Mary Schatz, M.D.

Yoga, The Mind & Immunity

A woman with a hypersensitivity to roses walks into her doctor's office, sees a rose on his desk, and promptly develops a severe nasal allergy attack. The rose is artificial. 1

A group of West Point cadets are under considerable stress: they express a strong desire for a military career but are not doing well academically. Unlike their less-stressed colleagues, who are exposed to the virus but do not develop symptoms, these cadets come down with clinical infectious mononucleosis. 2

Two women are diagnosed with breast cancer of similar type and stage. Wendy's response is accepting: "My mother always told me I would die young just like my father did." She is described as a model patient, very cooperative. Wendy soon succumbs to widespread cancer. Susan responds angrily and with great resistance to her diagnosis. Her physicians and nurses label her a "difficult patient." Susan continues to fight, triumphs, and remains cancer-free.3

John nurses and supports his wife through a long battle with terminal cancer. After her death his grief is prolonged and severe, and he dies within six months.4

It's not exactly news that a person's psychological state can influence his or her susceptibility to disease. What is new, however, is that scientists are now beginning to validate what folk wisdom has said all along: You can worry yourself sick; you can grieve yourself to death. Out of this research has emerged a new field: psychoneuroimmunology, a blend of psychology, neurology, and immunology. And with it comes fresh insights into the long-known salutary effects of yoga on health.

This article and its associated sidebars explore the links between the immune system, mind and personality, and yoga. Included are (l) some basics about how the immune system works and how its responses are affected by stress and relaxation; (2) a discussion of how immune function is influenced by personality, health practices, body language, and breathing patterns; (3) a section on how a yoga practice can enhance immune function; and (4) short pieces on restorative asanas, and a stress-reducing breathing technique of B. K. S. Iyengar.

ANATOMY OF IMMUNITY

Each person's immune system works constantly to protect against substances identified as foreign, or "non-self." Early in life, T cells (which mature partially in the thymus gland), B cells (which mature in the bone marrow; see Figure 1), and phagocytes (cell-eaters) learn to discriminate between self and non-self. Cancer cells, bacteria, viruses, parasites, and chemical and environmental toxins are among those substances recognized as non-self and destroyed in a healthy immune system. However, when there are inherited deficiencies in the ability to make immune components, or when the system is over-reactive or under-active, a broad spectrum of diseases can result.

Although the largest numbers of immune cells are in the spleen, bone marrow, lymph nodes, and thymus, immune cells are found virtually everywhere in the body. Some circulate constantly. Others are stationed permanently in organs and tissues exposed to the outside world: the lungs and upper respiratory passages, the stomach, the intestines, and the largest organ of all, the skin. Immune cells patrol and populate almost all other tissues as well.

From an anatomical point of view, a competent immune system must have healthy skin, healthy lungs, a healthy gut, and good circulation to all the tissues and organs. Good nutrition and proper exercise can promote health in these organs and systems and thereby enhance immune function. In addition, if one's parents passed on the genes for a healthy immune system, one's chances for good immunity are enhanced. But not all the influences on health can be described in terms of cells, organs, tissues, and genes. As research continues, it is becoming increasingly apparent that one's psychological make-up and approach to life's changes determine, to a large extent, whether one becomes ill or not. People who happen to have a disease-resistant disposition, as well as those who choose to acquire more immuno-restorative skills, are likely to be healthier than those who do not.

Phases of the Immune Response

The immune system responds to outside invaders (cells or organisms identified as non-self) in the following series of stages. The result is the destruction or neutralization of the threat.

  • SURVEILLANCE AND DETECTION. In a typical immune reaction, a virus or bacteria invades the body. Macrophages (large cell-eaters) ingest some of the virus particles during their routine clean-up of debris in the bloodstream. The macrophages summon helper T cells to the site. The helper T cells capable of recognizing the virus are activated and send out signals for reinforcement.
  • AMPLIFICATION. The activated helper T cells multiply. They also stimulate multiplication of B cells and killer T cells to fight the virus. B cells are signaled to begin manufacturing antibodies.
  • ATTACK. Antibodies (protein molecules) manufactured by B cells neutralize the virus or mark it for attack. Killer T cells puncture and destroy cells infected with the virus.
  • SLOW DOWN, CLEAN-UP, AND REMEMBERING. When the infection is conquered, suppressor T cells stop the immune reaction. Phagocytes, the cell-eating cleanup crew, ingest cellular debris from the battlefield as healing begins. Memory T cells and memory B cells circulate for years, ready to facilitate an even quicker response should the same foreign agent return.

