Ayurveda and the mind: a new perspective in the management of mental illness

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

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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.

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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.

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Ayurvedic & Western approaches to the treatment of Schizophrenia (by Rubén Vega, MA)

Overview

Ayurvedic medicine is one of the world’s oldest and most complete systems of natural healing which offers comprehensive and holistic treatment for physical and mental disorders. It promotes physical health and healing of the mind through diverse methods focused on treating all the physical, psychological, and spiritual aspects of each individual affected with physical and mental disorders. In a review Of the literature from the classical Ayurvedic texts to current Ayurvedic literature  As well as the most current Western Psychological / Psychiatric  Approaches to the treatment of schizophrenia. I will research the causes,  theories, and treatment methods utilized by these two divergent approaches in the treatment of schizophrenia and other mental disorders.  In addition, I will also briefly describe some of the Ayurvedic’s spiritual therapies and factors to the treatment of mental disorders.

Introduction

According to the National Institute of Mental Health, approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year have schizophrenia.  Schizophrenia is found all over the world, in all races, cultures and social classes. It affects 1 out of 100 people worldwide.  “More than two million Americans are affected by schizophrenia and approximately 1 percent of the population develops schizophrenia during their lifetime. More than 2 million Americans suffer from the illness in a given year and one out of every 10 people with schizophrenia commits suicide.” 1. (www.nimh.nih.gov).  “Approximately 10 percent of people with schizophrenia (especially younger adult males) commit suicide.”(2). (www.nimh.nih.gov). “It is generally assumed that suicide is a problem only for those with major depression.  This assumption is, unfortunately, not true. Suicide rates among people with schizophrenia are alarmingly high; in fact, suicide is the number one cause of premature death. Ten to thirteen percent kill themselves, and close to fifty percent attempt suicide at some point in their lives.”
(3). Keefe, H arvey, (1994). Number the citation+ give the page number from where you took quote.
Schizophrenia has been considered one of the most chronic, disabling, and difficult to understand of the mental disorders since ancient times.  People with this illness suffer with a loss of individual potential and personal anguish, resulting in significant psychological and social consequences.  People with schizophrenia suffer terrifying symptoms such as hallucinations, delusions, and distorted perceptions of reality, disordered thinking, lack of emotional expression and communication problems.

This often leaves them fearful, anxious, confused, and withdrawn for the rest of their lives.  A wide range of reason or events can and might lead some people to run a risk for suicide, although this risk may be higher for individuals with schizophrenia.  The underlying causes are the same for those who are afflicted with this disease. Some of the causes can be depression, feelings of hopelessness, being unemployed, being unmarried, experiencing deteriorating health and recent traumatic experiences and/or stress.

 Due to those reasons listed above, schizophrenia is considered a devastating disorder like no other, causing pervasive and profound social, economic and personal impact on those afflicted. Most of the people with schizophrenia continue to suffer chronically or episodically throughout their lives.  It has been estimated that no more than one in five individuals recover completely.

What is schizophrenia?  Why is schizophrenia still considered one of the most fearsome and disabling mental disorders?   What are the Western Psychiatric/psychological theories of Schizophrenia? What is the Ayurvedic interpretation of schizophrenia and mental illness?  What are the treatment methods utilized by psychiatric/Psychological approaches and Ayurvedic medicine in the treatment of schizophrenia and other psychotic disorders?   And, what Ayurvedic treatments are available for people suffering with mental illness? These are just a few questions that will be answered in the following pages.      

Western definition of Schizophrenia

According to Western Psychiatry, Schizophrenia is not a split personality condition, but a chronic relapsing psychotic disorder that primarily affects thought and behavior.  According to DSM-V, schizophrenia is described as  “ a disturbance that lasts for at least six months and includes at least one month of active-phase symptoms (i.e., two (or more) of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms)”.   DSM-IV criteria identify five subtypes of schizophrenia: Paranoid type, disorganized type, Catatonic type, undifferentiated type, and Residual type. All of these vary by their degree of severity and symptomatology.  

Ayurevedic Interpretation of Schizophrenia and other Psychotic Disorders

As noted by Dr. Halpern, Ayurvedic medicine offers the opportunity to understand the nature of the mind in a way that is completely unique and quite different from the variety of the Western Psychological and Psychiatric medicine models. “Ayurvedic medicine views psychotic disorders (schizophrenia) as the imbalance of energies on an inner level. According to Ayurveda and occult science, behind the gross physical is a subtle or astral body composed of the life-force, emotions and thoughts. The astral is a subtle form or underlying energy pattern of the physical, from which the physical is produced (3). Frawley (1989).
In the ancient texts of Ayurveda, there are detailed descriptions of mental disorders known as “Unmada”, and schizophrenia can be correlated with many of the types of “Unmada.  Ayurvedic’s physicians describe schizophrenia as a disorder of the mind caused by the doshas (vata, kapha, and vata.)  Moving in the wrong paths due to increased toxicity.  According to the classical Ayurvedic texts, the Charaka Samhita, insanity is defined as, “the perversion of the mind, intellect, consciousness, knowledge, memory, desire, manners, behavior, and conduct”.  It is denominated as insanity (umada) because it is madness (mada) of the mind caused by a deviation (unmarga) of the humors”.  Swami Sada Shiva Tirtha, (1998).

Western theories of the causes of Schizophrenia

The real causes of schizophrenia are unfortunately not known, however, there are several theories and hypotheses of the etiology of schizophrenia.  Western scientists and psychologists do not yet understand all the factors that produce schizophrenia.  An interaction of sociological, biological, and psychological factors seems to contribute to the condition. Schizophrenia also may result from various factors such as drug abuse, aging, and/or brain injuries and diseases. 

One of the more influential views of the origins of schizophrenia is the theory of biochemical and brain dysfunction.  This view attempts to “identify the biological abnormalities that are inherited or developed by persons with schizophrenia.  The two most likely candidates are biochemical abnormalities and abnormal brain structure.  It also involves disturbances of the brain’s chemistry, anatomy, and physiology, which in turn distort perceptions and subjective experiences.  This hypothesis revolves around the idea that schizophrenic symptoms might be the result of overactivity of a neurotransmitter called dopamine.” Maxmen, J. & Ward, N. (1995).   This theory is supported by the fact that drugs, which increase dopamine activity, can bring about a worsening of psychotic symptoms.

The treatment methods for schizophrenia with this biological view are based on clinical research and experience. (1)Antipsychotic medications treat the symptoms of the disorder, but do not cure schizophrenia.  “These medications reduce the psychotic symptoms of schizophrenia and usually allow the patient to function more effectively and appropriately.  Antipsychotic drugs appear to be the best treatment now available, but they do not cure schizophrenia or ensure that there will be no further psychotic episodes. The antipsychotic drugs include two major classes: dopamine receptor antagonists (for example: Chlorpromazine (Thorazine), haloperidol (Haldol), sulpiride) and serotonin-dopamine antagonists’ drugs (per example, risperidone (Risperdal) and clozapine (Clozaril)). Kaplan, S. & Sadock, B. (1998)

Genetic theories state that biology produces schizophrenia and environment alters its course.  More specifically, genetic and other biological factors create various degrees of vulnerability to schizophrenia.  Whether, and how severely, the predisposed individual Becomes schizophrenic depends on a mix of biological factors (e.g., severity of heredity, prenatal complications, or slow viruses).  Genetic scientists believe that “some people inherit a biological predisposition to schizophrenia and, in accordance with a diathesis-stress model, come to develop the disorder when they are confronted by extreme stress, usually during early adulthood.” (Gottesman, 1991).  Since schizophrenia tends to be familial, but does not follow a classical pattern of inheritance, the study of genetic factors in this disorder has been complicated.  It is extremely unlikely that a single gene will ever be found that is responsible for all cases of schizophrenia in the population.

Another theory is based on psychosocial influences.  The psychological view is based on the principle that “psychological factors are critical in the development of schizophrenia, (traumatic childhood experiences, intense negative intrafamiliar communication) substantially affect the extent of recovery; probability of relapse, overall quality of life, and the symbolic meaning attributed to the disorder.” Maxmen & Ward, (1995).  The leading psychological explanations have come from the psychodynamic, behavioral, family, existential, and cognitive perspectives.

Causes of Insanity from an Ayurvedic perspective.

From the writings extracted from the classical text: the Caraka Samhita by R. K. Sharma and Bhagwan Dash, the causes of inanity are due to  “having unhealthy foods which area spoiled, unaccustomed, contamined and using (food and drinks) improper manner; those who are dejected due to worry, grief, etc.), who are weak mind due to the effect of sudden increase of disease, emaciated persons indulging in activities in improper ways, doing mistakes in the method of worship, by doing sinful acts, loss of balance of mind, by the effects of strong poisons or weak poisons due to these reasons the doshas getting increased in the mind in persons of feeble mind, produces vitiation of the mind, and invading the manovaha shrotas channels of the mind / caused insanity”. Asthanga-Hrdaya of Vagbhta: the book eight branches of Ayurveda, (1994).
     In current literatures, Dr. David Frawley describes that, “mental disorders are caused by emotional stress, poor upbringing, repressive religion, coming under the influence of disturbed individuals, sexual abuse or perversion, and taking drugs”. Frawley, (1989).   Dr. Frawley further adds that metal illness are also caused by excess thinking or by the strain in yogic or meditation practices naively opening up to the influences the astral plane, and through occult methods”. He also states that “mental disorders, including schizophrenia are caused by a vitiation of sattva; that is, by a disturbance of the inherent clear quality of the mind. This occurs though excess rajas and tamas turbulence and darkness in the mind. Too much rajas involves excess of anger, hatred and fear, excessive nervousness, worry, and anxiety. Too much tamas involves excess sleep, dullness, apathy, inertia and the inability to perceive things as they are”. Frawley, (1996).

According to the Asthanga-Hydaya of Vagbhata insanity is a toxicity / disorder to the mind caused by dohas (vata, etc.) moving in the wrong paths due to their increase”. It also said that having unhealthy foods which are spoiled, unaccustomed, contamined and using (food and drinks) improper manner, those who are dejected due to worry, grief, etc.), who is weak mind due to the effect of sudden increase of disease, emaciated persons indulging in activities in improper ways, doing mistakes in the method of
worship, by doing sinful acts, loss of balance of mind, by the effects of strong poisons or weak poisons due to these reasons the doshas getting increased in the mind in persons of  Feeble mind produces vitiation of the mind, and invading the manovaha shrotas channels  Of the mind/ caused insanity”. All these corruptions causes the intelligence, understanding, and memory to go astray.  Because of that, the body loses any sense of joy or sorrow, and wanders about purposelessly like a chariot which has lost its driver”.

According to ancient medical texts written by the first Ayurvedic physicians, There are six kinds of insanity that arise from each of the humors, from a conjunction of them, from mental anguish, and from poisoning. Regarding the development of mental illness, Ayurvedic physician’s states that “The corruption of certain mental and physical things can cause the inflammation of the humors in the heart of someone whose mental faculty is weakened. Next, it causes defilement of the intelligence, destruction of the pathways along which mind flows and, finally, insanity. Wujastyk, (1998).

Types of insanity (unmada)

Wind insanity: (vayu)
“Wind gives rise to the following: an emaciated body; inappropriate lamenting,
shouting, laughing, and smiling, as well as dancing, singing, playing music, talking,
posturing, bursting out; repeatedly and tunelessly imitating the sound of a flute, veena, or other instrument; frothing at the mouth; constantly wandering about; ceaseless talking; using things which are not ornaments as decoration; trying to travel on things which are not vehicles; being greedy for food, but spurning it once it has been obtained; bulging, Bloodshot eyes, and illness after foods had been digested.” Wajastic, (1998). Swami Sada Shiv Tirtha notes, “Vayu insanity is also caused by fasting or an excessive intake of dry or cold foods. This affects the heart and mind with worry, passion, and anger which results in distortion of memory and perceptions.” Swami Sada Shiv Tirtha, (1998). 

