While it's not a cure for cancer, yoga enhances physical and emotional wellness and brings a peace many patients had thought they'd lost forever.
Fog softens the contours of the laurel tree, the white trunks of birches, the spiky holly tree that stands at the entrance to the Holly Tree Inn where the Ting-Sha Cancer Retreat is held. It's 5 p.m., and the participants make their way from the hot tub and massage room, or from the art studio, or from the trail next to the stream that winds through the woods, across the lawn to the yellow-frame bed and breakfast. We are not the usual guests, vacationers come to savor the peace and pleasure of this spot an hour's drive north of San Francisco.
We arrive at the house and enter the large ground-floor room: nine women and men, aged 30 to 75, one of us from as far away as Memphis. We enter quietly and arrange ourselves for meditation. Some of us, needing to lean, place pillows behind our backs and under our knees, and wrap ourselves in blankets.
Seated facing us is a narrow-bodied, tall woman with large eyes radiating kindness behind her glasses. Virginia Veach, our yoga instructor, is the director of the Ting-Sha Institute, the retreat's sponsor.
"It's in these moments of silence or relaxation that healing occurs," Virgina tells us. "Yoga, meditation, and relaxation are ways to quiet our minds. Relaxation is a state of openness and readiness. It is neither tension nor flaccidity, but availability for movement."
As we rise to begin the yoga postures, I glance at the other participants. Lois, a redhead in her early 30s and mother of two children, struggles with a rare form of leukemia. Eileen, a musician, holds herself carefully, mindful of the cancer in her spine. Three of the women have had breast cancer: Lucy, a commanding woman from the deep South; Janet from San Francisco, who has masses of thick hair and a whimsical, determined attitude that serves her well in her wholly alternative care for her cancer; and Ann, a slender, charming psychotherapist and mother of grown sons, who moves slowly, debilitated by the chemotherapy she has just received. Arnold, our oldest, most enthusiastically vigorous and life-affirming member, slips on his artificial leg, the result of an inebriated motorcycle ride many years ago. Now he faces bone metastasis from his prostate cancer. Ruth and Jake, a young married couple, are learning how to deal with her lymphoma and preparing for a bone marrow transplant. And I, a survivor of colon cancer, am seeking to put my life back together and understand what happened to me.
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Virginia guides us in a standing posture. She turns our attention to the breath, saying, "At the end of your exhale, feel a tiny release and let yourself relax more deeply into the posture."
Glancing at Lois, Virginia talks about pain. "If you're on chemo or if you have bone metastasis or tumors, you may be experiencing pain. Please don't do anything that hurts, and don't push into pain."
Now she asks us to sit on the floor, one leg out to the side, the other bent into the groin, and, lifting our arms, to bend along our outstretched leg. "Again, breathe in and out, and at the end of your exhale, feel that there is a little bit of give, and move with it."
Lois straightens up, her face distressed.
"What is it?" Virginia asks.
"My spleen is enlarged, and I feel like I'm squeezing it when I bend over."
"Does it hurt?"
"Then don't do this. Or maybe try bending just a little without lifting your arms. And stop if it's painful."
Lois tries again, frowning.
"What's going on now?" asks Virginia.
"Hurts," replies the redhead.
"Then try lying down and see what the openness will bring."
Lois sighs as she surrenders to her mat.
After a few minutes Virginia turns her attention to Lois again. "How is your breathing now?" she asks. "Is there more possibility for an inner quiet and rest?"
Virginia leads us in several more gentle postures, then has us lie on our backs. She comes to each person and covers him or her with a blanket. Draping the blanket at my feet, she unrolls it gently up over my legs and chest. Then she leans to tuck the soft cotton knit around my shoulders.
As we lie under our coverings, Virgina guides us to experience our toes, our calves, our knees, up the fronts of our bodies, then down the backs. Somewhere near pelvis level, I sink away into sleep.
When I awaken, my compatriots are chuckling and talking about the "sparkles" and tingles they had experienced in their chests and then throughout their bodies in the breathing exercises. I turn my head to see Virginia Veach smiling in the front of the room. "Those sparkles are prana," she tells us, "life energyhealing energy."
