Monthly Archives: September 2012

Yoga Therapy Research: Just a Wee Bit Closer!

Via PUBMED and Nicole DeAvilla-Whiting, Ananda Yoga Instructor and Author of The 2 Minute Yoga Solution:
 
J Neuropsychiatry Clin Neurosci. 2012 Mar 1;24(2):152-64.

Yoga as an ancillary treatment for neurological and psychiatric disorders: a review.

Source

Department of Psychiatry, West Los Angeles VA Medical Center, the David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.

Abstract

Yoga is gaining acceptance as an ancillary medical treatment, but there have been few studies evaluating its therapeutic benefits in neurological and major psychiatric conditions. The authors reviewed the literature in English on the efficacy of yoga for these disorders. Only randomized, controlled trials were included, with the exception of the only study of yoga for bipolar disorder, which was observational. Trials were excluded if yoga was not the central component of the intervention. Of seven randomized, controlled trials of yoga in patients with neurological disorders, six found significant, positive effects. Of 13 randomized, controlled trials of yoga in patients with psychiatric disorders, 10 found significant, positive effects. These results, although encouraging, indicate that additional randomized, controlled studies are needed to critically define the benefits of yoga for both neurological and psychiatric disorders.

PMID:
22772663
[PubMed – in process]

My Testimonial on Bikram Yoga and Bipolar Disorder

A similar version of this was submitted to the Bikram Yoga College of India website earlier this evening. www.bikramyoga.com/

How It Began
I was diagnosed with bipolar disorder at the age of 23. I began the Bikram practice at the age of 29, 11 years ago. I was overweight, isolated and living months at a time with depression that kept me in bed for most hours of most days every winter.

I began practicing Bikram Yoga and knew immediately that this practice would be good for me, if not just socially and for weight management but also for my circulation (I have had lymphedema since the age of 12) and for the relief of anxiety, hypo-mania and depression, all symptoms of bipolar disorder. I was fat, swollen, depressed, miserably sad, misunderstood and lonely. I was also grieving the death of my beloved older sister, D’Arcy two years earlier. She, too, had bipolar disorder. She went untreated and died a drug addict.

I have used Bikram Yoga successfully to manipulate and to help manage my bipolar mood changes. I have minimized my hypo-manic, anxious and depressive symptoms since beginning the practice in 2002 and have been without any extraordinarily unusual moods since 2005 (with the exception of once, after a break-up. I admit that I was angry and heartbroken.  I did some things that I should not have done. At least I didn’t set his bed on fire like my not-bipolar friend did when her boyfriend cheated on her! Yikes! ).

Yoga disrupted the cyclical and predictable mood changes that I had struggled with for years, leaving a smoother, more reliable energy level from which I could draw in order to live well, while still, more easily and more quietly, privately “entertaining” a mental illness.

How It Works
This practice regulates the rhythm of my days, my metabolism, my sleep/wake cycle, my appetite, my outlook, my confidence, my socializing, my feeling of connectedness to self and to others, and my weight fluctuations.

The practice of twenty-six postures and two breathing exercises in a room heated to 105′ ultimately relaxes me by lowering my heart rate, increasing my blood-oxygen level, synchronizing my respiratory, endocrine and nervous systems and realigning my musculo-skeletal system. It is detoxifying and purifying. The practice enforces self-confidence by practicing in the mirror for the entire ninety minutes. (“Look into the eyes of your own best teacher.”)

The practice provides an opportunity to cultivate the discipline and energy that it takes to manage a chronic and persistent mental illness.

The practice can help one cultivate a deeper awareness of oneself for the better management of both gross and subtle mood changes, with or without the diagnosis. It has done that for me.

It produces, in the end, over-all feelings of contentment, known as santosha in Sanskrit.

What Happened As A Result of My Daily Yoga Practice
Today, I am an Ananda Yoga and Meditation Instructor, in the same lineage as Bikram Yoga. I am also a disciple of Paramhansa Yogananda, Bishnu Ghosh’s brother (who was Bikram’s teacher). I continue to use the therapeutic, Yogic tools that I have learned for mood management on myself and I teach these to others now – with great success!

