This article has been written by Dr. Ram Manohar. He is the Director-Research, The Ayurvedic trust, Coimbatore.
Psychiatry was known in Ayurveda variously as Bhutavida and Grahacikitsa. In one way, the words bhuta (meaning that which existed in the past) and graham (meaning to seize) denotes the mind that is trapped in the past and is unable to tackle the experiences of the present moment. Psychiatry was recognized as one of the eight special branches of Ayurvedic treatment.
To develop a concept of mental health from the Ayurvedic perspective, we will perhaps have to look into the tradition of psychiatry in Ayurveda. It would be all the more relevant if this exercise is undertaken with reference to the living traditions of Ayurveda. At this juncture, it is important to realize that the concept of specialization in Ayurveda is different from that in scientific medicine. The most important branch of Ayurvedic treatment is General medicine (kayacikista). The word Kaya means the whole body with its specialized organs (avayava) including the mind and variable conditions (avastha). The other seven branches of Ayurvedic treatment giving special focus on certain specialized organs or variable conditions of the body are therefore to be included within the scope of General medicine itself.
Pediatrics deals with the condition of childhood and rejuvenation of old age. Surgery deals with conditions requiring surgical intervention and toxicology deals with conditions in which the body is afflicted with poison. Psychiatry deals with the mind, ENT-Dentistry-Ophthalmology deals with organs in the supraclavicular region and Reproductive medicine deals with the organs and function of reproduction. The seven branches of Ayurvedic treatment are therefore extensions of the branch of General medicine itself and not compartmentalized discipline. It is essential to revive these aspects of Ayurvedic treatment within the domain of General medicine first before promoting them as specialization. This is very much relevant with respect to psychiatry. In order to develop a concept of mental health from the Ayurvedic perspective that is relevant for modern times, we have to look at the branch of General Medicine itself and perhaps not Ayurvedic Psychiatry, to begin with.
With its holistic approach and perspective, Ayurveda looks at the human personality as a composite whole consisting of the body, mind, and self. Even in the normal course of treatment, Ayurveda seeks to restore not only physical health but also mental health. Indeed, Ayurveda emphasizes that mental imbalances are the root cause of many illnesses. Unfortunately, the current trend in Ayurvedic practice is not very encouraging in this respect. Current Ayurvedic practices seem to have lost much of its traditional holism and the emphasis is shifting from the person as a whole to just the physical body. Necessary attention is not being given to the emotional imbalances in the patients that might be working at the roots of a disease and also interfering with the process of healing. The classical texts of Ayurveda say that the physician who does not enter into the inner being of a patient fails to treat him ‘jnanabuddhipradipena yo navisati, yogavti, aturasyantaratmanam na sa rogamscikisati”. The texts have also emphasized that by treating the mind of the patient, the healing processes in the body can be initiated and the immune response activated. ‘manaso/ rthanukulyaddhi tustirurjabalodayah, sukhopabhogata ca syad vyadhescato balaksayah’. There is of course the debate as to whether the body should be treated to balance the mind or the treated to balance the body. Fact is that the mind and body should be handled together to achieve harmony and health. Therefore, it is very necessary to introduce the concept of mental health in the general practice of Ayurveda and not just in the specialty of Ayurvedic psychiatrist, but also the general Ayurvedic physician has the responsibility to restore the mental health of the patient.
In scientific medicine, the physician who treats the body often forgets about the mind and one who treats the mind forgets about the body. As Capra points out, “psychologists, following Descartes, adopted the strict, division between the res cogitans and the res extensa, which made it extremely difficult for them to understand how mind and body interacted with each other. The current confusion about the role and nature of the mind, as distinct from that of the brain, is a manifest consequence of the cartensian division’. Thus, it is essential that we have revive the concept of mental health and its applications within the context of General Medicine in Ayurveda that will encourage better understanding of the complex mind body relationship. As the Ayurvedic texts say, the relationship between the mind and the body is like that between ghee and an iron vessel. When one he is heated.’ Dehamanolaksanayorvastunoradharadheyabhavena sthitatvaddvayorapi santapo yuktah yathaadheyenayogolakena santaptena tadadharasya katahadeh santapah. Adharena ca katahadine santaptenadhe-yasya ghrtadeh santapah’.
Rena Dubos says, ‘whatever its precipitating cause and its manifestations, almost every disease involves both the body and the mind, and these two aspects are so interrelated that they cannot be separated one from the other’.
