Traditional approach to treat mental disorders

by Ayur. Dr. Saman S. Hettige

World Mental Health Day falls on October 10

The world's oldest classification in Psychiatry is found in Ayurveda and Desheeya Chikithsa Traditional system of psychiatry which is over five thousand years old probably the oldest systematic psychiatric treatment in the world classified by twenty two psychopathologies. It emphasises how important the biological predisposition is to amalgamate with the environmental factors to develop psychiatric disease in human beings. This system is still practised in its original form at Manasa Hospital Boralesgamuwa, Neelammahara by generations of traditional psychiatrists; a virgin system of holistic medicine which is endemic to them. There will be a free medical clinic and an awareness campaign which they have been conducting annually for many years, for mentally ill patients and their guardians on October 10th to commemorate World Mental Health Day.

"Subbepruthugjana Ummaththaka" a famous Pali saying preached by Lord Buddha 2500 years ago in Majjama Nikaya Moola pariyaya soothra, which means everyone in this society suffer from a Mental disease or psychological disturbance.

It may have been either a minor or a major disturbance.

Lord Buddha has also said in Anguththara Nikaye Duka Nipatha that there are two types of illnesses which people will suffer during their lifetime. That is Mental illnesses and Physical illnesses. Anybody can prevent getting a physical illness but nobody can prevent from infecting a mental disease during the course of their life.

There are 450 million psychiatric patients around the world. According to the WHO in one in every four families you find psychiatric patients. One million patients commit suicide every year. By 2220 Psychiatry will become second only to heart disease, says Dr. Saman Hettige, Medical Superintendent Manasa Hospital.

Ayurveda and Desheeya chikithsa, one of the oldest therapies known to human beings have dealt with many a Psychiatric disease probably a human brain could have had during their lifetime. Not only about the Psychiatric problems but also many aspects of psychiatric disorders such as treatments, rehabilitation, follow ups, social aspects of these illnesses has been discussed in these oldest art of healing.

In Ayurvedic classical text such as Sussrutha Samhitha, Charaka Samhitha, and Madava Nidana and in our traditional system of psychiatry many a psychological condition and psychiatric conditions have been discussed in length. This could have been the oldest recorded classification of psychiatric disorders in the world.

What is astounding is that all these diseases, which have been discussed four to five thousand years ago, are now being classified in modern psychiatric classifications.

Traditional classification and Modern psychiatric names according to the clinical features.

Pitta Unmada - Melancholia

Suthika Unmada - Postnatal Psychosis

Dubala Unmada - Senile Dementia

Sithperalum or Shokaja Umathu - Depression

Thundos Unmada - Mania

Madathaya or Sura Unmada - alcohol dependency

Kama Unmada- Nymphomania

Moha Unmada - Delusional Disorder

Butha Unmada - Hallucinosis

Viyasana Unmada PTSD

Though Buddhism and Ayurveda are two different philosophies its goals are more or less the same. That is Mental Physical and spiritual liberation or Vimukthi....

Ayurveda approach

The overall perception of health in Ayurveda depends on three factors. Waa, Pith, Sem. If imbalance is caused to any of these it can either create a disorder in one's physical health or create an imbalance in Mano dhosa. Mano dhosa consists of three elements of power which controlled the activities of the brain, one's behaviour, cognition and thoughts and perception. These factors are mainly responsible for one's mental health. Imbalance of three Mano dhosas namely Sathwa, Rajas and Thamas leads to Psychiatric disorder.

Human behaviour is a strange phenomenon that can be disturbed in many ways.

According to traditional psychiatric concepts human behaviour is totally controlled by the human brain - (Hurr da yam chethanasthanam - Charakasamhitha......).

When the brain loses its balance it effects human behaviour in every way. Severe distortion of reality can be seen. Thinking perception and emotion may deteriorate, there may be a withdrawal from social activities.

Their behaviour becomes abnormal or disordered presence with hallucinations, delusions and extremes of emotionality either aggressive or violent or do unwanted useless things or become less active, cry or laugh.Their speech becomes abnormal either flow is high or mute. Their feelings and thoughts get distorted. They will start feeling or thinking in an unusual way. They start feeling that they are being charmed or poisoned or there is cue behind them or they are being followed by police or the CID or suspicious about family members' neighbours.

Patient think that he or she has a direct connection with the God or he or she is about to get a special divine super power from God or a deceased person, etc.

These are called delusions. Delusions are abnormal beliefs and this is called Moha Unmada in Ayurvedic psychiatry.

Another disturbance can be seen in their perception.

