Yoga During the Golden Years

“Oh I can’t do Yoga” is the saddest thing to hear, because I believe deeply that as long as you have; -

· Breath in your body

· Capability to move – even the tiniest, restricted movement

· It is within your gift, to yourself, to PRACTICE GENTLE YOGA

and gain some wonderful benefits from doing so.

Deeply, deeply I believe this… it is at the core of my life.

I am going to show/tell you about my work experiences and some personal stories too to illustrate the benefits of yoga to myself and to my clients who are your patients.

You may be familiar with idea of Yoga as a gentle form of exercise but some of you will be unaware of the mental and physical relaxation, the mental ability to focus or centralise the mind and the power of visualisation, that is part of the yoga experience that brings many benefits

No matter how ragged and shallow the breath, gentle yogic techniques can CALM THE MIND AND STEADY THE BREATHING, deepening it, relaxing and centring the client.

No matter how restricted the movement, it can be reinforced, strengthened and even visualised into DEVELOPING MUSCLE MASS, BONE DENSITY AND CONFIDENCE.

And I can share with you some of the evidence…

Yoga is so evidence based, so scientific in the sense that you can do the practical.

I teach Yoga to Day Care and a small, variable group of residents in Bell Villa Community Unit, and in the Day Hospital, at the Royal, Donnybrook. Other Yoga teachers work in other centres. My clients are a plucky crew whose conditions include motor neurone disease, stroke to the right, stroke to the left, immobilising arthritis, dementia and other similar ailments. The approach is the same as in any Yoga class. We work through the range of movement that is available, and, we visualise the rest. As a group we work with the breath. The staff, the clients and their families can see the visible difference that even an hour a week makes – and many of the students practice quietly in their wheelchairs in between classes. We have seen many improvements, in posture, range of movement and, that hardest to define, increased quality of life.

Warming up with Pawanmuktasana exercises[1], anti-arthritic rotations and manipulations of the hands, feet, elbows, knees etc. Followed by back stretches, twists and, one way or another, working though the muscle groups and joints, resting when needed, with exercises for the intrinsic muscles of the hands, eyes or neck before moving on to the breath work.

Section A ; page 2

“USE IT OR LOSE IT”

Professor Ian Robertson[2] applies this age-old principle to brain synapse. Another snappy phrase of his is

“CELLS THAT FIRE TOGETHER, WIRE TOGETHER”

His research demonstrates that the conditioning of our habitual movements, thought patterns and emotions create patterns of chemical connections deeply embedded in the brain. Some synapse patterns can withstand the ravages of age-related deterioration and Acquired Brain Injury.

In my work I am fascinated with the process of maintaining and rebuilding the chemistry of synapse connections. Yoga has been aware of the benefits of exercise for millennia – now, we live in exciting times where Brain Imaging techniques can demonstrate the evidence incontrovertibly.

Robertson’s book “Mind Sculpture” inspires me. Challenged by a broken wrist soon after I read it, I road tested some of his ideas and “PUMPED IRON IN THE MENTAL GYMN” [3]. It was a total gift of an experience. It is not an exaggeration to say that it gave me my life’s vocation.

In any exercise program motivation is always going to be an issue. We are all familiar with the good intentions that overwhelm us, and occasionally precipitate joining a gym or signing up for a class, New Year, September…

When our sense of immortality regains the ascendance, maintaining the motivation momentum flags. The demons of Sloth, Inertia and In-a-minute take over after week three.

For the older person the darkly cloaked figure with the scythe lurks in the shadows. While their medical advisors urge that they would benefit from exercise, they are acutely aware of breathlessness and frailty, by the feedback from their own bodies. They suffer a massive loss of confidence. Fear of death through ‘overdoing it’ becomes an inhibiting factor. They really don’t know where or how to begin.

How to get the feel-good factor without the fear?

A simple solution can be gentle Yoga exercise, starting with the hands.

Dignity… of being able to dress and feed oneself, this is the way in for me, to catch the attention of even the most despondent client.

We start with the hands.

Stretching and moving the hands: taking the fingers and wrists through their range of movement to whatever extent is possible. No matter how crippled with arthritis / jackhammer vibration /or stroke I ask them to move their hands in actuality – or – in the their imagination, in real time, ‘to see’ the damaged hand / finger / arm is also working.

