I asked if he had ever had surgery on his left rotator cuff. No, he answered. The yoga solution, he added, had been working just fine for seven years now.
He held his left arm high over his head and smiled.
To become a physician, Fishman had to undergo an ordeal of schooling and formal assessment that, in the end, gave him admission to an elite club. The first big evaluation was the U.S. Medical Licensing Examination, a series of tests taken during medical school and residency. He then earned a medical license from the State of New York and its board of medical examiners. To stay in good standing, his license required that he do fifty hours of continuing education each year. He also earned professional certifications from the American Academy of Physical Medicine and Rehabilitation, the New York State Workers’ Compensation Board, and such professional bodies as the National Multiple Sclerosis Society.
So, too, the physical therapists who work for Fishman are licensed through the state and the American Physical Therapy Association. These organizations require graduate degrees in physical therapy, as well as continuing education. At first the degree tended to be a master’s, but the field of late has moved rapidly toward requiring a doctorate. The course work for such a diploma is heavy in embryology and histology, anatomy and physiology, pathology and pharmacology, kinesthesiology and imaging techniques. Many states require the dissection of cadavers.
The goal of mandatory licensure is to form groups whose members have met certain minimal requirements that—among other things—are meant to protect the public from harm. The highly regulated world of medicine is typically backed by the force of law and seeks to deter and penalize interlopers. In New York State, where I live, practicing medicine without a license is a felony punishable by up to four years in prison.
What Fishman underwent to become a yoga therapist bears no resemblance. He received no formal training, earned no license, faces no requirements for continuing education, and will never confront any oversight panel or threat of reprimand and penalization. His complete freedom of activity arises not because of any deficiency on his part but because the United States has no regulatory body for yoga therapy. None. Zip. Nada. Few countries do. The field is, on the whole, completely unlicensed and unregulated.
Even so, the yoga community has managed to foster the illusion that the United States has a system in place for the accreditation of yoga therapists. That New Age fiction is helping to promote the field’s growth. Unfortunately, it is also deceiving people, some desperate for healing because of serious illnesses and injuries.
Yoga teachers who aspire to the role of contemporary healer often put after their names the initials RYT—short for Registered Yoga Therapist. They do it on books, brochures, and Internet sites. The practice may seem innocuously similar to how physicians use MD and dentists DDS. But the situation is entirely different.
Since the RYT terminology is unfamiliar to many people, yogis, yoginis, and yoga groups often spell it out. For instance, Yoga Journal regularly uses the phrase “registered yoga therapist” to describe its experts and authors. So, too, a Google search produces many hundreds of hits for the phrase, identifying local healers from coast to coast.
In 2006, the Montgomery County Department of Recreation, in the Washington, DC, suburbs, advertised classes featuring a registered yoga therapist “sensitive to individual needs.” Authors and booksellers love the accolade. Publicity materials for Yoga and the Wisdom of Menopause, by Suza Francina, a popular yoga writer, call her “a registered yoga therapist with 30 years’ experience.”
And why not? The phrase sounds authoritative. The dictionary defines “therapist” as “a person trained in methods of treatment other than the use of drugs or surgery” and defines “registered” as “qualified formally or officially.” A Registered Yoga Therapist would, presumably, have undergone extensive training and passed the rigorous examinations of a national body of health-care specialists.
Wrong. In fact, there is no such thing as a Registered Yoga Therapist. It is an illusion—perhaps in some cases a lie. The world of professional recognition does have a category that centers on the practice of registration, though it is considered the lowest step in the expert hierarchy—far less meaningful than, for instance, licensing by a state medical board. National groups that register professionals typically record only various types of personal information, such as name, address, and form of practice. So, too, applicants for registration usually face no requirements to establish their education credentials, to pass national exams, or to show other evidence of expert proficiency. Registration, in short, bears no comparison to the rigorous world of health-care certification.
Yoga therapists have adopted the evocative terminology through guile or sloppiness, or perhaps an unconscious mix of the two that plays to their economic self-interest. For whatever reason, many simply assert the status. In doing so, they can arguably draw cover from long discussions in the yoga community about the possibility of creating a regulatory category known as the Registered Yoga Therapist, as well as confusion over the meaning of similar credentials.
Yoga Alliance uses the acronym RYT as shorthand for Registered Yoga Teacher. Its listed teachers can legitimately use RYT after their name. But individual yogis and yoginis, in their advertisements and self-promotions, often morph the term teacher into therapist—a change the field’s leaders actively discourage.
“A growing number of yoga instructors seem to be assuming the role of ‘yoga therapist’ without having had the necessary training and experience,” Georg Feuerstein, editor of the International Journal of Yoga Therapy, conceded in a 2002 editorial. The term, he added, gets used liberally and often interchangeably with “yoga teacher.” As a solution, yoga leaders around 2003 began discussing whether the alliance should expand its registry to include yoga therapists. Nearly a decade later, no such registry had materialized.
