Life according to Ayurveda is a conglomeration of the four interdependent components namely, the body (Shareera), the sensory and motor faculties (Indriya), the mind (Satva), and the soul (Atma). A healthy life necessitates a perfect complementary support of all these factors and thus the concept of health encompasses physical, mental, sensory and spiritual domains. It is also indicated that a person with Swastha Mana (healthy mental state), Prasanna aatmendriya (delighted soul with proper functioning of sense organs) along with sama dosha (well balanced state of dosha), Sama Agni (proper metabolism), Sama Dhatu (proportionate body organs and tissues) and Sama Kriya (proper physiology) is perfectly healthy.
Physical Health is the attainment of
While explaining the concept of Swasthya, Ayurveda has also included attributes of mental health like
The word Manas is derived from the root ‘man’ adding the suffix ‘asuna’ having the meaning, ‘to perceive’, ‘to lead to knowledge’, ‘to analyze by special knowledge’, ‘Mind or psyche’ (Monnier Williams). Synonyms of Mana are Chitta, Chetas, Hrit, Hridd, Manas and Satva.
“Chittam chetah hrdayam svantam hrnmanasam manah iti” (Amarakosha 1/4/3)
Mana is the entity through which the knowledge is obtained, which is closely related with Atma, through which one can perceive and the seat of Mana is Hridaya.
Mana is the superior analyzing faculty, the seat of soul or Atma and controls the whole body, by accommodating the superior senses and can be said as the seat of knowledge. The proof of existence of mind is given by Ayurveda is the existence of knowledge (Lakshanam Manaso Jnana). According to Vedanta Darshana, Manas, Buddhi, Chitta and Ahankara combine are called four Antahkarana (Internal instruments/Mechanism).
Manas is told as ‘Ubhayatmaka’ i.e. it is a dual faculty which has both sensory and motor functions and hence considered as a superior faculty because it controls and co-ordinates all other faculties connecting them with the soul.
In contemporary psychology, mind is an all-encompassing umbrella term that covers the joint functioning of the brain and body in conjunction with the memory, world view, personality, soul, and other intangible facets of human life and psychology. It covers the way a person interacts with people and the world, how they learn and express themselves and how they relate to abstract concepts such as religion, spirituality, metaphysics, and other areas of thought. The mind is the manifestations of thought, perception, emotion, determination, memory, knowledge, conscience and imagination that take place within the brain.
It is conventional in Ayurveda to attribute anatomical sites for conceptual entities to provide some concrete feature to abstract ideas. ‘सत्वादिधाम हृदयम् स्तनोरः कोष्ठमध्यगम्’ Acharya Vagbhata says that the Hrudaya (heart) is the seat of Satva or Manas, likewise Acharya Charaka and Sushruta [S.Śa 4/33] also explains the Hridaya as the seat of Manas as it is said to be the Chetana Sthana. Acharya Bhela [B.Ci 8/2] in context of Unmada, says Head (Shira) as the seat of Mana.
It is possible to conclude that the sensory and motor functions of mind are attributed to brain, while the psychological functions, especially the emotional aspect of psyche to heart. Brain can be said as the physical structure upon which the attributes of mind are bestowed upon. Hence the brain and mind has an intimate and complex relationship. With the advance in research in fields of neurology, psychiatry, psychopathology and psychology and remarkably advanced tools of molecular biology, various links has been established on the role of brain and neurotransmitters in Psychiatric conditions.
The properties of Manas are ‘Anutwa’ and ‘Ekatwa’i.e., subtlety and singleness or oneness. Due to its singleness, only single knowledge occurs at a time. Manas remains engaged in a particular sense organ and cannot perceive two or more objects at a time. And its subtlety enables it to move rapidly from one object to another by which it may appear that simultaneous perception of several objects is taking place. The inability to focus on one thing or inability to withdraw from perception related to any particular Vishaya or object may be considered abnormal. Prolonged lingering on one thought may form the basis of obsessions and compulsions while inability to focus may be seen as symptom in Attention Deficit Hyperactivity Disorder(ADHD), Generalized Anxiety Disorder, Depressive Diorder etc
The functions/actions of Manas has been described as Indriabhigraha (control of sense organs), Svasyanigraha (self-restraint), Uhya (hypothesis) and Vichara (consideration). Indriyaabhigraha is activation, direction and co-ordination of Jnanendriya and Karmendriyas. Swasyanigraha is self-control, restraining self from temptations and affected by emotions.
