Special issue with the Sunday Magazine
Well-being : March 12, 2000
Yoga and modern medicine
Dialogue: Dr. Uma Krishnaswamy talks to T. K. V. Desikachar
The achievements of modern medicine are spectacular to say the least. From organ transplants at the macro-level to genetic engineering at the micro-level, there can be no doubt whatsoever, that the edifice of modern medicine in its totality is one of the stupendous achievements of the collective scientific temper of mankind, perhaps best exemplified by putting a man on the moon.
Yet, as patients at the receiving end, we know all too well that this system of healing is far from perfect and that there are large hiatuses in addressing many common ailments: Arthritis, ischaemic heart disease and cancer, to mention but a few. While there is every possibility that ongoing research may well provide solutions for such problems in the future, what does one do in the interim period?
We are aware that many of the existing problems of modern medicine stem from a largely reductionist philosophy which has been relentlessly driving it in the past. A single defect at a molecular level cannot be overcome by a single external solution, however intellectually seductive such an idea may be.
Nor is it always sensible to seek external solutions, in lieu of solutions lying within the inner world of the human being. The truth that the human body is a powerhouse of healing is only now being recognised within the perspective of modern science and means are being explored to tap these hidden resources.
Nor indeed can one rely solely on chemical or physical solutions to tackle the soma while disregarding the psyche. There is a growing realisation within the bastion of orthodox medical research of the indivisibility of the three dimensions of the syncytium of life, physical - emotional - spiritual, set in the fourth dimension of time.
The merit of these viewpoints has been gathering weight and momentum slowly within the modern medical establishment and its research wing. This internal process of intellectual refinement can be seen externally in the progressive "greening" of modern medicine and surgery and the increasing dialogue between it and other systems of healing.
These dialogues tend to be amicable or abrasive, useful or unproductive depending not merely on the intellectual basis of the systems of healing in question, but largely on the intellectual and emotional flexibility, humility and honesty of those engaged in the dialogue.
The perception of many systems of healing as disparate or antagonistic is sadly an artifact of the intellectual arrogance of the respective practitioners. If these baser instincts and emotions are set aside, one automatically realises that a system of healing is greater than the practitioner of that system and that each system has a framework that is worthy of respect if not reverence.
Where there is reverence, there is a zeal to find resonance in thought and action. The rule here is simple: accept the individual and his current modality of treatment as an inseparable whole. And offer only that which will help and heal this whole, composite entity. The corollory to this is that if one cannot afford such a solution it is essential to admit one's inability honestly at the earliest opportunity.
Commercial concerns tend to often blunt ethics in such circumstances and all too often there is a temptation to use base tactics to wean the patient to one's preferred system of healing. Needless to say, it is a moral imperative to refer the patient to another practitioner of superior merit or to another "complementary" system of healing.
Having found a resonance of thought in a "complementary" system of healing, how does one translate mere thinking to a practice? The fundamental rule that governs all such composite solutions is that "one size" cannot fit all. Here lies the difficulty, for individualisation in approach cannot exist unless there is complete and true empathy between the "healer" and the patient.
To elaborate: a Yoga teacher is no doctor. He does not understand in medical terms what a "Spondylolisthesis" is or what "Bronchial Asthma" is. But he is sensitive and cognisant of the impact of these diagnostic labels on his student, both in body and mind: "low back pain" or "breathlessness", "irritability" from chronic and unrelieved pain or "depression" from an inability to play games!
In this process of understanding and cooperation therefore one may say categorically that the human factor is paramount in creating sycretism and hence an eventual synergy in the combined solutions. It is of interest that one such consistently synergistic therapeutic modality has been the combination of modern medicine with yoga.
This is particularly intriguing because yoga is not a mere system of physical healing, but a way to mental clarity and a path to the higher self. What is the secret of this unexpectedly amicable and cordial relationship between yoga and modern medicine?
While it is patently obvious that there is no identify of thought and deed between these two systems, there is yet an inexplicable congruence when the systems impact on an individual patient transcending the human factor of the doctor on the one hand and the yoga teacher on the other.
Where is the common ground for these apparently diverse systems of knowledge? How do they find a resonance of thought and action? How are these solutions being applied to a specific illness or combination of illnesses in an uniquely individual patient in practice? What are the pitfalls? What are the unexpected bonuses of such an approach? And what of the human equations which lie behind such approaches?
The first, and apparently the most difficult question in fact is the only one that can be answered with ease: the common ground enjoyed by all systems of healing however diverse, is their intense compassion for and desire to help and heal the sick.
