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People suffering from stress can tackle it in various ways - from counselling sessions to yoga classes or listening to mindfulness CDs. But it's only recently that sleeping and doing very little - the ways human beings have always rested - have come to be seen as an insufficient response to life's difficulties.
Paul Lehrer lay on a couch looking at the ceiling of a room on the third floor of the Commodore Hotel in New York and tried to relax.
But it wasn't, he recalls, "the most ideally relaxing situation". There was no music playing softly on the stereo, no aromatherapy or tea lights. Instead, because of the heat, the windows were thrown open and the air was filled with the fumes of buses and trucks. Lehrer's ears hummed with the clanging of the construction site across the street, where they were putting up a new skyscraper, and underneath that cacophony he could hear the bustle of Grand Central Station next door.
Worst of all, every few minutes an old man would come into the room and sharply upbraid him for not relaxing the right way. It was 1973 and Lehrer, a psychotherapist, had come to be treated and to train under an 85-year-old doctor called Edmund Jacobson.
Forty-four years earlier, in 1929, Jacobson had published a forbiddingly technical book called Progressive Relaxation, which detailed a procedure for removing muscular tension. But since the exercises in the book were designed to relieve pressure that was as much psychological as physical, Jacobson's work led to a surge in the use of the word "relax", in the sense of "to become less tense, anxious or stressed, to calm down".
Jacobson's book asks patients to tighten their muscles and then release them slowly, paying close attention to the sensations of tiny amounts of residual tension. The idea is that after much practice, they become able to detect any tension and then work on eliminating it.
Image copyrightUniversity of Chicago LibraryImage captionEdmund Jacobson as a young man. He received his MD from the University of Chicago in 1915
The Rest Test will be discussed on Health Check on the BBC World Service at 20:30 GMT on Wednesday 4 November. Afterwards you can listen again online here.
In his body, man was blessed with a "wonderful living instrument", Jacobson wrote. "He needs to learn how to run himself properly, just as he needs to learn to drive a motor car properly."
He demanded that trainees practise for an hour a day. If they said they didn't have time he told them to wake up an hour earlier, as his exercises were more important than sleep.
This idea - that special exercises could be more beneficial than pure rest - was relatively new to the West.
"From the 1920s, 1930s, there were these relaxation practitioners saying, 'That's not enough. The therapeutic effect of say, just 20 minutes of proper bodily relaxation is going to be worth more than several hours of bad sleep," says Ayesha Nathoo from the University of Exeter, who is currently researching the history of relaxation therapies.
The reason for the change was the widely held belief that modern life was placing special pressures on the body.
Image copyrightRex FeaturesImage captionCharlie Chaplin, in his 1936 film Modern Times, captured people's anxieties about new technology and industrial processes
"A much-repeated narrative in the literature is that with the advent of modernity, natural and communal rhythms such as day and night, the seasons, festive holidays, and so on were replaced by unnatural ones that do damage to people's energy economies and also to communal structures," says Anna Schaffner, the author of Exhaustion: A History, to be published next year.
The specifics of these ailments of modernity varied as the 20th Century progressed. The German sociologist Georg Simmel's 1903 essay The Metropolis and Mental Life examined the effect of city life on the intellectual. Later commentators focused on the effect of rapid transport and changing technology - a theme that still recurs today. "Many argue that new technologies have enslaved us such that we are constantly 'switched on', never properly resting," says Schaffner.
Herbert Benson's 1975 blockbuster book The Relaxation Response catalogued a long list of modern ills, ranging from job insecurity to the rapid change in the role of women in society, to the ever-present fear of sudden nuclear annihilation. The result, Benson wrote, was that our innate "fight-or-flight" mechanism was working in overdrive, leading to an "epidemic" of hypertension.
But whether all these anxieties were justified is an open question. "Exhaustion has always been with us from the very beginning of time," says Schaffner, "and what changes is the narratives we tell ourselves about its causes."
