LESSON 5

Death and Dying

Prepared by Deborah Myers, MS for Samata International Yoga and Health Center

 

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“It is as natural to die as to be born…”   Francis Bacon

“Life is for the living. Death is for the dead. Let life be like music. And death a note unsaid.”

Langston Hughes

“I am prepared to meet my Maker. Whether my Maker is prepared for the great ordeal of meeting me is another matter.”   Winston Churchill

“No one gets out of here alive.” Jim Morrison

 

To think about death is to be human. We are aware that our material lives are finite, regardless of how we may feel about a spiritual life beyond. Proverbs from vastly different cultures demonstrate that death, and the end, is on all our minds.

  • Three things come into the house uninvited: debts, age, and death —  German
  • The first breath is the beginning of death —  Traditional
  • If the bathroom and a brandy cannot help a man, then death is imminent — Finnish
  • Life is a temporary stop; death is the journey home — Vietnamese
  • Death makes no appointment — Kanuri  (Africa)

The number of links you can find on an easy internet search on death and dying attests to how much people feel the need to know about the unknowable, especially as our own deaths or those of our loved ones draw near. If you are a caretaker of the seriously ill or elderly, developing an understanding about how to talk about death becomes part of your vocation. The Zoom portion of this module will focus on how to speak with people who are losing or have lost a loved one, or are close to death themselves, and present a yogic lens through which to view death. This written piece will provide some basic background about death and dying that is helpful to know be it to help you cope with your own eventual departure, that of someone for whom you are caring, or for a friend or client who is experiencing this greatest of losses. But before we focus in on death and dying in our culture, let’s take another detour to see how it is viewed in other cultures.

According to Joincake.com, “death is the same across all cultures—we all live and die. The cycle of life is the same, but how we view death is different. You’re familiar with the traditional American funeral. Family members, friends, and relatives gather quietly around the body at a wake wearing all black. Later there is a church, synagogue, or temple ceremony with a priest or rabbi praying.”

Compare this with Asia, which comprises 60 percent of the world’s population. Their views and practices are very different from ours, and there is abundant diversity within Asia and its different cultures, and many in our own country come from those cultural roots. Asian views on death root back to Hindu, Islamic, Confucianist, and Buddhist religions. Here is a sampling. This piece is taken directly from the Joincake website. Students who are interested in learning about customs from other cultures around the world are encourage to explore Joincake.

  • China covers most of Northeast Asia. Chinese funerals are rich in superstition and rituals, which include removing mirrors and hanging cloth on the doorway of their homes. Not following proper rituals means death and misfortune for the grieving family. 
  • To the southwest of China is Tibet—a remote Buddhist territory. Tibetan sky burials leave the deceased’s body on a platform for vultures to eat. After the funeral, the deceased’s soul arrives in Paradise.
  • Korean funerals center around devotion to parents and Confucian tradition. In Korea, families keep cremation beads in their homes as a unique way to honor the deceased.
  • In the Philippines, superstitions mix with Catholic beliefs to make unique death customs. Some Filipino funerals even include animal sacrifice. 

In this same vein, let’s see what Joincake has to say about Mexico, our closest neighbor, and a group that is very much represented and intermixed with the dominant American culture.

Mexico might be America’s neighbor, but death perspectives couldn’t be more different. Mexican traditions focus on death as a new beginning. Conversations between family members are open, and often stories are shared about the deceased. 

Death is ingrained deeply in the Mexican culture. The Day of the Dead is a time to remember, honor, and celebrate those that have passed. All over the country, Mexicans take to the streets in joyful song and dance and leave offerings at cemeteries for the deceased. Some even sleep next to their graves at night.

Dealing with Grief

Most of us have heard of the Five Stages of Grief. What follows below is a piece from Verywellmind.com that describes each stage. In addition to reading this piece below, taken directly from their website, you are strongly encouraged to explore the website and the hyperlinks to related topics within it.

The 5 Stages of Grief

A theory developed by psychiatrist Elisabeth Kübler-Ross suggests that we go through five distinct stages of grief after the loss of a loved one: Denial, anger, bargaining, depression, and finally acceptance.1

Denial

The first stage in this theory, denial helps us minimize the overwhelming pain of loss. As we process the reality of our loss, we are also trying to survive emotional pain. It can be hard to believe we have lost an important person in our lives, especially when we may have just spoken with this person the previous week or even the previous day.

Our reality has shifted completely in this moment of loss. It can take our minds some time to adjust to this new reality. We are reflecting on the experiences we have shared with the person we lost, and we might find ourselves wondering how to move forward in life without this person.

This is a lot of information to explore and a lot of painful imagery to process. Denial attempts to slow this process down and take us through it one step at a time, rather than risk the potential of feeling overwhelmed by our emotions.

Denial is not only an attempt to pretend that the loss does not exist. We are also trying to absorb and understand what is happening.

Anger

It is common to experience anger after the loss of a loved one. We are trying to adjust to a new reality and we are likely experiencing extreme emotional discomfort. There is so much to process that anger may feel like it allows us an emotional outlet.

Keep in mind that anger does not require us to be very vulnerable. However, it tends to be more socially acceptable than admitting we are scared. Anger allows us to express emotion with less fear of judgment or rejection.

