In torticollis, the muscles on one side of the neck contract and cause the head to be pulled over to one side. The condition is typically accompanied by pain and stiffness in the neck.

Torticollis may develop in babies after a difficult birth involving neck muscle damage. In children, the disorder may be a result of swollen glands in the neck caused by an infection. Torticollis in adults is often caused by physical injury to muscles or by sleeping in an awkward position. The disorder can also be a side effect of certain drugs, such as some tranquilizers. An uncommon cause of the condition is cervical spondylosis, a form of arthritis that affects the bones of the neck.

Your doctor may make the diagnosis from a physical examination. Torticollis in babies will gradually get better with physiotherapy. In adults and older children, painkillers, local heat, massage, and use of a neck collar may help to relieve the muscle spasm. Recovery usually takes only a few days but if torticollis persists, a local injection of botulinum toxin may be given. If the disorder is caused by a particular drug, it will improve once the drug is stopped.

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Muscle cramps affect almost everyone from time to time. Painful spasms, often lasting only a few minutes, make the affected muscle become hard and tender. Muscle cramps may occur in any muscle in the body but they are most common in leg muscles. When abdominal muscles are affected, the condition is also known as a “stitch”.

Muscle cramps often develop during physical exercise, possibly as a result of reduction in the oxygen supply to the muscles or build-up of chemical waste produced by muscles during exercise. Another possible cause is the loss of salt and water that occurs due to heavy sweating during hot weather or strenuous exercise. Muscle cramps may also develop if you have been sitting or lying in an awkward position for a long time. Sometimes, there is no obvious cause.

Cramps are not the only cause of attacks of muscle pain. If you develop recurrent muscle pain in your calves when walking, you should consult your doctor; the cause may be lower limb ischaemia, a disorder in which the arteries that supply blood to the leg muscles become narrowed.

The immediate self-help treatment for muscle cramps is to stretch and rub the affected area and to apply a heat pad. You should drink plenty of fluids and eat something salty. If you regularly have cramps at night, your doctor may prescribe a low dose of quinine, an antimalarial drug that effectively relieves the symptoms.

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There are two types of amenorrhoea: primary and secondary. If a girl has not started to menstruate by the age of 16, she is said to have primary amenorrhoea. Once menstruation has become established during puberty, it is normal for periods to stop during pregnancy, for a few months following childbirth, while breast-feeding, temporarily after ceasing to take oral contraceptive pills, and permanently at the menopause. If menstruation stops at any other time for at least 3 months, the condition is known as secondary amenorrhoea.

What are the causes?

Amenorrhoea is often caused by a disturbance in the female sex hormones, which may be brought on by factors such as stress or depression. Excessive exercise and extreme or sudden weight loss may also lead to such hormonal disturbances and are common causes of amenorrhoea in athletes, gymnasts, and ballet dancers. Hormonal changes may lead to primary or secondary amenorrhoea, depending on when they occur.

Primary amenorrhoea is a characteristic feature of delayed puberty and may be caused by a chromosomal abnormality. The failure of menstruation to start at puberty may also be due to a condition in which the hymen (the thin membrane over the vagina) has no opening and menstrual blood cannot leave the body. In rare cases, the uterus is absent from birth, and therefore no menstruation can occur.

Secondary amenorrhoea may be due to a pituitary gland disorder, such as a pituitary tumour. Some women have a premature menopause, in which periods cease before the age of 33. Other possible causes include disorders of the ovaries, such as polycystic ovary syndrome, and treatments such as radiotherapy and chemotherapy, which can result in damage to the ovaries.

What might be done?

Treatment is not needed if amenorrhoea lasts for only a few months after stopping oral contraceptive pills or occurs during pregnancy or breast-feeding. Menstruation normally resumes within a few months of giving birth if you are not breast-feeding or within a month of stopping breast-feeding. After the menopause, amenorrhoea will be permanent.

