Insanity: Ayurvedic vs. Western Medicine Perspectives

By: Alexandra Compson

November 4, 2010

INTRODUCTION

    The condition of “insanity,” better known to the modern world as “psychosis,” is an illness of the mind that has been recognized throughout history within every known society. Today, insanity is characterized by the adherence to fixed, delusional beliefs existing outside the normal range of one’s subculture, including hallucinatory experiences and thought disorders in which the mind does not follow any rational line of thinking[1].
    Within the field of Western medicine, psychosis is viewed as a complex of visible symptoms and effects rather than as an indicator of a simple root cause. From this view, it appears that the primary threat posed by the condition is its potent ability to “prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others.”[2] The main goals of Western medicine in the treatment of psychosis includes the reduction of both positive and negative symptoms produced by the illness, maintaining or increasing cognitive abilities, minimizing side effects, reducing secondary diseases, preventing relapse, and enhancing the sufferer’s quality of life.
    In contrast, the Ayurvedic approach to insanity rests on the premise that, “All mental disease originates in a lack of clarity (sattva) within the mind.”[3] Halpern, p. 332. Thus, Ayurveda’s primary goal of treatment is the cultivation of sattva, a state of mind that, according to basic Ayurvedic tenets, can be attained through proper diet and lifestyle. Very little information can be found in Western medicine advocating either diet or lifestyle as a foundation of mental clarity or a cure for mental illness.
    In order to compare the Western and Ayurvedic approaches to insanity, we must first explore what “insanity” means within each world-view. How does the Western world’s understanding of insanity differ from that of Ayurveda’s? What sorts of treatment methods are utilized by these two medical sciences in its management? The objective of this paper is aimed towards the exploration of and answers to these questions.

WESTERN MEDICINE’S VIEW OF INSANITY

A Brief History
    As mentioned previously, “Madness, the non-legal word for insanity, has been recognized throughout history in every known society.”[4] It is known that primitive cultures turned to witch doctors or shamans to apply magic, herbal mixtures, or folk medicine to rid deranged persons of evil spirits or bizarre behavior[4]. However, it was the relatively recent years of the 18th century that saw the seeds of modern psychiatry begin to sprout. Though the Ancient Greeks and Romans had progressive ideas regarding mental illness, the Middle Ages witnessed the end of such revelations. It wasn’t until the 1700s that this tide again began to turn, as the French and British introduced humane treatment of the clinically insane[5]. The late 19th century advent of psychoanalysis led to increasingly enlightened exploration and treatment of mental illness. In retrospect, it seems inevitable that psychiatrists and their counterparts in the psychoanalytic field would soon begin to feel uncomfortable with the term “insanity” and its obscure definition within the realm of scientific medicine[6]. By the mid-20th century, insane asylums were outdated, and “Increasing disillusionment with and desire to distance theory and practice from the field’s asylum-dominated past provided further impetus for physicaians to leave the 19th century traditions behind…”[6]. Being able to define the difference between “normalcy” and insanity is part of what moved psychiatry and the psychoanalytic field to where it is today[5]. Insanity is no longer considered a medical diagnosis in the United States, although it is still a legal term[6]. “Psychosis” has become the modern medical equivalent of the term “insanity.”[4][5][6]

Insanity Defined from a Western Medical and Psychological Perspective
    According to the American Medical Association, psychosis is a mental condition defined as:
“A severe mental illness in which a person loses touch with reality, experiences unusual perceptions (hallucinations), and holds false beliefs called delusions. Psychotic disorders include schizophrenia (an illness involving delusions, hallucinations, abnormal speech, and strange behavior) and delusional disorder (in which a person has a persistent belief that seems very real to him or her but is not shared by others.”[3] pp. 575-576

Understanding Insanity from a Western Medical and Psychological Perspective
    The understanding of factors that define mental pathology and those that define “normalcy” are largely prescribed by one’s society and culture. For example, a behavior that may be seen as problematic in our society may be seen as normal within another society[8]. In Western medicine the mental illness known as “psychosis” is a syndrome classified as either “organic” (non-psychological) or “functional” (psychological). Psychosis arising from “organic” conditions are associated with numerous medical or pathophysiological diseases including electrolyte disorders [9], multiple sclerosis10] and syphilis[11], whereas “functional” psychosis can be caused by a variety of dysfunctions such as biochemical changes within the brain or differences in the brain’s ability to function and process information[8].

