A KOSHA MODEL FOR CREATING A YOGA THERAPY
BASED HEALING PROTOCOL
A Transpersonal Integration Paper
submitted in partial fulfillment of the requirements for the degree of
Master of Arts in Transpersonal Psychology
Institute of Transpersonal Psychology/Sofia University
Palo Alto, California
October 17, 2014
Copyright © Mimm Patterson, 2014
All Rights Reserved
However long the night, the dawn will break.
The bigger meaning of healing is “wholeing,”
a filling out of the missing pieces of a person’s life.
I want to thank the chronic pain patients I have met over the past five years through my work as a yoga instructor. Especially Lena*, who has been so generous with her time and patient with my endless questions. Her story and strength will continue to motivate and inspire me long after I’ve completed the work on this paper.
I thank the dear members of my co-heart in Sofia University’s Master of Arts in Transpersonal Psychology’s Global Program.
Heartfelt thanks are extended to Dr. Nancy Rowe, who held space for me to blossom.
Deep gratitude is extended to mentors Brandon Thompson and Susan O’Connell, whose support for me has never waivered.
Finally, thank you, Ben. You have opened my heart.
*Lena’s name has been changed to protect her privacy.
It bothers me that Western yoga is a $27 billion industry. It also bothers me that the once on-point but now much maligned Yoga Journal—the industry’s popular periodical— boasts that 30% of its readership has a household income of over $100,000 (Gregoire, 2013).
The loss of spiritual tradition and the corporate mishandling of yoga’s physical practice—a practice almost 5,000 years old—has deeply influenced my personal yoga practice. When I began to study asana 30 years ago, my sole intention was to collect as many postures as possible—the more advanced, the better. My current focus explores how I can transform a series of postures taking place on a 2’ x 6’ mat into a practice that fills my life and influences how I walk through the world.
I was drawn to the field of yoga therapy through my work with chronic pain patients. The teaching technique needed for this demographic is markedly different from the one required to teach a conventional studio class. There is a shift of energy that transitions away from thoughts of self-improvement and competition with others. Working with chronic pain clients has a plain purity and a natural presence to it that I have rarely witnessed.
There are many paths to choose from when creating a healing protocol. I chose the Pancha Maya Kosha model after being introduced to it through my esteemed teachers Bidyut Bose, Gary Kraftstow, and Richard Miller.
I might have based a healing protocol on Patanjali’s Eight Limbs of Yoga. Alternatively, I may have taken a more ayurvedic track to work with the three gunas. However, the koshas called, and I have tried to answer.
Suppose a wound is received. What happens? As a yoga therapist, is it my intention to provide a cure for the wound or to offer an opportunity to heal from the wound?
There is a difference.
Curing is a single solution to a singular problem. It is a mechanism requiring medication or surgery to mask or eliminate symptoms (Northrop, 1998). If the bone breaks, for example, a doctor applies a splint. The bone’s splintered ends knit and the break mends.
Healing, on the other hand, asks that we embark on a journey. It is a journey that might subdue or overwhelm. We will stumble and fall, rise, and move forward again. In our pursuit of physical, mental, and spiritual health and harmony, we may become temporarily confused and lose our ability to distinguish between curing and healing. The act of curing and the art of healing from a wound—no matter the origin of the wound— are dynamically different processes. Healing, after all, is a process generated from within and a process that journeys far beyond the physical. It is a process that is much deeper than the cure (Northrup, 1998).
How does yoga therapy support this process? When a wound occurs, it leaves a traumatic imprint that a cure will not resolve. Trauma carries with it residual physical pain, triggered memories and reflexes that create a disconnect between the psyche, the body, and the story we tell about the wound. The container for our spirit—the body—is damaged. Our soul is damaged, too. Bessel van der Kolk (2014) writes, “Trauma robs you of the feeling that you are in charge of yourself” (Kindle location 3747). Our loss of optimal health and our failure to thrive changes how we engage with the life we enjoyed prior to receiving the wound. After receiving the wound, we adopt a perspective that in one moment is desperate with the narrative weight of the trauma and in another moment is glib with denial. Our relationship with Self and our relationship with Other changes. This is trauma’s imprint. Trauma is not resolved through the application of a cure. The imprint of the trauma requires a separate protocol—the healing protocol that yoga therapy offers.