Amenorrhoea that occurs at any other time should be investigated. Your doctor will examine you and may perform a pregnancy test. You may also need to have blood tests to measure hormone levels, ultrasound scanning of the ovaries and uterus, and CT scanning of the pituitary gland.

Treatment of the underlying disorder induces menstruation in most cases. If the cause cannot be treated, hormonal treatment may be used to start menstruation. If periods are absent due to stress, weight loss, or excessive exercise, they should occur if the problem is overcome.

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Periods start at puberty and continue until the menopause. The average menstrual cycle lasts 28 days, but periods may occur as often as every 24 days or as infrequently as every 35 days. After puberty, most women develop a regular menstrual cycle with a relatively consistent length of time between periods. In some women, however, periods remain irregular. Menstrual bleeding normally lasts between 2 and 7 days, with the average length of bleeding being 5 days.

What are the causes?

Variations in the length of the menstrual cycle are usually the result of a temporary hormonal imbalance. Fluctuations in hormone levels during puberty mean that periods are often irregular when they first start, and wide variations in a woman’s normal pattern of bleeding are common in the first few months following childbirth and with the approach of the menopause.

Hormonal imbalances at other times may be caused by factors such as stress, depression, and severe or long-term illness. Excessive exercise and extreme loss of weight are also common causes of hormonal disturbance that can cause menstruation to become irregular.

Occasionally, irregular menstruation may be a symptom of a disorder of the ovaries or of the uterus. For example, polycystic ovary syndrome, in which there is an imbalance of the sex hormones, or endometriosis, in which fragments of the tissue that normally lines the uterus are displaced and become attached to other organs in the pelvis, may disrupt periods.

In some cases, an unsuspected pregnancy produces irregular bleeding that could easily be mistaken for a period. A single, late, heavy period may be due to a miscarriage. If you have a late period that is accompanied by severe abdominal pain, you should seek medical attention urgently because it may be due to an ectopic pregnancy. In some cases, the cause of irregular menstruation is unknown.

What might be done?

Irregular periods due to the normal hormonal changes that follow puberty or childbirth usually become more regular with time. In women who are approaching the menopause, irregular periods will eventually cease altogether. In all these cases, treatment is not usually necessary. However, if the problem persists and interferes with a woman’s lifestyle, drugs may be given to regulate menstruation. These drugs include oral contraceptives for younger women and hormone replacement therapy for women near menopause. Irregular menstruation that is due to extreme weight loss, excessive exercise, stress, or depression should become more regular once these problems have been overcome.

If there is no obvious cause for your irregular periods and no apparent pattern to menstrual bleeding, your doctor may arrange for you to have tests to look for underlying disorder. These may include a pregnancy test, blood tests to measure hormone levels, and ultrasound scanning of the pelvic region to look at the ovaries and uterus. If an underlying disorder is discovered, treatment of that disorder should regulate periods in most cases.

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Epididymal cysts, or spermatoceles, are harmless fluidfilled sacs that form in the epididymis, which stores and transports sperm away from the testis. Small epididymal cysts are common, particularly in men over the age of 40. The cysts develop slowly and are usually painless.

In many cases, there are multiple cysts, which can be felt as distinct, painless swellings like a tiny bunch of grapes on top of and behind the testis. The epididymal tubes in both testes may be affected by cysts at the same time.

If you detect a swelling on one or both sides of your scrotum, you should consult your doctor to rule out a serious condition, such as cancer of the testis. He or she will probably be able to make a diagnosis from a physical examination, but further tests such as ultrasound scanning may be necessary.

Epididymal cysts normally remain small and do not need treatment. Rarely, they become large and cause discomfort, in which case they can be removed.

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Men reach their sexual peak between the ages of 16 and 18, shortly after puberty. Since they are able to produce sperm continuously from puberty onwards, men remain fertile for a longer period than women; some man can become fathers at the age of 70 or older. Sperm are produced in the testes, and during sexual intercourse, the penis delivers them into the female reproductive system. The male reproductive system also manufactures sex hormones that are essential for sperm production and for sexual development during puberty.