Unfortunately, anger tends to be the first thing we feel when we start to release emotions related to loss. This can leave you feeling isolated in your experience and perceived as unapproachable by others in moments when we could benefit from comfort, connection, and reassurance.

Bargaining

When coping with loss, it isn’t unusual to feel so desperate that you are willing to do almost anything to alleviate or minimize the pain. Losing a loved one can cause us to consider any way we can avoid the current pain or the pain we are anticipating from loss. There are many ways we may try to bargain.

Bargaining can come in a variety of promises including:

  • “God, if you can heal this person I will turn my life around.”
  • “I promise to be better if you will let this person live.”
  • “I’ll never get angry again if you can stop him/her from dying or leaving me.”

When bargaining starts to take place, we are often directing our requests to a higher power, or something bigger than we are that may be able to influence a different outcome. There is an acute awareness of our humanness in these moments when we realize there is nothing we can do to influence change or a better end result.

This feeling of helplessness can cause us to react in protest by bargaining, which gives us a perceived sense of control over something that feels so out of control. While bargaining we also tend to focus on our personal faults or regrets. We might look back at our interactions with the person we are losing and note all of the times we felt disconnected or may have caused them pain.

It is common to recall times when we may have said things we did not mean, and wish we could go back and behave differently. We also tend to make the drastic assumption that if things had played out differently, we would not be in such an emotionally painful place in our lives.

Depression

During our experience of processing grief, there comes a time when our imaginations calm down and we slowly start to look at the reality of our present situation. Bargaining no longer feels like an option and we are faced with what is happening.

We start to feel the loss of our loved one more abundantly. As our panic begins to subside, the emotional fog begins to clear and the loss feels more present and unavoidable.

In those moments, we tend to pull inward as the sadness grows. We might find ourselves retreating, being less sociable, and reaching out less to others about what we are going through. Although this is a very natural stage of grief, dealing with depression after the loss of a loved one can be extremely isolating.

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database.

Acceptance

When we come to a place of acceptance, it is not that we no longer feel the pain of loss. However, we are no longer resisting the reality of our situation, and we are not struggling to make it something different.

Sadness and regret can still be present in this phase, but the emotional survival tactics of denial, bargaining, and anger are less likely to be present.

 

Types of Grief

As we consider the five stages of grief, it is important to note that people grieve differently and you may or may not go through each of these stages, or experience each of them in order. The lines of these stages are often blurred—we may move from one stage to the other and possibly back again before fully moving into a new stage.

In addition, there is no specific time period suggested for any of these stages. Someone may experience the stages fairly quickly, such as in a matter of weeks, where another person may take months or even years to move through to a place of acceptance. Whatever time it takes for you to move through these stages is perfectly normal.

Your pain is unique to you, your relationship to the person you lost is unique, and the emotional processing can feel different to each person. It is acceptable for you to take the time you need and remove any expectation of how you should be performing as you process your grief.

Additional Models

Although the five stages of grief developed by Elisabeth Kübler-Ross is considered one of the most easily recognizable models of grief and bereavement, there are other models of grief to be noted as well.2

Each model or theory works to explain patterns of how grief can be perceived and processed. Researchers on grief and bereavement hope to use these models to provide understanding to those who are hurting over the loss of a loved one, as well as offer information that can help those in the healing professions provide effective care for those in need of informed guidance.

Attachment Theory and Grief

Legendary psychologist John Bowlby focused his work on researching the emotional attachment between parent and child.3 From his perspective, these early experiences of attachment with important people in our lives, such as caregivers, help to shape our sense of safety, security, and connections.

British psychiatrist Colin Murray Parkes developed a model of grief based on Bowlby’s theory of attachment, suggesting there are four phases of mourning when experiencing the loss of a loved one:4

  • Shock and numbness: Loss in this phase feels impossible to accept. Most closely related to Kübler-Ross’s stage of denial, we are overwhelmed when trying to cope with our emotions. Parkes suggests that there is physical distress experienced in this phase as well, which can lead to somatic (physical) symptoms.
  • Yearning and searching: As we process loss in this phase, we may begin to look for comfort to fill the void our loved one has left. We may try to do so by reliving memories through pictures and by looking for signs from the person to feel connected to them. In this phase, we become very preoccupied with the person we have lost.
  • Despair and disorganization: We may find ourselves questioning and feeling angry in this phase. The realization that our loved one is not returning feels real, and we can have a difficult time understanding or finding hope in our future. We may feel a bit aimless in this phase and find that we retreat from others as we process our pain.
  • Reorganization and recovery: In this phase, we feel more hopeful that our hearts and minds can be restored. As with Kübler-Ross’s acceptance stage, sadness or longing for our loved one doesn’t disappear. However, we move towards healing and reconnecting with others for support, finding small ways to reestablish some normalcy in our daily lives.

How to Help When Others Are Grieving

It can be so difficult to know what to say or do when someone who has experienced loss. We do our best to offer comfort, but sometimes our best efforts can feel inadequate and unhelpful.

