Psychiatric Thoughts in Ancient India

Introduction

Ayurveda, the ancient Indian science of medicine, is directed towards positive health. It aims at studying man in his social, religious, seasonal, climatic and regional environment. It is known as Ashtanga Ayurveda because of its eight disciplines (Verma 1965[4]). Bhoot vidya, one of them, refers to the study of psychological and emotional disorders (Verma 1965[4]). Ghosts and demons are referred to as Bhoot. After studying Ayurveda in general and Bhoot vidya in particular, one observes that there is more emphasis on maintenance and preservation of normal physical and mental health than on the treatment of any disease or illness. Moreover, the role of lifestyle, life goals, personality, and dietary, cultural and social habits in health is highlighted. Medications have been assigned a secondary role. We have now understood the limitations of modern medicine. Most of the illnesses, except acute infections, require long-term treatment, e.g., Diabetes, Hypertension, Cardiac disorders, Rheumatic disorders, etc. It is only recently that physicians trained in modern medicine have studied the role of personality, lifestyle, dietary and social habits in genesis and perpetuation of these disorders. One may say that ancient Indian medicine begins where modern medicine ends — when acute phase of an illness is over- and efforts must be directed to maintain normal health and well-being.

Definition of Health and Normality

Health and normality have always remained elusive to define. The presence of health goes unnoticed, it is only the disease (dis-ease) or illness which is noticed immediately. Normality or health has been variously described as the absence of illness, presence of average health, presence of ideal health, health as adaptation, etc. None of these definitions are completely satisfactory. World Health Organization had defined health as ‘not merely the absence of disease or infirmity but positive physical, mental, social and spiritual health’ (Vaillant and Vaillant, 2005[3]). However, this definition is ambiguous, idealistic and cannot be used in practice.

Patanjali has defined health as ‘optimal utilisation of one’s physical, intellectual and emotional faculties to maintain harmony with self without undue preoccupation with the environment.’ (Verma, 1979[5]). This definition is easily the best among all other definitions. It takes into account capabilities of an individual and emphasises harmony with self. It stresses on avoiding undue and excessive comparison with others which is a major source of unhappiness.

Sushruta has not defined health but has elaborated certain parameters of health. They are:

1. Samdosha — equilibrium of body humours,

2. Samagni — uniform healthy digestion,

3. Samadhatu — normal body tissues,

4. Malakriya — normal process of excretion and

5. Prasannatmanendriyamana — coordination of functions of body organs, mind and soul to maintain happiness (Verma, 1979[5]).

Structure and Function of Mind

Kapil muni has discussed in detail the constituents of the human being consisting of 25 elements (Verma, 1979[5]).

1. Panchmahabhutas — the five great elements — (1) Prithvi (Earth), (2) Jala (Water), (3) Vayu (Air), (4) Akasha (Sky), and (5) Tejas (Sun)

2. Sense organs — (6) Eyes, (7) Ears, (8) Nose, (9) Tongue, (10) Skin

3. Motor organs — (11) Hands, (12) Feet, (13) Speech, (14) Excretory function, (15) Reproductive function.

4. Tanmatra or perceptual processes — (16) Vision, (17) Hearing, (18) Odour, (19) Taste and (20) Touch.

5. Directive elements — (21) Cognitive apparatus — helps to process and appreciate experiences received through sensory organs and tanmatra, (22) Intelligence, (23) ‘I’ concept, (24) an element which is source of all, and (25) an element which directs, creates, maintains and organises.

Patanjali has observed that there is a constant rhythmic interaction and harmony between all the element of the mind, that is, Cognitive apparatus, Psychological self, Physical self and Social self [Figure 1] (Verma 1979[5]). The shat ripus (six foes) — Kama (lust), Krodha (anger), Lobha (greed), Mada (Pride or aggression), Moha (desire) and Matsar (jealousy) or the primary instincts increase the vulnerability of an individual (Verma, 1979[5]). These can be compared to the Id in Freudian terms.

