This yoga course helped me to get through hard moments in my life. Before I was depressed, but no more. At those times when I had physical troubles, I practiced the exercises and the affirmations that I’ve learned; the troubles went away, and I could regain control of the situation.
– Tiziana, age 32, a program participant with Multiple Sclerosis
Question: How did all this begin?
Claudio: Donatella Caramia, a neurologist in Rome, has a lot of patients with Multiple Sclerosis (MS). They were requesting more and more an alternative way to deal with the disease – not just the normal way: taking medication (interferon), like they all do – because their lives are very active and they need a lot of energy. You see, one of the problems they face with this disease is up’s and down’s of energy.
Not knowing how to help all these people, Dr. Caramia, together with other neurologists at the University of Rome, conceived a project for improving the patients’ quality of life. As part of it, Dr. Caramia asked me to start a course, the first one in Italy, to see if yoga could help the MS patients and scientifically show how it impacts the process of the disease. Dr. Caramia also has connections with some American universities that are gathering the results of this course and its medical tests, and comparing them with results from other institutes.
Sevadevi (another Ananda Assisi retreat staff member) and I take the train from Assisi down to Rome to teach a two-hour class, every Wednesday evening for eight months, October through May (except for two-week breaks at Christmas and Easter). We’re now in our second year of doing this. We wanted to have 30 people in the study last year, but because the classroom space was so small, we started with 15. In fact, the experiment started with two groups: 15 doing yoga and 15 doing physiotherapy. They wanted to see if there would be a difference in the results for the two groups.
Our first-year (2002) yoga group all came more or less regularly. Three of them dropped out for various reasons, but otherwise we had a steady group until the end.
I didn’t think I could have so many benefits. Especially in facing my daily life, now I feel more serene in confronting this disease.
– Maurizio, 31
Question: What difficulties does MS present in these people’s lives?
Claudio: Low energy or sudden drops of energy. Depression. Also some disturbances in the body – very light at this point because all patients selected for the study had been diagnosed with MS only within the last five years, so their symptoms were relatively minor: difficulty with the function of their legs, arms, or eyes. It’s mainly those three body parts mainly that have difficulty.
The difficulty with the legs and arms is weakness and loss of control. They don’t have a connection with those body parts, so they can’t really use them well. The body part has not degenerated to the point that they can’t use it – they can use it, they can walk, they can use their arms – but it can be a struggle to move it. And it may not be completely predictable how it will move – the coordination begins to deteriorate.
They also have pain in the afflicted body parts. It is not strong pain because the interferon helps relieve that – it’s more like a disturbance, discomfort. Without the interferon, however, they would be experiencing significant pain.
There are also common symptoms on the subtle level. I soon realized, for example, that all of them have difficulty concentrating and interiorizing. They can’t relate to themselves, to their bodies or their minds. All of them have the same difficulty: the world outside is the reality. And they are so caught in it that they couldn’t really bring inside any experience that they have in life. They fear anything related to their body, to their mind.
Question: Because their body is no longer their friend?
Claudio: I think so. At first, they couldn’t relate to themselves – that was the common denominator. When I asked the first class to interiorize, just a little visualization and concentration, they couldn’t do it, because they were not used to bringing the mind inside, staying calm inside. Mostly, they were afraid of it.
It took a while before they began to accept that as a wonderful way to know themselves better. That is the greatest result that we gained from this. We introduced gradually, not only yoga postures and the Energization Exercises, but meditation, simple visualizations, and affirmations.
From a physical point of view, yoga loosened some of my body parts. On a mental level, it gives me more tranquility. Today I can better deal with my negative emotions and look with serenity at the future.
– Alessia, 32
They were slowly able to accept that and do it just a little bit, And they liked it so much that when I asked on the questionnaire at the end of the course, “What do you want to do more of in next year’s classes?”, they all said “meditation.” So I think that they now understand the value of meditation and concentration.
Question: You didn’t have any prior training in how to teach Multiple Sclerosis patients. How did you begin?