 Frawley states that when high vata, as excess ether, makes us ungrounded, spaced-out and unrealistic. We may have various wrong imaginations, hallucinations or delusions, like hearing voices. High vata in the mind manifests as fear, alienation, anxiety and possible nervous breakdown. There is insomnia, tremors, palpitations, unrest and rapid shifts of mood. Insanity of the manic depressive type or schizophrenia is an extreme vata imbalance”. Frawley, (1996).

Choleric Insanity: (pitta)

Choler gives rise to threatening behavior, fury, and charging at people with fists stones,
and the like. The patient craves coolness shade, and water. He goes naked, and has a
yellow color. He sees thing which are not there, such as ire, flames, stars, and lamps.
Pitta insanity results from indigestion, excess of hot, pungent, sour, or burning foods and
liquids, excesses pitta afflict the heart of the person lacking self-control. Wajastic (1988).
Frawley notes that the “fire and heat of pitta cause the mind to be narrowed and contentious, fighting either with others or with themselves. High pitta in the mind causes agitation, irritation, anger, and possible violence. The overheated body and mind seek release in venting the build-up tension. Pitta types can become domineering, authoritarian or fanatic. When disturbed they many have paranoid delusions, delusion of grandeur or can become psychotic.” Frawley, (1996).

Phlegmatic Insanity: (kapha)

Phlegm causes the patient to lose any desire for food. It causes vomiting, and a reduction
in motivation, appetite, and conversation. It causes a lust for women. It causes the patient
to enjoy solitude. He dribbles mucus and snot, and is very frightening. He hates being
clean. He sleeps, and has puffy face. This insanity is stronger at night, and just after
eating. This is caused by the overeating and excessive use of oily foods. This is
aggravated kapha afflicts the heart, troubling the mind and memory.  Wajastic, (1988)
Frawey stated that kapha type evolves attachment and lack of motivation lading to depression, sorrow, and clinging. The mind may be incapable of abstract, objective or impersonal thinking. There is lack of drive and motivation along with passivity and dependency”. Frawley (1996).

Conjunctive Insanity: (trisdosha)

When there is a conjunction of all the sources of disease, and symptoms, then the
resulting insanity is dreadful. A physician should stay away from such a patient.
This caused by the excessed condition of all thee doshas. It is considered serious because
the therapies will aggravate one or more of the doshas. Therefore, this condition is
incurable. Wajastic, (1988).

Insanity cause by loss:
A person crushed by the unbearable loss of his possessions or of a loved one becomes
pale, depressed, and swoons frequently. “oh, oh” he groans. He wails for no reason. He
loses consciousness. He thinks a lot about the qualities of what he has lost. His mind is
Distraught with grief and he cannot sleep for worrying. He thrashes about. Wajastc, (1988).

Insanity caused by poison:
Poison makes the face dark the complexion, strength, and senses are all ruined. The
Patient is delirious even in between fits, and has bloodshot eyes. He should be avoided. Wajastic, (1988).

Western Psychiatric and Psychological Treatment for Schizophrenia

The primary method of treatment for these patients is the use of psychotropic medications, which aim to mitigate symptomology such as visual and auditory hallucinations, suicidal ideation, anxiety and depression.  The proper treatment of schizophrenia may include a combination of different techniques.
 Generally, medications for treating psychotic symptoms of schizophrenia are referred to as antipsychotic, or sometimes neuroleptics.  Examples of standard antipsycotics include Thorazine, Mellaril, Modecate, Prolixin, Navane, Stelazine and Haldol.  The newer antipsychotic drugs are called atypical antipsychotic medications are being used more and more frequently.  They are called “atypical” because they do not have the same chemical profiles as standard medication and seem to work in a different way causing fewer side effects while helping patients to stabilize.  Examples include Risperdone, Clozaril, Zyprexa and Seroquel.   Most patients have to take medication regularly to keep their illness under control. It is not possible to know in advance which medication will work best for an individual.  Many medication adjustments may be required.  This period of trial and error can be very difficult for everyone involved. Some medications have unpleasant side effects such as dry mouth, drowsiness, stiffness, restlessness, muscle spasms, tremor, and blurring vision.

I have also observed that even patients who respond well to psychotropic medication continue to have secondary symptoms such as lethargy, disinterest, excessive sleep, lack of spontaneous emotions and other symptoms of relapse. In addition, patients often develop multiple medication adverse effect, but these can be corrected by lowering the dosage or controlled by other medications.  Different patients have different treatment responses and side effects to various antipsychotic drugs.
“Other biological therapies such as electroconvulsive therapy, although less effective than antipsychotic drugs, may be indicated for catatonic patients and for patients who for some reason cannot take antipyshcoitc drugs.  In the past, schizophrenia was treated with insulin and barbirute-induced coma, but these treatments are no longer used because of the associated hazards.  Psychosurgery, particularly frontal lobotomy, was used from 1935 to 1955, and is no longer considered an appropriate treatment.”
Kaplan, S. (1998).

Although antipsychotic medications are the mainstay of the treatment for schizophrenia, research has found that psychosocial interventions can increase the clinical status.  One of the main modalities used in psychosocial therapies is behavioral therapy.  This therapy uses techniques such as token economies and social skills training to increase social abilities, self-sufficiency, practical skills, and interpersonal communication.  Skills-based programs can lead to an improvement in life functioning and the subsequent discharge of people with schizophrenia who have had long-term stays in psychiatric facilities. 

Cognitive therapy is used to improve cognitive distortions, reduce distractibility, and correct errors in judgment.  Group therapy focuses on real life plans, problems, and relationships.  “Because patients with schizophrenia frequently become ill during the critical career forming years of life (e.g., ages 18 to 35), they are less likely to complete the training required for skilled work.  As a result, many suffer with lack of social and work skills and experience as well.” (www.nimh.gov).  Rehabilitation programs emphasize social and vocational training to help patients and former patients to overcome difficulties in these areas.  These programs include vocational counseling, job training, problem solving, money management skills, use of transportation, and social/communication skills training.

Although schizophrenia is not yet a “curable” disease, the treatment for this illness is more effective today than ever before, largely because of the careful thinking and research that has gone into it.  The most successful treatment programs are the ones that use a multimodal approach.  They use the proper treatment of schizophrenia that includes the following: medication, education, family counseling, residential and rehabilitation programs, self-help groups, nutrition, rest and exercise. 

  Ayurvedic Medicine Treatment methods of Schizophrenia

 Ayurvedic medicine is a holistic system of medicine that treats mental disorders from mild stress to severe condition, including insanity (psychosis). “Ayurveda employs whole series of yogi and spiritual therapies, including meditation, pranayama, mantra, prayers, visualizations, and rituals called “spiritual therapy” (daiva cikitsa).’ Frawley, (1998).

Ayurvedic’s treatments methods first works on balancing the biological humors through appropriate physical remedial methods of diet, herbs, and exercise. One of the best Ayurvedic’s treatment for schizophrenia includes panchakarma chikitsa. Some Ayurvedic formulations are Mahakalyanak ghrita, Vachadi churna, Purana ghrita, and Saraswatharistha. According to Frawley, all psychological disorders, including psychotic disorders reflect imbalances of the three biological humors. He says, “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” Frawley (1996). The imbalances caused by the lack or harmony in our lives weaken the doshas that afflict the heart where there is less sattwa in ones’s life and the mind. The disease develops through the  manovaha srota that sends psychic energy to the mind”

Treatment differentiation: Vata, pitta, and kapha type insanity

Frawley reports that for mental disorders, including schizophrenia treatments are similar that neurosis type and  Pancha karma treatment is recommended as a stronger method.

Vata type insanity: Dr. Frawley states that nourishing and sedating herbs are required, especially ashwagandha and its various preparations. Sarpagandha, rauwolfia serpentine, is an important ayurvedic herb for mental disorders. Other good herbs include valerian, guggul, jatamansi and calamus. Other therapies recommended are oil and ghee therapies, including oil enemas. Oil and ghee if the air passages are not blocked and laxatives which are given with the oils and ghee to remove the blocks.

Pitta type Insanity:  purgation is recommended, even with strong purgatives, is often helpful. The more violent type, the more purgation is required. Good herbs for this include rhubarb root, senna and aloe. Gotu kola is generally the best herb others are bhringaraj, sandalwood and passion flower. Shatavari is good for promoting a sense of love and compassion and is better for weaker pitta types. Also, oleation and fomentation therapies are recommended, then purgatives, followed by emetics. Also, medicated enemas evacuation from the head with jatamashi and gotu kola.

Kaph type insanity:  is recommended spicy brain-stimulating herbs. The treatment is mainly expectorant, to clear phlegm from blocking the channels and obstructing mental functioning. Important herbs are calamus, basil, bayberry, sage, myrrh, and guggul, which have good expectorant action. Other formulas include trikatu with ghee or calams ghee.

Other important miscellaneous therapies:

Other miscellaneous therapies describe in current Ayurvedic texts include, Abhyanga, shirodhara, shirobasti, ghee to stimulate the mind, intellect, memory and consciousness; and applying thick ointments. In addition, other Ayurvedic treatments recommend different kinds of nasal medicines mixed with mustard and oil. It is also recommended face and head massage with mustard oil and the inhalation of mustard powder. Other more intrusive treatments recommended were bloodletting and shock treatment. Some alternative treatments recommended for the insanity by the first Ayurvedic physicians were to help the patient’s mind to become still by throwing the patient into a dry well and keep him hungry until he/she is emaciated; send a policemen to grab the patient and take the patient outside and intimidate him/her with corporal punishment, and threatening him/her in the name of the king; terrify the patient with name lions, elephants or snakes whose fangs have been drawn or with knives in one’s hands or with tribesman, enemies, or robbers; tie the patient up, flog him and then cast him/her into a pit or into a completely dark room which has no knives, stones, or people in it; and to  friend may comfort the patient with conversations that inculcated virtue and profits; “  Wujastic, (1998).

Ancient ayurvedic herbal formulations for any mental disorders.

1. brahmi ghee-( 4 days worth).
Ingredients: Brahmi- 50 mgs., shankha pushpin-50 mgs., Ashwagandha-50 mgs.,  jatamanshi 50 mgs., and Ghee -100 mgs. Dose: 1 tsp. 2 times daily.
Preparation: make a paste from the herbs and roll into a ball, boil the ghee and add the paste and cook for1/2 hour, and filter. Swami Sada Shiva irtha (1998).
2. Cow’s urine potion:
“Cow’s urine is cooked in about three kilograms of ghee, together with about 200 grams of asofoetida, dark salt, and a mixture of black pepper, long pepper and dried ginger this is the best thing for banishing insanity” Wajastic, (1998 ).

The principles of treating mental disease

In the current body of literature, Dr. Marc Halpern writes, “All mental disease originates in a lack of clarity (sattwa) within the mind”. He adds, “The primary goal of spiritual healing is the cultivation of sattwa through proper lifestyle and through all five senses”. In addition, Dr. Halpern points out that some general principles are needed to heal the mind, including spending more time in nature, mediation practices, and yoga (8 limbs). He also adds that avoiding the influence of the media and eating a sattvic diet helps to restore the mind. Finally, it is also recommended to increase ojas and balance prana, tejas.

Summary

As noted by Psychiatric professionals, schizophrenia is not yet a “curable” disease, but the treatment for this illness is more effective today than ever before, largely because of the careful thinking and research that has gone into its main treatment method,  antipsychotic medication.  However, it is well known the multiple short and long-term mental and physical side effects caused by anti-psychotic medication.  Some of the of the “less serious” side effects include dry mouth, diarrhea, constipation, cough, and blurry vision. And some of the more serious long term side effects include, tardive dyskinesia, low white blood cell count, neuroleptic malignant syndrome, memory loss, uncontrollable body movements, unexplained muscle weakness, suicidal thoughts, liver failure, diabetes, weight gain, digestive problems, heart disease, sexual dysfunction,  degenerative disorders, among others. I believe the most successful treatment approaches are the ones that use a multimodal and holistic approach.

