Adverse effects of Incorrect Yoga practice included meditation-induced mania or psychosis, arterial occlusion, and “lotus neuropathy” which highlight the importance of using properly trained yoga therapists. Mindless Rejection of Effective Rational Rx is at times of great concern to evidence-based practitioners. In a study of 2562 breast cancer survivors, the research question was, “does the use of alternative medicine affect breast cancer prognosis in those who reject systemic therapy?” The results showed that those who refused proven systemic treatment had double the risk of adverse outcomes and that alternative therapies did not alter the outcome of breast cancer. Therefore yoga therapy is only an adjunct in cancer management and not a replacement for standard therapy.
Looking in to the Future:
• Advances in neuro-imaging, genomics & metabolomics will help unravel the secrets of natural healing processes • We could offer evidence based therapy incorporating these “endogenous healthcare forces” thus unifying the art and science of healing. • Let all the healing forces work together to help the suffering humanity.
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Yog For Healthy Lifestyle Madanmohan * Healthy lifestyle: a holistic view: Who does not want good health and long life ? However, there is no free lunch and one has to earn it by living a disciplined and healthy lifestyle. Health is the best wealth, so says the samskrit verse “Labhanam shreshtham arogyam”. If you possess good health, feel blessed, give thanks and preserve it at all costs. If not, do your best to achieve it, at any cost since our body is a temple of the Divine (Deho devalayah) and the means for performing all righteous deeds (Sharir madyam khalu dharm sadhanam). Vedic rishis have prayed for a full, enjoyable and independent life not just for 100 years, but even beyond (AUM tachchakshur devahitam …… bhooyashch sharadah shatat. Yajurved, 36: 14). Many warriors of Mahabharat war ( 3000 BC ) were of venerable age and the great warrior Bhishma Pitamah was absolutely healthy and strong at 186 years. The secret of their long and healthy life was disciplined lifestyle in tune with the laws of Mother Nature. These universal Divine laws of nature are called as “Rit” in Vedic language. Yog and ayurved which belong to the Vedic tradition are rooted in nature. In spite of spectacular advances in medical science, “modern” man is a victim of a host of chronic health problems like hypertension, diabetes, chronic pains and insomnia. The primary cause of these problems is our artificial lifestyle that is away from and against the laws of nature. What does being healthy mean? Health is difficult to define, easy to appreciate and a joy to enjoy. Positive health means perfect functioning of body and mind and ability to enjoy healthy life in its various dimensions. WHO definition of health is “A state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity”. It is a condition or quality expressing adequate functioning of the organism in a given situation. To this definition, WHO has added “spiritual wellbeing” also. However, it is not clear what spirituality means. Spirituality should not be confused with religion and this point has been discussed in the section on Spiritual Health and Healing: a Yogic Perspective. Physiological approach to the question of health is in terms of measurable, objective values. A person is healthy if his blood pressure, heart rate, body temperature, blood glucose and other parameters are within normal physiological range. A healthy person is able to meet adequately the demands of his profession / work, i.e. as a teacher, a soldier or a farm hand. In a healthy person, dynamically interacting homeostatic (regulatory) mechanisms of unimaginable complexity maintain various body functions and parameters within normal physiological range. These mechanisms are less developed and easily taxed in newborn (especially premature) babies and the elderly. In ayurved, the term for health is “swasth”, i.e. one who is established and comfortable in his own being, a state of being whole and feeling whole. Acharya Sushrut (~ 600 BC) has given poetically beautiful and philosophically holistic definition of health thus: “Health is a state of balance of elements, optimum digestion and elimination and happy senses, mind and soul” (Samadoshah samagnishcha. Sushrut Samhita, Sutrasthanam, 15:41). Lifestyle is the way people live and this has immense influence on the status of health or disease. Since one’s lifestyle is developed early in life, it is advisable to cultivate healthy lifestyle in early childhood. Many factors determine one’s lifestyle. Economic status determines incidence of under-nutrition in poor and obesity in the rich. Cultural values of the society dictate the incidence of vegetarianism in the population. Sedentary life is a major factor for coronary artery disease while personal habits like smoking and alcoholism determine the incidence of heart disease and cirrhosis of liver. Exercise, healthy diet and rest and relaxation are important components of lifestyle. From the yogic point of view, proper posture and brahmacharya are very important components of one’s lifestyle. Yog is the most perfect lifestyle module as it is comprehensive and holistic in its nature. Yog for healthy lifestyle: Yog is a scientific–spiritual discipline and conscious evolution of our physical, mental and spiritual aspects. Its ultimate aim is to become divine by achieving unity with the all- pervading Divine Consciousness. According to Sri Aurobindo, “All life is yog” because yog is a philosophy that can be applied to everyday activities of our daily life. The ancient marvel of yog which is the most precious gem of our cultural heritage has been preserved despite centuries of stagnation and suppression due to brutal foreign invasions. And now it is our duty to promote and propagate
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* Prof Madanmohan MBBS, MD (Physiology), PG Diploma in Yoga, MSc Yoga, DSc (Yoga), FIAY CYTER, MGMCRI, Puducherry Annals of SBV
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it for the benefit of entire humanity. Yog is holistic and its relevance is universal. It is the best means for improving our health as well as preventing and managing stress and stress disorders which are unmanageable by our health care delivery system. According to materialistic view, we are essentially a body that has a mind. On the other hand, from the spiritual and yogic point of view, we are spiritual beings having human experience. In other words, we are an individual soul that has two beautiful instruments, body and mind. These three entities, i.e. soul, body and mind continuously and dynamically interact with, and influence each other. Yog has profound influence on our total health and personality because it has desirable effect on all the three aspects of our being. Yog is holistic in nature since it is science, philosophy as well as art. It has promotive, preventive as well as curative potential. Its effect is augmentative as it improves our physical, mental as well as spiritual health. Yog is a time-tested and safe tradition. Compared to other modes of health intervention, it has many advantages. It is economical in terms of time, energy and resources. Being holistic, it is ideal for our horizontal, in-depth as well as vertical development. For prevention as well as management of stress and stress disorders, there is no method as effective and as far-reaching as yog. That is why Yogeshwar Krishn describes the superiority of a yogi in unambiguous terms (Tapasvibhyo adhiko yogi. Bhagavadgita, 6:46). Proper posture: From yogic point of view, proper posture and movement are important components of healthy lifestyle. Posture is a manifestation of physical and mental balance and has powerful influence on physical aging and mental mood. Good posture is very important for energetic and active life. When you are stooped, you look old and feel old. Do not think that slumped posture is natural to old age. So, lift yourself against the physical weight of gravity and mental weight of aging. Whether sitting or standing, maintain a good, firmly upright but comfortable and relaxed posture as asan should be firm but comfortable (Sthir sukham asanam. Yog Darshan). Stand and move with grace and vigor and do not tighten your muscles stiff in unwanted and awkward position. Of the 700 muscles that we have, good posture needs only 5 key muscles. Yogic posture is ergonomically appropriate and physiologically sound. Therefore, avoid poor posture and slouching in a chair as it: i) Distorts alignment of bones and creates more pressure on lower back. ii) Tenses muscles resulting in muscle pain and stiffness of joints. iii) Interferes with breathing and decreases vital capacity. iv) Interferes with circulation and oxygen delivery to brain resulting in poor concentration and drowsiness. v) Results in poor digestion and constipation. vi) Decreases productivity and accelerates aging. Yog improves physiological functions: Human body is a beautifully robust mechanism capable of taking care of itself. Yog assists this process and improves our physiological functions and health. Scientific research has shown that yogic techniques produce consistent and beneficial physiological changes and have sound scientific basis (Wallace RK. Science, 167: 1751, 1970; Madanmohan et al. Indian J Physiol Pharmacol, 36: 229, 1992). Even a few weeks of yog training can improve physiological and psychological functions. Practice of asans and pranayams results in overall improvement in physical fitness and cardio-respiratory functions. We have reported that yog training for 3 months produces a significant increase in respiratory pressures, breath holding times and hand-grip strength (Madanmohan et al. Indian J Physiol Pharmacol, 36: 229, 1992). This indicates an improved physical strength and cardio-respiratory function. In the same study, we also found a significant decrease in visual and auditory reaction times after the yog training. This indicates a faster and more efficient information processing by the brain. We have also reported that after yog training, exerciseinduced stress to cardio- vascular system in less severe (Madanmohan et al. Indian J Physiol Pharmacol, 48:461,2004 ). This means that yog training can enable one to tolerate more severe exercise load. Other workers have found that yog training produces a significant improvement in dexterity scores and motor speed (Manjunath & Telles, Indian J Physiol Pharmacol, 43: 225, 1999; Dash & Telles, Ibid, 43: 458, 1999). Yogis are capable of remarkable feats of endurance (Vakil RJ. The Lancet, 2: 871, 1950) and control of their autonomic functions (Chhina GS, Proc International Union Physiol Sci, 10: 103, 1974). Yog for mental health: Just as our body requires physical exercise, balanced diet and bathing for good health, our mind requires inner discipline for mental health. Ordinary mind is a clutter of uncontrolled thoughts. Meditation (dhyan) is the ideal way to calm the mind. Meditation is the inner (antarang) yogic discipline in which there is a continuous flow of thought towards a higher spiritual ideal in a higher spiritual center of our consciousness. It makes the mind one-pointed and produces psychosomatic relaxation. Meditation is not an ordinary concentration. 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ii) niyam or five spiritual discipline. Jap or repetition of holy name is very effective in achieving success in meditation. Jap should be done in a spirit of love and adoration as mystic worship and not in a mechanical way. Thus performed, jap and dyan are higher forms of worship to which our body, mind and soul, the whole being respond with better health and healing power. That is the secret of the power of yog. For success in dyan and to get attached to the universal Divine Consciousness, we have to create proper mood and loosen our worldly attachments. This attainment of unity and realization of identity is the goal of yog. In this state, our inner soul is freed from the thralldom of ego, mind and senses. Then problems of the world do not disturb our inner harmony. This is the basis of sound mental health, a distinguishing characteristic of a yog sadhak. Yog is equanimity (Samatvam yog uchyate. Bhagavadgita, 2: 48) and evenness of temper is the essential feature of mental health. Spiritual health and healing: a yogic perspective: Human body is the highest and best creation of the Divine and an instrument for performing noble deeds (Sharir madyam khalu dharm sadhanam). That is why Vedic Rishis have called this body has Devapuri and Ayodhya (Asht chakra navadwara devanam poorvayodhya. Atharvaved, 10: 2: 31). Our body-mind-soul complex is the real temple of the Divine. By yog sadhana, we should keep it fit, clean and pure and seek the Divine within. Spiritual healing is curing a disease by non-physical means, i.e. through powers outside medical intervention. By prayer, meditation and therapeutic touch, the healer channels Divine healing energy that improves patient’s life force (pran shakti). There are claims that spiritual healing hastens recovery and even hopelessly ill patients can recover miraculously. Faith, i.e. belief in a higher universal Divine power is the basis of the spirituality. Faith is what your heart tells you is true when you intellect cannot prove it. One can have faith in a religion or in eternal universal Truth called as Rit in Vedic language. It may be noted that spirituality is distinct from religion. Religion is a particular belief system and mode of worship. Religions are many, but spirituality is one. Religion may nurture spirituality, but spirituality does not depend on it. Prayer is another important component of spiritual life. Prayer can lift the mind and soothe the soul. Prayer enhances health and promotes healing of self and others. It is a medical secret - prayer heals. Performing actions and one’s duty with a spirit of selfless service (Nishkam karmyog of Bhagavadgita) is an important component of spiritual life. A person who believes in all-pervading universal Divine power feels connected not only to everyone, but to all forms of life and the whole creation. This promotes universal love which is distinct from selfish romantic love. A person who has these spiritual qualities is an asset to the whole society. Health benefits of spirituality are significant. Faith in higher Spiritual power relieves one of cares, anxieties and stress and promotes calmness and tranquility. Consequently, his heart rate, blood pressure, muscle tone, oxygen consumption and carbon dioxide production decrease. Even his cholesterol decreases over a period of time. Spirituallyoriented people get sick less often. They recover faster in case they fall sick. It is claimed that patients recover better if family and friends pray for them. Spirituality also decreases the incidence of stroke and death from heart disease and increases survival after surgery. Spirituality helps to prevent / overcome bad habits because spirituality is considered to be bigger than these. As a result, there is increase in longevity and quality of life. Here it is interesting to note that Benson (New England Journal of Medicine, 281: 1133, 1969) has reported that transcendental meditation (TM) can help one to kick off drug addiction, which is a serious problem among the “modern” youth. Power of pranayam: It needs to be emphasized that slow and deep pranayam breathing has a powerful influence on our wellbeing. A simple exercise to relieve stress and promote wellbeing is to straighten and mildly arch your spine as you inhale (purak) slowly and sequentially and then exhale (rechak) as you bend forward and round your back. It is claimed that pranayam reduces obesity and purifies the body. According to Patanjali, pranayam destroys the covering of inner light and the mind gains the power concentration (Yog Darshan, 2: 52-53). Manusmriti (6: 71) says that pranayam purifies the impurities of senses and the mind. From the physiological point of view, slow and deep breathing (as in mahat yog pranayam) has the following advantages: i) It is economical as it reduces dead space ventilation. ii) All the muscles of respiration are strengthened. iii) Different parts of the chest and lungs are stretched, improving their flexibility. iv) Abdominal viscera are gently massaged by the descending diaphragm. v) Venous return (blood flow) to heart is improved. vi) Mind-body coordination (thereby health) is improved. Annals of SBV
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There is evidence that pranayam has therapeutic potential. In an interesting work from our laboratories, we have demonstrated that subjects trained in yog can achieve a state of deep psychosomatic relaxation and significant decrease in oxygen consumption within 5 minutes of practicing savitri pranayam (Madanmohan et al. The Yoga Review, 3: 25,1983). Savitri pranayam is a slow, deep and rhythmic breathing in which the ratio between purak, kumbhak, rechak and shunyak (bahya kumbhak) is 2:1:2:1. Telles and Desiraju ( Indian Journal of Medical Research, 94: 357, 1991) also have demonstrated that pranayam can decrease oxygen consumption significantly. More recently, we have demonstrated the beneficial effect of pranayam in patients having premature ventricular complexes and palpitation (Prakash et al. International Journal of Cardiology, 111: 450, 2006; Ravindra et al. Ibid, 108: 124, 2006). It is clear that the power of pranayam is available to us freely. Let us use it for the benefit of the humanity. Yog for prevention and management of stress: The all- pervasive stress and stress disorders are the bane of modern society. The main cause of stress among the affluent sections is material progress without a parallel development of inner, spiritual resources and this results in deep rooted conflicts and disharmony. Healthy balance between worldly enjoyment (bhog) and detachment (tyag) is good for mental health. This point is beautifully taught in a Vedic verse thus: “This whole universe is pervaded by Ishwar. Enjoy this world with a sense of detachment and do not covet the wealth of others” (Ishavasyam idam sarvam. Yajurved, 40: 1). Chronic stress results in disturbance of mental and physical equilibrium. The consequence is a host of chronic disorders like hypertension, angina, diabetes mellitus, peptic ulcer, irritable bowel, chronic pains, insomnia and cancers. It is alarming that the incidence of these lifestyle diseases is increasing in India. The problem is more marked in urban areas where people are living a routine of daily rat race. Over-ambitious, everstruggling and restless persons (type “A” personality) are more prone to stress disorders. They can be screened in their early life by psychophysiological tests and taught yog relaxation techniques as a preventive measure. Yog has a comprehensive and holistic approach to health and is the best treatment for stress and stress disorders. A judicious combination of simple stretching asans, slow rhythmic pranayams, yog nidra and dhyan is most effective and ideal for prevention and management of stress. Mantr (e.g. AUM) chanting, jap and bhajan singing, especially in a dedicated group (satsang) are very effective for managing stress and improving mental health. Yogeshwar Krishn gives a very high place to jap and bhajan singing when he says “Among the offerings, I am the offering of jap (Yajnanam jap yajnosmi, Bhagavadgita, 10: 25) and “He is the best yogi who worships Me by bhajan singing (Shraddhavan bhajate yo maam, Bhagavadgita, 6: 47). Many workers have demonstrated the effectiveness of yogic techniques in the control of blood pressure and hypertension ( Selvamurthy et al. Ind J Physiol Pharmacol, 42: 205, 1998: Datey et al. Angiology, 20: 325, 1969). Yog lays great stress on proper diet, a distinctive feature of which is emphasis on purity (satvik ahar) and moderation (mitahar). Overeating is a form of malnutrition that results in conditions like obesity, diabetes mellitus, and arthritis. Yogeshwar Krishn emphasizes the importance of regulation in diet, recreation, sleep-wakefulness and other activities for the yog sadhak (Yuktahar viharasya. Bhagavadgita, 6: 17). Chhandogya Upanishd emphasizes the importance of purity of diet for our inner purity (Ahar shuddhou satva shuddhi. 7: 26: 2). Purity of mind results in improved mental health and freedom from psycho-somatic disorders. It is clear that yogic lifestyle is very effective for prevention as well as management of stress and stress disorders.
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Yogic Lifestyle S.Sridharan * “Life Style”, in simple terms, is a modern day usage to connote how one is spending time including the behavior and attitudes. This is related to the purpose of life as envisioned by an individual. Mostly the purpose of life is limited by the station of life, i.e. student, employment and earning, family life and retirement. Today, a student wants to get good grades and thus focuses on the marks/grades. Even, studying is oriented towards that goal and particularly to place one at the gateway of employment. The purpose of employment is directly linked to the earnings, which in turn is to increase the comforts of life. Today a family life is a social compulsion. At every stage there are limited goals and thus ‘life style’ is linked to the goals. A student today spends more time in the night to study and the cycle of the day is thus changed. There is hardly any time for physical activity leave alone good exercise pattern. An employed person’s clock is decided by his employer and often it could relate to a different time zone. A family person has hardly time left to introspect. The ancients put the station of life under the term ‘Ashrama’ and divided it as, Brahmacharya, Grahasta, VAnaprasta and Sanyasa. The ancient model of ‘Ashrama’ was based on the four purpose of life (purushArtAs) which are “dharma, artha, kAma and moksha”, which can translate to “discipline, wealth, desire and liberation”. The ultimate purpose of life for the ancients was “liberation”, liberation from the cycle of birth and death. Thus the ancient ‘life style’ took into account the ultimate purpose of ‘liberation’ without compromising on the pleasure of living within the discipline. There are various paths for ‘liberation’ and one can choose according to their background, taste and ability. One can choose the path of action or path of knowledge or path of devotion or path of total surrender. However, any of these paths need the basic discipline and this is provided by “Yoga”; the discipline at the body and mind level. Without this discipline no one can progress in any of these paths. They merely become attempts often leading to frustration. Yoga has a well laid out path of discipline structured to address all the dimensions of the human system, i.e. annamaya (body), prANamaya (breath), manomaya (mind), vigyanamaya (ego/intellect) and anandamaya (emotion). Yogic lifestyle thus disciplines the practitioner at all the levels and makes him/her fit for undertaking the spiritual path. Even if one does not have a spiritual inclination mere ‘yogic lifestyle’ will lead the person on the path of realisation, by providing a healthy body and mind. A healthy and perfect mind is the best tool for ‘Self realisation’. There are various models of ‘yogic lifestyle’ based on various traditions and the path of realisation. From the Vedas, Sages culled out the points required for ‘life style’ and gave them in the form of ‘Agamas’ and ‘kalpa sUtras’. There are various divisions in them based on the particular Veda, i.e. Rg, Yajur, Sama or Atharva or the particular deity such as Vishnu, Shiva, Shakti, etc. All of them have certain common regulations such as what should be done in what part of the day, etc. For all these regulations, there are certain common activities which will include Yogic tools of Asana, Pranayama and Dhyana. One such model is called “Panca kAla ParAyanam”, which literally means “the activities to be filled with in the five parts of the day”. This is a part of the “PAncha RAtra Agama”. Here a day is divided into 5 parts and the activities are assigned to each part.
* * Yogacharya S.Sridharan , Trustee, Krishnamacharya Yoga Mandiram; Member, Governing Body of Morarji Desai National Institute of Yoga, New Delhi Annals of SBV
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Part of the day (1) Early morning (2) Forenoon (3) Noon (4) Afternoon (5) Night
What is to be done
Name in the Agama
Getting up and getting prepared for Abhigamanam the day Collect things required for worship UpAdAnam or spending time for earning things
Worship
Ijya
Study of scriptures towards ‘Self SvAdhyaya Realisation’ Yoga (Here the word denotes sleep when the Individual Self merges Yoga with the Supreme Self)
This model, even though it is practiced by a limited number of people in some form or other, cannot have direct relevance for practicing in the same way. But this can be adapted. A yogic life style is not just practice of yoga in the morning or in some part of the day depending upon the convenience. It is to integrate the yoga quantitatively and qualitatively into every part of the day. For example, in the above said model, practice of Asana, Pranayama and Dhyana will be found in at least four parts of the day except in the second part which is the part of employment. Here also the principles of Yama will be observed. The Early morning part will have a large portion of Sun Meditation including doing postures, breathing and meditation. In the Noon, worship will include largely meditation. In the afternoon, there will be recitation of scriptures and in the night a small Pranayama to end the day. To adapt it to modern life style will be to take up practice of a full length course of Asana and Pranayama and Meditation first thing in the morning. This can include Surya Namaskar and important postures such as MahAmudra, etc. The Pranayama could be “Nadi Sodhana Pranayama”. On return one can do a Pranayama course aimed at ‘unwinding’ and ‘relaxation’. This will have a longer exhalation and hold and can be “Chandra bhedana Pranayama”. Before hitting the bed, one can do a small Meditation to end the day properly and prepare for the next day. This can include relaxation of parts of the body and visualizing a nice natural scene or form of Divinity of choice and hear soothing music. A yogic life style, adapted to an individual, is possible in today’s contest and will bestow the benefit of a good physical and mental health turning one inwards towards ‘Self Realisation’ by still being a part of family life.
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Yoga : The Original Mind Body Medicine Latha Satish * The Mind –Body connections, interactions and miracles in onset of disease, its progression, in healing and rehabilitation is a recent phenomenon in modern medicine. Experts in the fields of immunology, neuroscience, psychology, psychiatry and epidemiology have recognized that 70-80% of problems or sufferings that human encounter lies at the mind body interactions and the solution is also dictated by the same interplay of psycho physiological systems. Emergence of the terms like- holistic medicine, caring, healing rather than curing, patient doctor communication, faith, spirituality, alternative therapies and complementary medicine are testimony to the role of mind body medicine as the field that is defining the strategies of health promotion, maintenance and management These trends are of very recent origin dating back to the pioneer work in the field of stress, researches in yoga more specifically in meditation and also contribution of psycho-neuro-immunology. The origin and roots of the mind body link, its interactions and implication for medicine can be traced to the Indian cultural heritage ie Veda-s and particularly the philosophy and practice of yoga. Sage patanjali has profounder this knowledge in the form of “sutra-s� (Brief aphorisms), and is accepted as the most authoritative text. Yoga sutra presents the concept of mind, senses, consciousness and the interplay of these entities.-thus represents the psychology that originated in India. How Yoga of Patanjali facilitates the knowledge of mind and body and its implication for therapy? This is clearly delineated in the concept of Mind as a Matter, which is different from Consciousness and thus gives scope to regulate and control mind. Mind which is characterized by the three guna-s, can be agitated and consequences of this can be felt at body, breath, thought level. The suggestions of different mental afflictions and the body breath oriented methods to pacify the mind is solutions which covers the holistic perspective in providing therapy Somatic oriented practices, life styles, attitudes and its consequence on the mind and mind oriented practices and its impact on the body is extensively presented in yoga sutra and related scriptures. The great masters of the century have been models who demonstrated the practice of yoga as mind body medicine and kept these traditions alive. Today science is trying to explore this connection and is able to demonstrate its benefits.