Yoga is but one component of the Ting-Sha Institute Cancer Retreat, a stress reduction, health education, and group support program for people with cancer and their family members or close friends. The retreat also provides a delicious vegetarian, low-fat diet; the participants have three massages during the week; they are encouraged to express their feelings in art and poetry; and they're given information that will allow them to make choices for their care. We gather in group sessions to explore the issues raised by a life-threatening illness and to build support for each other in the time to come.
At Ting-Sha I begin to see that disease can be "negotiable." I realize that we can learn new ways to visualize, respond to, and work with our disease and the often difficult therapies that cancer patients endure. A Ting-Sha brochure given to participants quotes Alec Forbes, M.D., of the Bristol Cancer Help Centre in England, who says that through our own efforts and with the help of professionals and our community, we can become "well cancer patients," who still have cancer but are fighting it from a state of much better health, with generally improved results.
The care given at Ting-Sha and other cancer-help centers around the country is grounded in theories of stress management derived from several decades of scientific research. A solid body of experimental studies has demonstrated that stress influences the immune system and contributes to the development and progress of immune-based diseases such as cancer and AIDS. As early as 1962, an article in the journal Cancer Research reported the beneficial effects of stress reduction on laboratory animals injected with cancer. In the 35-plus years since, the empirical evidence has piled up. A landmark 1989 study by Stanford psychiatrist David Spiegel found that women with metastatic breast cancer who participated in a support group lived longer than those who did not. The group support was seen to protect against or lessen stress. Likewise, yoga, breathing exercises, and meditation can reduce stress and promote healing. Indeed, even the American Cancer Society, on its Web site (www.cancer.org), notes that yoga which it describes as a "complementary therapy...not a treatment for any disease"can "reduce levels of stress and bring about feelings of relaxation and well-being...[and] enhance quality of life for some patients with cancer."
The notion that cancer is "negotiable" offers revolutionary possibilities for a patient struggling to survive. From this perspective, life-threatening illness can become not just something to be endured and prayed about until it either goes away or kills us, but a challenge to take control of our lives. Instead of being stuck with a few grim options, in the strange and frightening territory where patients find themselves suddenly exiled at diagnosis, we can develop some self-empowering ways to meet and live with illness. And health practitioners who work with cancer patients can help us learn how not to run away from our cancer but to live with it while we must; if trained in the appropriate disciplines, they can teach us to strengthen the immune system so we can soften the worst effects of both the illness and the treatments.
Relax into Healing
Traditionally, yoga's power to bring deliverance from pain and sorrow comes as the student learns to work with his or her senses and intellect. While the practices of yoga, as codified by the Indian master Patanjali centuries ago, classically begin with ethics and self-purification, the cancer patient probably benefits initially from the asanas themselves. These poses are designed to exercise every muscle, nerve, and gland in the body. Refined over centuries, the postures precisely address the tension, holding, and sometimes blockage of energy in any particular joint or organ. When the tension is released, energy can flow more easily in the body and allow patients to experience a sense of well-being and strengtha balance of body, mind, and spirit.
Healing requires a slowing down, a relaxation of tension - both the tightness and holding of the body and the mind's incessant worrying and thinking ahead to dreadful possibilities. But this seems an almost impossible task. While acute stress has the effect of stimulating the cells that protect our system (if attacked by a lion, we would experience a very high level of tension and attendant physical changes that would promote our chances for survival), chronic stressthe kind of daily worry and pressure that a cancer patient typically experiencesmarkedly depresses the function of the natural "killer cells" that protect, thus leaving us even more vulnerable to our disease. The growth of tumors and other cancer indicators have all been shown to be exacerbated by stress.
Most of us are so used to being tense that we are not even conscious of our tightness. If cancer is detected in your body, the news itself raises your anxiety level tremendously. Then, in quick succession, you prepare to undergo surgery and are given a debilitating course of chemotherapy and/or radiation. What could be more frightening? How are we to relax in the midst of the most stressful thing that has ever happened to us? How can we bypass the anxiety and despair that cause us to tighten up and turn away from life, and learn to recognize and pursue more positive possibilities?
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As if to answer these questions, Ann Getzoff, sitting in the garden at the Ting-Sha retreat, talks about her experience with yoga. "I consider the yoga class a life-saver. When I was sickest from the treatments, yoga was the one steady thing I could do, no matter what. When I couldn't even commit to going to a movie because I wasn't sure I could sit up for an hour and a half, still I could go to yoga and do the postures."