Ayurvedic medicine can be of great assistance to the treatment of people suffering from schizophrenia and other psychotic disorders. In addition to all the therapies described above, Ayurvedic Medicine employs a whole series of Yogic and spiritual therapies not yet explored by Western approaches for the treatment of mental illness. Some of these spiritual therapies include meditation, pranayanma, mantra, prayer, and visualizations besides its regular physical healing means and modalities to treat mental conditions such as herbal medicine, education, yoga, diet/nutrition, aromatherapy, and color therapy.
Unfortunately, Ayurvedic medicine is not totally yet incorporated as a complementary therapy to the treatment of mental disorder by Western Medical establishment. Although Western treatment methods for the treatment of schizophrenia are more effective today, still there is no cure and not a single effective Western treatment method for schizophrenia. Most of the western methods are more focused on improving their quality of life, minimize symptoms, prevent suicide, avert relapses, enhance the patient’s self- esteem, and to improve social and occupational functioning.  In addition, Psychiatric treatment methods are to stabilize the patient’s symptoms, reduce the need for psychiatric hospitalizations and to increase the patient’s social and independent living skills.  Unfortunately there is no scientific research done on Ayurvedic treatment for schizophrenia that can validate the effectiveness of its treatment methods. Finally, Ayurvedic medicine offers a great hope for people with psychotic disorders that can help them to live a more balanced life. As noted by Frawley, “Ayurveda teaches harmony with nature, simplicity and contentment as the keys to well being. Ayurveda shows us how to live in a state of balance in which fulfillment in a matter of being, not becoming. It connects us with the wellsprings of creativity and happiness within our own consciousness, so that we can permanently overcome our psychological problems”. Frawley, (1998).

References

Keefe, R., and Harvey, P. (1994).  Understanding schizophrenia: A guide to the new research on causes and treatment. New York: The Free Press.
Manxmen, J., and Ward, N., (1995). Essential psychopathology and its treatment. New York: Norton.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington, DC: Author.
Liberman, R. (1988). Psychiatric rehabilitation of chronic mental patients. Washington, DC: American Psychology Association.
Comer, R. (1992). Abnormal Psychology. New York: Freeman and company.
Kaplan, H., and Sadock, B. (1998). Synopsis of Psychiatry: Behavioral Science / Clinical Psychiatry. Pa: Rose Tree Corporate Center.
British Columbia Schizophrenia Society. (2001, April). Basic facts about schizophrenia: National Institute of Mental Health. (1999, June 1). Schizophrenia. Retrieved from http:www.nimh.gov/publicat/schizoh.htm
A Review of Schizophrenia by Dr. B. Green, consultant Psychiatrist, UK. (1995). Schizophrenia an independent review article in Psychiatry on-line. Retrieved from http://www.pol-it.org//schizo.htm
Schizophrenia Research at the National Institute of Mental Health. (1999, April 14). Schizophrenia research. Retrieved from http://nimh.gov/publicat/schizresfact.htm

American Institute of Vedic Studies
Frawley, (2004) Ayurvedic Healing Course for Health Care Professionals Part IV
Santa Fe, N.American Institute of Vedic Studies.
.Frawley, (1989). Ayurveda and the Mind the healing of Consciousness
Salt Lake City, Utah. Passage Press
Wujasty, (1998). The Roots of Ayurveda.  London. Penguin books
Halpern. (2005)  Principles of Ayurvedic Medicine.  8th edition.
Grass Valley CA. California College of Ayurveda.
Swami Sada Shiva Tirtha. (1998). The Ayurveda Encyclopedia. Natural Secrets to Healing, Prevention, & Longevity. First edition. Bayville. NY. Ayurveda Holistic Center Press.

Ayurvedic Approaches to the Treatment of Depression: By Laura Perlin

Depression is a major health epidemic, affecting 10-15% of the population of the western world.1  While almost everyone has experienced depression to some degree as a feeling of extreme sadness and melancholy, more and more people are being diagnosed and treated for clinical depression, a mood disorder characterized by ongoing sadness, anger, loss or frustration that lasts for weeks, months, or years and interferes with one’s abilities to work, go to school, and perform the functions of normal daily life.
 
Western medicine does not attribute a precise cause to depression, and medical researchers are currently exploring theories linking clinical depression to genetics, as well as to abnormalities in brain biochemistry. Depression can be triggered by disruption to normal brain chemistry caused by factors such as long-term sleep disturbance, long-term use of drugs affecting the endocrine system, patterns of drug and alcohol abuse, and diseases of the thyroid.2  Depression can also be triggered by stressful or traumatic events.
 
Depression is diagnosed by the ongoing presence of some or all of the following symptoms, present continuously over time and of such severity that they interfere with the functions of everyday life34:
  • negative distortion of worldview/negative attitude/hopelessness/pessismism
  • helplessness/low self esteem
  • sadness
  • agitation/restlessness/irritability/anxiety
  • changes in appetite/weight gain/weight loss
  • difficulty concentrating
  • fatigue/low energy
  • feelings of worthlessness/self-hate/guilt
  • withdrawal/isolation
  • headache/stomachache/digestive disturbance
1 “Incidence of Depression and Anxiety: the Stirling County Study.” http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1349333/
2 “Major Depression.” Causes, Incidences, and Risk Factors. http://www.ncbi.nlm.nih.gov/pubmedhealth/ PMH0001941/
3 “Major Depression.” Symptoms. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
4 “Understanding Depression.” Symptoms. http://www.webmd.com/depression/default.htm
  • loss of interest/pleasure in activities that were once enjoyed
  • suicidal tendencies/preoccupation with death
  • insomnia/excessive sleep
  • worsening of co-existing chronic disease
 
In its more severe forms, symptoms of depression can become psychotic, and patients may suffer from delusions and hallucinations. In the United States, approximately 3.4% of people with depression commit suicide, and approximately 60% of people who commit suicide suffer from depression or another mood disorder.5
 
The main methods that allopathic medicine uses to treat depression are pharmaceutical anti-depressants, the most common of which work by affecting the uptake of seratonin in the brain, and psychotherapy, which can help the patient increase awareness of thought patterns, develop skills to fight off negative thoughts, and explore unresolved personal issues.6  Additionally, western medicine recognizes the therapeutic benefits of having contact with others suffering from similar symptoms in the form of support groups. Electroconvulsive therapy (shock therapy) is used in extreme cases of depression, and light therapy is used in seasonal affective disorder, a seasonal form of depression.7
 
Ayurveda has a very different approach to depression, stemming from a radically different understanding of mind. In Western medicine, the understanding of mind is often limited to the function of the biochemical processes of the brain, an organ which is in itself little understood. Although consciousness, thought, emotion, and feeling are all recognized as universal realities of the human experience, Western medicine lacks a functional cohesive framework for working with these aspects of the human being.
Ayurveda has a lot to offer in this respect. By providing a complex theory of the human being and of health, as well as a holistic methodology of healing and transforming consciousness, Ayurvedic psychology offers many approaches to the understanding and treatment of depression.
 
5 “Major Depressive Disorder.” http://en.wikipedia.org/wiki/Major_depressive_disorder
6 “Major Depression.” Treatment. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/ 7 “Light Therapy.” http://www.mayoclinic.com/print/light-therapy/MY00195/ METHOD=print&DSECTION=all
 
In Ayurvedic thought, consciousness, or ‘chitta,’ describes the totality of the contents of the mind, including conscious, unconscious, and superconscious thought, ideas, emotions, sensations, energy, will, memory, intuition, instinct, love and faith.8  Chitta contains all memories and attachments, all mental conditioning which distorts our perception and disturbs our emotions.9  The term ‘chitta’ encompasses the totality of our inner world, and Ayurveda and its sister science Yoga teach us that by learning to look within and observe the contents of chitta with clarity, we can grow mentally and spiritually. As human beings, we have the ability to perceive through the aspect of consciousness known as ‘buddhi,’ or intelligence.
  • Buddhi is the aspect of consciousness that is filled with light and reveals the truth. When one’s Buddhi becomes fully developed, one becomes a Buddha or enlightened one. The main action of intelligence is to discern the true and real from the false and unreal.10

So what is the nature of the truth that is revealed when one’s intelligence is fully developed? In Ayurveda, truth is understood as the awareness, beyond time and space, beyond thought forms and forms of all types, of the unity of all existence, of all of creation pulsating together as a variegated but singular expression of the unfolding of divine consciousness. The journey to this thought-free awareness of one’s true identity as spirit is the journey towards moksha, liberation. This is the spiritual goal of existence.

 
Classical Ayurveda has the goal of alleviating all disease and suffering, including that related to chitta, which includes mental, psychological and emotional suffering. Ultimately the key to health on all levels is remembering one’s true nature as spirit.11  When one remembers this truth and abides in this knowledge, one chooses actions that are congruent with health and wholeness. Rather than identifying with the chitta, the personal consciousness, as the self, one recognizes one’s broader identity (or lack thereof) as a drop of water in the ocean of consciousness, a part of the greater whole and not differentiated from it.
 
8 Ayurveda and the Mind. Ch 6 - Conditioned Consciousness: The Greater Mental Field.
9 Ibid. p.75.
10 Ayurveda and the Mind. p. 93-94.
11 Principles of Ayurvedic Medicine. p.5.
 
Ayurveda looks at the world through an elemental model in which all aspects of manifest reality are created from the building blocks of the five elements - earth, water, fire, air, and ether.12  The earth element creates all solidity and stability. Earth is heavy, gross, dense, and static. The earth element provides material form and structure. In the mind, earth creates dependability, reliability, consistency, and stubbornness.
 
The water element embodies flow and liquidity. Water flows along the path of least resistance. It is moist, heavy, gross, and soft. The water element creates liquid matter, which has cohesion like earth but more movement and less density. In the mind, water creates love, gentleness, compassion, and attachment.
 
The fire element represents light, heat, and transformation. It allows us to see, perceive, and change.
 
Fire is hot, dry, mobile and sharp. Fire creates the potential for growth and evolution by allowing us to digest knowledge and experience. In the mind, fire is linked to perception, anger, judgement and criticism.
 
Air is the source of all motion, the force that pushes. Neither fire, water, nor earth will move without the force of air behind it. Air allows us to do, to move, to breathe and to be active. Air is light, subtle, flowing, and mobile. In the mind, air is the force that moves our thoughts.
 
Ether is the subtlest of the five elements. It is the empty space that exists all around. Ether represents the field of existence on which all that happens plays out. Ether is present between all things and thus connects all things. As the backdrop to all existence, ether is extremely light,subtle, and clear and difficult to perceive compared to the other elements. However, it is omnipresent. Without ether, there would be no consciousness because there would be no space to contain it.13
 
12 Ibid. p. 51.
13 Ibid. p. 50-51.
 
In Ayurvedic philosophy, the elements group together to form doshas, the three basic energies or principles that are present, in varying degrees, in all people and things.14  We each have a unique genetic blueprint, a unique constitution that accounts for the many differences in the way we look, feel, and behave.  When the doshas are in balance in our bodies and minds, our health is optimal and we are peaceful and at ease. It is easier for the light of truth to shine and for perception to be clear and
unmarred by negative thought patterns. However, the doshic balance can easily be disturbed by stress, environmental factors, and improper diet, which gives rise to negative emotions and physical and mental disease.15
 
Vata dosha is the energy of movement, comprised of the elements of air and ether. When vata is in balance, we are creative, flexible, happy, and joyous. When out of balance, vata creates fear, anxiety, and ungroundedness. Vata is related to prana, the pure life force that animates us without which we could not survive for one second.16  Prana provides us with a sense of excitement about life, an inherent enthusiasm and joy.
 