* * Dr. Latha Satish MA, M.Phil, PhD in Psychology and Dip in Yoga (KYM).Former Research Scientist, Dept of Psychology, University of Madras. Consultant Psychologist and yoga teacher. Currently Managing Trustee, KYM, Chennai. Annals of SBV
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Psychosomatic Mechanisms Of Yoga Ananda Balayogi Bhavanani * Yoga is the original mind-body medicine that has enabled individuals to attain and maintain sukha sthanam, a dynamic sense of physical, mental and spiritual well being. Bhagavad-Gita defines Yoga as samatvam meaning thereby that Yoga is equanimity at all levels, a state wherein physical homeostasis and mental equanimity occur in a balanced and healthy harmony. Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj, the visionary founder of Ananda Ashram at the International Centre for Yoga Education and Research (ICYER) in Pondicherry and one of the foremost authorities on Yoga in the past century, has explained the concept of Yoga Chikitsa (Yoga as a therapy) in the following lucid manner. “Yoga Chikitsa is virtually as old as Yoga itself, indeed, the ‘return of mind that feels separated from the Universe in which it exists’ represents the first Yoga therapy. Yoga Chikitsa could be termed as “man’s first attempt at unitive understanding of mind-emotions-physical distress and is the oldest wholistic concept and therapy in the world.”
To achieve this Yogic integration at all levels of our being, it is essential that we take into consideration the all encompassing multi dimensional aspects of Yoga that include the following: a healthy life nourishing diet, a healthy and natural environment, a wholistic lifestyle, adequate bodywork through Asanas, Mudras and Kriyas, invigorating breath work through the use of Pranayama and the production of a healthy thought process through the higher practices of Jnana Yoga and Raja Yoga.
Psychosomatic Disorders:
The Nirvana Prakarana of the Laghu Yoga Vashishta, one of the ancient Yoga Texts describes in detail the origin and destruction of mental and bodily diseases. Sage Vashishta teaches Lord Rama that there are two major classifications of disease. Those that are caused by the mind are primary (adhija vyadhi, the psychosomatic, stress disorders) while those that afflict the body directly are secondary (anadhija vyadhi, infectious disease, accidents etc). The primary disease has two sub divisions. These are the samanya (ordinary physical diseases) and the Sara (the essential disorder of rebirth that may only be destroyed by atma jnana or knowledge of the Divine Self). Samanya diseases are the ones that affect us physically and may be destroyed by the correction of the mind-body disharmony. It is in these psychosomatic disorders that the actual practical application of Yoga practices as a mode of therapy can be very useful.
From the Yogic viewpoint of disease it can be seen that psychosomatic, stress related disorders appear to progress through four distinct phases. These can be understood as follows: 1. Psychic Phase: This phase is marked by mild but persistent psychological and behavioural symptoms of stress like irritability, disturbed sleep and other minor symptoms. This phase can be correlated with vijnanamaya and manomaya koshas. Yoga as a mind body therapy is very effective in this phase. 2. Psychosomatic Phase: If the stress continues there is an increase in symptoms, along with the appearance of generalized physiological symptoms such as occasional hypertension and tremors. This phase can be correlated with manomaya and pranamaya koshas. Yoga as a mind body therapy is very effective in this phase. 3. Somatic Phase: This phase is marked by disturbed function of organs, particularly the target, or involved organ. At this stage one begins to identify the diseased state. This phase can be correlated with pranamaya and annamaya koshas. Yoga as a therapy is less effective in this phase and may need to be used in conjunction with other methods of treatment.
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* Yogacharya Dr. Ananda Balayogi Bhavanani, MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD (Alt.Med)
Deputy Director, CYTER, MGMCRI, SBVU and Chairman ICYER at Ananda Ashram, Pondicherry. Email: yoga@mgmcri.ac.in and yognat@gmail.com Page 27
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4. Organic Phase: This phase is marked by full manifestation of the diseased state, with pathological changes such as an ulcerated stomach or chronic hypertension, becoming manifest in their totality with their resultant complications. This phase can be correlated with the annamaya kosha as the disease has become fixed in the physical body. Yoga as a therapy has a palliative and ‘quality of life improving’ effect in this phase. It also has positive emotional and psychological effects even in terminal and end of life situations.
Potentialities:
Extensive research on Yoga being done all over the world has shown promise with regard to various disorders and diseases that seem to be amiable to Yoga therapy (www.iayt.org, www.icyer.com, www.svyasa.org ). These include psychosomatic, stress disorders such as bronchial asthma, diabetes mellitus, hypertension, irritable bowel syndrome, gastro intestinal ulcer diseases, atherosclerosis, seizure disorder and headache. It also includes physical disorders such as heart disease, lung disease, and mental retardation. Psychiatric disorders such as anxiety disorders, obsessive-compulsive disorder, depression and substance abuse can also be managed along with other therapies. Musculoskeletal disorders such as lumbago, spondylosis, sciatica and carpel tunnel syndrome can be tackled effectively with Yoga practices that offer a lot of hope in metabolic disorders such as thyroid and other endocrine disorders, immune disorders, obesity and the modern metabolic syndrome.
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It is well established that stress weakens our immune system. Scientific research in recent times has showed that the physiological, psychological and biochemical effects of Yoga are of an anti-stress nature. Mechanisms postulated included the restoration of autonomic balance as well as an improvement in restorative, regenerative and rehabilitative capacities of the individual. A healthy inner sense of wellbeing produced by a life of Yoga percolates down through the different levels of our existence from the higher to the lower producing health and wellbeing of a holistic nature. Streeter et al (2012) recently proposed a theory to explain the benefits of Yoga practices in diverse, frequently comorbid medical conditions based on the concept that Yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored. They hypothesized that stress induces an: 1. Imbalance of the ANS with decreased parasympathetic and increased sympathetic activity, 2. Under activity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and 3. Increased allostatic load. They further hypothesized that Yoga-based practices 1. Correct underactivity of the parasympathetic nervous system and GABA systems in part through stimulation of the vagus nerves, the main peripheral pathway of the parasympathetic nervous system, and 2. Reduce allostatic load. According to the theory proposed by Streeter and colleagues, the decreased parasympathetic nervous system and GABAergic activity that underlies stress-related disorders can be corrected by Yoga practices resulting in amelioration of disease symptoms. HRV testing has a great role to play in our understanding intrinsic mechanisms behind such potential effects of Yoga. Innes et al had earlier (2005) also postulated two interconnected pathways (given below) by which Yoga reduces the risk of cardiovascular diseases through mechanisms of parasympathetic activation coupled with decreased reactivity of sympathoadrenal system and HPA axis.
Psychosomatic Mechanisms Of Yoga:
Yoga understands the influence of the mind on the body as well as that of the body on the mind. This is the principle of adhi-vyadhi elucidated in the Yoga Vasishta more than 5000 years ago! It is interesting that modern medicine has only realised this connection in the last hundred years whereas Yogic of India were teaching and practising it for thousands of years. No wonder Yoga may be considered as the original mind-body medicine.
We are what we think, yet we also start to think that which we do. Yogic concepts and techniques enable the development of right attitudes towards life and enable us to correct the numerous internal and external imbalances we suffer due to our wrong lifestyle/ genetic potential. Yoga enables us to take responsibility for our own health and happiness and as Swami Gitananda Giri would say, “If you want to be healthy do healthy things, if you want to be happy Page 29
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do happy things”. The following are just a few of the mechanisms through which Yoga can be said to work as an integrated mind-body medicine: 1. Cleanses the accumulated toxins through various shuddi kriyas and generates a sense of relaxed lightness through jathis and vyayama type activities. Free flow in all bodily passages prevents the many infections that may occur when pathogens stagnate therein. 2. Adoption of a Yogic lifestyle with proper nourishing diet, creates positive antioxidant enhancement thus neutralizing free radicals while enabling a rejuvenative storehouse of nutrients packed with life energy to work on anabolic, reparative and healing processes . 3. Steadies the entire body through different physical postures held in a steady and comfortable manner without strain. Physical balance and a sense of ease with oneself enhance mental / emotional balance and enable all physiological processes to occur in a healthy manner. 4. Improves control over autonomic respiratory mechanisms though breathing patterns that generate energy and enhance emotional stability. The mind and emotions are related to our breathing pattern and rate and hence the slowing down of the breathing process influences autonomic functioning, metabolic processes as well as emotional responses. 5. Integrates body movements with the breath thus creating psychosomatic harmony. In Yoga the physical body is related to annamaya kosha (our anatomical existence) and the mind to manomaya kosha (our psychological existence). As the pranayama kosha (our physiological existence sustained by the energy of the breath) lies in between them, the breath is the key to psychosomatic harmony. 6. Focuses the mind positively on activities being done, thus enhancing energy flow and resultant healthy circulation to the different body parts and internal organs. Where the mind goes, there the prana flows! 7. Creates a calm internal environment through contemplative practices that in turn enable normalization of homeostatic mechanisms. Yoga is all about balance or samatvam at all levels of being. Mental balance produces physical balance and vice versa too. 8. Relaxes the body-emotion-mind complex through physical and mental techniques that enhance our pain threshold and coping ability in responding to external and internal stressors. This enhances the quality of life as seen in so many terminal cases where other therapies are not able to offer any solace. 9. Enhances self confidence and internal healing capacities through the cultivation of right attitudes towards life and moral-ethical living through yama-niyama and various Yogic psychological principles. Faith, self confidence and inner strength are most essential if at all we wish for healing, repair, rejuvenation and re-invigoration. 10. Yoga works towards restoration of normalcy in all systems of the human body with special emphasis on the psycho-neuro-immuno-endocrine axis. In addition to its preventive and restorative capabilities, Yoga also aims at promoting positive health that will help us to tide over health challenges that occur during our lifetime. This concept of positive health is one of Yoga’s unique contributions to modern healthcare as Yoga has both a preventive as well as promotive role in the healthcare of our masses. It is also inexpensive and can be used in tandem with other systems of medicine in an integrated manner to benefit patients.
Need For Coordination:
The need of the modern age is to have an integrated approach towards therapy and to utilize Yoga therapy in coordination and collaboration with other systems of medicine such as Allopathy, Ayurveda, Siddha and Naturopathy. Physiotherapy and Chiropractic practices may be used with the Yoga if needed. Advice on diet and lifestyle is very important irrespective of the mode of therapy that is employed for a particular patient.
A Word Of Caution:
A word of caution is also required. Though Yoga and Yoga therapy are very useful in bringing about a state of total health it is not a miracle cure for all problems. It needs a lot of discrimination on the part of both the therapist as well as the patient. It may not be useful in emergency conditions and there is a strong need to consult a qualified medical doctor where in doubt. Each patient is different and so the therapy has to be molded to suit the individual needs rather than relying on a specific therapy plan for patients suffering the same medical condition. A very true problem is that there is a different approach of the different schools of Yoga to the same condition. It is better to follow any one system that one is conversant with, rather than trying to mix systems in a “Yogic Cocktail’. One must also be vigilant as there is a strong presence of numerous quacks pretending to be Yoga therapists and this leads to a bad name for Yoga therapy as well as Yoga in general. Annals of SBV
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Conclusion:
The dedicated practice of Yoga as a way of life is no doubt a panacea for problems related to psychosomatic, stress related physical, emotional and mental disorders and helps us regain our birthright of health and happiness. It is only when we are healthy and happy that we can fulfill our destiny. With the adoption of a proper attitude and lifestyle through the Yogic way of life, we can rise above our own circumstances and our life can blossom as a time of variety, creativity, and fulfillment. Yoga helps us regain the ease we had lost through dis-ease (as implied by sthira sukham asanam-PYS). It also produces mental equanimity (samatvam yoga uchyate-BG) where the opposites cease to affect (tato dwandwa anabhigatha-PYS). This enables us to move from a state of illness and disease to one of health and well being that ultimate allows us to move from the lower animal nature to the higher human nature and finally the highest Divine Nature that is our birthright.
References And Recommended Reading: 1.Ananda Balayogi Bhavanani. A Primer of Yoga Theory. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2008. www.rishiculture.org 2.Back issues of International Journal of Yoga Therapy. Journal of the International Association of Yoga Therapists, USA. www.iayt.org 3.Back issues of Yoga Life, Monthly Journal of ICYER at Ananda Ashram, Pondicherry. www.icyer.com 4.Back issues of Yoga Mimamsa. Journal of Kaivalyadhama, Lonavla, Maharashtra, USA. www.kdham.com 5. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract 2005;18: 491-519. 6. Srimad Bhagavad Gita by Swami Swarupananda. Advaita Ashrama, Kolkata. 2007 7.Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 2012; 78:571-9. 8.The Supreme Yoga: Yoga Vashista. Swami Venkatesananda. Motilal Banarsidass Publishers Pvt Ltd.Delhi. 2007 9.Ananda Balayogi Bhavanani. Yoga for health and healing. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2008. 10.Anantharaman TR. Ancient Yoga and Modern Science. Mushiram Manoharlal Publishers Pvt Ltd, New Delhi. 1996 11. Ananda Balayogi Bhavanani. Yoga Chikitsa-Application of Yoga as a Therapy Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2013. www.rishiculture.org 12. Yoga: Step-by-Step. A 52 lesson Correspondence Course by Yogamaharishi Dr. Swami Gitananda Giri. Ananda Ashram at ICYER, Pondicherry. www.icyer.com 13. The Forceful Yoga (being the translation of the Hathayoga Pradipika, Gheranda Samhita and Siva Samhita). Translated into English by Pancham Sinh, Rai Bahadur Srisa Chandra Vasu and Romanized and edited by Dr GP Bhatt. Mothilal Banarsidas Publishers Private Limited, Delhi. 2004. 14. Yoga the Science of Holistic Living. Vivekananda Kendra Patrika. Vol. 17- 2. 1988. 15. Taimni IK. The Science of Yoga. The Theosophical Publishing House, Chennai.1961 16. Meena Ramanathan. Thiruvalluvar on Yogic Concepts. Aarogya Yogalayam, Venkateswara Nagar, Saram, Pondicherry-13.2007 17. Swami Satyananda Saraswathi. Four Chapters on Freedom. Bihar School of Yoga, Munger, India. 1999 18. Nagarathna R and Nagendra HR. Integrated approach of Yoga therapy for positive health. Swami Vivekananda Yoga Prakashana, Bangalore, India. 2001. 19. Healthy mind, healthy body. Sri Ramakrishna Math, Chennai, India.1997. 20. Feuerstein Georg. The Shambala Guide to Yoga. Shambala Publications Inc, Boston, Massachusetts, and USA.1996.
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Yoga Practices for Prevention and Management of Lifestyle Disorders Ananda Balayogi Bhavanani * Stress is inevitable in the modern world because of the imbalance between the demands of one’s environment and one’s capabilities. In fact, it is the distress, which causes the problem and can be defined as every physical and mental tension that we experience as unpleasant. The environment today is more demanding. From childhood onwards, the development of capacities and capabilities of the individual is not able to keep pace with the increase of demands on them. This gap in most cases goes on widening. The huge crowds at Temples, churches and mosques in some way or the other are related to this imbalance. Everyone seems to be going there in order to beg or bribe the almighty to perform the balancing act. When we talk of stress we must also remember that some amount of stress is necessary in order to bring out the best in us. However it is vital to learn how to manage stress and keep it under our control. It is important to also remember the words of Epictetus in 60 A.D. who said, “Men are not disturbed by things, but the views, they take of them”. As Swamiji Gitananda Giri Guru Maharaj jocularly used to say’ “You don’t have problems—you are the problem!” A positive frame of mind will help us to be cheerful and unstressed. Maharishi Patanjali’s advise in this regard to cultivate Pratipaksha Bhavanam (The Opposite View) is vital to achieve balance of the emotions and mind. It is also worth trying to follow his advice of Maitri-Sukha (Friendliness towards the happy), Karuna-Dukha (Compassion towards the suffering), Mudhita-Punya (Cheerfulness towards the virtuous) and Upekshanam-Apunya (Indifference towards the wicked). The most common causes of stress are the Shat Ripus or the six enemies of the spirit. These are Kama (Uncontrolled passion), Krodha (Senseless Anger), Lobha (Greed), Moha (Blind infatuation), Mada (Massive Ego) and Matsarya (Malice / envy). Corruption of character, conduct, thought and interpersonal dealing is another cause of stress. An environment where sadistic pleasure gives satisfaction, where ethics have little or scant regard, where self-interest is more important and where under cutting and backbiting are a common feature, will surely lead to the development of extreme stress. It is important to realise these facts and be aware of them in our life. Unless we develop awareness and consciousness of what we think, feel and do, there cannot be a lasting solution to stress. We must strive to become persons of “Equal mindedness in all situations” that is described as Stitha Prajna or Samabhava in the Srimad Bhagavad Gita. Though stress probably cannot be avoided, it can, however, be managed. The following actions may help reduce/ eliminate the stress. 1. Awareness: It is important that we first become aware of the stress and then try to let it go. Sharing your tension with a friend and/or a family member may solve the problem to a great extent. You cannot wish away problems by nonacknowledgement of them. 2. Movement: Movement helps in reducing tension. This can mean walking, jumping, making noise, swimming and playing. Stress tends to accumulates in the joints and movement helps to dissipate it. Rotation of the neck and shoulders in many cases helps a lot. Some corporates have even established stress-relieving chambers where employees may shout, screams or hit a hanging pillow to relieve the pent up tension. 3. Yoga techniques: The regular practice of various Yoga techniques and inculcating the Yogic values in daily life will go a long way towards not only reducing the stress levels bit also in giving us that elusive “Peace of Mind”. Yogic relaxation practices such as Shavasana and Yoga Nidra help to create a sense of awareness and relaxation in the whole body as well as the mind. 4. Hobby: A hobby can help to relieve tension because it helps us to divert our mind from an unpleasant occurrence. Music, dance, painting, cooking and gardening are effective ways to take our mind to a different “Zone”. Playing with your pet can also help relieve tension and many people have ‘Thera-pets” or pets that help them therapeutically! 5. Breathing: Breathing is one of the easiest ways of relieving stress. Whenever you feel tension rising, take a few
*
* Yogacharya Dr. Ananda Balayogi Bhavanani, MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD (Alt.Med)
Deputy Director, CYTER, MGMCRI, SBVU and Chairman ICYER at Ananda Ashram, Pondicherry. Email: yoga@mgmcri.ac.in and yognat@gmail.com Annals of SBV
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deep breaths and you will immediately feel the difference. 6. Attitude: It is important to “Let things lie” for sometime when facing problems and many situations resolve on their own. Other situations may appear smaller and less stressful after some time. Development of a detached attitude can also help us to have a better perception of situations and this in turn helps us to face them better. 7. Visualization: Visualization of a pleasant solution to the problems can also help a lot. This is quite different from daydreaming. This is widely adopted by players and athletes for improving their performance. After a stressful encounter, coolly sit in your chair, close your eyes and visualize the episode as an act of an ignorant person and excuse him for the incident. 8. Auto-Suggestion: Another mental technique is Positive self-suggestion. The negative thoughts are to be replaced with positive ones and an attitude of ‘I can and I will ‘ is to be developed. 9. Self effort: Stress is related to the individual’s environment and their tolerance capacity. As both of these are different in different people, each individual has to settle for their own method for managing their day-to-day problems. It must be clearly understood that we are responsible for our health and happiness and have a duty to take care of these Divine gifts. Swami Gitananda Giri used to often say, “Health and happiness are your birthright”. It is through our own efforts and will power that we can ultimately solve the problem of stress and achieve our birthrights. Yoga is an integrated way of life in which awareness and consciousness play a great part in guiding our spiritual evolution through life in the social system itself by understanding that “Yoga is the science and art of right-use-ness of body, emotions and mind”.
Basic Warming Up Practices
Jattis are basic movements of the body parts that help to release pent up tensions in those parts. They increase circulation to the part and also the flow of Pranic energy is increased due to the movements. A few of these practices will be described now. Take up a comfortable standing position such as the Samasthiti Asana. Stand on one leg and shake the other leg. Repeat on the other side and then alternate a few times between right and left. Stand on both legs and start to shake your hands one at a time. Alternate between the right and left a few times and then start to shake both hands at the same time. Shake your hands and move them up, down, to the left and to the right. Shake your hands all around you in a circular movement. This helps to energize the Pranamaya Kosha, our energy sheath or subtle body. Come back to the standing position. Open the legs two feet apart and keep the hands on the hip. Move the torso in all four directions clock-wise and anti clock-wise in a grinding action. Then do it in a continuous manner. Bend forward and perform some toe touching with a bouncing action. Bounce to the front, and then move to your left. Move to your right and then come back to the front. Come back to the standing position. Spread your feet a bit and lift both your arms to the side. Start to twist your torso from side to side a few times. Feel the stretch in your hip region and back. Come back to the standing position and relax with deep breathing for some time. Sit down with both legs stretched out in front of you. Draw your right knee up to your chest and then kick out with a whooshing sound. Perform the same action on the left side. Continue to alternate legs for some time. Draw up both your knees and do the same action with a whooshing sound as you release the feet. Relax with your feet stretched out in front.