Claudio: We started out with Energization Exercises, and for the first four to six weeks, we just trained them to work with the muscles, with the body parts, helping them get more in touch with the energy behind the muscles. It was a wonderful process for them to realize that there is energy, they can work with the muscles, they can work with that energy. We also used affirmations to help them get more dynamic in that.
We used the Superconscious Living Exercises. We did that and a lot of relaxation for the first month or two, with simple breathing exercises like diaphragmatic breathing, just to let them breathe and see how they can take it inside.
Question: Speaking of breathing, do you notice any typical breathing habits in this population?
Claudio: They have a lot of stress in their lives, so they had difficulty breathing. They had difficulty with diaphragmatic breathing in the beginning. After they had been practicing for a few months, I saw that most of them had improved their breathing.
One, however, just couldn’t coordinate when to inhale and when to exhale; even now she has a problem with that. We tried different ways to help, and she does a few rounds well, then goes back into her old habits: breathing with the mouth and chest instead of with the nose and diaphragm. It was hard to get her to breathe with the nose, and diaphragmatically, but most of the class improved, and it was very, very helpful for them to breathe diaphragmatically.
Question: How old are your students?
Claudio: Young, from 22 to 40 years old, with one exception at 55. MS often strikes younger people. Dr. Caramia told me that it usually starts between ages 20 and 40.
Question: With regard to postures, what works or doesn’t work?
Claudio: We use all the basic postures of Ananda Yoga®, but we use just a very few postures every time to help hem to get comfortable and relaxed. We always emphasize the simple variations. At the end of the 2002 course, we did some more-advanced variations, but otherwise I usually used simple variations.
In the asana practice, we focus mostly on working with the spinal energy, helping them to be aware of the spine and to be centered in the spine, especially in standing poses. That feels important.
Question: Why do you do only a few postures? Is it fatigue?
Claudio: No, it’s the way we set up the class. We want to practice Energization and have a good relaxation afterwards, plus time for meditation and affirmation at the end. That leaves time for only a few postures. Two hours go very quickly.
There has also been a need at the beginning and end of the class to explain things, just to encourage them. I have to spend at least half an hour at the beginning of every class to present some point of view that encourages them in their practice, helps lift them out of depression.
You see, their tendency is to become negative, so we teach how yoga can help them to overcome this tendency. We also have some philosophical presentation together with the yoga routine and Energization.
When we began with Energization, I talked about the benefits and principles. Every time, I explained a little bit more. Every time, I had to bring out their interest in what we’re doing. Without that, the practice was not deep enough for them to feel the energy.
Energization, asanas, meditation – I think it is a mixture of all three that has worked. I cannot say that one helps more than others. I think all three tools work in harmony. I think that any one of them alone would not bring out as much success for these people.
Question: Do you ask them to practice at home?
Claudio: We invite them to practice Energization and meditation at home, but in fact they only practice Energization at home; only one so far has stayed with meditation at home.
Question: How about pranayama techniques other than basic breathing?
Claudio: Rarely. We usually do some pranayama technique before sitting for meditation, and I introduced ujjayi and alternate nostril breathing, but we didn’t practice regularly – maybe just a couple of times during the year.
I try to work with them at the level of what they need. It’s very much about tuning into what they need at that moment. Outside of the class, even before the class, we have a lot of conversations with them, while we change our clothes. They are very much exteriorized in their behavior, and they like to talk a lot and have an exchange with others. So you can get a lot of information about what they need at the moment.
That helps me to tune in, and I start the class trying to let Master work through the need of that moment. That’s why it’s a mixture of everything. I prepare the class, but also I have to be alert to make many changes during the classes.
Question: What do you most often learn from this process – “Oh, tonight they need this, or tonight they need that”?
Claudio: They themselves show us what they need. Sometimes they are ready to start with Energization. But if, for example, they had a hard time on the job that day, I instead start with a bit more relaxation.
At other times I observe a tendency toward discouragement over the outward situation, so I have to help them to get out of the depression: we do some affirmation to get more dynamic in thinking positively.
Question: It’s the same in any yoga class, but maybe this discouragement is related to their disease – they’re more prone to it because life is such a struggle for them on many levels.