Pitta dosha is the energy of metabolism or transformation, composed primarily of fire but always contained within water. When pitta is in balance, or perception is clear and we are logical, understanding, and quick to learner. As pitta goes out of balance, anger, jealousy, criticism and hate arise. Pitta is related to tejas, the strength of the intellect and the capacity of the mind to understand, discriminate, and know truth.17
 
Kapha dosha consists of water and earth, and creates structure, strength and immunity. What kapha is balanced, love, compassion, and gentleness are expressed. When there is a vitiation of kapha dosha, the mind tends towards attachment, greed, and clinging. Kapha is related to ojas, the force of stability and contentment. When our ojas is strong and healthy, we have endurance and are able to withstand
 
14 Complete Book of Ayurvedic Home Remedies. p. 11.
15 Ibid. p. 11.
16 Ibid. p. 12.
17 Principles of Ayurvedic Medicine. p. 237.
 
physical and mental stress. Without adequate ojas, we lack the reserve strength to contain all the motion and activity of prana and tejas. Ojas is the protective foundation of good health.18
 
Another important concept in Ayurvedic physiology and psychology is ama, or toxicity. Ama is like a viscous sludge that forms when foods or experiences are not fully digested. In the physical body,
ama can clog up all bodily systems and suppress their healthy function. The same is true of the mind. Things that we see or hear stay with us, often leaving negative traces on our psychic fabric. Remnants of abusive, hateful, or violent things that we have heard or experienced become a cloudy haze in our consciousness, adversely affecting our ability to see clearly, love fully, and act harmoniously. A process of purification or detoxification is often necessary to return to a state of optimal health.
 
Finally, Ayurvedic psychology offers us the language of the three gunas of sattva (clarity), rajas (activity), and tamas (ignorance) to describe the state of a person’s consciousness. The state of the gunas is reflected in the mind and the lifestyle. As a person evolves from ignorance to understanding, and
from understanding to transcendent awareness, the state of mind and actions of the person reflect this evolution. The cultivation of sattva is of great importance in rising above the negative and compelling dramas of the mind.
 
Sattvic consciousness is joyous, calming witnessing and observing, non-judgemental and compassionate, unconditionally loving, and without attachment. It creates a clarity and purity of mind, which allows
the divine spark to shine through and a person’s highest qualities to manifest. The state of sattva is a transcendent state, in which the dualities of good/bad no longer exist. It is achieved not by analyzing and resolving one’s personal dramas and conflicts, but by letting them go.19
 
Rajasic consciousness is turbulent and dramatic, distorting the truth of experience through the muddy lens of the ego. It is in this state of consciousness that most of humanity finds itself. Always desiring,
 
18 Principles of Ayurvedic Medicine. p. 238.
19 Ibid. p. 191.
 
striving, and struggling, rajas lacks stillness and peace. The constant internal chatter obscures the truth of our divine nature, and blinds us to our purpose and potential. As one moves from rajas towards sattva, there is a process of questioning and reevaluation. Glimpses of awareness create emotional repercussions, and there is often attachment to the cycle of growth and learning and the pain that comes with it.  The rajasic state of consciousness is characterized by constant mental activity.20
 
The tamasic state of consciousness is rooted in ignorance, darkness and inertia. An individual with a predominance of tamas will usually not have a connection to anything beyond him/herself, seeing the world in a simplistic, self-centered framework. There is little mental activity or deep thinking, and dullness predominates. In its more extreme forms, tamasic consciousness will express itself through violent or harmful behavior.
 
Thus, the essence of the treatment of depression and all mental disease is to move from tamas to rajas, then from rajas to sattva, and finally to transcend sattva entirely as the mind becomes liberated from the bonds of individual egoic identity.21  Usually the totality of this process takes many lifetimes, although it doesn’t have to. By bringing the doshas into balance, purifying ama, and increasing sattva guna, an individual learns to skillfully use the human mind and the human body as tools. Remembering one’s true identity as a divine being, one wields the tools of the human form with awareness and intention, using them in the service of all beings.
  • The sense faculties, together with the mind, get vitiated by excessive utilisation, non-utilisation and wrong utilisation of the objects concerned. This causes an impediment to the respective sense perceptions. If, again, due to correct utilisation, they come to normalcy, they bring about the respective sense perceptions properly. Thinking constitutes the object of the mind. So
  • the proper utilisation of mind or mental faculty is responsible for normal or abnormal mental conditions. This is to say, if mind or mental faculties are properly utilised, this is conducive to the maintenance of the normal mental conditions; if not, abnormal conditions prevail.22

This condition of normal utilisation of the mind is the goal that Ayurveda strives for, using many methods of treatment including diet, herbs, mantra, pranayama, and pancha karma therapies.

20 “Anxiety and Depression.” Lecture Notes.
21 Ayurvedic Psychology: Anxiety and Depression. Disc 6.
22 Caraka Samhita. Volume 1, Chapter 8. Principles of Psychopathogenesis. V. 15-16.
 
Classical Ayurvedic texts offer an understanding of mental illness that addresses many of the symptoms, root causes, and treatments of depression. They also provide instruction on the maintenance of health and prevention of disease.
  • Normally, mind and sense faculties remain undisturbed. In order that they are not disturbed in any way, one should make all efforts to maintain their normal condition. This can be achieved by the performance of duties after duly considering their pros and cons with the help of the intellect together with the sense faculties applied to their respective wholesome objects and by
  • acting in contradistinction with the qualities of place, season, and one’s own consitution including temperament. So one, who is desirous of his own well being should always perform noble acts with proper care.23
  •  
  • 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 becomes affected by unmada.24
Mental health issues are present in vata, pitta, and kapha forms.  Mental illness of all types is addressed in classical texts under the category of ‘unmada,’ insanity, which presents itself in different forms according to the dosha(s) affected. Many of the characterizations of unmada are applicable to modern clinical manifestations of depression.
  • Intellectual confusion, fickleness of mind, unsteadiness of the vision, impatience, incoherent speech and a sensation of vacuum in the heart (vacant mindedness) - these in general are the signs and symptoms of unmada. Such a patient, with bewildered mind becomes incapable of experiencing pleasure and sorrow. He becomes incapable of conducting himself appropriately. Therefore, he loses peace of mind altogether and becomes devoid of memory, intellect and recognition.  His mind wavers here and there.25
Vata type depression can often be triggered by loss, which by creating emptiness in one’s life, increases the elements of air and ether. Loss of a partner, a job, a friend or family member, or a home can all contribute to vata type depression. Certain symptoms of depression, such as emaciation, are particularly linked to disturbances in vata dosha.26
 
Attachment, or clinging, to the object that is lost, is an attribute of kapha type depression, characterized
 
23 Caraka Samhita. Volume 1, Chapter 8. Principles of Preventing Psychic Disturbance. Verse 18.
24 Ashtanga Hrdayam. Volume 3, Chapter 5. Treatment of Insanity. V 59.
25 Caraka Samhita. Volume 3, Chapter 9. Treatment of Unmada: Signs and Symptoms. V 6-7.
26 Ibid. Etiology, Signs, and Symptoms of Vatika Unmada. V 10.
 
by an increase in the elements of water and earth. Water creates cohesion and attachment, an enduring sense of connection, whereas earth creates a stubborn and enduring stability, a resistance to and discomfort with change. Sluggishness, lack of appetite, desire for solitude, and excessive sleep are kaphic manifestations of depression.27
 
Pitta type depression is often associated with the perception of failure or burnout, the state of mind that arises when one does not live up to one’s own expectations of performance or achievement. Getting fired, failing a class, or not passing an exam can all be triggers of pitta type depression. Irritablility and ‘continuous anguish’28 are classical symptoms of pitta type depression.29
 
It is important to remember that multiple doshas can be simultaneously vitiated, and that a patient’s experience of depression may be dual-doshic or tridoshic (sannipatika). Traumatic events or abuse may trigger depression in all individuals, although those with a vata imbalance have less stability and often less endurance in the face of trauma. In treating depression, it is important to consider which doshas are out of balance and design treatment to restore balance.
 
An important aspect in treating depression is reestablishing a harmonious relationship with the cycles of nature. Healthy routines include waking in the morning, around the same time as the sun. Rushing should be avoided as this creates anxiety and disrupts the mind. Food should be fresh, free of chemical residues, and well-prepared, and should be consumed mindfully. Sattvic spices such as ginger, cardamom and basil open the mind and the heart.30 Herbal formulas are instrumental in lighting the path towards growth and healing. Intake of ghee builds ojas and is recommended for those suffering from diseases of “impaired intelligence and memory.”31  Healthy eating habits include sitting still while eating, resting after meals to give food time to digest, chewing all food to an even consistency, and eating without
 
27 Ibid. Etiology, Signs, and Symptoms of Kaphaja Unmada. V 14.
28 Caraka Samhita. Volume 2, Chapter 7. Diagnosis of Insanity. V 7.
29 Caraka Samhita. Volume 3, Chapter 9. Etiology, Signs, and Symptoms of Pattika Unmada. V 12.
30 Ayurvedic Healing. p. 325.
31 Sarngadhara Samhita. Section 3. Chapter 1. V. 12.
 
distractions like music or television. Bedtime should be early, around 10 pm, to avoid aggravating vata. Daily practice of asana, pranayama, mantra and meditation is recommended to increase sattva.
 
Pancha karma is recommended in the classical texts as a treatment for mental illness.32  Internal and external oleation as well as fomentation are powerful methods of liquefying ama and purifying the channels of the body.  Therapeutic emesis removes excess kapha and can alleviate depression, grief and attachment. Therapeutic purgation alleviates anger and irritability (pitta), and enema therapy treats fear, anxiety, insomnia and many other symptoms of vata mental disturbance.33
 
The practice of pranayama, control of the breath, is the main way to increase prana, the vital life force. This can be a powerful practice for alleviation depression, especially of kaphic type. Pranayama increases the flow of energy in the nervous system and strengthens the mind. Alternate nostril breathing brings balance to the right and left hemispheres of the brain.  Solar breathing can be used to alleviate kaphic depression as well. Inhaling through the right nostril and exhaling through the left burns ama and unblocks the flow of energy. The mantras RAM and YAM can be used in conjunction with this practice to bring in the energies of fire and air, respectively.  Lunar breathing, which consists of breathing in through the left nostril and exhaling through the right, is calming and sedating, creating a grounding and stabilizing effect. This can be very helpful for vata and/or pittagenic depression. The mantras VAM and LAM can be used in conjunction with the solar breathing technique to activate subtle energies of water and earth.34
 
The practice of pratyahara, or internal withdrawal of the senses, can alleviate the negative effects of sensory overstimulation and purify the mind from the barrage of sounds and image that often prevail in modern society. One could begin treatment by reducing those sensory inputs that are most negative or injurious to the mind and senses. The mind is fed by the senses in much the same way that the body is fed by food, and junk impressions create toxicity and disease. Going hiking, spending time in nature, gardening, and contemplating the sky, clouds, and stars are all forms of bathing the senses in
 
32 Sarngadhara Samhita. Section 3. Chapter 1 & 3.
33 Ayurveda and the Mind. p. 203.
34 Ayurvedic Psychology: Anxiety and Depression. Disc 6
 
harmonious impressions. Fasting from the media, especially screen-based media, can be a very effective method of reducing vata.35
 
Color and aromatherapy also have applications in the treatment of depression. Use of the color gold can help to build ojas and increase mental endurance, stability and immunity.36  It is gently uplifting and transforms the consciousness to a sattvic state. Essential oils of tulsi, calamus, camphor and wintergreen can help to detoxify the channels of the mind and promote emergence from the dull haze of depression.37 Myrrh, frankincense, sage and mint promote the powers of perception.38
 
Mantra is a powerful tool to change the energy field of the mind.  All sounds, thoughts and words have their own vibratory power that affects the mind on the subconscious level. By repeating a mantra, it is embedded into one’s consciousness. This repetition gives us the power to change the dominant thought forms of our minds.  Bija mantras are single syllable sounds that have no meaning beyond the vibratory power inherent in their sound. Mantras or prayers that invoke the names of God or the divine create positive thinking patterns and help to create connection with divine forces. Extended mantras, which can also be described as prayers, invocations, or affirmations, exist in all spiritual traditions and can be used to increase intentionality and work on particular aspects of healing. The use of mantra helps the mind develop its power of concentration and memory.39
 
Ayurveda offers many tools in healing from depression, and as an ancient and evolving science is open to expansion and utilisation of new technologies and methods. By bringing balance to the doshas, increasing sattva, building ojas, and purifying ama, optimal health of mind and body can be achieved. Individualized treatment plans incorporate a diversity of modalities that address all aspects of the human being. Ayurvedic approaches to the treatment of depression can be combined with Western approaches
 
35 Ayurvedic Psychology: Anxiety and Depression. Disc 6.
36 Principles of Ayurvedic Medicine. p. 334.
37 “Anxiety and Depression.” Feb 2011. Lecture notes.
38 Ayurvedic Healing. p. 322.
39 Ayurvedic Psychology: Anxiety and Depression. Disc 7.
 
to mental health care. The journey to perfect health is approached as a journey of spiritual development, a philosophy which heals not only the individual but also has positive repercussions throughout society.
 