By the regular practice of Bikram Yoga, people living with bipolar disorder can practice self-discipline, self-study, and devotion (tapasya, swadhyaya and ishwara pranidana in Sanskrit, respectively), just by showing up, all of which are helpful and applicable conducts of behavior that apply to everyone… but that are especially therapeutic for a disorder of mood inconsistency. These tenets of Yogic philosophy have been especially important in my personal recovery.

Yoga is like a miracle. I can’t believe that there aren’t any other testimonials about Bikram Yoga as mood management for bipolar disorder. Hopefully there will be more, soon! (We are a shy and stigmatized, self-protective bunch, by necessity. Bipolar is commonly misunderstood and can be scary. It can be dangerous and it can be deadly.)

Conventional Therapies and Clarity
Medication was the only treatment plan for me at diagnosis. I was irresponsibly over-medicated at onset. I gained 50 pounds, my hair fell out, I was like a zombie. I had to drop out of school for 6 months, though I was expected to (and did) graduate from college. I went off of medication after one year. I was horrified by the results.

I resumed medication in 2005: Three years of a daily, 90-minute Yoga practice gave me the clarity to understand that my brain needed something to steady the shifting tides, something that my will alone could not provide, and I recognized that I was working as hard as I possibly could at this hot, sweaty, crazy Yoga thing – that definitely helped steady my moods, more than anything else that I had ever tried – but it didn’t help all the way. I was no longer willing to spend my energy controlling – or trying to control – all of my brain’s activities on my own. The illness was just too in-born for me to completely manage on my own. I gave in to the temptation for a higher quality of life.

After years of hot, sweaty contemplation and observation, wearing next-to-nothing and twisting my body in the mirror morning, noon and night, I could finally surrender to this understanding of a certain powerlessness and to the possibility of a finding a proper doctor to prescribe proper medication in proper dosages.

What a gift to have such clarity.

Adjunctive Therapies, Breakthrough Symptoms and Bad Genes
I finally had the energy and well-being to seek out and find a doctor whom I trusted. This took about a year, if I recall, going through a quacky doctor or two before finding dear Dr. Olson. I have also had a talk-therapist since 2004, Ruth. She practices Yoga and understands its therapeutic value. Talk-therapy, including Cognitive Behavior Therapy and Dialectical Behavior Therapy, is the only adjunctive treatment to medication therapy that is universally recognized as treatment for bipolar disorder (though still not completely reimbursed by insurance companies). Yoga research is needed to reveal Yoga’s therapeutic value and potential for this population. Yoga needs to be made widely available to those who suffer.

A common attitude of doctors is that those with bipolar disorder can live a high-quality life once medicated. Yet it must be understood that breakthrough symptoms occur no matter the medication, because stress triggers symptoms. I found my breakthrough symptoms greatly neutralized only with a combination of the regular practice of Yoga and proper medication. Bikram Yoga is highly stress-reductive. It is demanding, yes  but, also, the posture series is complete.The spine is manipulated in a sequence that calms the nervous system. The practice has transformed my breakthrough symptoms to make them more infrequent and ever-so-gentle.

Bipolar disorder has high rates of co-occurring suicide, homicide and substance abuse associated with it. My older sister committed suicide. My father, who self-medicates with alcohol and prescription drugs, and my aunt both have this disorder of the brain. With this close genetic influence, it is understood that my health is “delicate” and that I need therapies and support for the rest of my life to stay active and to lead a normal life. Yoga helps me remain watchful and stable.

From Survival To Recovery
Without Yoga, I might not be alive today. This sounds dramatic, but it is the truth.

In 2002, when my friends and surviving sister suggested that I go to my first Bikram class, I had been in bed, for about four months straight, with my usual seasonal depression, for the third winter in a row. I was having suicidal thoughts at the time. Yoga literally saved my life – Bikram Yoga literally saved my life, actually – because of its popularity, its accessibility, its encouragement of a consistent, daily practice and because of its effects on the brain.

Within 24 hours of that first class, I noticed a shift in my mood that lasted from… that lasted from about twenty minutes into the class, from about the second set of half-moon pose (“I can do this!”) to hours later and into the next day, when I decided to go for another class.

Like most people, I do not hear voices as a general rule. That is not one of my illness’ symptoms, not for me, anyway. However, I find it notable that during my third class, while in savasana, I heard a voice that said, “This is the thing.” I knew then and there to keep showing up.

