Another step is self-discipline (niyama), which includes bodily hygiene as well as the development of a culture of contentedness and a healthy lifestyle. The moral basis is yamas, consideration for other living beings, which also includes the recommendation for a vegetarian lifestyle. The aim of physical exercises mainly consists of being able to devote oneself to sitting in meditation (dhyana) for as long as possible which then (potentially) leads to smadhi, the unity of everything and a superconscious experience. It needs to be emphasized that yoga is not a religion.
YOGA: OFTEN MORE EFFECTIVE THAN EXERCISE AND PHYSICAL THERAPY
I practice yoga regularly and yet I still find myself amazed at how the different poses can lead to different physical effects. Bending forward tends to be calming, while bending backward is strongly stimulating and makes you alert. There are exercises that facilitate sleep and some that prevent it. This is something we don’t find in our Western sports, and modern science is unable to explain this with hormones and molecules alone. Another unique feature of yoga is the enormous delicacy and precision of body postures and movements. The technical term is “alignment.” Every millimeter is counted for, and the fine tuning is of a precision that our European physical therapy lacks.
Yoga is therefore also applied anatomy. So, it’s all the more surprising that this knowledge of muscles, tendons, ligaments, fasciae, and organs already existed before anatomical knowledge was garnered from corpses at a much later stage. On a visit to India I once witnessed this astonishing skill: B. K. S. Iyengar showed me a patient who was having trouble breathing after bypass surgery. My first thought as a doctor was that the bypasses had closed again. But that wasn’t the case. Iyengar palpated the patient and determined that his ribs were blocked after the intense surgical intervention, and the scar allowed only for very shallow breathing movements in the chest. With targeted instructions, he showed the patient how to stretch the ribs wider in order to use the whole chest for breathing. The respiratory problems were resolved quickly.
By the way, a study conducted by the Technical University of Munich from 2000 to 2005 with approximately one thousand heart attack patients showed that patients who were breathing faster after a heart attack had a bigger risk of dying earlier.36 Yoga or meditation can lower quickness of breath.
Iyengar yoga has an excellent effect in women who have undergone treatment for breast cancer. It’s possible that this may be the result of something similar to the Iyengar example with the bypass patient. Surgery, radiation, and chemotherapy compromise physical feeling and thus the flexibility of the ribs. With yoga, the chest and breathing can be freed, and a pleasant physical feeling can be restored.
An article in GEO magazine on the Iyengar school was entitled “Pain Is Your Master.” The article was published in 1990 and has often been misinterpreted. The intention is not for yoga to cause pain, but to teach us to feel the limits of endurance. When stretching or reinforcing muscles we may experience some pain. But this pain, which in naturopathy we call “the good pain,” is different from the kind of pain that causes us suffering. Some massage and physical therapy techniques work with dosed and controlled pain, as do acupuncture and cupping to a certain degree. Yoga helps us find sensation and mindfulness, it uses the “body’s intelligence,” as Iyengar described it.
When I look at the scientific data on yoga—at its great effectiveness and safety—it remains incomprehensible why there aren’t more hospitals that offer yoga, and more health insurance companies that bear the costs for it. In Germany, it’s possible to be partially reimbursed for one’s expenses for yoga classes from health insurance companies as part of a prevention measure. But the use of yoga lies pre-eminently in therapy, not just in prevention. In any case, there is no rational reason to reimburse the costs of orthopedic injections and all kinds of surgeries while the equally effective, if not superior, yoga has to be paid for out of one’s own pocket.
MEDITATION: THE ART OF INNER REFLECTION, OF CALM, OF NOT THINKING
I had my first practical experience with meditation during my mind-body training with Herbert Benson at Harvard Medical School. My initiation, however, wasn’t exactly laudable. Peg Baim, Benson’s meditation expert, asked us to pay attention to our breath and not to let thoughts disturb the silence. When thoughts arose, we were to welcome them—and then send them off again. In no way were we to linger on them. Rather, we were meant to simply send these thoughts on their way.
This was difficult for me, since I was and continue to be in a line of work that requires a lot of thinking. I was sitting on my chair (it’s not mandatory to sit on the floor) and tried to focus on my breath. After three or four minutes my thoughts had calmed down somewhat, but suddenly a strong feeling of fear arose within me. I was about to quit and leave the room, but that was too embarrassing for me, so I tried to conquer my fear. After a while the panic disappeared, and it has never returned during any of my sessions of meditating.
It’s not unusual for fear to arise during the first attempts at meditation. Having to deal with emptiness all of a sudden is probably strange for the brain. The consciously chosen experience of quiet is a key component of meditation. It is an interruption of our permanently flowing stream of thoughts. Some irreverently call this automatized activity of the brain the “madhouse” or the “autopilot.” For most people it’s a completely unexpected realization to see how hard it is not to think.