Control of the Immune Response

The neural (nerve) and hormonal (endocrine) pathways by which the body responds to ordinary mental and physical challenges, as well as to threatening situations, are intimately intertwined with the immune system. In the "stress response,"5 neural and hormonal signals divert the resources of the body toward activities necessary for survival, i.e., fight or flight. This happens at great cost to immune function. The ability of immune cells to respond effectively to non-self invaders is greatly compromised by hormones secreted by the adrenal glands during stressful situations. With prolonged stress, immune function can be sufficiently depressed for infections or cancers to become established. Conversely, during the "relaxation response" (experienced during Savasana, pranayama, and meditation), levels of stress-related hormones decline and immune function is enhanced. The signal is given that "all is well," and immune cells carry on with normal surveillance activities.

The immune system receives and responds to neural and hormonal messages from the brain and the endocrine glands (e.g., pituitary, thyroid, ovaries, testes, adrenals). For example, the surveillance activity of macrophages is inhibited by the adrenal hormone cortisol, which is released in response to stress. Research suggests that the immune system is capable of sending specific signals about the type of invader (virus, bacteria, cancer, etc.) it encounters. This would allow the body to respond with the most appropriate array of defensive strategies.

An example of this type of communication occurs when a macrophage encounters a virus, The macrophage will release a hormone that. causes the brain to raise the body temperature, The fever promotes immune efficiency and is hostile to viral growth. Thus, we have a totally integrated circuit: the immune system sends information about invaders to the nervous system, causing widespread physiological change; similarly, the nervous system reports what it is encountering through the organs of perception (eyes, ears, mouth, nose, thoughts, emotions, feelings, touch) to the immune system, with resultant changes in immunological status. It is through this latter pathway that opportunities arise for thoughts, actions, and emotions to affect health.

YOUR BODY HEARS WHAT YOU SAY

Man is not disturbed by things, but by his opinions about things.

- Greek philosopher Epictetus

 

The body responds to its own conscious and unconscious communications. Many and varied are the signals interpreted as stress - e.g., tight jaw; tense muscle in the abdomen, upper back, and neck; poor posture; mental agitation. Status reports are constantly being sent through language, coping behavior, breathing patterns, posture, and health practices. If these reports indicate danger or threat, resources are shifted toward the stress response, with its negative effects on immunity. On the other hand, messages of safety and well-being encourage a shift toward the relaxation response, creating an environment that enhances immune function.

Coping Behavior

How one reacts to stress has more influence on immunity than the severity of the actual stressful event.8  A number of studies have correlated positive coping behavior with healthy immune function, and poor coping behavior with defective immune function.

Of the personality traits associated with low resistance to disease, feelings of helplessness are especially destructive to immunity in times of stress. Just knowing that there is something constructive to be done during times of stress is protective of immune function. Even if the actual situation cannot be changed, reducing stress levels through relaxation and breathing techniques has been shown to mitigate negative effects on immunity. 10,11

Another way to look at coping involves the concept of "locus of control." Studies have shown that people with an external locus of control believe that events are entirely unrelated to their choices and decisions, and that they are helplessly adrift in a chaotic world. This chronically stressful environment depresses immunity. Conversely, people with an internal locus of control believe that, through active participation, they can exert a definite influence on events in their life. Rather than as calamities, events are experienced as natural developments based on conscious choices. As feelings of helplessness decrease, the stress response lessens and the immune system flourishes.12

Health Practices

Positive and negative health practices speak directly to the body and, through it, to the immune system (see chart). Enjoyable exercises,13 yoga asanas, and restorative relaxation14 reinforce the message that all is well, and that normal immune function is appropriate.  Every instance of choosing, preparing, and eating healthful and nourishing food, in amounts commensurate with one's needs, is received as good news.15 The body thinks, "I must be worthy of life; I am being so well-fed, well-exercised, and well-rested. Let me be well.”

When one continues negative health practices such as smoking and ignores the resultant danger signals (cough, chronic bronchitis, etc.), the body gets a message of low self-esteem, and its defenses are lowered. This stressful, psychologically depressed state, combined with repetitive tissue injury from inhaled smoke, leads to diseases of immune failure such as cancer.16

Body Language

Body language is read by the nervous system and translated as a signal either of danger or of well-being. According to studies, facial expressions alone can cause changes in the involuntary nervous system.17 Consider how the body might respond to the position of depression - bowed head, slumped chest, furrowed brow.

By now, readers who are also students of yoga have probably recognized that so many "recently discovered" psychological and physiological determinants of good health are indeed integral components of the ancient science and philosophy of Ashtanga Yoga. There is a clear correlation between yoga and the positive health practices documented in the medical literature. And this list will certainly grow as Western medicine further explores the mind-body relationship.