Western Medical Etiology
    In Western medical thinking, insanity, or psychosis, is largely known to be caused by various medical conditions and organic disorders (e.g. thyroid abnormalities[1]). In addition, the introduction of foreign chemicals into the body (e.g. alcohol, cocaine, various prescription drugs) may also disturb normal neurological processes. In Western medicine the above pathologies are known to cause structural defects and/or physiologic brain dysfunction, which, in turn, can lead to the onset of psychosis within the affected individual[1].

Signs and Symptoms
    Symptoms of psychosis may include disordered thought and speech[2], false beliefs that are not based in reality (delusions)[2], hearing, seeing, and/or feeling things that are not there (hallucinations)[2], thoughts that “jump” between unrelated topics (disordered thinking)[2], and what is known as “disturbance of affect”[1] in which a person’s apparent emotions are not consistent with their thoughts or fluctuate rapidly[1].

Western Medical Treatment
    Various treatment methods are available in the management of psychosis, though treatment depends largely upon the cause, diagnosis or diagnoses of the psychosis. Most treatment methods, however, typically begin with the administration of antipsychotic medication as the first line of treatment, while hospitalization is often required to ensure the patient’s safety. Cognitive behavioral therapy[12], family therapy[13] and animal-assisted therapy[14] is supported by growing evidence in the management of symptoms and for the patient’s general long term well-being. Electroconvulsive therapy (also known as electric shock treatment) may be applied if all other treatments prove ineffective.
    Additional treatment methods include early intervention in psychosis, a relatively new but effective concept based upon the observation that identifying and treating a person in the early stages of psychosis can significantly improve their long-term outcome[15]. This approach advocates use of intensive multi-disciplinary techniques during the “critical period” – the period when intervention is seen as critical to the outcome of the patient’s condition – and prevents long-term morbidity associated with chronic psychotic illness. Cognitive behavioral therapy during this “critical period” can aid further in the delay or prevention of psychosis[16].

AYURVEDIC VIEW OF INSANITY

Insanity Defined from an Ayurvedic Medical and Psychological Perspective
    According to the Ayurvedic text Ashtanga Hridayam, “Unmada (insanity) is of six kinds, by each dosa separately, by the combination of all of them, by sins and by poison. Unmada is mada (toxicity, disorder) of the manas (mind) produced by the dosas (vata, etc.) moving in the wrong paths (because of their increase).”[17] Murthy, p. 56. Similarly, the Ayurvedic text Charaka Samhita defines insanity as the perversion of the mind, intellect, consciousness, knowledge, memory, desire, manners, behavior, and conduct[18].