The Pancha Maya/Kosha Model
For our healing journey, we might consider the Pancha Maya/Kosha (PM/K) model a traveler’s guide. Pancha is Sanskrit for five. Maya—not to be confused with māyā, which means veil or illusion—means “that which spreads” (Kraftstow, 1999). A kosha describes a sheath or encasement (Frawley, 1999). Pancha maya kosha, therefore, refers to the five “encasements” that surround our center and prevent the light of Atman, our transcendental Self, from shining (Feuerstein, 2003).
The koshas first appear, although not by name, in the Taittrirya Upanishad (Feuerstein, 2003). The literal meaning of Upanishad conjures the image of a disciple sitting by their beloved guru. Like parables from the Bible, the Upanishads are scriptures written by saints and seers (The Upanishads, trans., 1975).
Vibrational by nature, the five koshas store our samskaras, our collected mental patterns (Burke, 2013). Both yoga and Buddhism teach the concept of samskaras. According to McCall (2007), samskaras are “habits of action and thought that get deeper all the time” (p. 20). Easwaran (1992) defines personality as “the sum of our samskaras, the collection of our patterns of thinking” (p. 89). Unlike McCall, who suggests all samskaras are negative, Easwaran believes that “samskaras are a process” (1992, p. 90). As such, they can be either negative or positive.
Do our koshas resonate with the vibrations created by our samskaras? If they do, then it follows that to support healing we must reflect on our collection of desires and delusions, our ecstatic moments, and our moments of envy. Yet to do so requires that we have an understanding of the profound connection between body, mind, and spirit.
Authentic healing requires the integration of body, mind, and spirit. The PM/K model allows us that integration. The koshas surround us and are at home within us. As we study the koshas, we begin to understand how they represent the promise of yoga. It is a promise that delivers unity, equilibrium, and homeostasis. Yoga’s promise brings fierce and graceful balance to our whole being—from the outermost to our deepest layers. Yoga draws balance through the surface of our skin to our bones, our viscera, our breath, our beating heart, and our metaphoric heart.
I acknowledge and embrace the truth that the Pancha Maya Kosha model is one born from the yoga tradition. I am grateful, too, that this model provides space and heart for other transpersonal practices to be introduced to the healing process.
Complex Regional Pain Syndrome (CRPS)
From a transpersonal and yoga therapeutic perspective, we might consider complex regional pain syndrome a “condition of excess.” Similar to an allergy, individuals with CRPS experience an excessive reaction to a trigger. In susceptible individuals, the trigger might be an event as insignificant as a bee sting, a minor strain, or a needle stick.
Individuals with CRPS show peripheral nerve abnormalities that involve unmyelinated and thinly myelinated nerve fibers. Myelin is the substance that surrounds and insulates some nerve fibers, and these fibers are the ones that carry pain messages and signals to blood vessels. If the protective covering of a nerve fiber is compromised, the nerve may become hyper-aroused and chronically over-stimulated (Juris, 2014).
The peripheral nerve anomalies cause abnormal neurological function in the spinal cord and brain. They predispose blood vessels to excessive dilation and contraction. When the vessels dilate, fluid leaks into the surrounding tissue. This action starves underlying tissue of oxygen and nutrients. When vasoconstriction occurs, the skin becomes cold and white. The result is damage and increased pain (National Institute of Neurological Disorders and Stroke, 2014).
There are indications that the immune system is involved in the course of CRPS. In addition, some studies have shown grey matter shrinkage in area of the brain’s somatosensory cortex corresponding to the patient’s affected limb (Juris, 2014) (Geha, Baliki, Harden, Bauer, Parrish & Apkarian, 2008).
Simply put, with CRPS the body is in a consistently reactive state, with the sympathetic and central nervous systems being abnormally sensitive. The constant firing of pain signals affects the limbic system. The limbic system is in the cerebral cortex and governs cognition of emotions , pleasure, and pain (Juris, 2014).
One of the difficulties of working with CRPS as a therapist is developing empathy for the client’s intense suffering. Empathy is easy when it is a shared experience. We have all experienced a flu virus or a muscle sprain, and we can remember the inconvenience and discomfort. The constant and severe pain of CRPS, however, is unfathomable to others.
The instigating trauma begins with a minor wound that is easily cured. After the wound is cured, however, a physical imprint remains in the body—the CRPS. In my opinion there will be an imprint on the psyche, too, in the form of anxiety, depression, and post-traumatic stress.
Many doctors remain unaware of the syndrome while others will not consider a CRPS diagnosis until the patient has experienced months or years of debilitating pain. Moreover, for many the pain of CRPS never ends, and the individual remains severely disabled (Juris, 2014).