Ann has been living with illness for a year, undergoing intensive radiation and chemotherapy treatments for Stage IIIB breast cancer, knowing the statistics give her only a 40 percent chance of surviving the next five years. Extremely thin, her hair just barely growing back, she says she does many complementary therapies in support of standard medical procedures.
Ann had been doing yoga for 20 years, most recently in a class in Santa Cruz, California, led by Teri Mehegan. But when she began the radical radiation and chemotherapy treatments, her strength declined so much that "sometimes I had to drag myself into the yoga class and just lie on the floor. Teri knew what was happening with me and always greeted me with a big hug and a few loving words. Sometimes, she would acknowledge me verbally during class by saying, 'You may not want to do this, Ann,' or 'You might want to do the posture this way, Ann.' When she came around to adjust people, she might pat me or help me get into an easier position. Then as each class progressed and I did the postures, it was amazing how strong I would feel. During the rest of my day, I could barely stand up, barely walk, but I would be able to hold the Triangle Pose, for instance, for as long as everyone else! The only way I can explain that is that yoga awakened my energy, and maybe I was getting energy from the other people there too." Yoga, she adds, "was a very important part of my healing."
"How do you think the healing occurs?" I ask.
Ann pauses for a moment, then says, "It happens on three levels. On the physical, the yoga gives me increased energy; on the psychological level, I always feel acknowledged and even cherished, mostly by the instructor but also by the other students; and spiritually, it gives me a time to reflect, to go inside." Ann describes the inward, quiet time at the end of the sessionwhen the students lie still and Teri leads them in a short meditationas invaluable.
My own experience echoes Ann's. When I was most ill and depleted from chemotherapy treatments, I attended a body-movement class. Always, no matter how terrible I had felt upon entering the session, I would leave feeling centered and energized. I began to believe that no matter how sick we may bein pain, nauseated, exhausted, diseasedthere is within us a healthy body or a healthy being. For many cancer patients, yoga offers techniques that allow us to support and awaken this vital part of ourselves.
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A Skeptic Signs On
Many medical doctors tend to dismiss the beneficial effects of yoga and meditation, opting to stay within the safe though limited enclave of conventional medical practices. Sometimes it is only the crisis of his or her own incurable cancer that can bring a doctor to the yoga mat. A few years ago, Dr. William Fair was one such skeptic. But, as an October 26, 1998 New Yorker article reported, he now incorporates complementary therapies including yoga and meditation, vitamins, and a high-soy, low-fat dietto help him live with his own incurable colon cancer.
The epitome of the hard-driving, Type A, highly successful physician, Dr. Fair worked at California's Stanford Medical Center, Washington University in St. Louis, and for 13 years was chairman of the Department of Urology at Memorial Sloan-Kettering in New York, one of the most prestigious cancer hospitals in the country. A top-flight surgeon specializing in cancers of the prostate, bladder, testes, and kidney, he typically performed several surgeries a day at Sloan-Kettering, directed research projects, and administered the department. Reached at his home in Manhattan, Dr. Fair spoke about the alternative practices he now employs in dealing with his own condition.
"Yoga has made a tremendous change in my life!" he claims. He expresses warm enthusiasm for his yoga teacher, Lisa Bennett, of the Yoga Zone, who comes to his house once a week to lead him and his wife in a yoga session that lasts for an hour or more. Just as important is his meditation practice. He meditates every day and can point to junctures in the progress of his disease when meditation gave him crucial support.
While he could see the value of diet and exercise, initially Dr. Fair completely resisted the "California touchy-feely" practices of yoga and meditation. He was introduced to both by Dr. Dean Ornish, the noted proponent of lifestyle changes for heart patients. But Dr. Fair was not convinced that yoga would be helpful for him.
After his diagnosis in 1995, Dr. Fair underwent surgery and chemotherapy. He resumed his work schedule, but two years later the tumor recurred, and he was told his chances of surviving had dropped dramatically. "As my choices with conventional therapy diminished," he says, "and I saw that the scientific evidence showed some measurable benefit from yoga and meditation, that was my thrust to get started." At the urging of Dr. Ornish, he went to a retreat at the Commonweal Cancer Help Program near the Northern California coastal town of Bolinas. (The prototype for residential cancer healing programs, Commonweal has spawned Ting-Sha and similar retreats in several states.) There he learned from yoga teacher Waz Thomas and massage therapist Jnani Chapman, and took his new regimen back to Manhattan.