Understanding Insanity from an Ayurvedic Medical and Psychological Perspective
    Ayurveda views mental disease as the result of a lack of clarity (sattva) within the mind[4]. As the quality of sattva becomes diminished within the mind, it is only a matter of time before imbalances appear within the three biological humors: vata, pitta and kapha[19]. In his book, Ayurveda and the Mind: The Healing of Consciousness, Dr. David Frawley states, “Health problems, whether physical or mental, are not merely personal problems, but energetic problems in the mind-body complex. They are not so much personal or moral failings as an inability to harmonize the forces within us.”[19]
Within the classical texts, six types of unmada (insanity) are described. These include one for each dosha (Vatonmada, Pittonmada, Kaphonmada), one for a combination of all three doshas (Sannipatonmada), one due to mental shock (Citta Ghataja Unmada) and one caused by poisons (Visaja Unmada)[17].
    According to Ayurveda, the mind, or manas as it is known in Sanskrit, is composed primarily of the air and ether elements[19]. Thus, of the three doshas vata is commonly behind most psychological disorders[19]. Excess air within the mind causes mental instability and agitation, which leads to excessive thinking, worrying, and ultimately the perception that our problems are much worse than they really are[19]. “The mind becomes overly sensitive, excessively reactive, and we take things too personally. We are prone to premature or inappropriate action that may aggravate our problems.”[19] Frawley, pp.154-155.
    Pitta-type psychological disturbances occur moderately, as pitta tends to have strong self-control[19]. However, pitta’s tendency to be self-centered and anti-social can lead to problems, while its fire and heat often creates a narrow, quarrelsome mind[19]. Excess aggression and hostility are the root cause behind most pitta-type psychological disorders[19]. “Typical Pitta is the overly critical type who finds fault with everyone, blames other people for everything, sees enemies everywhere, is always on guard and ready for a fight.”[19] Frawley, pp. 155-156
    Psychological disorders due to kapha dosha are least common to occur due to the dosha’s inherently strong, stable nature. Problems can arise, however, when vitiated kapha produces blocked channels and clouded senses[19]. Excess kapha within the mind causes mental dullness, congestion and poor perception[19].
    According to Frawley, Ayurveda sees the deluded mind as a condition dominated by the quality of tamas or darkness[19]. The mind is absorbed in a blank state in which consciousness of the body is obscured or lost[19]; it is a mindless, non-feeling state of inertia: “…like a drunk lost in a drunken stupor lying half-conscious on the floor.”[19] pp. 294-295.
    The quality of tamas generally dominates within the schizophrenic mind as well[19]. In this condition, a person goes into trances, sees hallucinations, hears voices, etc.; the mind is absorbed in its own fantasies and the patient loses conscious control over their own mind[19]. Frawley states, “All these are not merely aberrations in the brain. They may include psychic abilities or psychic sensitivities but are beyond the control of the person. The person may connect up to the astral plane and lose contact with physical realities. In these cases, the mind goes into an absorption of the dull or blank type and sometimes an astral entity comes in to use the mind.”[19] p. 297. Interestingly, according to Frawley all severe mental derangement involves some type of astral entity possession or influence[19].