Claudio: Exactly. It is the same with any class, but the depression component is very strong in everyone because interferon, the medication they take, has a side effect of depression. It’s not that depression is inherent to MS; it’s more a side effect of interferon.
The medication helps them feel more comfortable in the body, not in pain, to smooth down all the reaction in the nervous system, but it also creates that depression problem with all of them. I guess it just calms them down so much that they don’t have enough energy to be uplifted.
MS is an inflammatory disease of the nervous system. The cover of the nerve cells get inflamed, so this disease is really a lot of agitation. Interferon helps relieve that inflammation but does not solve the non-physical problems.
Doctors know that this a neurological disease, but they don’t know its exact cause. They know that it’s coming from a trauma, but the trauma is not just at a physical level – it’s also on the psychological and emotional levels. So treating a disease like that only with chemical medication could not possibly be 100% effective; they have to find other ways. That’s why they are looking at yoga, because yoga works on the psychological and emotional levels. And they have seen that, so far, we have good results.
Question: In general what results have you observed?
Claudio: When they started, it was just low energy, fatigue, and so on. Doing Energization Exercises regularly, they could change that situation into a state of more control of their energy and feeling that, whenever they needed to do some activity, they could draw from that energy that the practice brings to them. That’s one of the results they’ve experienced: overcoming fatigue or that sense of low energy.
They also gained more control over their body function, over their arms and legs. Comparing what I saw at the end of last year, with what I saw this year when we met for the first time just a week ago, I could see that they had more control of their body parts, and they felt more relaxed in practicing the yoga and Energization.
At least it was true for the people who practiced regularly. Those who didn’t practice went backward a little bit, and they are still struggling. It was obvious who continued to practice and who did not.
Question: How about psychologically? What differences did you see?
Claudio: Psychologically we had many testimonials from the students. Also the media asked for comments, so a journalist interviewed some of the students. What they all said is that the main effect is on the psychological level: their spirits were better because the yoga helped them overcome a dark moment in their lives. Whereas before they would react emotionally to a situation, now they could face it more and be centered in themselves and deal with that.
Yoga helped them realize what they have that they didn’t know about before – that they could be centered and be in control of their energy and emotions. That brings out more willingness, more love for life, and all those good qualities that they lost when they found out that they have MS, when they were left without any hope – in despair, really.
Even those who didn’t continue to practice benefited, because they learned some principles that they could apply in their lives to get more serenity – a different way of looking at things and circumstances outside.
Before they had tended to say that the problem is outside, to blame the situation. I told them that a prime principle of yoga is that you have to learn to deal from what you are, and not blame the situation outside, because in some way you created that situation, and you have to determine what you can do about it. It completely changes the perspective on dealing with the situation. Now they can relate better to the problem of having MS, and they say, “I can accept that, it’s okay to live with it.”
Before they couldn’t accept anything that was happening in their lives. So helping them to accept more was a big step.
Question: You couldn’t ask for more than that, yet you got much more: they learned to deal more effectively with their bodies on a practical, outward level.
Claudio: Yes, and there’s another aspect: the spiritual aspect. I could see that these people didn’t have any spiritual life before. They were completely immersed in mundane life, dealing with everything on the physical and material level. They didn’t have an inner life. Now they’ve begun to understand that there is an inner life, there is a spiritual life.
Some were more ready than others – this is a long process, after all – but we help them find an inner strength, help them ask for help when they need it, and face all the situations in their lives.
Some people were really ready, as though they had always been looking for something like this. I remember one lady who was ready right away to follow the spiritual path as we introduced Kriya Yoga. For others it has been a slow process, but they are open to it. It’s a good step for them, to understand that they are not just the body, not just the mind, that there is something inside of each of them, some reality that they can understand better.
Question: Swami Kriyananda has said that to have a healthy approach to the spiritual life, you need to start with a relatively healthy ego. You seem to have given them this, a different way to perceive themselves to bring about these changes that you saw.
Claudio: We can’t really mention the spiritual aspect in our practice, but it’s so tangible in everything we do with yoga that it just comes out naturally. It is not an imposition on them.