Like raindrops finding their way ultimately to the same ocean, through many geographically distinct and distant rivers, all systems of healing are united in their common goal.
These issues are addressed and an attempt made to answer some of the questions raised above in the following dialogue between the eminent Yoga teacher T.K.V. Desikachar and myself.
T.K.V. Desikachar: Some doctors like you send your patients to us, though we have not been trained in the field of health and sickness. The patients too come to us and report back to you. So, I am sure you are not washing your hands off your patients! How is it that you are so confident about us, who are not technically competent in your field?
Dr. Uma Krishnaswamy: Despite the fact that modern medicine has made such enormous strides as far as management of illness is concerned, there are certain areas where we are unable to proceed beyond a particular point. Consequently we as practitioners of medicine and as impartial scientists honestly acknowledge that there are limitations to our system of healing.
We acknowledge the fact that we can go thus far and no further. On account of this, we tend to be always on the look out to see how else we can help the patient. This may be in conjunction with what we have done or what we hope to do with the patient or it may take the patient completely away from our hands. Either way it does not matter, as long as the patient benefits. Among the various alternative systems of healing, I feel comfortable with yoga, because it is a system of healing which concentrates on physical movement very deeply.
Of course one is not blind to the fact that this concentration on the body is towards a spiritual end - but, that is a different dimension altogether. As yoga teachers you know more about the physicalities of the body and its requirements for health than most other systems of healing. For example, you know which particular asana or posture can relax a muscle or which can help joint mobility.
From my point of view, these are all very well defined and very precise areas of anatomy and physiology that you understand instinctively, by habit, by practice, by study or by tradition! You may not view anatomy or physiology the way we do. But I see that you are working on human anatomy and physiology, albeit in a different manner. This gives me confidence that yoga has the potential to help some of my patients.
TKVD: But the patients that you send to us do not merely have physical problems. They may have other dimensions to their illness. Why do you think yoga can help such individuals?
UKS: The canvas keeps on enlarging. On the one hand we may actually be able to see the physical deficit and send the patient to you for help. On the other hand we have those patients where there are no physical problems to see. They may have emotional problems or stress related problems that are now so common. I find that yoga is not just compartmentalised to asanas or gymnastics of the body, but goes beyond all this to the cultivation of mental clarity.
The techniques that you use to obtain that mental clarity are very useful in that they concomitantly reduce stress. Yoga produces a tremendous impact as far as stress related illnesses are concerned - whether it is a tension headche, or angina precipitated by the "Monday morning" businessman's stress! I see in my clinical practice that when an individual takes up yoga, his stress management becomes that much better. This is the other dimension of help that I seek from yoga for my patients.
TKVD: I get the impression that you prefer yoga over other systems of healing. Is this true?
UKS: It would be incorrect to say that I prefer yoga, over other systems. I think I am equally receptive to all systems of healing. There are some illnesses where I may prefer to send the patient to an Ayurvedic physician. There are some illnesses where I think the patient may benefit from the Unani or Siddha traditions or even a combination of systems! But it seems as if yoga offers answers for many of the problems that I commonly face in my clinical work.
TKVD: Many years ago my father said that yoga is a simple system that does not require any equipment. One only requires some floor space! It is an inexpensive system of healing. Why is it then that the people who seek help from yoga or practise yoga are usually financially and intellectually of a higher strata than the majority of the Indians?
UKS: I think there are two very interesting socio cultural aspects to account for this state of affairs. Yoga is viewed as an esoteric and abstruse system of philosophy by contemporary society. So it is only the western-educated intelligentsia of modern society that read the Yoga Sutras of Patanjali.
On the other hand, the traditional or orthodox scholars by and large do not appreciate the physicality of yoga. They are concerned (and rightly so) that yoga will be translated into a fashionable and shallow physical culture by the non-traditionalists, as in many Western countries. That yoga uses the body as a mere means to a lofty spiritual end gets forgotten in such situations.
Moreover, there is a narrow sectarian sense of rivalry between the various schools of philosophy. Why study or uphold the merits of Yoga darsana while there is a compelling sense of duty to foster one's own traditional school of philosophy? Why fritter away one's lifetime on anything less than the study of Vedanta darsana?
Such attitudes continue to condition society to a very large extent. Until revolutionary teachers such as your father, Sri T. Krishnamacharya, came onto the scene and pointed out that yoga is a practical science that can help an individual in distress, many were unaware of the healing dimensions of yoga.
