Optimal Healing Environment (OHE) is a post modern concept that aims to promote healing through positively influencing and supporting the four domains of OHE, viz, Personal, Interpersonal, Behavioral and External domains. Sense of coherence approach to wellbeing (Salutogenesis) fits in well with interpersonal and behavioral domains of OHE. Yoga therapy uses holistic approach to mind-body healing and can focus on promoting optimal healing as a complementary healthcare service to Evidence-based modern medicine in an integrative practice of holistic care.

1. Dr K R Sethuraman. MD
Creating an Optimal Healing Environment through Salutogenesis
for Yoga therapy – Yoga Week Oration
16/6/2021 SBV_CYTER Yoginar-2021

2. Two Quotes to set the Tone
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Opening Stanza of ‘Choruses from the Rock’ Maintain the balance between
exploring new ideas with an
open mind and a healthy
skepticism

3. Issues/Concepts Covered in My Talk
• Curing versus Healing
– How piece-meal healthcare creates “cured but not healed” people
• Four factors of Healing (Wickenburg-1988 consensus report)
– How Yoga Therapy uses all elements of the healing process
• Optimal Healing Environment – a post-modern Global initiative
– How Yoga therapy could adopt OHE concepts in practice
• Sense of Coherence approach promotes Wellness (Salutogenesis)
– How Yoga therapist adopts Salutogenic mentorship approach
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4. My Epiphany Moment-1: Cure and Healing
“Healing goes beyond Cure, Doctor.
Let us say, as we are chatting, your car is being
stolen now. You find it out during lunch hour and
report to the Police. Let us say, using GPS, they
locate it and get it back in a day or two. The police
will close the case as they have solved (cured) your
problem.
But, are you back to the Normal self after that?
No, while you are at work here, you are worried
about the car being stolen again! So, your problem
is ‘cured’ but you are not ‘healed’ yet...”
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KRS

5. A teaching case: a School Principal with Asthma
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What is the point in living
like this Doctor? (sigh...)
I am the Head of a large
School but I can’t even
breathe with ease like all
the others. You claim that
my lung function is OK on
medicines. I don’t feel so!
KRS
Lung Function normalcy is not the same as Healing

6. My Epiphany Moment-2a (WHO Workshop “Medicine & Society, 1990):
“Effective Therapies include Information & Faith”
- L Sachs, G Tomson (Medical/Anthropological Study, Karolinska Institute)
Therapy = intervention + information + faith
My surmise: Yoga Therapy combines the art and science of
Mind-Body Medicine to offer effective therapy

7. My Epiphany Moment-2b (WHO Workshop “Medicine & Society, 1990):
Healing Factors (Wickenburg Consensus,1988)
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Rational Rx
‘Scientific’
Spiritual Factor
‘Faith in Self or in
Supernatural’
Hawthorne Effect
‘Faith in the System’ Placebo Effect
‘Faith in Rx’
* https://www.researchgate.net/publication/329962082_The_Wickenburg_consensus_of_1988_and_the_new_MBBS_curriculum_of_today

8. I. Placebo & Nocebo Effects*
• Placebo:
“I shall please” in Latin.
• Nocebo:
“I shall harm” in Latin.
*Any effect attributable to a medication or a procedure,
not based on its pharmacologic or specific properties

9. Placebo Quantified…
• Placebo response rate:
• 15% to 58% ; mean = 35%
– Prof Beecher of Harvard in 1955
• “in randomized clinical trials on duodenal
ulcer, the placebo benefit was up to 70%
and a mean of 50%”
– Professor H.M. Spiro of Yale in 1986
The Power of Nothing (Placebo) in New Yorker 2011
https://www.newyorker.com/magazine/2011/12/12/the-power-of-nothing

10. PET Scan Proof of Placebo effect
• Normal PET scan of basal
ganglia for comparison
• Pre and Post are before and
after administering a placebo
in Parkinson's disease
• Placebo effect is mediated by
dopamine release in the basal
ganglia
de la Fuente-Fernández, R. et al., Expectation and dopamine release: mechanism
of the placebo effect in Parkinson’s disease. Science, 2001; 293: 1164–6.

11. Dr Ted Kaptchuk, A Harvard Professor says…
“It is time that the powerful
placebo be examined in all
its myriad facets; otherwise
medicine will always have a
limited perception of
healing.” -- Kaptchuk T, 1998
Watch TED Talk at this link:
https://www.tedmed.com/talks/show?id=299407

12. Post Modern Voices…
• “Patients could benefit from
clinicians maximising the
potential of placebo effects
associated with effective
therapies.”
– Ernst, 2007
• “A successful doctor–
patient relationship can
foster a strong placebo
response while mitigating
any nocebo response.”
– Olshansky, 2007
“In Clinical Practice, Placebo is not an unwanted interference;
Nocebo is” – Prof KR Sethuraman (1993 – 2020-’21)