Image captionThese two books were essential reading in the 70s for anyone interested in relaxation
Jacobson's progressive relaxation was just one of the therapies that sprang up to deal with the perceived problem. A rival technique was devised by the German psychiatrist Johannes Schultz. Unlike Jacobson's programme, with its emphasis on patients playing close attention to their physical sensations, Schultz's system of "autogenic training" required patients to adopt certain postures, and visualise a calming image twice or three times a day.
Jacobson and Schultz disagreed vehemently about relaxation, and when Schultz visited the US in the 1930s there was no meeting of minds. Schultz was working for the German Medical Society for Psychotherapy, a fascist organisation run by Hermann Goering's cousin, and Jacobson later said Shultz refused to dine with him because he was Jewish.
Jacobson's strict relaxation technique would go on to be modified by other practitioners. Some performed the muscle exercises but instead of getting patients to explore the sensation of minimal tension, they emphasised the sense of relief that followed straining them.
Other therapists removed the need for patients to be aware of feelings of tension by employing devices that measured their muscle activity, sweat levels or heart rate. They found that consciously or unconsciously, patients responded to this information by adjusting their stress levels. The health and fitness apps on watches and phones today are in some ways a development of a machine called an "integrating neurovoltmeter" which Jacobson invented in 1940.
Meanwhile, throughout the 20th Century, the practice of yoga in the West moved from being a niche activity for those interested in Eastern spirituality to a more secularised exercise programme with wide appeal to the mainstream. While pictures of the Maharishi Mahesh Yogi practising yoga with the Beatles were beamed around the world, government-funded evening classes in yoga were starting in London.
Image copyrightGetty ImagesImage captionThe Beatles and their partners in India with the Maharishi Mahesh Yogi, March 1968
People signing up may have thought they were taking part in an ancient Indian ritual, but it was a very modified and modernised form of yoga. BKS Iyengar, the only guru whose yoga was permitted in these classes, had stripped away the references to spirituality, and there were elements that owed more to people like Jacobson than they did to the yogis of India.
"At the end of an Iyengar yoga class, there's this idea that there is a practice of lying in 'shavasana' or 'corpse pose' in which you should be completely relaxed, without any thoughts but conscious," says Suzanne Newcombe, a historian of yoga at Inform, based at the London School of Economics. "There's a lot of different ways to teach that and the progressive relaxation of tighten-and-release is sometimes taught, but that's definitely a Western medical imposition, it's nowhere in the medieval yoga texts. But at the same time it's not inconsistent with the goal of classical yoga in 'stilling the fluctuation of the mind'."
Newcombe says that it was the publication of Benson's wildly popular book The Relaxation Response in 1975 that really made "relaxation" a buzzword in much the same way that "mindfulness" is now. Indeed, the approaches have some common ground. Benson was a cardiologist who had become convinced of the benefits of transcendental meditation techniques on physical health, and he instructed patients to adopt a passive attitude and hold a thought or word in their minds for an extended period.
Image copyrightThinkstockImage captionShavasana, or corpse pose
"Essentially what he did is have people close their eyes and say the word 'one' to themselves and exhale," says Paul Lehrer. "He had people paying attention to their breath and relaxing. We have people now, doing work on mindfulness meditation, asking people to pay attention to how their breath feels, how their clothing feels, how the floor feels. That's what the Zen Buddhists do.
"All these techniques have some similar effects - Benson's technique and meditation methods, and mindfulness and muscle relaxation and breathing techniques - they all have some common effects in relaxation. Although they also have some very specific effects because they work by different pathways."
Edmund Jacobson, however, never stopped believing that all stress - indeed all thought - was manifest in the muscles of the body. But his cherished and influential idea received a blow in 1966 when a young psychiatrist at Harvard named Lee Birk undertook an extraordinary experiment.