When this truth was endorsed by the spiritual luminaries of our day, such as the Paramacharya of Kanchipuram and J. Krishnamurti, it served as a catalyst to the process of public awakening. But this awakening unfortunately is only amongst the urban intelligentsia.
In the rural areas, traditional scholars are familiar with the Yoga Sutras, but if you ask them whether they practise asanas, they will pooh-pooh it. The uneducated people in the rural areas on the other hand often have not even heard of yoga, or they may perceive it as a gymnastic exercise that allows one to stand on one's head! Thus there is a dichotomy in our society, of thought and of practice.
There are so many systems of healing in our country. You are very fond of pointing out that though they are different, the basis for all systems of healing is the desire to help the sick by the use of whatever technique is available to one. For instance, you will not condemn Ayurveda or Siddha because you know that the Ayurvedic or Siddha physician wants to help the patient, just as you do.
TKVD: Even at the philosophical level, the concern has always been to find a solution to cure the suffering of an individual. If you look at Sankhya darsana or yoga darsana, there is a basic tenet that human suffering must be reduced.
I feel that if something helps someone, then it is right for that person. But because it works for one individual, it does not mean that it will work for everyone. This is why we have to be very careful. Anything that helps must be accepted. The consideration is the person and not the system. The whole objective should be to remove the suffering of the person and nothing else. I sometimes send people to astrologers - if it helps, then why not?
UKS: Mani, mantram, ausadham (lucky gems, spells and medicine) - anything can help! From a very traditional standpoint of yoga, how is health viewed?
TKVD: Instead of health, I shall talk about sickness. The first chapter of the Yoga Sutra of Patanjali says that there are obstacles in the path of both spiritual and personal quest. The most important obstacle is vyadhi or illness. Vyadhi is an imbalance of the human system.
Sickness produces emotional disturbance, loss of confidence and loss of energy through a lack of prana or vital energy to function with. There are also certain manifestations at the physical level such as pain. The saint Nathamuni says that irrespective of whether you are a king or a monk, you cannot pursue your goal if you are sick. In order to reduce these obstacles, many suggestions are proposed by Patanjali.
UKS: Certain systems insist on an extremely rigid diet pattern, which is not feasible in today's world. Even if a person is well intentioned and wants to stick to the diet, he or she may not be able to, because of the pressures of daily life. How does yoga view diet?
TKVD: The discipline of food is defined as mita hita aharam, That is, one should partake moderately of wholesome food. If I introduce something harmful into the body, then the system will not function well. We must ensure that our food does not add to the problems already present in the system.
Jihva chapalyam (fickleness of the palate) is one of the most powerful chapalyams of ficklenesses. I insist on a dietary regime only if it is absolutely essential. For example, if a foreigner comes to India, I ask him to be careful about drinking water.
A lady from Italy was not able to eat due to to emotional trauma. In this case I tempted her appetite with chicken soup, because, she was used to it! Food must nourish the person. Hence I would say that diet restriction should be minimum. Once there is dietary discipline, there is very little that we have to do!
UKS: Very true! Would the same rule apply to any lifestyle changes also?
TKVD: I saw a lady from Austria who smoked to cope with emotional stress. She worried that I would ask her to stop smoking. I told her that I would not stop her from smoking. If my insistence of lifestyle change becomes an obstacle for the person to pursue yoga, then it will not work. It is like getting the camel into the tent. The first thing is to get the animal in! The lady in question stopped smoking on her own when she started meditation. I have seen people with the drug or drinking habit stop on their own after they practice yoga for a while. This is what yoga does for them.
UKS: I had noticed that when some people undertake a discipline such as yoga, they start looking at themselves critically. In other words, they want to set right what is wrong by self help. Why does this happen? Is it because they focus on their body and are more aware of it and its needs?
TKVD: Yoga initiates svadhyaya or self study or observation. There are people who are not even aware of the fact that they cannot raise their arms above their head. When we asked them to do so, they found that they could not do it. This triggers a situation where they begin to look at themselves, and sometimes they become too critical about themselves. The teacher has to be very careful. If the teacher is too strict, the student becomes a fanatic or a hypochondriac. This is another sickness!
UKS: What you are advocating therefore is moderation in all things. As the divine author of the Bhagavad Gita puts it: "To him whose food and recreation are moderate, whose exertion in actions is moderate, whose sleep and waking are moderate, to him accrues yoga, which is destructive of pain."
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