And so I did.

The stormy seas of my mind calmed and stayed calmer. The jabs of anxiety weren’t so sharp and they finally subsided altogether (they did return ten years later when I couldn’t practice for other health reasons. I had been out of the studio regularly for over nine months. Mood instability became detectable, first subtly and, over time, more loudly, illustrating the long-term buffering effect Yoga had on my moods, biochemically). The deep depressions disappeared immediately.
I lost weight, I gained strength and flexibility and I made friends and developed a community.

I practiced eight days of the ten of my original ten-day trial-package. After 2 1/2 years of practicing anywhere from five to ten times a week (a week of doubles!), in 2004 I recognized that not only did I want to attend a Yoga teacher training program to learn more about Yoga and why it was so fulfilling and therapeutic for me, but also that I was ready to try a new medication.

I went from working two days a week to currently teaching six classes a week, independently (I am not affiliated with any studio, unusual for this region) and teaching twice a week privately to a client with bipolar disorder.

I have not been hospitalized since taking medication and practicing Yoga. My focus has shifted from my illness to my wellness.

I plan to offer more Yoga/Bipolar Therapy group and private classes both locally and, hopefully, at conferences nationally and internationally, to continue to represent those living with bipolar disorder in a respectful and enlightening way and to share the healing potential that Yoga offers to the mental health community.

I hope also to inspire the conduct and publication of scientific research on this subject, if I cannot execute it myself. No research currently exists on Yoga therapy and bipolar disorder.

I may be the world’s expert on Yoga and bipolar disorder – I have found no others – at least, that’s what three different people suggested to me, just in the last week!

I used to spend months crippled in bed by this disorder. “Like a flower petal blooming,” through Yoga I have become a Yogini, an advocate for Yoga and bipolar therapy and research, a teacher and a more confident woman. I continue my outreach, education, teaching and personal practice to share the therapeutic effects of Yoga to those in need and to help break the silence that veils mental illness.

Not a Study on Yoga and Bipolar Disorder Specifically, But We’re Getting Close

Self-management strategies important in bipolar disorder
By Andrew Czyzewski
15 June 2010
J Affect Disord 2010; 124: 76–84

MedWire News: High functioning patients with bipolar disorder who have a long history of illness use a range of self-management strategies to aid their well-being, a qualitative study has shown.

Strategies fell into six broad categories: sleep, rest, exercise and diet; ongoing monitoring; enacting a plan; reflective and meditative practices; understanding bipolar disorder; and connecting with others.

“Clinicians can use these qualitative data to underscore the power of proactive well-being strategies and inspire positive therapeutic engagement,” Erin Michalak (University of British Columbia, Vancouver, Canada) and colleagues comment in the Journal of Affective Disorders.

Noting a lack of prior research in this area, Michalak et al recruited 32 patients with bipolar disorder who had a significant clinical history of illness, in terms of episodes and hospital admissions, but whose functioning and quality of life were in the normal clinical range.

Participants underwent either an individual interview or focus group session to answer open questions about the self-management strategies they used to maintain or regain wellness.

Sufficient and regular sleep was identified as one of the most important strategies for maintaining or regaining wellness. Choosing healthy foods, eating regularly scheduled meals, and taking vitamin supplements was also commonly mentioned, as was regular exercise.

Participants described the importance of learning to pay close attention to their moods and activities, in order to judge when to make changes. Related to this was planning for impending manic or depressive episodes, involving either an informal understanding between family members or friends or a more detailed document to guide decisions.

A variety of reflective and meditative practices were advocated by patients – ranging from practices such as Tai Chi, yoga, and meditation to activities like regular journal keeping, inspirational reading, and praying.

Many patients sought out information about their illness through a variety of channels including books and newsletters, the internet, attending groups and talking to healthcare practitioners. Some also found it useful to share what they had learned with family member and friends.

Not surprisingly connecting with others was an important strategy for many patients, although finding a balance between solitary and social time was important. Connections included family and friends, seeking out professional support, and for some people, doing volunteer work.

Discussing the findings, the researchers emphasize the important of patients discovering the best coping strategy for themselves.

