“Hearing sounds—voices—that nobody else can hear is terrifying. Sometimes it seems like nobody will listen to you or wants to be around you, as you are making them 'uncomfortable' with your story.” This is a quote from a then 15-year-old girl, let’s call her M.T., who I worked with for three years while I was a clinician at The Clifford Beers Child Guidance Clinic in New Haven, CT. The clinic works with children and their families. And at that time, we had to discharge our clients when they became adults, after their 18th birthdays, as the state no longer considered them eligible for care in a child guidance mental health clinic. At the end of those three years, we transitioned M.T. to her new therapist over a series of sessions, focusing on the closure of our work together, processing (therapist-speak for “talking with awareness about”) her setbacks and triumphs in treatment, and acknowledging the relationship we had developed and our feelings about saying good-bye.
Working with clients to support their ability to live with mental illness is an important skill set for a therapist. (For each and every one of us, the ability to accept ourselves is important if we want to live easeful and joyful lives.) The goal in therapy for this client was to help her learn to work with her anxiety. She reported feeling like the “victim of my mind,” so to support her therapeutic goal, we worked to develop a tool set that would allow her to “work with my mind, to help me calm it down when I start to speed up.”
Working with clients to support their ability to live with mental illness is an important skill set for a therapist.
When it was time for M.T. to transition to another therapist, we were blessed to find someone else with a background in asana, pranayama (breathwork), and meditation. These were M.T.'s requirements. Requirements that she felt were necessary in order to maintain the sense of balance she had cultivated in her life—what we had worked to build in her sessions, and what she valued most about her time in therapy: becoming a person who accepted her mental illness, which was only one aspect of her self-identity. Yoga played a big part in the success that she recognized from treatment.
Mood disorder is a large diagnostic category that covers many different presentations. M.T. had been experiencing symptoms of what is clinically known as bi-polar disorder. Generally, folks with this set of diagnostic symptomology do not have any issues with hallucinations, but at times in M.T.’s case history she had reported not being able to sleep, and secondary to the “days of no sleep,” there had been reports of the client hearing “voices in my head that tell me to do things." There are many variables that need to be considered to understand the connection between her diagnosis and her hallucinations, including medication changes and life events. Due to the complexity of the case, the only consistent predictor we could track for the hallucinations was stress.
Nonetheless, over the course of our work together, M.T. reported fewer and fewer hallucinations, but when under stress or not working with her treatment plan, she would occasionally report some auditory or visual hallucination, or false perception. Dr. David Read Johnson (my first supervisor at the National Center for PTSD, VA Hospital in West Haven, CT, almost 30 years ago) taught me that “Hallucinations are false perceptions that occur without any identifiable external stimulus and [they] indicate an abnormality." These false perceptions can be identified via one of the five sense modalities: hearing, seeing, feeling, tasting, or smelling, and are usually mood congruent—associated with the current mood of the individual. For example, if I am depressed, my hallucination might be more symbolic of fear, guilt, or despair. Often, folks who have these false perceptions are viewed as outcasts by society and have trouble navigating the outer world. They are often identified as odd—and may take on that identification—causing them to lose the fullness of who they are, reducing their self-identity to that of their symptoms. There is often a sense of disdain for self that increases, and this can also promote more intensity of their symptoms. Those of us who are familiar with yoga philosophy may view this as an example of a wheel of samskara (impression), vasana (tendency), and karma (action) that keeps the patient in pain.
Our treatment goal was for the patient to be more compassionate to herself.
During my work with M.T., we began to use breathwork, asana, and deep relaxation to encourage her brain to “pause” before reacting to the tendency (vasana) toward stress. When working with someone who has been identified as the “kid who sees weird things” by peers, we must not only address the hallucinations themselves, but also the social identification that goes with the experience. I will not go into the treatment of the bi-polar disorder or hallucination, as that is not actually the clinical issue we treated with yoga and meditation. One of the treatment goals for these practices was for M.T. to learn to be more compassionate to herself. Another treatment goal was for her to begin to write her own “definition of self”—a step toward self-acceptance.
For our asana work, we used crocodile pose, a prone posture with head resting on the hands to help her “find” her belly breath. This pose helps to calm vata dosha and supports a sense of containment for the mind and body. We also worked with forward folds and twists to help her ground and digest her experiences.
We brought in systemic relaxation to help her begin to find quiet within. Going within, or closing her eyes, was not identified as “safe” for this teenager, so we started with trataka (fire gazing) and later moved to deep relaxation practices as she progressed in her mastery over breath and self- regulation. Over time, she was able to close her eyes and to follow her breath with minimal guidance. (This "going within," or changing the locus of control from the outside world to the inner world, requires stability in the mind, and can be challenging for many of us when we start to meditate). When M.T. was discharged from our clinic, she was sitting for practice ten minutes a day, starting with alternate nostril breath, and then working with a guided meditation.
Was her mental illness gone? No. Was she better able to manage her symptoms? Sometimes. Did she feel therapy had been successful? A little. What she did feel was useful was her newfound ability to accept herself (most of the time) and to see herself beyond her symptoms. She felt that she had developed the ability to adjust the acceleration of her anxiety, and she now had “things to do” when she started to feel “worked up.”
Was her mental illness gone? No. Was she better able to manage her symptoms? Sometimes.
For me, too, learning to accept myself is an ongoing process. I feel each time I work with a client or patient that I am being given an opportunity to share the tools that have helped me, and many others, learn to go within. These tools support all clinical work, as well as the goal of self-evolution!