Surya Namaskar
Rishikesh Surya Namaskar, the Yogic sun salutation is a series of twelve physical postures. These alternating backward and forward bending postures flex and stretch the spinal column through their maximum range giving a profound stretch to the whole body. The basic breathing principle is to inhale during upward and backward bending postures and exhale during forward bending postures. Stand erect with your feet close together. Perform Namaskar Mudra by joining your palms together in front of your chest. Breathe in and stretch your arms over your head into the Anjali Mudra and then arch your back. Feel the healthy stretch in your whole body. Breathe out and bend forward while keeping your arms and back in one line and as straight as possible. Perform the Pada Hasta Asana by bringing your head to your knees while keeping your hands on either side of your feet. Breathe in and extend your right leg back until it is straight as possible and you are balanced on your toes and hands. Your left leg should be bent with the sole flat on the ground. Lift your head and bend back and open up your chest. This Page 33
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is the Ashwa Sanchalana Asana, the equestrian posture. While breathing out bring your left leg back towards the right and keep the feet just a foot apart with your heels flat to the ground. Simultaneously raise your buttocks and lower your head between your arms, so that your body forms a triangle with the ground. This is the Mehru Asana or mountain posture. While maintaining the posture, take a deep inhalation. While breathing out drop both knees to the ground and slowly slide the body down at an angle and bring your chest and chin to the ground. Eight parts of your body namely your toes, knees, chest, hands and chin should touch the ground while the buttocks are kept up. You’re your breath while performing this Ashtanga Bhumi Sparsha, the eight limbed prostration. Breathe out and come into Bhujanga Asana, the Cobra posture. Focus your awareness at the base of your spine and feel a healthy stretch in your back and neck. Exhale and come back to the Mehru Asana, the mountain posture. This strengthens the arms and legs as well as the spinal column. Inhale and bring your right leg forward in-between your hands while keeping your left leg in its original
position to perform the Ashwa Sanchalana Asana. Breathe out and bring your left foot forward to come into the Pada Hasta Asana. Breathe in and come up and perform the Anjali Mudra and bend backward. Breathe out and come back to the standing while bringing your hands back to the chest in Namaskar Mudra. To perform the Rishikesh Surya Namaskar on the opposite side perform the practice again with a slight modification. To complete the other half the same movements are repeated except that the left leg is brought back while performing the Ashwa Sanchalana the first time. The other postures such as Mehru Asana, Ashtanga Bhumi Sparsha and Bhujanga Asana are done in the same manner. When coming back to the Ashwa Sanchalana the left foot is brought forward and then the Pada Hasta is performed by joining right foot to the left before completing the practice with the Anjali Mudra and finally relaxing in the Sama Sthithi with deep breathing. One full round consists of the 12 poses done twice in sequence. Practice 3 to 9 rounds of the Surya Namaskar daily for maximum benefit. When the exercises are done little quickly the gain is more physical and when they are done slowly with breath awareness the gain is more mental and spiritual.
Yoga Asanas TALA KRIYA
The term, “Tala” refers to a Palmyra tree and you should try to stretch yourself as tall as that tree while performing this practice. Take up a comfortable and stable Samasthiti Asana. Breathe in and lift both arms up over your head until they are parallel to each other. Let the palms of both hands face inward and then go up onto your toes and stretch up as high as possible. Hold the breath and feel the healthy stretch along your whole body from toes to finger tips. Breathe out and relax your arms back to your sides while coming back to the flat foot posture. Repeat the practice two more times at each session for maximum benefit. With practice the posture can be held for a longer time and normal breathing done while holding the posture for 30 to 45 seconds.
HASTHA KONA KRIYA
Stand in a steady Samastiti Asana with your arms by your side. Breathe in and lift your right arm over your head. Try to extend the arm over your head towards the left as far as possible without bending it. This gives a good stretch to Annals of SBV
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the entire right side of the body. Slowly start to breathe out and lower your arm slowly back to the side. Repeat the practice a few more times. Make sure that you lift your arm on the in breath and lower it on the out breath. Perform the practice on the opposite side by lifting your left arm over your head while breathing in. Extend it as far towards the right as possible without bending it. Feel the excellent stretch on the entire left side of your body. Lower your arm back to your side while breathing out. Repeat the practice a few more times. The Hastha Kona Kriya helps to stretch and tone up the musculature of the arms, shoulders and the Para-spinal area in a way not done in day-to-day life. This helps trigger the relaxation response in these tissues that are normally tensed due to disuse, misuse and abuse. A sense of profound relaxation is obtained after the practice of this activity that is also known as the Ardha Kati Chakrasana.
TRIKONA ASANA
Stand in Samasthiti Asana. Place your feet two to three feet apart facing forwards. Stretch your arms to the sides so that they are pulling the chest in opposite directions. Turn your head and right foot to the right side and slowly bring your right hand down to the right foot and place the palm of the right hand on the ground in front of the right foot. Look up at the middle finger of the left hand. Let the entire torso get a good twist and stretch. Hold the position for 30 seconds while performing deep breathing. Release and come back up to the open arm position and then do the opposite side by placing your left hand down in front of the left foot. Hold the position for 30 seconds while performing deep breathing. When ready come back up to the Samasthiti Asana and relax with a few rounds of deep breathing.
VAKRA ASANA
Sit erect with your legs stretched out in the Uttana Asana. Bend your right knee and place the right foot by the side of the left knee. Turn to your right and place your right hand on the ground behind you to support your erect position. Bring your left arm round the outer side of the right knee and catch hold of the right big toe. Turn your head and look back over your right shoulder. The erect knee acts as a fulcrum for getting maximum twist of the spine. Keep your torso as straight as possible. Hold the posture for 30 seconds with soft breathing. Release the posture and come back to the Uttana Asana. This posture gives an excellent massage to the abdominal organs and is very useful for those suffering from diabetes as well as digestive disorders. It is also useful for neck and back problems. Repeat the practice on the opposite side in a similar manner. Hold the posture for 30 seconds with soft breathing. Release the posture and come back to the Uttana Asana and relax with deep breathing for some time.
ARDHA MATSYENDRA ASANA
Sit erect with both legs stretched out in front and your palms gently pressing on the ground by your sides in Uttana Asana. Fold your right knee and place the heel tight in against the perineum. Place your left foot by the side of your right thigh by crossing it over the knee. Bring your right hand round the outer side of the left knee passing between the chest and the knee and catch hold of the left big toe. Your right shoulder blade rests on the outer side of your left knee. Take your left hand round your back and try to get a grip on your right thigh. Look back over your left shoulder. The erect knee acts as a fulcrum for getting maximum twist of the spine. Keep your trunk vertical. Hold the posture for 30 seconds with soft breathing. This posture gives an excellent massage to all the abdominal organs and is very useful for those suffering from diabetes as well as digestive disorders. Release and come back to the Uttana Asana. Repeat on the opposite side by folding your left knee with the heel tight in against the perineum. Place your right foot by the side of your left thigh by crossing it over the knee. Bring your left hand round the outer side of the right knee passing between the chest and the Page 35
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knee and catch hold of the right big toe. Your left shoulder blade rests on the outer side of your right knee. Take your right hand round your back and try to get a grip on your left thigh. Look back over your right shoulder. The erect knee acts as a fulcrum for getting maximum twist of the spine. Keep your trunk vertical. Hold the posture for 30 seconds with soft breathing. When you are ready slowly release the posture and come back to the Uttana Asana.
CHATUS PADA ASANA AND VYAGRAHA PRANAYAMA Take up the Chatus Pada Asana with your weight evenly distributed between your hands and knees. Start breathing in and out for an equal count of six. While breathing in slowly lift your head and arch your back downwards. Then breathe out slowly and lower your head while arching your back upwards. Breathe in while lifting your head and arch your back down. Breathe out while lowering your head and arching your back up. Repeat this excellent practice at least nine times at each session. Vyagraha Pranayama helps us to utilize all sections of our lungs in a balanced and controlled manner thus energizing the whole body with healing Pranic energy. When ready slowly relax back to the Vajrasana for a period of quiet contemplation.
BHUJANGINI MUDRA
To perform the Cobra gesture, take up the Unmukha Asana which is a prone position with your entire body in a straight line. In this technique the emphasis is on the breathing pattern and the production of a mighty hissing sound through the clenched teeth. Slowly bring your arms forward and keep your palms on the ground alongside your shoulders. Take in a deep breath. While making a mighty hissing sound, flare back into the Bhujanga Asana. Slowly relax back onto the floor while breathing in and then again flare back with a mighty hiss. Repeat this Mudra at least three to six times at each session. This technique helps release the pent up stress that accumulates in our system from our daily life and provides great emotional and mental relief. It is an excellent stress-buster and is a must for all in this day and age. After completing the practice come back down to the face prone pose. Place your arms alongside your body and turn your head to the side. Relax for a few minutes and let the benefit of this Mudra seep into each and every cell of your body.
PAWAN MUKTA ASANA
Lie down in a comfortable Shavasana and start to breathe in and out for an equal count of six or eight. To perform the single legged Eka Pada Pawan Mukta Asana bend and lift your right knee while breathing in and simultaneously also lift your head off the ground. Catch hold of your knee with your arms and try to touch your knee to your forehead. Hold the position a few seconds and then while breathing out slowly release the position and lower your head while at the same time bringing your foot back to the ground. Repeat this at least two more times to complete a set of three rounds of the practice. Relax a few seconds in the Shavasana and then perform the practice on the left side. Relax in Shavasana for a few minutes with deep and rhythmic breathing while concentrating on your abdominal area that will help to relax you further. To perform the double legged Dwi Pada Pawan Mukta Asana bend and lift both your knees while breathing in. Bring them as close to your forehead as possible while simultaneously raising your head to meet the knees. Hold a few seconds and then while breathing out, lower your Annals of SBV
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head and simultaneously bring your feet back to the ground. Repeat this two more times to complete a set of three rounds at each session. Relax in Shavasana for a few minutes with deep and rhythmic breathing while concentrating on your abdominal area. This will help you to relax even further as the emotional tensions tend to tighten up the abdominal area leading to a feeling of “butterflies in the stomach�.
EKA PADA UTTANPADA ASANA
From Shava Asana lift your right leg up towards the sky on the in breath. Try not to bend the knee if possible. On the out breath lower the leg back to the ground. Use a breath cycle of in and out for a count of six or eight. Repeat this two more times. Perform the same practice on the left side. Lift your left leg up towards the sky on the in breath. Try not to bend the knee if possible. On the out breath lower the leg back to the ground. Use a breath cycle of in and out for a count of six or eight. Repeat this two more times. After performing the practice at least three times on each side relax in Shava Asana with deep breathing.
DWI PADA UTTANPADA ASANA
From Shava Asana lift both legs up towards the sky on the in breath. Try not to bend the knees if possible. On the out breath lower the legs back to the ground. Use a breath cycle of in and out for a count of six or eight. Repeat this two more times and then relax in Shava Asana with deep breathing. Those who have back problems should not do straight leg lifting and should do it with bent knees instead to avoid increasing the strain on the back.
SARVANGA ASANA
Lie down in Shava Asana. Breathe in and lift both legs at a time until you are in the Dwi Pada Uttanpada Asana. Continue the upward motion and lift your back off the ground using both arms to support the lower back. Keep your trunk and legs in a straight line by supporting the entire trunk on the shoulders. Breathe in a shallow manner while concentrating on the healthy pressure at the throat region. Release the posture after 10 to 15 seconds and while breathing out slowly come back to the Shava Asana. Roll your head from side to side to ease away any pressure that may have accumulated in the neck. After a short relaxation, repeat the practice two more times.
VIPARITA KARANI
Viparita Karani is the shoulder stand-like Mudra where the weight of the body is supported by the elbows while the hands are placed against the pelvic girdle. From the supine Shavasana slowly lift both your legs up as if performing the Sarvangasana. However the weight of your body should be balanced on your elbows and arms and not on your shoulders. Hold the posture in a comfortable manner and then start to perform the incomplete and complete actions of this Mudra. Perform the incomplete action by taking a deep inhalation and bringing your straightened legs towards your head so that your body makes an acute angle. Then perform the completed action by pushing your legs away while exhaling the breath. Make sure that your feet are extended in a rigid position making an obtuse angle. Breathe in bringing your feet towards your head 1-2-3-4-5-6. Breathe out pushing your feet away 1, 2, 3,4,5,6. Continue the practice for a minimum of three to nine rounds of this alternation between the incomplete and complete postures with the breath cycle at every session. This Mudra promotes a healthy metabolic function by stimulating the pancreas and the uptake of insulin by cells of the body. It is highly recommended for the prevention, control and possible cure of conditions such as Diabetes Mellitus
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and imbalances of the thyroid gland. When ready slowly bring your legs down to the ground in a phased manner and enjoy a quiet period of relaxation in the Shavasana.
SHAVASANA WITH SAVITRI PRANAYAMA
Lie supine on the ground with your head preferably to the north enabling your body to be in alignment with the earth’s electromagnetic field. Make sure that your head and body are in a straight line while hands are kept relaxed by side with palms facing upwards. Bring your feet together and let forefeet fall away into a ‘v’ shape with heels as close together as possible. Start to consciously watch your breath by letting your awareness settle in the abdominal area. Feel the abdominal movements as your abdomen rises as you breathe in and falls as you breathe out. After a few rounds of this practice, slowly let your awareness settle at the tip of your nose. Feel the cool inspired air flowing into your nostrils as you breathe in and become aware of the warm expired air flowing out of the nostrils when you breathe out. Consciously regulate your breath so that the duration of the incoming and outgoing breathes are equal. The inspiration and expiration can be for a count of 4 or 6 initially and then with practice elongated to a count of 8 or 10. Perform at least nine rounds of this conscious deep breathing and enjoy the relaxed sensation that spreads throughout your body. Relaxation in Shavasana can be further deepened by utilizing Savitri Pranayama to relax and rejuvenate your body, emotions and mind. Breathe in through your nose for a count of 6. Hold in the breath for a count of 3. Breathe out through your nose for a count of 6. Finally hold the breath out for a count of 3. Make sure that you are breathing in and out through both nostrils and that you are using the complete Yogic breathing. Perform at least 9 rounds of this combination practice that heightens the relaxation to a very deep level. After performing 10 to 15 minutes of the Shavasana slowly start to move your fingers and toes. Perform conscious stretching and make a smooth transition from the relaxed to the active state. Lift your left arm over your head and turn over onto your left side. Continue the turning action until you come into the face-prone posture. Perform Makara Asana by placing your right hand on the left while the left is placed palm down on the ground in front of you. Keep your forehead or chin on your right hand while keeping your legs a foot apart. Bring your hands forward near your shoulders and push yourself back into the Bhujanga Asana. Continue the back bending movement and go into the four footed Chatus Pada Asana. Relax into the Shashanga Asana with your arms stretched out in front and then finally come back to the Vajrasana. With your palms on your thighs sit quietly for some time and enjoy the effects of the deep relaxation that has spread to every part of your body.
SPANDA – NISHPANDA KRIYA
This practice is done from Shavasana using the yogic concept of Shpanda Nishpanda, which means the coupling of tension and relaxation. We consciously tense different parts of our body as much as possible and then relax them to the maximum in a step-by-step manner. This produces a better relaxation response than the mere attempt to relax without putting in the initial effort of tension. Lie down in a comfortable supine Shavasana with your entire body in a singe straight line. After a few seconds of relaxation in this position, start to tense your entire body part-by-part from your toes up to the top of your head until every part of your body is as tense as possible. Hold this 100% tension state of Spandha for a few seconds. Let all the muscles of your entire body be as tense as possible. At the peak of the tension, just ‘let go’ and immediately relax your entire body 100%. This is the state of Nishpanda. Enjoy this relaxed state and with conscious awareness continue to watch your breath as it comes in and goes out of your nose. Repeat this practice again by tensing up your entire musculoskeletal system to the state of Spandha and hold it for a few seconds. When ready let go completely and enjoy the Nishpanda state for a few minutes. To complete the practice repeat the Spandha – Nishpanda Kriya a third time by tensing up your entire musculoskeletal system from your toes to the top of your head. Hold the complete tension for a few seconds. When ready let go completely and enjoy the complete relaxation that ensures. Be aware of how all your muscles relax in this practice because the relaxation is deepened when it is contrasted with tension. This practice is a boon for those suffering psychosomatic, stress induced and stress aggravated life disorders such as hypertension, diabetes, asthma, insomnia, peptic ulcers and bowel disorders.
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MARMANASTHANAM KRIYA
The twenty-two sensitive parts of the body are known by the collective Sanskrit term Marmanasthanam. To concentrate upon these parts in a particular order or to command these areas to relax in a particular way while concentrating, gives a very satisfactory, deep relaxation that has been found by tested experiments to give relief even to compulsive dreaming. This is an excellent Kriya to do at the end of a strenuous session of Asanas and Pranayamas. The relaxation should be preceded by at least nine rounds of Savitri Pranayama, the Rhythmic Breath, to create the proper atmosphere. This technique (Kriya) can be done in two ways, one for relaxation the other for deep concentration. For relaxation the technique is done from “feet to the head.” For deep concentration from “head to feet.” While concentrating upon twenty-two body parts, each part is commanded (by mind) “to relax” or a thought of peace or serenity” directed to the areas. For relaxation, concentrate upon the (1) toes and command the toes to relax (2) feet (3) lower legs to knees (4) upper legs to hips (5) buttocks (6) base of spine (7) pelvic area (8) abdomen (9) chest and (10) shoulders. Now take your concentration down to the (11) fingers, and command the fingers to relax then (12) hands (13) lower arms to elbows (14) upper arms to shoulders where your concentration joins with body concentration (15) throat (neck) (16) around the mouth and chin (17) around the nose and cheeks (18) eyes (19) back around the ears (20) back of the head (21) top of the head (22) Cavernous Plexus in the middle of the forehead. All the while you should command “relaxation.” Perform Jyoti Dharana and Jyoti Dhyana (concentration and meditation on the Divine light) at the Bhrumadhya Bindu (Midpoint between the eyebrows). Visualize the Divine Jyoti to be having the brilliance equal to 1000 suns but without the glare. Absorb yourself into this Divine Jyoti.
PRANAYAMA PRACTICES
PRANAVA PRANAYAMA ‘Tasya vachakah pranavaha’, the sacred sound of the Divine is the Pranava says Maharishi Patanjali. This develops abdominal, thoracic and clavicular regions of the lungs to their maximum capacity. This Pranayama has unlimited healing potential and brings about harmony of body, emotions and mind. It is an important part of Rishiculture Ashtanga Yoga tradition as taught by Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj. Adham Pranayama, the abdominal or lower chest breathing. Put the fingers into the Chin Mudra with the index and thumb fingers touching each other at the tips. Keep the other three fingers straight and united. Take a deep breath into the lower chest and abdominal regions and then let it out with the sound aaa……. To perform thoracic or mid-chest breathing, the Madhyam Pranayama, curl your fingers inward to form Chinmaya Mudra. Take a deep breath into the mid chest and thoracic regions and then breathe out with the sound ooo……. Adyam Pranayama is the clavicular or upper chest breathing and utilises Adhi Mudra. Clench your fists with your thumb in the centre. Keep the Adhi Mudra on your thighs and breathe deeply into the upper chest and clavicular regions and then exhale with the sound mmm……. Joining the earlier three parts of the breath in a complete Yogic breath is the fourth stage, known was Mahat Yoga Pranayama. Put the Adhi Mudra with knuckles of your right and left hands touching in front of the navel. This is now known as the Brahma Mudra. Take a deep breath into the low, mid and upper chest regions. Now let the breath out with the sounds of aaa…ooo…mmm…. Relax and enjoy the feeling of potent healing energy flow through the entire body. NASARGA MUKHA BHASTRIKA Nasarga Mukha Bhastrika is a forceful expulsion of the breath through the mouth that can accompany different movements to relieve our pent up stress. Take up a comfortable standing position and then start to shake your hands as vigorously as possible to help loosen up the accumulated tensions of your daily life. Visualize all the tensions that have accumulated in your wrist and elbow joints getting a good ‘shake up’ by this action. When you have got the tensions loosened up, take in a deep breath through your nose and clench your fist as if catching hold of all your tensions and stress. Now with a powerful blast through your Page 39
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mouth “whoosh” away all your accumulated tensions and stress as forcibly as possible. Again shake your hands as fast as possible. Breathe in and catch hold of the tension in your fist. Throw it all away with a blast. Make sure that you are using your diaphragm muscle vigorously while blasting out the breath in this practice. Perform this practice 3, 6 or 9 times as necessary. After performing 3 to 9 rounds of this practice, relax in the standing position and enjoy the feeling of relief that sweeps through your arms as you relax with some deep breathing. CHANDRA PRANAYAMA Sit in Vajrasana and perform Nasarga Mudra with your right hand. Close your right nostril with your thumb. Inhale slowly through your left nostril for a count of four. Now exhale through the same left nostril for a count of eight. Keep your right nostril closed throughout the duration of the practice. Repeat the Chandra Pranayama for a minimum of nine rounds at each session. Patients of lifestyle disorders such as anxiety, hypertension, insomnia, diabetes and other stressful conditions can benefit by practising this Pranayama 27 times before breakfast, lunch, dinner and before going to bed at night. BHRAMARI PRANAYAMA Sit on the heels in the Vajrasana with the spine erect. Perform the Shanmuki Mudra with the thumbs of the hands closing the external auditory canal. The first two fingers are then placed over the closed eyelids while the ring fingers regulate the flow of air through the nostrils. The little fingers are placed over the closed lips. This Mudra helps in joining together the nerves of the hands with the facial and trigeminal nerves on the face. Take a slow and deep breath in for six counts. Let out the breath very slowly while making a sound in the nasal passages like the high-pitched sound of a female bee. This buzzing sound is very much like the Anuswarah sound of “mmm” of the Pranava AUM. Repeat this at least nine times. Bhramari is one of the Swara Pranayamas and stimulates the secretions and tones up nerve centres. This helps relive Pitta conditions and rejuvenates the skin. It also creates a beautiful voice. It is a contemplative prelude to Nada Yoga.
CONTEMPLATIVE PRACTICES
PRANA DHARANA -BREATH AWARENESS: Sit in Vajrasana or lie down in Shava Asana. Begin to be aware of your breathing and how the air passes down from the nostrils into the lungs and then back out the nostrils. Feel the abdominal movements as the abdomen rises with the in breath and falls with the out breath. Let your awareness settle in the abdomen. Feel the cool inspired air flowing into the nostrils and the warm expired air flowing out of the nostrils. Let your awareness settle at the tip of the nose. Consciously regulate the breath so that the ratio of insp: exp is equal. It can be a 4,6,8 or 10 count. Perform nine rounds of this practice. MINDFULNESS BASED MEDITATION: One of the most productive of the many forms of “quiet sitting”, popularly grouped under the heading of meditation is the mindfulness based awareness of one’s thoughts. This is to be done without identifying with the thoughts and without either justifying or condemning them. Take up a straight back sitting position and sit facing to the North or East in the early morning. Keep your mind as placid as possible, as this is the important feature of the early morning meditation. Breathe slowly and rhythmically, but very quietly. Do not upset the peace. Hold your mind concentrated inside your head at a point in line with the eyebrows. Relax. Don’t attempt to force visualization, simply be alert and expectant. Presently, you will have the sensation of movement within the head, as though watching a “ticker tape” of your thoughts. The thoughts will be in extreme slow motion. Observe the thoughts. Don’t get emotionally involved with them, just watch them. You will actually be able to see your thoughts, as well as hear them. Usually, the thoughts are quite mundane, but benign. Simply observe them, passively and dispassionately. OM JAPA: Take up any meditative posture and start to perform the Savitri Pranayama in a 6 by 3 or 8 by 4 rhythm. Make an audible Pranava OM in the Bindu Nadi. With Japa-Ajapa, make silent intonation of the Pranava OM concentrating at this same point. Do not let the mind waver away from either a conscious repetition of the Mantra OM, as Japa, or as the silent Ajapa. AJAPA JAPA: Take up any meditative posture and start to perform the Savitri Pranayama in a 6 by 3 or 8 by 4 rhythm. As you breathe in listen to the sound of SAH made as the breath enters your respiratory passages. As you breathe out listen to the sound of HUM that is made as the breath leaves your respiratory passages. Concentrate on this Ajapa Japa of HAMSA SOHAM in tune with the breath. Annals of SBV
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Activites at cyter Modern medical advancements provide the rationale for the integration of various traditional healing techniques including Yoga to promote healing, health, and longevity. It is imperative that advances in medicine include the wholistic approach of Yoga to face the current challenges in health care. The Centre for Yoga Therapy, Education and Research (CYTER) in MGMC & RI is conducting a scientifically sound Yoga therapy programme through its Yoga Therapy OPD. This is functioning from 9.30 am to 12 noon daily (Monday-Friday). Consultations are offered by Dr. Ananda Balayogi Bhavanani, Deputy Director (Yoga) and Mrs Meena Ramanathan, Coordinator and Yoga Therapist and qualified Yoga instructors are imparting the schedules. Individualised and group Yoga therapy sessions are being conducted for various medical conditions such as diabetes, hypertension, musculoskeletal and psychiatric disorders with excellent feedback from participants. Numerous pilot studies have been completed and major research studies are being planned under guidance of Dr. Madanmohan, Professor and Head, Department of Physiology, MGMC & RI.