“The notion of an idiosyncratic narrative is not surprising given the complex pattern of interactions that are likely to moderate well-being in bipolar disorder,” Michalak et al conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Speaking Out Is Breathing Out and Breathing Out With Control Is A Pranayama Practice

I became a member of the Yoga Service Council this weekend. They meet in late spring every year at The Omega Institute in Rhinebeck, New York (which I think of as the East Coast’s Esalen or Naropa Institute). I answered a call for presentations for their 2013 Conference on behalf of Yoga/Bipolar Therapy.

This Yoga/Bipolar Therapy project is nascent, is young. Perhaps too young yet to present, in some schools of thought. Really, there’s no non-profit, no incorporated business, no research. There’s just me, and what I do, and what I’ve been doing.

What I have been doing is practicing Yoga and living with bipolar disorder, every minute of every day, for over ten years. I have been grieving the death of my sister, caused by an untimely suicide with drug overdose undertones and untreated bipolar disorder overtones. What I’ve been doing is I have been missing my sister every minute of every day for over ten years. It sounds romantic, but it’s not.

It’s fucking permanent.

Speaking out about bipolar disorder, to create awareness of the powerful destruction it can cause, to create fellowship among survivors, and to offer another therapeutic modality – Yoga – is, for me another way that I practice Yoga. I am practicing pranayama, energy control, when I move the breath from my lungs through my throat to speak out about a misunderstood, scary disease. I am pumping the grief from my heart-center upward as I share the truth and I am transforming that grief from kapha to pitta, from heavy to firey, to serve others. I am affecting my energy in a controlled and positive manner.

It doesn’t matter if I am called to become a presenter at the Yoga Service Council’s 2013 Conference. What matters is that I transmuted my pain and experience to educate, if only the reader of my 500-word abstract. She will hear from me again because this practice, this illness, this grief is permanent. This passion, this knowing, this Yogic management of bipolar moods is too big to muffle.

Pardon my French back there.

500-word abstract:

Bipolar disorder is an often misunderstood, episodic, chronic brain disorder with significant morbidity and mortality rates causing manic, depressive and mixed mood states that are traumatic and exhausting for the survivor and their caregivers. Bipolar disorder often requires hospitalizations and long-term care. High rates of co-occurring substance abuse, homicide and suicide occur with bipolar disorder with estimated losses of $15.5 million annually. Bipolar disorder is among the most heritable of all medical illnesses, affecting family systems and the community as a whole. Bipolar disorder affects men and women equally. It knows no racial barriers. Bipolar disorder is the 6th leading cause of disability in the developed world.

Medication management of the illness is recommended. Bipolar survivors, however, can remain symptomatic whether they are medication-compliant or not. Talk-therapy, to manage commonly occurring addiction, behavior disorders, panic disorders and social phobia, for example, is also recommended. There exist few other resources for wellness.

Yoga and meditation offer a refuge to this under-served sector of the mentally ill.

But while Yoga and meditation have been clinically shown to affect depression, anxiety, post-traumatic stress disorder and sleep disorders – all symptoms of bipolar disorder – currently, no published research exists on Yoga/bipolar therapy.

Yoga and meditation are accessible, affordable, and effective therapeutic modalities for bipolar disorder when applied with care. With instruction, these tools can eventually become clinician-free practices to help practitioners manage bipolar moods. Bipolar disorder is a lifelong illness. Yoga can serve as a life-long practice for survivors and for caregivers. Yoga can help to address the long-term needs of consistent mental and physical therapy for people living with this chronic and severe mental illness.

Cost-effectiveness and the ability to practice independently are key when considering therapeutic intervention for this oft disabled and impoverished population.

Brooke West is an Ananda Yoga® and Ananda Meditation® teacher who has been successfully using Yoga as a therapeutic mood management tool for herself personally and for her students living with bipolar disorder for more than a decade. She is representative of, a practitioner of and an advocate for Yoga/Bipolar Therapy.

Born of Patanjali’s Ashtanga Yoga system, including asana and pranayama, and guided by basic ayurvedic lifestyle tenets, the Yoga/Bipolar Therapy sequence systematically produces dramatic, relieving effects for the bipolar mind, both immediately and in the long-term, by relieving stress, anxiety, feelings of depression and malaise and by cultivating awareness, comfort, focus and feelings of well-being.

Yogananda’s Energization exercises, asana, pranayama, restorative postures and guided meditation make up this 90-minute bipolar-specific Yoga session designed to relax the body, bring balance to the mind and gently inspire the participant, no matter their diagnosis.