Here are a few tips to keep in mind:

  • Avoid rescuing or fixing. Remember, the person who is grieving does not need to be fixed. In an attempt to be helpful, we may offer uplifting, hopeful comments, or even humor, to try to ease their pain. Although the intention is good, this approach can leave people feeling as if their pain is not seen, heard, or valid.
  • Don’t force it. We may want so badly to help and for the person to feel better, so we believe that nudging them to talk and process their emotions before they’re truly ready will help them faster. This is not necessarily true, and it can actually be an obstacle to their healing.
  • Make yourself accessible. Offer space for people to grieve. This lets the person know we’re available when they’re ready. We can invite them to talk with us but remember to provide understanding and validation if they are not ready just yet. Remind them that you’re there and not to hesitate to come to you.

A Word From Verywell

It is important to remember that everyone copes with loss differently. While you may find that you experience all five stages of grief, you may also find that it is difficult to classify your feelings into any one of the stages. Have patience with yourself and your feelings in dealing with loss.

Allow yourself time to process all of your emotions, and when you are ready to speak about your experiences with loved ones or a healthcare professional, do so. If you are supporting someone who has lost a loved one, remember that you don’t need to do anything specific, but allow them room to talk about it when they are ready.

 

Additional reading

https://www.verywellmind.com/how-to-deal-with-death-and-dying-as-you-age-2223446

https://www.verywellmind.com/coping-with-death-of-spouse-2301016

https://www.verywellhealth.com/hospice-care-4014065

https://www.verywellhealth.com/palliative-care-overview-1132621

https://www.verywellmind.com/five-stages-of-grief-4175361

https://www.cancer.net/coping-with-cancer/managing-emotions/grief-and-loss/understanding-grief-within-cultural-context

https://www.joincake.com/blog/death-in-different-cultures/

 

In addition to the links above, please review the links below to help you prepare for the interactive Zoom portion.

www.livinglifedyingdeath.com

https://www.dropbox.com/sh/adqyusumj1dg7px/AACbT6996lDJfzsvsAcHRHIka?dl=0

 

For further reading:

Can’t We Talk About Something More Pleasant? Roz Chast 2014

Being Mortal: Medicine and What Matters in the End     Atul Gawande

http://www.orthodoxytoday.org/articles4/JohnsonDeath.php

 

End-of-Life Yoga Therapy: Exploring Life and Death  Jennifer Taylor, MSW, RYT, CMP

 

INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008) 97

Yoga Therapy in Practice

End-of-Life Yoga Therapy: Exploring Life and Death

Jennifer Taylor, MSW, RYT, CMP

Transitional Yoga at Dynamic Systems Rehabilitation, Scottsdale, AZ

Abstract: Loss and death are ongoing, universal, natural aspects of life. Yoga therapy is a profession that inherently addresses the many physical, mental, emotional, and spiritual aspects within end-of-life care and requires extensive preparation both profession- ally and personally. This article introduces concepts, tools, and specific guidelines that can assist Yoga therapists to more effectively and compassionately serve those who are living with serious illness, loss, and end-of-life issues. Yoga philosophy that supports end-of-life therapy is discussed.

Keywords: Yoga, hospice, dying, meditation, pranayama Introduction

Many individuals relate to Woody Allen’s statement, “It’s not that I’m afraid to die, I just don’t want to be there when it happens.”1 Society is focused on youth and beauty, as well as being overstimulated and consumer-oriented. All of this can make the experience of dying lonely, pain-filled, and without dignity. This trend is compounded by the human tendency not to confront personal mortality while still living a healthy, active life. But, of course, death, dying, and loss are universal and can occur at any time throughout the lifespan, from infancy to old age.

Thanatology is the study of death and dying. Many disciplines contribute to this field, including philosophy, so- ciology, medicine, nursing, psychology, anthropology, law,

education, theology, and spirituality.4 Thanatologists Charles Corr and Kenneth Doka propose that these disciplines “strive toward better concepts and a clearer understanding of the issues faced by human beings as they seek to live an examined life and prepare themselves to face death.”5

Yoga therapy is poised to contribute richly to the field of thanatology. Yoga therapy is steeped in the philosophical tradition of Yoga, which calls students to be aware of the polarities of life, as well as the practical art and science of living. Yoga practices such as âsana, prânâyâma, and medita- tion can alleviate the anxiety and suffering that arises from illness, loss, and death, while opening the heart and mind to the mystery of life and death. Paradoxically, a Yoga practice that embraces the natural cycle of life and death can enrich living. The courageous exploration asks, “Knowing that you will die, how do you wish to live?”

End-of-Life Yoga Therapy

For the purpose of this paper, end-of-life Yoga therapy includes 1) the practice of dying while living, 2) support for individuals experiencing grief and loss, 3) support for individuals experiencing life-threatening illness, and 4) support for those transitioning from physical life to death. Personalized end-of-life Yoga therapy emphasizes gentleness,

In 2030, 20% of Americans will be age 65 or older. This aging population, as well as people of all ages and na- tionalities, will want the same choices in “dying well” as they have had in “living well.” Contemporary society would benefit from a vision of death that is not dissociated from life, but that embraces the significance and dignity of each individual.3 Grief, loss, and dying are not phases to “move through” but rather are natural life experiences that are inte- grated into and inform our living.