References
 
Agnivesa's Caraka Samhita: Text with English translation & Critical exposition based on Cakrapani Datta's Ayurvedadipika. Translators: Ram Karan Sharma & Bhagwan Dash.
Chowkhamba Sanskrit Series Office. Varanasi:1994.
 
California College of Ayurveda. “Ayurveda and the Treatment of Attention Deficit Disorder.” Ryan Strong. http://www.ayurvedacollege.com/articles/students/ADD
 
California College of Ayurveda. “Ayurveda vs. Western Medicine Perspectives.” Alexandra Compson. http://www.ayurvedacollege.com/articles/students/Insanity
 
California College of Ayurveda. “Ayurvedic Management of Bipolar Disorder.” Josh Greene. http:// www.ayurvedacollege.com/articles/students/Bipolar%20Disorder
 
California College of Ayurveda. “Ayurvedic & Western Approaches to the Treatment of Schizophrenia.” Ruben Vega. http://www.ayurvedacollege.com/articles/%E1%B9%A3tudents/schizophrenia
 
California College of Ayurveda. “An Ayurvedic and Yogic Perspective of Mental Illness.” Gauri Eleanora Trainor. http://www.ayurvedacollege.com/sites/default/files/Mental_Illness.pdf
 
California College of Ayurveda. “Cultivation of Sattva Guna through Ayurveda and Yoga as the Basis for Stress Reduction.” Jolanda Davies. http://www.ayurvedacollege.com/articles/students/SattvaGuna
 
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). American Psychiatric Association. 4th Edition: 2000. ISBN 0-89042-025-4.
 
Frawley, David. Ayurveda and the Mind: the Healing of Consciousness. Lotus Press. Wisconsin: 1996. Frawley, David. Ayurvedic Healing: A Comprehensive Guide. Lotus Press. Wisconsin: 2000.
Frawley, David and Marc Halpern. Ayurvedic Psychology: Anxiety and Depression. CD set. Recorded 11/ 2006. San Francisco.
 
Frawley, David. Yoga & Ayurveda: Self-Healing and Self-Realization. Lotus Press. Wisconsin: 1999.
 
Halpern, Marc. “Anxiety and Depression.” www.medicinecrow.com. Webcast Lecture. Personal notes. February 1, 2011.
 
Halpern, Marc. Principles of Ayurvedic Medicine. Textbook. 10th edition. 2010. Hay, Louise. You Can Heal Your Life. Hay House. Carlsbad, CA: 1984.
Lad, Vasant. The Complete Book of Ayurvedic Home Remedies. Three Rivers Press. New York: 1998. Mayo Clinic. Mayo Clinic Staff. “Light Therapy.” http://www.mayoclinic.com/health/light-therapy/MY00195
PubMed Health. ADAM Medical Encyclopedia. “Major Depression.” http://www.ncbi.nlm.nih.gov/ pubmedhealth/PMH0001941/
Abstract: A brief article describing clinical depression and its causes, symptoms, tests, treatment, prognosis, complications, and prevention.
 
PubMed Central. “Incidence of Depression and Anxiety: The Stirling County Study.” J M Murphy, D C Olivier, R R Monson, A M Sobol, and A H Leighton. Department of Psychiatry, Massachusetts General Hospital, Boston. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1349333/
Abstract: Prevalence studies in psychiatric epidemiology out-number incidence investigations by a wide margin. This report gives descriptive information about the incidence of depression and anxiety disorders in a general population. Using data gathered in a 16-year follow-up of an adult sample selected as part of the Stirling County Study (Canada), the incidence of these types of disorders was found to
be approximately nine cases per 1,000 persons per year. The data suggest that for every man who became ill for the first time with one of these disorders, three women became ill. Incidence tended to be higher among relatively young persons. These incidence rates are consistent with prevalence rates of approximately 10 per cent to 15 per cent for depression and anxiety disorders aggregated together, given an estimated average duration of illness of about 10 years. It is concluded that these incidence rates are fairly realistic in view of evidence that disorders of these types tend to be chronic.
 
Sarngadhara Samhita: A Treatise on Ayurveda. Translator: Srikantha Murthy. Chaukhambha Orientalia. Varanasi: 1995.
 
Swami Rama, Rudolph Ballentine, Alan Hymes. Science of Breath: A Practical Guide. Himalayan Institute Press. Honesdale, PA: 1979.
 
Tolle, Eckhart. A New Earth: Awakening to Your Life’s Purpose. Plume. New York: 2006.
 
Vagbhata's Astanga Hrdayam: Text, English translation, Notes, Appendix and Indices.Translator: KR Srikantha Murthy. Krishnadas Academy. Varanasi: 1995.
 
 
Wikipedia. “Major Depressive Disorder.” http://en.wikipedia.org/wiki/Major_depressive_disorder
 
The Yoga Sutras of Patanjali: Translation and Commentary by Swami Satchidananda. Integral Yoga Publications. Yogaville, VA: 1978.
 
 
 
 
 
 

Ayurvedic Management of Bipolar Disorder

By: Josh Greene

Introduction
    Bipolar disorder is a Western psychological diagnosis, characterized by mood swings between elation or mania and depression. It has an extensive amount of symptoms and manifestations that can vary greatly depending on the constitution, environment and imbalances of the individual. In susceptible individuals, bipolar disorder is primarily amplified by low ojas (immunity, strength, contentment, ability to cope) and high vata (biological principle of movement and dryness) in the mind and nervous system. As we shall discover, Ayurveda offers a multitude of holistic tools and ways of approaching this disease that can restore health so as to not rely as heavily on conventional treatments.

Western Definition
    “Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time.”   Modern psychology defines several subcategories of bipolar disorder that make up a spectrum of possible manifestations. All of these types are characterized by extreme mood swings that alternate between mania, hypomania (elevated, euphoric, hyperactive or irritable mood) and depression or can exist in a variety of combinations simultaneously. Bipolar I disorder involves episodes of the most severe high and low mood swings and is your classic manic to depressed presentation.  It is defined as: “One or more manic episodes.”   Bipolar II disorder is a milder form, involving episodes of hypomania that alternate with depression. It is defined as: “No manic episodes, but one or more hypomanic episodes and one or more major depressive episode.”   Cyclothymic disorder describes even milder mood changes. It is defined as: “A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes.”   When the episodes do not fall into the previous three subcategories, the term Bipolar Disorder NOS (Not Otherwise Specified) is used and defined as: “A catchall category, diagnosed when the disorder does not fall within a specific subtype.”   Another subcategory is “rapid cycling,” which can pertain to any of the aforementioned subtypes. It is characterized by frequency and is defined as: “A patient who presents with more than four or five episodes in 1 year.”    This disease is quite different from normal mood states of happiness and sadness that everyone experiences, symptoms of bipolar disorder can be quite severe and potentially life threatening.

Ayurvedic Definition
    Traditional Ayurveda has no specific equivalent disease for the diagnosis of bipolar disorder written in the classical Ayurvedic texts. One of the main ancient treatises on Ayurveda is the Charaka Samhita. It uses the term “Unmada” as a very general term for insanity. Insanity according to the author Charak is “wandering about of mind, intellect, consciousness, knowledge, memory, inclination, manners, activities and conduct.”   Charak goes on to describe five different types of insanity. While none of these perfectly correlate to the western description of bipolar disorder, some of the descriptions and symptoms are similar and some parallels can be drawn. Fitting a set of symptoms into the diagnosis of a particular disease is not a prerequisite to treating it using Ayurvedic methods.  Bipolar disorder manifests due to imbalances in the three fundamental biological qualities that govern the body and mind; vata, pitta and kapha; and the mental principles of sattva, rajas and tamas, which are the “qualities of consciousness.”  
    Some modern Ayurvedic practitioners liken bipolar disorder to being a lack of stability or ojas, which leads to difficulty sustaining emotional responses.   Ojas is defined to “maintain immunity, strength, integrity, and vitality.”   It acts as the container that holds the other two energies in the body: tejas, the energy of intelligence and discrimination; and prana, the body’s life energy. These three subtle energies are the forces that govern the functioning of the mind.  During the elated or manic phase, prana and tejas are high and during the depressive state, prana will be low and tejas can be either high or low.

Signs and Symptoms (Rupa and Laksana)
    Bipolar disorder is a disease in which individuals experience periods of elation, either manic or hypomanic and periods of abnormal depression that interfere with functioning in daily life.  In general, men tend to have more frequent elated or manic episodes, while women more often depressive episodes. The peak age of onset is in the early thirties. 
The elated and vata symptoms of bipolar disorder include talkativeness, excessiveness, racing thoughts, hyper-sexuality, euphoria and impulsive over-spending (of money, time, energy). Some other manic and more pitta type symptoms include over-confidence, irritability, aggression or anger directed outwardly against other people, under-sleeping and hyperactivity. On the other side of the coin are the depressive (more kaphic) symptoms of bipolar disorder, including feelings of sadness, lethargy, lack of enthusiasm, apathy, lack of appetite, lack of sexual interest, over-sleeping and hypoactivity. It should be noted that while there are typical vata, pitta and kapha symptoms, you could have for example a depression that is primarily governed by vata, pitta or kapha. “There are many people who say, "well if anxiety is due to vata then depression must be due to kapha, because it is heavy." Well, that’s sometimes true, but not always true in fact severe depression tends to be more of a vata condition.”   Emptiness, hopelessness, difficulty concentrating or making decisions, insomnia, restlessness, memory problems, uncontrollable crying, weight loss, despair and even suicidal thoughts are also all symptoms of depression that are chiefly vata symptoms.  All of these listed symptoms can manifest in the short term as well as the long term and can appear in countless combinations, making each patient a unique case.

