Freud Meets Patanjali: Integrative Psychology Part 1

(Excerpted from my Medscape.com Blog for physicians)

In this series, I hope to demystify and destigmatize eastern approaches to psychological health.

To most western trained physicians, eastern conceptualizations of the body and the mind must seem like superstition or conjecture.

The recent wave of new age commercialization of these ancient concepts has not helped.

“Mind, Body and Spirit” is a cliche, meditation is often an affectation, and the words “Let me align your chakras” is the pickup line of choice at health food stores across the country.

This is unfortunate because in my experience as a physician and psychiatrist, I find that integration and reconciliation of western and eastern approaches to health are incredibly powerful, with the potential to help people transform into a higher state of psychological health.

Consider the case of Steve (name changed). He is in his mid -50’s, a career scientist, well respected in his field. He has published over a hundred papers in noted journals, and as the head of the department is well liked and respected by his peers. He has 2 children, both in college. He has been married for over 20 years, and has a relationship with his wife that is stable, if somewhat dull.

In the last few years, Steve has started to feel bored. He wakes up in the morning and often does not feel like going to work. He notes that his sex drive , never very strong to begin with, has all but disappeared.

He is eating well and sleeps well. He denies feeling anxious or depressed, however, as is often the case, his primary care physician starts Steve on an SSRI, after all investigations for a physical cause for his symptoms are ruled out. ( The primary care physician orders a TSH, BMP, CBC, and serum testosterone – all normal).

Now let us consider the psychological problems of Steve, through a western as well as eastern perspective.

From a western psychological perspective, some of the possible formulations are:

1. He has spent the last 20 years building a family and a career, and in doing so, has walled off some of his emotions and drives. He is suffering the effects of long term repression. He will be helped by insight oriented therapy or brief dynamic therapy

2. He has negative automatic thoughts , and his cognitive distortions about himself and the future, cause him distress. He will be helped by cognitive behavioural therapy.

3. He has poor interpersonal relationships because of sublimated narcissism. His career is a reflection of his drive for attention and control, and he is cerebral and intellectual at the expense of his own psychological well being. He will be helped by psychoanalysis.

None of these approaches are wrong, but they all are similar in one thing: They assume that Steve’s problems are a result of pathology: from a western perspective, negative emotions and thoughts are seen as a result of disease rather than health.

In the east, however, all of Steve’s symptoms are seen as normal, a by product of conventional, mundane, “Unaware” human existence.

According to the psychology of Yoga, Steve is suffering because his identity is tied up with situations and circumstances that are outside his control.

This feeling of separateness, according to Yoga psychology, is a delusion, and a universal one at that – we think we are individuals, when we are in fact, encapsulations of the cosmos.

Everything we see, indeed every aspect of our consciousness and being, is part of this cosmic energy. But as long as we live under the misconception that we are separate from the cosmos, we will continue to experience the neurosis of individual existence.

Although this concept seems to be metaphysical, and seems not to have any practical application, Yoga says that this is an experiential truth, that through the practice of Yoga and meditation, a person can transcend individual consciousness, and experience true psychological (and physical) well-being.

To be continued