Their perceptions become totally or partially disturbed. They will start hearing voices "unclear voices" talking or discussed or criticized about the patient himself, blaming them, being pursued towards unethical things by these voices or shouting obscenities at him. Healthy people do not hear these voices. Those are called auditory hallucinations. Hallucinations are perceptions occurring in the absence of stimulus, which the patient takes to be real.

In Darshana Unmada or visual hallucinations they see animals, geographical pictures different colours etc...

There are different types of hallucinations. Besides auditory and visual hallucinations olfactory (smell), gustatory (taste), tactile (touch) or somatic (bodily or visceral sensations).

In our society there is a mythical belief that the cause for the mental diseases is of an evil spirit or by an influence of a ghost or a God.

A Patient thinks that he or she has a direct connection with the God or he or she is about to get a special divine power from God or a deceased person. This condition is well described in our classical texts (under 22 types of psychopathologies) as "Butha unmada". Butha means invisible spirit, god, ghost or whatever according to their belief. Unmada means a psychiatric condition.

When the force Rajas is excessive the patient has a tendency to be violent, hostile and aggressive. They also develop uneasiness and lack of sleep, which, if left untreated, could develop in to Sinahasum Anthaya.. Sinahasum means smiling and Anthaya means end the smiling, end of one's mood or the Mania as described in traditional texts. Manic patients feel too much happiness, smiling to self, laughing to self, hallucinations and delusions, big ideas (grandiosity) I am the king, I am the president, I am the god etc.......

If Thamas force is in imbalance the individual develops sadness and pessimistic idea. As the condition worsens, the patients develop symptoms such as social withdrawal, intense contemplation, lethargies, thoughtfulness and become irritable. This end is called "Hadum Anthaya". This condition is known as clinical depression in western psychiatry.

Sathwa force operates as the neutral force which balances the two other forces. It provides its full power to keep the other two forces in harmony.

The exclusiveness of our system of psychiatric medicine is that, we do not use our treatment on the disease or the condition by the name itself. We treat the patients and use our therapies to remove the root cause. There are situations where these ends alternate each other from time to time. The mood is fluctuating from time to time or from period to period. Manasa Ayurveda Hospital is located in a village called Neelammahara 20 miles away from Colombo city and a long established place for a local traditional (Desheeya Chikithsa) or Ayurvedic psychiatry.

This village Neelammahara, has, anyway been famous for indigenous treatment for psychiatric disorders. Before my father Ayur. Dr D. S. Hettige established the hospital, the entire village was making a living from the medication they provided. Each family was entitled to one patient.

The history of the traditional psychiatric medication method goes back to 500 years. The traditional knowledge is believed to have been bequeathed by a Royal physician who served King Rajadi Rajasinghe who reigned during the late 18th Century.

The physician had served as a consultant psychiatrist and a counsel or to both the royal family and royal Army. The ancient text which refers to psychiatry, has detailed writing on the disease, management and treatment suited for each affection.

Textual facts indicate that the ancient healers used these secret herbal formulas to treat many psychological, psychiatric and medical disorders

According to this tradition there are 22 types of psychopathologies. These medical texts explain further the etiology, management and the treatment of the psychiatric disorders. Apparently these facts are etiologically and symptomatically very close and similar to the descriptions given in modern psychiatry.

'Manasa' Ayurvedic hospital is a long established Ayurvedic centre for psychiatric treatment now managed by the 8th generation of traditional physicians.

They have been following the same Ayurvedic traditional ritualistic pattern of treatments as their ancestors did as you can see how they perform treatments blending ayurveda and Buddhist psychology for various kinds of chronic and acute psychological problems. These time-tested and clinically-proven secret formulas were taken from an ancient ola leaves endemic to the Neelammahara Hereditary Psychiatrist's tradition.

Treatment

In ayurveda the treatments are mainly divided into three. Ukthhi Viyapashra (Rational therapy), Daivap Viyapashra (Spiritual therapy) and Sathvawviyapashra (Psycological therapy).

Treatments are conducted according to the severity of the individual's condition. If the patients are aggressive, hostile, and if the treatment cannot be conducted at home, we admit them to our hospital.

For patients who are aggressive and hostile, special treatments such as Nasna (Nasal draining), Hisagalvum (head packs) Werechana (Purgatives) and Sheerodara are administered. There is no point in subjecting to counselling, because, if their condition is critical, counselling would have no effect. So that is why we are using these special methods to sedate the aggressive patients in the initial stage.

The head packs are prepared using various formulas, described in the ancient texts of ola leaves.