I am informed by the research published in Prof. Robertson’s “Mind Sculpture” in my approach to working through the imagination. He demonstrates that

· ‘Working out’ in the mind

· Doing ‘brain gym’

· In real time and

· With dogged determination is

· Worth the effort

It sufficiently fires the neural circuitry to create appropriate brain chemistry that triggers the muscle mass to be; -

· Maintained

· Redeveloped

· Repaired

He describes the TANGLED WEB of acquired brain injury and shows that it can be encouraged to rebuild itself. This is astonishing and unimaginable, to a population that was brought up in the belief in the rigidity of brain mass. Cells used to be considered irreplaceable when damaged. Through the imaging systems it is possible to ‘see’ the mind at work. Our understanding of the nervous system and how it operates is rapidly changing. We now know the brain to be very malleable.

Soon after reading ‘Mind Sculpture’, I had the dubious fortune of breaking my left wrist. I was nearing the end of my three-year Yoga Teacher Training Course. I had assignments for qualification to achieve and training to complete.

I was not motivated to sit idly by for a couple of months.

I leapt at the chance of ‘doing the practical’. Here was my opportunity to road test Professor Robertson’s thesis. I continued attending my training, even upped the hours of classes. I worked the right hand while ‘imaging’ the left hand doing the same, spreading the shoulder muscles or whatever, as though the wrist was participating in the action… but I forgot about my hand. Totally. I was focussed on the forearm and wrist. The intrinsic movements of the hand were totally taken for granted.

The time came to have the cast removed. I caused consternation for the plaster technicians. My arm did not look like one that had been in plaster for 7 weeks. It was hard to convince them that it had, that I had maintained muscle mass through brain gym.

But… I had forgotten about my hand.

Released from the plaster, I could do headstands, elbow balance, dog-face-down, all the poses with no weakness at all… If anything my body was stronger.

But my hand was unable to grip. I had no opposable strength. I had visualised no intrinsic movements of the hand, my slight tendency to arthritis had had a field day. After a magic injection and loads of yoga, physiotherapy and rehab (I am a professional potter), my hand recovered. But it took two years to get back to doing a proper handstand, with the whole of by 75 kg carried by my hands.

But Prof. Robertson was right! I had proved it in my own body. My ‘mistake’ only underlined the reality of the power of Brain Gym.

This experience inspires my work with everyone I meet, both with the older clients and the younger ones, working their way back to wellness from chronic fatigue and chronic pain. Weaving the web of connectivity in the brain is the key to our experience of life. Every thought has a chemical consequence; every action is created by chemical and electrical interaction. We are the subtlest of mysteries. Vast metropolis of bacteria, virus and subtle, subtle chemistry contribute to our wellbeing.

I tell them my story and encourage them to DO THE PRACTICAL themselves.

We work with the hands spreading and stretching and doing our best. At any age, all you could ever do is your best. At 6 or 96 we do what we can. Even clients that seem to be cognitively impaired, join in with what seems to be such a do-able exercise. We tend to think of our bodies in sections, not realising that in order to move one finger, A DOZEN PLUS MUSCLES COORDINATE. Cerebral blood flow is maintained and increased – both by actual movement and my movement visualised in real time.

Mary thanked me profusely for teaching her these movements – during the class she immediately felt how they warmed up her hands, increased circulation and eased tension in her neck. She felt sure that she could remember them accurately, practise them safely, and was MOTIVATED to repeat them every day, confident that her heart was at no risk at all.

What she did not expect was to get improved sleep, sleep like she had not experienced for years. She told me how she had become resigned to ‘pins and needles’ in the fingers that would wake her up during the night, making subsequent sleep fitful with pain. Already her face looks fuller and more relaxed. In some way she had healed a chronic irresolvable condition.

I call that an everyday miracle.

Let me put it another way… When we don’t even move our hands, several dozen other muscles atrophy, connectivity in the brain is lost and mobility is impaired. This can lead to all sorts of non-specific tingling, pins and needles, spasm, cramp and outright pain.

How can I encourage a body to heal itself?

How do I facilitate the generation of a feel-good factor that makes life worth living? How best to support the EVERYDAY MIRACLE of correct transmission of intricate chromosome detail over gazillions of cell reproductions; the miracle of repair work from cuts and bruises: the many healing pathways that are triggered by chemical, enzymes and cell messengers that activate processes to enable tissue repair?