The more we present the Energization Exercises and the principles of yoga, the more they understand how to live that and what it means. We encourage them, help them to be more conscious about the potential of their soul, and see that they can really overcome if they put their willingness, love, and joy into whatever they do.
We had to meet them at the level where they were. We could not just impose the spiritual practices, including meditation. We presented meditation a little bit at a time, more as an experience of interiorization first, just to introduce them a little bit, because I thought to give them an experience of what is instead of just talking about it. So we had a little experience every time, and they liked it.
Most of the people came to me afterwards and said: “It was very nice. I feel very calm and very peaceful now. I would love to do it longer.” So the process of meditation and the spiritual practices come naturally, as they are ready.
Question: Some of them must have had a relationship with God. Does this ever come up in your discussions?
Claudio: We do that mostly on the individual level, because some in the class are not ready for anything spiritual.
But others have been very ready. I have a wonderful testimonial from one, saying that she was just waiting for this course and for Ananda for her whole life, and she realizes how this disease had to happen so she could get in contact with Ananda.
Question: Can you share any of the specific research results?
Claudio: The neurologists and their assistants made measurements on every patient at the class – testing before the course started, in the middle of the course, and at the end. There was the fatigue impact scale, the fatigue severity scale, the level of depression and anxiety, the visual analog scale, the social experience test. The results were that fatigue was less frequent and less severe, anxiety was lower, depression was radically lower. Vision improved, too. Everything they tested seemed to improve.
Question: Now you’re into the second year with the program. What’s happening this year?
Claudio: Everybody is very excited to continue. Originally it was to be a one-year course to see how it worked, but Dr. Caramia managed to get the sponsor to extend it to a two-year course.
At the end of this year, we will probably conclude with this group, and perhaps continue with another.
We kept all the students from last year, but this year we have a bigger room, so we added five more students, selected by the doctor. Now Sevadevi and I usually alternate teaching.
But sometimes we go together, and she helps especially with talking to the ladies. We spend maybe half an hour before class and 20 minutes after class just helping them as friends.
Sevadevi and I decided at the outset to keep the students in our prayers constantly. All last year and this year too, we’ve sent out healing energy to them, and that surely has helped – not in a small way – to open the channel for God’s grace to flow in their bodies, minds and souls, and helping them to accept yoga with an open heart.
Question: Does Sevadevi help in her professional capacity as an osteopath, or as a yoga teacher?
As a teacher. At the beginning of the course she was tempted to help them more via adjustments and therapy. I said, “Let’s wait for them to do yoga first, and then maybe later you can help also with that.” She agreed with that.
Isn’t that good advice for any teacher? Let students find their own way in the practice before doing too much adjusting or detail or precision. Especially when the group has come to you, not specifically for yoga, but for healing – and yoga just happens to be what they’re trying right now – it’s good to be very patient and let them find their footing before going in too much.
Question: Yes, and stay aware of this group’s particular priorities. There was an inspiring article not long ago in Yoga International about working with MS patients. Did you see it?
Claudio: Yes, it’s wonderful to see the amazing work that this MS patient and her yoga teacher are doing to promote yoga in this country as an alternative way to work with MS. But I realized that the emphasis of the practice they suggest is just asana and pranayama, though they did mention meditation’s benefits.
Very little was said on how to help people to heal the emotional, psychological, and spiritual imbalances related to this disease. This is where Ananda Yoga – and in fact, Kriya Yoga, in my opinion – would be a more complete approach to working with this disease. We really have something to offer.
From Paolo, age 35:
I came to yoga with a bit of skepticism. I never was a sportswoman and I wondered if I’d be able to do any physical exercises.
But the benefits were immediate. After only a few sessions I stopped taking antidepressants; I realized that I was fine without them. The Energization Exercises were giving me back the energy that I’d lost, helping me overcome physical troubles like pins and needles, which is the first alarm in moments of stress.
The most important result is serenity. After each class I felt light and recharged; now I face my daily life more tranquil, more positive. Many situations that bothered me before, now slip away easily.