Birk allowed himself to be administered a dose of curare, the plant extract that is used by some South American tribes on the tip of poison arrows, and which has the effect of cutting off the brain's ability to control muscles. He was therefore completely paralysed, and in need of artificial ventilation.
In this state, Birk showed two things. Firstly, thanks to a biofeedback device that showed him his heart rate and sweat level, he was able to control these by mental effort alone. Secondly, the very fact that he felt terrified during the experiment showed that muscle tension was not necessary to the experience of anxiety.
Birk's experiment would go on to be cited by psychologists advocating a new approach to the treatment of anxiety, one which would become dominant in the last part of the century. In cognitive behavioural therapy (CBT), patients learn, with help from a therapist, techniques which adjust their patterns of thought to forestall the onset of physical symptoms.
For Lehrer, Birk's experiment is striking but did not strike a definitive blow against the techniques he learned in the Commodore Hotel in 1973, which he still uses alongside other therapies. True, muscles don't always play a role in relaxation, but they do sometimes and for some patients.
"I think unfortunately what it did is it led psychologists to de-emphasise really meticulous muscle learning in the way Jacobson taught it, to the point that very few therapists train people as thoroughly as Jacobson did," says Lehrer, "and that's too bad because Jacobson's method worked."
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For many people, the main concern in a yoga class is whether they are breathing correctly or their legs are aligned. But for others, there are lingering doubts about whether they should be there at all, or whether they are betraying their religion.
For many people, the main concern in a yoga class is whether they are breathing correctly or their legs are aligned. But for others, there are lingering doubts about whether they should be there at all, or whether they are betraying their religion.
Farida Hamza, a Muslim woman living in the US (pictured above), had been doing yoga for two or three years when she decided she wanted to teach it.
"When I told my family and a few friends, they did not react positively," she recalls. "They were very confused as to why I wanted to do it - that it might be going against Islam."
Their suspicions about yoga are shared by many Muslims, Christians and Jews around the world and relate to yoga's history as an ancient spiritual practice with connections to Hinduism and Buddhism.
Last year, a yoga class was banned from a church hall in the UK. "Yoga is a Hindu spiritual exercise,"said the priest, Father John Chandler. "Being a Catholic church we have to promote the gospel, and that's what we use our premises for." Anglican churches in the UK have taken similar decisions at one time or another. In the US, prominent pastorshave called yoga "demonic".
One answer to the question of whether yoga really is a religious activity will soon be given by the Supreme Court in the country of its birth, India.
Last month, a pro-yoga group petitioned the court to make it a compulsory part of the school syllabus on health grounds - but state schools in India are avowedly secular. The court said it was uncomfortable with the idea, and will gather the views of minority groups in the coming weeks.
So is yoga fundamentally a religious activity?
"Yoga is such a broad term - that's what causes a difficulty," says Rebecca Ffrench, the co-founder YogaLondon - a yoga teacher academy - and the philosophy tutor at the school.
There are different forms of yoga, she says, some of which are more overtly religious than others. Hare Krishna monks, for example, are adherents of bhaktiyoga, the yoga of devotion. What most people in the West think of as yoga is properly known as hathayoga - a path towards enlightenment that focuses on building physical and mental strength.
But what "enlightenment" means also depends on tradition. For some Hindus it is liberation from the cycle of reincarnation, but for many yoga practitioners it is a point where you achieve stillness in your mind, or understand the true nature of the world and your place in it.
Whether that is compatible with Christianity, Islam and other religions is debatable.
To those in the know, for example, the yogic asanas, or positions, retain elements of their earlier spiritual meanings - the Surya namaskar is a series of positions designed to greet Surya, the Hindu Sun God.
Image captionThe Surya Namaskar or Sun Salutations
"It's got a trace from history of a religious pathway," says Ffrench. "However, is something religious if you don't have the intention there? If I was to kneel down does that mean I'm praying - or am I just kneeling?"