“The good news is that regular physical exercise… is linked to maintenance of normal cerebral blood flow during aging. Older people who continue to work after retirement or continue regular physical exercise show much more constant cerebral blood flow values during aging than people who retire and engage in little if any physical activity. Increased brain and blood flow has been linked to good scores in psychological tests. Some element of self-selection could be at work here: maybe those who are able to maintain cerebral blood flow are also able to go on working, whereas those who cannot, find work too effortful. Brainwork will increase blood flow to that part of the brain doing the work. Maybe for these mechanisms to remain efficient and intact, they must be constantly used. Perhaps they become inefficient with disuse.[4]”

When I read that, everything in me resonates with the sheer common sense of the man!

Section C; page 7

Self-Healing can be supported (or just as effectively undermined) through; -

· Expectancy

· Conditioning

· Meaning

Fortunately clients seem to have a link in their minds, YOGA IS VERY RELAXING. They are primed to feel relaxed after the class (almost in spite of what I do with them!) Dare I say that they are CONDITIONED to feel relaxed. They are open to feeling better. They come to the class EXPECTING to feel better. They would not put it in so many words but the PLACEBO RESPONSE OF SELF-HEALING is poised for release.

Again, my bedtime reading… Dr Brody’s The Placebo Response, inspires me.

“The Placebo Response can be defined as; -

A change in the body (or the body-mind unit) that occurs as the result of the symbolic significance which one attributes to an event or object in the healing environment.”[5]

This book also looks at the NOCEBO RESPONSE, the flip side; those triggers that undermine the mind’s subtle chemistry, causing the integrity of the whole organism to disintegrate. Extraordinary! But true – we have all witnessed the self-destructive mindset.

Reading this I get all excited, are there ways that we can exploit the EXPECTANCY THEORY OF SELF-HEALING?

“How does what I think is going to happen to me in the future affect my inner pharmacy?[6]

The mental state of expectancy can have an impact in the health – or illness – of the body. A person’s expectation can produce a bodily effect undermine different circumstances, and not merely when a person is given substances that are chemically inactive… If a message is received that resembles in its outward form something that the person expects to be associated with healing: that might be enough to trigger a release from the inner pharmacy, followed by bodily healing…. ‘Remembered wellness’ is a better description of what the brain actually does in calling up from its stored files one of the top-down healing responses…. The expectancy theory gives us a very valuable handle on the inner pharmacy [Placebo Response]” [7]

Through exercise and activity the client stimulates REMEMBERED WELLNESS. In class I actively work to recapture that by asking them to describe places that they have enjoyed walking in when we are doing a seated ‘walking’ exercise. I want to stimulate as many parts of the brain as possible – get the visual and auditory memories going. I so want the possibility of Remembered Wellness to activate. I can’t conduct the experiments, but I can seek to do the practical and see the outcome in my client’s faces and body language.

With conditioning the question is, “How does what has happened to me in the past affect my inner pharmacy? … The situation or setting that we find ourselves in is a potent predictor of the Placebo Response”[8]. Perhaps one of the conditioned responses that I am challenged to overcome is a negative feeling around the concept of exercise as difficult, sweaty, of a sergeant-major barking out the orders…

One of the treasured memories after a class was of a former military man saying that he loved his yoga class – “You have a way of making me want to exercise for the first time in my life! It is great for the arthritis.” Again, there it is, somehow, blessings on The Media! They seem to have successfully conditioned us to see yoga as an activity apart from Physio or drill.

And Meaning?

“An encounter with a healer [includes all health professionals] is most likely to produce a positive placebo response when it changes the meaning of the illness experience for the individual in a positive direction. The meaning of the illness experience most likely changes in a positive direction when these three things happen:

1. The individual is listened to and receives an explanation for the illness that makes sense.

2. The individual feels care and concern being expressed by the healer and others in the environment.

3. The individual feels an enhanced mastery or control over the illness or its symptoms[9]”

Brody also draws our attention to this; -

“if the patient leaves an encounter… feeling more bewildered than ever about the illness, uncared for, and helpless then we would expect our old bugaboo the nocebo effect to occur just as readily.7”

I feel that I can generate some of activity in the third ‘positive direction’.

Can the yoga class contribute to the client’s sense of ENHANCED MASTERY OR CONTROL over symptoms?

How can this be achieved?

