Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

As the present chapter deals with the psychopathogenesis and diagnosis of ''unmada'', the fundamental approach of Ayurveda in the etiopathogenesis of psychiatric diseases needs to be discussed. Charaka considers violation of dietetic rules as an important causative factor for ''unmada''. Both body and mind are affected by diet. ''Unmada'' occurs in individuals taking diet in manners forbidden by the dietetic rules, consuming improper dietary articles, food articles that are unclean and ill prepared, incompatible and vitiated. According to Chandogya Upanishad, quality of mind depends upon the food taken by the individual. Once digested, the food is divided into three components – gross (''sthula''), medium (''madhyam'') and (''sukshma''). The subtle portion of the food nourishes the mind. Bhagavad Gita also opines that the sattvika, rajasika and tamasika types of buddhi (intellect) is derived from the characteristics associated with the type of diet. Thus, Ayurveda considers that incompatible, vitiated food articles affect the physical as well as mental state of an individual, predisposing him to psychiatric illnesses in general, if he is already harboring other causative factors.

As the present chapter deals with the psychopathogenesis and diagnosis of ''unmada'', the fundamental approach of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] in the etiopathogenesis of psychiatric diseases needs to be discussed. Charaka considers violation of dietetic rules as an important causative factor for ''unmada''. Both body and mind are affected by diet. ''Unmada'' occurs in individuals taking diet in manners forbidden by the dietetic rules, consuming improper dietary articles, food articles that are unclean and ill prepared, incompatible and vitiated. According to Chandogya Upanishad, quality of mind depends upon the food taken by the individual. Once digested, the food is divided into three components – gross (''sthula''), medium (''madhyam'') and (''sukshma''). The subtle portion of the food nourishes the mind. Bhagavad Gita also opines that the ''sattvika, rajasika'' and ''tamasika'' types of ''buddhi'' (intellect) is derived from the characteristics associated with the type of diet. Thus, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] considers that incompatible, vitiated food articles affect the physical as well as mental state of an individual, predisposing him to psychiatric illnesses in general, if he is already harboring other causative factors.

Secondly, psychiatric illnesses with special reference to unmada are not only associated with the vitiation of manas doshas but there is vitiation and provocation of sharira doshas as well. It points to the fact that though psychiatric illnesses are associated with subtle pathological changes at the bio-energetic level, they are also simultaneously accompanied by qualitative as well as quantitative changes/imbalances in the neurotransmitters & other bio-chemicals at the physical level. Thus, the normal psychological processes as well as the psychopathologies, operate simultaneously at multiple levels (biological, bio-energetic) & also at subtler levels where the intangible thought processes start appearing in the relatively tangible field of bio-energy. All this needs extensive exploration using the available scientific tools.

 

Thirdly, entire thought processes, attitudes, emotional experiences, desires and behaviors of an individual, which are relatively intangible, have the capacity to bring about qualitative as well as quantitative changes in the manas and sharira doshas, agni, and ojas. These psychological factors are also capable of bringing about structural as well as functional changes in the dhatus (body tissues), malas (biological byproducts & wastes) and srotasas (macro & micro-channels). These are some of the most fundamental considerations. which needs special attention.

Secondly, psychiatric illnesses with special reference to ''unmada'' are not only associated with the vitiation of ''manas doshas'' but there is vitiation and provocation of ''sharira doshas'' as well. It points to the fact that though psychiatric illnesses are associated with subtle pathological changes at the bio-energetic level, they are also simultaneously accompanied by qualitative as well as quantitative changes/imbalances in the neurotransmitters and other bio-chemicals at the physical level. Thus, the normal psychological processes as well as the psychopathologies, operate simultaneously at multiple levels (biological, bio-energetic) and also at subtler levels where the intangible thought processes start appearing in the relatively tangible field of bio-energy. All this needs extensive exploration using the available scientific tools.

 

Thirdly, entire thought processes, attitudes, emotional experiences, desires and behaviors of an individual, which are relatively intangible, have the capacity to bring about qualitative as well as quantitative changes in the ''manas'' and ''sharira doshas, agni,'' and ''ojas''. These psychological factors are also capable of bringing about structural as well as functional changes in the ''dhatus'' (body tissues), ''malas'' (biological byproducts and wastes) and ''srotasas'' (macro and micro-channels). These are some of the most fundamental considerations. which needs special attention.