Ayurvedic Etiology
    The Charaka Samhita states, “One of the criteria for the disease process to rapidly manifest, occurs in these circumstances: when his mind is afflicted over and over again by passion, greed, excitement, fear, attachment, exertion, and grief. In the circumstances…the mind gets seriously affected and the intellect loses its balance. So the doshas aggravated and vitiated enter the cardiac region, obstruct the channels of the mind resulting in insanity.”[20] p. 89. Furthermore, the text cautions against the disharmonious acts of Prajnaparadha (intellectual blasphemy, the failure of the intellect, or crimes against wisdom[21] p. 7) and its ability to provoke the  gods who in term cause the insanity.
Within Ashtanga Hridayam, Vagbhata relates, “Indulgence in unsuitable (unhealthy) foods and drinks, foods which are spoilt, unaccustomed, containing dirt (contaminated) and using (foods, and drinks) in improper manner; those who are dejected (due to worry, grief, etc.), who are of weak mind, by the effect of sudden increase of diseases, emaciated persons indulging in activities in improper ways, committing mistakes in the procedure of worship of the worshipful, by committing sinful acts, loss of balance of mind, by the effect of strong poisons or weak poisons -- by these causes the doshas getting increased in the heart (mind) in persons of feeble mind, produce vitiation of the mind, and destroying (invading) the manovaha srotas (channels of the mind) cause unmada (insanity); dhi (discriminating/deciding capacity) vijnana (capacity of special knowledge to understand the science, arts etc.) and smriti (power of remembrance of earlier happenings) having become abnormal (lost or impaired) make the body lose the feeling of happiness and unhappiness and like a chariot devoid of a charioteer, the person begins to resort to activities without any thinking.”[17] pp. 56-57.
    In Ayurveda two types of insanity are described: According to B.S. Venkataram in his article “Ayurvedic Definitions and Classification of Manovikara,” nija rogas, or insanity due to endogenous conditions are, “…caused by irregular food habits and psycho behavioral excess resulting in the impairment of the Sarira [body] dosha physical element.” [22] p. 60. Falling under the category of nija roga, manasa (psychological) rogas occur due to the gain of undesired objects or losing the desired object/cherished ones, resulting in the impairment of the Manodosha (mental elements)[22].
    Insanity due to exogenous conditions are caused by injuries, poison, fire, and wind[22]. The Charaka Samhita adds that exogenous insanity may be caused by the “…effects of sinful activities in a past life. Lord Punarvasu Atreya considers intellectual blasphemy as the Nidana (causative factors) of this condition.”[20] p. 93.
    As the dominant dosha within the mind, vata-type psychological disturbances occur most commonly. Fasting, irregular eating habits or insufficient food, and the excessive intake of dry, cold foods easily weaken and upset the vata-dominated mind[19]. “…Disturbing sensations are hard for Vatas to handle, particularly too much exposure to mass media, loud music or noise. Drugs and stimulants easily derange them…Excessive or unnatural sexual activity quickly drains their often low energy. Stress, fear and anxiety affect them emotionally because they lack calm and endurance. Violence and trauma leaves them hurt and withdrawn. Neglect or abuse as a child creates a predisposition for a Vata-deranged psychology.”[19] Frawley, p. 155
    Pitta-type psychological disorders occur due to conditions of excess heat[19]. Overly hot, spicy foods easily disturb the pitta mind[19]. Strong, bright colors and sensations irritate their senses[19]. Exposure to violence and aggression increase similar attitudes within them[19]. Sexual frustration, excessive anger and ambition often cause problems as well. Frawley expounds, “Too competitive an education or too much conflict in childhood are additional factors.”[19] p. 156
     The basis of kapha-type psychological disorders lies within the consumption of excess sugar and oily foods. Excess pleasure, enjoyment, attachment, too much sleep, sleep during the day, and lack of exercise add to the potential of a psychological disturbance within the kapha-type individual[19]. In addition, “Emotional problems combine with Kapha physical conditions like over-weight congestion. Educational factors include being overly indulged as a child or emotionally smothered by parents.”[19] Frawley, p. 157.

