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Mental illnesses and their treatment as per principles of ayurveda

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Mental Illnesses in Ayurveda

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Ayurveda seeks to remove the root causes of mental illness in a holistic way. Its focus is on prevention through correct diet, exercise, meditation and cultivation of the right attitude. It offers a complex array of therapeutic techniques and natural medicines to restore balance and harmony.

In an increasingly insecure and chaotic world, many people are finding conventional psychiatry and psychology inadequate for healing the mind marred by constant stress. Conventional psychiatric practices based on symptom suppression and drugs that cause serious side-effects have prompted people plagued by mental ailments to look for alternative and holistic healing.

The prevalence of Psychiatric disorder in the community is of such mangnitude that every doctor must be able to carry out a psychiatric assessment. The range of presenting problems is wide, and many patients with emotional disturbance may present, not with overt psychiatric symptoms, but with 'more respectable' physical symptoms. In some patients physical and psychiatric illness may coexist or there may be a direct casual relationship between the two, as in the depressed patient who takes a drug overdose, or the elderly man with a postoperative confusional state. On the other hand, physical and psychiatric illnesses may be unrelated, as in the chronic schizophrenic who develops a neoplastic lesion. In addition, every patient reaction to illness will be influenced by their emotional state and this will itself affect the course of illness.

Diagnosis in Psychiatry is mainly based on recognised patterns of subjective symptoms which are volenteered by the patient or elicited during a clinical interview. With the exception of the organic psychiatric disorders there are no objective markers of disease, such as radiological or laboratory abnormalities, by which diagnosis can be confirmed. In this context psychiatry differs from other branches of medicine where diseases have come to be classified in terms of their aetiology, such as an infective agent, biochemical abnormality or structural lesion.

The two main classification systems currently used in clinical practice are the American Psychiatric Association's Diagnostic and Statistical Manual (4th edition), usually abbreviated to DSM-IV, and the world Health Organization's International Classification of Disease (10th edition), known as ICD-10. The two systems are very similar but ICD-10 is the more widely accepted outside the United States.

Psychiatric disorders have tradiotionally been classified into two main groups: organic and functional. In the organic disorders a known physical aetiology can be established, the symptoms resulting from overt brain disease, as in dementia, or from metabolic upset or circulating toxins, as in acute delirium. In the functional disorders, such as schizophrenia, affective disorders and anxiety disorders, which constitute the large majority of psychiatric illnesses, it was implied that no such physical factors were present. 

Another traditional distinction which has become eroded is the separation of the functional disorders into psychotic or neurotic, depending upon the presence of certain 'psychotic' symptoms. These are abnormal beliefs (delusions), abnormal perceptions (hallucinations and illusions) and certain disturbances in the pattern of thinking. Neurotic symptoms, in contrast, are mainly exaggerations of emotions such as anxiety and depression which are universally expereinced. Psychotic illnesses were often considered as being associated with lack of insight, while patients with neurotic disorders were considered to have insight into their condition. 

Concepts of Mental Health in Ayurveda
The ancient system of ayurveda (science of life) offers a holistic approach to mental health that integrates the mind, body and soul. Sushruta, the ancient exponent of ayurveda, defines health as svasthya-a state of total biological equilibrium, where the sensory, mental, emotional and spiritual elements are harmoniously balanced. Ayurvedic theory of health is based on tridosha (primary life forces or biological humours). The five elements (panchabhuta) combine in pairs to constitute the three doshas-vata (ether and air), pitta (water and fire) and kapha (water and earth). The combination of these doshas inherited at birth indicates an individual's unique constitution. The dynamic balance of tridoshas creates health.

Ayurveda defines mental health as a state of mental, intellectual and spiritual well-being. "A complete and foolproof definition and interpretation of the mind is impossible to provide…Yet ayurveda has attempted to examine every detail of the mind's attributes with fair success. The concept of health in ayurveda encompasses not only the physical and mental aspects but also the spiritual aspect, which is missing in the modern psychological discourse," says Dr. P. A. Antony of Trichur in Kerala. The ancient classical ayurvedic expert, Charaka, places the mind in the heart though other texts locate it at the head and the navel. These various views are considered complementary rather than contradictory. The mind is functionally divided into ahankara (ego), ichha (desire, will) and buddhi. Ichha, directed by ahankara, controls the mind. Buddhi, or the intellect, takes the decisions. 

The three gunas (sattva, rajas, tamas) are connected to tridosha in ayurveda. According to S. K. Ramachandra Rao, Ayurveda Academy, Bangalore, "The three gunas together are responsible for the existential, experiential, evaluative and transactional dimensions, each of which may serve as a motivational source of stress." The ideal state of mind is sattvic, marked by equanimity. An agitated mind is in the rajasic state, while the lethargic and gloomy mind is in the grips of tamas.

The accumulation of toxins in the body is termed ama. Psychologically, ama arises from holding on to negative emotions and undigested experiences. According to Dr. Deepak Chopra, who has popularized ayurveda worldwide, "The guiding principle of ayurveda is that the mind exerts the deepest influence on the body, and freedom from sickness depends upon contacting our own awareness, bringing it into balance and extending that balance to the body."

Bhutavidya is the special branch of psychiatry in ayurveda dealing with mental diseases. Some scholars interpret 'bhuta' to mean ghosts and spirits who cause abnormal psychological conditions. Others say 'bhuta' represents microscopic organisms like viruses and bacteria. Bhutavidya also examines past life karmic causes, which have no explanation in terms of tridosha. Mental disorders are generally divided into doshonmada (physical basis) and bhutonmada (purely mental basis).