"I just love yoga," he says. "It helps my breathing, and gives me better flexibility and more energy." He admits that, true to his high-achiever personality, he began by trying to duplicate the perfect form of young, flexible yoga instructors and wound up frustrated. Bennett urged him to concentrate instead on his breathing as he did the postures. Soon, with her encouragement, he was able to relax in the poses; gradually he stretched and strengthened.
Dr. Fair's daily meditation brings him, he says, to "a whole new outlook on life. Meditation has taught me to keep in mind what's important and what's not." When his cancer recurred in August 1997, he was offered radical chemotherapy that might have shrunk his tumor but would not have eliminated itand would certainly have made him very ill.
"When you have cancer," he says, "anxiety eats on you. But when I meditate, I'm able to put things in perspective. No one lives forever. The time I have lefthow do I want to spend it? This is what I asked myself." His yoga and meditation practice, along with the support of his family, allowed Dr. Fair to make the decision to refuse conventional treatment. Now, as described in the New Yorker article, he treats his tumor with Chinese herbs, and continues his yoga and meditation sessions.
"How are you doing?" I ask.
"I'm doing fine!" And he tells me what a good decision it was. "If I had accepted the chemotherapy treatments, I would have spent last year sick and miserable." Instead, he went trekking in Patagonia, learned to scuba dive, and pursued a full professional and personal life.
Another important dimension for cancer patients is breathwork, or Pranayama. "Many people who are going through the distress of an illness don't breathe very efficiently," Waz Thomas points out. "But when we optimize breathing, we are bringing into the body not just oxygen, but a much more subtle force. Prana, air, breaththe essential life force. Even if you can't do the postures, you can still benefit from breathing practice."
The term pranayama combines prana, breath, with yama, meaning extension or control, and describes a crucial practice in yoga. This "science of the breath" involves attention to inhalation, exhalation, and retention or holding. Through pranayama, one learns to breathe slowly and deeply, in rhythmic patterns. These patterns strengthen the respiratory system, calm the nervous system, and can reduce our craving for something more to fill our needs.
When we are frightened, we hold our breath or breathe shallowly or raggedly. To open up the chest again, one can practice breathing techniques based on pranayama, such as abdominal breathing, deep breathing, bellows breathing (with forceful abdominal exhalations), and alternate-nostril breathing. (As breath practices can have powerful effects on the body, they should be learned from a qualified yoga instructor, for safety's sake.) Done properly, they can dissolve stress and emotional excitation, freeing the mind from anxiety.
Dr. Fair's breathwork regime includes an exercise in which the belly and chest are expanded, filling the whole torso with air. In another innovative exercise combining breath and visualization, he starts at the base of his spine. As he inhales he visualizes a light moving up his back, vertebra by vertebra; as he exhales, he sees the light coming down the front of his spine; and when it reaches the level of his tumor, he sees the tumor going away.
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Breathing practices can have another benefit, Waz notes. "Prana not only sustains life, it also acts as a cleanser. With cancer and chemotherapy, our bodies are quite polluted. You're putting in industrial-strength toxins. A very simple way to help the body's natural cleansing system is to put more oxygen in it, because oxygen goes into the bloodstream and helps eliminate toxins. So if someone here at Commonweal can't do asanas, I give them breathing exercises. They're going to feel better just opening the chest and inhaling."
Waz sees meditation as a crucial dimension of yoga. For people dealing with life-threatening illness, with all the psychological and emotional havoc that wreaks, meditation can offer a method to quiet the terrified voices that jabber in our heads. The simplest forms of meditation ask us to be physically still and direct our attention toward an object. We may be led to imagine a particular scene or visual image, or we may pay attention to sensations in the body, traveling through it from top to bottom; one very common object of attention in meditation is our breathing, the in-and-out motion of the breath that occurs automatically many times each minute and which we are rarely aware of.