YOGA THERAPY More than 3000 patients have benefited from Yoga Therapy consultations and sessions since 2010. Of these around 20% were hypertensive, 10% with musculo -skeletal disorders, 20% with psychiatric disorders, 15% with skin disorders, 10% with breathing disorders and the other had other disorders. The patients who attend the Yoga Therapy unit belong to many walks of life; from poor farmers to highly placed executive, uneducated laborers earning daily wages to the most qualified people, alcohol-dependent addicts, and trans-gender people etc. Those who have attended sessions regularly attained benefits physically and psychologically, enabling them to attain, maintain or regain their health and wellbeing. These satisfied participants also motivate their friends and relatives to start yoga to enjoy all the benefits, which they are enjoying now.
Year
Male
Female
Transgender
Total
2010 2011 2012 2013
31 440 210 331
28 750 542 696
27 10 2
59 1217 763 1029
Grand total 3068
YOGA EDUCATION Yoga training has been imparted to nursing students of Kasturba Gandhi Nursing College over the past few years and efforts are being made to include a Yoga component in the MBBS curriculum. We have also proposed a PG Diploma in Yoga Therapy for Medical professionals. Regular Yoga awareness programmes are being held in the MRD of MGMCRI and till now 100 participants have benefited from these Yoga consultations and counseling sessions. Regular talks are being conducted as part of Arthritis, Obesity, back pain, diabetes awareness programmes organized by various departments. Capsule talks and lecture demonstrations have been given during SAF meetings to create awareness of Yoga and its potential, amongst the faculty and PG students of SBVU. The CYTER team has also participated in outreach programmes in educational institutions and other social organizations to create awareness of Yoga and the functioning of CYTER at MGMCRI.
YOGA RESEARCH
As we are getting a regular in-flow of patients and normal volunteers, we have been doing some studies on the effects of Yoga. The following are some of the studies done at CYTER in the past few years.
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1.Immediate effects of suryanamaskar on reaction time and heart rate in female volunteers.
Abstract : Suryanamaskar (SN), a yogic technique is composed of dynamic muscular movements synchronised with deep rhythmic breathing. As it may have influence on CNS, this study planned to investigate immediate effects of SN on reaction time (RT) and heart rate (HR). 21 female volunteers attending yoga classes were recruited for study group and 19 female volunteers not participating in yoga were recruited as external-controls. HR, auditory reaction time (ART) and visual reaction time (VRT) were recorded before and after three rounds of SN in study group as well as 5 minutes of quiet sitting in both groups. Performance of SN produced immediate decrease in both VRT and ART (P<0.001). This was significant when compared to self-control period (P<0.001) and compared to external control group, it decreased significantly in ART (p=0.02). This was pronounced when Δ% was compared between groups (P<0.001). HR increased significantly following SN compared with both self- control (p=0.025) and external-control group (p=0.032). Faster reactivity may be due to intermediate level of arousal by conscious synchronisation of dynamic movements with breathing. Rise in HR is attributed to sympathetic arousal and muscular exertion. We suggest that SN may be used as an effective training means to improve neuro-muscular abilities. Status: This research was published in Indian J Physiol Pharmacol 2013; 57(2) : 199–204.
2.Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers.
Abstract : This study planned to compare immediate cardiovascular effects of different Yoga Asanas in healthy young volunteers. Heart rate (HR), systolic pressure (SP), and diastolic pressure (DP), blood pressure (BP), were recorded using the non invasive blood pressure (NIBP) apparatus in 22 healthy young subjects, before and after the performance of Dhanurasana (DA), Vakrasana (VA) (both sides), Janusirasasana (JSA) (both sides), Matsyasana and Shavasana for 30 s. HR and BP were further recorded during supine recovery at 2, 4, 6, 8, and 10 min. A repeated measure of ANOVA was used for statistical analysis. There were significant changes in HR and BP both immediately after the Asanas as well as during the recovery period. Overall comparisons of ∆% changes immediately after the performance of the Asanas revealed significant differences with regard to HR that increased significantly after DA. In the recovery phase, there were significant intergroup differences from 2 min onward in both SP and DP. The decrease of SP after VA (right side) (VA-R) was significantly greater than Shavasana (4th, 6th, and 8th min) and JSA (left side) (JSA-L) at 6th and 8th min. DP decreased significantly after performing JSA-L compared to VA-R at the 6th and 8th min. The cardiovascular changes immediately after the Asanas and during the recovery phase reveal inherent differences between the selected postures. The rise of HR in DA may be attributed to increased sympathetic response due to the relative difficulty of the posture as well as abdominal compression occurring in it. The effect of supine relaxation is more pronounced after the performance of the Asanas as compared to mere relaxation in Shavasana. This may be attributed to a normalization and resultant homeostatic effect occurring due to a greater, healthier de-activation of the autonomic nervous system occurring towing to the presence of prior activation. There were also subtle differences between the right sided and left sided performance of VA and JSA that may be occurring due to the different internal structures being either compressed or relaxed on either side. Our study provides initial evidence of differential cardiovascular effects of Asanas and subtle differences between right and left sided performance. Further, cardiovascular recovery is greater after the performance of the Asanas as compared to shavasan; thus, implying a better response when effort precedes relaxation. Status: This research has been accepted for publication in International Journal of Yoga.
3.Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time.
Abstract : Recent studies have reported the differential physiological and psychological effects of yogic uninostril breathing (UNB) and alternate nostril breathing (ANB) techniques. This study aims to determine differential effects of these techniques on reaction time (RT), heart rate (HR), and blood pressure (BP). Twenty yoga-trained subjects came to the lab on six different days and RT, HR, and BP were recorded randomly before and after nine rounds of right UNB (surya nadi [SN]), left UNB (chandra nadi [CN]), right initiated ANB (surya bhedana [SB]), left initiated ANB (chandra bhedana [CB]), nadi shuddhi (NS), and normal breathing (NB). Overall comparison of ∆ % changes showed statistically significant differences between groups for all parameters. There was an overall reduction in HR- and BPbased parameters following CB, CN, and NS with concurrent increases following SB and SN. The differential effects of right nostril initiated (SB and SN) and left nostril initiated (CB, CN, and NS) UNB and ANB techniques were clearly evidenced. Changes following NB were insignificant in all respects. The overall comparison of ∆ % changes for RT showed statistically significant differences between groups that were significantly lowered following both SB and Annals of SBV
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SN. Our study provides evidence of sympathomimetic effects of right nostril initiated pranayamas with sympatholytic/ parasympathomimetic effect following left nostril initiated pranayamas. We suggest that the main effect of UNB and ANB techniques is determined by the nostril used for inspiration rather than that used for expiration. We conclude that right and left yogic UNB and ANB techniques have differential physiological effects that are in tune with the traditional swara yoga concept that air flow through right nostril (SN and pingala swara) is activatory in nature, whereas the flow through left nostril (CN and ida swara) is relaxatory. Status: This research was presented at the International Yoga conference , Kaivalyadhama, Lonavla in Dec 2012 and full paper has been accepted for publication in International Journal of Yoga.
4.Hematological, biochemical and psychological effects of a yoga training programme in nursing students.
Abstract : We were granted the opportunity to impart a 6 month comprehensive course of yoga training for nursing students. The two goals of this study are to analyse the effects of the training on the participants´ health and quality of life (QoL) and to help the participants better understand the scientific basis of these yoga practices. 60 healthy nursing students (12 M, 48 F) aged 18.60 ± 0.67 (SD) y were recruited, and 60 min of yoga training was given twice weekly, for 6 months. Selected biochemical and hematological parameters were recorded along with Ferrans and Powers QoL index before and after the training period. QoL was also tested at mid term. Post-intervention statistical analysis (repeated measures of ANOVA) revealed highly significant and beneficial changes in most hematological and biochemical parameters. These changes correlated positively with the subjects´ frequency of attendance, as evidenced by Pearson’s linear correlation testing. There were also significant improvements in QoL index and its subscales, both at mid training and post training. These improvements also correlated positively with attendance. The present study provides evidence of the beneficial psycho-physical effects of yoga training. All parameters tested showed positive changes, and most were statistically significant. Major findings are enhanced bone marrow function, reduced allergic tendency, alkalization of urine, metabolic reconditioning (with special emphasis on liver function) and improvement in all QoL indices. This may be attributed to an improved functioning of the body-mind complex, which is facilitated by the breath-body practices of yoga. Because we were not able to establish a separate control group, we correlated changes with the subjects´ frequency of attendance. The majority correlated positively. In conclusion, our study confirms both psychological and physical benefits of yoga training in a graduate course student population. We recommend that yoga be made an integral part of medical and paramedical collegiate education. Status: This has been submitted for publication in Journal of Biomedical Human Kinetics.
5.Immediate cardiovascular effects of a single yoga session in different conditions.
Abstract : This retrospective review of clinical data was done to determine cardiovascular effects of a single yoga session in normal subjects as well as patients of different medical conditions. Data of 1896 patients (1229 female, 633 male and 34 transgender) with mean age of 36.28 ± 12.64 y who attended yoga therapy sessions at CYTER between November 2010 and September 2012 was used for analysis. Heart rate (HR), systolic (SP) and diastolic pressure (DP) had been recorded using non-invasive blood pressure (NIBP) apparatus before and after 60 minute yoga sessions at CYTER and indices like pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (DoP) were derived from recorded parameters. Participants were undergoing appropriate yoga therapy protocols as per their individual condition while normal subjects had a general schedule of practice. Typical yoga sessions included simple warm ups (jathis and surya namaskar), breath body movement coordination practices (kriyas), static stretching postures (asana), breathing techniques (pranayama), relaxation and chanting. There were statistically significant (p < 0.001) reductions in all the studied cardiovascular parameters following the yoga session (Tables 1 & 2). The magnitude of reductions differed in the groups, it being more significant in those having hypertension (n = 505) and less significant in those having endocrine/skin (n = 230) and musculoskeletal (n = 120) conditions. It was moderately significant in the normal subjects (n = 582) as well as patients having psychiatric (n = 302) and respiratory (n = 157) conditions. There is a healthy reduction in HR, BP and derived cardiovascular indices following a single yoga session. The magnitude of this reduction depends on the pre-existing medical condition as well as the yoga therapy protocol adopted. These changes may be attributed to enhanced harmony of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to yoga. Status: Submitted for publication in Journal of Alternative & Integrative Medicine.
6.Immediate effect of chandra and suryanadi pranayamas on cardiovascular parameters and reaction time in a geriatric population.
Abstract : Previous studies have reported differential physiological and psychological effects of exclusive right and left nostril breathing. Though potential health benefits have been postulated, further clinical research is required to prove Page 43
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immediate and sustained efficacy of these techniques. This study evaluated immediate effects of exclusive right (SNP) and left (CNP) nostril breathing on cardiovascular (CV) parameters and reaction time (RT) in a geriatric population. 26 subjects attending regular yoga sessions at a senior citizen hospice, were recruited for this self-controlled study. They were instructed to sit in any comfortable posture and relax for 5 min before taking the pre-intervention recordings of Heart rate (HR), blood pressure (BP), auditory and visual RT (ART and VRT respectively). They then performed the selected technique and parameters were recorded immediately after performance of 9 rounds of either SNP or CNP. The entire sequence of recordings was randomised to avoid any bias. Intra and inter group statistical analysis was carried out using Student’s paired t test for data that passed normality testing and Wilcoxon matched-pairs signed-ranks test applied for the others. Overall intra-group comparison of pre-post data and inter-group ∆ % comparisons showed statistically significant (p < 0.05) differences for all parameters. There was an overall reduction in HR and BP-based parameters following both SNP and CNP. However, inter-group ∆ % comparisons revealed a significantly greater reduction after CNP for all parameters. Inter-group comparisons revealed highly significant decreases (p < 0.001) in VRT and ART after SNP. In conclusion, our study sheds new light on the physiological changes occurring after SNP and CNP in a geriatric population. While both techniques reduce HR and BP, CNP does it more significantly. There is shortening of RT following SNP and this may be attributed to enhance sensory motor function that is of great significance in the elderly. We suggest that Yoga should be part of the heath care facilities for the elderly as it can enhance their quality of life and improve their overall health status. Status: This research has been accepted for publication in International Journal of Physiology.
7.Effect of yoga training on cardiorespiratory health in obese subjects.
Abstract : Obesity is a major health challenge worldwide. It is a contributing factor to morbidity and mortality in lifestyle disorders such as diabetes, hypertension, coronary artery disease and premature aging. Yoga is the best lifestyle ever designed for preventive health as it also promotes positive wellbeing. Studies have suggested the beneficial effects of yoga in prevention and management of obesity and its complications. However, the cardiorespiratory health benefits of yoga in obesity have not been studied in detail. The present single blind RCT aims to determine cardiorespiratory health status of obese subjects (BMI 25 - 40) and evaluate the effect of Yoga training in them. 120 obese volunteers (BMI 25 - 40) will be recruited and randomized into yoga group (60) and wait list control group (60). Cardiorespiratory health status will be evaluated by anthropometric indices (Ht, Wt, BMI, WC/HC), physiological parameters (resting HR, BP and HRV, PFT and exercise tolerance), Ferrans and Powers QoL Index and biochemical parameters (HOMA, micronutrients, LFT, lipid and thyroid profiles) before and after the study period and appropriate statistical analysis will be done. 12 weeks of Yoga training consisting of an integrated schedule of asan, pranayam and relaxation techniques along with lifestyle modifications and Yogic counseling will be given to Yoga group. Participants in control group will be treated as wait list control and will be given an opportunity to attend yoga training programme after completion of study period. A significant improvement is expected in cardiorespiratory health status that will be an indicator of the preventive and health promotive effects of Yoga. Status: This proposal has been submitted to CCRYN, Deptt of AYUSH, Ministry of Health & FW, Govt of India after obtaining clearance from IHEC.
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Music Therapy Music Therapy or Music Medicine ? P.Barathi * The choice ultimately rests on the availability of skilled personnel as well as patient-preferred musical pieces, ease of administration and other factorsâ&#x20AC;Śâ&#x20AC;Ś An overwhelming increase in stress-induced psychosomatic ailments are evident today as a result of the impact of global crises culminating in social and environmental issues such as inflation, war, social violence, communicable diseases, epidemic outbreaks, etc., The ramifications are far-reaching, affecting not only the directly impacted victims and survivors, but also the indirectly affected among the population, such as those edged on the poverty line, middleclass people, and the class of business executives who strive to keep their endeavours going in spite of the vicious cycle of corruption, lay-offs, strikes and other non-cooperative movements by the workers. Music therapy nourishes the mind and spirit of the psychologically afflicted individuals, but in a country like India it is not easily accessible to one and all, since it necessitates the need for trained personnel in order to establish a therapeutic relationship through music, involving the triad of music, client, and therapist. A trained music therapist implements a music intervention in an on-going therapeutic process, invoking personally tailored music experiences. The discipline of music therapy is still in its sprouting stage in the fertile soil of India, though it is exhibiting signs of rapid evolution from its nascent stage before a decade. Music medicine or the use of pre-recorded music comes to the rescue, since it is affordable, patient-friendly, with the possibility of the musical piece for selection by the patient himself for regular listening at home, under proper clinical supervision, and at suitable intervals..
Music medicine is widely used in medical interventions to enhance or facilitate the treatment, and to assist rehabilitation. Music is used to influence the patientsâ&#x20AC;&#x2122; physical, mental, or emotional states before, during, or after medical, dental, or paramedical treatments like physiotherapeutic procedures ( Bruscia,1998 ; Dileo,1999). There is usually no therapeutic relationship established through music administered during such procedures. From a paradigmatic point of view, music medicine might be seen as a cognitive-behaviourally oriented intervention model, since it is based on a stimulus-response paradigm, unlike music therapy which is purely relational. In music medicine interventions, the patient simply listens to pre-recorded music that is offered by a medical professional. There is evidence that both music medicine and music therapy are effective. Dileo and Bradt (2005) examined the therapeutic effects of the two practices in 11 medical areas, based on 183 controlled studies. Their conclusions were that both practices have a significant effect in 10 of the 11 areas, Therefore, it can be concluded that both music medicine and music therapy are effective and can serve as complementary practices in somatic care. Now let us glean an insight into the discipline of music medicine from the perspective of a Cognitive-Behaviourally oriented intervention model. In Cognitive-Behavioural Music Therapy (CBMT)*music is used to modify behavior through conditioning, and * Dr. P.Barathi, M.D., Prof of Physiology, Music Therapist e-mail : iyer.bharthi@gmail.com Page 45
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the results can be analysed by applied behaviour analysis. The therapeutic process is based on a stimulus- response paradigm, and as a dependent variable the music must be controlled. This explains why specific music, often recorded, is preferred to improvisation in the treatment of patients using this procedure (GroTrondalen and Ole Bonde,2012). Many types of behaviours such as physiological, motor, psychological, emotional, cognitive, perceptual, and autonomic behaviours are manipulated in CBMT. A patientpreferred music stimulus is given or withdrawn as related to the patient’s target behavior, for example, continuing the music if the subject attentively listens to it, and vice versa. The session format has a firm structure as well as well-defined protocols, though it is adapted to suit the cognitive or behaviour modification goals. The sessions necessitate factors such as predictability and control of the musical stimulus. The music acts as a reinforcing stimulus of non-musical behaviorCBMT is therefore music in therapy, music being used as a means to achieve cognitive and behavioural changes. Neurological rehabilitation is an important arena for CBMT, and Michael Thaut has developed a specific training in ‘neurological music therapy’, based on the principles of CBMT ( Thaut, 2000, 2005). People with Parkinson’s disease, autistic children, premature infants, geriatric population and adolescents with developmental disabilities respond to this therapy. CBMT is recognized by the scientific community, since it ensures the possibilities of replication and standardization. Extensive research has been carried out to determine what types of music will promote specific therapeutic and treatment objectives. Thaut has shown that pulsed, rhythmical music can facilitate good walking patterns in patients with Parkinson’s disease. According to Thaut, the rhythm in itself has a high potential for gait training, and a metronome can be sufficient to produce the right stimulation ( Thaut and Abiru, 2010). Music with slower tempos is used when older adults are prompted to move or dance. The effect of the music medicine/ music therapy intervention over time is assessed through applied behavior analysis by the researcher or the therapist. According to a Cochrane systematic review headed by Dr. Joke Bradt of Drexel University, Philadelphia,USA, both music therapy and music medicine employing pre-recorded music demonstrate positive results, and that there is not enough evidence currently to determine if one intervention is more effective than the other. The trials were conducted with cancer patients that had been offered recorded music, (17 patients) or music therapy with a trained therapist( 13 patients). The results indicate that both music medicine and music therapy remarkably decrease anxiety based on clinical anxiety scores in comparison to those on standard treatment regimes. Similar studies done on patients subjected to mechanical ventilation, and coronary heart disease reveal that both types of music interventions are effective in improving psychological and physical outcomes. My opinion is that in addition to conventional therapies, clinicians should also focus on developing suitable music medicine protocols (apart from nurses and music psychologists), in order to extend soothing hands to embrace the stress-afflicted population, loaded inadvertently with toxic allopathic drugs which leave their undesirable, permanent imprints on liver and renal physiology.
References 1.Bruscia, K.E.(1998). Defining music Therapy. Second Edition ed. Lower Village: Barcelona Publishers. 2.Dileo, C.(ed.) (1999). Music Therapy and Medicine: Clinical and Theoretical Applications. Silver Spring, MD: American Music Therapy Association. 3.Dileo, C. and Bradt, J.(2005). Medical Music Therapy: A Meta-Analysis of the literature and an Agenda for Future Research Cherry Hill, NJ: Jeffrey Books. 4.GroTrondalen and Lars Ole Bonde (2012). Music Therapy: Models and Interventions : Music, Health and WellBeing. Eds Raymond Mac Donald, Gunter Kreutz, and Laura Mitchell, Oxford University Press. 5.Thaut, M.H.(2000). A scientific model of music in therapy and medicine.St. Louis, MO: MMB Music. 6.Thaut, M.H.(2005). Rhythm, human temporality, and brain function. In : D. Miell, R. Mac Donald, and D. J. Hargreaves(eds.) Musical Communication, pp.171-92. Oxford: Oxford University Press. 7.Thaut, M. and Abiru, M.(2010). Rhythmic auditory stimulation in rehabilitationof movement disorders: A review of current research. Music Perception: An Interdisciplinary Journal, 27(4), 263. 8.Bradt,J., Dileo,C. Grocke,D., Magill, L.(2011). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, issue 8. Art. No: CD006911
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Indian Music Reorganizes Time and Establishes Homeostasis P.Barathi *
Homeostatic effects of Rag Ahir Bhairav on the circulatory system
“ Music can form a bridge between external and internal worlds making whole out of apparent disparate elements” According to Mozart, man is an antenna, a ceaseless receptor of the waves and rhythms in the universe( Alfred Tomatis, 1991). The biological and neuro-physiological rhythms are attuned to and in balance with the cosmic rhythms that are beyond human auditory perception. Music awakens the fundamental rhythms existing in each of us. Cardiac and respiratory rhythms are made to synchronize with the deeper, innate rhythms existing in each of us through the medium of music putting man into resonance with the universe. Indian classical ragas can adapt the eternal rhythms to our neurons, and the body in turn resonates in tune with the melodic modes. The latent harmony existing in each of us is aroused, and the body re-establishes its lost equilibrium. The homeostasis established by music administration has been documented in a study conducted in Tokai University, Japan. The study reveals that music has homeostatic effects on emotion, when listeners were analysed by the Profile of Mood States (POMS), a psychological test for measuring emotion (yamamoto et al., 1999).
How does Indian Music establish homeostasis? Music exerts homeostatic effects by harmonizing psychological and biological time. Music, as an external oscillator entraining our internal oscillators, has the potential to affect not only our sense of time, but also our sense of being in the world ( Mari Reiss jones,1989). Jones postulates a propensity for an individual’s endogenous rhythms to synchronize with the musical item, the entrainment experiences varying according to physiological, and psychological factors, as well as the stage of development of the listeners exposed to identical musical pieces. The subjects slowly drift into the realm of ‘reorganized time’, the metaphysical domain where intellectual abilities are replaced by imaginary realities. I have documented several case studies after administering Rag Ahir Bhairav to patients with acute as well as chronic hypertension, and was amazed to find that it not only brought down the elevated blood-pressure in hypertensives but also restored the normal blood pressure in hypotensive individuals. An exploration into the entrainment properties of music will throw a light on such homeostatic phenomena.