Acknowledgments: I wish to acknowledge and thank the four generous peer reviewers who encouraged and enhanced this article. A special thanks to Dr. McGonigal for her guidance and support.

98 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008)

listening, and empowerment. It may include a wide range of tools and practices from the Yoga tradition, as well as other therapeutic tools such as music and touch.

Yoga therapy end-of-life care has the overall therapeutic goal of providing a professional, safe, healing atmosphere that allows students to openly explore living, illness, grief, and dying. The care is based in models of service, education, and wellness. End-of-life care aims to alleviate suffering by compassionate, nonjudgmental support as the student moves through the many physical, mental, emotional, and spiritual experiences associated with serious illness, grief, and end of life.

This article is a culmination of 26 years of personal and professional exploration of end-of-life issues. After a per- sonal loss, I sought to find meaning within the experience and ultimately within the universal and natural cycle of life and death. Formally, I began as a hospice volunteer. I later completed two national music certifications, bringing harp music to the bedside for healing. I completed my Master’s of Social Work, with my thesis focused on death attitudes and spirituality. My experience working as a social worker in a palliative care hospice unit allowed me to witness and provide emotional and spiritual support to patients, as well as to their families and friends, as they transitioned through the full spectrum of their death and dying experiences. My formal Yoga therapy training has been with Integrative Yoga Therapy, under the guidance of Joseph and Lillian Le Page. I presently offer private and group Yoga therapy to sup- port individuals who are facing health challenges, a change in their lives, a loss experience, or are in the end-of-life transition.

Preparing the Therapist

Compassion for self and others is essential as one ex- plores the natural wholeness and wellness in dying. Before working with any students, it is important to thoroughly address one’s own personal grief and experience with loss. An exploration of personal mortality is necessary before opening oneself to others’ losses and deaths. For these rea- sons, an ongoing personal end-of-life practice is essential for the Yoga therapist as they support others who are experi- encing change, serious illness, loss, grief, or the end of life. Therefore, Yoga therapists may find it useful to practice the âsana, prânâyâma, mudrâ, meditation, and Yoga nidra prac- tices described in this article. Creative expression, including art, journaling, photography, poetry, or music may also be of value while exploring loss. Allow adequate time to center and ground yourself in right action and appropriate inten- tion before each and every session.

Maintaining a connection to your own teachers or men- tors is invaluable for supporting your personal and profes- sional end-of-life practice. It is also essential to develop a broad referral network of mental health professionals and spiritual counselors before working with students. Such preparation insures timely and compassionate support for all circumstances that may arise that are beyond the scope of Yoga therapy. There is the strong possibility that a stu- dent with serious illness will have intricate medical needs and physical contraindications. Preparation therefore may include communication with the student’s healthcare team.

Teaching Guidelines

Setting the Stage for End-of-Life Yoga Therapy

Thought and care should be put into creating an envi- ronment of peacefulness and comfort. Consider the light- ing, temperature, and privacy of the environment. Choose any Yoga props, including bolsters and thick Yoga mats, with care. Also consider bringing in the additions of music or natural beauty, such as flowers, shells, or plants. The use of music to support the individual is an art and science unto itself. I recommend using unfamiliar, instrumental music. The music is intended to provide an atmosphere of relax- ation and support for the Yoga practice; it is not intended to provide entertainment or distraction. Without know- ing the student’s music preferences, present circumstances, emotional state, and spiritual or religious beliefs, the use of predetermined music can add to the discomfort of the stu- dent. Consulting with a student on this and other decisions communicates ahimsâ, respect and care.

From the first session onward, the practice of non- judgmental listening is a skill to be studied and practiced by the Yoga therapist. The initial health history and assess- ment should set the stage for an open and compassionate therapeutic space and relationship. Consider asking questions that encourage the student to explore the topics of loss, grief, death, and dying. For example:

  • What are the main challenges or issues in your life right now?
  • What would you consider to be the main losses you have suffered?
  • How would you describe the spiritual dimension of your life?
  • Do you have close friends or others you can confide in?
  • What do you see as ultimately most important in life?
  • Do you feel you have a particular mission or vocation in life, and are you fulfilling it?
  • What would you consider your philosophy of life?

END-OF-LIFE YOGA THERAPY 99

Any meaningful discussion of death must address what, if anything, exists beyond death. It is beyond the scope of this paper to explore the many beliefs and implications of life beyond physical death. Ultimately, death is seen as ei- ther a door to pass through or a wall where there is nothing beyond. It is paramount to respect all individual religious beliefs and experiences of loss, death, and dying. There will be instances when the therapist needs to resist the tendency to be offer answers or advice. At times, we may feel that we would make different choices if we were in the student’s circumstances. Respect requires standing beside the student and serving from a place of nonjudgmental love and sup- port. Proselytizing the therapist’s religion, beliefs, and spiri- tuality contradicts ethical boundaries.

Yoga Therapy Session Possibilities

There are many Yoga practices that can support end- of-life therapy. The student’s own goals and current needs should always inform the Yoga therapist’s selection of prac- tices (based on the therapist’s lineage). The following ex- amples are some of the practices I have found most useful. If any of these practices are unfamiliar, further training may be needed before integrating them into your own practice or teaching.