For the therapist: Learn simple Yoga practices to capture the client’s attention and to help the client regain focus both on and off the Yoga mat.

For everyone: Gain a deeper understanding of bipolar mood states and how to affect them.

Please dress warmly, in layers.

Everyone experiences mood changes. Yoga helps.

AUM

The Effortless Breath

DSC03353

Morro Rock over sandspit, Morro Bay, CA

One year ago, I began the pursuit of Yoga therapy research demonstrating the efficacy of Yoga therapy on mood management in bipolar disorder. For more than 365 days, I have been astonished, stunned and baffled, over and over, by the lack of information on such potent therapy for this dangerous and, often deadly, disease.

I know first-hand the destructive nature of this disorder when left un-medicated. Now, I am your most “gani,” most health-food store-y, most au natural gal you can find. I normally eschew medications. I was raised a Christian Scientist, where doctors are passed over for prayer, even in one’s time of dying. But bipolar disorder calls for different measures, and psychosis cannot be prayed away. In fact, it often leads to suicide or, more socially punishable, homicide.

And my family has been ravaged by this illness. My aunt, my father’s sister, traces bipolar disorder back along our family lines to “the crazy Welsh side of the family, the Wests.” That aunt had her break in her forties during her divorce, after her kids had grown and moved out of the house. She is now supported by lithium and by the finances of my father.

My father, a highly successful, creative advertising executive and, later, jeweler, has never been properly treated for his mercurial inner life. He has self-medicated with alcohol and prescription medication since before I was born. He has had few lasting relationships. My mother divorced him, he left when I was seven. He and I are estranged and have been since about age 10.

My sister, D’Arcy, my brilliant, gorgeous, funny, smart older sister, never was properly treated and her moods took her through addiction to drugs from age 12 to 30 when she died of a drug-overdose, a suicide, and a broken heart from a failed relationship. It is to her that I dedicate this Yoga Therapy work.

I was diagnosed with bipolar disorder in college. I don’t talk about it much, fearing stigma and changed attitudes toward me. Hiding my illness has become habit. I have learned to become vigilant. Hiding my treatment, however, my personal discovery of Yoga as therapy for mood modification, can no longer be a practice for me. Yoga has worked too well. It sustains me. Too many people can benefit from this information. Research must be done. Advocacy and education are essential. Access must be created.

So I dare to come out.

Not associated with a hospital, college or other institution, without a Master’s degree and on a Yoga teacher’s budget, I have spent over 20 hours per week, on average, since September of 2011, making phone calls, writing emails, searching the Web, reading books and journals and magazines, learning about research designs and scales and measures, discovering Institutional Review Boards, learning to read research articles, meeting with local mental health organizations and chapters, presenting this idea, educating on Yoga and on research and on bipolar disorder, sharing my story, offering free Yoga classes, developing relationships with new mentors, deepening relationships with existing mentors, talking to my instructors, continuing my Yoga Therapist certification through classes at The Expanding Light at Ananda, where I have trained as a Yoga instructor and as a Meditation instructor…

In August, I traveled to Sacramento to discuss this project with a psychiatrist who already incorporates Yoga into his practice, Dr. Paul Copeland. He acknowledged that this project has great potential, greater than he was willing to take on presently. I do not travel much, on my budget and as an owner of two dogs, so making the trip was significant in displaying my commitment to this project, to Dr. Copeland and to myself.