 

 

#Developing an elaborate and objective assessment scale based on Ayurvedic principles for making it more understandable and useful in a clinical set up. The scale has been named as ''ashta manas bhava pariksha'' (assessment of eight mental faculties).

Now described in some detail would be each of the eight psychological and behavioral factors used in Ayurvedic studies on mental health:

Now described in some detail would be each of the eight psychological and behavioral factors used in Ayurvedic studies on mental health:

The term manas in this context refers to the thought, affect and emotional aspect of mind. Therefore, the various kinds of thought abnormalities like delusions and delusional ideations, and states of mood e.g. depressed, elated, anxious etc are assessed under this factor.  

 

The term buddhi (ya buddhi niscayatmika Ca. Sa 1/33) refers to intellect, decision making, and problem solving aspects of mental functioning. Standardized tools for assessing intelligence e.g. Weschler Intelligence scale, Bhatia Battery for Performance Test of Intelligence etc & clinical methods of test judgement are useful in this regard.

#The term ''manas'' in this context refers to the thought, affect and emotional aspect of mind. Therefore, the various kinds of thought abnormalities like delusions and delusional ideations, and states of mood e.g. depressed, elated, anxious etc are assessed under this factor.  

The term sanjna jnana refers to the awareness of surroundings and response to external stimuli and measures, phenomena such as orientation and responsiveness, and attention and consciousness. Clinical methods available for measuring these aspects should be used.

#The term ''buddhi'' (''ya buddhi niscayatmika'' Ca. Sa 1/33) refers to intellect, decision making, and problem solving aspects of mental functioning. Standardized tools for assessing intelligence e.g. Weschler Intelligence scale, Bhatia Battery for Performance Test of Intelligence etc. and clinical methods of test judgement are useful in this regard.

The term smruti refers to all components of memory, such as immediate retention and recall, recent memory and remote memory including learning acquisition. The available tools of memory measurement viz. digit span, object recall, Weschler Memory scale, PGI Memory scale etc. are useful for assessing this factor.

#The term ''sanjna jnana'' refers to the awareness of surroundings and response to external stimuli and measures, phenomena such as orientation and responsiveness, and attention and consciousness. Clinical methods available for measuring these aspects should be used.

The term bhakti refers to the normal, intact, altered & unusual desires related to food, dress, entertainment, study, work, hobby, sex etc. which are measured under this aspect.

#The term ''smriti'' refers to all components of memory, such as immediate retention and recall, recent memory and remote memory including learning acquisition. The available tools of memory measurement viz. digit span, object recall, Weschler Memory scale, PGI Memory scale etc. are useful for assessing this factor.

The term sheela refers to habits, temperament and general behavior, which are measured under this aspect.

#The term ''bhakti'' refers to the normal, intact, altered and unusual desires related to food, dress, entertainment, study, work, hobby, sex etc. which are measured under this aspect.

The term cheshta measures the psychomotor activity by clinically observing the retardation, agitation, restlessness, co-operativeness/ non-co-operativeness etc. in a psychiatric patient.

#The term ''sheela'' refers to habits, temperament and general behavior, which are measured under this aspect.

Finally, the term achara refers to personal & social conduct measured by misbehavior, quarrel, disrespect to elders & other respectable and other similar activities by a psychiatric patient.

#The term ''cheshta'' measures the psychomotor activity by clinically observing the retardation, agitation, restlessness, co-operativeness/ non-co-operativeness etc. in a psychiatric patient.