Here I feel we are working in the area of increased the client’s confidence, finding a do-able activity that creates the pay-off – a feel-good feeling. How I would love to know that gentle exercise could be “a reinforcing task which helps to keep the SigA [immunoglobin A] levels high”[10] it seems very possible to be the case.

Section B Page 4

A huge factor in any interactivity is DESIRE. There are so many expressions in every language around the world to do with inability to make someone do something if they don’t want to do it. ‘Take a horse to water but you can’t make him drink’ etc.

Here I have to admit that I don’t inspire all my clients. There are some who for one reason or another sit through the classes without joining in, or are so depressed that they don’t want to come.

“physical activity of any kind can be a mood elevator…. Exercise and diet play an important role in the progress of affective illness… Exercise produces endorphins. Endorphins are endogenous morphine, and they make you feel great if you are feeling normal. They make you feel better if you are feeling awful;. You have to get those endorphins up and running – after all they are upstream of those neuroitransmitters too, and so exercise is going to raise your neurotransmitter levels.”[11]

Even the tiny amounts of gentle exercise that we do can make such a difference when I can encourage, cajole, even wheedle, participation.

For a while I had permission from one client with Motor Neurone Disease to wheel her into the class even if she said that she did not want to come. But now the depression has got too great a grip on her. Depression is difficult at any age, but EXERCISE ALTERS MOOD … AT ANY AGE.

Clients report a “good” feeling of stiffness the next day that clears quickly, leaving a FEEL-GOOD-FACTOR, of having done something that was useful and improved their sense of ‘wellness.

Increasingly Brain Imaging techniques make it possible to see the brain in action.

Which brings me to The Relaxation Response. It is a universal experience of good yoga classes that it is very hard to recall after the class, what it is precisely, that you did during the class. That is because a good class induces the relaxation response. The body goes into a DEEP STATE OF RESTFULNESS, a ‘floaty beyondness’. This is hard to achieve in a Day Hospital environment, I can tell you. Incredibly we do!

Most of us have developed habitual muscle tension, of clenching, holding or gripping with parts of the body that have no relevance to what we are doing. At one stage in my life, when I was dealing with a huge amount of anticipation anxiety, it was drawn to my attention that I always had white-knuckle clenched fists. I was staggered. But it was true. Need I say those were pre-yoga days! Still, many, many times a day I tell my legs and jaw to relax, particularly when I am at the keyboard. I am no touch typist! My toes and jaw tense up in sympathy as my fingers seek to hit the right keys. Both legs can end up cramped.

Most of these simple exercises that I do with the older clients are done with my students seeking release from Chronic Pain.

Many can be done very usefully

· At a desk

· In a smoke or tea break…

· In the car

· While waiting for the kettle to boil

How dangerous would it be to your street-cred to BECOME THE OFFICE ECCENTRIC…

EXERCISE AT YOUR DESK, do a few stretches… when the benefit is so phenomenal? One client says she uses the disabled loo – well, it has Rest Room written on the door…

In this slide you see some men working at exhaling while drawing their elbows together, on the inhale drawing them apart. They FEEL IMMEDIATE RELIEF in their backs. As might you!

The breath and Yoga

A feature that distinguishes yoga from other forms of exercise is the emphasis on the breath. While not all clients can follow the suggested breathing, I encourage them to work mindfully and appropriately to their bodies. Yet, many will unconsciously follow the instructions, and only be unable to follow them if they start to think about it. Ideally one seeks to achieve a

· Breath to a movement

· Movement to a breath

· With exertion occurring on the exhale

Often in the same room there may be patients suffering from advanced dementia apparently aloof to all activity around them. Interestingly, I have often noticed participation in the breathing. Those with a tendency to agitation can be calmer for a time afterwards.

How can this be?

As the rate of breathing slows, the activity of the sympathetic nervous system decreases, contributing to the relaxation response.

We know that ‘increase in neural activity in any particular brain area results in a rapid increase in regional blood flow to that area, to supply increased needs for oxygen, glucose and to remove carbon dioxide’[12]

I suggest that the task of following instruction, even unconsciously, has a similar effect and counteracts the reduced blood flow in regions of the brain associated with demntia10.

A key section of each class is the breathing exercises where I encourage the group to abandon polite behavior, dump their lady-like or gentlemanly social graces and release pent up frustration and anger, with abandon.

We do the ‘HA’ BREATH. Good for EXCHANGING THE AIR IN THE LUNGS.