Etiology and Pathology (Nidana and Samprapati)
    In western medicine the exact cause of bipolar disorder is unknown. Genetics are a substantial factor in the disease manifestation, but it rarely appears without environmental circumstances such as traumatic life events or extreme social stressors. It is found to be more common among individuals who are affluent, extroverted, achievement-oriented and use activity to combat depression.  Outwardly, bipolar disorder is seemingly two opposing high and low conditions that have a pendulum type correlation to each other. However there can be aspects of anxiety, elation or mania even during depressive states and vise versa.  While multiple doshas will likely be involved in the oscillations of bipolar disorder, the very changeability of this disease points to an underlying variable vata imbalance as the principal doshic disturbance. “High Vata in the mind manifests as fear, alienation, anxiety and possible nervous breakdown. There is insomnia, tremors, palpitations, unrest and rapid shifts in mood. Insanity, of the manic depressive type or schizophrenia, is an extreme Vata imbalance.”   More specifically, the cause is primarily samana vayu (vayu is another word for vata).   Dr David Frawley refers to samana vayu as “the equalizing life energy.”   Samana vayu literally means, “balancing air.” “In the mind, the role of samana vayu is to balance and stabilize the other vayus. When it is healthy, the other vayus find greater stability. When it is disrupted, a person loses control of his thoughts and feelings. Samana vayu is also responsible for absorbing sensory impressions into the workings of the brain and mind.”   The other two vayus that play an essential role in this disorder are prana and vyana. When prana vayu is disturbed it affects our thoughts and emotions. Prana is also responsible for the intake of impressions into the brain and mind as well as movement of neurotransmitters through the nervous system. Vyana is also responsible for movement in the nervous system and circulation of thoughts and emotions.  Aggravated pitta pushed by vata leads to the mental principle of rajas, which may result in mania. Rajas is defined as “quality of consciousness; the principle of kinetic energy; active, mobile.”   It is responsible for all movements, changes and excitability. Aggravated kapha pushed by vata leads to the mental principle of tamas, which may result in depression. Tamas is defined as “quality of consciousness; inertia.” and is responsible for sleep, heaviness, dullness and depression.   These two principles of the three basic mental states are destructive. The third being sattva which brings balance, light and purpose. The higher the air element in the vata, the faster the individual moves through the different cycles.
    Regardless of the doshic imbalance, all patients suffering from bipolar disorder are likely to have low ojas (contentment, ability to cope, vitality and immunity). This low ojas is the instability that is allowing the vata movement from one mood state to another. The patient will also be more susceptible to vata changes in mood when they are under stress. It is this stress that wears down the “container of ojas.”    As was mentioned previously, bipolar disorder usually doesn’t manifest until one’s twenties or thirties.  It is possible that as the patient moves out of the kapha phase of life into the busier more stressful pitta time of life, they lose the grounding of the water and earth elements and become more susceptible to the heat of pitta, which in turn contributes to the drying of vata. Changes in the underlying emotions are brought on by vata-provoking qualities in the individual’s lifestyle, habits, foods and activities. These qualities are dry, rough, light, cold, subtle and mobile.  Some specific etiologies include: Eating while anxious or depressed, eating on the run, taking in stimulants such as coffee or cigarettes, using intoxicants such as alcohol or recreational drugs, following irregular routines, traveling frequently, going to bed late, loud music or noise, engaging in excessive physical or sexual activity, failing to change with the seasons (especially autumn), overloading on stimulation such as TV, mass media, suppressing inner creativity and emotional sensitivity.  Bipolar disorder affects as many as 5.7 million American adults, which is about 2.6 percent of the population over the age of eighteen.  The disease is also quickly on the rise especially in children; one study showed as high as a 40-fold increase between 1995 and 2002.  One of the reasons for this could be the increasingly vatagenic environment to which today’s children are exposed.  “The fact that we have more of these problems is because our culture is over stimulating people.” “Wherever there is excess stimulation, the natural consequence is long term depression once the stimuli gets removed.”  
    The pathology path of vata’s movement through the body begins when vata accumulates and becomes aggravated in the purishavaha srota (colon). From there it overflows into the rasa dhatu (plasma tissue), and rakta dhatu (blood tissue). If the bodies’ tissues and pathways have preexisting weaknesses due to genetics or in the case of the brain and mind, emotional trauma, then under the right conditions repeated doshic disturbances will relocate to those sites. In the case of bipolar disorder, vata moves from the plasma and blood and relocates to the mano vaha srota (pathway of the mind) resulting in loss of awareness of one’s situation and fluctuations in emotional states. It also secondarily relocates into the majja dhatu (nervous tissue) and majja vaha srota (pathway of the nervous system), resulting in biochemical changes to the neurotransmitters being released effecting our thoughts.  Once vata has taken root in these tissues and pathways, it starts to manifest the myriad of signs and symptoms of bipolar disorder.

Diagnosis (Nidanam)
    The Western diagnosis of bipolar disorder is based on symptoms and how they change and progress, as well as life and family history. There is no definitive biological test and diagnosis can be difficult even for an experienced psychologist or psychiatrist. The diagnosis is primarily based on the self history as well as what is reported by friends, family and co-workers “using the criteria for both manic and major depressive episodes.”   Both of these must have been present, and the subtype of bipolar disorder will depend on the frequency, severity and duration of the episodes.
    In Ayurvedic medicine the label of bipolar is not really relevant to treatment. Diagnosis is based on the patient’s prakruti (underlying constitution) and the past and present history of vikruti (short-term symptoms and doshic imbalances).  The practitioner must consider the long- and short-term state of doshas and subdoshas; the patient’s levels of ojas, tejas and prana; as well as the state of mental principles, sattva, rajas and tamas.  Ayurvedic practitioners must also identify the major stressors that are pushing the patient’s mental states to opposite poles. 

Western Medical Treatment
    There is no known cure for bipolar disorder. The two main Western methods for treatment are medications and psychotherapy. When used in conjunction, they have shown to be effective at preventing relapses and reducing the severity of the patient’s symptoms.  As Dr David Frawley states: “Modern Medicine attempts to change the consciousness through altering the chemistry of the brain.” 
    The main medications used are mood stabilizers such as lithium, valproic acid (Depakote) and lamotrigine (Lamictal); antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel) and aripiprazole (Abilify); and lastly, antidepressants such as fluoxetine (Prozac), paroxetine (Paxil) and bupropion (Wellbutrin).  These medications are an amazing product of modern science. They have a strong effect on brain chemistry and are often very useful for managing this disease and improving the lives of individuals. Any medical doctor can prescribe these medications, but typically a psychiatrist, rather than a family practice or other specialty physician, would manage bipolar disorder. The downsides to these medications include countless known side effects and imperfect research as to how they affect the body and mind in other ways especially long term. From an Ayurvedic perspective, these medications do not treat the deep doshic root causes of the disease, but rather they balance and suppress the manifesting symptoms. “One of the main problems with modern medicine is that acute care has become the primary care both for the physical and the psychological medicine, which often causes more trouble with the chronic diseases.”   It is also very possible that these medicines simply move the doshas into other parts of the body, only to negatively affect the health of the individual in other ways. For example, vata being pushed into the medas or asthi dhatu could cause wasting, osteoporosis, or arthritis; vata staying in the majja dhatu could lead to other types of brain problems, such as Parkinson’s or Alzheimer’s; vata entering the shukra dhatu could cause sterility or low libido. 
    The other main Western treatment is psychotherapy or “talk” therapy.  Some common psychotherapy treatments that have been used to treat bipolar disorder are:
    “Cognitive behavioral therapy, helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.  Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs.”  
    Usually a licensed psychologist, social worker, or counselor provides these therapies. The efficacy of therapy and medications was highlighted in the largest treatment study ever conducted for bipolar disorder. Researchers compared people in two treatment groups: the first was treated with three psychoeducation sessions over six weeks, while the second was treated with medication and thirty of the above mentioned types of intensive psychotherapy sessions over nine months. The results showed that group two individuals were more likely to get well faster and stay well longer with fewer relapses, lower hospitalization rates, and greater adherence to their treatment plans.   Some other Western treatment methods include electroconvulsive therapy (ECT), sleeping medications, increased omega 3 fatty acid intake, ketogenic diets and canabanoids. All of these have mixed results or insufficient data to show significant usefulness.