Paraphrasing Pelletier,’it is becoming apparent that the role of the patient’s personality is a crucial element in the generation of many illnesses prolonged stress somehow seems to be channeled through a particular personality configuration to give rise to a specific disorder. The most convincing link between personality and illness has been found for heart disease, and links are being tentatively established for other major diseases, most notably cancer’.
Therefore the study of mental health cannot be pushed aside as a topic relevant for only the branch of Ayurvedic psychiatry lest we repeat the flaw that happened in the case of scientific medicine and separate the body from the mind.
The concept of mental health from the perspective of Ayurveda
The Indian tradition has been preoccupied with the study of the higher potentials of the human body and therefore seems to project a concept of potential mental health that transcends the notions of the nature of the mind as understood by the modern psychology. Works like the Patanjala yoga sutras are illustrative in this regard. Ayurveda, with its deeper connections with Indian spirituality also promotes this concept of a higher realm of mental health in which stress is overcome and the mind is at ease with itself, resting peacefully in a healthy body. This is called the state of yoga, which can ultimately lead to liberation. ‘yoga mokse ca sarvasam vedananamavartanam mokse nirvrttirnihsesah yogomoksa pravartakah’. To elaborate on the idea of perfect mental health, one will have to go beyond Ayurveda into the spiritual traditions of India. The concept of sthitaprajanh that is elucidated in the Bhagavad Gita, for instance, is a good picturization of the ideal state of supreme mental health. This concept points to a state of mental equanimity in which the mind is neither excited nor depressed, neither sorrowful nor happy but established in a state of constant bliss. This refers to a realm that is beyond the ken of the majority of the people and hence very difficult to comprehend or understand.
It is pertinent to note that reference to the spiritual traditions of India should not be mistaken as taking recourse to religious conversion or superstition. Capra points out that ‘Eastern mystical traditions are noted, however, primarily concerned with a theoretical concept. They are, above all, ways of liberation, concerned with the transformation of consciousness. During their long history, they have developed subtle techniques to change their follower awareness of their own existence and of their relation to human society and the natural world. Thus traditions like Vedanta, Yoga, Buddhism, and Taoism resemble psychotherapies much more than religions or philosophies, and it is therefore not surprising that some Western psychotherapists have recently shown a keen interest in Eastern mysticism’.
The Ayurvedic texts say that transforming one’s consciousness by taking refuge in the wisdom of such mystical traditions is the best remedy for the faults of the mind.
‘Dhidhairyatmadivijnanam manodosausadham param’
Looked at from this perspective, a majority of people are in a state of ‘normal abnormalcy’ of their minds. Unable to rise to a higher level of mental health, a large section of humanity is being collectively deluded and unaware of their plight are being constantly injured by the trauma inflicted by the stressful states of their minds, therefore, the person who has discovered true sanity is often considered as insane. This is perhaps the idea conveyed by the legend of nila river in pattambi kerala naranan’s strange behavior caused him to be portrayed as a lunatic by the people of his times. One of his favorite pastimes was to roll heavy stones fall down, he would break into laughter. He would spend days together just doing this and the people could not make sense of his seemingly stupid acts. There are many stories about Naranan the lunatic that reveals how he tried to awaken his fellowmen by them giving rude shocks through his weird acts. Those who have read the inner meaning of his ways have realized that the stones this lunatic used to roll up the hill symbolized the passions and negative tendencies of the human mind with which we labour hard uphill in our lives. Naranan the lunatic beckons us to drop the weight of the ego and the attendant negative tendencies to make our minds light and free. It seems that punkudil naranamangalattu mana representing the classical tradition of Ayurvedic Psychiatry might have got its name from naranan the lunatic. A lunatic’s name is associated with a tradition of psychiatry! What does this indicate but the fact that sanity is often mistaken as lunacy by people who are themselves not fully sane!
Will it require the efforts of another ‘sane’ lunatic to re-introduce the concept of perfect mental health in modern times? Will the efforts to promote the concept of mental health from the Ayurvedic perspective be scoffed at as impractical and utopian? Only time will provide the answer. But efforts in this direction are definitely worth the pursuit.
The concept of mental health to transform the normally abnormal minds
When we think of Ayurvedic Psychiatry and mental health, the idea that of mentally sick people. Little do we realized that the so called ‘normal’ people are not really enjoying the kind mental health that would make their lives more comfortable and blissful. So there is a dire need to think about mental health for the ‘normally abnormal minds’ and not just for the ‘abnormal minds’. A preoccupation with pathological states of the mind leads us to a concept of mental health that is not really healthy by any standards.