ASANA, PRANAYAMA, AND IMMUNITY:  HOW YOGA CAN HELP

Yoga is the method by which the restless mind is calmed and the energy directed into constructive channels.18

- B. K. S. Iyengar

 

Circulation

A regular, balanced, and varied practice of classical asanas is an ideal exercise program to keep the immune system healthy. The many salutary effects of yoga postures and breathing on circulation are well documented.19 Good circulation is crucial to all phases of the immune reaction.  Immune cells travel throughthe bloodstream and lymphatic fluid to patrol the body for invaders. Since not every helper T cell can recognize every invader, it is necessary to assist helper T cells in getting around to all their checkpoints. Exercising the "muscle pump," "chest pump," and "heart pump" with each asana helps immune surveillance by promoting the circulation of macrophages and helper T cells. Improving circulation promotes two-way communication between immune cells and the hypothalamus, the pituitary, lymphoid tissues, and other target organs.

Yoga asanas that squeeze, soak, and spread (create space in) the organs of immune surveillance (skin, gastrointestinal tract, respiratory tract) also promote strong defenses at these important body frontiers.

Breathing

The body constantly monitors the quality (rate and depth) of the breath as well as its effectiveness (blood concentrations of oxygen and carbon dioxide). Shallow, agitated respirations are read as "Danger. Initiate stress response!" Breathing with paced respirations (as in pranayama or the stress-reducing breathing technique of B. K. S. Iyengar. see sidebar) reduces arousal and anxiety in threatening situations20

The conscious breathing system of pranayama provides a direct avenue of communication to the self.21 The practice of pranayama quickly induces the relaxation response and its accompanying enhancement of immunity. The improved blood oxygenation associated with more complete chest expansion is another message of good news to the inner self. Continuing to return the attention to the breath teaches that one need not respond to every arising thought. This is a practical lesson in developing an internal locus of control. As events in the mind can be influenced through conscious choice, so can events in life. Aside from the formal practice of pranayama, simple breathing techniques can be practiced anytime, anywhere, to rapidly reduce tension and anxiety.

Sympathetic/Parasympathetic Balance

According to B. K. S. Iyengar, the practice of asana and pranayama "balances the nadis (you call them nerves), and the sympathetic and parasympathetic nervous

systems."22  These two divisions of the automatically functioning portions of the nervous system govern internal organs and blood vessels (e.g., heart rate, blood pressure, unconscious breathing, digestion, etc.). A predominance of sympathetic impulses creates the stress response, with its readiness for fight or flight. Predominance of the parasympathetic components creates the relaxation response, which restores energy and heals the body. The relaxation response experienced during Savasana, meditation, pranayama, and the restorative poses promotes healthy immune surveillance and responsiveness. In particular, the restorative poses offer a way to benefit from the relaxation response in a supported position that conserves and restores energy, while enhancing circulation and respiration.

Communication to the Self

Think of asana as mime - the architecture of each pose communicates not with others, but with the inner self. With the language of the asanas, one counteracts the feelings of helplessness and weakness so destructive to immunity. Each asana strengthens one's internal locus of control. The body becomes an actor, not a reactor. Self-worth is enhanced.

The vigorous standing poses exhibit strength and confidence and reinforce those personality characteristics, furthering internal locus of control. The backbends teach that flexibility, openheartedness, and strength can coexist. The forward bends demonstrate physically an environment safe enough from danger that vigilance can cease. The inversions and arm balances teach balance and poise in difficult and/or disorienting situations. One learns that when the mind is centered and the breathing quiet, energy can be directed into constructive solutions, rather than wasted in the free-floating anxiety and helplessness so harmful to immune defenses. Self-imposed limitations relax as tight muscles lengthen and body carriage improves.

The postures and pranayama provide the opportunity to explore the self and observe how it reacts to life's challenges and surprises. One's yoga practice can be a personal growth laboratory for working out in body and mind what can soon be applied to daily life. With time, one realizes that one can control how one responds to events, just as one can control how one responds to an intense stretch of the hamstrings or the fear of one's first full arm balance.

Yoga provides the means to become physically fit in the context of a philosophy that encourages positive health practices and personality characteristics. The body is no longer divorced from the mind and the spirit. Rather, the body is the vehicle for growth and spiritual development - and the immune system becomes the guardian of high-level wellness.

Mary Pullig Schatz, M.D., Author of Back Care Basics, the best-selling yoga book and creator of YogaMD Computer Relief iPhone application, graduated from Vanderbilt University School of Medicine. Dr. Schatz is a certified Iyengar yoga instructor and has studied with the yoga master, B.K.S. Iyengar.