Brain, Entrainment, and Physiological rhythms
Two aspects of the new view on the brain seem to be relevant in this context : a) most brain functions can best be described as cooperative, synchronized activity of large,distributed ensembles of neurons, and b) a large part of this synchronized activity is of an oscillatory nature(Basar 1983; Nunez et al 1993). These autorhythmic oscillatory properties of neurons in the central nervous system are a consequence of their electrochemical properties. The cooperative and oscillatory activities of these neurons can be seen, amongst others, as the basis for the timing of sensory-motor coordination ( Llinas 1988). With these new views on the functioning of the brain, it seems most promising to apply the concept of entrainment to the analysis of human interactions at the interpersonal and social level as well. Indeed, such applications have been pursued in the social sciences in parallel with the development of neuroscientific approaches, the mathematics of coupled oscillators, and numerous other related strands of research(Martin Clayton et al,2004).. A good deal of current medical research is concerned with the behaviour of endogenous physiological rhythms in humans (such as the variation of body temperature over the 24-hour cycle), and how the study of those rhythms might be further developed as a tool in the diagnosis of pathological states and ultimately lead to the development of
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new treatments ( Glass 1996). An important part of this work is the consideration of entrainment and in particular, identifying which physiological rhythms entrain to which stimuli, and under what conditions. There are many examples where relatively stable and entrained biological rhythms are associated with good health (the enhanced stability of the heart rate afforded by a pacemaker is an example of this), while conversely asynchrony and instability of rhythmic processes can be associated with pathologies. The behaviour of our endogenous cardiac rhythm ought to be predictable when stimulated by a pacemaker, but if the period of the pacemaker were set outside a certain range, the behaviour of the cardiac rhythm would be for practical purposes unpredictable. But entrainment does not necessarily imply stability of biological rhythms, and in any case stability is not necessarily associated with good health. In the case of brain waves, for example, we have a different pairing: stable brain waves may indicate a pathology (epilepsy) while unstable waves may indicate a healthy state. Indeed, a certain amount of flexibility and dynamic equilibrium seems to be associated with health in many systems. Examples of endogenous or naturally occurring rhythms within the human body include the heartbeat, blood circulation, respiration, locomotion, eyes blinking, secretion of hormones, female menstrual cycles, and many others. It has been suggested, indeed, that all human movements are inherently rhythmic: Jones writes that “All human performance can be evaluated within a rhythmic framework”. Music psychologists have begun to apply an entrainment model in which rhythmic processes endogenous to the listener entrain to cues in the musical sound (Large and Kolen 1994). Although there is much to be done in this area, the entrainment model seems to reflect the cognitive processes much better than do previous other models.
What is special about musical entrainment?
It seems that certain kinds of musicking can afford particularly precise synchronisation between individuals’ behaviours. This may in fact be one of the basic reasons for the development of different kinds of musical repertories, since musical metre is often (although is not invariably) more regular, with more hierarchical levels, than the rhythmic patterning of speech and other communicative behaviour. Since certain degrees of entrainment between individuals seem to be associated with positive affect, it may be the case that particular patterns, periodicities, hierarchies or intensities of entrainment afford particular affects. It is also possible that particular kinds of music may promote the switching of attention between temporal levels. Musical experience, while individually unique in every case, is nevertheless always social. Through exploring the phenomena of entrainment, ethnomusicologists are able to better understand how musical sound serves as an interface that connects selves—viscerally and cognitively—to society. Measured music is a realm of ‘reorganized time’, but so is non-measured music. Both types of music display high temporal coherence, at least if they are studied as dynamic systems, not as static products. A brief glance at Chinese folk songs may serve to illustrate this. There are several Chinesefolk song performances in which the lyrics sung are essentially meaningless. In these performances the whole act of singing seems meaningless, except in its quality of ‘organized time’: a capacity of people to employ sound (i.e. voices) to revive bonds and fates shared beyond daily realities, in the realm of metaphysics. Just how many new hard core facts we will be able to unearth via ‘entrainment’ remains to be seen: if entrainment is the study of ‘reorganized time’, it is also, by definition,the domain of metaphysics – a realm where poets operate more successfully than most academics. Indeed, “rhythmical entrainment” and its physicality are not everything. The bio-physicism of rhythmical entrainment leads to the attuning of other psychological realms, to the transformation of persons’ state of mind, which is also a form of periodicity. By disconnecting the mind from its ordinary cycles (regularities or irregularities), inner oscillators and oscillations set up an affected perception, sensitivity or emotional availability. This is how – in an “extended” version of the theory of entrainment – the contextual variety of music’s effects can be understood or explained. Physical entrainment refers to the synchronization of concrete objects in the world, determined by some objective measure, while cognitive entrainment refers to the appearance of synchronization as determined by the subjective Annals of SBV
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measure of an observer or participant. Cognitiveen trainment is the process whereby an individual comes to sense a certain degree of synchronization between two or more rhythmic processes in the world.
From the above references, we can hypothesize that some heptatonic ( having all the 7 notes of the octave) ragas like Ahir bhairav have the inherent capacity to ‘cognitively reorganize’ psychological time, thereby influencing the biological time and the associated homeostatic mechanisms, rectifying the disordered homeostasic mechanisms towards their normal rhythmic balance.
About Rag Ahir Bhairav It is characterized by the use of Komal Re and Komal Ni. Often times, this rag is referred to by its south Indian
name of Chakravaka. This is an early morning rag. . Arohana Avarohana Jati :Sampurna – Sampurna;Time-Early Morning :That-Chakravaka
References 1. Alfred Tomatis(1991).”Pourquoi Mozart ?” Paris: first edition, pp-91-92. 2.. Basar, E. (1983) EEG and synergetics of neural populations. In Basar, E. et al. (Eds.), Synergetics of the brain (pp. 183-200). Berlin, Heidelberg, New York: Springer. 3. Clayton, M., Sager, R., and Will, U. (2004). In time with the music: The concept of entrainment and its significance for ethnomusicology. ESEM CounterPoint, 1, 1-45. 4. Glass, L. (1996). Synchronization and rhythmic processes in physiology. Nature, 410 (6825), 277-284. 5. Jones, M.R. (1976). Time, Our Lost Dimension:Toward a New Theory of Perception, Attention, and Memory. Psychological Review, 83(5), 323-355. 6 . Large, E.W. and Kolen, J.F. (1994). Resonance and theperception of musical meter. Connection Science: Journal of Neural Computing, Artificial Intelligence and Cognitive Research, 6(2-3), 177-208. 7 . Llinas, R. (1988). The intrinsic Electrophysiological Properties of Mammalian Neurons. Science, 242,1654-1664. 8. Nuñez, A., Amzica, F., and Steriade, M. (1993).Electrophysiology of Cat Association Cortical Cells in Vivo: Intrinsic Properties and Synaptic responses. Journal of Neurophysiology, 70, 418-430. 9. Yamamato Kenji, Iga Tomiei, Takahashi Sachiko, Schimuzu Tetsuo (1999). Tokai journal of Sports Medical science: Tokai universitybehavior, for example, continuing the music if the subject attentively listens to it, and vice versa. The
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Effect of Rag Bowli (early morning raga) on a Case of Monosymptomatic Nocturnal Enuresis Associated with Nocturnal Polyuria P.Barathi * Music has a remarkable power to stimulate many social-emotional processes and to influence emotions in everyday life ( Bernatzky et al.,2002). Music stimulation may also relieve negative cognitions such as feelings of helplessness and hopelessness and undesired stresses that many patients experience ( Spintge,1992). In recent years, a number of studies based on principles of evidence-based medicine which have proven the effectiveness of defined interventions, have suggested music as a powerful resource for the treatment of various illnesses ( Hillecke et al.2005). Music exerts effects on subcortical brain centers and has a strong influence on the psychological and physiological state of the organism ( Panksepp and Bernatzky,2002). The emotions aroused due to music stimulation are elicited either by sounds themselves, or as a result of associations in patientsâ&#x20AC;&#x2122; memories, and these emotions can enhance self-experience and coping strategies. Here we present a case of nocturnal enuresis which responded to music therapy based on the early morning raga, Bowli. B aged 25, came to the Music Medicine Unit of MGMC&RI with the complaints of mono- symptomatic nocturnal enuresis associated with nocturnal polyuria, for which he was treated with anxiolytics and detrusor inhibitors for the past 2 years. He was asked to continue the pharmacological treatment along with music based on the early morning raga known as Bowli. This raga was chosen because he had the habit of going early to bed when compared with others of his same age, and this raga would facilitate his awakening early in the morning, inducing arousal and feelings of refreshment, in synchrony with the morning atmosphere. He listened to the music between 7 to 8am in the mornings, continuously for a period of 1 month, twice a day, each session lasting for half an hour. After a month of continuous listening, he came back reporting that the frequency of nocturnal polyuria had decreased from 9 times to 4 times during the nights. After a gap of one month, he was given another music based on a different rag which had no specific time cycle attributed to it. After a month of continuous listening, he came back reporting that his nocturnal polyuria remained at the same frequency, i.e 4 times at night. The above finding makes one ponder whether there could be a possible link between circadian rhythmic mechanisms present in renal and other tissues and certain types of ragas endowed with specific temporal attributes.
Absence of the circadian rhythm of GFR leads to nocturnal polyuria :
Several studies have confirmed that the circadian timing system plays a major role in renal function ( Voogel et al.,2001; Buijsen et al., 1994). The findings reveal that renal excretory rhythms are driven by circadian changes in both glomerular filtration and tubular reabsorption/secretion, due to a large number of genes essential for water and solute homeostasis following a well-marked circadian expression pattern ( Zuber et al., 2009). The vast majority of them are based on self-autonomous local circadian oscillators (self-sustained intrinsic renal clock mechanism) which regulate the homeostatic mechanisms by controlling the activity of certain metabolic enzymes and transport systems, and also interact and affect the core clock mechanism located in the supra-chiasmatic nucleus of the hypothalamus.
The circadian rhythm of GFR in normal individuals :
Day time- maximum of 122 ml/mt Night time- minimum of 86 ml/mt ( Koopman et al.,1989). In healthy adults, the ratio of day time to night time urine production is usually greater than 2:1, so that only about 25% or less of daily urine output occurs during sleep( 70 to 80 ml/hr during the waking period vs 30 to 40 ml/hr during sleep), these rates of urine production being linked to the day-night sleep pattern. Beyond the age of 60, there is a decline in the molecular clock oscillations due to ageing, and this causes a shift towards a greater proportion of urine production
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to the night time. In the case of B, ageing cannot be the reason for the disrupted renal circadian rhythm, since he is only 25 year old. Other factors like anxiety, stress etc. could have played a role. Finding ways to restore the lost circadian rhythm might lead to a possible therapy for biological clock damage and help in the prophylaxis of such disorders.
The relationship between the Time Cycle of Ragas and tissue-specific functional rhythms:
It is well known that music influences neuronal, immunological and endocrine systems, and modulates homeostasis and vegetative functions because of its intrinsic properties (Aldridge,1989). According to Panksepp and Bernatzky (2002), music listening activates cortical and subcortical neural networks in the human brain, that are associated with endocrine systems and homeostatic responses. Recent studies have implicated that brain circuits of structural and functional relevance to the hypothalamo-pituitary axis are implicated in the emotional processing of music. Ragas belonging to different Time Cycles have their corresponding impact on the emotionality and affect of listeners. A raga or melodic mode creates an atmosphere which is associated with particular feelings and sentiments, making us synchronize completely with nature. The time cycle of ragas is based on the presence or absence of flat notes ( komal swaras in Hindustani terminology), particularly Re, Dha, and Ga ( rishabh, dhaivat and gandhar respectively). The fourth note Ma is rendered as sharp note ( teevra swar) when singing the twilight ragas after sunset, to define the change in mood between the two hours before sunrise and sunset. In Indian music the entire mood of the raga changes with the subtle change in one note : Ma1(Ma flat) Ma2( Ma sharp) g Sunrise period Sunset period g These twilight melodies convey a certain pathos or a feeling of yearning.
Biological basis of the differences in affect produced by changes in rendition of the same note from flat to sharp and vice versa : Our emotional behavior and motivational drives are controlled by the limbic system, which decides the affective nature of the sensations, i.e. whether they are pleasant or unpleasant. Brain imaging studies have revealed that intensely pleasurable music activates numerous brain areas including ventral striatum, amygdalae, and anterior cingulate cortices (Blood and Zatorre,2001), known as reward or satisfaction areas. In contrast, when other nearby areas in the same circuitry are stimulated electrically, terror, pain, fear and other unpleasant sensations are felt, and these are labeled as punishment centers( Ganong,2005 ). Only a narrow margin separates the pleasure and pain centers, similar to the narrow margin separating the flat and sharp Ma ( madhyam), which evoke just the opposite feelings, sharp Ma conveying a feeling of pathos in contrast to flat Ma which induces a pleasant feeling.
The affective components of Indian music include two main features:
1) Bhava or emotional expression, and 2) Rasa or aesthetic essence which that bhava engenders in the listener. Eight ‘emotive stereotypes’ or ‘permanent emotions’ known as sthayibhavas have been elucidated, each of which evokes a corresponding rasa or aesthetic essence ( Rowell,1992). All musicologists agree that the bhava or the essence of raga is knowable only through direct experience ( performance or listening), and is not the result of its inherent scale type, transilience, tessitura, characteristic motion etc. The affective responses like emotional expression and its aesthetic essence are no doubt induced by a raga, but are also tinged by the listeners’ temporal experience, since they believe that it denotes a specific meaning, due a prior conditioning as a result of the knowledge of association between performance and context. In short, musical meaning is coloured by the listeners’ conditioning through generations dating millennia back. At this juncture, we can hypothesize that listening to music that is synchronized with the sympathetic overtones of the time and hour of the day harmonizes the individual with the natural environment, and regulates his moods. Early morning ragas create a very tender, calming and refreshing mood that helps us to step out of sleep into a harmonious waking state. This waking state is associated with a steady increase in the levels of stress hormones like cortisol, which show a specific and well-defined day- night rhythm. The attunement to a refreshing state in the mornings may be enhanced by the synergistic effect created by listening to such early morning ragas, which are synchronized with the sympathetic overtones of the morning hours, inducing appropriate changes in the affect of the listeners, by acting on Page 51
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the brain circuits of structural and functional relevance to the hypothalamo-pituitary axis implicated in the emotional processing of music. Such an influence may be exerted on the set of circadian genes driven by systemic humoral or neuronal circadian signals, which are connected with the core oscillators. An interesting finding which emerged from treating the above case is that, the disease process even though partly rectified, remains at the same level of improvement even after cessation of music-listening, unlike pharmacologic treatments which need to be continued indefinitely to prevent the recurrence of symptoms in cases of such chronic duration. One can readily surmise that music has acted at some deep, inner level connected with endogenous rhythms, reaching out to physiological homeostatic mechanisms via affective channels, and once the disorder is set right, it attains a state of permanent stability. More exploration is needed regarding the connection between the time-cycles designated to different ragas and tissue- specific functional rhythms which interact with and affect the core clock mechanism. About RagBowli â&#x20AC;&#x201C; ( Early morning raga.) Arohan- S R1 G3 P D1 S Avarohan- S N3 D1 P G3 R1 S
References 1. Aldridge, D.(1989). Music, communication and medicine: Discussion paper. Journal of the Royal Society of Medicine, 82, 743-6. 2. Bernatzky, et al. (2002). Emotional sounds and the brain: the neuro-effective foundations of musical appreciation. Behavioural Processes, 60, 133-55. 3. Blood, A.J. and Zatorre, R.J.(2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated with reward and emotion. Proceedings of the Natural Academy of sciences, 98, 11818-23. 4. Buijsen JG, et al.(1994). Circadian rhythm of glomerular filtration rate in patients after kidney transplantation.Nephrol Dial Transplant. 9: 1330-1333. 5. Ganong, W.F.(2005). Review of Medical Physiology (Lange Basic Science). The Mc graw-Hill Companies, Inc. Twenty second edition. pp256-259. 6. Hillecke, T., Nicke, A., and Bolay, H.V. (2005). Scientific perspectives on music therapy. Annals of the New York Academy of Sciences,1060, 271-82. 7. Koopman et al.(1989). Circadian rhythm of Glomerular Filtration Rate in normal individuals.Clin.Sci.,77(1): 105-11. 8. Rowell, Lewis (1992). Music and Musical Thought in Early India. Chicago: University of Chicago Press. 9. Spintge,R.(1992). Toward a research standard in music medicine/ music therapy: A proposal for a multimodal approach. In R. Spintge, and R. Droh(eds). Music Medicine, pp 345-47. Saint Louis, MO: MMB. 10. Voogel AJ et al.(2001). Circadian rhythms in systemic hemodynamics and renal function in healthy subjects and patients with nephritic syndrome. Kidney Int., 59: 1873-1880. 11. Zuber AM et al.( 2009). Molecular clock is involved in predictive circadian adjustment of renal function. 106,(38) : 16523-16528.
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Sound Doc’s Panel P.Barathi * A physician examines a patient, comes to a preliminary diagnosis, prescribes some medicines, and advises him to come for a follow-up. In what way music therapy differs from the routine clinical practice ? All forms of music therapy include musical experiences such as performances, improvisations and listening experiences. Such experiences, as well as the related physical, emotional, affective, cognitive, behavioural reactions develop during each session and throughout the complete set of sessions which make up the whole music therapy relationship. All these experiences and the related reactions develop in time- a temporal development process. To sustain the whole process, it necessitates a core of conceptual contents that must maintain a certain level of stability which is designated as structure. A professional relationship is maintained which is marked out by the level of consciousness the professional therapist has of the structural elements he is placing at his patient’s disposal while performing his role, in contrast to a ‘normal’ relationship where the structural factors can function automatically without us necessarily being aware of them. The music therapeutic process involving application of music includes musical experiences which characterize the relationship between the music therapist and the client, the therapeutic process being chosen, planned, led, judged, concluded, interrupted or carried on according to the structural elements constituting it, namely, the psychological and cultural factors through which one interprets the process. The therapist needs to possess a consciousness of his own psychological balance, which necessitates training in order to develop his personal consciousness followed by ‘didactical analysis’- in other words, it is of prime importance to develop ‘interpretive competence’. It is necessary to distinguish between two types of ‘supervision’ in music therapy: Classical Supervision Model • Has an absolutely firm ground from both a theoretical and methodological point of view. • Historically well-established. • Clearly identifies everyone’s roles, spheres of competence, responsibilities. • Involves the danger of relegating music to a condition of inferiority or irrelevance. • Music is recognized to be a significant element only if it is translated into the psycho-therapeutic language, basically different from itself, so that a great deal of its essence or specific musical dimension inevitably gets lost. • Includes music therapy models based upon psycho- dynamic, humanistic, cognitive- behavioural approaches. • The music therapist sees his place in the hierarchy of the different kinds of knowledge, knowing whether he is competent or not as for a why socially recognized as related to the care of health- capable of being reduced to a merely technical acting, which sticks to the standard norms of operation. • The therapist’s knowledge is usually included among the ‘ interpretive logoi’ which are traditionally recognized, and he is conferred the responsibility and power for orientating clinical or ‘curative’ processes. Technical Supervision Model • Musically-oriented music therapy. • The music therapist should be a musician ‘provided with musical skills’ being able to achieve true interpretative quality through his musical practice. • There is a gradual unfolding of the process in development, based on the communication between the music therapist and his client. • The musician grasps the ‘why’ dimension, which is the basis for interpretation, guided by his intuition- the artist gains access through an intuitive why. • Whereas the musician usually pursues aesthetic goals, the music therapist aims for some responsible ‘care’ of his client. • The music therapist should have reached a true psychological maturity, which allows him to meet the Other in music through non- mystifying and non-‘projective’ attitudes, unlike a pure musician, who aims at appreciable artistic results. • In this way music therapy becomes an autonomous and not merely operative discipline, in other words a therapeutic application of music. * * Dr. P.Barathi, M.D., Prof of Physiology, Music Therapist e-mail : iyer.bharthi@gmail.com Page 53
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Responders vs Non-Responders to Music Therapy P.Barathi * During music administration to patients, I have always been confronted with the interesting phenomenon of coming across patients who respond well to music therapy on the very first session itself, these individuals gradually exhibiting signs of improvement after a duration of 3-4 weeks, as opposed to others who either show no response at all or become restless even before 10 minutes of listening, and it is not surprising that they fail to show any improvement even if they are made to listen regularly. I found that this phenomenon was repeated, even if the patients were made to choose the music according to their own preferences.
What could be the reasons behind these unique variations among individuals regarding music stimulation?
1. Musical Intelligence- The “Expression” in Music as Interpreted or Felt by a Performer/ Audience : According to Dr. Howard Gardner there are 7 Emotional Intelligences, viz., verbal( the ability to use words), visual( the ability to see things in your mind), physical( the ability to use your body well), musical( the ability to understand and use music), mathematical/logical( the ability to apply logic), intrapersonal( the ability to understand thoughts and feelings), and interpersonal (the ability to relate well to others).
The common issue faced by researchers is that it is hard to classify music based on its emotional content. The emotional content of music is difficult to discuss since it is a ‘subjective” experience, meaning that each listener or performer may construct a slightly different personal experience, even for the same music. It is important to consider the fundamental issue between music and human perception: the possibility of educating or enhancing our emotional responses to music. Many people take it for granted that listening to music requires no skill, but it is vital to remember that not only musicians but also listeners need to improve the ability to understand music in order to fully appreciate it. Differences among interpretations of music do exist, our perception of emotion from music varying, depending on varying situations and individual differences in perception- not everybody associates the same musical features with the same emotion. According to Feieraband,JM(1995), individuals with high music intelligence “think music” with greater clarity and are affected more deeply by music, in an aesthetic sense, than those with less music intelligence.
Musical Intelligence and Response to Music Therapy
Recent insights about the psychological development of musical thinking have revealed that musical intelligence is nurtured by the children at a very early age. Since synaptic connections are at their peak production at the age of 2, music stimulation should begin immediately at birth in order to preserve musical intelligence, because it starts declining prior to the age of 5. According to researchers, a child stores a mass of musical impressions well before commencing school education, and what a child has heard in his first six years of life cannot be eradicated later. Therefore, it is of utmost importance to stimulate musical intelligence well before the child starts entering school life.
How to stimulate musical intelligence?