The objects, which are perceived through the sensory organs, are termed as Artha. Considering Manas as an independent Indriya, it must have its own objects, which are experienced by the mind. Thus, besides being capable of perceiving Indriya Visaya (sensory objects), Manas has the ability of experiencing its own objects like anything that is thinkable.Thus the objects of manas are:
Manas also functions introspectively without the relation to the sense organs. Any knowledge gained through this method or emotions perceived by the mind also become the subject of thought. Sukha(happiness), Dukha(unhappiness), Kama(lust), Krodha(anger), Bhaya(fear), etc., belong to this kind of knowledge.
Manas process the inputs from outside perceived directly or indirectly through sense organs and develop responses by the interrelated activity of its attributes
Dhee, Dhruti, and Smruti are the three main faculties, which are closely related to Manas.
Dhee: [Buddhi]“Buddhirhi Nischayatmika”
The function of Buddhi is decision-making or determination of input Manas places before it, as perceived through Indriyas. It is correlated with Intellect.
Dhriti: ‘Dhŗtirhi Niyamatmika’
It is the power of will, which control Manas from the various diversions or temptations of surroundings.
Smriti: ‘Smaraņat Smŗti’
Recollection of the past is known as Smriti. The experiences get registered by Drishta (seen), Shruta (heard) or Anubhuta (experienced) by the person and can be recalled later. An unimpaired condition of all these functional aspects is necessary for mental health.
Since living being is a microsome of the macrosome or the universe, the mind in living organism is also endowed with the properties of Trigunatwa i.e., Satva, Rajas and Tamas. The Akasha is represented in Satvaguna, Vayu and Teja are represented in Rajas while Prithvi and Jala are represented in Tamas 1 .Satva, Rajas and Tamas are the three essential constituents of mind, of which last two are noted „Manas dosha‟, which can potently cause Mano vyadhi (mental disorders).
Out of these three, Satva is only pure (Shuddha) in quality due to its characteristic feature Kalyanamsha (Positive Elements) while, Rajas and Tamas are said to be impure due their qualities Roshamsha (Intense passion/drive) and Mohamsha (Being misconstrued), respectively2. Activities of Psyche are due to the dynamic interplay between the 3 Gunas. In every individual; the cognitive, conative and affective aspects of the mind is guided by the predominance of any of the three Gunas.
According to Susruta, the predominance of either Satva guna or Mano doshas will show the following characteristics accordingly3.
Sattvika - Mercy, sharing nature, Endurance, Truthfulness, Good conducts, Belief in God, Knowledge, Intellect, Capacity to learn, Memory, Self-control/ dhruiti, and Selfless service.
Rajasika -Excess grief, moving habit, lack of self-control, inflated self-esteem, Lying nature, Cruelty, Wickedness, Pride, Excitation, Attachment and Anger.
Tamasika - Depressed mood, lack of faith in God, lack of good conducts, intellectual deficits, ignorance, crookedness, laziness and sleepiness.
All the positive attributes of the mind are due to the Satva constituent, and unwholesome activities are results of Rajas and Tamas constituents. These factors are responsible for the various behavioural patterns of human being. According to the predominance of gunas the phenomenon of interaction between Purusha(microcosm) and Loka(Macrocosm) can be of 3 types.
Samyakyoga (normative interaction)- wholesome interaction with Satva predominance, which maintains the mind in a well balanced and harmonious state.
Atiyoga of mental activity is owing to Rajoguna predominance and will be characterised by excessive emotional outbursts, excessive excitement, anger, preponderance to violence etc.
Heena yoga of mental activity represents Tamoguna predominance and is characterised by Avasada(depression), ignorance, lack of interest in day to day activities etc.
Mithya yoga occurs due to erroneous interaction of three Gunas and is unwholesome to mental health. Heenaati-mithya yoga of mind with its Artha, in the level of psyche is the first step in the pathogenesis of psychiatric conditions as per Ayurveda.
Satva has genetic endowment as it is inherited at the time of conception and this part of the individual gets nurtured in the womb especially by the influence of ‘Satva vaisheshikakara bhavas’ and also by the influence of ‘one’s own experiences’ during infancy, childhood and adolescence and based on their characteristics they are classified into about 16 types (Kayabheda or Personality traits). Though these classifications help to understand the mental disposition better, Charaka has utilized the concept of ‘Satva bala ‘in determining the predisposition to develop mental illness.
Mental strength is graded into superior, medium and inferior. Those with superior mental strength [Pravara Satva] can withstand mental trauma well. Those with inferior mental strength [Avara Satva] are incapable to suffer even trivial trauma and pain. Those with medium strength [Madhyama Satva] can afford to take hardships if consoled to do so.