The male reproductive system begins to develop before a male baby is even born. The only visible parts of the male reproductive system are the penis and the scrotum, but inside the body there is a complicated network of ducts, glands, and other tissues that work together to make the production and transport of sperm possible.

Sperm production

Once puberty is reached, sperm are manufactured continuously in the two testes at a rate of about 125 million each day. Since sperm production is not efficient at body temperature, the testes are kept cool by being suspended outside the body in a sac of skin called scrotum. Mature sperm leave each testis through an epididymis, a long coiled tube that lies above and behind each testis. The sperm are stored in the epididymis and mature there before going to the vas deferens, the tube that connects an epididymis to an ejaculatory duct. During sexual activity, each vas deferens contracts and pushes sperm towards the urethra (the tube that connects the bladder to the outside of the body). The sperm are ejaculated during sexual activity or are reabsorbed into the body. Some dribble through the upper end of the vas deferens into the urethra and are later washed away in the urine.

The sperm are carried in a fluid consisting of secretions from various glands. Most of these secretions are produced by glands called seminal vesicles as the sperm leave the vas deferens. Fluid is also added by the prostate gland. In addition to acting as a vehicle for the sperm to help them to swim, the fluid provides nutrients that keep the sperm healthy. Together, these secretions and sperm form semen, containing about 50 million sperm per millilitre.

In order for reproduction to take place, sperm must enter the female reproductive system. During arousal, the penis becomes enlarged and firm. Muscular contractions at the base of the penis then force sperm through the male urethra and into the vagina during male orgasm.

Male hormones

The principal male sex hormone, testosterone, is produced throughout life. Testosterone plays an important part in the development of the genitals and other male sexual characteristics. During puberty, there is a dramatic increase in the level of testosterone. This increase triggers the growth of the genitals and the development of secondary male sexual characteristics, such as body and facial hair, deepening of the voice, and muscle development.

Puberty

Puberty is the process of sexual development. In boys, puberty usually occurs between the ages of 12 and 15 and lasts 3-4 years. Hormones secreted by the pituitary gland cause levels of the male sex hormone testosterone to rise, stimulating changes such as genital growth and the development of secondary sexual characteristics.
Physical development: during puberty, the penis, scrotum and testes enlarge, and pubic hair grows. Hair also appears on the face and other parts of the body. Rapid growth occurs, the muscles develop, and the voice deepens.

Male reproductive system

The male genitals consist of the penis, scrotum, and the two testes, which are suspended in the scrotum. Above and behind each testis is an epididymis, a coiled tube that leads to another tube called the vas deferens. The upper end of each vas deferens is joined by a duct draining from a gland called the seminal vesicle. This duct and a vas deferens together form an ejaculatory duct. The two ejaculatory ducts then join the urethra where it is surrounded by the prostate gland, and the urethra passes through the penis to the outside.

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Abstract

Vipassana meditation is a scientific technique of self-exploration: a system of self-transformation by self-observation, a healing by observation of and participation in the universal laws of nature. Its theoretical basis, health potential and practical applications are discussed and reviewed in this paper.
Key Words: Vipassana Meditation, Positive Mental Health, Self-Actualization, Transpersonal Consciousness.

Introduction

Health, as defined by the World Health Organization, is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity. This is considered to be an idealistic goal, setting out the standard of positive health, with due emphasis on the promotion and protection of health. "Health for All by 2000 A.D." is the main social target set the by the 30th World Health Assembly [14]. Health, therefore, is a dynamic concept and can be described as a multidimensional process involving the well being of an individual in the context of his or her environment.

This presentation shall deal primarily with the mental dimension of health since it is the "mind" which is the central directing force of one's entire life and activity, and also because every health disorder is affected directly or indirectly by psychological factors. It is truly said that mind matters most.