Introduction, Greeting, and Sharing

Begin with the student in a comfortable position. Depending on the individual’s capacity, this might be any- where from a supported, upright seated posture to lying in a hospital bed. Provide an introduction and greeting that is based in professional, unconditional love. Ask questions, and listen to the individuals’ story. Use this sharing to co- create a Yoga therapy session that meets their goals, and al- lows relaxation and awareness to unfold. Share the precept of ahimsâ, and let students know that if any words, instruction, metaphor, breathing exercise, or movement does not sup- port them in their Yoga and belief system, they may either disregard it silently or share their concern with the therapist. By encouraging students to share their perceptions, you offer additional opportunities for inquiry or reflection.

Centering and Intention

Invite students to close their eyes if they are comfortable with the darkness, and begin to gently focus their conscious- ness inward. Encourage shifting positions or using a cen- tering breath for physical comfort when needed. Ask if the student wishes to create an intention for the Yoga practice. In some circumstances, modeling by sharing your intention for the session can be helpful. For example, “My intention is

to provide a comfortable, warm, fun, open, educational, in- spirational Yoga session that supports and co-creates aware- ness and peace in heart, mind, body, and spirit.”

Body and Breath Scan

Lead students through a body scan, guiding them in nonjudgmentally sensing and witnessing the physical body. Allow them to focus inward and rotate consciousness through body regions. Invite them to notice what might be present for them, today in their physical body, in the present moment. This is a practical means to create a deeper rela- tionship with the physical body. This can be an appropriate time to introduce Yoga philosophy, which says that we are more than our physical bodies.

A guided breath scan is a bridge to more subtle aware- ness. Assist students to non-judgmentally explore their breathing and the qualities of breath. Allow them to ex- perience and embody their natural breath by watching the breath. Later on, if appropriate, ask questions such as “Who am I today in this breath?” “Can you let the breath come into you?” “Who or what is breathing you?” and “Where did your first breath come from?”

The body and breath scan often are the foundation for an extended Yoga nidra practice. Yoga nidra is a form of pratyâhâra practice that should be used with precautions for this population. For therapists interested in the profound power and value of this practice, further study is warranted (see Resources List below). The practice has immense poten- tial for the experienced student and therapist, but it requires more than a cursory introduction to instruction.

Prânâyâma

Simple and straightforward prânâyâma is indicated for this population. More technically demanding techniques should be used sparingly and only with experienced Yoga practitioners. Possibilities for practice may include:
Abdominal Yogic breath.
Sounding “Ahhhh” while releasing the breath.
Directing breath, energy, and awareness to different regions of the lungs or body.
Balanced breathing (even ratio of inhalation to exhalation).
Moving toward longer exhalation than inhalation during times of stress or anxiety.
Exploring the natural pause (silence) between inhalation and exhalation.
Balloon Breath—expanding as if the lungs or regions of the body were balloons. Guide and allow students to visualize their deep, slow abdominal inhalation “inflating” their arms and hands fully like a balloon and on the exhalation releasing or “deflating” the fullness of the balloon sensation.

Skin Breath—after cycles of centering in full abdominal Yogic breathing, asking students to visualize the subtle sensing of where their skin ends and the air and outer world begin, or asking them to sense the pores of their skin breathing.

Mudrâ

Individuals of all levels of mobility are able to experience mudrâs, hand gestures that direct breath, energy, and awareness. The subtle energy of a mudrâ affects all koshas:

body, breath, energy, mind, emotions, wisdom, and spirit.

a focus on the energetic or symbolic properties of the âsana, rather than a focus on achieving a picture-perfect pose. The therapist must be prepared to provide modifications, sup- ports, and adaptations for the student. Be aware that ac- cepting support or modifications is sometimes difficult for students, as it may appear to be another example in their life of present or future loss. This situation provides an op- portunity for a student to explore accepting, receiving, and surrendering within life.

A few examples of supported, modified âsana include:

Supine or seated wrist, neck, shoulder, feet or ankle warm-ups.
Seated ardha chandrâsana (half moon) side bend or tadaka mudrâ (supine crescent moon) with the cue to open, lengthen, and breathe into the side body.
Paschimottanâsana (seated forward fold) or sukhâsana (easy pose, with a forward bend) with the cue to breathe fully into the back body and, when appropriate, placing hands on the student’s upper and lower back to assist with the awareness and direction of the breath.
Supported matsyâsana (fish pose) with a bolster/blanket under the torso, a bolster under the knees, head support, and a comfortable arm position.
Makarâsana (crocodile pose), explored from a resting posture to fuller spine extension.
Tadâsana (standing or supine mountain pose), exploring the bidirectional energy of being grounded, rooted, and connected into the earth (downward energies), and being open and lifted (upward energetic qualities).
Savâsana (corpse pose), with modifications, adapta- tions, bolsters, and support to ensure comfort for the physical body (see below for more detailed discussion of this important pose).

Within each and every posture, create space for the “sweet spot,” where all instruction and striving is suspended, and silence and effortlessness may be enjoyed. Take into con- sideration that stillness in certain poses may elicit a strong emotion in the student. Being prepared for these moments is essential. Compassionate, entrained breathing can hold the space for the both the student and therapist to fully ex- perience the emotional response in a safe atmosphere.

