Yoga and Aids

By Paula Kout

(Two pages of drawings of recommended Yoga poses and brief descriptions of each pose were originally published with this article. Each page is reproduced here as a gif image, each 18k. If you are not familiar with these poses, please seek instruction from a qualified Yoga teacher. Illustrations Page 1. Illustrations Page 2.)

The atmosphere in the room is possessed of a truly spiritual aura. The afternoon light is pale and grey, the trill of a lone bird, perched on a tree branch near by, floats across the space. Five men are positioned on the floor in Supta Baddha Konasana, reclining bound angle pose. Bolsters and blankets are supporting their heads and torsos, the soles of their feet are touching, knees dropping off to the sides, slung by belts and supported by corduroy-covered foam bricks. Their soft breathing and the upturned palms of their hands, like the open leaves of a plant, put the finishing touches on this picture of repose and surrender.

I am at A.A.H.P., AIDS Alternative Health Project, an alternative clinic on the near northside of Chicago, teaching my weekly yoga class. A yoga teacher by profession, I came to A.A.H.P. in an effort to make a positive contribution to the AIDS epidemic.

My trepidations ran the gamut of the predictable: "Will I get infected?," "Can I handle the emotional implications?," "What will I do if one of them dies?" Now being actually in the experience, those questions no longer seem pertinent. I don't think about getting infected from one of my students. My work with them does not involve close physical contact or the opportunity for exchange of bodily fluids. Emotionally, I get great energy from these men. They are generally positive and up beat, and not in the least self-effacing, even when being plagued by an opportunistic infection, the real killer in an AIDS condition. Two of them have died, gracefully and with great dignity. Death is something our culture is in denial about. We want to stay forever young, so we sweep death into a dark corner and shroud it in mystery. Here is where I became the student, learning from the example of these two brave souls as they faced their transformation from one plane of consciousness to the next.

The class size is limited to five. More clients of the clinic are interested in joining our class but we only have props for five. Props meaning mats, blankets, bolsters, blocks, belts, eyebags and sandbags. We were fortunate in that my regular suppliers donated their products, the clinic bought the bolsters, I donated the sandbags and another practitioner made the eyebags. It is hard for the clinic, run wholly on donations to justify spending one hundred twenty dollars per person on props. On the other hand, what does a week of AZT cost? Props are a one time investment, to be used for years and shared with others.

Used particularly in the restorative or theraputic poses, the shape and alignment of the pose is determined by the props while the muscles remain quiet. These restorative poses elicit the "relaxation response," necessary in counteracting the negative effects of stress, a major immunosupressor.

Inversions are the other category of poses in our weekly sequence. Handstand, forearm balance, headstand and shoulderstand work on the immune system, particularly the endocrine or ductless glands.

Manouso Manos, a senior Iyengar teacher from the San Francisco area, gave me this sequence in November of 1990 while he was in Chicago for a workshop. Knowing Manouso had experience working with HIV+ and Yoga, I trusted his expertise. When the class actually began in January of 1991, I hesitated to use his sequence. It was too much, or so I thought. For the first two months, we did restorative poses and I read meditations from Stephen Levine's books, Healing Into Life And Death and Who Dies? while the group was in Savasana or corpse pose. At that time, we did not have our props and were making due with some large plastic-covered mats that had graciously been donated.

One day, for no particular reason, I asked the class to attempt handstand or full arm balance. At this point, each of them was asymptomatic. Much to my surprise, they all succeeded in going up against the wall. That was the end of lying on the floor and being passive. We began using Manouso's sequence in earnest. Props were forth coming.

After using the sequence for about nine months, Manouso was back in town again. We talked about the postures - why they were chosen and what they do. They were chosen because "They actually renovate the hormonal system of the body, the ductless glands of the body, to start to balance their activities. Production of hormones, the endocrine system as a whole, is all renovated," Manouso explained. A much maligned and misunderstood endocrine gland is the thymus. Steven Locke tells us in his informative book, The Healer Within, ". . . for decades, it was considered a vestigal remnant of evolution that shrinks with age. During infancy and childhood, it is at its largest. It begins to shrink at the onset of puberty, in a process that continues throughout at Albert Einstein College of Medicine in New York during the early 1960s showed that the thymus was a gland that produced very important hormones: thymosins. Thymosins not only regulate white blood cells, specifically T-cells, but control other hormones and are important in the growth and aging process. The thymus gland, as one immunologist put it, 'directs the immunologic orchestra."

One of the more widely used diagnostic tools in reading the effect of the HIV virus on the body is the T-cell count. It is in the thymus gland that T-cells are transformed into fully functional thymus derived T- cells. The open-chested poses such as Supta Baddha Konasana (reclining bound angle pose) or Setu Bandha over bolsters or a bench (bridge pose) stimulate the thymus gland. Manouso pointed out that "as the immune system weakens and you get sicker, the chest automatically closes."

Another idea that Locke touches upon in his book is that of overcoming feelings of helplessness along with the corrosion of will power that comes with confronting an impossible situation over and over again. The reaction one has to stress is more influential on the immune system than the actual stressful event. Positive coping behavior has been correlated with healthy immune function.