In Indian parlance, health is a positive concept: "swasthya" means being oneself. Indian introspectionists over millennia have produced a rich harvest of profound psychological insights, which needs to be reinterpreted in the contemporary context and the currently familiar idiom; for example, nibbaana or "nirvana" by Gotama Buddha as the burning out of passions or mental impurities; "moksha" by Lord Krishna as freedom from conditioning and constraints of all kinds; "sahaja" by Guru Nanak as one's nature: literally born along with oneself [7]. Various austerity and self-control measures and meditative approaches have been detailed in their treatises, to enable one to attain the desired goal of self-realization or self-liberation, called in modern parlance a higher psychic state or transpersonal consciousness.

Abraham Maslow [6], generally regarded as the modern founder of transpersonal psychology, postulated the concept of "self-actualization", which emphasizes the importance of maximal growth and development of human potential. It has also been equated with such terms as self-realization, optimal functioning, psychological health and individual autonomy. All these imply the highest stage of personality development or the optimal personality functioning and positive mental health. Shostrom [8] describes self-actualization as an ongoing process of growth towards experiencing one's potential in terms of creative expression, interpersonal effectiveness and fulfilment in living. Vipassana is a way and means to such self-actualization or self-realization.

Vipassana Meditation [11]

Also known as Insight Awareness or Mindfulness Meditation, Vipassana is a very ancient meditation technique of India, laudatory references to which are found even in the Rigveda. Long lost to humanity, it was rediscovered twenty-five centuries ago by Gotama Buddha. Although Vipassana contains the core of what was later called Buddhism, it is not an organized religion, requires no conversion and is open to students of any faith, nationality, colour or background.

To learn Vipassana, one is required to take a ten-day residential course under a qualified authorized teacher. Meditation teacher Shri S.N. Goenka and about two hundred assistant teachers trained by him ' hailing from various parts of the world and practically all walks of life, are discharging this onerous responsibility voluntarily and selflessly.

There are in all thirty-one permanent Vipassana Centres across the globe in countries like India (14), Nepal (2), Sri Lanka (1), Myanmar (1), Thailand (1), Japan (1), the United States (4),Australia (4), New Zealand (1), France (1) and the United Kingdom (1). The main Centre is the Vipassana International Academy, located at Dhamma Giri, on the outskirts of the town of lgatpuri in the Nasik district, about 135 kilometres from Bombay.

Vipassana is a Pali term and it means insight, to see things as they really are. It is a scientific technique to explore the laws of nature (called Dhamma), within the framework of one's own mind and body. During the training period of ten days, the participants follow a basic code of morality, which includes celibacy and abstention from all intoxicants. For the first three and a half days, one is trained to focus one's attention on breathing (Anapana) and thereafter, one learns to examine the reality pertaining to oneself, systematically and dispassionately. One realizes, by direct experience, the scientific laws that operate on one's thoughts, feelings, judgements and sensations. One also learns to live in conformity with these laws, a life full of peace and harmony, a really healthy and happy life.

Mechanism and Psychological Effects

The teachings of the Buddha embody "Abhidhamma", a very systematic and intricately laid out psychology, which presents a set of concepts for understanding mental activity and methods for healing mental disorder. It differs markedly from the contemporary psychotherapeutic outlook. In this model of mental activity, every mental state is composed of a set of properties of mental factors, which gives it its distinctive characteristics. There are 52 basic perceptual, cognitive and affective categories of these properties. The basic dichotomy in this analysis of mental factors is between pure, wholesome or healthy and impure, unwholesome or unhealthy mental properties; healthy mental states are antagonistic to unhealthy ones, inhibiting them. Vipassana meditation aims to eradicate these unhealthy properties from the mind; the operational definition of mental health is their complete absence, as in the case of an arahanta (saint) [4].