13. II. Hawthorne effect
– caring as a beneficial force
• When employees perceived
that the employer “cared”,
productivity always
improved.
– Classic Harvard study in
Western Electric Co’s
Hawthorne plant during
1927 – 37
• Hawthorne effect is relevant
to all “caring” enterprises
including health care.
• Patients “feel better” after
deciding to put themselves
under the care of a
physician, a nurse, or a
hospital.
Google search ‘Hawthorne effect’ to get interesting stories on this “Force”

14. Hawthorne Effect Matters
• The attitudes of the
management and
supervisors influenced the
length of hospital stay:
• Evidence shows that “the
more supportive the admin
staff of healthcare, the
shorter the hospital stay.”
• “Unfortunately, the
healthcare providers and
managers have, until
recently, ignored these
seminal ideas”
– Dr Kerr White, 1996.

15. III. Spiritual factor and Health
• The WHO definition of
health was revised in 1984:
• “Health is a dynamic state
of complete physical,
mental, spiritual and social
well-being…”
• Khayat, 1998

16. WHO study: Quality of Life, Spirituality, Religion
& Personal Beliefs (SRPB) N = 5087 in 18 countries
• SRPB factors correlated with all
the Quality of Life domains.
• Women reported greater
feelings of spiritual connection
and faith than men.
• Less educated reported greater
faith.
• We need to assess
our patients’
Spirituality,
Religion &
Personal Beliefs
• they affect the
perceived quality
of life - WHO

17. AAMC Endorses Eclectic Spirituality
• “Spirituality: an individual’s search for the ultimate meaning
through participation in religion and/or belief in God,
family, naturalism, rationalism, humanism, and the arts.”
• these factors influence how patients and health care
professionals perceive health & illness and how they
interact with one another.”
– Association of American Medical Colleges 1999

18. Post Modern Views on Spirituality
• Prayer is not a substitute for rational medical treatment
• It is an important element in the way patients cope with
chronic illness, suffering, and loss
• Physicians need to address and be attentive to all suffering of
their patients – be it physical, emotional, or spiritual
• Doing so is part of the delivery of compassionate care
– Jantos & Kiat, 2007; Puchalski, 2001.

19. Piece-meal Specialty Care vs Holistic Medicine
• “Holistic healing is rarely discussed in
organ-focussed specialty care”
– unlike other disciplines like
– Medical Sociology,
– Medical Anthropology
– C.A.M. Options (AYUSH disciplines )
Dear doctor: a personal letter to a physician
by Charles E. Odegaard

20. Holistic Healing*
• To heal is to achieve or acquire wholeness
as a person.
• The wholeness involves physical,
emotional, intellectual, social, and spiritual
aspects of human experience. Thomas R. Egnew
Family medicine Chief,
Washington School of
Medicine
* The Meaning Of Healing. http://www.annfammed.org/cgi/content/abstract/3/3/255

21. Types of Healing
• Spontaneous natural healing
• Technological healing
– based on active medications or procedures
• Interpersonal healing – Placebo effect etc
-- Miller, et al. (2009)
Miller, F.G., Colloca, L. & Kaptchuk, T.J., 2009. The placebo effect: illness and
interpersonal healing. Perspectives in Biology and Medicine, 52, pp.518–39

22. “If I use non-rational means for healing,
will I be just be another
‘Snake Oil Salesman’?”
Can We Ethically Promote
innate Healing Responses?
Self Doubt on Appropriateness of Modern Physicians
to Holistic-care

23. How to Ethically Promote Innate Healing Response
• i) speak positively about
treatment
• ii) provide encouragement
• iii) develop trust
• iv) provide reassurance
• v) support relationships
• vi) respect individuality
(uniqueness of each case)
• vii) explore values
• viii) create ceremony

24. Part-2 - Optimal Healing Environment
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25. Moving from Curing to Optimal Healing
• Healing & cure are complementary; both are essential.
• Healing processes are
– preventive (retain health and build resilience),
– restorative ( facilitate recovery), and
– palliative (maximize function and wellbeing)
• One can ‘heal’ even when recovery & cure are not possible.
• Adopt Healing-oriented care & approach to create an optimal
healing environment (OHE)
• Post Modern trend: create patient centered OHE

26. 4 domains of Optimal
Healing Environment (OHE)

27. OHE: 1 - Internal Factors
• How Yoga attends to the
internal factors
• A – Meditation &
Mindfulness
• B - Wholeness
A B
1
PERSONAL

28. Meditation: Positive Psychological Attitudes
• serenity under pressure,
• interest and satisfaction in life,
• a sense of purpose & meaning in one's work,
• contentment with self and life,
• low levels of worry and anxiety,
• a sense of self-worth, hope, and
• self-confidence

29. OHE: 2 - Interpersonal Factors
• How Yoga-therapist
attends to the
interpersonal factors
• A - Therapeutic
relationship for wellness
• B - Promote Holistic
healing
2
A B