Yoga, and specifically the HIV+ sequence, is about self empowerment, through a sense of standing on your own two feet and working on your own rather than having someone else do the work for you. One of my students, John M., pointed out that the increasing expense of maintaining a program of superior health has made Yoga stand out as one of the things he can do for himself.

When I queried Manouso about the repetition of the same sequence, week after week, his reply included a minimum of confusion for those who have been coming regularly, knowledge of how they will feel after the end projected result and development of a sensitivity about "what does them right." This was corroborated by each student.

If being infected with the HIV virus is a death sentence, then I have some men who resemble cats, using their nine lives. Five of the six tested positive in 1986 or 1987. The sixth is a relatively recent disclosure, early 1991. During the five to six years of cognizance, while there may have been a few years of having the virus while not being aware of it, two of them, John M. and Michael, have remained completely asymptomatic and take no drug treatment of any kind although each of their T-cell counts continues to drop. Of the remaining four, two, Nick and John O., have died, John K., has a Kaposi's sarcoma lesion and on his most recent positive test, Robert, is also symptom free.

When I spoke with John M. and Michael, they had no real answer as to why they have maintained the symptom free status. In reviewing the path each has followed commencing with testing positive, control of stress stands out in the gestalt. During a visualization workshop, John M. found his guide and asked what he should do. The reply was to just relax, there will be more later but for now, just relax. He found this very profound in its simplicity. His initial reaction to his positive test was denial and anger so he partied a lot telling himself: "I feel too good for this to be happening to me." When people around him began dying he began to change his lifestyle, working out more, cutting back on liquor and drugs and eating a more healthy diet. Concurrently, he began reading about people who were surviving AIDS. This led him to seeking out acupuncture and massage and to come to A.A.H.P., upon which he now relies for most of his health care and looks at doctors for just opinions. Denial has taken on a new meaning - denying AIDS the power to take over his life. Things that a year ago would have been viewed as out of the question are now being considered. He'd rather stand on his head than take a pill!

In John's own words, "Yoga is the main thing that makes me feel good, besides emotional things I can do with a partner or being in love. I really feel it if I don't have it every week. It is a big security blanket. Yoga does more for me than anything else I do. It makes so much sense, especially now that I am studying massage and learning about the organs. I'm feeling more in touch with my body than I thought I ever could. It helps me to slow down and look at life week by week, day by day; using what I have, not always wanting more; learning to live in the moment."

Michael's positive test results came circuitously after a blood donation. Perceiving the impersonal letter that arrived carrying the news as a death sentence, he went through all five stages of acknowledging death: denial, anger, bargaining, depression and finally, acceptance. Having always been a good eater, initially, he didn't do much to change his lifestyle. Beginning meditation helped and his approach became one of destressing and relaxing. His path to A.A.H.P. was through T.P.A., Test Positive Aware, the first place he discovered where he could be with other people in his situation - something he found comforting. As a way of counteracting the tendency to focus on "poor me," an all too easy trap to fall into, Michael began volunteering; first at a hospital as a lay clergyman, next at A.A.H.P., and now at another alternative clinic in the Uptown area. "Volunteering is highly effective and theraputic. There is another power or energy that comes through you when you are helping someone else," he told me.

In conjunction with acupuncture, massage and Chinese herbs, Michael has been practicing Yoga since January of 1991. Although he has no regular practice outside of class, it has become a tool he uses when he is stressed out or not sleeping well. He claims it helps him listen more closely to his body and focus on his life. He likes being able to see results, a change from beginning to the end of class. "All therapies work together synergistically. It feels good to take an active part in my own health. My attitude towards AIDS is 'I'm going to control it - it won't control me.'"

The comradery of the group is of great value to Michael. When Nick died last fall, he felt a part of us was gone. When Robert and John K. went up in their first handstands, they knew we were behind them, cheering them on.

Other clinic activities don't involve working in a group. Everyone in the Yoga class echoes the feeling that the class allows for intimacy without sex. The communal feeling is nice and they would like to see it made available to more people.

Again, denial; John K. was out of control in his life. The HIV+ test result was nothing to be dealt with right away. He got involved in a relationship to take the focus off of himself so as to not have to think about the whole thing. That was in 1987. Now his focus is totally on himself, "...not in terms of what I can do to beat this disease but what I can do to be here right now - not worrying about the past or the future. How can I not be present? When I am present, the reality of my health is quite good. The point is not the quality of my health, but to experience it the way it should be experienced as opposed to making it more agonizing or not understanding what it has to teach me."

Not a total stranger to Yoga, John's history includes two previous experiences. He joined our class in the fall of 1991. As yet, not in the place of using Yoga in problem situations, he says he still just panics. Instead, he uses it mostly for stretching before his workout at the health club he joined in January of 1990, prompted by a T-cell count of only 410 (anything under 200 in the opinion of some is bad news). A combination of regular workouts, rolfing, Yoga and change in diet brought his T-cell count up 200 points where it stayed until June of 1991. The biopsy report of the lesion on his leg came back Kaposi's sarcoma and the T-cell count went down again. John shared his feelings with me: "I feel the healing comes not so much from the posture but in realizing that you have a tool to use. The visualizing in Yoga has helped me develop my own ability to visualize. I can now see the bigger picture. I'm not holding on."