Cancer patients often find themselves in distracted states of mindbombarded as they are by frightening, sometimes contradictory, information, subjected to invasive, painful procedures, and not-always-compassionate medical care. When our minds are so grievously disturbed, we may find it impossible to make crucial decisions or relate satisfactorily to our family and friends. With the practices of concentration (Dharana) and meditation (Dhyana) which yoga affords us, a patient can focus and let go of nagging preoccupations.
Again Dr. Fair's experience comes to mind, perhaps because his mastery of meditation was so hard-won. He found that learning to meditate was more difficult for him than the physical postures or breathing. At first he floundered, not sure what he was doing. But with focus on his breath, he was able to steady his mind. Then he learned to concentrate on the "third eye," a point in the middle of the forehead. As an aid to concentration, he licked his finger and placed a drop of saliva on his forehead so that he could actually feel it.
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Now he is able to achieve concentration without this help, and has gone on to add other practices to his meditation sessions. If he starts to lose concentration, he always returns to focus on his breathing. Dr. Fair is so enthusiastic about meditation that he has built a meditation garden, complete with Japanese-style stones and a pond, at his Long Island weekend house. When he is meditating in noisy Manhattan, he keeps the image of this garden in his mind.
"The great teachings, and life itself," Waz says, "show us that most of our terror, our dread, our problems lie in the past or in the future. Whereas basically, right here and now is pretty much okay." Control of the mind in meditation can lead from wanting what we cannot have, from craving, grieving, and being unhappy, to just arriving in this moment, where we may possibly experience a feeling of contentment, and may be able to make better decisions about our medical and complementary care.
Among the fundamental issues that predispose us to disease and affect our healing is our estrangement from ourselves and others. Now some physician-researchers are beginning to emphasize this dimension as a key aspect of coping with illness.
Dr. Dean Ornish has written about the various forms of isolation, including the social and spiritual, and the disconnection from our very own beingour feelings and sensations, our inner sense of ourselves. In everyday life, we tend to focus so thoroughly on the external worldmeeting the requirements of job and family, hoping for the satisfactions of future fulfillmentthat we lose awareness of the actual, intimate, moment-by-moment experience of our own physical, mental, and emotional selves.
Yoga postures require us to hold still and to be aware of our bodies. Asana, pranayama, and meditation begin to break down that distance from ourselves and bring us into close contact with our sensations and feelings. Knowing how our bodies really feel, we can notice when we are stressed and can make decisions about our activities and our attitudes that can change our relationship to our cancer healing. That is, yoga can help us open up to different ways of integrating our experience. For example, when faced with a challenging medical procedure, rather than tensing ourselves against it or going away mentally, because of our yoga practice we may be able to relax and welcome the procedure, thus minimizing its stressful effects.
Eileen Hadidian, a professional musician and music professor, responded to her own difficult medical experiences by urging oncologists at local hospitals to enlist the aid of nutritionists in helping patients mitigate the effects of cancer treatments. A slender woman, bald from chemo, Eileen looks at me with large, alert eyes. As we talk in the comfortable living room at the Ting-Sha retreat, she smiles often. She leans back gratefully into the couch cushions. Her cancer now infiltrates her spine, and she has told me that her back hurts most of the time. But yoga, which she studies in classes at a community center near her home, helps her tolerate this pain.
"I went back to doing yoga a month after surgerylumpectomy and lymph node dissection," she says. "I was sore, but within a half hour of going back to my yoga class, my arm went from being able to go this far"she holds her arm just a few inches away from her body"to going up [higher]. And so I said, 'Bingo!' The class caters to all levels. What I did was I just tailored it to what I could do, and then week after week I was able to do more and more."
"The instructor was aware of your condition?" I ask. "She was trusting you not to push yourself beyond where you needed to go?"
"Exactly. She was very good about saying to me, 'Just do what you can. Follow your body, follow your intuition.' So that's what I did. And it felt great. I breezed through radiation, had minimal side effects. The fatigue that comes with radiation set in just during the last week. So my recovery was relatively easy. And I attribute a lot of that to the yoga. Along with meditation, visualization, acupuncture, and herbs."
Three years after the radiation treatments, when she began to experience severe back pain and discovered her cancer had metastasized to her spine, Eileen had to stop going to the yoga class. But then a chance experience allowed her to adapt her yoga practice to suit her changed condition.