Savâsana

In its fullest expression, savâsana is a courageous ex- ploration of the mystery of life and death. Dying is natu- ral and universal. Savâsana—literally translated as “corpse pose”provides an opportunity to practice moving toward the ultimate letting go. As we lie down and rest in stillness, we honor the “being” of life. We rest in our wholeness, just

There are mudrâs to open, to receive, to ground, to pray, to offer, and to meditate. A few of the possibilities for an end- of-life Yoga therapy mudrâ practice include:

  • Anjali mudrâ: Hands in “prayer” position, near the heart. A balancing, calming mudrâ.
  • Vajrapradama mudrâ: Hands interlaced openly, palms toward chest, with thumbs upward. A mudrâ that can elicit steadfastness, confidence, connection, and trust.
  •  Padma mudrâ: A mudrâ that creates the image of a lotus flower. Hands in anjali mudrâ, allow the base of the palms to stay together as the mid-palms and fingers open like a flower blooming. Thumbs and little fingers touch lightly at tips. An opening mudrâ that may bring sensations of hope and healing.
  •  Samputa mudrâ: Hands cupped, palms together one on top of the other, creating a space within the hands. A mudrâ that may evoke gratitude.
  •  Adhi mudrâ: Fingers lightly curled around the thumbs, place the soft fists palm down on knees, floor, or bed. A grounding mudrâ that may calm and comfort.
  •  Mandala mudrâ: Right cupped hand resting in your left cupped hand, creating an oval. Thumbs come together at the top, completing the circle. A balancing mudrâ that may bring a sense of wholeness and connectedness.

Âsana

Âsanas may vary from strong, active sequencing to adaptive, restorative poses, but should always reflect the stated goals and needs of the individual on that day. The ses- sion can be a creative, organic exploration of postures based on meeting the student where he or she is. Throughout the âsana practice, provide ongoing cues for how to integrate breath with movement.

When selecting postures, follow the wisdom of “less is more.” For this population, postures may be explored with

as we are in that moment, in that body, with that current emotional and mental state, and the current circumstances of life. This nonjudgmental awareness also provides an op- portunity to witness our impermanence and mortality. Through savâsana, a glimpse of what some call the true Self—the unborn, undying consciousness—may occur as we move beyond our personal experience toward a connection with the universal.

It is essential to include savâsana in every session. In savâsana, the physical body should be supported and com- fortable; the breath and energy body should be natural; the mind should have a quiet, gentle, inner focus; the emotional body should be moving towards equanimity; the wisdom body should be honored; and the bliss body should be open. As thoughts, emotions, and sensations are witnessed, they can be gently released to allow fully being present in the moment. The practice encourages finding comfort in our deepest self.

Gentle, supportive verbal cues assist the student in savâsana. Some examples are:

  •  Allow your bones to melt into the Yoga mat.
  •  Imagine your entire body breathing.
  •  Witness thoughts and emotions as they pass by.
  •  Honor your wisdom as you connect to the universal wisdom.
  •  Let joy, peace, and bliss wash over you.
  •  Release, relax, guide, notice, receive, rest, dissolve, allow, open, let go, accept, honor, soften, welcome, be present, be still, connect, permit, embrace, sense, enjoy, surren- der, pause, unfold.

Sharing and Closing

It is essential to allow time for sharing of the student’s experience as the session comes to a close. If appropriate, the use of a carefully chosen quote, poem, or prayer can be inspirational, once you have understood the student’s spiri- tuality and circumstances.

Extending Yoga Therapy into Everyday Life

It is important to remember that individuals experienc- ing change, loss, serious illness, and the end of life have goals. Researchers Kinnier, Tribbensee, Rose, and Vaughan observed, “Confrontation with death can serve to shake in- dividuals into reassessing their priorities and may provide them with sagacious insights about life.”7 Yoga practice cultivates introspection and distills what is important in life and living. Svâdhyâya, or witnessing and introspec- tion, helps the student prioritize goals and assists in finding meaning in life.

If it supports the student’s goals, a home practice may include a wide range of activities and experiences. Never as “homework,” but as an organic extension of Yoga and the awareness that unfolds from the practice. Through non- judgmental listening and sharing, the synergy between the student and therapist can guide the co-creation of a creative home practice.

A daily practice of savâsana, or any practice of con- necting with silence, is very beneficial. Beyond the obvi- ous home-practice possibilities of âsana, prânâyâma, and meditation, other possible activities might include creative expressions inspired from the Yoga therapy session. For ex- ample, writing a letter or poem, painting, or gardening as a natural expression of the physical, mental, emotional, and spiritual awareness that arises from Yoga practice.

End-of-life Yoga therapy sessions may also move students to experience a “life review,” either formally or informally. It is an honor to witness individuals who come to their person- al understanding of what their mission and purpose in life is and has been. Contemplation, vichara (self-awareness), and discernment supports this process. Furthermore, the prac- tice of aparigraha (letting go and the releasing of control, transgressions, fears) can allow for peacefulness and joy to emerge. Students may choose to communicate to their loved ones emotions such as love, forgiveness, and gratitude, as well as memories and beliefs. The open communication and dialogue with family and friends allows for perspectives and life stories to emerge, which may support personal meaning- making for the student.