Along with the Dhatusara lakshanas, Acharya Charaka has mentioned the ‘Satva sara lakshanas’ which can be considered as the Gold standard in terms of Positive Mental Health & Behaviour. The characteristic features are as follows:
The kind of dietary and lifestyle practices an individual habitually chooses to follow will either influence Satva guna resulting in increase of Satva bala leading to positive state of mental health or vitiate Mano doshas resulting in decrease of Satva bala leading to a state of Heena Satva wherein the individual is at ahigher susceptibility to develop psychiatric disorders. An individual with increased Satva guna will choose wisely whereas a Heena Satva individual will succumb to various faulty practices and therefore this vicious cycle will become difficult to intervene and resolve.
The functional components, involved in the normal physiological state of the body are Dosha, Dhatu, and Mala which maintain the integrity of the human body
Sareera Doshas and Manas
All the three Sareerika dosha are also related with the normal functions of the mind. More precisely Praņa vayu, Udana vayu, and Vyana vayu, Sadhaka pitta and Alocaka pitta, and Tarpaka kapha are more related with the normal mental functions. Of the three humours Vata is mainly responsible for the activities of the mind i.e. it is the controller and stimulator of mind and is responsible for enthusiasm.
Though in general Satva, Rajas and Tamas are concerned with the mental faculties and Vata, Pitta and Kapha with the anatomical and physiological entities, the former also have a part to play in the normal anatomy and physiology and latter affect the psyche of an individual. Thus, all these Doshas can be regarded as factors having psychosomatic role to play.
Dhatus and Manas
Dhatu: Dhatus are stated as the structural and functional units of the body. They support and nourish it. They are also said to support the mind and life, promoting the growth of an individual. Sara, the essence of dhatu, is dependent on the proper structure and the function of dhatus. Sara in different forms of Rasa, Rakta, etc. are acting vigorously in keeping the human body with good physique, good mental strength, and free from morbidity. This indicates that, dhatus also influence certain psychological characteristics, which are dependent on the excellence of the particular Dhatu.
Rasa Dhatu, Rasavaha Srotas and Manas
Among the seven Dhatus, the prime one is Rasa Dhatu which is formed from the essence of food nourishing all other dhatus and the foetus in the womb, since conception to death, circulate in the Shareera. Its prime site is Hrudayam and Dasha Dhamanya (ten great arteries), and in same way, Manas adhisthana is Hrudayam. An affliction of Manas directly affects Rasa Dhatu, Hrudaya and Rasavaha Srotas. The emotional factors like fear, anger, grief and excessive thoughts /stress leads to vitiation of Rasavahasrotas. On considering the Rasapradoshaja Vikaara (diseases resulting from vitiated Rasa Dhatu) most of the causative factors are unwholesome food and life style related. A close interrelation between the Manas and Rasavaha Srotas are responsible for influencing on each other.
MalaMalas are the by-products of digestion and metabolism. They are of equal importance, for supporting the body as well as the life. They should be retained and eliminated through the body in proper time, for the normal functioning of the individual. Recent studies emphasise the role of gut bacteria and probiotics in normal brain functions.
It is known from earlier times itself that mind and body influence each other. Psychological suffering is often expressed through somatic problems. In individuals with difficulty in recognising and expressing emotions, physical manifestations are often seen in the form of loss of sleep, decreased/increased appetite, loss of libido, vague aches and pains in the body, fatigue, anger issues, eating disorders etc. Some physical diseases such as eczema, psoriasis, auto immune diseases, blood pressure etc are thought to be prone to worsen by mental factors such as anxiety and stress. A person’s current mental state may affect how bad a physical disease is at any particular moment. Hypochondriasis, conversion disorder, Somatization disorder etc are believed to be rooted on mental problems.
Certain chronic conditions and life threatening conditions such as Cancers, Renal Diseases etc also affect mind retrospectively in the form of anxiety, depression, worthlessness, feeling of rejection etc.
Mind also can exert a positive or negative impact on the effect of treatment on body also. The positive impact of placebo on treatment is due to the effect of mind. The positive response of a patient to therapy is also guided by the innate positivity in the individual.
The concept of Satvavajaya Chikitsa in Ayurveda is centred on the mind by promoting positive vibes to the individual. Ayurveda believes individual as a whole, encompassing body and mind together and treatment is also aimed for both.