The Pancha Maya/Kosha model supports the softening and release of the physical and psychic markers created by CRPS. I believe it is a model that can be adapted to create a protocol for the authentic healing of all physical and emotional trauma.
Suppose a wound is received. What happens? In 2012, when Lena was 17, she received her wound. A competitive tennis player, weight lifter and avid runner, Lena says, “My physical strength was my defining trait” (personal communication, September 17, 2014).
Three years earlier, however, Lena had noticed a small cyst forming on the inside of her lower right leg. Although it caused no pain and did not interfere with her athletic lifestyle, doctors nevertheless suggested aspiration. Because the cyst did not affect the quality of Lena’s life and because she had a fear of needles, Lena and her parents decided against aspiration. Instead, Lena continued to plan for a future that included a move to the East Coast and a Columbia University education. The cyst grew to a noticeable size.
Six months before Lena was expected to leave for college she chose to have the mass surgically removed. The surgery to remove the cyst—now the size of two golf balls —was uneventful. Lena’s doctors told her she could return to full activity within 10 days. Three days post surgery the drain that had been inserted to prevent reformation of the cyst was removed. The following morning, Lena woke up howling with horrible pain in her lower leg, ankle, and foot. “It felt as though someone had placed needles under my skin and they were pushing out against it” (personal communication, September 17, 2014).
In the weeks after awaking in agony, Lena visited the emergency room three times for help with the pain, but she remained undiagnosed. One month after surgery, a family friend who was an anesthesiologist suggested Lena might have complex regional pain syndrome. Stanford Pain Clinic confirmed the diagnosis 14 days later. The diagnosis came 6 weeks post surgery.
Lena was fortunate that the doctors assessed her condition and arrived at a diagnosis so quickly. An optimal outcome for CRPS depends upon early diagnosis. Studies indicate that when an individual is left undiagnosed for months after the initial wound has mended, CRPS becomes highly debilitating and patients experience long-term suffering (Geha, Baliki, Harden, Bauer, Parrish & Apkarian, 2008).
Unfortunately, early diagnosis is atypical. Many doctors remain unaware of the syndrome while others will not consider a CRPS diagnosis until the patient has experienced months or years of intense pain (Juris, 2014).
Despite the early diagnosis and the promise of a good outcome, for three years Lena’s pain has been relentless. Early in her pain journey, the lightest touch or contact was excruciating. Sometimes Lena’s pain is experienced as a burning sensation. At other times, she feels sharp pins and needles or an intense compression. Lena has also experienced many of the other complications of CRPS, including deterioration of the muscle and bone tissue in her ankle and foot.
Other characteristics of CRPS include changes in the temperature and skin color of the affected limb. (Lena’s foot may run cool or hot.) The limb can appear blotchy, tinged with blue, deathly pale, or deep red. Edema occurs due to damage that causes an abnormal microcirculation to the nerves controlling blood flow. There are changes to skin texture, abnormal sweating patterns, changes in nail growth, and stiffness. In some CRPS patients, abnormal coordination and movement take the form of sustained muscle contractions known as dystonia. Others patients experience jerks or tremors in the affected limb (Juris, 2014).
When Lena received the diagnosis of complex regional pain syndrome, priority was given to finding the correct combination of medications to reduce and control her suffering. In the past 36 months, Lena has been prescribed over two dozen different medications. Many of the drugs in Lena’s combination of drugs are opiate agonists. Opiate agonists are a category of drugs that mimic the effects of naturally occurring endorphins by interacting with opioid receptor sites. One of the receptors, the “mu” receptor, is found in our limbic system and controls not only our emotions but how we sense pleasure and pain (Cloe, 2011). This can be effective in temporarily “damping down” the pain, but quite often Lena develops an intolerance to the drug combo and the process of finding a new combination begins again.
Lena has also endured physical therapy, a pharmaceutical trial that featured an experimental capsaicin-based drug designed to burn nerve endings, and more recently Lena had surgery to implant a spinal cord stimulator.
In the summer of 2015, Lena will undergo a ketamine infusion. The drug ketamine, discovered in the 1960s and used in veterinary medicine, is a controlled substance and an abused street drug. It is also an anesthetic with profound analgesic effects. While conventional medications reduce Lena’s pain to a tolerable level, low-dose infusion of ketamine over several days offers temporary but potentially complete relief from pain (Pennsylvania State University, 2004). Between 30% and 50% of CRPS patients given ketamine infusions find meaningful relief (Juris, 2014).