Inhale as the arms raise and exhale with a loud ‘HA’!

bring in the arms down as though you were chopping the head of a sneaky snake. VENT ALL THE FRUSTRATION, anger and ire as fully as possible. I give permission to be as noisy as possible, to see if we can frighten the staff, to use the opportunity vent all that pent up emotion.

… and we do!

We ease heartache with the SANTA CLAUS BREATH.

What does Santa say?

“HO, HO, HO”

And what is the best medicine?

Laughter, of course!

We do three rounds HO x 7, HA x 7, HE x 7 (gently, be aware of slight hyper ventilation – resting between rounds and watch the blood pressure).

Yes of course, we have a good laugh too!

Why something so daft?

Try it yourself!

Have you ever wondered what causes the HEAVY HEARTACHE FEELING when you are upset? I have a theory that being upset makes the diaphragm rigid, the breath becomes shallow, the heart misses its diaphragmatic massage, it has to work a little harder, and aches. Being seated a lot with no reason to exert oneself has the same result.

I have done this breath with a respite care client, her husband had died very recently; in a few minutes the Santa Claus breath eased some of the pain and shock. She said she felt so much better and left the class looking much lighter and brighter.

It does not change the, sometimes terrible, situations that people find themselves in but the Santa Claus breath can ease the heartache, free one up to breathe more easily, and so… cope. I have felt it myself, and seen it so many times.

The face is taken into extremes of expression – clients describe how this releases jaws that are clenched by pain, anger and frustration. One client told me that his speech therapist approved and encouraged him to do it.

Then we take the possibility for release further.

We do a seated LION BREATH (Simhasana). Here think, like a lion, sitting on a rock, overlooking the Savannah – we unsheathe our claws, sink them into the object of our frustration as we roar like a lion and stick out the tongue as far as possible and bring the eyes to look up at the ceiling – to look as terrifying as possible. Again, easing jaw-clenching pain, releasing emotion… and giggle without inhibition!

Laughter, the best medicine!

So often with mental/emotional pain it is not what is actually happening that matters, so much as the perception of what has occurred. If the client feels as though an issue has been addressed though Brain Gym, to a greater extent then we can dare to imagine, it has.

There are very basic Range of Movement exercises that we do, again bringing in memories where possible.

· Stirring the Christmas pudding

· Rowing a boat (what lake / river / sea?) easier in one direction – much stronger in the other

· Boxing – now there is a good one for venting, and bring in the sound effect too – Biff, Bang, Wham – Denis the Menace and Beril the Peril.

· Ankle rotations – one client who suffered from cramps in her calf ever since she had had a hip replaced found that simple ankle rotations eased the pain, she got back the ability to sleep.

Few of us have got through life without sitting down hard at one time or another. I hope children don’t still pull the chair out from under someone sitting down – it is an awful insult to the tailbone. One lady with Parkinson’s has almost that experience everyday, as she is unable to control her movements. She found that the deep pain in her tailbone is eased by the deep and gentle exercises that she does lying down in my own yoga studio – her quality of life has so much improved.

In the Royal Hospital Day Care we are looking at the possibility of doing some classes lying down.

A gentle hip rotation that eases out lower back pain can be done seated, first in one direction and then, guess what, in the other.

Old injuries can often lead to favouring that we don’t notice. Another of my personal stories is about my left hip. For years it had been painful occasionally and seemed to have a ‘sticky ligament’, it clicked. I did not know what to do about it – it did not seem serious enough to get an opinion. During my Teacher Training it deteriorated to waking me up at night. How bad does a pain have to become before we do something about it? The yoga I was doing was not sorting it out. However I was so impressed by the assistance I got with my hand after the wrist break business that I looked for advice about my hip. Straight off the Physiotherapist spotted that I must have damaged the cruciate ligaments in my left knee at some stage. Bang on! About 30 years earlier in fact, I was flabbergasted. She gave me some exercises that did indeed sort out the problem. She showed me how to rebuild the one muscle that had been favoured and under active for all those years. My gait changed, my yoga changed and I have no pain, and no sticky ligament. The body and mind are so malleable. Three decades of abuse corrected in a few months.

Of course Physio exercises are notoriously hard to do and can often be quite painful. They are working precisely on the problem area. I could do all sorts of things with my body but not these exercises that she gave me. It took a lot of perseverance, but the payoff was worth it.