The concept of mental health that would be relevant for the modern age is one that will enable us to recognize the undesirable tendencies of the mind in the seemingly normal people. It should be understanding that will enable even Ayurvedic physicians engaged in general practice to detect and remedy mental problems before they inflict irreversible damage. It should be an insight that will restore the lost holism in the approach of Ayurvedic treatment and encourage the physician to look at patient more completely and comprehensively. It should be a vision that will give rise to techniques that will enable people to handle their emotions in a more balanced manner.
Much before we think of strengthening the branch of Ayurvedic Psychiatry with an Ayurvedic concept of mental health, we have to reinforce the branch of General Medicine in Ayurveda with a sound approach to mental rehabilitation. In a society that does not seek higher levels of mental health; the people who suffer from serious mental illness do not stand a good chance of rediscovering mental balance and social acceptance. If leprosy and certain other conditions are perhaps no longer nurturing the kind of social stigma that they used to in bygone days, thanks to advance in scientific medicine, mental diseases unfortunately still continue to be looked at in an unwholesome way. It is not easy for a mentally sick person to rehabilitate him/herself even today because of the lack of support from society at large. A society that has failed with people possessing ‘normally abnormal minds’ cannot really help people who have ‘abnormal minds’. Hence the focus should shift from ‘abnormal’ minds to the ‘normally abnormal minds’. This is where the general practices of Ayurveda can benefit immeasurably from a comprehensive idea of perfect mental health that can be advantageously applied in clinical practice.
The entire world is today turning toward alternative modalities of healing. In the beginning, the search was for safer and natural drugs. Then it was for healing sources of energy. Now it is approaches to health care that will treat the person as a whole with due attention to both the body and mind. Ayurveda needs to prepare itself not merely as modality of healing based on safe and natural herbs. Nor as energy medicine. But as an approach to healing that will go beyond physical health to perfect mental health, which is the ultimate analysis.
In the process of Rediscovering Ayurveda for the modern age, we will have to inevitably rediscover the concept of mental health that is buried in the Ayurvedic texts and linked to the hoary spiritual traditions of this ancient culture. Then we will be taking the first step to create a mentally healthy society that can support the treatment of those who are pathologically deranged in their minds. As the Acharya of punkudil mana would put it,” As far as Ayurvedic Psychiatry is concerned, the fourth limb of treatment is not the patient but the society. A mentally sick person cannot become a limb of the treatment because s/he cannot control a situation”. If this very society enjoying good mental health, then one of the most important limbs of Ayurvedic psychiatry would become handicapped. So the creation of a mentally healthy society is an essential prerequisite to promote the branch of Ayurvedic psychiatry which has an exclusive focus on the pathological state of the human mind.
When the Ayurvedic physicians of the future cleanse not only the bodies of their clients with the techniques of Panchakarma but also their disturbed minds with techniques derived from a deeper understanding of mental health. We will witness the emergence of a new breed of Ayurvedic healers who can truly initiate the healing process in their patients by touching the inner core of their personalities. This new found mental health will enable us to nurture better relationships between humans, play better politics, engage in a healthier way of commerce and create a peaceful society. For this, the physicians have to themselves become role models and healthy in their minds and bodies. To quote Capra, ‘It is intriguing and quite ironic that physicians themselves are the ones who suffer most from the mechanistic view of health by disregarding stressful circumstances in their lives. Whereas traditional healers were expected to be healthy people, keeping their body and soul in harmony and in tune with their environment, the typical attitudes and habits of the doctor today are quite unhealthy and produce considerable illness. Physician’s life expectancy today is ten to fifteen years less than that of the average population, and they have not only high rates of physical illness but also high rates of alcoholism, drug abuse, suicide, and other social pathologies.
There is an urgent need to work in the direction of bringing greater clarity to the concept of mental health that will transform the ‘normally abnormal minds’ to a healthier state of existence. A state of mind that will take one to the highest levels of spiritual experience and inner contentment that transcends the fear of death.
Esa brahmi sthitih parthah nainam prapya vimuhyati
‘O! Partha, this is the state of the Supreme Brahman and one who is established in the state is not deluded and attains the highest good even when embraced by death’.
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