Life Style and Life Goal: Ashramas and Varnas

An individual was prescribed certain nodal functions according to his age and social status, which were known as the four Ashramas:

1. Brahmacharya ashrama covered late childhood, adolescence and young adulthood. The person was supposed to reside with his teacher (and teacher’s family) along with other students in a place known as Gurukul (clan of the teacher). Besides formal education, they were taught martial arts, religion and morality. The teachers taught the students according to their ability, aptitude and inclination. A student was also expected to participate in the day-to-day household chores in a cooperative spirit with other students.

2. In Grihastha ashrama, an individual got married, established his household and raised his family. He was directed to pursue the four Purusharthas of Dharma (Religion), Artha (money), Kama (desires, including sex) and Moksha (Enlightenment and Emancipation of soul).

3. During Vanaprastha ashrama, the individual was supposed to relinquish his desires in the material world and retreat to a quiet place. He still maintained interest in his family affairs and offered counsel and guidance whenever solicited.

4. In Sanyasa ashrama, detachment from worldly affairs was complete, and the person spent his time in spiritual activities and contemplation.

If this system were followed today, the problem of a generation gap and disturbed family relationship would be greatly reduced.

The Chaturvarna (four categories) system emphasised that a person should take up a vocation best-suited to his temperament, physical and intellectual abilities. The four basic vocational categories were:

1. Brahmin (engaged in religious, philosophical and intellectual activities);

2. Kshatriya (engaged in physical activities and in defence — the warrior clan);

3. Vaishya (engaged in trading, farming, artisans etc.); and

4. Shudra (engaged in serving the above tree and in menial labour).

Of course over a period of time, this system degenerated into the rigid caste system and became a tool of exploitation and discrimination against the weak. Each basic vocational type advocated an archetypal mode to achieve Moksha. Brahmins were advocated Bhaktiyoga, Kshatriyas Karmayoga and Vaishyas Rajayoga.

A person was extorted to keep only a quarter of his earning for himself, second quarter for any unsolicited guest (symbolizing the needy and underprivileged individual), third quarter for cow (symbolizing mother earth and concern for animal kingdom) and the last quarter for the priest (symbolizing the religion and the state) (Neki, 1975[2]). This system is not much different from the present day system of direct and indirect taxation!

There were some philosophers like Charvaka who advocated materialism. His advice was to enjoy life here and now without any regards for the consequences or the future. Rinam kritva ghritam peebet (‘May you borrow and enjoy ghee’) (Verma, 1979[5]). Though some did follow such a bohemian lifestyle, it was not a standard practice. But one does find echoes of such a practice in modern times where people borrow recklessly and overspend in the present not bothering about the future, the consequences of which are disastrous.

The System of Trigunas and Tridoshas

The complementary triad of Trigunas (Sattva, Rajas and Tamas) and Tridoshas (Vaata, Kapha and Pitta) represents dimensions of personality and constitution, respectively (Gupta 1977[1]). The food and diet were also classified according to this system to indicate foods which facilitate or inhibit the gunas or doshas.

Trigunas (Gupta, 1977[1]) or personality types:

1. Satvika — intellectual, pure, strong, healthy, possessing long life and equanimity.

2. Rajasik — emotional, passionate, fiery and restless.

3. Tamasik — vegetative, lustful, ignorant, dull, (comparable to dumb-witted, whose extreme form would be mental retardation).

Tridoshas (Gupta, 1977[1]) or Constitutional types:

1. Vata — asthenic body build, tall and lean,

2. Pitta — pyknic body build, short and obese,

3. Kapha — athletic body build, muscular, well built.

Effect of food — Food should be consumed to subdue the dominant element. Satvik guna is facilitated by food which is sweet, agreeable to taste. Rajasik guna is facilitated by sour, pungent, salty, spicy food. Tamasik guna is facilitated by stale, foul-smelling food. Vata dosha is subdued by sweet, sour and salt and is aggravated by pungent, bitter and astringent food. Kapha is subdued by pungent, bitter and astringent and is aggravated by sour and salty food. Pitta is subdued by astringent, sweet and bitter, and aggravated by pungent, sour and salty food (Gupta 1977[1]).