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Let us now discuss how
Sense of Coherence Approach to Wellness
links with Inter-personal factors of optimal healing
Interpersonal Factors for Healing through
Sense of Coherence

31. Antonovsky’s Sense of Coherence (SoC) & Wellness
• A strong SoC helped that individual to cope better with stressors and feel
well despite the challenges
• He enunciated that SoC had three components:
i) Comprehension, ii) Manageability, & iii) Meaningfulness
• Manageability requires general and specific resistance resources to
oppose the Stressor
• My Surmise: Yoga therapy is a General Resistance resource for all
and provides Specific Resistance resource for Mind-body Medicine.
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SOC & Ikigai Lenses for Holistic view

32. 16/06/2021 32
SOC & Ikigai Lenses for Holistic view
Sense of 1-My world is
understandable”
2-My world is
manageable
3-My world has
meaning
Coping
Sense of Coherence = Understand + Manage + Find-Meaning
Over 70 studies done in 40
nations, support the concept of
sense of coherence approach &
manageability by GRR & SRR as
pathway to wellness...

33. WELLNESS
Manageability based on Resistance Resources *GRR/SRR
*GRR & SRR
Lack of SOC/GRR/SRR
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SOC & Ikigai Lenses for Holistic view
* General / Specific Resistance Resources
Salutogenesis
illness (Pathogenesis)

34. OHE: 3 - Behavioral Factors
• How Yoga-therapist
attends to the
behavioral factors
• A - Promotion of
“Satvik lifestyle”
• B - Integrates well
with “Western
Medicine”
A B
3

35. How Yoga therapy impacts Behaviour
• Yoga therapy involves integrated mental, physical and
spiritual practices that promote Salutogenesis.
• Lifestyle-based wellness choices can maximize positive life
experiences through salutogenic approach:
– joy, vitality, serenity, happiness, self-actualization, and
other qualities that make life worth living
• Wellness & Health go beyond mere absence of pathology
– 40% of illnesses have no pathological basis (MUS)
– Yoga therapy can be quite beneficial in MUS

36. Self Rumination Promote Subjective vitality
• spans both psychological and physical
wellness
• correlates with and contributes to
health and well-being across all age
groups
• Salutogenic Components:
• zest, enthusiasm,
• vigor, having energy and being alive
WELLNESS
SUBJECTIVE
VITALITY
SELF
RUMINATION
Hypothesized Model of Self
Rumination, Vitality & Wellness

37. OHE: 4 - External Factors
• How Yoga-
therapist attends
to the behavioral
factors
• Foster
• A- Sattvik guna
• B- Symbiosis with
Nature
A B

38. Wellness through Transcendence & Mental Mastery
Transcendence includes
• feelings of oneness with surroundings,
• intense happiness, ecstasy, bliss, or unity
with the entire human community.
• mental mastery, resulting in as a low level
of anxiety, sadness, irritability, and
depression

39. • Salutogenesis is a general process of healing in all dimensions of a
person—body, mind, social, and spirit to foster wellness, laughter, Joy
of living and coping with life’s challenges
• Promote Sense of coherence by making the clients understand the
challenges, offer advice on coping strategies that they find meaningful
to follow, which go to make them feel well & joyful
• In addition to evidence based scientific therapy, create an optimal
healing environment, for which Yoga Therapy as a complementary
process will be of great assistance.
Summing
Up:

40. Looking in to the Future
• Advances in neuro-imaging and genomics will provide insight
into the body’s own natural healing capability
• We will unravel the secrets of the placebo effect and other
healing factors (Hawthorne effect & Spiritual factor)
• Then we could offer evidence based healing therapy
incorporating these “endogenous healthcare forces” that
unify the art and science of healing

41. Before I end, 4 photos of a Patient with
Terminal Cancer (ETD – 1 week)
Sad patient, who
is aware of his
impending demise
Therapist finds out
the “best song” he
has enjoyed in his
life.
(from a movie of the
1960’s)
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42. 16/6/2021 SBV_CYTER Yoginar-2021 42
Pt is Alive, Happy and Sings along...

43. He thanks the Therapist and wants it Daily...
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44. Let us all Introspect ...
• The patient heard the song daily for the next few days and
then succumbed to the terminal cancer
• Two Questions to all Doctors to introspect:
1. With all the powerful remedies that we have in our
armamentarium, can we make a terminally ill patient feel
alive and smile?
2. If we cannot do it, why not get therapists, who can do so??
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45. Let all the healing forces work together to
help the suffering humanity.
Let Innovative
Academic Centres
like SBV accelerate
this process of
harmonisation of
Healing forces and
Salutogenic pathway
for Wellness in
Modern Healthcare

46. T H A N K S
Our Goal for the Future: To Produce
Enlightened Medical Professionals,
who can integrate healing arts with
Evidence based Rational Therapies.