Some exogenous causative factors of unmada along with their mode of psychiatric infliction in a person have been enumerated below. However, these details are taken with contemporary assumptions, experiences and clinical practices applicable to a particular disease. Many of these beliefs and practices are still extant in many parts of the world. One of the bodies of practices in this field of study, Bhutavidya, was one of the eight branches of Ayurveda. The diagnosis of these  exogenous factors is based upon the clinical features, behavior patterns and time of affliction. These factors are being studied well under the purview of demonology, parapsychology. The beliefs regarding ghosts, demons are noted and studied to know exact mechanism behind them. However psychiatrist caution to rule out any other mental disorder first before labeling it as a demon. The negative energies in the cosmos may be regarded in view of exogenous factors causing unmada. Rajas and tamas are responsible for negativities, while sattva for positivity. Therefore these must be considered as psycho-dynamic factors to be treated.   

#Finally, the term ''achara'' refers to personal and social conduct measured by misbehavior, quarrel, disrespect to elders and other respectable and other similar activities by a psychiatric patient.

Last, but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of unmada are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.

 

Some exogenous causative factors of ''unmada'' along with their mode of psychiatric infliction in a person have been enumerated below. However, these details are taken with contemporary assumptions, experiences and clinical practices applicable to a particular disease. Many of these beliefs and practices are still extant in many parts of the world. One of the bodies of practices in this field of study, ''Bhutavidya'', was one of the eight branches of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. The diagnosis of these  exogenous factors is based upon the clinical features, behavior patterns and time of affliction. These factors are being studied well under the purview of demonology, parapsychology. The beliefs regarding ghosts, demons are noted and studied to know exact mechanism behind them. However psychiatrist caution to rule out any other mental disorder first before labeling it as a demon. The negative energies in the cosmos may be regarded in view of exogenous factors causing ''unmada''. ''Rajas'' and ''tamas'' are responsible for negativities, while ''sattva'' for positivity. Therefore these must be considered as psycho-dynamic factors to be treated.   

 

Last but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of ''unmada'' are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.

 

 

Table 1: Behavioral and psychological manifestation of triguna  

==== Table 1: Behavioral and psychological manifestation of triguna ====

 

Sattva Rajas Tamas

Sattva Rajas Tamas

Enlightening Propulsive & dynamic Inhibitive

Enlightening Propulsive & dynamic Inhibitive

Tense

Tense

Table 2:Predominance of raja and vata

==== Table 2:Predominance of raja and vata ====

 

Disease Clinical features Predominant dosha

Disease Clinical features Predominant dosha

1. Panic attack Palpitation, sweating raja, pitta

1. Panic attack Palpitation, sweating raja, pitta

vata-pitta

vata-pitta

Table 3:Predominance of raja and vata

==== Table 3:Predominance of raja and vata ====

 

Disorder Clinical features Predominant dosha  

Disorder Clinical features Predominant dosha  

Generalized Anxiety Excessive anxiety & worry (apprehensive expectation) raja, vata

Generalized Anxiety Excessive anxiety & worry (apprehensive expectation) raja, vata

Sleep disturbance Vata

Sleep disturbance Vata

Table 4:Predominance of tamas and kapha dosha

==== Table 4:Predominance of tamas and kapha dosha ====

 

Disease Clinical Features Predominant dosha

Disease Clinical Features Predominant dosha

Major Depressive Illness Depressed mood most of day tama, kapha

Major Depressive Illness Depressed mood most of day tama, kapha

recurrent suicidal ideas tama, kapha

recurrent suicidal ideas tama, kapha

Table 5:Predominance of Raja and Pitta dosha

==== Table 5:Predominance of Raja and Pitta dosha ====

 

Mania A distinct period of abnormality and raja, pitta

Mania A distinct period of abnormality and raja, pitta

persistently elevated, expansive or

persistently elevated, expansive or

During the period of mood disturbance any three or more of above Symptoms have persisted

During the period of mood disturbance any three or more of above Symptoms have persisted

Table 6: Predominance of Raja and Vata

==== Table 6: Predominance of Raja and Vata ====

 

Schizophrenia Social withdrawal, often with

Schizophrenia Social withdrawal, often with

deterioration in personal care, tama, kapha

deterioration in personal care, tama, kapha

of one's own actions. raja and vata

of one's own actions. raja and vata

Case Paper Format Points

=== Case Paper Format Points ===

 

The format for the clinical assessment of manovahasrotas or The psychiatric assessment.

The format for the clinical assessment of manovahasrotas or The psychiatric assessment.