Psychiatric Disorders (Gupta, 1977[1])

Unmad was the term for psychosis. Mental disorders were named after Gods and devils. The terminology and clinical picture does not correlate well with modern terminology. However, approximate and loose correlation is as follows — Endogenous disorders were provoked by humours or tridoshas. They are:

1. Vatonmad — similar to schizophrenia,

2. Pittonmad — similar to mania,

3. Kaphonmad — similar to depression, and

4. Tridoshonmad — Depression.

Exogenous disorders resembling schizophrenia were — Bhujang graha vyadhi, Rakshasa graha vyadhi, Pishachha graha vyadhi, asura graha vyadhi etc.

Those resembling mania were — Daiva graha vyadhi, Yaksha graha vyadhi and Gandharva graha vyadhi. Pitru graha vyadhi resembled depression (Gupta, 1977).[1]

The following factors were described as causative:

1. Weak will and nervous temperament;

2. Wrong diet;

3. Lack of healthy habits, indulgence in wrong activities,

4. Preoccupation with shat ripus, that is, preoccupation with primary instincts, namely Kama (lust), Krodha (anger), Lobha (greed), Mada (Pride or aggression), Moha (desire), and Matsar (jealousy),

5. Preoccupation with something,

6. Exhaustion and

7. Demonological possessions (Gupta, 1977[1]).

These factors appear to be based on common sense approach. There was no systematic documented study.

Determinants of Psychopathology

Psychopathology was classified as prenatal and postnatal. Prenatal was further classified as preconception and postconception. Postnatal was further classified into personal and environmental factors. These are detailed in Table 1.

Yoga and Mental Health

Patanjali defines Yoga as Citta Vritti Nirodha (Regulation of the turbulent forces of the mind). Abhyasa (Regular practice) and Vairagya (detachment) are essential to master Yoga. Yoga aims to lessen the five kleshas (afflictions) that is, avidya (ignorance), asmita (egotism), raga (personal likes), dwesha (personal dislikes) and abhinivesha (possessiveness). Yoga consists of eight steps (Ashtanga Yoga). The first two, Yama (abstentions) and Niyama (observances) are social and ethical in nature. The next three Asana, Pranayama (regulated controlled breathing) and Pratyahara (purging of undesirable thoughts and deeds) are methods to discipline the mind. The last three, Dharana, (concentration), Dhyana (meditation) and Samadhi (contemplation and total detachment from the material world) are crucial for enlightenment, emancipation of soul and to be with the God Almighty.

1. Yama — comprises five abstentions. (a) Ahimsa (non-violence), (b) Satya (truthfulness), (c) Asteya (not stealing or avoidance of misappropriations in thought and action), (d) Brahmacharya (sexual abstinence, some interpret this as regulated sexual activity) and (e) Aparigraha (non-acquisitiveness)

2. Niyama — has five observances. (a) Shauch (purity in thought, word and action), (b) Santosh (contentment), (c) Tapas (self-denial, not to pamper body), (d) Swadhyaya (self-enlightenment, objective study of self) and (e) Ishwara pranidhana (submission to God’s will, being one with God)

3. Asana — right posture conducive for meditation.

4. Pranayama — right breathing technique, regular, slow, deep breathing with proper pauses.

5. Pratyahara — to keep one away from distracting stimuli so as not to disturb the meditation.

6. Dharana — concentration.

7. Dhyana — meditation.

8. Samadhi — the ultimate step which implies contemplation leading to enlightenment (Verma, 1979).[5]

Gita and Mental Health

Gita, along with the Upanishads and Brahmasutras, form the Prasthan trayi (scriptural trinity, helpful in the journey towards enlightenment). Gita is based partly on the Ishavasyopanishad and Kathopanishad and on the philosophical systems of Sankhya and Yoga (Venkoba Rao, 1980[6]). The eighteen chapters of the Gita with over seven hundred verses form an inset in the Bhishma parva of the Mahabharata. Gita period is interpolated between the end of Upanishadic period and the elaboration of the shat darshanas (the six orthodox systems of Indian philosophy — Sankhya, Yoga, Nyaya, Vaiseshika, Mimamsa and Vedanta) that is, around the 3^rd and 4^th century B.C. (Venkoba Rao, 1980[6]).