In the last year, I have communicated with The Centers for Complementary and Alternative Medicine, The National Institutes of Health, researchers at Stanford, Harvard, Brown University, UCLA, UC San Francisco, University of Iowa, University of Southern Indiana, UC Merced, Ananda University, NIMH, Johns Hopkins, Dr. Camille O’Bryant at Cal Poly San Luis Obispo, Dr. Foresman of Arroyo Grande, CA, Yoga Instructors Shoosh Crotzer, Nicole DeAvilla, Barbara Bingham, Liz Owen, Patricia Walden, Bo Forbes, Amy Weintraub, Leslie Daly, Laura Ghiringhelli Knutson, Julie Clayburgh, Dr. David Shannahoff-Khalsa, Cottage Hospital of Santa Barbara, Johanna Powden NP and staff at San Luis Obispo County Mental Health, Niroga Institute, local MFTs Kelsey Kehoe, Cynthia Saffell, Ruth Lapp, and Michelle Kilcoyne, Katy Hansen LCSW, local psychiatrists Dr. Douglas Murphy and Dr. Russel Marks, LA Yoga Magazine, The International Bipolar Foundation, SPOKES, STRIDE, Restorativepartners.org, Kelly Boys of iRest, Kelly McGonigal, Kelly Birch and John Kepner of The International Association of Yoga Therapists, Dr. Lisa Uebelacker, Elyn Saks, The Amen Clinics, Julianna Englund-Flores ND, Mark Schector ND DO, Krishna Kaur, Windhorse of San Luis Obispo, Prajna Yoga, Rob Steffke and Daniela DiPiero of Movimiento, LinkedIn Yoga, Meditation and Mental Health groups, Bipolar Today, Yoga For The Mind, The National Council of Community Behavioral Healthcare, Mental Health America, Bipolar Advantage, California Institute of Integral Studies, Drug and Alcohol Services of San Luis Obispo County, San Luis Obispo Community Foundation, Healing Yoga Foundation, Bikram Yoga San Luis Obispo, Sukha Wellness Center, QOYA and countless other Yoga instructors, friends and family members.

This list is not exhaustive.

This project has consumed my life a little, admittedly, but it is my life and it feeds me. Yoga and bipolar disorder are my life, my every effortless breath. I stay aware to stay well, for my life. Every thought matters. Every breath counts, so I now stay vigilant with intention, for my wellness. For my life.

My frustration is that no one of the above named has any more information than I do about using Yoga as a tool for mood management in bipolar disorder. It has been suggested that I may be one of the world’s leading experts on the subject and that it may be up to me alone to expand this project.

I need help.

Last week, my research mentor, Dr. Brandon Eggleston, informed me that he had too many other commitments and had no further time for this project. Brandon had been my liason to his university’s Institutional Review Board, should I pursue a group study. Because of the climate in my community and perhaps also because of my inexperience with organizing such endeavors, I have not been able to cull even a small group of locals living with bipolar disorder willing to participate in three months of free Yoga classes to conduct a pilot study, thus I was not able to take Brandon up on his offer to assist through his school’s IRB. My sense is that he does have a lot going on, that I would be indulgent to take his removal of himself personally. Still, I am terribly disappointed. He has been very important to me both personally and professionally.

This week, I have been in touch with Stephanie Teasdale of STRIDE at Cal Poly and she is asking around for potential grad students interested in collaborating with me. Who knows, I may go back to school myself.

I feel discouraged, frustrated, hopeful and proud. It all depends on where I look, what I focus upon, how I choose to think.

Still, this work has been effortless. My passion is driven by inspiration, by the love I feel when remembering my sister, by the conviction that Yoga helps and must be made accessible to those with mental illness, perhaps best by others who have mental illness, too, to stimulate compassion and to eradicate stigma, one effortless breath at a time.

I’m’a keep goin’.

…Bring Your Awareness Back To The Breath…

“I’ve been meaning to e-mail you and tell you how much I enjoyed your
class.  It was absolutely wonderful and relaxing!” -D. Dornan

Restorative Yoga classes and workshops are offered to relax the body and soothe the mind. Here are some tips for any Restorative Yoga class:

Please dress in comfortable, layered clothing to keep the body warm as
you relax.
Mats, eye pillows and blankets will be provided, though feel free to
bring your own.

Slow the activity of your mind as you rest cradled in postures for two
hours of calm retreat, but try not to fall asleep! If you hear someone
snoring, it might be you. Staying awake is part of the practice.
Hover in that place of non-waking and non-sleeping to stimulate your
body’s healing response in passive poses that will calm and refresh
the mind.
Please RSVP so that a station may be prepared for you.
All of my classes are taught in the Ananda style. Ananda Yoga can be made
accessible to anyone willing to try, no matter health issues. No
experience is necessary.

I look forward to seeing you very soon!

AUM Shanthi!
Namaste,
Brooke West

“Be steadfast in yoga, devotee. Perform your duty without attachment,
remaining equal to success or failure. Such equanimity of mind is
called Yoga.”
-Paramhansa Yogananda