I met Lena when she was 20, three years after her CRPS diagnosis. Lena and I worked together for several months during the summer of 2014. She chose to begin a yoga practice but had no expectations. Lena simply hoped that moving her body would ease her pain (personal communication, October 10, 2014). Sometimes it did. More often it did not.
I, on the other hand, had many expectations. I was uninformed and naïve enough to believe that I might be the one to change her life. That did not happen, but she has changed mine. Lena’s story and inspiring outlook fuel the passion I feel for deepening my understanding of the koshas and for strengthening my skills as a yoga therapist. Lena has taught me to trust what I know but more than that, she has taught me to listen.
I failed Lena. I failed Lena because I failed to listen. I failed to observe. Focused on the physical, I provided an asana-based protocol that accomplished little. On at least one occasion, the protocol instigated a flare-up that sent her to the hospital.
I believe that individualized case-by-case protocols that move beyond what is seen with the eye toward a place that is seen with the heart is how healing happens. I believe that, as a well-trained and informed yoga therapist, I need to work diligently to develop the skill of deep listening. A friend recently told me, “We want to solve the problem but it’s the story that wants to be heard” (B. Shaibe, personal communication, November 2, 2014).
By focusing on her body’s limitations, I failed to create space for Lena’s story. I will not make that mistake again.
We can imagine the koshas as a set of Russian nesting dolls. It is simplistic and effective. There’s a concise, hard-edged clarity to the notion of one kosha simply stacked over another. In my mind, however, the koshas do not have the same clearly-delineated boundaries as the carved wooden dolls. They are more like layers of ectoplasm, delineated but softly so. The edges are blurred and malleable so that each kosha is informed by its immediate neighbor. Each kosha, too, is capable of extending filaments of energy through all koshas. In that way, the koshas are in silent dialogue with one another and can draw energy from each other.
Despite knowing the koshas as interdependent encasements of energy, we still begin our healing journey with the outermost kosha, the Annamaya Kosha. Annamaya Kosha is our physical body (Kraftstow, 2002), and it asks us to stand in the present (Rea, 2014) with the part of ourselves that we can see, feel, and touch. The Annamaya Kosha reminds us, too, of our connection to the material. In that way, we begin to shift our protocol from the manifest to the unmanifest (Feuerstein, 2003).
Pranamaya Kosha is our breath body and our life force, the vital metabolic functions that deliver health and wellness (Kraftstow, 2002). This kosha is our breath that converts external oxygen to internal vitality (Frawley, 1999). Moderating the breath allows us to moderate our emotions, our response to stress, our energy levels, and the level of pain we are experiencing (Slovik, 2013).
With our third layer, the Manomaya Kosha, we rest in a space that transitions toward the koshas that embrace subtle impressions. The Manomaya Kosha is our outer mind and our internal voice. It brings our memories into awareness. It includes the knowledge we have gained through experience and education (Kraftstow, 1999). Our sense perceptions in Manomaya Kosha are born from our instinct, impulse, perception, and cognition (Kraftstow, 1999; Slovik, 2013).
With Vijnanamaya Kosha, our beliefs begin to deconstruct and our ability to discern truth from falsehood is refined (Frawley, 1999; Miller, 2011). This kosha refers to intuitive understanding (Kraftstow, 1999). A shift occurs when we connect with Vijnanamaya Kosha because it supports the emergence of spirit and our witness consciousness (Burke, 2013).
When we embrace the shift to the unmanifest, we arrive at the innermost kosha, Anandamaya Kosha. This is our bliss body; it includes those things that bring to our heart a sense of joy and fulfillment. With Anandamaya Kosha, we focus on union with those things we most cherish (Kraftstow, 1999). Here, we have arrived at the threshold of our nondual nature (Miller, 2011). What lies within the center of our five koshas is our authentic self. Atman.
The protocol cannot be created until we establish the nature of the wound. In my opinion, when an accident occurs, trauma’s imprint can mark the psyche in a single instant. When there is a series of events or if one must live in an environment that feels unsafe or threatening, the imprint of trauma is marked in a series of moments.
Knowing the nature of Lena’s wound, as a yoga therapist my intention is to weave together a healing protocol based on five areas that equate to the five Koshas: food, breath, mind, wisdom, and bliss. Working from an intuitive level, I want to ask two sets of questions. The first set of questions relates to Lena and her relationship to the wound. This set of 5 questions is called Client-Centered Protocol Questions:
- What wound is held in Lena’s body?
- What is the physiological course of this wound?