Ayurvedic Treatment (Chikitsa)
    In management of any psychological disease, Ayurveda works to change the energetics of the mind.  The two main Ayurvedic treatments for managing bipolar disorder center on increasing our ojas and reducing our stressors. The stronger our ability to cope and withstand the stressors of the world, the less likely our moods will fluctuate between highs and lows. When ojas is strong  we are less likely to be buffeted by the doshas.  The more we identify our stressors and reduce them, the less ojas will be worn down.  The patient’s therapist and family are good allies in helping the patient identify these stressors. The main tools used in managing the mind are “diet and herbs on a physical level, prana and the senses working at a more subtle level, and mantra and meditation working more at the level of the mind itself.” 
    In dealing with the doshas, vata must be balanced first even if there are other current imbalances. The practitioner does not want simply to treat the current vikruti, only to drive the movement from one mood to another. It is no coincidence that many of the treatments for vata will also build ojas.  The main thing that helps both is to develop regular solid routines and stability. This includes: waking and sleeping times, eating times and food choices, work schedules and one’s general activities throughout the day.  Irregular patterns place stress on our body’s ability to function at its best. Some examples of this are regular mealtimes and bedtimes. When our body’s biological clock can anticipate meal or sleep times, it will release chemicals such as amylase, pepsin and acid needed to digest food in the former and chemicals such as melatonin needed to sleep in the latter. When the body is subject to irregularity, we will be prone to problems like indigestion and insomnia that put great stress on our bodies and reduce ojas. This is especially true of digestion, since we identified samana vayu as being the main causative factor in changes from one mood to another and the digestive tract as being the primary site of all doshic disturbances in the body.  Sleeping times are also important. Going to bed around 10:00pm and awakening near sunrise will help the body change mental states in the kapha times of day when it is more stable. The morning should be devoted to steady and healthy morning routines, including meditation and exercise.   Since vata has the qualities of: “cold, light, mobile, dry and piercing, and follows a transverse course,”  it is necessary to implement the opposite qualities in any treatment. Regardless of the type of treatment, an emphasis on warm, heavy, stable, moist, oily and dull qualities should be made.
    The best place to start in dealing with bipolar disorder is to identify and minimize stressors that trigger changes in the mood states. Family and friends may be useful in helping to identify what these are as patients may have some denial about this. Our society is largely work driven and it may be necessary for patients to reduce their workload in order to reduce stress and focus on their health. Prioritization of all the things one wants to do in order to create a more laid back and relaxed schedule can often be difficult. The patient’s surroundings at home can also be a major source of stress. Keeping the home tidy, free of clutter and clean helps to cultivate a more sattvic and stress free environment. Time in nature is also an excellent method for reducing stress, building ojas and pacifying vata.
    The most important factor concerning meals is eating at regular times each day and also making sure not to go without eating. Food pacifies vata and diet should emphasize whole grains, cooked vegetables, mung beans, meats, fresh dairy, nuts and oils in order to ground the patient and build up ojas. Generally, sweet, sour and salty tastes should be emphasized, as well as the qualities of warm, moist and heavy foods. When one is having a pitta manic phase, then cooler and blander foods may be useful, and during depressive states, spicier foods can be used. Canned, frozen, old, processed, microwaved and rancid foods should be avoided.   It is also important to stabilize blood sugar.  Increasing the ratio of fats and proteins in relation to carbohydrates and keeping simple carbohydrates to a minimum will help with this.  Coffee and other stimulants should be avoided since they will only serve to keep someone going artificially without getting true rest and will lead to more vata imbalance. Lunchtime should be the main meal of the day. It should last at least one hour and be taken at the same time, everyday while seated in a peaceful, distraction free environment in order to let food settle and digest before moving on to other activities. Some form of grace and blessing should be given before eating in order to help center ones mind. 
    When treating bipolar disorder with herbal therapies, nervine tonics become the most important for building stability and mental ojas. Nervine sedatives may be useful for elated or manic episodes and nervine stimulants may be useful for depressive states; however, the intent is not to force the brain out of a particular episode by providing herbal uppers or downers. While having sedatives and stimulants on hand is okay, the goal should be to balance the doshas and normalize the production of neurotransmitters using tonics.  A specific formula should depend on the particular constitution and state of the patient. Some generally good herb choices for tonics are ashwagandha, brahmi, shatavari, ginseng, shanka pushpi, nutmeg, skull cap, kappikacchu, haritaki and bhringaraj.  Also, jyotishmati, ginkgo, jatamamsi, oat straw, valerian root, St. John’s wort and Gotu Kola may be useful in some patients.   Brahmi is a great choice for any mood state since it can both act as a mild stimulant and sedative depending on what mood state needs to be balanced. Ashwagandha is very useful for building ojas and pacifying vata in the nervous system and mind. All of these herbs should be taken with herbs that aid in their digestion and absorption.  Triphala is a useful combination of three fruits that not only strongly reduces vata in the intestines, but also helps with the absorption of the other herbs and foods that are being taken and will exponentially multiply their effects. Since bipolar disorder is partially rooted in the nervous system, medicated ghees are an ideal medium for enabling these herbs to penetrate deeply into these tissues.
    The five sense therapies (vision, sound, taste, touch and smell) can be used to place the patient in balancing and restorative surroundings. Color therapy may be useful for the visual sense. Yellow, green, gold, blue, white, violet, and pastels in general are considered sattvic colors; gold and brown are considered to raise ojas; and yellow, green, gold, brown and purple are considered to decrease vata.   Colors can be applied to clothing, home décor, meditation and flowers. Music that the patient finds enjoyable or mantra therapy may be beneficial sound therapy. Since vata is rough, dry cold and sharp, touch therapy should have the opposite qualities. Clothing worn and bedding should be soft and warm. Regular, gentle and steady massage with lots of oil is also an excellent therapy for the touch sense. While professional massage is also excellent, daily self-massage with sesame oil is more affordable, easier to implement and offers the added benefit of self-love needed for more insecure vata type individuals. Aromas that may be useful to calm the mind during elation include sandalwood, chamomile, clary sage and jatamamsi.  For depression, rosemary, cinnamon, thyme, mint and eucalyptus may be useful to help get moving. Rose, basil and lavender may add balance to bipolar disorder.   They can be taken in the form of essential oils with an infuser, or by adding a few drops to a warm bath.
    Exercise can also be an important factor in managing the doshas, as well as helping one relax and sleep well. It is; however, important not to over exert oneself since that can deplete ojas. Generally, working out to half of one’s capacity is advised. Calming exercises like Yoga, Qi Gong, Pilates and Tai Chi are generally wise choices for all three doshas. Aikido, gardening, walking and gentle hiking are also good activities. When the patient is experiencing more pitta manic symptoms, then slow and cooling exercises are best like a cool walk in nature or slow swimming.  When the patient is in a more depressive state, mild running, team sports or Bikram Yoga may be of use.
    Panchakarma (“the five actions”) is the main Ayurvedic method for purification. “Owing to the subtle nature of its processes, it penetrates deep into the nervous system. It is useful for psychological problems caused by excess of the three doshas. Yet it can also be helpful for psychological problems caused by internal factors, emotions and karma.”     The practitioner must of course evaluate the state of the patient’s ama (toxins) and strength of ojas, before deciding on a plan for how aggressively to pursue panchakarma. Since the patient is likely to be low ojas, a slower palliative plan that focuses on strengthening the patient during purification is more likely to be useful. Since the primary problem is vata imbalance, a program with an emphasis on bastis (therapeutic enemas) should be adopted. If the patient is in a manic phase, virechana (therapeutic purgation) may be used and if the patient is in a depressed state, vamana (therapeutic emesis) may be an option. Oleation with medicated oils through abhyanga (Ayurvedic massage) is also a key therapy in palliation, as well as for managing vata whether or not it is a part of panchakarma. Shirodhara (flowing oil on the forehead) and shirobasti (oil in a crown on the head) are also highly recommended for their direct action on the brain, mind and subtle energy fields.
    In Ayurveda sleep is considered one of the great pillars of health. Sleep builds ojas and pacifies vata. Its importance for treatment of bipolar disorder cannot be understated. “There is also a connection between mental health and deep sleep.” “It is the state of deep sleep that allows the mind to renew itself.”   Sleep allows the body and mind to naturally rest and heal. Many of the other therapies, foods and herbs listed here help to regulate the body so that it can get enough quality sleep. Most sleeping pills are a class of drugs called “hypnotics” that put the body into trance-like states that do not go through the normal sleep stages. They do not provide the same quality of sleep as a natural, healthy sleep cycle.
    Meditation, breath, pranayama, as well as other yogic practices, are also of great importance in managing bipolar disorder. They have the ability to cultivate a sattvic mind, as well as to teach the patient how to manage the internal channels and energy moving through their body and mind. Meditation brings us back to a state of awareness that allows us to see the transient nature of things including our own moods and emotional states. Repetition of these practices actually has the ability to change our internal biochemistry, lessening the large fluctuations in our minds. While diet, herbs and lifestyle practices can do much on an outer level to pacify doshas and prevent disease, practices like meditation work on a much deeper and more fundamental level to change the subtle energies in our consciousness.
    Since Ayurveda is not a quick process and relies on the development of healthy routines and habits over a lifetime, it is important for a patient already diagnosed as bipolar to continue with the treatments laid out by his or her physician. If the patient has not received a formal diagnosis and the Ayurvedic practitioner, patient, or a patient’s family has concerns about a severe mood disorder, the patient should be referred to a primary care physician for evaluation.  Even if a patient currently seems stable, if there is a history of severe mood states and he or she falls back into them, then the patient will likely be unable to follow an Ayurvedic lifestyle. Western pharmacology can often provide the acute stability needed for the individual to work on developing long-term habits and routines.  A year on an Ayurvedic treatment plan would be a reasonable minimal timeframe for a patient to follow before talking with his or her physician about coming off medications. 

Conclusion
    Bipolar disorder is a multi-faceted disease consisting of periods of elation and depression. It is a condition of low ojas and high vata in the mind and nervous system. A regimen of Ayurvedic treatments to tonify, develop regularity and reduce stressors can help to build ojas and pacify the vayus. Ayurveda is useful for managing bipolar disorder because it is a holistic approach that looks at the constitution, the state of current imbalances, and the whole environment of an individual before deciding what is the best regimen to bring him or her into a balanced state.  It provides a complete package of useful everyday tools such as lifestyle, diet, herbs, purification and meditation that best suits the specific individual. This is contrasted with Western medicine, which has the tendency to put everyone with similar symptoms into the same box and provide them with pharmacological solutions that suppress symptoms but don’t solve the underlying problem. Ayurveda not only has the ability to treat symptoms of a psychological disease like bipolar disorder, but it can also move past the disease to identify its root causes and the underlying patterns affecting the individual. Combined with meditation and other yogic practices, Ayurveda works on the subtle aspects of mind to heal consciousness and release individuals from disease.

References

  "NIMH • Bipolar Disorder." NIMH • Home. U.S. Department of Health and Human Services, 06 Oct. 2009. Web. 02 June 2010. <http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml>.

  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th, text revision (DSM-IV-TR) ed. 2000. ISBN 0-89042-025-4. Bipolar Disorder.  DSM-IV-TR. Bipolar I Disorder.

  ^ DSM-IV-TR. Diagnostic criteria for 296.89 Bipolar II Disorder.

  ^ DSM-IV-TR. Diagnostic criteria for 301.13 Cyclothymic Disorder.

  ^ DSM-IV-TR. Not Otherwise Specified (NOS)

  Judd, Lewis L., and Leighton Y. Huey. "Part Thirteen Psychiatry." Harrison's Principles of Internal Medicine. By Eugene Braunwald. 11th ed. New York [etc.: McGraw-Hill, 1987. 2085-087. Print.

  Charaka. Charaka Samhita Handbook on Ayurveda. Ed. Gabriel Van Loon. Vol. 2. Chaukhambha Orientalia, 2002.  1100. Print.

  Lad, Vasant. Textbook of Ayurveda: Fundamental Principles of Ayurveda. Albuquerque, NM: Ayurvedic, 2002. 308. Print. 

  Thompson, Mary. "The Nervous System." AHP Level 2 Class. California College of Ayurveda, Grass Valley. 16 Sept. 2010. Lecture.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 306.

  Halpern, Marc. Principles of Ayurvedic Medicine. 9th ed. Vol. 2. Grass Valley: California College of Ayurveda, 2007. Print. Textbook.

  Frawley, David, and Marc Halpern. Ayurvedic Psychology: Anxiety and Depression. Rec. 18 Nov. 2006. California College of Ayurveda, 2006. CD.

   Ibid Harrison's Principles of Internal Medicine. 2086.

  Ibid Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression”

  ^Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression”

  ^Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression”

  Frawley, David. Ayurveda and the Mind: the Healing of Consciousness. Twin Lakes, WI: Lotus, 1997. 155. Print.

  Ibid "The Nervous System."

  Ibid Ayurveda and the Mind. 316.

  Halpern, Marc. Principles of Ayurvedic Medicine. 9th ed. Vol. 1. Grass Valley: California College of Ayurveda, 2007. Print. 81. Textbook.

  Ibid Principles of Ayurvedic Medicine. 9th ed. Vol. 1. 78-83.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 308.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 8.

  Ibid "The Nervous System."

  Yarema, Thomas, Daniel Rhoda, and Johnny Branningan. Eat-taste-heal: an Ayurvedic Cookbook of Modern Living. Kapaa, HI: Five Elements, 2006. 28-31 Print.

  ^ Eat-taste-heal: an Ayurvedic Cookbook of Modern Living. 31.

  Moreno, C., G. Laje, C. Blanco, H. Jiang, A. B. Schmidt, and M. Olfson. "National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth." Archives of General Psychiatry 64.9 (2007): 1032-039. Print.

  ^ “National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth.”

  Ibid Ayurvedic Psychology: Anxiety and Depression

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid Harrison's Principles of Internal Medicine. 11th ed. 2086.

  Ibid "NIMH • Bipolar Disorder." How is bipolar disorder treated?

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "NIMH • Bipolar Disorder." Medications.

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. Chapter 6.

  Ibid "NIMH • Bipolar Disorder." Psychotherapy.

  Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, Nierenberg AA, Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase ME, Sachs GS. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program (STEP). Arch Gen Psychiatry. 2007 Apr;64(4):419-426.

  Ibid "NIMH • Bipolar Disorder." Other treatments.

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "The Nervous System."

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "The Nervous System."

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Bhishagratna, Kaviraj Kunjalal. An English Translation of Sushruta Samhitá: Based on Original Sanskrit Text with a Full Comprehensive Introduction, Additional Texts, Different Readings, Notes, Comparative Views, Index, Glossary and Plates. Varansi: Chowkhamba Sanskrit Series Office, 1981. Chapter 1. Print.

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid Psychology of Ayurveda: Treatment of Psychological Conditions.

  Ibid "The Nervous System."

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "The Nervous System."

  Frawley, David, and Vasant Lad. The Yoga of Herbs: an Ayurvedic Guide to Herbal Medicine. Twin Lakes, WI: Lotus, 2001. Print.

  Halpern, Marc. Psychology of Ayurveda: Treatment of Psychological Conditions. Grass Valley: California College of Ayurveda, 2006. Print.

  Ibid Principles of Ayurvedic Medicine. 9th ed. Vol. 2. 442.

  Ibid Psychology of Ayurveda: Treatment of Psychological Conditions.

  Ibid Ayurveda and the Mind. 203.

  Ibid Ayurvedic Psychology: Anxiety and Depression. Disc 3. “Prana, Tejas and Ojas”. Track 4.

Bipolar Disorder: from Western Medicine and Chronobiology to Ayurveda By: Lucia Pagani

Bipolar disorder (BD): a psychiatric definition and treatment

Bipolar disorder (BD) is a chronic, disabling and life-threatening illness1. Patients with a diagnosis of BD have a
suicide mortality rate of more than 10 times that of the general population2-4. BD has a lifetime prevalence of 4.5%
in the adult US population, equally affecting females and males5. Currently, BD etiology is still unknown. Recent
studies hypothesize BD to be driven by the interaction between genetic and environmental factors, although no
genes have been unequivocally linked to BD, yet6.
 