NOTES

  1. 1. J. N. Mackenzie, "The Production of the So-Called Rose Cold by Means of an Artificial Rose," American Journal of Medical Science, 91 :45, 1886.
  2. 2. S. Greer et al., "Psychological Response to Breast Cancer; Effect on Outcome," Lancet, ii:785, 1979.
  3. S. Kasi et aI., "Psychosocial Risk Factors in the Development of Infectious Mononucleosis," Psychosomatic Medicine, 41:445, 1979.
  4. S. J. Schliefer et aI., "Suppression of Lymphocyte Stimulation Following Bereavement," Journal of the American Medical Association, 250:374, 1983.
  5. M. P. Schatz, "Yoga, Circulation, and Imagery," Yoga Journal, January/February 1987, pp. 54-61, 72-73.
  6. R. K. Wallace and H. Benson, "The Physiology of Meditation,” Scientific American, 226:84, 1972.
  7. J. E. Blalock, "The Immune System as a Sensory Organ," Journal of Immunology, 132: 1067, 1984.
  8. S. E. Locke et aI., "Life Change Stress, Psychiatric Symptoms, and Natural Killer Cell Activity,” Psychosomatic Medicine, 46:441, 1984.
  9. M. L. Laudenslager et aI., "Coping and Immunosuppression,” Science, 221 :568, 1983.
  10. R. Glaser and J. Kiecolt-Glaser, "Relatively Mild Stress Depresses Cellular Immunity in Healthy Adults,” Behavioral and Brain Sciences, 8:401, 1985.
  11. S. O. Kobasa et aI., "Hardiness and Health: A Prospective Study," Journal of Personality and Social Psychology, 42: 168, 1982.
  12. J. H. Johnson and 1. G. Sarason, "Life Stress, Depression, and Anxiety: Internal/External Locus of Control as a Moderator Variable,"  Journal of Psychosomatic Research, 22:205, 1978.
  13. H. B. Simon, "The Immunology of Exercise,” Journal of the American Medical Association, 252:2735, 1984.
  14. Glaser and Kiecolt-Glaser, loco cit.
  15. M. C. Gershwin et aI., Nutrition and Immunity (Orlando, Fla.: Academic Press, 1985).
  16. P. Hersey et aI., "Effects of Cigarette Smoking on the Immune System,” Medical Journal of Australia, 2(9):425, 1983.
  17. P. Ekman et aI., "Facial Expressions of Emotion and Involuntary Nervous System Changes," Science, 221: 1208, 1983.
  18. B. K. S. Iyengar, Light on Yoga (London: Allen & Unwin, 1972).
  19. Schatz, loco cit.
  20. K. D. McCaul et aI., "Effects of Paced Respirations and Expectations on Physiologic and Psychologic Responses to Threat," Journal of Personality and Social Psychology, 37:564, 1979.
  21. B. K. S. Iyengar, Light on Pranayama (New York: Crossroad Publishing, 1981).
  22. B. K. S. Iyengar, personal communication, Pune, India: February 1987.
  23. H.A. DeVries et aI., "The Tranquilizer Effect of Exercise,” American Journal of Physical Medicine, 61: lll, 1982.

RESOURCES

Hatha Yoga Pradipika of Svatmarama (Madras, India: Adyar Library and Research Centre, Theosophical Society, 1972).

Jeret, Peter, "Our Immune System: The Wars Within," National Geographic, 169:702, 1986.

Mishra, R. S., Yoga Sutras, TheTextbook of Yoga Psychology (Garden City, N.Y.: Anchor Books. 1973).

Side Bar:

Health Practices, Attitudes, and Immunity

 

ENHANCES IMMUNE FUNCTION                       DEPRESSES IMMUNE FUNCTION

 

Health Practices

Good Nutrition

 

Poor diet (poor   quality, improper quantity)

Proper Exercise

Inactivity

Adequate sleep

Insomnia,   somnolence

Relaxation, meditation

Constant stress

Breathing practice   of paced respiration

Smoking

 

Heavy alcohol   consumption

 

Approach to Life

Active approach to   illness

Resigned, helpless   approach to illness

Optimistic,   positive outlook

Pessimism

Change seen as   opportunity for growth

Change seen as   threat

Internal locus of   control

External locus of   control

Inner stability,   equanimity

Agitation,   emotional volatility

Appropriate   self-confidence

Too much or too   little self-confidence

Sense of purpose,   commitment

Apathy

Social support   system

Isolation

Involvement

Alienation

Warm relationship   with parents

Poor communication   with parents

 

 

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