Where clients are less motivated the exercise has to be more do-able.

Increasingly we are becoming a Pain Averse Culture. In a society where we expect to be pain free 100% of the time, and to have all pain alleviated it becomes necessary to educate that there are TWO TYPES OF PAIN, and to be able to develop sensitivity to make the distinction. Pain that is a clear ‘don’t go there’ is different from what I call a USEFUL, HEALING PAIN that can be worked with and through. Say there is the pain of a graze, then there is the itch as it is nearly healed and one can endure that until the scab comes off. There is the pain of a trigger point, and the experience of having knowing fingers massage it out. There is the pain of a stiff joint and the sense of usefulness of gently manipulating it until movement is more released and easier.

Like a creaky gate some joints squeak when they are taken beyond their accustomed range of movement. Encouraging clients to go beyond the usual range and work their way through the sound effects and useful pain stimulates secretion of synovial fluid from the synovial membranes generating the possibility for easier, smoother future movement. If I see a pain response in body language, I often ask if the pain could be a useful one, if the movement was repeated in a gentler, more mindful way.

If the clients find nothing much of benefit as the movement is being done – great! it is do-able; pay attention to the outcome of the action – the consequences – relief, easing? Great! We have found something that is safe and easy to do that gives benefit.

“It is generally believes but not rigorously tested that exercise, even when it cause pain, shortens periods of pain.”[13]

Conclusion

In conclusion, from my limited experience in working with older people I have encouraged them to do the best that they are able and to imagine the rest. I have seen faces relax and smile again as pain is eased. I have seen limbs move that have not moved in years, even small movements serve to ease out large muscle groups. At the very least one-to-one attention, touch and the bit of banter lights up the day.

When I came in to work the other week one very old blind man was sitting weeping. At first he felt he would not join the class, but then he said that he would “I’ll feel the better for the movement – I can hardly feel worse!” He did feel better and now he is my #1 fan!

Gradually over the months postural muscle groups become stronger, limbs can even begin to twitch back into real, not imagined, participation.

Above all quality of life improves.

I find the clients inspiring.

Of course, occasionally, members of the group have passed away. Out of my great respect for them, I attend their funerals. I introduce myself to family members that I may never have had the opportunity to meet before. One man’s son filled up with tears; “To think that my Da took up Yoga at 93! And he always said it did him so much good.”

Acknowledgements;-

I am very grateful for the assistance of the staff and clients of Bell Villa Community Unit, SCR and the Royal Day Hospital, Donnybrook, and at my own Yoga studio, SERAPH. I have learned so much from each one and find them utterly inspiring, facing each day with courage and spirit. I am grateful to my parents, Ivy and Ken Crowe, whose Diamond (60^th) Wedding Wnniversary graces these pages, for their support and encouragement throughout my life… and for their excellent genes! My partner, John Earle whose technical assistance, patience and enthusiastic companionship has brought me to the place I am today. Then there are my poodles… their insistence on ‘walkies’ over the years has kept me exercising and sane, no matter what

References; -

(MS) Mind Sculpture Ian Robertson ISBN 0 593 04386 3

(APMB) Asana, Pranayama, Mudra, Banda Sw Satyananda Saraswati ISBN 8186336141

(AB) The Ageing Brain Lawrence Whalley ISBN 0 297 64587 0

(PR) The Placebo Response Howard Brody M.D.,Ph.D. ISBN 0 06 019493 6

(ND) The Noonday Demon; an anatomy of depression Andrew Solomon ISBN 0 701 16819 6

(RR) The Relaxation Response Herbert Beson M.D. ISBN0 688 02955 8

(PCB) The Physiology Coloring Book Kapit / Macey / Meisami ISBN 0 321 03663 8

(P) Pain the Science of Suffering Patrick Wall ISBN 0 75380 997 4

Other books / audio of interest; -

The Gift of Pain Dr. Paul Brand ISBN 0310 221 447

The Science of Medical Intuition Caroline Myss (12 CD’s) ISBN 1 59179 006 9

How the Mind Forgets and Remembers Daniel Schacter ISBN 0 285 63683 9

[6] ‘Inner pharmacy’ those endogenous substances that maintain, repair and restore

[10] PR p 92 Mc Clelland and Kirshnit research 19871987 into immunoglobin A in the saliva, this is an aspect of the immune system; study showed the sensitivity of the immune response to mental tasks and mood.