"I had a one-time yoga session with a woman, the mother of one of my young music students, who is training to be a yoga teacher. We had a very gentle session where she gave me about four different postures that I could do. This was back when I had a lot more pain. She propped me up with pillows so when I did Child's Pose it was not the regular Child's Pose but one that was supported. I've been doing those postures ever since.
"It would be wonderful if someone had a little traveling yoga practice, and went around to people's homes, for people with multiple sclerosis, cancer, chronic fatigue, or AIDS. It would have to be somebody who knew enough about physiology to say 'Okay, here are some things that you can do.' It could be such a service, because people living with physical limitations need to be empowered by being shown what they can do."
A number of physician-directed programs, like Dr. Ornish's Prostate Cancer Lifestyle Trial and the Breast Cancer Personal Support and Lifestyle Integration Program in San Francisco, train patients in yoga postures, breathing, and meditation techniques.
Cancer-help retreats offer intensive contact and support. In addition, some individual yoga instructors are adapting their teachings for patients limited by illness or disability. In these settings, yoga teachers work individually with their cancer-patient students. They have learned to be extremely sensitive to special needs, to maintain strong, open communication with the patient, and to creatively adapt postures and other yogic elements.
Perhaps the most compelling reason cancer patients are turning to yoga is this: It shows us how a person stricken with a serious illness, instead of "running away" from their threatened body, can connect more strongly to that body and begin to experience self-empowerment and well-being. As we engage our physical selves in the precise body gestures of yoga, our minds come along, growing accustomed to focusing on the affairs of this moment and leaving worries and future-thinking behind. As we breathe and meditate, our minds grow more clear and steady.
The physical benefits of yoga seem obvious to a cancer patient. Range of motion, flexibility, strength, relaxation, and a sense of bodily well-being are enhanced by practicing the postures. But there is an additional, more mystical, benefit of yoga.
Waz Thomas calls this an experience of one's "essential nature," and uses the language of the great spiritual traditions to characterize it: "A stillness, a oneness, a unity; the void, the great ground of being." Another yoga therapist speaks of the "life force."
Gary Kraftsow, of the Center for Viniyoga Studies in Hawaii, speaks of helping patients "connect with their hearts," achieving a deeper union with themselves and something larger than themselves. These practitioners are attempting to put words to an experience that is subtle but unmistakable, and precious to anyone who has experienced it.
Managing one's cancer can be a difficult, demanding task. Even with consistent support from family and friends, each day can be a struggle to assess one's failing energy, to change or sometimes just endure the uncomfortable, often painful side-effects of treatment, to struggle against depression at the thought of further weakness and death. I remember, at the worst times, thinking that my life energyI could feel it somewhere inside my chest, like a little pilot lightwas burning very, very low. I was miserable. One cannot overestimate the value, to someone in that condition, of a moment of ease, joy, and well-being.
With a skilled and sensitive teacher in a safe environment, yoga can give us that gift. It can begin to create an inner environment that prepares the ground for healing. It is as if, when we clear away the mental debris through yoga and meditation, our being breathes a sigh of relief, and the residual energy alive in us is allowed to grow and flourish. We empower this most vital and elemental part of ourselves when we hold still, when we pay attention. Some would call this process spiritual. All of us, whatever our beliefs, can recognize this state of grace, this moment of freedom. Yoga teachers can show us how to cultivate this healing condition, give us the physical and mental tools, even when we are gravely ill, to access our deepest, most sustaining energy.
One recent night I went to yoga class at the gym. In a mirrored studio, I worked at lengthening my neck in shoulderstand, and the other moves and awarenesses the young male instructor encouraged us to experience. Of the 20 or so students in the room, I may have been the only one who had experienced cancer. I was probably the oldest person, and I'm sure I was the one with the roundest tummy. But perhaps I knew, better than the others, why I was there.
For 20 years I did the same five yoga postures every morning, never challenging myself. Now I want to develop precision, build strength, experience the farthest reaches of my body's possibilities. Will this help, along with diet, aerobic exercise, and meditation, to prevent a recurrence of my cancer?
On the one hand, I believe it will. On the other hand, it doesn't matter, because the real reason I do yoga is the feeling I get, that visceral sense of be