To develop musical intelligence, one must develop neuronal pathways for musical thinking early in life. If the musical mind is engaged in early stimulation through music listening or playing, we establish neuronal pathways that will understand and perceive music from this intellectual framework, since the synapses are formed, strengthened, and maintained by interaction with repeated experience, as a result of the information being processed through certain conditioning. Appropriate stimulation of musical intelligence from the earliest experiences is necessary, if the pathways are to be built to understand musical phenomena from a musical perspective. Once the pathways for understanding
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musical or any other phenomenon for that matter are established, it is difficult to reshape the mind to perceive that same phenomenon from a different perspective. “It is much more difficult to reorganize a brain than it is to organize it in the first place. Organization inhibits reorganization. Carving out neuronal tracks for certain types of learning is best accomplished when the synapses for that particular skill are malleable, before they harden up around certain types of responses.” Jane M. Healy. Musical intelligence can be demonstrated by the fact that individuals who learn to play an instrument through ready notation- without appropriate musical skills such as singing and moving with music- engage only their logical/ mathematical intelligence and would most likely have later difficulty to play by ear. Edwin Gordon has suggested that music intelligence is determined by one’s ability to “think” music, or in his words to “audiate” music. The better one is in creating music inside one’s head, the better developed is one’s potential to succeed in real musical understanding and appreciation. The emotional content of music is difficult to discuss since it is a ‘subjective” experience, meaning that each listener or performer may construct a slightly different personal experience, even for the same music.
2.The Psycho- Neuro- Endocrinologic Responses to Music Stimulation It is well known that individuals and cultures identify emotionally with different musical stylings. What is stimulating for one may induce a neutral response to another. The reason could be attributed to the psycho-neuro-endocrine effects of music in the human brain and body which provide direct links between music stimulation, activations in the brain during music processing and emotional response at both physiological and subjective levels. Music emotion research at the hormonal levels might yield more information regarding the relationship between perceived and felt emotions during music stimulation. In other words, by understanding how music affects the endocrine system, we will increase our knowledge of how music affects emotions. Ultimately, research in psycho-neuro-immunology should contribute to answering questions about how musical behaviours function as psychological components in processes related to wellbeing and health ( Kreutz et al., 2012). According to Blood &Zatorre (2001 ), intensely pleasurable responses to music are associated with activity in brain regions implicated with reward and emotion. Pleasurable music invokes emotions releasing the reward hormone dopamine, in correlation with the “chills” running up and down the spine during intense peak responses. It has already been established that strongly felt emotions could be rewarding in themselves in the absence of a physically tangible reward or a specific functional goal, and it is amazing to find that there is also an anticipatory release of dopamine to an aesthetic stimulus- a stimulus that is abstract, complex and not concrete (Salimpoor et al.,2009). Are there any other factors that play a role in healing the signs and symptoms of the disease process in those who respond well to music therapy?
The intricate biological time structures in humans : Overview of the favored periodic duration (frequency ranges) of the rhythmic functions in humans. The scale of periodic duration is divided logarithmically. The stable frequency ranges of the spontaneous rhythms are specially emphasized.
Figure : 1 Page 55
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The results of modern chronobiology and chronomedicine have shown that the human organism does not only have a complicated interior design in terms of space structure, but also has a foundation based on an intricate time design, being composed of numerous rhythmical time structures_the intricate biological time structures in humans (Vide Fig:1). Figure : 1 shows a spectrum of the main types of rhythmical functions, arranged logarithmically according to the periodic duration. It includes approximately 2 into 12 octaves, from approximately one millisecond to an order of one year. With an increasing periodic duration, the complexity of the rhythms grow, from the cellular rhythms via the tissue and organ rhythms towards the rhythms of more complexity, finally including the entire organism and even the population rhythms- a hierarchical structure existing and determining the way in which the longer wave rhythms include the shorter ones. This illustrates that there are structures in humans which follow musical conformities to a natural law. The whole of the human organism participates as a moving entity, as a sensory being, and as an intellectual receptor in experiencing music. This could be the ultimate achievement for music in entraining the organism and shaping regularities from irregularities. In this way music therapy becomes an autonomous and not merely operative discipline, in other words a therapeutic application of music.
References
1. Blood AJ and Zatorre RJ (2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences of The United States of America; vol. 98 ( 20) 11818-11823. 2. Edwin Gordon (1968).A Study of the Efficacy of General Intelligence and Musical Aptitude Tests in Predicting Achievement in Music. In Bulletin of the Council for Research in Music Education.No. 13, pp. 40-45.University of Illinois Press 3. Feierabend, J.M.(1995). Music and Intelligence in the Early Years. The Hartt School University of Hartford From Early Childhood Connections. 4. Gardner, Howard (1983; 1993) Frames of Mind: The theory of multiple intelligences, New York: Basic Book 5. Gutenbrunner,C., Moog,R, and Hildebrandt,G, (1993). In Chronobiology & Chronomedicine. Peter Lang GmbH Kreutz G., Murcia CQ, and Bongard,S (2012). Psychoneuroendocrine Research on Music and Health: An Overview In Music, Health, & Wellbeing. MacDonald R, Kreutz,G,and LauraMitchell (Eds). Oxford University Press. 6.Salimpoor VN, Benovoy M, Longo G, Cooperstock JR, Zatorre RJ (2009) The Rewarding Aspects of Music Listening 7. Are Related to Degree of Emotional Arousal. PLoS ONE 4(10): e7487. artistic results.
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The “ Right” Music for the “Right” Situation P.Barathi * A case study from the Music Medicine Unit, MGMC&RI
Mrs. X was referred to the Music Medicine Unit from the post-operative ward, for the complaints of agitation, aggression, and restlessness. She was administered a piece of music based on Rag Neelambari through the head-phones, for a period of 30 minutes. She calmed down after sometime, and reported that she felt peaceful and relaxed. The music administered was sedative in nature, and had a sustained melodic nature, lacking in strong rhythmic and percussive elements.
Helen Bonny (1986) has stated that “sedative music has an easy flowing melody, and a tempo similar to the resting heart beat. It is pleasing to the ear, not dissonant, and it has no major changes in pitch, dynamics, or rhythm. It supports its listeners. It makes no demands on them.” According to her, people who are seriously ill need sedative music. Hence it is important for health professionals, when assessing a client’s musical preferences, to take into consideration the client’s current health status also.
How to assess the musical preferences of the patient?
The initial step consists of reviewing their “musical listening” using relevant questionnaires (Le Navenec & Slaughter, 2001). This is followed by asking them to describe their responses to a particular piece of music.
Aldridge (1996) warns for the quantitative approach in music research. He holds that we should be careful not to organize nature according to concepts imposed on it and demonstrates the need for a more phenomenological, holistic understanding of musical experiences through qualitative research. Factors that affect one’s musical preferences: 1) Health Status: According to Helen Bonny, one’s preference for stimulating music may change when ill. She emphasizes the need for sedative music at such times. Furthermore, depending on one’s hearing status, certain types of music (e.g., with high pitches) may be a source of discomfort. 2) Alertness or fatigue level: Just as when we are ill, we prefer sedative music, so too, when we are very tired, the sounds of silence may be preferred. 3) Mood at the time of listening: The iso-moodic principle ( Katsh and Merle- Fishman, 1985) implies that we need to match the music to the current mood we are in and that a person’s mood state may be altered on exposure to music that evokes or tends to evoke a similar mood state. The iso-moodic principle of music therapy assumes that individuals attend to music selectively that is relatively congruent with their current mood state. If we wish to change our mood, we need to change the selection of music gradually by choosing music that evokes emotional responses in an adjoining category of Hevner’s Mood Wheel(1937). Fig.1 shows the moods depicted in Hevner’s Mood Wheel. 4) Age: Musical preferences of the elderly has been extensively studied ( Moore et.al., 1992). Pittigio (2000) suggests that music from childhood and adolescence may be helpful for older people with dementia during reminiscence group sessions because long-term memory is often preserved. 5) Socio-Cultural and environmental characteristics: Examples in this category include how familiar the music is to the listener, cultural and ethnic background, and related contextual features (e.g., whom you are with, the physical environment in which you are listening to the music, etc.)
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6) Musical background 7) How one uses music in everyday life: Compensatory: e.g., diversion, relaxation; emotional: e.g., whether music supports the expression of emotions or moods; background: e.g., background music stimulates some people while working and it fills the silence when one does not feel at ease with others. 8) Availability of various categories of preferred music. The above facts underscore the importance of assessing the musical preferences of the persons for whom you are administering music. According to Scartelli, Lloyd ( 1987) and other investigators in the field of psycho-neuroimmunology (PNI), there is a constant reciprocal communication between the mind and body which is accomplished via the secretion of various types of neuro-transmitters that are triggered in an individual by ”environmental ,emotional, physical, social, and even spiritual changes”. These changes in turn affect the functioning of one’s autonomic nervous system, endocrine, and immune systems. Exposure to carefully selected music produces the following effects:1) Positive physiological outcomes; 2) Effects on cognitive and psychological functioning; 3) Social and spiritual well-being of people, and 4) The emotional sphere. Scartelli (1989) implies that this emotional sphere is“the prime target of music”. Hevner concluded from her study that “the perception of emotion in music was most influenced by the tempo, modality, and pitch level of the music, and less by the harmony, rhythm, and melodic direction”. The Hevner Mood Wheel consists of 8 clusters of related emotions organized in a counter clockwise direction along a solemn-exalting continuum, and has been used extensively in research on music and emotions ( Bonny & Savary,1973; Gabrielsson & Lindstrom,2001). The moods within each cluster of the Hevner Wheel are closely related (sad, mournful, gloomy) and adjacent clusters are moderately related ( cluster 6-happy and cluster 7-excited). Hence mood transitions between adjacent groups are made without abrupt changes. Diametrically opposite clusters reflect opposite moods that are more distantly related (cluster 8-vigorous, and cluster 4-serene). Hevner also includes descriptive qualities of moods and not just distinct emotions (for example, heavy and dark are included in the same cluster as depressed, melancholy, and mournful). Fig 1 :The Hevner Mood Wheel (Arrangement of adjectives for recording the mood effect of music) Kate Hevener: “An experimental study of affective value of sounds and poetry” Eight different groups each with differences within. Different responses are elicited when participants listen to the same music excerpt. Such aesthetic verbal descriptors can be useful in the expression and understanding of emotions, particularly as they arise in musical experiences.
How to use the Mood wheel?
The participants are asked to describe what they think about the music that is played. They are shown the adjectives in the various groups, and advised to circle the adjectives that really reflect how the music makes them feel, and to leave all of the adjectives blank if the music did not affect them at all. They listen to a musical selection, then check the mood adjective group that they feel most corresponds to the mood of the music. The Mood Wheel essentially asks listeners to attribute emotional affect in relation to the musical pieces that they are listening to. At a subconscious level a process of identification occurs to the extent that one’s moods may, by degrees, be modified. Variations in certain musical properties, including tempo and dynamic intensity, encourage or reproduce variations in an individual’s mood state. At its most potent, the vectoring power of music is such that mood states may actually vary, not simply by degrees across the same mood state, but also across altogether different mood states, from one Annals of SBV
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affective pole (anger) to its opposite (joy), for instance. Merritt et al.,(1996) indicate that if one is feeling irritable, hyper activated, or edgy, the music therapist starts with music that is not too quiet so that the listener may transfer some of his or her anxiety over to the music ( the transference effect, in which individuals in therapy often transfer feelings of anger about others to the psycho therapist). If a person is feeling depressed, then a quiet piece of music would be played at a slow tempo. If he or she is feeling joyful or wants to celebrate, then a melody based on Rag Hamsadvani is recommended ( in the case of Indian Music therapy, which has been tested and tried on several participants). If Western Music is preferred, Vivaldi’s Four Sessions can be used. If a person is feeling angry, a melody based on Rag Bageshree can be used for Indian Music lovers, or Mozart’s Eine Kleine Nachtmusik or the first or third movement of his symphony No.41 in C can be used. But a distinction has to be made between mood and emotion. In music psychology, both emotion and mood have been used to refer to the affective effects of music, but emotion seems to be more popular. Researchers tend to choose mood over emotion. In addition, existing music repositories also use mood rather than emotion as a metadata type for organizing music. The music psychologists focus on human’s responses, the latter focus on music. It is human who has emotion. Music does not have emotion, but it can carry a certain mood. Therefore, Hevner’s methodology adopts the term music mood rather than emotion. What We Know about Music Mood: 1. There does exist mood effect in music. It is also agreed that it seems natural for listeners to attach mood labels to music pieces 2. Not all moods are equally likely to be aroused by listening to music. In a study conducted by Schoen and Gatewood (1927), human subjects were asked to choose from a pre-selected list of mood terms to describe their feelings while listening to 589 music pieces. Among the presented moods, sadness, joy, rest, love, and longing were among the most frequently reported while disgust and irritation were the least frequent ones. 3. There do exist uniform mood effects among different people. Sloboda and Juslin (2001) summarized that listeners are often consistent in their judgment about the emotional expression of music. Early experiments by Schoen and Gatewood (1927) have shown that “the moods induced by each (music) selection, or the same class of selection, as reported by the large majority of our hearers, are strikingly similar in type”. Such consistency is an important ground for developing and evaluating music mood classification techniques. 4. Not all types of moods have the same level of agreement among listeners. Schoen and Gatewood ranked joy, amusement, sadness, stirring, rest and love as the most consistent moods while disgust, irritation and dignity were of the lowest consistency. The implication for researchers is that some mood categories would be harder to classify than others. 5. There is some correspondence between listeners’ judgments on mood and musical parameters such as tempo, dynamics, rhythm, timbre, articulation, pitch, mode, tone attacks and harmony (Sloboda and Juslin (2001). Early experiments showed that the most important music element for excitement was swift tempo; modality was important for sadness and happiness but useless for excitement and calm; and melody played a very small part in producing a given affective state ( Capurso et. al.,1952). Schoen and Gatewood pointed out the mood of amusement largely depended upon vocal music: “humorous description, ridiculous words, peculiarities of voice and manner are the most striking means of amusing people through music”. Such correspondence between music mood and musical parameters has very important implications for designing and developing music mood classification algorithms. Perhaps no one, be he a music expert or casual listener, would deny the fact that music and mood can never be separated. Some music may not describe a story, but all music must express, strongly or softly, a certain emotion or a mixture of emotions. In consequence, music listeners often experience some sort of affective responses. Just as Juslin and Sloboda [15] stated : “Some sort of emotional experience is probably the main reason behind most people’s engagement with music. Emotional aspects of music should thus be at the very heart of musical science.”
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References 1. Aldridge D. (Ed.). (1996). Music Therapy Research and Practice in Medicine : From Out of the Silence. London: Jessica Kingsley. 2. Bonny Helen (1986). Music and Healing. Music Therapy, 6A, I, 3-12. 3. Bonny H & Savary L (1975). Music and your mind: Listening with a new consciousness. New York: Harper & Row. 4. Capurso, A., Fisichelli, V. R., Gilman, L., Gutheil, E. A.,Wright, J. T. and Paperte, F( 1952). Music and Your Emotions. Liveright Publishing Corporation. 5.Gabrielsson, A. and Lindström, E. 2001. The influence of musical structure on emotional expression. In P. N. Juslin and J. A. Sloboda (Eds.), Music and Emotion: Theory and Research. New York: Oxford University Press. 6. Hevner, K. 1936. Experimental studies of the elements of expression in music. American Journal of Psychology, 48: 246-68 7. Juslin, P. N. and Sloboda, J. A.( 2001). Music and emotion: introduction. In P. N. Juslin and J. A. Sloboda (Eds.), Music and Emotion: Theory and Research. New York: Oxford University Press. 8. Katsh S, Merle-Fishman C (1985). In The Music Within You: Barcelona Publishers. 2nd edition. Gilsum, NH. 9. Le Navenec C., & Slaughter S. (2001). Laughter is the best medicine: Music, remi- niscence, and humour enhance the care of nursing home residents. Nursing Times, 97(30), 42-43. 10.Meyer, L. B. 1956. Emotion and Meaning in Music.Chicago: University of Chicago Press. 11 Lloyd R (1987). Explorations in psychoneuroimmunology. Orlando, FL: Grune and Stratton. 12.Moore RS., Staum MJ., & Brotons M. (1992). Music preferences of the elderly: Repertoire, vocal ranges, tempos, and accompaniments for singing. The Journal of Music Therapy, 29(4), 236-252. 13.Pittigio L.(2000). Use of reminiscence therapy in patients with Alzheimer’s disease. Lippincott’s Case Management, 5(6), 216-220. 14.Scartelli, J (1987). Subcortical Mechanisms in Rhythmic Processing. Paper presented at the meeting of National Association for Music Therapy, November 1987, San Francisco. 15.Schoen, M. and Gatewood, E. L.( 1927). The mood effects of music. In M. Schoen (Ed.), The Effects of Music (International Library of Psychology) Routledge, 1999. 16.Sloboda, JA. and Juslin, PN.( 2001). Psychological perspectives on music and emotion. In P. N. Juslin and J. A. Sloboda (Eds.), Music and Emotion: Theory and Research.New York: Oxford University Press.
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Prognosis in Music Therapy Interventions is Associated with The Emotional Intelligence-Alexithymia Spectrum P.Barathi * A case study from the Music Medicine Unit, MGMC&RI
Emotional processes are critical to understanding and promoting lasting therapeutic change in music therapy interventions (Kerr et.al.2001). Emotional experience is at the heart of many of the problems experienced by the patients attending music therapy sessions, and hence an understanding of these experiences and the corresponding changes in affective states is a prerequisite for successful music medicine interventions. When a person listens to music emanating positive emotions, it activates a set of organizing principles or “schemes” constructed from the individual’s innate response, repertoire and past experience which are collectively encoded in memory, and which later interact with the present situation and generate current experience through a form of associative memory networks (Bower,1981). This is the mechanism by which music modifies the negative affect aroused during anxiety-provoking situations- an affective modification by music.
The role of emotions in the adaptive and survival mechanisms of primitive humans:
Emotions served to organize the psychological processes in adaptive ways right from primitive human existence, by activating certain responses and suppressing others. The fear reaction in response to an impending threat (for eg. the threat from a predator) would arouse the physiological systems (i.e. increase in heart rate, respiration), resulting not only in an inability to sleep, but in a focused, goal-directed series of decisions and actions to safeguard oneself. In an emotional state of fear, an individual has a sharpened perception, and decision making and information processing shift to the area involved in reacting to the presumed threat, thus increasing the chances of escape if the threat is real. But in many cases there is a “false alarm” which sets into motion a series of fear-induced reactions, which are physiologically harmful to the organism in the long run. Humans who acted in successfully adapted ways passed on their traits to their off springs through the process of Natural Selection. Primitive human groups underwent several adaptive behaviors to survive in their natural environments, and music and emotion are believed to have served important functions in this adaptive process to the natural world (John Pellitterri,2009 ). Thus we can understand that emotional traits and tendencies are deeply ingrained in our nature and are less malleable from those that are shaped by individual history, which are more amenable to change. The emotional state of fear creates the ‘flight response’, while the state of anger creates the ‘fight response’. Anger like fear, also focuses attention, increases adrenaline levels, and enhances goal directedness. Resources are mobilized to destroy the object of threat, and to feel less pain in the process of battle. The ‘fight or flight’ response underscores the notion that emotions are adaptive to the physical environment. The cognitive problem-solving strategies necessary to respond to threats or challenges are often triggered by affect, since affective cues inform us about the benign or problematic nature of the situation, which in turn, tune our thought processes to meet these situational requirements-emotions are placed at the intersection between the person and his or her environment.
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What is Emotional Intelligence?
Emotional Intelligence (EI) is concerned with the understanding of how individuals perceive, understand, utilize and manage emotions in an effort to predict and foster personal effectiveness. According to Salovey and Mayer (1990), individuals vary in their ability to process information of an emotional nature and in their ability to relate emotional processing to a wider cognition. This ability is seen to manifest itself in certain adaptive behaviors. Perceiving emotions, harnessing emotions to facilitate various cognitive activities such as thinking and problem solving, comprehending emotion language, and the ability to regulate emotions in both ourselves and in others are the four types of abilities included in Mayer & Saloveyâ&#x20AC;&#x2122;s model. Bar-On model of Emotional-Social Intelligence: Bar- On Emotional Quotient Inventory (EQ-i) can assess a clientâ&#x20AC;&#x2122;s general degree of emotional intelligence, potential for emotional health, and psychological well-being ( Bar-On, 1997 ). Results can evaluate the successfulness of therapeutic interventions and to decide when to terminate therapy. Bar-On hypothesizes that those individuals with higher than average EQs are in general more successful in meeting environmental demands and pressures. Deficiency in Emotional Intelligence can mean a lack of success and the existence of emotional problems.
What is Alexithymia?
Alexithymia is a term used to describe people who appear to have deficiencies in understanding, processing, or describing their emotions. It is a complex mixture of personality traits which remains stable over time, even after distress or depression have diminished, and does not belong to any diagnostic category( Taylor &Bagby,2000).The alexithymia construct is strongly inversely related to Emotional Intelligence, representing its lower range (Schutte et.al.,1998). The Online Alexithymia Questionnaire (OAQ-G2) is a valid measure of alexithymia, and has been used in this study for scoring alexithymia. The present case study was designed to compare the Emotional Intelligence of a patient who exhibited good response to music therapy after continuous music listening for 2 months, with that of another patient who refused to show any response at all from the very first session. The Bar-On EQ-i scores of both the responder and non-responder were compared with the EQ-I scores of the music therapist. The level of alexithymia of both the patients were computed using the Observer Alexithymia scale, and compared with the scores of the music therapist( since a music therapist is supposed to be endowed with psychological maturity and balance along with increased Emotional intelligence). The results are summarized graphically in fig.2a. The responder is seen to exhibit less stress tolerance, problem solving, optimism, happiness, independence, and assertiveness when compared to the non-responder, but shows more flexibility, impulse control, empathy, and emotional self-awareness when compared to the non-responder. According to Bar-On, problems in coping with oneâ&#x20AC;&#x2122;s environment are thought to be common among those individuals lacking in the subscales of reality testing, problem solving, stress tolerance, and impulse control. Therefore we can presume that music is not used mainly as a coping strategy as stated by some authors (Ballard,1995; North,2004), since in the case of the patient who shows a good response, there is no difference in the subscales of reality testing, and he exhibits more impulse control than the non-responder. Factors like emotional self-awareness, flexibility and empathy seem to play important roles in enabling a good prognosis in music therapy interventions.
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The responder has a score of 104 (95-112 represents possible alexithymia), in contrast to the non-responder who has a score of 142 ( greater than 113 denotes the presence of alexithymia), and the music therapist who has a score of 60 (94 and below- non-alexithymia). The non-responder is found to have difficulty identifying feelings, difficulty describing feelings, externally oriented thinking, restricted imaginative processes, and problematic interpersonal relationships. An insight into the probable etiology of alexithymia can throw some light on the reasons behind the emotional unresponsiveness which make these individuals resistant to music interventions. A neuropsychological study has indicated that alexithymia may be due to a disturbance of the right hemisphere of the brain which is largely responsible for processing emotions ( Jessimer & Markham,1997), while another neuropsychological model suggests that alexithymia may be related to a dysfunction of the anterior cingulate cortex ( Lane et. al.,1997). The French psychoanalyst Joyce McDougall(1985) introduced the alternative term â&#x20AC;?disaffectationâ&#x20AC;? to stand for psychogenic alexithymia, stating that the Fig : 2a
Fig : 2b
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disaffected individual had at some point “experienced overwhelming emotion that threatened to attack their sense of integrity and identity”, to which they applied psychological defenses to pulverize and eject all emotional representations from consciousness. He also suggested that since all infants are “by reason of their immaturity inevitably alexithymic”, the alexithymic part of an adult personality could be “an extremely arrested and infantile psychic structure”. The above findings make it clear that emotional processes should be taken into account while evaluating the outcome of music therapy interventions. More exploration involving large number of cases is needed to reinforce these findings.