The International Association of Yoga Therapists, based in Prescott, Arizona, for several years has led public discussions of the possibility of creating standards as well as its own registry for yoga therapists. It has done so in the pages of the International Journal of Yoga Therapy, its publication. For instance, in 2004, John Kepner, the association’s executive director, wrote an editorial arguing that registration with his group “should be a mark of high accomplishment, acceptable to those steeped in the Yoga tradition and credible to integrative health care providers.” His article made repeated references to Registered Yoga Therapists.
But as of 2011, after more than a decade of discussion, nothing had come of the registration idea. Yoga therapy remains a free spirit. Anyone can claim to be a yoga therapist.
Individual schools have sought to fill this void (and their bank accounts) by teaching courses in healing and graduating what they call Certified Yoga Therapists. But the schools make up their own curriculum and teach whatever they deem appropriate, as does, for example, the Namaste Institute for Holistic Studies, in Rockport, Maine. Namaste is a Hindu greeting meaning “I bow to the divine in you.” The school’s program for certified therapists “provides in-depth training,” runs for a month, and costs nearly four thousand dollars. As is the case with registration, no national body administers tests, awards certifications, polices the field, or sets rules for what constitutes minimal education requirements for Certified Yoga Therapists. Once again, anything goes.
“There is no such thing as a Registered Yoga Therapist,” Kepner of the International Association told me. “And the schools offering certifications in yoga therapy provide widely different types and amounts of training—say, from eighty to eight hundred hours.” Kepner also disparaged the registry idea as a “weak form of accreditation and credentialing, and not really sufficient to develop a credible professional field.”
He said his group was investigating the conventional route to professional accreditation—as nutritionists, chiropractors, and acupuncturists have done successfully over the years. As a first step, he said, the association was supportin
g the formation of a council of schools that would establish a standard academic curriculum for the training of yoga therapists.
All that may sound quite reasonable and forward-looking. But the association has long engaged in activities that have helped blur the issue of what constitutes a genuine credential.
Every time members pay their annual dues to the association, they receive a fancy certificate suitable for framing that looks very much like a school diploma. It is personalized, too. I’ve gotten a number of them—one when I joined and others when I have renewed my membership (which now costs ninety dollars). The first one hangs on the door of my home office.
It looks quite elegant. The certificate is printed on parchment-colored paper and bears a gold border in a fine geometric pattern. The whole idea of a certificate—which the dictionary defines as “a document proving that the named individual has fulfilled the requirements of a particular field and may engage in its practice”—is evocative of professional accomplishment. The certificate’s reference to an “award,” and its twin signatures at the bottom, reinforce that idea. But a quick read shows that the document is in fact quite meaningless. In my case, it says I received the certificate “in recognition of supporting Yoga as an established and respected therapy in the West.”
The certificate is signed at the bottom by Kepner, the group’s director, and Veronica Zador, its president. I’ve seen similar ones displayed prominently in yoga studios—framed and lending an air of authority to the teaching and healing enterprise.
The phony credential does an injustice to the talented yoga therapists who have labored for years and decades to develop their healing expertise and have helped countless people. From what I saw, Nina Patella in Fishman’s office ministered to a patient needing special attention with great skill and compassion. So did Amy Weintraub, the yogini who specializes in treating depression. The organizational ups and downs of the field reveal its troubled development but say little about the genuine therapeutic abilities of particular individuals.
Even so, the continuing lack of regulation and the hundreds of false claims that aspiring healers make about their credentials are helping fuel the field’s rapid growth. The International Association of Yoga Therapists has seen its membership rolls increase from hundreds to thousands of members. Dozens of books hail yoga therapy as a sound treatment for most every kind of ailment—including cancer and AIDS, Alzheimer’s and Parkinson’s. And clients are lining up, ready to pay for what appears to be an all-natural, innovative kind of healing.
The surge is creating not only a lively commerce but, as the last chapter showed, a threat, since yoga in unskilled hands can bear the risk of serious injury. Patients can get hurt. In some cases, yoga therapists have managed to prescribe what turns out to be exactly the wrong move. As Fishman put it, “They treat in a very generic fashion that can be dangerous.”
In 2008, Yoga Journal released a market study done by Harris Interactive. The survey of more than 5,000 people—a sample large enough to be considered statistically representative of the entire population of the United States—showed that yoga therapy had achieved wide acceptance among patients and, arguably more important, among the nation’s health-care providers. The survey extrapolated to conclude that a doctor or therapist had recommended yoga to nearly fourteen million Americans—or more than 6 percent of the population. And nearly half of all adults reported that they held the field in high esteem, saying they felt yoga would help them if they were undergoing treatment for a medical condition. Even if the poll targeted yoga enthusiasts and overstated the degree of national interest, the trends nonetheless seemed quite real.
“Yoga as medicine represents the next great yoga wave,” Kaitlin Quistgaard, the editor of Yoga Journal, stated during the study’s unveiling. “In the next few years, we’ll be seeing a lot more yoga in healthcare settings and more yoga recommended by the medical community.”
Perhaps so. But for the moment, yoga therapists are wholly unregulated and thus the quality of their care is random. Some are geniuses. Some are charlatans. And many are surely mediocre and potentially dangerous, their heads filled with dreamy nonsense about healing and empty of real knowledge about the serious dangers of some poses. Yoga therapy is now in the Wild West stage of development. Some practitioners are busy putting up shingles, selling snake oil, and making astonishing claims. Buyer beware.