Yoga Philosophy for End-of-life Yoga Therapeutics

Yoga philosophy is rich in its ability to deepen the ex- perience and understanding of an end-of-life yoga therapy practice. When appropriate, sharing Yoga philosophy with students allows the theoretical background to come to life.

The Pancha Maya Model

The pancha maya model (originating from the Vedic scripture the Taittiriya-Upanishad, and later found in the Vedanta doctrine of the five sheaths, or panca-kosha)8 cre- ates a practical structure for Yoga therapy. The kosha model provides a framework for understanding the integration of body, mind, and spirit, which is essential in end-of-life Yoga therapy. It may be useful to share this model with students when describing the many ways Yoga therapy can be of support.

Pancha maya model

  •  Anna maya kosha: physical and medical considerations
  •  Prana maya kosha: breathing and energy considerations
  •  Mano maya kosha: mental and emotional considerations
  •  Vijna maya kosha: inner knowing and wisdom considerations
  •  Ananda maya kosha: spiritual and joyful bliss considerations

In our living and our dying, the kosha model provides a framework for experiencing unifying wholeness. Held together, the concepts of life and death can seem paradoxical. Yet, Yoga allows for the integration of all opposites. The balance of “opposites,” such as will and surrender, can be explored at all levels—body, breath, energetic, emotional, mental, and spiritual.

Starting with the physical body and âsana, we can experience bidirectional muscular, skeletal, and energetic forces that ultimately bring a pose into alignment. Within the prana maya kosha, seemingly opposite forces may be experienced in the differing effects of the inhalation compared to the exhalation. Upon closer exploration, the breath can be viewed and experienced as the natural circular cycle it is. The energetic body also reveals seemingly opposite forces when one is sensing the subtle nuances of “doing” versus “being.” Additionally, the energetic body allows for sensations of feeling “grounded” and “expansive” simultaneously.

Outwardly, emotional opposites such as joy and sorrow seem radically different. However, the bittersweet emotions can be viewed as a spectrum of emotion that occurs during serious illness, loss, and dying. During end-of-life, our wisdom body may move toward the recognition of connection with all of life. But as human beings, there will likely still be moments when we also experience separation, doubt, and fear.

The dying individual, along with family and friends, will likely experience the capacity to hold “opposite” emotions at the same time. Tears of sadness, tears of fear, tears of memories, tears of laughter, tears of relief, and tears of joy can fluctuate rapidly, and even be present simultaneously. These tears are a physical expression of the integration of opposites. Life is strong and fragile, complex and simple, sorrowful and joyful.

Through each and every kosha there lies the opportunity for this paradoxical awareness to move us toward free- dom from experiences such as physical pain, mental anguish, emotional upheavals, or spiritual separation. Ultimately, glimpses of bliss and vidya (non-duality/wholeness) remind us of our true and essential nature. Present in the moment with an open heart, along with prasadam (grace), we enter into rahasya, the deep mystery of life and death.

Pantajali’s Yoga Sûtras

There are many classic Yogic references to support the philosophical foundations for end-of-life Yoga therapy, in- cluding the Yoga Sûtras of Patanjali. The yama of ahimsâ (firmness in nonviolence) referred to in Patanjali’s sûtras is integral to end-of-life Yoga therapy. The following overview will highlight some of the sûtras that I have experienced as most relevant for end-of-life therapy. The translation of these sûtras is by Swami Venkatesananda.9

Yoga Sûtra I.2: Yoga citta vrtti nirodhah. (Yoga is the stilling of the movement of thought in the indivisible intel- ligence.) In end-of-life care, there are times when confu- sion, anxiety, and fear are present. Through Yoga practices such as meditation and savâsana, equanimity and peaceful- ness are cultivated.

Yoga Sûtra I.3: tada drastuh svarupe ‘vasthanam. (Then the seer exists by itself and as itself.) Yoga allows students to explore and discover who they truly are, their essen- tial Self, through introspection and witness consciousness. Through the awareness practices of Yoga, what is impor- tant and meaningful in life may shift and be reprioritized. Daily life is re-examined and daily concerns tend to fade as death approaches.

Yoga Sûtra I.18: virama pratyaya ‘bhyasa purvah samskara seso ‘nyah (Different from this is the practice which is based on cessation of all effort.) Whether in âsana, prânâyâma, or meditation, integrating a philosophy of non-striving opens the body, breath, mind, heart, and spirit to relaxation and peacefulness within. The cessation of all effort is, in essence, “permission” to “just be” and rest in Self. Non-striving is an expression of the “being” of Yoga. The philosophy can extend to affirming to the student that they are complete and whole just as they are.

Yoga Sûtra I.23: Isvara pranidhândâd vâ. (Surrender to the omnipresent, ever-existing reality, or God.) The theme of “surrender,” understandably a very difficult practice, is ul- timately the core of end-of-life Yoga therapy. The practice of savâsana provides an opportunity to practice acceptance and surrendering to the “ever-existing reality,” however named, and to the mystery of life and death.