References 1.Ballard M. E., & Coates S. (1995). The immediate effects of homicidal, suicidal, and nonviolent heavy metal and rap songs on the moods of college students. Youth & Society, 27(2), 148-168. 2. Bar-On, R.(1997). Bar-On Emotional Quotient Inventory: Technical Manual. Toronto, ON: Multi- Health systems Inc. 3. Bower, GH.(1981). Mood and memory. American Psychologist, 36(2), 129-148. 4. Jessimer M & Markham R (1997). “Alexithymia: a right hemisphere dysfunction specific to recognition of certain facial expressions?” . Brain and Cognition 34(2): 246-58. 5. John Pellitterri (2009). In Emotional Processes in Music Therapy. Barcelona Publishers, New Hampshire 6. Kerr T, Walsh J, and Marshall, A.(2001). Emotional Change Processes in Music-Assisted Reframing. Journal of Music Therapy,38(3), 193211. 7. Lane RD, Ahern GL, Schwartz GE, Kaszniak AW (1997). “Is alexithymia the emotional equivalent of blindsight? ”. Biol.Psychiatry 42(9):834-44. 8. McDougall,J (1985). Theatres of the mind: Truth and illusion on the Psychoanalytic Stage. New York: Basic Books. 9 .North, AC., Hargreaves D.J. & Hargreaves J.J. (2004). The uses of music in everyday life.Music Perception, 22, 63–99. 10.Paula-Perez,I.(2010). The Online Alexithymia Questionnaire (OAQ-G2). Alexitimia y sindrome de Asperger, Rev Neurol.;50 Suppl 3:S8590 11.Salovey P.,& Mayer JD.(1990). Emotional Intelligence. Imagination, Cognition, and Personality, 9, 185-211 12.Schutte, N. S., Malouff, J. M., Hall, L. E., Haggerty, D. J., Cooper J. T., Golden, C. J., & Dornheim, L. (1998). Development and validation of a measure of emotional intelligence, Personality and Individual Differences, 25, 167-177. 13.Taylor, G.J., Bagby, R.M., Luminet, O.: Assessment of alexithymia: Self-report and observer-rated scales. In Handbook of Emotional Intelligence, edited by R. Bar-On and J.D.A. Parker. Jossey-Bass: San Francisco, 2000, pp. 301-319.
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Sedative Ragas can Relieve Addiction to Sleeping Pills A Case Study from the Music Medicine Unit, MGMCRI P.Barathi * Mrs. Y, aged 35, was referred to the Music Medicine Unit to get some relief from addiction to the sleeping pill Zolpidem ( a non benzodiazepine sedative-hypnotic drug with similar effects as the benzodiazepines). This drug was prescribed for her insomnia resulting from marital discord. She had become both physically and psychologically dependent upon this medication. Whenever she tried to stop these sleeping pills, she not only had to battle a mental compulsion, but also had to go through physical withdrawal symptoms. The main danger associated with the abuse of Zolpidem is increased tolerance. The individual will feel compelled to take higher doses of the drug. This means that there is the risk of overdose. This type of drug abuse can lead to depression, and associated with it is an increased risk of suicide. There will be an obsession with ensuring a regular supply of the drug, along with a reduction in the individual’s ability to meet his/her personal and social responsibilities. Inability to reduce the sleeping pill dosage is also commonly observed. The bad sleeper convinces him/herself gradually that he/she is unable to sleep without the help of a drug. That feeling of helplessness and distrust (which can be acquired from the childhood on) is in the heart of the mechanisms of insomnia.
Disadvantages of sedative pills:
1.They conceal the natural signals of sleep and, thereby, aggravate the handicap of someone who “no longer knows what it is to feel sleepy in the evening”; 2.The increase of the sleep duration is carried out at the expense of its quality (with the disappearance of slow wave sleep); 3.The sleeping pills lose their efficiency very quickly even if they are not used every night; 4.They cause side effects during the night (sleepwalking, confusion ...) and during the day (sleepiness, tiredness, dry mouth, dizzy spells ...); 5.They are responsible for memory and attention disorders; Mrs. Y had all these symptoms of addiction to the sleeping pill. She could not get sleep even after 5mg of Zolpidem, and has to exercise vigorously so that she could become fatigued and then get some sleep. She was asked to listen to 4 night ragas which were endowed with sedative-hypnotic characteristics ( Jaijaiwanti, Pooriya, Kapi, Neelambari, in the same sequence regularly for a duration of 1hr per day for a one month period) before going to bed. The music had an easy flowing melody, and a tempo similar to the resting heart beat. It was not dissonant, pleasing to the ear, with no major changes in pitch, dynamics, or rhythm, supporting its listeners without making any demands on them. After one month of continuous listening to the music prescribed for her, she was able to cut down the dose of Zolpidem to 2.5 mg per day. Before she was exposed to music therapy, 2.5 mg/day was not sufficient for her- she used to wake up at 3am in the mornings, lying down completely awake. She was also able to overcome the feelings of hopelessness, and expressed more self confidence in her ability to deal with issues.
According to a study conducted by the Baya Karve Women’s study centre in Pune, India, such an addiction
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is common among educated women with marital discord, pertaining to the 31 to 40 age group. The study says that high levels of stress coupled with a sense of loneliness, and a failure to open up and release pent-up emotions are the contributing factors for sleeping pill addiction among women. Sometimes, old prescriptions of sleeping pills are used repeatedly without consulting the physician who initially recommended it. Extra-marital affairs and a sense of loneliness are found to be the prime emotional factors that have landed some in the red zone of addiction with an overriding feeling of self-pity. Signs that a person is having problems with sleeping medication include: difficulty falling asleep, an inability to fall asleep without the pills after months of taking them, daytime sleepiness, feeling poorly rested despite sleeping, headaches, etc. In fact, anything that makes one feel chained to the medication should set off warning bells into full swing. One should be aware that as he/she comes off sleeping pills, his suppressed REM returns and his dreams will be more vivid than usual. This will calm over time but may cause some disturbance initially.
How does music therapy help in cases with insomnia ?
For insomnia, music therapy is one of the most promising natural remedies, which has been proved to help people defeat sleepless nights. A new research carried out by the Gail C Mornhinweg, PhD has shown that music therapy is scientifically sound as it can help you to sleep better and deeper. In the study, a group of adults suffering from insomnia has been followed by the researcher for about 6 months. In the group, no one was taking medications or sleeping pills to help them sleep or trying other therapies for insomnia. All the adults involved in the study were only listening to relaxing music before going to bed. All the participants in the study excluding one have reported getting asleep faster and sleeping better and longer than normal when they listened to soothing and relaxing music previous to going to bed. Others, who were not exposed to music, reported that sleeplessness returned on the nights. The study found that approximately 80 percent of people had a positive response to music therapy which was shown to significantly boost melatonin levels. Music therapy or listening to soothing music can help you to concentrate on the sounds you hear in place of the thoughts in your mind.
Sergio Castillo-Perez et. al (2010) from Mexico preformed a controlled experiment comparing music therapy treatment to psychotherapy. In the experiment a total of 79 participants were tested to have low to medium level depression according to the Zung Depression Scale. 41 of these patients were assigned to music therapy treatment, while 38 patients were assigned to psychotherapy. Participants taking part in musical therapy treatment were asked to listen to selections of classical and baroque music for 50 minutes at home every day, as well as an additional group session at the hospital every week. Participants taking part in the psychotherapy treatment attended personalized, one on one sessions with a trained expert psychologist for 30 minutes every week. In both groups, evaluations measuring depressive symptoms were conducted weekly as well. The results after 8 total sessions were in favor of musical therapy. Out of the original 41 participants undergoing musical therapy treatment, 29 reported improvement, 4 reported no improvement, and 8 had abandoned the study. Out of the original 38 participants undergoing psychotherapy treatment, 12 reported improvement, 16 reported no improvement, and 10 abandoned the study(4). This experiment provides more evidence supporting music therapy as a legitimate treatment option for depression. The neuro-scientific basis of music therapy- a â&#x20AC;&#x153;heuristic working factor model for music therapyâ&#x20AC;?: Five factors which contribute to the effects of music therapyThese modulating factors are attention, emotion, cognition, behavior, and communication. 1) Attention modulation: Music can automatically capture attention and thus distract attention from stimuli prone to evoke negative experiences (such as pain, anxiety, worry, sadness, etc.). This factor appears to account, at least partly, for anxiety-, and pain-reducing effects of music listening during medical procedures ( Nelson et.al.,2008; Klassen et.al.,2008). 2) Emotion modulation: Studies using functional neuroimaging have shown that music can modulate activity of all major limbic- and paralimbic brain structures, that is, of structures crucially involved in the initiation, generation, maintenance, termination, and modulation of emotions. These findings have implications for music-therapeutic approaches for the treatment of affective disorders, such as depression, pathologic anxiety, and post-traumatic stress disorder (PTSD) because these disorders are partly related to dysfunction of limbic structures, such as the amygdala, Annals of SBV
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and paralimbic structures, such as the orbito-frontal cortex. This factor is also closely linked to peripheral physiological effects. Emotions always have effects on the vegetative (or autonomic) nervous system, the hormonal (endocrine) system, and the immune system. Systematic knowledge of the effects that music listening and music making have on these systems is still lacking, but because of the power of music to evoke and modulate emotions, it is conceivable that music therapy can be used for the treatment of disorders related to dysfunctions and dysbalances within these systems (Thaut MH et.al.,2009). (3) Cognition modulation: This factor includes memory processes related to music (such as encoding, storage, and decoding of musical information, and of events associated with musical experiences), as well as processes related to the analysis of musical syntax and musical meaning. This factor might contribute to the effects of music therapy on the facilitation of Alzheimer’s patients’ adaptation to residing in long term care centers (Gerdner and Swanson,1993). (4) Behavior modulation: This factor accounts for the evocation and conditioning of behavior (such as movement patterns involved in walking, speaking, grasping, etc.) with music. Modulation of behaviors and actions is likely to affect cognitive processes, and therefore cognitive processes can be modulated by the learning of different or new behavioral and action patterns. A similar relation presumably exists between actions and emotions (Gottfried Schlaug et al. and Eckart Altenm¨uller et al). (5) Communication modulation: The numerous effects of music on activity in a large variety of brain structures accounts for what is referred to as cognitization. Such “cognitization” induced by music listening could be responsible for the effects of music on the recovery of stroke patients (Forsblom et.al.,2009) Let us review some effects that are usually evoked when listening to music, and which play important roles in the emergence of beneficial effects during music therapy. These effects originate from three domains: emotion, perceptionaction mediation, and social cognition. Emotion: With regards to emotional processing, previous functional neuro- imaging studies have shown that listening to music can have effects on the activity of all limbic and para limbic structures (that is, of core structures of emotional processing) in both musicians and in non musicians. In a PET experiment, Blood and Zatorre used naturalistic music to induce extremely pleasurable experiences during music listening, such as “chills” or “shivers down the spine. Activity changes were observed in central structures of the limbic system (amygdala and hippocampus). The finding that music modulates amygdala activity is important for two reasons: First, it provides evidence for the assumption that music can induce “real” emotions (because the activity of core structures of emotion processing is modulated by music). Second, it strengthens the empirical basis for musictherapeutic approaches for the treatment of affective disorders, such as depression and pathologic anxiety, because these disorders are partly related to dysfunction of the amygdala. The network comprising amygdala, hippocampus, parahippocampal gyrus, and temporal poles has been observed in several studies investigating emotions induced by music. This suggests that these structures play a consistent role in the emotional processing of music. The activity changes in the (anterior) hippocampal formation evoked by listening to music are relevant for music therapy because patients with depression or Post Traumatic Stress Disorder show a volume reduction of the hippocampal formation (associated with a loss of hippocampal neurons, and blockage of neurogenesis in the hippocampus), and individuals with reduced tender, positive emotionality show reduced activity changes in the hippocampus in response to music. It is plausible that music therapy can help to reanimate activity in the hippocampus, prevent the death of hippocampal neurons, and lift the blockage of hippocampal neurogenesis (Sammler et.al.,2007). The hippocampus (perhaps particularly the anterior hippocampal formation) plays an important role for the generation of tender, positive emotions and happiness, and, according to several authors, one of the great powers of music is to evoke hippocampal activity related to happiness. Activity in the nucleus accumbens(or NAc innervated by dopaminergic brain stem neurons located mainly in the ventral tegmental area of the midbrain) has been shown to correlate with self-reported positive emotion elicited by a reward cue. It has been suggested that, in humans, NAc activity corresponds to experiences of “fun” (which should be differentiated from experiences of “happiness”). Music therapy can make use of such experiences, for example to elevate the mood in individuals with mood disorders ( Koelsch et.al.,2006). It is important to add that emotional processes always have effects on the vegetative nervous system, as well as on the hormonal system, which, in turn, modulates immune system activity. All these effects are potentially relevant for music-therapeutic applications because they open the possibility for using music to achieve beneficial effect in patients with autonomic, endocrine, or (auto)immune disorders. Perception-action mediation: The premotor cortex is a critical structure for perception-action mediation. Premotor Page 67
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activity during listening to music is modulated by the emotional valence of the music, suggesting that perception-action mediation is modulated by emotional processes (Haslinger et.al.,2005) . Music perception evokes a number of actionrelated processes. Perception-action (“mirror”) mechanisms are relevant for music therapy, because these mechanisms serve the learning of actions, the understanding of actions, and the prediction of actions of others. Activation and training of perception-action mechanisms can be used in patients with neurologic disorders: for example, melodic intonation therapy can help patients with Broca’s aphasia to regain language production, and music can be used in various ways for the recovery of fine and gross motor skills in stroke patients (Eckart Altenm¨uller et. al). The premotor cortex is also involved in a number of cognitive functions. The rehearsal of verbal information relies in part on premotor activity. Other cognitive functions in which the premotor cortex is involved comprise the analysis, recognition, and prediction of sequential auditory information, and—perhaps related to this—the processing of musical structure (or musical syntax). Social cognition and music: Listening to music automatically engages areas dedicated to mental state attribution (in the attempt to understand the composer’s intentions). Studies have shown that the meaning of music may be derived in part from the understanding that every note reflects an intentional act, which signals personal relevance to the artist representing a communication between the creator and the perceiver of the music. A study on the therapeutic effects of music making for individuals with impulsive aggression or moderate intermittent explosive disorder has revealed that music and music therapy has beneficial effects on the psychological and physiological health of individuals ( Koelsch et.al.,2008).Since music listening activates a multitude of brain structures involved in cognitive, sensori-motor, and emotional processing, we can understand that it can easily modulate and induce changes in the activity of the neuronal networks involved in sleeping pill, alcohol and other addictions. Indian ragas endowed with sedative characteristics are capable of harmonizing the activity in these neuronal structures by modulating the dysfunctions arising out of addiction and drug abuse.
References 1.Altenm¨uller, E., J. Marco-Pallares, T.F. M¨unte & S. Schneider. 2009. Neural reorganization underlies improvement of stroke-induced motor dysfunctions by music-supported therapy. Ann. N. Y. Acad. Sci. Neurosciences and Music III–Disorders and Plasticity.1169: 395–405. 2.Blood, A. & R.J. Zatorre.( 2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proc. Natl.Acad. Sci. USA 98: 11818–11823. 3.Castillo-Perez, Sergio, Virginia Gomez-Perez, et al. “Effects of music therapy on depression compared with psychotherapy.” Arts in Psychotherapy. 37.5 (2010): 387-391. 4.Forsblom, A., S. Laitinen, T. S¨ark¨am¨o & M. Tervaniemi.(2009). Therapeutic role of music listening in stroke rehabilitation. Ann. N. Y. Acad. Sci. Neurosciences and Music III–Disorders and Plasticity.1169: 426–430. 5.Gail C Mornhinweg (2009); Creating Balance in a World of Stress: Six Key Habits to Avoid in Order to Reduce Stress.. Susan J. Del Gatto( Ed.) Bloomington,IN ,USA. 6. Gerdner, L.A. & E.A. Swanson. 1993. Effects of individualized music on confused and agitated elderly patients. Arch.Psychiatr. Nurs. 7: 284–291. 7. Haslinger, B., P. Erhard, E. Altenm¨uller, et al. 2005.Transmodal sensorimotor networks during action observation in professional pianists. J. Cogn. Neurosci. 17:282–293. 8.Klassen, J.A., Y. Liang, L. Tjosvold, et al. 2008. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambul. Pediatr. 8: 117–128. 9 . Koelsch, S., T. Fritz, D.Y. von Cramon, et al.( 2006 ). Investigating emotion with music: an fMRI study.Hum. Brain Mapp. 27: 239–250. 10. Koelsch, S., D. Sammler, S. Jentschke & W.A.Siebel. 2008. EEG correlates of moderate Intermittent Explosive Disorder. Clin. Neurophysiol. 119: 151–162. 11. Nelson, A., W. Hartl, K.-W. Jauch, et al. 2008. The impact of music on hypermetabolism in critical illness.Curr. Opin. Clin. Nutr. Metab. Care 11: 790–794. 12. Sammler, D., M. Grigutsch, T. Fritz & S. Koelsch.2007. Music and emotion: electrophysiological correlates of the processing of pleasant and unpleasant music. Psychophysiology 44: 293–304. 13. Schlaug, G., S. Marchina & A. Norton. 2009. Evidence for plasticity in white matter tracts of chronic aphasic patients undergoing intense intonation-based speech therapy. Ann. N. Y. Acad. Sci.Neurosciences and Music III–Disorders and Plasticity. 1169: 385–394. 14. Thaut,M.H., J.C. Gardiner, D.Holmberg, et al.(2009) Neurologic music therapy improves executive function and psychosocial function in traumatic brain injury rehabilitation. Ann. N. Y. Acad. Sci. Neurosciences and Music III–Disorders and Plasticity. 1169: 406–416.
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Rag Bilaskhani Todi Relieves Psychological Distress in Adolescents with Increased Neuroticism and Decreased Agreeableness P.Barathi * Introduction
Music is widely used for three different purposes, viz., emotional use ( the extent to which music is used for inducing moods that change an individual’s experienced emotionality), cognitive or intellectual use of music ( the extent to which an individual listens to music in an analytical and intellectual manner), and background or social uses of music.1 Music’s emotional affect, which is people’s primary motivation for listening, may prepare them to act on prevailing conditions to attain or maintain a state of well-being.2For adolescents, the major gratification they get from music is the relief of tension and diversion from concerns.3Music can evoke powerful emotional reactions in people, and listening to music affects the emotional and cognitive experience of an individual as well as physiological arousal.4 It has also been stated that music is used as a coping mechanism in emotionally unstable individuals, in contrast to those scoring high on emotional stability who are even tempered, and therefore may not need music to cope with emotions.5,6 According to certain authors, the three factors regarding the use of music( emotional, cognitive and social) are associated with the Big Five personality traits (Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness),7 the above studies confirming that there are a number of personality predictors of music use, which may generalize across cultures. These authors have reported that positive correlations exist between Neuroticism and emotional use of music, and Openness to Experience and cognitive or intellectual use of music. A study conducted in Malaysia by Chamorro-Premuzic et al. has found that individuals higher in Neuroticism are more likely to use music for emotional regulation.8 The positive association between Neuroticism and reports of using music for emotional regulation is consistent with the idea that individuals higher in Neuroticism experience higher intensity of emotional affect, especially negative emotions.9
The Big Five personality traits provide a comprehensive profile of an individual’s behavioral tendencies, including their consistent affective and cognitive patterns, and though several studies have examined the relationship between personality factors and musical taste,10,11 to date no references are available regarding the association between personality traits and response to music therapy. The present study was carried out to determine whether there are any definitive links between the different personality traits and response to music therapy using classical Indian ragas.
Aim of the study
To determine the association between the Big Five personality traits and response to music therapy based on classical Indian ragas, as evaluated by the improvements in self-rated anxiety and depression scores before and after music administration.
Materials And Methods
28 adolescent students (15 males, 13 females) who recently joined the medical career with signs and symptoms of clinical anxiety and depression as evaluated by the Self- Rating Scale for Anxiety and depression (SAS and SDS) devised by Zung12, 13 were chosen for the study. Written informed consent was obtained from all the participants. The exclusion criteria included chronic physical ailments such as hypertension, obstructive pulmonary disease, diabetes, or history of drug abuse. The anxiety and depression scores before and after 21 days of music administration (30 minutes twice a day, through head phones ) were compared. The personality traits of the students was assessed using the NEOFFI of Costa & Mc Crae.14Association between the personality traits and the difference in anxiety and depression
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scores before and after 21 days of music listening was calculated using Pearson’s Correlation Coefficient. The results have been tabulated below: Results Correlation with SAS N E O A C r = 0.32* 0.02 0.2 - 0.31* 0.15 Correlation with SDS r = 0.16 0.04 0.1 - 0.3* 0.05 * denotes significant correlation coefficient. Table-1
Discussion
The results from our study indicate that response to music therapy is associated with the personality traits of Agreeableness and Neuroticism among students of the adolescent age group. Significant negative correlation exists between those with low scores on the Agreeableness scale and indices for anxiety and depression ( r= -0.3 for anxiety scores; r= -0.2 for depression scores). Positive correlation is found to exist between those with high scores on the Neuroticism scale (r=0.3 for anxiety scores ) and improvement in the anxiety indices when assessed before and after the music therapy sessions. The low correlations could be attributed to the small sample size, which, if increased may yield more significant associations. It is thus evident that participants with low Agreeableness and high Neuroticism scores demonstrate a good response to music therapy using classical ragas. While Neuroticism has been linked to brain mechanisms associated with avoidance, fearful temperaments, or negative emotionality, low Agreeableness is associated with lack of consideration for others and decreased empathy.14,15 Both the above characteristics being linked to negative emotional states, the notion that music is used as a coping strategy is reinforced, as emotionally stable people are believed to be even tempered and not the type to let things get them; therefore they may not need music to cope with emotions. This could be the reason for the lack of good response to music therapy observed in participants with personality traits not related to negative emotionality. The increased receptivity for music therapy in those individuals with elevated Neuroticism and decreased Agreeableness may be connected with their emotional experience induced during music listening. Though autonomic and electrophysiological recordings have provided time-sensitive biological markers for emotion perception in music,16,17 the degree to which biological markers predict the multidimensional psychological experience of musical emotion is unclear. Scherer18 put forth the component process model of emotion which consists of the “emotion response triad” of physiological arousal, motor expression, and subjective feelings. Further, a given song might elicit one emotion from participant A and a completely different sentiment from participant B,17 and these variations have been correlated with potential personality differences.19
The above findings have been reinforced by recent studies which have suggested possible connections between Agreeableness and emotion.20 In a study conducted by Tobin et al.,21 both Neuroticism and Agreeableness emerged as significant predictors of emotional experience, when the participants’ degree of emotional perception was assessed using standard psycho- physiological methods for examining responses to both positively and negatively charged emotional materials. Participants lower in Agreeableness rated the psycho-physiological measures as more pleasant than did participants higher in Agreeableness when positively charged emotional measures were used. They concluded that Agreeableness was related to nonverbal psycho-physiological measures of emotional responses. According to Rothbart and Bates,22 individual differences in Agreeableness may have their origins in temperament systems that control reactions to frustration. Therefore we can hypothesize that a good response to music therapy using pleasant, soothing classical ragas infused with love and compassion, is associated with the inherent personality traits, namely Agreeableness and Neuroticism. The findings from the above study reinforce the fact that the brain is built to changes in response to mental training due the phenomenon of neural plasticity, and therefore it is possible to train a mind to be happy in those individuals endowed with personality traits linked to negative emotional states. More studies involving the association between the personality traits which are genetically determined, and receptivity to music therapy are needed to validate these findings.