This mixture is made from a blend of several medicinal herbs, after the patients wear the head pack for three hours, he or she is directed to have a bath, usually from a special pond prepared for this purpose. This treatment balances the three humours.

Or the Mano dhosa which controls the brain. There are many types of head packs which are selected according to severity of the problem and patient's health conditions.

Nasna karma or nasal draining is done after several head packs are completed. This is done mainly to drain the stagnated "Shelshmala" or the phlegm which obstruct the cognition, thought and disturb one's behaviour and perception. By draining we expect the three Mano dhosa and Kaika dosha to be balanced.

Acute patients are also treated with "Desheeya Chikithsa"such as Kasaya (Decoctions), Guli, Kalka which comes under Yukthi Viyapashra or rational therapy in ayurveda and use "Nila" or the pressure points to controlled the patient.

Treatment connected with occult science is important for patients who suffer from "Butha Unmada" (Hallucinosis) because these patients tend to imagine that they are blessed by god and are given a special super human divine power.

Also in this condition they start hearing voices. In Ayurveda Charaka samhitha it is defined as Sanghna Vibrama. Sanghna means perception and vibrama means distorted.

Psychotherapy in ancient Sri Lanka

The ancient Sri Lankans too, believe in this concept that psychological disorders and psychiatric conditions are caused due to demonic influence and evil spirits. One famous belief among Sri Lankans are the Black -prince demon (Kalukumaraya) widely held responsible for a psychiatric disorder affecting young women whose marriages are getting delayed. They suffer from episodic altered behaviour and consciousness and they believed that a black demon visits them for sex regularly. Women suffer from loosing weight, poor appetite, sleep deprivation, lack of concentration, heatiness of body symptoms.

The "Kalukumaraya" is a symbolic concept among ancient Sri Lankans which reflects repressed emotions in unconscious. This is a clear indication where it shows ancient Sri Lankans knowledge of an unconscious mind leading to psychological disturbances and psychiatric disorders.

Repression is the most fundamental mechanism. It is a process in which some need conflict or hurtful unpleasant experience is shut down into the unconscious.

It is not a voluntary process. Many of the unhappy things which we have experienced in the past can no longer be remembered because at some point they have been repressed. This does not mean that they no longer exist.

Neurosurgeons discovering that many things we thought we had forgotten, perhaps everything which has ever happened to us, remain stored in the brain as on a tape recorder.

Repressed materials may come out when the person least expects it.

Psycho analysts believe that in order to cure a mental disorder it is necessary to uncover repressed material, even powerful repressions which go back to the first years of life.

Had ancient Sri Lankans known psychoanalytic phenomena, psychology and psychotherapy? Certainly they would have known but not merely by the modern terms. Another example for psychotherapy is, as earlier mentioned for psychiatric or psychological disorders they performed rituals or remedies such as exorcisms of all kinds bali, thovil, yaga homa, shanthi karma. It has been suggested with good reasons, that these bali, thovil, yaga homa have a psycho therapeutic effect on patients. Even in modern Sri Lanka they perform these ceremonies like "Daha ata paliya" for hysteria and "Kohomba kankariya" for sub fertility. But not for all psychiatric disorders

Causes for psychiatric disorders

According to Ayurveda, "Nidrava" or sleep plays a vital role in one's mental health. One needs to have a sound sleep for at least 7 to 8 hours a day for the well-being of one's mental health. It is stressed that breaking rest at night and sleeping during the day time, are factors detrimental to the well-being of one's mental health.

The food we consume has an impact on our Mano dhosa and Kaika dhosa (Mental and physical health). If consuming harmful food influences the Mano Dhosa, it can affect the Kaika dhosa and Manasika dhosa as well as in the end cause the malfunction of the brain.

This also indicates that physical conditions also affect the psychological state of and individual and vice versa. In Sankaya dharshanaya this bond is known as "Samavai Sambandathavaya" if broken there will be losses in the bond between the body and mind.

Environment plays a vital role in one's mental health. If the individual is frequently exposed to stress induced environment or, if a person is addicted to substance such as alcohol, heroin, or even betel leaves they are vulnerable to mental illness.

Hereditary factor is also mentioned in the classical text as Nija Roga.

World Mental Health Day

October 10 World Mental Health Day. The Manasa Ayurvedic Hospital would be conducting a mental health campaign at the hospital premises on October 10 from 10 a.m. to 6 p.m. to create awareness among the people on issues regarding the mental health.

We want to make people aware of three conditions. Most often patients' guardians fail to recognize these conditions. and bring them to us only after the situation is worse.

Once the disease becomes Nidangatha or chronic, it is very difficult to handle than during acute phase.