Gita is the forerunner of the modern concept of tripartite mental functions, namely cognition (dhyana), conation (karma) and affect (ichcha or emotionally tinged desires or Bhakti) (Venkoba Rao, 1980[6]). Bhakti is put in affect to highlight its emotional roots. The inaugural verse of the Gita, which incidentally is the only one from Dhritarashtra — ‘Gathered together at Kurukshetra, the field of religious activities, what, O Sanjaya, did my war inclined sons and those of Pandu do?’ is a fine and elegant simile that epitomises the natural state of affairs of the human mind and the disturbing forces within it. The mind is like a veritable battlefield. The whole of the Gita is in reply to this question. The personality in the Gita is compared to a chariot drawn by horses — the horses represent the senses, and buddhi (intellect) is the charioteer, the reins denote the mind. Gita advocates the attainment of a state of evenness of mind — Samatham, its steadiness — Sthitapradnya and peace — Shanti (Venkoba Rao, 1980[6]).

Gita illustrates exemplary psychotherapy. Lord Krishna represents the master healer of the minds of humanity while Arjuna symbolises the person in a state of anguish. Gita depicts the arousal of a gloomy and dejected Arjuna, who is torn between intellectual doubts, ethical dilemma and filial bondage. Arjuna’s arousal is from three areas of inactivity — from ignorance to knowledge, from apathy to a positive feeling and from inertia to purposeful activity. It is important to note that the healer Lord Krishna did not force the ideas but suggested that certain things have been discussed, and it was up to Arjuna to act as he liked (Yatha ichchati tatha kuru) (Neki, 1975[2]). In psychotherapy, the client is not taught or forced to do certain things but is encouraged to choose positive and viable options after intellectual and emotional discussion. The final decision to act was taken by Arjuna while Lord Krishna only cleared his doubts. However, Lord Krishna gave advice in such a manner that Arjuna was left with no alternative but to fight!

Concluding Remarks [Figure 2: Flowchart of the Paper]

The ancient Hindu texts — Vedas, Upanishads, Shrutis, Smrutis and Puranas house literally a treasure trove of knowledge. The time has come to perform the Amritmanthan (symbolic churning of the ocean of knowledge) once again to recover gems of knowledge from the ancient Hindu texts.

Take Home Message

Study of psychiatric concepts in ancient Indian texts is not only interesting but also fruitful in the contemporary practice of psychiatry.

Questions that this Paper Raises

1. Are thoughts on psychology and psychiatry in ancient India in anyway relevant today?

2. It is nice to revere the old, but does it stand scientific scrutiny?

3. Can we develop replicable models form ancient thought?

4. Can intuition and subjectivity become the object of scientific enquiry?

About the Author

Ravi Abhyankar, M.D. (Psych. Med.), D.P.M; M.N.A.M.S; F.I.P.S., Consultant Psychiatrist has been President, Indian Psychiatric Society (West Zone) 1991–1992, President, Bombay Psychiatric Society, 1988-1989, Hon. Gen. Secretary, Indian Psychiatric Society, 1995-1997, Chairman, Rehabilitation Psychiatry Specialty Section of The Indian Psychiatric Society, 2003–2005, Chairman, Awards Committee, I.P.S. (West Zone) 1993-1997. He has been Consultant Psychiatrist and Head, Child Guidance Clinic, (Retd) at B.J. Wadia Hospital for Children, Parel, Mumbai. He is recipient of J.C. Marfatia Gold Medal and also Distinction in M.D. (Psychological Medicine) Examination of University of Bombay, 1977; recipient of Tilak Venkoba Rao Oration Award of the Indian Psychiatric Society, 1985; and also recipient of the Best Paper Award at the Annual Conferences of the I.P.S. (West Zone) thrice in 1977, 1981 and 1993. He also received the S. M. Lulla Oration Award of the Bombay Psychiatric Society, 2003. He was Participant in a W.H.O. training programme at Basle (Switzerland), 1981. He has more than 30 scientific papers in National and International Journals. He has contributed two chapters in the book ‘Recent Advances in the Biology of Schizophrenia – State of Art, as also contributed a chapter on ‘Rehabilitation Psychiatry in India’ in the Text Book of Psychiatry edited by Dr. Vyas. He has several articles in the lay press, delivered many lectures at I.M.A, social service and voluntary organisations, schools etc., besides more than 20 talks on radio, television etc. His areas of research interest are Alcoholism, Child Psychiatry, Geriatric Psychiatry and Psychosomatic Medicine.