Signs and Symptoms
     “In unmada (insanity) produced by (increased) vata, the body is emaciated the person weeps becomes angry, laughs, smiles, dances, sings, plays musical notes, speaks, does movements of the different parts of the body, and makes loud sound – all these at improper time and place; imitates the sound of the flute, vina (lute) etc. violently and often; froth exudes from the mouth, roams about constantly, speaks too much, decorates himself with non-decorating things, attempts to travel on things which are not vehicles; desires foods but abuses them after obtaining, the eyes protruding and red in color and the disease (symptoms) appearing after the food is digested.”[17] Murthy, pp. 57-58. Excess vata within the mind causes the individual to become ungrounded and unrealistic, producing overactive and wrong imaginations, hallucinations and delusions[19]. Over activity of the mind results in dispersed life-force energy (prana), leaving the afflicted weak, with a diminished connection to the physical body and physical reality. Vata-type psychological disorders are behind feelings of fear, alienation, anxiety, and nervous breakdowns[19]. Insomnia, tremors, palpitations, unrest, and rapid shifts in mood are due to vata as well. Frawley adds, “Insanity of the manic-depressive type, or schizophrenia, is an extreme Vata imbalance.”[19] p.155
     “In unmada (insanity) caused by pitta, the patient threatens others, becomes angry, attacks others with the fist, stones etc. desires cool shade and cold water, remains naked, has yellow color (of the skin etc.) sees fire, flames, stars and lamp which are not actually present.”[17] Murthy, p. 58. Excess pitta (heat) within the mind produces agitation, irritation, anger, and possible violence[19]. “The overheated body and mind seek release in venting the built-up tension. Pitta types can become domineering, authoritarian or fanatic. When disturbed they may have paranoid delusions, delusions of grandeur, or can becomes psychotic.”[19] Frawley, p. 156.
     “In unmada (insanity) caused by kapha, the person has loss of appetite, vomiting, very little of desires, foods and talk; desire for the woman (sex) and solitude, copious saliva and nasal secretions flowing, terrifying activities, hatredness to cleanliness, sleep, swelling of the face, symptoms strong during nights and soon after taking food.”[17] Murthy, p. 58. Excess kapha in the mind results in over-attachment and lack in motivation and mental drive that often leads to depression, sorrow, and excessive clinging. A person becomes passive and dependent; “We want to remain a child and be taken care of…Such people often end up being taken care of by others and are unable to function on their own.”[19] Frawley, pp. 156-157. Stronger kapha types may find themselves suffering from greed and possessiveness, which renders the mind heavy, dull and depressed[19]. They want to own and control everything, but when control and ownership are lost psychological instability results[19].
In Sannipatonmada (insanity caused by the combination of all three doshas[17]), the Ashtanga Hridayam notes that symptoms attributed to all of the doshas appear simultaneously. The text cautions against the treatment of these patients, as this type of insanity is often too difficult to cure[17].
    In Citta Ghataja Unmada (or insanity due to mental shock[17]), “Loss of money, wife etc. which is unbearable, which persists for long time leads to insanity. The person becomes pale, timid, faints often, weeps making sounds such ha, ha etc. (alas, that is lost, alas, that is gone, etc.) weeps without any (other) reason; dies (loses consciousness), praises the qualities of the things lost, with the mind suffering from grief he worries much, keeps awake without sleep and does unusual acts.”[17] Murthy, p. 59.
    Visaja Unmada is insanity caused by poisons. In this type of insanity it is said that the face turns blue, the eyes become red, there is a loss of healthy complexion, strength, physical senses, and the mind is unstable even throughout the different stages of poisoning[17]. Again, the patient who presents with this condition is seen as too difficult to cure and should be rejected by the physician[17].