Elements of Ayurvedic Psychology
Charaka in his treatise Charaka Samhita, describes eight essential psychological factors that are negatively affected in various ways in all psychiatric disorders. The psychopathological condition is a function of these factors, which are manas (mind), buddhi, smriti (memory), sajna jnana (orientation and responsiveness), bhakti (devotion), shila (habits), cheshta (psychomotor activity) and achara (conduct). Compared to other major ayurvedic texts like Sushruta Samhita, and Ashtanga Hrdayam, Charaka Samhita gives more emphasis to the view of life as a self-aware field of pure consciousness and natural intelligence where the knower and the known are one.

Signs of Mental Health as per Ayurveda
o Good memory
o Taking the right food at the right time
o Awareness of one's responsibilities
o Awareness of the self and beyond self
o Maintaining cleanliness and hygiene
o Doing things with enthusiasm
o Cleverness and discrimination
o Being brave
o Perseverance
o Maintaining cheerfulness irrespective of the situation
o Fearlessness in facing situations
o Sharp intellectual functioning 
o Self-sufficiency
o Following a good value system
o Ability to proceed steadfastly against all odds.

Dr. Marc Halpern, founder and director of California College of Ayurveda, Nevada City, California, explains that according to ayurveda, the greatest factor in a person's sensitivity to stress is a substance found within all cellular tissues and the mind, called ojas. Ojas is the vital essence of the immune system and provides the mind with both stability and contentment. The body produces ojas through digesting nourishing foods. A nourishing diet combined with excellent digestion is the key to building ojas. Ayurveda greatly emphasizes proper digestion. This includes selecting the proper foods for a person's constitution and eating properly. Long-term problems with digestion and elimination deplete ojas, which is protected by instituting a lifestyle that avoids overindulgence, includes sufficient rest and reinforces self-love. Dr. Chopra aptly calls ojas"the bodily counterpart to pure joy."Other essential factors are prana and tejas. Prana is the subtle energy behind all mind/body functions and governs higher states of consciousness. Tejas confers inner radiance and higher perceptual capacities.

Dr. Hemant. K. Singh who served as Scientist at the Government of India's Central Drug Research Institute (CDRI) for thirty years, asserts,"Mental ill health is essentially a result of disequilibrium brought about by unwholesome interaction between the individual and the environment. This interaction operates through an axis consisting of three fundamental factors namely kala (time rhythm), buddhi and indriyata (sense inputs)".

In one of his articles, Dr. Singh summarises the classification of a wide range of psychiatric conditions described in ancient ayurvedic texts as below:

Primary psychological conditions caused purely by mental disorders are kama (lust), krodha (anger), lobh (greed), moha (delusion), irshya (jealousy), mana (pride), mada (euphoria), shoka (sorrow, grief), chinta (anxiety), udvega (neurosis), bhaya (fear), harsha (happiness). The psychiatric conditions caused by a combination of physical and mental (psycho-physical) disorders are unmada (psychosis), apasmara (convulsive disorder), apatantraka (hysteria), atattvabhinvesha (obsession), bhrama (illusion, vertigo), tandra (drowsiness), klama (neurasthenia), mada-murchha-sanyasa (loss of sensory perception leading to coma), madatyaya (alcoholism), gadodvega (hypochondriasis).

The third classification consists of prakriti or personality disorders. There are sixteen manasa prakriti (psychological personality) representing sixteen types of behavioral traits.

Other conditions are buddhimandya or mental retardation of varying degrees, jara-janya-manasa vikara (psychiatric problems of the aged or gerontological disorders), and manodaihika vyadhis or psychosomatic diseases where the cause of disease is mental but the manifestation is somatic. 

Ayurvedic Treatment Methods
In Ayurveda, no two patients are treated alike, and there is no mind/body dualism. Ayurveda implies that whatever affects the body has its effect on the mind and vice versa. Ayurveda treats individuals according to their unique physical constitution indicated by the combination of tridosha along with the mental, social and environmental conditions that affect them.

The focus is on prevention of illness, promotion of health and longevity for which Charaka and Susruta recommended a life-style consisting of dinacharya (daily) and ritucharya (seasonal activities), involving diet (ahara tatva), vyayam (exercise), meditation and virtuous qualities (sadvrutta). Asmi Ayurveda Consultancy & Herbals prescribes the ayurvedic daily routine, beginning with abhyanga (oil massage), which removes toxins and stimulates the flow of natural intelligence in the body. Transcendental Medit-ation that dissolves deep-rooted stress and promotes harmony, creativity and clarity of mind through bliss consciousness, is an essential component of this routine. A proper diet in tune with the ayurvedic body type is also important.

Though ayurveda is essentially preventive in approach, it has a comprehensive system of curative medicine. According to Dr. M. P. Parvatheedevy, Medical Officer at the Government Ayurveda Mental Hospital, Kottakkal, Kerala, the only one of its kind in India, "Charaka Samhita's formulae involve 'purify, pacify and remove the cause'. The physician should purify the system by eliminating unwanted material to soothe the faculties that are injured and lastly remove the original cause of the disease. Samshodhana (internal purification) is the method adopted by ayurveda for cleaning the body and the therapeutic measures are collectively called panchakarma".

This ayurvedic mental hospital uses the unique methods of the Kerala school of ayurveda. Panchakarma is effectively used in treating all kinds of mental illnesses here. Panchakarma means five types of therapeutic measures. Snehana (whole bodyOil massage) and swedana (sweating induced by medicated steam bath) are the preliminary procedures before panchakarma. They enable the free movement of the dosha by liquefying the toxins and dilating the circulation channels. Panchakarma therapy is followed up with samana or purification treatment with oral medicines including herbal powders.