Ojas is the finest essence of the seven Dhatus (tissue elements). It is also called Bala (strength) and body ceases to exist in its absence. Ojas is closely related to the proper functioning of the various functions of the body including that of the Manas. Ojas is depleted by mental emotions such as anger and grief and in conditions of its Kshaya, the person becomes fearful, worried and his faculties will not function properly. Fainting, confusion, delirium and even death may occur if Ojas is highly depleted. A normal level of Ojas is conducive to the proper functioning of mind and the factors which are good for Manas will improve Ojas.
Though Ayurveda has defined ‘Life’ in physical, mental and spiritual dimensions, the receptacles of diseases are related to Body and Mind only. Nature of Dosha vitiation (Shareera/Manasa) and symptomatology of manifested illness lead to the categorisation as Somatic or Psychic diseases/disorders. However, body-mind exists as continuum. Further the basic cardinal entity that is responsible for the formation of body and thus helping to create a conducive abode to the optimal functioning of mind is ‘Food’. Therefore along with the physical health, mental health and illness also fundamentally depend on the wholesome or unwholesome food intake.
This is the branch of Ayurveda dealing with Psychiatric conditions and their treatment aspects. The different descriptions under this section are mainly characterized by gross behavioral abnormalities that are categorized and named according to the similarity of expression of their behavioural breakdown to those of the ‘Bhootas’ or living beings of mythological origin viz., Asura, Rakshasa, Pitru, Pisacha, etc. These terms have been misconstrued widely and give Ayurvedic Psychiatry a superstitious outlook. Here the word ‘Bhoota’ is used not in the concept of spirits or demonic possession or the microbes causing infections, but in the concept of ‘living beings’ that are clearly explained by Acharya Vagbhata 7 i.e., the similarities shown in appearance, behaviour, speech, posture, gait and other psychomotor activities to the characteristics of the respective Bhootas is the basis behind the concept of Bhootonmada.
In Ayurveda, due importance was given to the role of psychotherapy (Satvavajaya) in somatic as well as psychiatric diseases. The essence of psychotherapy in many forms has been established in civilizations since the beginning of life in the form of counselling by elders either in supportive or in a rehabilitative way. Satvavajaya is achieved through spiritual knowledge, philosophical understanding, fortitude, remembrance of good things and concentration, Mantrah (Incantations), Manidharan (Precious Stones), Oushadam (Amulets), Mangalam(rites), Balih (sacrifice), Homah (oblations), Upavasah (fasting), Japah (prayer) and Vratam (vows) were considered a part of the Daivavyapasraya Chikitsa(spiritual therapy) which was deemed to be effective in diseases of mind and body alike. Current psychotherapy is a version of the Satvavajaya Chikitsa mentioned in traditional Ayurveda system.
For the sake of convenience in treatment, Manasika Vyadhi can be classified according to Dosha involvement and seat of manifestation. They may be divided as Kevala Manasika and Ubhayatmaka. Kevala Manasika Vyadhis are nothing but Vikara or Vega of Manas. Ubhayatmaka involve the Sharira and Manasa doshas. The classifications can be listed as:
This indeed help to understand that Ayurvedic texts describe a range of mental disorders, which seem to include all kinds of neurotic, psychotic, convulsive and personality disorders as known today.
The word Unmada is derived from the root word मद्prefixed with उद् and suffixed with घञ्
उन्माद = उद्मद--अधारेघञ् (Vachaspatyam)
Acharya Charaka defines Unmada as the impairment in function of the eight aspects or faculties that make up a human being viz., Manah (psyche/mind), Buddhi (intellect), Sanjna, jnana (knowledge/perception/ cognition), Smruti(memory), Bhakti (inclination), Sheela (Character/Nature/habits), Cheshta (psycho-motor activity/behaviour) and Achara (Conduct/Behavior), It can be understood that this definition encompasses a wider meaning; beyond the purview of mere Unmada, Unmada word itself becomes a prototype to describe all mental abnormalities with variation in presentation of these cardinal features.
Acharya Charaka in Chikitsa Sthana explains Unmada under two categories as Nija and Agantuja. Those with Doshic predominance are included under Nija and hence their Nidana, Laksaņa and Samprapti are explained on the basis of Doshas and are further divided into Vatika, Paittika, Kapahaja & Sannipatika. The term ‘Unmada’ refers to indiscriminant knowledge. The disturbances in intellect, perception and memory reflect in the form of alteration in the habits, preferences and behaviour of the person.
