I’ve just completed a course on Mental Health Aware Yoga. I took the course because I wanted to learn more about how to meet the needs of students dealing with mental health challenges. As I progressed through the course it became apparent that everyone at some point or other has dealt with some sort of mental health issue. In fact, nearly half the population has experienced a diagnosable mental illness at some point in their lifetime.[1]
When I discovered yoga in my late teens, I realized the value of yoga in supporting me in dealing with my own challenges. As a young girl, after the sudden death of my mother I experienced anxiety. At the time it showed up as digestive issues and a fear of being by myself. My father and step-mother did their absolute best to support me, but back then unless there was a real observable physical or deep mental disturbance we were expected to cope and move forward.
The discovery of the physical practice of yoga gave me my first taste of true relaxation and surrender. I didn’t really understand why it worked. All I knew was that I wanted more. Yoga gave me a sense of peace and security and I loved its physicality. Little did I know that the yoga class was a transformational space and the yoga itself a transitional object.
In Stephen Cope’s book “Yoga and the Quest for the True Self” he explains that, a transformational space is a place where you can find refuge from the demands of everyday life. A place where you can let go and say, “it’s not up to me.” A place where you can find acceptance and support for who you are rather than what you have. [2] He also explains what a transformational space is not. It’s not a place where you are asked to trade one set of ideologies or beliefs for another. I.e. trading ideas about religion with ideas about yoga or spirituality. Or that you must do a practice in a certain way to gain the peace and freedom you crave.
It was easy in the early days of my yoga life to think that I had to be rigorous with myself and push myself into the forms and shapes of the physical practice. Even though I had all the necessary ingredients to transform and grow, trying to be like my teacher or like the person next to me on the mat only served to make me more anxious. If I couldn’t get it right, I’d try harder. It took years of looking in all the wrong places and a diagnosis of type 1 diabetes to recognize that a transformational space didn’t have to be external, it could be the purest form of acceptance. Acceptance of one’s self.
Living with diabetes carries with it it’s fair share of trauma, anxiety, stress and depression. It’s a very rare person that can escape unscathed. No matter how much information you are given via your health care providers or support team no one knows exactly what you must do to manage your condition. No body responds to medication, diet and exercise in the same way. The amount of energy that goes into daily management is exhausting. You are asked to think like a pancreas 24/7.
One of the biggest things that’s overlooked by our health care system is how traumatic it is to receive a diagnosis of type 1 diabetes. The initial shock and disbelief are overridden by the huge amount of information one needs to assimilate to immediately manage the condition. Without missing a beat, you are expected to self-medicate, learn how to use technology and treat any hazardous side effects. I.e. keep yourself alive!
Trauma occurs as a result of powerlessness in the face of an overwhelming force, and when the ordinary systems that give people a sense of control, meaning and connection are overridden[3]
Trauma like anxiety is not an uncommon occurrence. According to studies in the US more than half the population (60.7% of men and 51.2% of women) reported exposure to at least one traumatic incident in their lifetime, including rape, molestation, physical attack, combat, shock, threat with a weapon, accidents, natural disasters, abuse, neglect or witnessing something traumatic. [4]
I find it interesting that being diagnosed with a chronic illness is not emphasized on the above list. Nearly half the global population are dealing with some sort of chronic disease, and one in three adults worldwide is living with multiple chronic conditions: cardiovascular disease alongside diabetes, depression as well as cancer, or a combination of three, four, or even five or six diseases at the same time.[5] That’s half the population or more dealing with multiple traumas.
It’s astounding to me that more time and resources aren’t devoted to supporting the population to manage all the associated mental health challenges that come along with these chronic conditions.
It’s encouraging that yoga is now being seen as a viable adjunct alongside western psychological treatment. In studies on Yoga and Trauma In a randomized control trial (RCT) by Bessel Van der Kolk, David Emerson and colleagues, 64 women with chronic, treatment-resistant PTSD were assigned to either a trauma-informed yoga class or a supportive women’s health class.[6] Students were taught physical yoga practices, breath work and meditation with an emphasis on inner sensing, taking note of how the postures felt internally as opposed to how they looked externally. The group was also encouraged to modify a pose or hold a pose longer or stop as they needed. Key phrases like, “notice, allow and when you are ready” were used in the instructor’s language. The key ingredient here was not to pressure the student. Rather inviting the student to follow what the body was telling them as they executed the poses.
The results of the study concluded that, [7]yoga significantly reduces PTSD symptomatology, in a manner comparable to well-researched psychotherapeutic and psychopharmacological approaches, and that yogmay improve the functioning of individuals with PTSD by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance.