Joining A.A.H.P. was a natural progression to the program of rolfing, acupuncture and Yoga John was following on his own. Remembering John's first few classes last fall - he is the newest edition as of this writing - he exhibited fear, rigidity and a sense of holding back. The change has been delightful and inspiring to witness. A spirit of adventure pervades his participation; a new openness and fearlessness is woven into his approach. In a short time he has become an integrated member of the group.

Sometimes, a formal testing isn't the primary messenger of an HIV+ condition. For Robert, back in 1987, an inner feeling telling him something wasn't right predated his testing positive in February of 1991. Even with a T-cell count as low as 8 at times, he has made a firm decision not to use drugs. Two different doctors were left behind in the dust because they could not support his choice. One dialogue went something like this: "You are going to die so I can offer you drug treatment to buy you some time." "No thank you!" "What about hope?"

Robert is suspicious of drugs. AZT has been known to straighten hair on blacks. To straighten his hair topically requires strong chemicals so what would he be putting into his body to accomplish the same thing from the in- side. "I see my diagnosis as a warning and something that can really help understand myself." he told me. There's the hope.

Fortunately, Robert is still asymptomatic. Yoga helps him relax and let things happen. It has helped his sinuses and his back. His friends have commented on his improved posture and increased height. Often, he will arrive for class with a sluggishness that disappears with the first posture and his energy is transformed in the hour of class.

I met Nick the first time I dropped by the clinic. The director had suggested I spend some time hanging around a bit to get a feel for the place. After introducing myself as the Yoga instructor, he cheerily informed me that he would be coming to class, which he did until late spring of 1991, when he was diagnosed with a rare form of TB. Things got rough for Nick, he went on some experimental drugs and was in and out of the hospital a few times. When he stopped coming to class, I purposely waited around for him one day, knowing he had an acupuncture appointment scheduled and was coming over to the clinic. My objective was to encourage him to come to class, particularly since he was feeling low, energy wise and psychologically. Always polite and soft spoken, he thanked me and promised he would come to class again.

Sure enough, the next week, there he was, as promised. Nick had beautiful clear blue eyes, but that day they had a yellowish pallor to them. I had him do restorative poses, it was all he had the strength for. Not only did he feel much better afterwards but the color of his eyes were once again the color of the sky on a brilliant, sunny day.

The last time I saw Nick was in class two weeks before he died. When he arrived upstairs after an acupuncture treatment, I did a double take. It looked as if someone had rearranged his face. There appeared to be an internal distortion, the eyes and forehead shifting to the right, his mouth and jaw going to the left. Not wanting to alarm him or make him uncomfortable, I hid my incredulity and went on with the class. Halfway through the class, I noticed a return of some of the color to his eyes and pointed it out to him. After the final pose, his eyes had taken on the color of the marine blue shorts he was wearing; his face appeared normal.

Nick left his body in October of 1991. It was an honor to have shared some time with him.

On January 15, 1992, John O. died. A diagnosis of Kaposi's sarcoma in his esophagus and stomach drew the final curtain on the prolonged drama of his battle with AIDS that had begun in 1987. Of sound mind, he chose to come home from the hospital and discontinue all medications and food. Calmly, he arranged his funeral, said goodbye to family and friends and slipped away.

John's saga begins with a case of shingles. Three months later, when he received an HIV+ test result, he was disappointed but not surprised. Even though his doctor did not feel the shingles were AIDS defining, he knew differently. Being in the best shape of his life, why would he now get shingles?

When I asked him about his reaction to the confirmation of his suspicions, he told me he knew he just had to adapt and look at this as a learning experience. In retrospect, it made him slow down and take a look at his life and what he wanted from it.

Yoga made him feel better, sometimes subtly, but always different. Besides my class at A.A.H.P., he had also participated in a class at East West Yoga for a year. Facilitated liver function and release of tension were two things he cited as particular benefits. He had no real practice outside of the two classes but in specific instances, like not being able to sleep, he found Yoga a useful tool.

If the eyes are the windows to the soul, they are also the mirror of the state and quality of the inner energy. As Nick's life force was ebbing away, it was reflected in his eyes. Manouso put it well when he said, "We can't save people's lives, by and large, but to spend an hour or two in class and get a couple hours of peace is a real gift - not from the teacher, but from Yoga itself."

Paula Kout is a yoga instructor and Director of White Iris Yoga in Evanston, Illinois. She welcomes any questions or comments about this article or the accompanying sequence.

The International Association of Yoga Therapists may be reached by writing IAYT, 109 Hillside, Mill Valley, CA 94941 415-383-4587.

(The foregoing article by Paula Kout was originally published in vol. 3 of The Journal of The International Association of Yoga Therapists. It is reproduced here on The Yoga Group's Web site through the gracious permission of I.A.Y.T. and the author. Copyright 1992 by The International Association of Yoga Therapists, all rights reserved.)

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