- What brings joy to Lena’s life?
- How does Lena’s mind work?
- How has the treatment and medication for Lena’s wound affected Lena’s body and brain?
As important as it is to know what Lena is bringing to this healing journey, I need to know what I am bringing, too. It is, after all, a journey we are taking together. Therefore, my second set of questions concerns my wound, my agenda and my expectations. These are questions about objectivity, receptivity, and non-judgment. They remind me to extend compassion toward Lena and to hold space for self-compassion. Finally, these questions connect me to Lena’s story without sacrificing the connection I have to my own. This second set of 5 questions is called Therapist-Centered Protocol Questions:
- Is there a judgment about Lena’s wound I need to release?
- What is my motivation for working with Lena?
- How can I best create an authentic process for Lena and myself?
- How best can I untangle the story Lena holds about her wound from the story I hold regarding my own wounds?
- How best can I guide us both toward our full potential?
As crucial as these sets of questions are it is how we listen to the answers that will determine our healing fate.
With the answers to both sets of questions in hand, I now can create a healing protocol that supports and moves beyond the cure. Designed for a specific client—Lena—and for a specific wound—complex regional pain syndrome, this protocol is an example created for my own use with Lena but also as a guide for other yoga therapists.
In the following table I organize the koshas and their qualities with the practices and activities I will encourage Lena to add to her life. It is important to note, however, that although the protocol is systemized, it is not my intention to work through the koshas systematically. We can assume that we have, at the minimum, 8 one-hour sessions held over the course of two months to introduce the PM/K protocol to Lena. At a maximum, there could be 12 one-hour sessions held over a period of three months. I have broken therapeutic practices into two camps: a) those that are derived from the yoga tradition and b) those that originate in other transpersonal practices. Although we will begin with Annamaya Kosha because it is the one that feels most familiar, as our practices begin to integrate, I believe that it will be possible to draw from koshas as our resonance and gut-feelings indicate.
Asana practice to encourage connection to the body:
· Chair Yoga
· Yin Yoga
· Restorative Yoga
Together we will write a morning practice to encourage heat and strength. We’ll create an evening practice to prepare her for sleep.
· Examine craving and aversion
· Look at diet to witness how foods affect feeling/pain levels
Breathing practices to generate energy, lessen anxiety, and support a restful sleep:
· Three-part Breath
· Alternate Nostril Breathing
· Ocean Breath
Her morning practice will include breath retention. In the evening she’ll practice breath suspension.
Connecting with nature:
· Spending time in a landscape that resonates—the ocean or perhaps a forest
· Noticing how the earth/trees/water “breathe”
Connecting with others:
· Sitting in silence with a close friend or family member.
Mindfulness Meditation Practice
· Sitting for 5 minutes morning and evening in quiet contemplation; watching the thoughts and the breath without judgment or agenda.
· Looking for appro-priate avenues for volunteering or creating opportunities to give back.
· Reducing time on social media in order to create more time for personal reflection.
Deepening Meditation Practice
· Compassion Practice
· Tonglen Practice
· Creative Expression: Exploring avenues of non-verbal self-expression, such as painting, photography, music
Joy and Fulfillment
Mudra and Sound Healing
· Using Symbolic Gestures
· Using Chanting or Song
· Taking time to remember and to embrace any activity that encourages stillness and peace.
The imprint of trauma is more than the story (van der Kolk, 2014), but the story is where we begin. I believe it is our relationship with the story of our trauma that will determine how we heal. I once asked Lena what it was like to have complex regional pain syndrome. Her response follows:
It’s a difficult question only because I feel like my answer downplays how hard it is to have CRPS. For me, despite the losses that have come with CRPS, it seems like the blessings are infinitely greater. . . . CRPS has given me a clarity that I think most people my age don’t have—I know who I am and who I want to be as the result of so much hardship. (Lena, personal communication, October 10, 2014)
How wonderful would it be for us all to have the clarity that Lena possesses?
Beyond the story, however, is the path we choose. As a yoga therapist, the healing journey I choose to take with my clients is one that looks beyond the surface, beyond the cure, toward a place with heart and meaning.
After long searches here and there, in temples and in churches, in earths and in heavens,at last you have come back, completing the circle from where you started, to your own soul and find that He, for whom you have been seeking all over the world, for whom you have been weeping and praying in churches and in temples, on whom you were looking as the mystery of all mysteries shrouded in the clouds, is nearest of the near, is your own Self, the reality of your life, body and soul.
How to Know God (pp. 142-143)
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