In my own experience, I have been able to find comfort and safety and a way through the traumatic shock of my own diagnosis and subsequent challenges with the use of what Stephen Cope calls “transitional objects.” A transitional object can be anything that is constant, reliable, and supports the student during this period of transformation. It could be the teacher, the room, a favourite book, a chant or a specific practice.[8]
As I transitioned from healthy person to person living with a chronic illness and specifically diabetes I found the following ‘objects’ of immense support.
A guide – having someone to literally and symbolically hold my hand through the transition. Not only is the support of loved ones invaluable but having a guide who knows the pitfalls and goalposts can help ease the transition. For me that started with my first CDE who showed me how to inject and work out my insulin to carb ratios. She also gave me significant emotional support. Reminding me that a diagnosis of type 1 diabetes happens to anyone. There’s nothing I could have done differently.
Hearing this brought tears of relief. I had tried so hard to fight the inevetable and here was someone letting me know it wasn’t my fault. So often with a disease like diabetes we are told by the media and the medical establishment that we ate the wrong things, had the wrong kind of lifestyle. These ideas made me feel like somehow, I was wrong. Her kind and gentle words let me off the hook and helped me to relax.
A community – After my diagnosis I went online to see if there were any other people into yoga or healthy lifestyles living with type 1 diabetes. To my surprise I discovered a thriving community in online forums and Facebook groups. I tentatively sent out a question and immediately received 15 replies. Realizing I am not alone, that the problems I have living with this condition are shared, helped me come out of isolation. Whenever I have a question related to my diabetes management or my feelings about living with diabetes I can reach out and get immediate support. This has been especially potent when in the middle of the worst hypoglycemic event ever I reached out to a fellow type 1 on Instagram and received her advice on how to treat the event with glucose and post low insulin dosing.
A routine – Having a regular daily routine has been another potent tool. Knowing that I’ll be taking my insulin shots at the same time each day, eating at the same time, with roughly the same amounts of carbs. Going to bed at the same time each night and waking up at the same time each morning. Having a regular daily yoga practice and afternoon walk are all regimes that give me a sense of certainty and stability. I may not be able to control my pancreas, but I can control the parameters around how I respond to stress. Keeping things simple and rhythmic is a great way to stay stable and grounded throughout changing conditions.
A practice – Having a consistent yoga practice has been my number one transitional object. I’ll never forget the day of my diagnosis and how after returning from my GP I went straight to my yoga mat. As I settled into child’s pose to prepare for the practice I symbolically felt myself giving up and giving over to a higher power. Asking for support, healing and whatever else I could think of. I rededicated myself to yoga and all that it offers not only as a practitioner but a teacher. I recognized myself in the wounded healer and that I could only ever teach from my own experience. This shocking new normal would have to serve as the springboard for my journey into this next phase of life. Returning to my mat day after day, especially amongst the challenges of anxiety or re-traumatization from a severe hypoglycemic event. My yoga practice rebuilds my inner strength.
In yoga a transitional object is called an ‘Alamba’ the word means crutch. We may need the aid of a crutch in the beginning but eventually as we regain our inner strength and heal from a traumatic event we walk freely again.
Learning more about mental health and how to support someone living with a mental health challenge through the medium of yoga has been an inspiring and healing journey for me. Not only have I gained valuable tools in working with others but it has been exactly the kind of transformative space and transitional object I’ve needed in my own healing journey.
With great respect…
Rachel
[1] Mental Health Foundation. (2016). Fundamental Facts About Mental Health 2016. London, UK: Mental Health Foundation.
[2] Cope, S. (2000). Yoga and the Quest for the True Self. New York, USA: Bantam Books.
[3] Herman, J. (1997). Trauma and Recovery. New York, US: Basic Books.
[4] Kessler, R.C., Hughes, M., Sonnega, S. and Nelson, C.B. (1995). Posttraumatic Stress Disorder in the National Comorbidity
Survey. Archives of General Psychiatry. 1995; 52(12): 1048-1060.
[5] https://www.weforum.org/agenda/2017/12/healthcare-future-multiple-chronic-disease-ncd/
[6] Van der Kolk, B.A, Stone, L.,West, J., Rhodes, A. Emerson, D., Suvak, M., and Spinazzola, J. (2014). Yoga as an Adjunctive
Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 75(0), e1-7.
[7] Van der Kolk, B.A, Stone, L.,West, J., Rhodes, A. Emerson, D., Suvak, M., and Spinazzola, J. (2014). Yoga as an Adjunctive
Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 75(0), e1-7.
[8] Mental Health Aware Yoga Teacher Training Manual © Lauren Tober 2020