Ayurvedic Treatment (Chikitsa)
    In his book The Roots of Ayurveda, Dominik Wujastyk states, “Any deficiency or excess of either Doshas or Dhatus or Malas may induce disease and Ayurveda always aims at keeping an equilibrium in the level of these things. Physical diseases and mental diseases are caused by the irrevelevent contacts, intellectual blaspheme and suppression of natural urges.”[23] p. 20.
    In Ayurveda the primary treatment goal of all psychological illness is the cultivation of sattva[3], as this is the quality that brings balance to body and clarity to the mind. The principles of treating mental disease emphasize sattvic activities that bring peace and stability into one’s life. Sattvic activities include spending more time in nature, meditation, yoga, avoiding the influence of the media, and the consumption of a sattvic diet.
    Internal and external oleation therapies are the cornerstone of treatment in vata-type insanity. Should the moist, heavy qualities inherent within the oil induce channel obstruction, Vagbhata recommends mixing mild purgatives with the therapeutic oils being used[17]. Numerous vata-reducing impressions may be applied, as they help bring peace and stability to the vata-deranged mind. Such impressions include sitting or walking quietly and peacefully in a garden, listening to calming music, and gentle exercise such as Hatha Yoga or Tai Chi[19].
    For pitta-type insanity, emesis, purgation, and enema therapies administered after oleation and sudation should be administered[17]. Purgative therapy for the head is also recommended[17]. Pitta-reducing impressions include the use of cooling colors (blue, white, silver), cool, sweet fragrances like rose and sandalwood, and the use of pitta-pacifying mantras such as Shrim and Sham[19].
Similar to the treatment of pitta-type insanity, kapha-type insanity also calls for emesis, purgation, and enema therapies administered after oleation and sudation, including purgative therapy for the head[17]. Kapha benefits immensely from strong aerobic exercise, cultivating of detachment, and meditation on active, wrathful deities like Kali or Rudra.
    In the treatment of insanity due to lust, grief, fear, anger, joy, jealousy, and greed (i.e. Citta Ghataja Unmada), the patient should be exposed to the condition’s opposite qualities[17]. Lust should be met with dislike, grief with delight, fear with faith, etc.
    Patients suffering from insanity due to loss should be given that which is identical to what was bereaved, along with assurances and consoling words.
    Should the above therapies prove ineffective, alternate recommendations are described in the Ashtanga Hridayam that, while outdated, are interesting to take note of. In this section of the text Vagbhata suggests that the physician treat the patient by“…making him happy, assuring him, threatening, causing fear, beating and terrorizing him should be resorted to, oil massage, dry massage, anointing with paste, fumigation, drinking of medicated ghee should be administered; purified by these the mind becomes normal.”[17] Murthy, p. 60. Vagbhata also recommends beating the patient with lashes, binding the patient, throwing the patient into a ravine, and confining the patient in a dark room free from weapons, stones, and men[17]. The result of such therapies, he says, is the notion that the fear of death is more powerful than the troubles of the body, thus the disturbed mind becomes free of its abnormalities[17].
    According to the Charaka Samhita, “Purity of the sense organs, their objects, intellect, soul and mind and normalcy of the tissues of the body are the features of (the person) cured of insanity.”[20] Dash, and Sharma, p. 66

CONCLUSION

The mental condition known insanity is well known to describe a mentally unstable person. Though the term “insanity” may no longer exist as accepted medical terminology, the mental conditions that the word once described most certainly do.
    Insanity is a disease that has been common throughout history within every culture of the world, invoking diverse views of understanding and the development of numerous treatment methods. The Western approach to mental illness appears to be primarily concerned with the complicated, minute details of brain chemistry in its quest to understand the logistics of mental disease. The Western tendency is to concentrate on specific aspects of sensory impressions and brain lobes and the effect of various forms of multiple neurotransmitters and hormones within the body. On the other hand, the condition of mental illness is a much more accepted, explored, and understood concept within Ayurveda and Eastern medicine in general. Whereas Western medicine scrutinizes the minute, Ayurveda is much more concerned with the bigger, simpler picture of humoral and energetic imbalances, which it sees as a physical manifestation of karma that allows for the teaching of spiritual lessons.
    Charaka, perhaps, speculates that the avoidance of disease and conservation of health is even more simple: “The person of a strong mind who does not indulge in meat and wine; who eats only healthy food, remains clean (both physically and mentally) does not become affected by either nija or agantu unmada (endogenous or exogenous insanity).”[20] Dash, and Sharma, pp. 65-66.

References

1.    “Health Encyclopedia – Diseases and Conditions: Psychoses.” healthscout. The HealthCentralNetwork, Inc., n.d. Web. 11 Oct 2010. <http://www.healthscout.com/ency/68/77/main.html>.

2.    “Psychosis.” National Library of Medicine, National Institutes of Health. U.S. National Library of Medicine, 7 Feb 2010. Web. 20 Sept 2010. <http://www.nlm.nih.gov/medlineplus/ency/article/001553.htm>.

3.    Halpern, Marc. Principles of Ayurvedic Medicine. 9. 2. Grass Valley: California College of Ayurveda, 2007. Print.

4.    Weinstein, Raymond M. “Madness.” The Blackwell Encyclopedia of Sociology. Blackwell Publishing 2007. Print.

5.    “Conquering Depression: Historical Background.” SEARO. WHO Regional Office for South-East Asia, 18 Aug 2006. Web. 16 Sept 2010. <http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1826_8097.htm>.