Prajnaparadha(Intellectual blasphemy), Asatmyendriyartha Samyoga(inappropriate contact of sense organs with objects) and Parinama(transformations of nature) are said to be factors that contribute to any disease, whether Sareerika or Manasika. Improper use of the intellect which results in a wrong understanding or impairment in judgement/discrimination which leads to hazardous or untoward activities is called Prajnaparadha. An unwholesome (excessive/deficient/distorted) stimulus perceived through senses, produces an unwholesome effect in the mind which in turn causes disturbance in the Sattvic quality of the mind and creates a Rajasic or Tamasic state, which predisposes the individual to disease. Kala Parinama refers to being out of synchrony in terms of natural transformation of nature, in terms of diurnal or seasonal variations.
‘Prajnaparadha’ is defined as perversion of dhee, dhriti and smriti resulting in defective decision making and inability in controlling mind from harmful objects. A wide list of factors under Prajnaparadha has been described in Ayurveda
A person whose intellect, fortitude and memory are impaired, subjects himself to intellectual blasphemy by virtue of his bad actions leading to the aggravation of all Doshas. In Charaka Samhita the causes of Manovikaras like Irshya, Shoka, Bhaya, Krodha, Mana, and Dvesha are attributed to the defects in the intellectual or mental faculty of the person.
Due to Prajnaparadha the person is unable to delineate the good and bad and therby causing impairment in judgement. He dreams and desires unattainable things, become too much attached to worldly things and laments over their loss and fails in facing adverse situations. Hence Prajnaparadha is considered as the root for all the manifestations.
Though many other etiological factors are mentioned under etiological factors of Mano Rogas, Charaka has clearly said that due to the Prajnaparadha of the person only, he is affected with mental illness.
It is due to Prajnaparadha that the ignorant indulge in unwholesome gratification of senses, suppression of natural urges, exposure to strain beyond their capacity and adoption of temporary pleasing regimen. But the wise due to the clarity of vision do not fall into it. Observance of certain regimens may produce temporary unhappiness but in the long run leads to happiness. The wise observe wholesome regimen after proper examination and understanding whereas others who are devoid of these qualities are afflicted with Rajas and Tamas, get tempted to do unwholesome activities and succumb to various types of psychosomatic diseases.
The doshas vitiated by unwholesome food, regimes and other causative factors in an individual with Alpa Satva mounts upwards through Manovahasrotas and vitiate Hrudaya, which is the seat of Buddhi, and disturb Manas occluding Manovahasrotas. As a result, Chitta is disturbed. This in turn causes loss of Buddhi due to which the individual loses the power of discrimination and indulges in faulty activities. And this disturbed state is referred to as Unmada.
Vibhrama of mind begin in the subtlest levels, often due to Prajnaparadha which leads to imbalance in Manogunas, which gradually grows with further interaction with physical, psychological, social, economical and environmental stressors and begin to manifest in gross level which is expressed in the form of Vibhrama’s which constitute Unmada.
Nija/Doshaja Unmada is characterised by the features such as intellectual confusion, fickleness of mind, unsteady vision, lack of patience, incoherent and indistinct speech, and inability to perform/process sensory information.
The symptoms of each variety of Unmada,viz., Vataja, Pittaja, Kaphaja, Sannipataja and Agantuja Unmada, is described in detail in all classical textbooks of Ayurveda and needs to be ascertained by the physician. Unmada is characterised by impaired functioning of Budhi(intellect), Sanjna(consciousness), Jnana(knowledge), Smrti(memory), Bhakti(inclination), Sheela(character), Chesta(behaviour), Achara( conduct).
A second category of Unmada has been described as Agantuja, which often manifest acutely without/with manifestation of prodromal symptoms. The different descriptions under this section are mainly characterized by gross behavioural, psychological and physical attributes and named according to the similarity of the expression of these behavioural breakdown to those of the ‘Bhutas’ or living beings, as described earlier Agantuja Unmada in general are characterized by abnormal behaviours in terms of exhibition of unnatural strength, energy, activity and enthusiasm, altered levels of perception, retention and memory, abnormality in speech and abnormality in perceiving self & environment and unexpected change in symptoms/relapse and remissions.
The word Graha - ‘Gŗhņati iti graha’ - that which catches or seize - is used to denote the unknown, unexplainable pathogenesis, especially in terms of doshic concept. For eg: In the case of Deva graha, it has to be inferred that the individual shows characteristic behavioural changes similar to that of a Deva like radiant face like that of a full blown lotus flower, calm and serene looks, lack of anger and less speech etc. Thus, the word Graha denotes the obscure mode of pathogenesis or manifestation and the mythological characters to which the similarity is shown became the basis of nomenclature.
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