If the origins of the modern field can be traced to a single person, it would be Larry Payne, the founding president of the International Association of Yoga Therapists. Like Fishman, Payne came to yoga therapy early—decades before its current popularity. But his background is quite different from that of Fishman, and his long pursuit of professional credibility illustrates some of the difficulties that the field must overcome if its would-be healers are to become trusted members of the health-care community.
A native Californian of athletic build and interests, Payne began as an advertising executive in Los Angeles. It was a good life. Payne had lots of money and perks, including a generous expense account and a company car. By 1978, however, the rising pressures started to hurt. His blood pressure soared and his back went out.
The pain drove him crazy. (I can sympathize. I once got hauled away in an ambulance, blind with agony.) He tried orthopedic specialists, physical therapists, and drugs. Nothing worked. He looked into surgery. He felt like an old man, though only in his midthirties.
Desperate for relief, Payne let a friend drag him to a yoga class. He did the postures, the deep breathing, the relaxation. It was amazing. For the first time in two years, his back pain disappeared. He marveled at the unfamiliar feeling of happy relaxation. Overall, it was as if a huge weight had been lifted from his shoulders. In some ways, he felt reborn.
Payne continued the lessons and left his advertising job. Soon he decided to devote himself to yoga.
In India, he traveled to Madras (later known as Chennai) and studied at the Krishnamacharya Yoga Mandiram, a school of yoga therapy that had been recently founded by T. K. V. Desikachar, the son of Krishnamacharya, the guru to the gurus. The school, like its namesake, hailed yoga’s therapeutic benefits and focused on healing. Among its specialties: the relief of lower back pain. It also treated everything from headaches and high blood pressure to asthma and schizophrenia. By 1980, Payne was hooked. He proceeded to recast himself with all the energy and marketing savvy of an ad executive.
In 1981, he founded a yoga center in Los Angeles that he named Samata, Sanskrit for “balance.” It was located near Venice and Marina del Rey, two seaside playgrounds. Payne taught regular yoga. But he also toiled to advance the kind of healing that he himself had experienced and to integrate it into Western medicine. If nothing else, that was an astute business move that helped distinguish his enterprise from the region’s growing number of yoga teachers.
The credential he needed for high credibility in his new calling was a medical degree. But the course work was staggering. The next best thing was a doctorate. It, too, could open doors. But either a doctor of philosophy degree or doctor of physical therapy degree represented a huge investment in time and money for a young person, much less a man of forty who was trying to reinvent himself. A solution beckoned. It was convenient, located just across the Santa Monica Freeway in Brentwood, home to the rich and famous. Payne found a book on alternative colleges that gave it a thumbs-up.
Pacific Western University had just one drawback. It was what federal investigators came to look upon as a diploma mill. The private school gave the appearance of being an institution of higher learning, but in reality provided little by way of education for its students. It accepted the transfer of academic credits and gave credit for life experience, but required no classroom study or instruction. What it did with enthusiasm was award master’s and doctoral degrees—all for a flat fee. A doctorate cost a bit more than two thousand dollars. That was nothing compared to what a student could pay at a real school, semester after semester.
Pacific We
stern had no national accreditation, and that meant its degrees carried no weight with informed scholars and employers. In time, state, federal, and foreign governments came to regard the school as an educational fraud. Some states blacklisted its degrees as worthless or illegal.
In 1987, when Payne got his doctorate, the school was fairly new and had yet to receive much scrutiny. On his résumé, he declared that he “earned a master’s degree and a doctorate in fitness education with an emphasis in Hatha Yoga from Pacific Western University.” The school might have had no foreign language requirement or classroom challenges, but its message was relentlessly upbeat: “Look within yourself,” the school told prospective students. “Exert yourself with dynamic will power through positive thinking and persistence and you will stretch your talents and imagination and achieve new heights of learning while attaining professional and personal success.”
Payne did just that. He became a whirlwind. Armed with his new credentials, he gave lectures, wrote books, made instructional videos, appeared on radio and television shows, and, in 1989, helped found the International Association of Yoga Therapists. As its founding president, and later its director and chairman, he enjoyed a new world of global influence. The group began its journal in 1990, and Payne worked hard in his new job to drum up new readers and memberships.
Bigger things beckoned, and in 1999 Payne entered the burgeoning field of popular yoga books. Yoga for Dummies featured his Ph.D. prominently on the cover, along with that of his coauthor, Georg Feuerstein. As a team, Payne covered yoga’s modern aspects while Feuerstein, an Indologist, handled its ancient ones. The twin credentials lent the book an air of authority and set it apart from competitors, although its biographical materials gave no indication of where Payne received his doctorate or in what field. The book identified him as chairman of the International Association of Yoga Therapists and a yoga teacher with a thriving practice who “responds to his clients’ specific health challenges,” implying that he was a credentialed healer. At a minimum, many readers probably assumed that his doctorate—ostensibly a proof of high academic standing—meant that the book reflected the best understanding of modern science.
The Science of Yoga: The Risks and the Rewards Page 20