6.    Tighe, Janet A. “‘What’s in a Name?” A Brief Foray into the History of Insanity in England and the United States.’” Journal of the American Academy of Psychiatry and the Law Online. American Academy of Psychiatry and the Law, 2005. Web. 15 Sept 2010. <http://www.jaapl.org/cgi/content/full/33/2/252>.

7.    American Medical Association: Concise Medical Encyclopedia. Ed. Martin S. Lipsky, MD. Random House, 2003. Print.

8.    Merlino, Dr. Joseph. Wikinews. Interview by David Shankbone, 5 October 2007. Web. 13 Oct 2010. <http://en.wikinews.org/wiki/Dr._Joseph_Merlino_on_sexuality,_insanity,_Freud,_fetishes_and_apathuy>.

9.    Rossman, Philip L., and Robert M. Vock. “Postpartum Tetany and Psychosis Due to Hypocalcemia.” California Medicine 85.3. 1956: 190–93. eBook.

10.    Rodriguez Gomez, Diego, Elvira Gonzalez, and Oscar Perez Carral. “Acute Psychosis as the Presenting Symptom of Multiple Sclerosis.” Revista de Neurologia 41. 4. 2005: 255-56. eBook.

11.    Karaizou, E, C Mitsonis, N Dimopoulos, K Gkiatas, I Markou, N Kalfakis. “Psychosis or Simply a New Manifestation of Neurosyphilis?” J. Int. Med. Res. 34. 3. 2006: 335-37. eBook.

12.    Birchwood, M, and P Trower. "The Future of Cognitive-Behavioural Therapy for Psychosis: Not a Quasi-Narcoleptic." British Journal of Psychiatry. 188. 2006. 108. eBook.

13.    Haddock, G and S Lewis. "Psychological Interventions in Early Psychosis." Schizophrenia Bulletin. 31. 3. 2005. 697–704. eBook.

14.    Nathans-Barel, I, P Feldman, B Berger, I Modai, and H Silver. "Animal-Assisted Therapy Ameliorates Anhedonia in Schizophrenia Patients." Psychotherapy and Psychosomatics. 74. 1. 2005. 31–35. eBook.

15.    Birchwood, M, P Todd, and C Jackson. "Early Intervention in Psychosis: The Critical Period Hypothesis". British Journal of Psychiatry. 172. 33. 1998. 53–59. eBook.

16.    French, Paul, Anthony Morrison. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis. Chichester: John Wiley and Sons, 2004. eBook.

17.    Murthy, Prof. KR Srikantha. Vagbhata’s Ashtanga Hridayam. 3. Varanasi, India: Chowkhamba Sanskrit Series Office, 2008. Print.

18.    Swami Sada Shiva Tirtha. The Ayurveda Encyclopedia: Natural Secrets to Healing, Prevention & Longevity. 1. Bayville: Ayurveda Holistic Center Press, 1998. Print.

19.    Frawley, Dr. David. Ayurveda and the Mind: The Healing of Consciousness. Twin Lakes: Lotus Press, 1996. Print.

20.    Dash, Bhagwan and RK Sharma. Caraka Samhita. Varanasi, India: Chowkhamba Sanskrit Series Office, 2001. Print.

21.    Halpern, Marc. Principles of Ayurvedic Medicine. 9. 1. Grass Valley: California College of Ayurveda, 2007. Print.

22.    Venkataram, BS. “Ayurvedic Definitions and Classification of Manovikara”. Ayurvedic and Allopathic Medicine and Mental Health: Proceedings of Indo-US workshop on Traditional Medicine and Mental Health. Bhavan’s Book University, 2003. Print.

23.    Wujastyk, Dominik. The Roots of Ayurveda. London: Penguin Books, 1998. Print.