In its Latin origin, meditatio means “to center toward the middle.” It’s a return to a prelinguistic experience. All of us were conscious before we learned to speak. But as soon as language arrived, it dominated everything. And as successful as it is in shaping our lives, it can interfere with relaxation and calmness. As early as two decades ago, stress researchers pointed out that it’s not only situations that are exhausting—thinking about them is just as exhausting.37 And so, it’s possible for the memory of a trauma to elicit a physical response. Worries, brooding, and a merry-go-round of thoughts can place the body in a state of constant stress. And our endless stream of thoughts don’t necessarily even lead to a solution, as many problems can’t be solved by thinking alone. Herein also lies the central difference to psychotherapy or to conversations: Meditation begins before language. Through silence and not thinking we can reach realizations that wouldn’t be possible to reach by thinking. In the quiet, our brain seems to be able to find solutions via paths that would normally be closed off by the constant stream of thoughts.
All forms of meditation incorporate the knowledge that it’s extremely hard for people not to think. To make it easier, various aids are used, such as monotonous word sequences—mantras—that are employed mainly to busy our restless mind. You repeat them and concentrate on, for example, the colors or images that appear in front of your closed eyes at the same time. Zen meditation attempts to gather the concentration, for example, by focusing on looking at a candle. Another Zen technique consists of paradoxical thought experiments, the kōans, which are puzzles that cannot be solved by rational thinking; only through prolonged meditation can a different understanding be reached.
Scientific research into mind-body medicine, by the way, has used transcendental meditation as a starting point, which is why its effects on the body have been well-examined (the lowering of blood pressure, the reduction of stress, and the relief from pain). Still, I don’t recommend it, because a lot of money is asked for the transfer of a mantra. This contradicts meditation as it is practiced in Indian yoga.
MINDFULNESS: THE RECIPE FOR STRESS REDUCTION
Over the past ten years, mindfulness meditation has spread widely. Here, you’re not concentrating on anything nor are you repeating any specific words; you are silent and aware. You are aware of what is happening in the body, in your thoughts and feelings—without judging anything. Mindfulness meditation was developed further and introduced to medicine by the molecular biologist and stress researcher Jon Kabat-Zinn. To free it from its religious references and
thus make it accessible to everybody, he stripped it of its Buddhist and spiritual approaches. That way, this secularized form of meditation was able to spread around the globe.
It uses mainly two techniques: In one technique, the entire body is palpated from head to toe, like in a CT scan, in what is called a body scan, but not in a mechanical and imaging way, but with the aid of perception. Therefore, it is possible for you to feel where a pain is actually located and what it feels like exactly for the first time. But it’s also possible that pleasant physical feelings are perceived through this exercise for the first time. In the other technique of mindfulness meditation, awareness is directed toward the breath. Any thoughts that pop into your head are named, such as financial worries or disputes in the family, in order to then separate yourself from your thoughts.
Based on this, Kabat-Zinn developed an eight-week training program, the Mindfulness-Based Stress Reduction Program (MBSR). Over the course of these eight weeks, the participants are asked to perform certain meditative exercises for forty-five minutes every day. This commitment is worth it: A considerable number of studies have been able to prove the great effectiveness of MBSR in the treatment of many chronic diseases. They show a clear healing effect or at least a relief of the symptoms in chronic back pain, depression, and stress.38 In mild and moderate depressions, mindfulness meditation is just as effective as antidepressants.39 And in very severe, incurable diseases like cancer or multiple sclerosis, it’s truly beneficial. The interruption of thoughts enables patients to push aside their anxieties about the future and return to the present, to the moment. That’s when they often find that their condition is not actually that bad. This in turn can reduce tension, relieve pain, and improve the functioning of the immune system.40
In fact, one of the most exciting effects of meditation is that though pain doesn’t actually disappear, it is perceived as less debilitating. To demonstrate this, researchers inflicted a pain stimulus—the prick of a needle or heat—on test subjects and subsequently examined the activation of pain centers in the brain in an MRI scanner. People who had been meditating regularly showed only half of the amount of pain center activation in the brain. It follows that meditation not only enables people to deal with pain better, but even leads to a real reduction of pain perception in the brain—the actual place from which pain originates.41
Meditation is very soothing, particularly with incurable, chronic diseases since it trains us to accept symptoms that cannot be eliminated through therapy. And the fact that lifelong complete health is not attainable for most people is what makes meditation so valuable. It’s not for nothing that Kabat-Zinn entitled his first book Full Catastrophe Living. Chaos, sorrow, and illness are a part of life. Meditation can help us learn to be happy in spite of this realization.
DISTANCING YOURSELF FROM YOUR SUFFERING
I first met Jon Kabat-Zinn in 1999. Gustav Dobos had invited him to the naturopathic hospital in Essen to lead a training course. We rented a school gym and meditated in a group for several sessions, each thirty to forty-five minutes. The course was interspersed with presentations and discussions of scientific findings on psoriasis, fibromyalgia, or post-traumatic stress disorder. It was a cheerful, inspiring atmosphere and our guest didn’t even let on that he was jetlagged. When the event came to its close, we were determined to introduce mindfulness meditation as a therapeutic method at our hospital in Essen.