This was what Farida Hamza anxiously asked herself while she was doing her yoga training, which was held in a Hindu temple.
"I felt very guilty but in the end, I had to trust that Allah understood my intentions," she wrote on her blog. "I let them know I did not want to take part in any rituals and they were so respectful of how I felt."
Yoga classes vary. While some feature the chanting of Hindu sutras, others will make vaguer references to a "life force" or "cosmic energy". A session might end with a greeting of "namaste" and a gesture of prayer. There will probably be a moment for meditation, at which point participants may be encouraged to repeat the sacred word "Om", which Buddhists and Hindus regard as a primordial sound which brought the universe into being.
But other classes may make no overt reference to spirituality at all.
That's the way things are in Iran, where yoga is very popular. It has managed to flourish in a country with Sharia law and an Islamist political system, by divesting itself of anything that could be construed as blasphemy. Yoga teachers are careful to always refer to "the sport of yoga" and are accredited by the Yoga Federation, which operates in the same way as a tennis or football organisation.
Classes tend to be slower than in the West with much discussion about the physical benefits of each position. As with other sports, yoga competitions are held, judged by specially invited international yoga teachers.
Similar prohibitions on spiritual yoga exist in Malaysia, where a 2008 fatwa - a religious ruling - resulted in a yoga ban in five states. In the capital Kuala Lumpur, the physical activity is permitted but chanting and meditation are forbidden. Clerics in the world's most populous Islamic nation - Indonesia - make a similar distinction.
Yoga has been repackaged in the US as well.
Children at nine primary schools in Encinitas, California, take part in classes twice a week based on a style of yoga called ashtanga yoga. After some parents complained - US schools, like Indian ones, are secular - the Sanskrit names for the postures were replaced with standard English names and some special child-friendly ones, such as "kangaroo" "surfer" and "washing machine". The lotus position has been rebranded "criss-cross apple sauce", the Surya namaskar has become the "opening sequence" and the organisers insist that it is all just a form of physical exercise.
Image captionStudents in their yoga class in Encinitas, California
Some parents remained unconvinced though, and a Christian organisation, the National Center for Law & Policy (NCLP) took up their case. In September this year, the San Diego County Superior Court ruled that although yoga's roots are religious, the modified form of the practice is fine to teach in schools.
The NCLP is appealing. Dean Broyles, the organisation's president and chief counsel sees movements like the Surya namaskar, regardless of what they're called, as "deeply symbolic rituals that express and instil religion through repetition".
The reason many people in the West think yoga is non-religious, Broyles says, is that it falls into a theological blind-spot. "Whereas Protestant Christianity focuses on words and beliefs, ashtanga yoga's focus is practice and experience," he says. Religious intentions may not be there to begin with but practising yoga might lead them to develop.
To an extent, this point of view is endorsed by Hindus themselves. The Hindu American Foundation recently ran a campaign called "Take Back Yoga". Sheetal Shah, from the organisation, says someone raised in an "exclusivist" tradition like Islam or Christianity who becomes very interested in yoga may eventually experience some conflict with their religious beliefs.
So, for American Christians who don't like the idea of yoga, there are alternatives, including PraiseMoves.
This exercise regime combines Christian worship with stretching exercises. As the class adopts a posture, they recite a verse from the Bible. In this way, bhujangasana or the cobra pose becomes the vine posture, with a corresponding verse from John 15:5. "I am the vine and you are the branches. If you remain in me and I in you, you will bear much fruit; apart from me you can do nothing."
"The word yoga is a Sanskrit word that means 'union with god' or 'yoke'," says Laurette Willis, the founder of PraiseMoves. "And as a Christian, it's a different yoke - Jesus said: 'My yoke is easy, my burden is light.'"
For someone who has set about drawing people away from yoga, Willis couldn't have a clearer idea of the opposition's terrain. Her mother was a yoga teacher and she started doing it when she was seven, often acting as a demonstration model for the class. She did yoga for 22 years, eventually becoming a teacher herself.