"Everything that arises in the mind is accompanied by a concomitant physical sensation", said the Buddha. This interrelationship is the key to the practice of Vipassana meditation. Vipassana trains the concentrated attention to follow the mechanics of mental processing with the base of physical sensations, in a detached fashion. This perspective of an observer allows the controlled release of mental contents such as craving and aversion, past and future, in a seemingly endless stream of memories, wishes, thoughts, conversations, scenes, desires, dreads and lusts. Thousands and thousands of emotionally-driven pictures of every kind rise to the surface of the mind and pass away without provoking a reaction, while simultaneously anchoring one in concrete, contemporary reality.[1]

The mind is deconditioned with meditation altering the process of conditioning per se, so that it is no longer a prime determinant of future acts [4]. A refinement of awareness occurs and one responds consciously to life situations thereby becoming free from limitations, which were forged by mere reactions to them. One's life becomes characterized by increased awareness, reality-orientation, nondelusion; self-control and peace.[1] Such a person is able to make quick decisions, correct and sound judgement and concerted effort-mental capabilities which definitely contribute to success in contemporary life.[10]
Vipassana is not merely an exercise to be performed in the special environment of a meditation retreat. When a ten-day course is over, meditators take the tool home with them. The path of Vipassana is a continuous, disciplined pursuit of this experiential gnosis throughout life; it is a human capacity and a personal choice. Through Vipassana, one can transcend body-mind or even East-West dualism and shake hands with ethical rootedness, cultivated mindfulness and wisdom in all its enduring forms.[2]

Vipassana, Health and Healers: A Review

Considerable data is available, documenting the various biopsychosocial benefits that accrue from the practice of Vipassana meditation. It indicates the vast th rapeutic potential that Vipassana has. For instance, many case report studies have been recorded on the positive effects of Vipassana in different psychosomatic disorders such as chronic pain, headaches, bronchial asthma, hypertension, peptic ulcer, psoriasis, etc., and so also in different disorders including alcoholism and drug addiction. Beneficial aspects of Vipassana have also been studied in special population groups such as students, prisoners and police personnel, besides individuals suffering from chronic pain and various mental disorders.[11,12,13].

However healing-not disease cure, but the essential healing of human suffering-is the purpose of Vipassana. Suffering springs from ignorance of one's true nature. Insight, truth experiential truth-alone frees one.[2] "Know thyself" all wise persons have advised. Vipassana is a practical way to examine the reality of one's own mind and body to uncover and solve whatever problems lie hidden there, to develop unused potential and to channel it for one's own good and the good of others.[5]

All people need healing, most particularly healers. "Physician heal thyself" is a well-known phrase. Freud and Jung insisted that analysts be analysed. The very vulnerability and compassion that sets the healer on a lifelong journey to heal, coupled to the constant exposure to human suffering, requires a treatment of its own. Vipassana is acceptable and relevant to healers of diverse disciplines because it is free of dogma, experientially based and focussed on human suffering and relief. With its practice, healers are able to deepen their autonomy and self-knowledge, at the same time augmenting their ability to be a professional anchor to others in the tumult of their lives. Vipassana is verily the path of all-healing, including self-healing and other-healing.[2]

A Model for Clinical Application

The clinical utility of Vipassana is more likely to be in terms of providing a general psychological pattern of positive mental states rather than a response to any particular problem. Generally, the conventional psychotherapies are generated as treatments for the latter. Many therapists [11,12,13], who are themselves meditators, teach "Anapana"-a preparatory step in the training of Vipassana, to their clients. The clients may be suffering from various neurotic, psychosomatic and personality disorders including addictions, and Anapana is taught as a supplementary form of treatment, with a good clinical response.

Before commencing the formal training in Anapana, the therapist explains to the patient its potential benefits, particularly relaxation. This helps reduce the patient's apprehension and enables him or her to cooperate and participate actively in the treatment. In addition, it is necessary to ensure that the physical environment is one that will facilitate relaxation; the room should be quiet and free from interruptions and the patient's couch should be reasonably comfortable.

The patient is asked to lie comfortably on the couch, close his eyes and observe, that is, cultivate awareness, of his respiration at the entrance of his nostrils-whether in-breath or out-breath, deep or shallow, fast or slow; natural breath, bare breath and only breath. When his mind wanders, the patient is asked to passively disregard the intrusion and repeatedly focus his attention on his breath, without getting upset or disturbed about the drift of his mind.