Yoga Sûtra I.26: sa esa pûrvesâm api guruh kâlenâ ‘na- vacchedât. (Enlightening experience of all the sages from the beginning of time is not conditioned by time.) Timelessness or a shift/loss in the sense of time arises in both Yoga and at the end of life. An end-of-life Yoga practice allows for personal philosophies of life and death to be re-examined, strengthened, or transformed.

Yoga Sûtra I.31: duhka daurmanasyâ ‘ngam ejayatva svâsa prasvasa viksepa saha bhuvah. (The presence of the following

 

Resources

Books

A Year to Live: How to Live This Year as If It Were Your Last by Stephen Levine
Who Dies? An Investigation of Conscious Living and Conscious Dying by Stephen Levine and Ondrea Levine Handbook for Mortals: Guidance for People Facing Serious Illness by Joanne Lynn & Joan Harrold

Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life by Jon Kabat-Zinn

Websites

www.adec.org Association for Death Education and Counseling
www.nhpco.org The National Hospice and Palliative Care Organization

www.nondual.com Richard Miller’s Yoga nidra training

Experiences

Local hospice volunteer training
Network with local end-of-life care professionals College course in death and dying

symptoms reveals the disturbance of the mind: sorrowful mood, psychological despair, the motions of the body, and inhalation and exhalation.) Sorrow, anxiety, physical dis- comfort, and despair, which are recognized in this sûtra, are often present for the dying and their families and friends as they face the physical, mental, and emotional anguish of saying goodbye. The practices of Yoga offer preparation, compassion, and a deeper exploration of death and dying that may alleviate some suffering.

Yoga Sûtras II.3-4, 6, 7-9: avidyâ ‘smritâ râga dvesâ ‘bhiniesâh klesâh: (ignorance, egotism, attraction, repul- sion, and clinging to life); avidyâ ksetram uttaresâm prasupta tanu vicchinno ‘dârânâm (Ignorance is the cause of all the other sources of psychic distress, whether dormant, weak or spread out.); drg darsana-saktyor ekâtmateva ‘smitâ (The power of sight sees; however, when fragmented identifies itself as the seer; there is ego-sense.); dukha ‘nusâyi dvesah (repulsion abides in the erroneous classification of an object or experience as pain-giving.); svarasavâhi viduso ‘pi tatha ‘rudho ‘abnivesah (Clinging to life is self-sustaining and a dormant factor in wise beings.)

The kleshas of avidyâ, (ignorance of the truth of oneness, duality, separation);

asmitâ (attachment to a disintegrating experience of ego);

raga/dvesha: sukha and duhkha (attachment and aversion);

abhinivesha (clinging to life, finite self, fear of death) can be present through experiences of loss, grief, death, and dying. The relevance of the kleshas can be seen in Kübler-Ross’s widely known five stages of grief and dying, which incorporate experiences of denial, fear,

Closing

Through the philosophy and tools of Yoga therapy, we have the honor and opportunity to heal ourselves, our soci- ety, and our planet. Each of us is a part of this transforma- tion as we allow Yoga to guide the courageous exploration of life, illness, grief, and physical death. I continue to be amazed that with all of the “doing” of Yoga, the moments of “being” Yoga are, to me and my students, the most pro- found. End-of-life Yoga therapy has the capacity to allow the strength and beauty of the human spirit to shine.

References

Allen, W. Bartleby.com http://www.bartleby.com 1996. Accessed April 20, 2008.
Agency for Healthcare Research and Quality and the Centers for Disease Control. Physical Activity and Older Americans: Benefits and Strategies.

June 2002.. http://www.ahrq.gov/ppip/activity.htm. Accessed July 13, 2008.
Jackson CO. American attitudes to death. The Journal of American Studies. 1977;II(3):297–312.

Neimeyer RA, Van Brunt D. Death anxiety. In: Wass H, R. Neimeyer R, eds.. Dying: Facing the facts. Washington, DC: Taylor & Francis; 1995:49–88
Corr CA, Doka KJ. Master concepts in the field of death, dying, and bereavement: Coping versus adaptive strategies. Omega. 2001;43(3): 183–99.

Le Page J, Le Page L. Prânâyâma, Mudrâ & Pranic Healing. Integrative Yoga Therapy. 2007.
Kinnier, R.T., Tribbensee, N.E., Rose, C.A., & Vaughan, S.M. In the final analysis: More wisdom from people who have faced death. Journal of Counseling & Development, 2001 Spring; 79(2), 171-178.

Feuerstein, G. The Yoga Tradition: Its history, literature, philosophy and practice. Arizona: Hohm Press. 1998
Venkatesananda, S. Enlightened Living: a new interpretative translation of the Yoga Sûtra of Maharsi Patanjali. 3rd ed. California: Anahata Press. 1999.

Kubler-Ross, E. On death and dying. New York: Macmillian. 1969.

Address all correspondence to: Jennifer Taylor, Dynamic Systems Rehabilitation, 10213 N. 92nd Street, Suite 102, Scottsdale, AZ, 85258. Tel: 480.699.4867. Email: jennifer@transitionalyoga.com

 

 

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