Image captionLaurette Willis in the Jars of Clay position "But we have this treasure in earthen vessels, that the excellence of the power may be of God and not of us" (2 Corinthians 4:7)
But she says that on 25 February, 2001, at 10:35 in the morning, while she was working out to a video tape, God gave her the idea for PraiseMoves. She sees it as a process of redeeming or "buying back" yogic postures for God. Just as a musical scale can be used to make good or bad music, so the repertoire of positions in yoga can be put to Christian use.
Despite the similarities between PraiseMoves and a yoga class, Willis says she wants her classes to ruminate, not meditate.
"People leave yoga classes saying 'I feel so good. I feel so tranquil.' Well I believe that tranquillity is not peace - the peace that God gives - but it's almost a numbness.
"You've been told the whole time to 'Empty your mind! Empty your mind!' And what we do instead is fill your mind with the word of God."
But for some Muslims, Christians and Jews, yoga is attractive precisely because it supplies a mysticism they feel is lacking in their own religion.
Estelle Eugene co-runs the Jewish Yoga Network and for 20 years has taught yoga to Jewish and non-Jewish people in London.
"I've found with general Judaism here that it's difficult to find a spiritual side that I relate to," she says. "So the yoga helps me to do that. And it enhances my respect and understanding of Jewish practices that I hadn't fully understood previously."
She says she makes small adjustments to yoga where she feels there is a conflict with Judaism. She never attends or holds a class on the holy day, Saturday, and she prefers classes without the chanting of mantras.
Eugene recently ran a Day of Jewish Yoga, which explored ways of combining yoga with Judaism. One of the sessions combined yoga with practices to help participants reach kavanah, the meditative mind-set seen as an essential for Jewish prayer and rituals.
On her website, a testimonial from Rabbi David Rosen, the former chief rabbi of Ireland, says yoga offers "much blessing and enlightenment" and arguably helps "recapture Jewish wisdom and practice which may have been lost".
An Iranian yoga teacher - who wishes to remain anonymous - told the BBC that her religious students sometimes report that they pray with more concentration after practising yoga. "They say when we go to Mecca, we feel we are able to make a deeper pilgrimage because of the yoga," she says. "Our minds and our bodies move closer to our faith."
This is not as contradictory as it might seem, according to Rebecca Ffrench.
"Something that is interesting about yoga is that whilst it is spiritual, it doesn't stipulate a specific religion," she says. "Even in the devotional forms of yoga, it says you can use any object of devotion you like, be it Ganesh, Krishna, Jesus or Allah."
She adds that atheists can also perform yoga - they can fix their attention on the "wonder of the universe" or perhaps the complexity of the DNA helix.
Farida Hamza, meanwhile, is convinced that yoga and Islam are not only compatible, but overlap significantly. The ethical precepts of yoga - captured in the principles of yama and niyama - share many essentials with the five pillars of Islam, she argues.
"Each pillar that we follow in Islam, or the duty that we have to do, is sort of existent in yoga. Simple things like - you give alms to the poor. Well, a yogi is supposed to do service. You have to be honest, you have to be non-violent - all of these are in Islam and in yoga.
Image captionLeft: sujood (part of Muslim prayer). Right: someone doing yoga
"The way we pray as Muslims, each pose that we do is a yoga pose," she adds. "So Muslims that hate yoga are probably doing yoga without realising it." Muslims even join their middle finger and thumb together during prayer, similar to a yogamudra, she says, though she doesn't believe Islam came from yoga or was influenced by it.
Born in India but raised in Oman, Hamza sees her path towards yoga as part of a plan drawn up by Allah. "I am grateful for the joy I felt when my hamstrings opened," she says. "And my big toe stretch, or the first time I did a standing bow - it took me two years to do a standing bow.
"But I did it and that is Allah's grace - he blessed me with that."
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