References
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Ann. SBV, July - Dec, 2013 2(2) 1. Chamorro- Premuzic T., & Furnham A. (2007). Personality and music: Can traits explain how people use music in everyday life? British journal of Psychology, 98, 175-85. 2. Krumhansl C. L. (2002). Music: A link between cognition and emotion. Current Directions in Psychological Science, 11, 45-50. 3. White A. (1985). Meaning and effects of listening to popular music: Implications for counseling. Journal of Counseling and Development, 64, 65-69. 4. Labbé E., Schmidt N., Babin J., & Pharr M. (2007). Coping with stress: The effectiveness of different types of music. Applied Psychophysiology and Biofeedback, 32, 163-168. 5.Ballard M. E., & Coates S. (1995). The immediate effects of homicidal, suicidal, and nonviolent heavy metal and rap songs on the moods of college students. Youth & Society, 27(2), 148-168. 6. North, AC., Hargreaves D.J. & Hargreaves J.J. (2004). The uses of music in everyday life.Music Perception, 22, 63–99. 7. Dollinger S., (1993). Personality and music preference: Extraversion and excitement seeking or openness to experience ? Psychology of music, 21, 73-77. 8. Chamorro-Premuzic, Swami V., Furnham A, and Maakip I (2009). Journal of Individual differences, 30(1): 20-27. 9. Costa and Mc Crae, (1992). 10.Schwartz, K.D. & Fouts, G.T. (2003). Music preferences, personality style, and developmental issues of adolescents. Journal of Youth and Adolescence, 32, 205–213. 11. Little P.,& Zuckerman M. (1986). Sensation seeking and music preferences. Personality and Individual Differences, 7, 575-577. 12. Zung WWK.(1971) A rating instrument for anxiety disorders. Psychosomatics. ; 12(6): 371-379 13. Zung, WW (1965). “A self-rating depression scale”. Archives of General Psychiatry 12: 63–70. 14. Costa PT., Jr.,& Mc Crae RR (1992). NEO PI-R and NEO-FFI professional manual. Odessa, FL: Psychological Assessment Resources, Inc. 15. Peabody D.; Goldberg L.R. (1989). “Some determinants of factor structures from personality-trait descriptors”. Journal of Personality and Social Psychology : 57 (3): 552–567. 16. Bernardi L., Porta C., & Sleight P. (2006). Cardiovascular, cerebro-vascular, and respiratory changes induced by different types of music in musicians and non-musicians: The importance of silence. Heart, 92, 445-452. 17. Blood, A J., & Zatorre, R J. (2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences, 98, 11818-11823. 18. Scherer KR. (2004). Which emotions can be induced by music? What are the underlying mechanisms? And how can we measure them? Journal of New Music Research, 33, 239-251. 19. Rentfrow PJ., & Gosling SD. (2003). The do re mi’s of everyday life: The structure and personality correlates of music preferences. Journal of Personality and Social Psychology, 84, 1236-1256. 20. Graziano, WG., & Eisenberg, N.(1997). Agreeableness: A dimension of personality. In R. Hogan, J. Johnson, & S. Briggs (Eds.), Handbook of personality psychology, pp. 795-824. San Diego, CA: Academic Press. 21. Tobin RM, Graziano GW, Vanman EJ, and Tassinary LG, (2000). Personality, Emotional Experience, and Efforts to Control Emotions. Journal of Personality and Social Psychology: 79(4), 656-669. 22. Rothbart MK., & Bates J. (1998). Temperament. In W. Damon ( Series Ed.) & N. Eisenberg ( Vol.Ed.), Handbook of child psychology: Vol.3, Social, emotional, and personality development ( 5th ed., pp.105-176). New York: Wiley.
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Rag Hamsadvani Relieves Fatigue and Elevates The Mood of Listeners A Case Study From The Music Medicine Unit, MGMCRI P.Barathi * Mr. S, a 46-year-old, married male with persistent fatigue, muscle pain, and insomnia was referred to the Music Medicine Unit. To identify the cause of his fatigue, routine blood test along with thyroid, liver, and renal functions were performed. However, nothing abnormal was detected. Additional laboratory evaluations were also carried out to rule out systemic infections. The fatigue persisted for about 6 months, could not be relieved by rest and a concrete medical diagnosis could not be arrived at. Because he had only 2 accompanying symptoms (sleep dysfunction and musculoskeletal pain), he did not meet all of the criteria for Chronic Fatigue Syndrome (CFS) and his fatigue was diagnosed as Idiopathic Fatigue Syndrome (ICF). The Piper Fatigue Scale (PFS)1 was used to assess the severity of his fatigue. The PFS is composed of 22 numerically scaled, “0” to “10” items that measure four dimensions of subjective fatigue: behavioral/severity (6 items); affective meaning (5 items); sensory (5 items); and cognitive/mood (6 items). These 22 items are used to calculate the four sub-scale/dimensional scores and the total fatigue scores. The severity codes range from “0” or “none”, 1-3 (mild), 4-6 (moderate) to a score of 7-10, which is designated as severe in intensity. Rag Hamsadvani was administered through head phones for 40 min, everyday in the morning at 10 am, for a duration of 1 month. To facilitate continuous listening, he was given the music CD to listen at home, whenever he was unable to come to the MMU for listening to the music. After 1 month of continuous listening, his fatigue score came down from 7 (severe) to 4 (moderate). There were also considerable changes in his lifestyle. Before the therapy he stated, “I never feel refreshed after waking up in the morning”, ‘I am not able to remember things properly”, “In the daytime, I am constantly feeling the desire to sleep”. After 4 weeks of listening to Rag Hamsadvani, he no longer complained of severe fatigue, and his family noticed that he was much more lively and energetic than before.
About Rag Hamsadvani
Rag Hamsadvani radiates positive energy imbibed with vitality, enthusiasm and optimism. Sri Muthuswamy Dikshitar, one of the trinities of South Indian Carnatic music, has composed a kriti in Hamsadvani, ‘Vatapi ganapathim’, which is played at the beginning of musical concerts to enliven the audience. In this composition, he glorifies Lord Ganesha as destroying all sadness/obstacles. It is interesting to note that most of the compositions in Hamsadvani by various composers is based on an invocation to Lord Ganesha, who is the Lord responsible for clearing all obstacles and hindrances, and is therefore invoked for auspiciousness at the beginning of any event.
The nature of emotion evoked on listening to Rag Hamsadvani- joy, happiness, enthusiasm. Hamsadhvani literally means ‘Sound of Swans’. It has a pentatonic scale, which is a derived scale, as it does not have all the seven musical notes. Hamsadhvani does not contain Ma (madhyamam) or Dha (dhaivatam). ārohana or ascent: S R2 G3 P N3 S avarohana or descent: S N3 P G3 R2 S This rag instills joy and happiness in the mind of listeners.
Other factors responsible for relief from fatigue 1) Certain elements within the music, such as a change of melodic line or rhythm, that create expectations about
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the future development of the music. The expectation the listener has about the further course of musical events is a determinant for the experience of `musical emotions. Music arouses expectations, which may or not be directly and immediately satisfied. The greater the build-up of suspense of tension, the greater the emotional release upon resolution 2. The primary dimension on which emotion is experienced is in terms of a build-up of tension and release of tension, both within the music and in the listener. The more elaborate the build-up of tension to a certain climax, the more intense emotions will be experienced. When resolution follows, relaxation follows. 2) A `naive’ listener without much music theoretical knowledge has a predominant affective response towards music whereas a trained listener reacts mostly cognitively while listening to music 3 . 3) Both Berlyne 4, Mandler5 see arousal as an important factor in emotional experiences while listening to music. A typical example of physical experiences reported when listening to music is the experience of thrills. Goldstein6 illustrated that thrills were experienced by 96% of the subjects. Such a thrill can be experienced, when Hamsadvani is played, accompanied by a fast rhythm. This may be responsible for the mood elevation induced on listening to this rag. To conclude, Rag Hamsadvani may have a potential positive effect on ICF, and it can be used as an alternative treatment of choice for patients with ICF. Well-designed clinical trials including randomized controlled trials with large number of participants are necessary to assess the exact mechanisms involved.
Other benefits of listening to Rag Hamsadvani
Mr. Y was referred to the Music Medicine Unit with the complaints of extreme anxiety, palpitations and dyspnea, after her son met with a brain injury in a road traffic accident. She was found to have a normal ECG, and her lung function tests did not reveal any abnormality. She was diagnosed as suffering from anxiety due to her son’s poor prognosis. She was administered Rag Hamsadvani at a speed of 42/mt (the speed of the patient’s breath rate) for a duration of 15 mts, followed by the same Rag at a speed of 12/mt. Her breath rate gradually subsided to a count of 16/mt.
The role of Entrainment in Music Therapy:
Entrainment is one thing time locking into another7. In the 1700’s German scientists, working with grandfather clocks in their workspace, left one night after setting the clocks, noticing all the clock’s pendulums were swinging randomly. The next morning they found that all of the pendulums were swinging together, again, one thing time locking into another. Entrainment is a natural phenomenon of physics. With this idea of entrainment, the music therapist matches, for example, the music’s tempo to the patient’s breath rate (heart rate or mood can also be considered). Entrainment is complete when the music therapist can affect change in the patient’s physiology through musical variation. Example: If a painful patient is anxious and breathing rapidly, the music therapist will play (live) music at the speed (tempo) that matches the patient’s rapid breath rate. When it is noticed that the patient is focused on the music, the music therapist will gradually begin to slow the music down, thereby effectively slowing the patient’s breath rate at the same time. This completes the entrainment process. Entrainment is also very effective for pain management. In an entrainment study Rider used different types of music and imagery to reduce pain and effect muscle relaxation. The entrainment music, which was one of five conditions in which the prevalent mood shifted from tension to relaxation, was significantly the most effective condition in reducing pain and EMG levels. One key to music’s well-documented positive effects on pain management and entrainment is preferred music. Through assessment, the music therapist will help the patient (or family) identify music that will elicit positive, euphoric or sedative responses. Or very simply, what music does the patient have the most positive associations? When we can identify music that elicits feelings and emotions of past positive experiences, the patient can use these conditioned responses to override feelings of anxiety and pain. Because of its pentatonic structure and non-complicated ascent and descent, this rag can be ideally used for entrainment purposes. Page 73
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References 1. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. (1998 ). The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum ;25(4): 677-84. 2. Meyer, Leonard B. (1956). Emotion and meaning in music. Chicago: Chicago Press. 3. Jansma, Mireille & Vries, Bart de (1995). Muziek en emotie (pp. 204-222). In: Evers, Jansma, Mak, De Vries (Eds). Muziekpsychologie. Assen: Van Gorcum. 4. Berlyne, Daniel Ellis (1971). Aesthetics and psychobiology. New York: Appleton Century-Crofts. 5. Mandler, George (1984). Mind and body: Psychology of emotions and stress. New York: Norton. 6. Goldstein, Avram (1980). Thrills in response to music and other stimuli. Physiological Psychology, 8, 1, 126-129. 7. Rider, M.S., Floyd, J.W., & Kirkpatric, J. (1985). The effect of music, imagery, and relaxation on corticosteroids and the re- entrainment of circadian rhythms. Journal of Music Therapy, 22(1), 46-58.
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Ragas can Modulate Circadian Rhythms P.Barathi * Biological rhythms control much of the body’s normal functions, including performance, behavior, sleep and endocrine rhythms. These functions are primarily regulated by the circadian clock, a cluster of nerves located on the hypothalamus in the brain. The circadian clock relies on environmental cues to regulate its function, primarily light cues from the day/night cycle. Abrupt shifts in routine, such as shift changes, or travel resulting in jet lag can alter the sleep cycle and have a detrimental effect on normal circadian rhythms. Additionally season changes, which are accompanied by a decrease in the number of daylight hours, can negatively impact the function of the circadian clock, primarily the secretion of melatonin to induce sleep. If the alterations in biological rhythms are strong enough they may lead to mood disorders including mild depression and seasonal affective disorder. There are two major categories of biological rhythms, endogenous, and exogenous. Endogenous rhythms come from within and are regulated by the organism itself, for example the body temperature cycle. Exogenous rhythms are the result of external factors, such as a change in the seasons, or the transition from day to night. Environmental stimuli that help to maintain these cycles are called zietgebers, which comes from German and translates as “time givers.” Zietgebers include sunlight, noise, food, and even social interaction, all cues that help the biological clock maintain a 24-hour day. There are four categories of biological rhythms that extend beyond just classifying them based on internal and external sources. This system maintains that criteria, but extends to include the duration of the cycle as a defining factor. The resulting categories are circadian rhythms, diurnal rhythms, ultradian rhythms, and infradian rhythms. Circadian rhythms: Circadian rhythms are defined as endogenous rhythm patterns that cycle on a daily (approximately 24 hour) basis under normal circumstances. The circadian cycle regulates changes in performance, endocrine rhythms, behavior and sleep timing (Duffy, Rimmer, & Czeisler, 2001). More specifically these physiological and behavioral rhythms control the waking/sleep cycle, body temperature, blood pressure, reaction time, levels of alertness, patterns of hormone secretion, and digestive functions. Due to the large amount of control of the circadian rhythm cycle it is often referred to as the pacemaker. Two specific forms of circadian rhythms commonly discussed in research are morning and evening types. There is a direct correlation between the circadian pacemaker and the behavioral trait of morningness-eveningness (Duffy et al., 2001). People considered morning people rise between 5 a.m. and 7 a.m. go to bed between 9 p.m. and 11 p.m., whereas evening people tend to wake up between 9 a.m. and 11 a.m. and retire between 11 p.m. and 3 a.m. The majority of people fall somewhere between the two types. Evidence has shown that morning types have more rigid circadian cycles evening types, who display more flexibility in adjusting to new schedules (Hedge, 1999). One theory is that evening types depend less on light cues from the environment to shape their sleep/wake cycle, and therefore exhibit more internal control over their circadian rhythms.
Mood Disorders and Biological Rhythms
Mood disorders are characterized by opposite polar moods: depression, which involves extreme feelings of sadness and dejection, and mania, which involves unrealistic feelings of excitement and joy. There are a variety of unipolar mood disorders, which involve mania or depression, and bipolar disorders, which are characterized by both mania and depression.
Sleep and Depression
The circadian clock is responsible for controlling sleep patterns. Melatonin secretion from this region of the brain actually induces sleep. Commonly depressed patients experience a wide variety of sleep disorders. It should come as little surprise then that there is a connection between disruptions of the circadian cycle and depressive disorders. Generally a decreased amount of deep sleep per night comes just before the onset of depression. Therefore a drastic change in sleep schedule caused by extensive occurrences of jet lag, or multiple shift changes may result in a disruption of circadian rhythm function. In these instances it is possible for the circadian clock to induce REM sleep 15 to 20 minutes
*
* Dr.P.Barathi, M.D., Prof of Physiology, Music Therapist e-mail : iyer.bharthi@gmail.com Page 75
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earlier in the sleep cycle, resulting in decrease in the amount of deep sleep, and ultimately leading to the beginning stages of depression (Butcher, Mineka, & Hooley, 2004). In order to help prevent disruptions in the circadian sleep cycle it is important to maintain a regular sleep schedule, which includes retiring and waking at approximately the same time each day, and sleeping a consistent number of hours each night. This is especially important for people with morningness tendencies because their circadian cycles are less adaptable to changes in behavior.
Seasonal Affective Disorder
In recent years psychologists have recognized the impact of seasonal changes on mood and behavior. Seasonal affective disorder (SAD) is a unipolar mood disorder in which patients are highly responsive to the total amount of light available in the environment. Individuals who suffer from seasonal affective disorder show signs of depression during the fall and winter months when there are fewer hours of sunlight each day. Disturbances in mood are the main psychological component of seasonality (Ennis & McConville, 2004). Persons suffering from seasonal depression generally show an increase in appetite and hypersomnia, which oddly is opposite of the behavior normally associated with most other forms of depression. This behavior is consistent with research conducted on animals and may be related to baser survival instincts. The explanation behind this theory is that like some animals people may have a natural tendency towards increasing fat stores in the body during the winter, as well as sleeping more often in order to preserve energy levels. Several more recent studies suggest that sufferers of seasonal affective disorder display disturbances in their circadian cycles, as indicated by less consistent rhythm patterns. A common therapy used to treat seasonal affective disorder is light exposure therapy (Oren & Rosenthal, 1993). Though the effects of light exposure are not completely understood it has been shown that the presences of either natural or artificial light seems to work towards correcting circadian disturbances caused by seasonality.
Conclusion
There are four types of biological rhythms that regulate cycles within the body. The primary type, circadian rhythms, controls performance, endocrine rhythms, behavior and sleep timing, and is regulated by the circadian clock, a collection of nerves located on the hypothalamus. Diurnal Rhythms are a specialized form of circadian rhythms, which are closely synchronized with day and night cycles. Both cycles have a duration of approximately 24 hours. Ultradian rhythms are biological rhythms, which operate on a shorter time scale than circadian rhythms, feeding schedules for example. Infradian rhythms are those with cycles longer than 24 hours, the most commonly studied example is the human menstrual cycle. Although all of these biological rhythms are controlled internally there are a number of external factors that are capable of influencing their regularity. Some of the most prominent examples are exposure to light, specifically the changes caused by seasonal transitions, alterations in work shift which change sleeping schedules, jet lag, and caffeine. With the exception of light affects the other influencing factors cause sleeping patterns to change. Due to the fact that circadian rhythms can only shift one to two hours each day drastic changes in sleep patterns can have a detrimental effect on the circadian clock. Seasonal changes cause an alteration in the amount of light that individuals are exposed to. During the months where the days are shorter, primarily in the winter, circadian patterns are disrupted. The reason is that the circadian clock is programmed to release melatonin to induce sleep, a function that is initiated by darkness. Because the sun sets earlier in winter months this reaction begins occurring earlier in the evening, which results in a disrupted sleep pattern, a common problem for depressed patients. Individuals with Seasonal affective disorder are more likely to experience the affects of this change, and are prone to an increased amount of sleep, known as hypersomnia, and an increased appetite. There is still a great deal that is not known about the relationship between biological rhythms and mental and physical health disorders, however there is enough existing evidence to support further study in this field. By gaining a better understanding of the rhythms and environmental factors that influence them it is possible to begin making connections to mood disorders. Once the link can be traced it is possible that new treatments may develop which are designed to correct disruptions in biological rhythms, or perhaps even prevention methods, which help to avoid major disruptions.
The moods expressed by ethnic Indian ragas
Music and mood can never be separated, since all music expresses, strongly or softly, a certain emotion or a mixture of emotions. In music psychology, eight clusters of moods devised by Hevner are being used popularly, viz., majestic, Annals of SBV
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passionate, happy or joyous, humorous, tranquil, yearning or longing, sad or mournful, and solemn or sober. Music listeners experience some sort of affective responses, which can be employed for therapeutic or healing purposes. In Indian musical tradition, a musical mode is known as a raga, each raga being associated with a particular emotion, time of day, and season of the year. The moods inherent in ragas have been depicted through paintings, known as ragamala pictures. Nine primary moods or ‘rasas’ ( meaning juice or sap) are in vogue in Indian classical music. The nine ‘rasas’ include: 1) Sringara -love, joyful, happy. 2) Karuna -sadness, longing, grief, resigned acceptance. 3)Shanta – peace, tranquility. 4) Vira -noble, dignified, energetic, warrior like 5) Adbhuta -wonder, surprise, astonishment 6) Hasya -laughter, humor 7) Abhyanka –fear, terror 8) Krodha -anger 9) Vibhatsa –disgust, revulsion Let us glean an insight into some of the moods expressed by Indian ragas, their favoured time and season for listening, etc.: Rag Kedar ( Hindustani )- is a serious and contemplative raga which is represented in ragamala paintings as an ascetic in meditation, and is meant to be played on a winter night. Raga Shri ( Hindustani )- conveys a mood of love and is meant to be heard on a late afternoon in winter. Rag Bilawal ( Hindustani )- ‘Shanta Rasa’ - Serene, quiet, peaceful, meant to be played in the early hours of the morning. Rag Bhairavi ( Hindustani)- ‘Gambhir’ – Serious, Timing - Evening. Sri Ragam ( Carnatic) - evokes devotion/bhakti and is an ‘auspicious raga’. Rag Darbar (Carnatic ) - conveys a majestic mood. Ragas Behag and Khamas ( Carnatic) - exude Sringara rasa. Some interesting facts about the moods pertaining to Indian ragas Rags Sankarabaranam and Kalyani represent the ascetic-erotic duality of Lord Siva: The paradoxical duality of Lord Siva, ascetic-erotic, creative-destructive, good-evil, is also represented musically, as is evident in the following two Thaats prevalent in Hindustani music- Bilawal Thaat and Yaman Thaat. Kukubh Bilawal ( Sankarabaranam in Carnatic music) portrays a light and mood-elevating atmosphere, while simultaneously inducing a state of tranquility- akin to Siva’s ascetic state. Hindola, an offspring of Yaman Thaat ( Kalyani in Carnatic music) evokes the rasa of Sambhoga Sringara, i.e. love tainted with eroticism, signifying Siva’s erotic nature. Kalyani differs from Sankarabaranam only because of Ma2, all the notes being similar. Ma1 in Sankarabaranam has a frequency value of 498 cents, while Ma2 in Kalyani has a value of 590 cents, a small interval of less than 100 cents making all the difference between the emotions evoked by both the ragas.
References 1. Duffy, J. F., Rimmer, D. W., & Czeisler, C. A. (2001). Association of intrinsic circadian period with morningness-eveningness, usual wake time, and circadian phase. Behavioral Neuroscience, 115, 895-899. 2. Hedge, A. (1999). Biological rhythms: DEA 325. Retrieved January 18, 2005 from Cornell University 3. Butcher, J. N., Mineka, S., Hooley, J. M., (2004). Abnormal psychology (12th ed.). New York: Allyn & Bacon. 4. Ennis, E., & McConville, C. (2004). Stable characteristics of mood and seasonality. Personality and Individual Differences, 36, 1305-1315.
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Annals of SBV Sri Balaji Vidyapeeth
(D eemed
to be
U niversity , u / s 3, UGC A ct , 1956)