The most important action to undertake in meditation is distancing oneself from one’s own suffering. The technical term for this is metacognition—taking the position of an observer, like seeing the world from a bird’s-eye perspective. From my own experiences with meditation I know this: If you truly commit to it, you can free yourself from even the gravest worries and distance yourself from what is bothering you. Of course, pain and grief remain, but they don’t drain you of your energy so much.
Another big advantage that comes from meditation is becoming less judgmental. Usually, we immediately attach a feeling, often a negative one, to everything that happens. When you see the brake lights of the car in front of you on the highway light up, you automatically start “catastrophizing”: Is there an accident ahead? How long am I going to be stuck in traffic? What happens if I don’t get to my destination on time? And so on. When you meditate regularly, non-judging is reinforced. Non-judging helps in our communication with others, because you no longer try and comment on everything straight away, but rather just perceive things as they are for the time being. Even when you feel anger, you don’t lose control but seek to observe, occupying a position of insight.
And finally, mindfulness is connected to basic virtues: a curious attitude, compassion, empathy, joy, and patience.
For people who put emphasis on their body, focusing on the breath is the best way to get started. For people who have a hard time relaxing, it can be helpful to name occurring thoughts before dismissing them, or visualize putting those thoughts in a drawer. Those interested in spirituality might want to try Vipassana meditation.
I chose to follow a mystic meditation from India, a mantra meditation where you close your eyes and concentrate on what you see and on the images that appear. We conducted two studies on this Iyoti meditation. A few patients with neck pain that had persisted for ten years on average were instructed in this type of meditation, others were asked to wait. After two months it became apparent that the group that meditated was experiencing significantly less pain, even though their limited mobility had not disappeared—this, in turn, showed that meditation is a way of influencing the brain, not a method of miraculous healing.
A multitude of studies on meditation have produced fascinating results. The team around Herbert Benson, for example, was able to document in 2013 that regular mindfulness meditation has a favorable influence on gene expression even after a relatively short period of practicing it.42 Other researchers proved that telomerase activity can be improved through meditation—telomerase are the enzymes that repair genetic material.43 Additionally, brain research was able to demonstrate that meditation is linked to an increase in the density of gray matter in the areas responsible for learning, emotions, and perspective thinking.44
Studies have shown that meditation is superior to most other relaxation methods, such as progressive muscle relaxation.45 Though patients often prefer progressive muscle relaxation because it only takes a short time, where hypertension is concerned it is defeated by the positive effects of meditation. Meditation is simply the most effective method of mind-body medicine.
Take your time—it’s worth sticking with it. In mindfulness-based stress reduction (MBSR) you should meditate for forty-five minutes every day (including doing the body scan). In transcendental meditation it’s forty minutes, and in Iyoti meditation it’s thirty to sixty minutes. For those who can’t sit still for that long I recommend going jogging or doing yoga beforehand and then meditating afterward, into the period of relaxation.
There are four reasons why it’s worthwhile to meditate:
Meditation causes the “relaxation response” in the body and does so in the most effective way compared to other methods.
The brain responds to meditation to such an extent that you almost get the impression that the body has been waiting for this specific program. Meditation and yoga help us find balance in our severely accelerated lives. The enormous concentration on spoken activity has largely replaced physical work, thoughts “tower” in our heads, and stress hormones can no longer be reduced. Meditation offers a way of creating a balance here.
Meditation sharpens our ability to concentrate and focus. Some may find the fact that companies use meditation to increase efficiency to be in bad taste. There’s nothing wrong with that, but it’s not its original purpose.
And finally, there is the path to spirituality, which is connected to questions about our existence and the purpose of life. It is a yearning for answers that most people experience,
no matter whether they are religious or not. Even atheists can devote themselves to these issues in meditation. Meditation is medication for the soul, wrote the renowned meditation teacher Rajinder Singh.46 Perceiving the limitations of our individual agency can have a comforting effect in the way we approach our everyday lives. “Everybody has to die, maybe even I,” the German comedian Karl Valentin, a hypochondriac, once said.
So try to learn meditation, either in person or following a video or audio recording. Try to find time for it on a regular basis—this, sadly, is where I fail from time to time, but that’s life. Mornings are better than evenings, because the brain is not quite so overloaded yet. You’ll be better prepared for a busy day and will suffer less stress. Meditate for thirty minutes, maybe half as long in the beginning, but then you should seek to continuously increase the duration. Find a seated position in which you feel as comfortable as possible—in no way does it have to be the lotus position. You can also sit straight on a chair. Get ready, get set, go: Don’t wait—meditate.
BREATHING SLOWLY PROLONGS YOUR LIFE
Both pranayama (yogic breathing) and meditation cause us to breathe a little slower (which, coincidentally, is also a positive result of endurance sports). Normally, we breathe fifteen times a minute. Under stress and physical exertion that number is higher. Many yoga and qigong exercises aim to reduce this frequency to six breaths a minute. This leads to a slower pulse and is supposedly very healthy for the heart, the blood vessels, and the organs. Ancient yoga texts claim that everyone has a predetermined number of breaths. You may dismiss this as a mystic legend, but what’s interesting is that slow breathing, particularly in patients with heart disease, is actually connected to a longer lifespan.
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