Ancient Indian Perspective on Psychosis

In early part of 19th century, Dr. James Esdaile, a surgeon working in Kolkata under the East India Company, with the help of his native assistant, experimented with and used Mesmerism as a pain relieving technique during the surgeries he performed and also in some cases of mental problems. Due to good appreciation for his work from his peers, he managed to get official support to establish a Mesmeric hospital in Kolkata. Later his work was considered to be controversial rather than being appreciated for its painless techniques in treating people. He was also criticized to be a trickster.

Modern psychiatry and its is explained in terms of series of western science neglecting the cultural aspect of it. The history of psychiatry has elements of both scientific and cultural traditions, thus it is also considered as heterogeneous. There is no universal conceptualization of psychiatry as traditions differ from one population to the other. When it comes to history of ancient India chronology becomes a greatest issue. According to Vedanta, Atman is the core of personality that controls mind, body and intellect, but Vasanas determines the functions and characteristics of them. This difference between the mind and Atman has always confused the Western philosophers, till the researches of Freud, Jung, and Adler recognized the reality of unconscious.

Cartesian dualism differentiating mind from matter is very recent to the Western thought while the Indian philosophy, particularly the Upanishads understood the mind “more from within than from without. ” Vedas mention mantras for prayers to bring noble thoughts to mind and purify it. Rigveda describes sattva, raja, and tama as personality traits and also identifies mental illness independent of physical illness. Yajurveda conceptualized mind as the inner flame of knowledge. Atharvaveda describes Manas, a tool of hypnotism and explains about will power, emotions, unconscious and inspiration in detail. “Unmad” (psychosis) has been mentioned as a deluded state of mind in Vedas with etiology suggestive of both organic (worms/microorganisms, fever, etc. ) and functional (sins toward Gods) origin.

Vedas also mention treatment for mental disorders ranging from psychosis, epilepsy, sleep disorder, and aggression in the form of “Bheshaj” (medicine) and prayers to God (psychotherapy), along with preventive methods such as “Yam” and “Niyam” (behavioral control) and “Asan” and “Pranayam” (physical activities). Upanishads describe the various states of mind (Jagrat, Svapana, Sushupti, and Samadhi), theories of perception, thought, and memory. Ichchha Shakti (will) Kriya Shakti (Action) and Jnana-Shakti (Knowledge) were described by them as the three mental potencies, and the psychopathology was understood by Trigunas and Tridosas. Bhagavad Gita is the simplified and condensed form of the Vedas and Upanishads as they are difficult to comprehend by all.

Charak Samhita and Sushrut Samhita, the two classics of Ayurveda describe mental disorders according to trigunas (sattva, raja, and tam) and tridoshas (three humors in the body vat, pitta, kapha). They also describe 14 causative factors which include immoral behavior, weak mind, stress, anxiety, and substance to name a few. They also classify mental disorders as “Nijmanas rog” (endogenous) and “Agantujmanas rog” (exogenous) with further subdivision of “Nijmanas rog” into “manas dosh” (psychological) and “Sharir Doshanubandh” (physical) causation types. In Ayurveda, over 200 herbal medicines have been described and categorized into various categories such as memory enhancer, intoxicating, antipsychotics, and anticonvulsants. Buddhism and Jainism (around 6th century AD) brought in the philosophical systems (Nyaya, Vaiseshika, Samkhya, Yoga, and Vedanta) following which medicine separated from the magicoreligious tradition and entered into an alliance with these philosophical systems.

Buddhist conceptualization of psychosis as the “breakdown of one's worldview with insufficient emotional support from within” and severe mental illness as a result of pursuing a lifestyle that is different from inherent disposition and spiritual destiny, appears to be the bridging gap between the religious certainties and rationality during those times. With the advent of the Delhi sultanate and the Mughal dynasty which followed it, Unani medicine gained prominence. Najabuddin Unhammad (1222 AD), a prominent Unani practitioner of his time, described seven types of mental disorders; Sauda-a-Tabee (Schizophrenia); Muree-Sauda (depression); Ishk (delusion of love); Nisyan (Organic mental disorder); Haziyan (paranoid state), and Malikholia-a-maraki (delirium).

Overall, after the classical era (maybe till 2nd century AD), development in the conceptualization and management of mental illnesses from an Indian perspective was not evident and following the arrival of the British empire, India became a part of the modern psychiatry.