Two things happen. One-his mind gets concentrated on the flow of respiration. Two-he becomes aware of the relationship between his mental states and the flow of the respiration; that whenever there is agitation in the mind-anger, hatred, fear, passion, etc.-the natural flow of respiration gets affected and disturbed. He thus learns to simply observe and remain alert, vigilant and equanimous.

The patient is advised to continue practising the technique on his own, twice daily-in the morning and in the evening, each session lasting f6r about thirty minutes. The therapist reviews the progress of his patient from time to time, simultaneously counselling and motivating him to undertake a regular ten-day Vipassana meditation course. The patient is thus encouraged to continue to strive for his personal autonomy9, that is, to take personal responsibility of his own health and well-being.

Conclusion

Vipassana's ability to tranquillize the human mind, changing its turbulence to calmness with increased vitality, makes it a positive mental health measure and an excellent human potential development method. The meditator becomes free to live for higher values, richer goals: loving-kindness, compassion, sympathetic joy and peacefulness. Vipassana thus leads people from narcissism to mature, social love, to a life of altruiSM3 and this personal transformation becomes the catalyst for social change and development.

More scientific research needs to be pursued on the role of Vipassana, both as a self-regulation strategy for specific psychotherapeutic and psycho-physiological aims and as a discipline and way of life for deep self-exploration and transformation. The various psycho-physiological changes with Vipassana ought to be studied with the aid of modern sophisticated instruments. Also, long term prospective studies on meditators, besides multicentred controlled clinical trials of this technique, need to be conducted to clarify which individual types and health disorders respond to and benefit from the practice of Vipassana. Such endeavours will make "Health for AW' a more realistic proposition.


References

[1]. Fleischman P.R., "The Therapeutic Action of Vipassand' and "Why I Sit," Buddhist Publication Society, Kandy, Sri Lanka, 1986.
[2]. Fleischman P.R., "Vipassana Meditation: Healing the Healee' and "The Experience of Impermanence," Vipassana Research Institute, lgatpuri, India, 1991, 3-15.
[3]. Goenka, S.N., "Altruism: Quintessence of Religion," in Issues of Biomedical Ethics - Proceedings of the Festival of Life International Congress, December 1988, Bombay; Editors: Vas C1 & de Souza E1, McMillan India Ltd., Delhi, 1990, 95-102.
[4]. Goleman D., "Meditation and Consciousness: An Asian Approach to Mental Health," American Journal of Psychotherapy, 1977, 30: 41-54.
[5]. Hart W., "The Art of Living"in Vipassana Meditation as taught by S.N. Goenka, Harper and Row, New York, 1987.
[6]. Maslow A.H., Motivation and Personality, Harper and Row, New York, 1954
[7]. Neki J.S., "Psychotherapy in India," Indian Journal Psychiatry, 1977, 19(2): 1-10.
[8]. Shostrom E.L., "Comments on Test Review: The Personal Orientation Inventory," Journal of Counselling Psychology, 1973, 20: 479-491
[9]. Surya N.C., "Personal Autonomy and Instrumental Accuracy," in: Psychotherapeutic Processes, Editors: Kapur M., Murthy VX, Sathyavathi K., & Kapur R.L., N.I.M.H.A.N.S., Bangalore, India, 1979, 1-19.
[10]. Thray Sithu Sayagyi U Ba Khin, The Real Values of True Buddhist Meditation, Buddha Sasana Council Press, Yegu, Rangoon, Bunna, 1962.
[11]. "Vipassana Research Institute: A Reader International Seminar on Vipassana Meditation,"December 1986, Igatpuri, India, 1986.
[12]. "Vipassana Research Institute: A Reader: Seminar on Vipassana Meditation, Relief from Addictions, Better Health," November 1989, Igatpuri, India, 1990.
[13]. "Vipassana Research Institute: A Reader: International Seminar on Vipassana Meditation and Health," November 1990, Igatpuri, India, 1990.
[14]. World Health Organization, "Health for All," Sr. No. 1, Geneva, 1978.

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