The most updated edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies BD
as a mood disorder. The DSM-IV defines BD as a “cyclic” or “periodic illness”, in which a subject experiences
mood swings from positive symptoms (mania, period of elevated mood) to negative episodes (depression), most
often transitioning through a euthymic phase (normal non-depressed and positive mood)7.

Specific symptoms characterizing the two poles of the disease are:

- Mania: on the basis of the severity of the symptoms mania can be sub-classified into hypomania, acute mania, and
delirious mania. Hypomania is a state in which the patient has a heightened mood, high self-esteem and selfconfidence;
because of that, he/she may engage themselves in other people’s lives or even in dangerous situations.
Patients are distractible, present with hypersexuality, have flights of ideas and lack the need of sleep7. During acute
mania phases, the symptoms of hypomania are exacerbated; in addition, hallucinations and delusion symptoms
appear, together with increased strength and decreased pain threshold7. The most severe form of mania is delirious
mania, in which, in addition to the exacerbation of acute mania symptoms, the patient may experience confusion,
clouded consciousness, dysphoric mood, loss of self-control, and catatonia7.
 
- Depression: patients experiencing depression report loss of energy and psychomotor retardation with agitation,
despair, low and irritable mood and no attraction to life, eventually leading to suicidal thoughts or attempts.
Depression presents with hallucinations, delusions of guilt and belief in deserved punishment, hyperphagia, leading
to weight gain, hyper-somnolence due to a feeling of being always exhausted, insomnia, sluggish thoughts, impaired
concentration, memory and decision making7.
 
BD is further classified as BD-I and BD-II, on the basis of the severity of symptoms BD-I subjects experience acute
and delirious mania symptoms, while BD-II subjects experience only hypomania.
 
Normally, in BD, the two phases of the disease are separated by a period of euthymia. However, sometimes a patient
shows a mixture of manic or depressive symptoms, such as “weeping uncontrollably” while saying “they never felt
so well in their lives”, or manic and depressive phases occur in direct succession.; these episodes are called mixedmanic
episodes7. In general, women tend more toward depressive episodes, while men toward manic episodes,
although the cycling, duration of each episode and the “polarity” are very subjective7.
 
The current treatment of BD is characterized by empirical trials and many side effects; often, the treatments include
a combination of several kinds of medications8 and psychotherapy. The main pharmacological classes of
medications prescribed to BD patients are mood stabilizers and antiepileptic drugs9, such as lithium chloride and
valproic acid. Lithium is effective in reducing mania episodes, although its mechanism of action is still unclear.
Often, mood stabilizers and antiepileptic treatments are not enough to prevent manic or depressive episodes9; when
the depressive phase of BD occurs, antidepressants, such as selective reuptake serotonin inhibitors or tricyclic drugs,
are often administered along with mood stabilizers. In general, antidepressant treatments are used for a limited time,
as it was observed that antidepressant drugs may trigger manic episodes or cause cycles to be more rapid. When
manic episodes occur, antipsychotic medications, such as haloperidol, are prescribed10. All drugs used to treat BD
have strong side effects, and can be toxic; moreover, the efficacy and dosage of these treatments are unpredictable
and subjective.
 
In addition to medications, psychotherapy11 and other therapies, such as electroconvulsive therapy12 for manic and
depressive episodes, vagus or vagal nerve stimulation, transcranial magnetic stimulation13 and light therapy for
depressive episodes14, are important for the treatment of BD.
 
Ayurveda and BD
Originating in India, Ayurveda is the most ancient health discipline. The roots of the word Ayurveda come from the
Sanskrit Ayur (life) and veda (knowledge); Ayurveda is thus the science of life. In its ancient texts (“veda”)
Ayurveda comprises etiology, pathology and pharmacology of diseases.
 
Ayurveda acknowledges that the constitution and illnesses of every individual are caused by three bodily humors, or
doshas: vata, pitta and kapha. According to the compendium Charaka Samhita, one of the fundamental classic texts
of Ayurveda, written in the early centuries of the Common Era, the doshas are defined as “the three body energetics,
made of qualities, which support right body function in right amount, and destroy right body function in excess or
deficiency”15.
 
Every dosha is built from different elements (ether, air, fire, water, earth), and thus possesses unique qualities. Vata
(air and ether) is the lighter of the doshas. In the Charaka Samhita, Charaka describes vata qualities as “nonunctuous,
cold, light, subtle, mobile, non-slimy and rough”16. Pitta (fire and water) is the only warm dosha., Its
qualities are “slightly unctuous, hot, sharp, liquid, sour, mobile and pungent” according to the Charaka Samhita17.
Kapha (water and earth) is the heavier and most still of the dosha, and it is described as “heavy, cold, soft,
unctuousness, sweet, immobile, slimy”17.
 
According to Ayurveda, when a person is conceived, the unique relative ratios of the doshas form the constitution, or
prakruti. Any imbalance of this relative ratio leads to a disease. The imbalanced dosha would reside in the weakest
system or organ, that can be physical (such as the digestive tract) or not physical (e.g. the mind)18.
 
In the same way as the body presents attributes that are driven by the doshas, Charaka Samhita describes also the
attributes of the mind (gunas): tamas (“inertia, dullness, sleep, darkness”), rajas (“momentum, desire, action”) and
sattva (“peaceful, clear, balanced, steady”)16.
 
The state of mind of bipolar patients is seldom sattvic; it can be said that persons experiencing milder forms of the
disease (BD-II) have a rajasic state of mind, while during severe episodes of depression or mania (BD-I) they have a
tamasic state of mind.
 
According to Ayurveda, there are three energies that are essential for the vitality, that are subtle counterparts of the
doshas: prana (“subtle energy of air as the master force behind all mind-body functions”)19, tejas (“subtle energy of
fire through which we digest impressions and thoughts”)20 and ojas (“subtle energy of water as our vital energy
reserve, essence of digested food, impressions and thoughts”)20. Prana is the force that allows the mind to “move
and respond to challenges”, tejas allows good judgment, and ojas is the mind’s endurance, providing psychological
stability20.
 
In BD patients the level of ojas is low, and this is reflected by the mental instability that characterizes the pathology.
In acute phases, prana is high during mania, where there is an excess of movement of thoughts, and low during
depression, where, opposite to manic phases, thoughts become sluggish. Tejas is high in manic phases, where
patients lack clarity and determination, and can be either high or low during depression19,20.
 
Although a perfect overlap between BD and ancient Ayurveda pathology definition is not found, Charaka and
Sushruta (a second fundamental classic Ayurveda author) describe symptoms of psychiatric diseases and classify
them as “unmada”. Unmada comprises all psychiatric disorders and can be translated as “psychosis”21,22. In the
Sushruta Samhita, unmada is subsequently divided in 6 subcategories: three due to the vitiation of a single dosha,
one involving the vitiation of multiple doshas, one due to anxiety and mental stress and one caused by poison. The
different types of unmada carry etiological, pharmacological and prognostic importance. Specific symptoms of BD
can then be driven by specific doshas vitiating the mind (manovaha srota). Vataja unmada is characterized by vataspecific
behaviors, such as “patients laugh without a reason, shout, and wander about”. Anger and hostility become
predominant features for patients experiencing pittaja unmada. Kaphaja unmada is accompanied by loss of appetite,
lethargic actions and voice, and increased sleeping time. From this brief overview, vataja and pittaja unmada can be
associated with the western definition of mania, while kaphaja unmada would correspond closely to depressive
phase. However, due to the volatile nature of the disease, BD can be considered more associated with vata
imbalance; indeed “vata’s excess of air causes instability and agitation in the mind”, thus being the principle
responsible for creating the space that would be eventually filled by other doshas23,24.
 
Between the 5 different expressions of vata (prana vayu, samana vayu, vyana vayu, udana vayu and apana vayu),
samana vayu, “mental digestion and homeostasis”, results as particularly compromised in BD. Vitiation of samana
vayu leads to an altered homeostasis of the mind, that subsequently affects vyana vayu, increasing the circulation of
thoughts, and prana vayu, altering the intake of sensory impressions in the mind20.
 
Ayurveda recognizes that all pathologies start in the digestive system, as the accumulation and aggravation of the
vitiated doshas. Prodromal symptoms of BD would be typical of vata vitiation (apana vayu) in the digestive system
(purishavaha srota), affecting the moisturizing of the mucous membranes of the colon, leading to constipation. Vata
would overflow from the digestive system to the mucous membranes of all the body (rasavaha srota) and the
circulatory system (raktavaha srota), producing generalized dryness and fatigue. Vyana is the vayu that becomes
vitiated at this level. The pathology manifests when vata relocates in the manovaha srota, the channel of the mind,
and modifies and diversifies, leading to the symptoms typical of BD, caused by the vitiation of samana (restlessness,
mood swings, tremors), prana and vyana vayu (vata-driven and circulated emotions and thoughts).
 
From this perspective, it become clear that, as BD is mainly driven by vata (that may lead to the vitiation of other
doshas in the mind) all actions taken to pacify vata would improve the symptomatology of BD. Vata’s principal
characteristic is being mobile, thus constant routines would improve vata-driven pathology such as BD; vata is also
associated with movement, that would then be reduced by “sitting or walking quietly and peacefully by” nature,
listening to “calming music”, gentle massage using sesame or almond oil, calming colors (in particular gold), “rich
and nourishing food abounding in sweet, salty and sour tastes”, “sweet, warm and calming” fragrances (“jasmine,
rose, sandalwood, eucalyptus”). Calming activities such as gentle practice of Hatha Yoga, Tai Chi, and swimming
will also have a positive effect on BD; these activities will help the mind to build peace and contentment, essential
for a good prognosis of the disease. Chanting vata-pacifying mantra, such as “Ram, Hrim, Shrim” is another way to
ameliorate BD symptoms20.
 
Ayurvedic pharmacopeia utilizes herbs to assist and sustain the lifestyle changes required to decrease vata in the
manovaha srota. To pacify vata in the manovaha srota, nervine tonics and sedatives should be administered.
Examples of these herbs, considered beneficial in the management of BD, are ashwagandha, shatavari, shank
pupshi, brahmi, taken with a dipanas to help digestion. The ideal anupanas for the formulation would be ghee, since
it is particularly beneficial for increasing ojas, which should be the primary goal of treatment, in order to give
stability to the system25.
 

Chronobiology: a new branch of western medicine

A relatively new branch of western medicine is chronobiology, that considers the timing of periodic phenomena of
essential importance. The most important periodic phenomenon is circadian rhythm.
 
Circadian rhythms are all the reactions and substances that occur in the body with a period of roughly 24 hours.
Circadian rhythms are very well conserved through evolution, controlling the physiology and behavior of almost all
living beings. In complex beings like mammals, the circadian rhythm is organized in a hierarchic fashion: the master
clock, the suprachiasmatic nucleus (SCN) of the hypothalamus, that possesses an endogenous rhythm, contains an
input pathway that links the external light-dark stimuli to the internal cycle and synchronizes peripheral oscillators
through a variety of stimuli; thus, light is the main entrainment cue for humans. Peripheral oscillators, virtually all
the cells of the body, possess the same molecular clock machinery as the SCN. The basis of the molecular
machinery that constitutes the circadian rhythm is a negative feedback loop. The same clock genes that are activated
and repressed in a circadian (about 24 hours) fashion are present in every cell of the body26,27.
 
Increasing evidence highlights the link between health and proper circadian rhythm function. It is demonstrated that
many pathologies lead to impairments of circadian rhythms (“sundown syndrome” in Alzheimer’s disease patients,
for example) and that abnormal circadian rhythms (eating at the wrong time) can cause disorders (metabolic
syndromes).
 
Much evidence provides support for an association between circadian rhythm dysfunction and BD. Alteration of
hormonal circadian rhythms (e.g. cortisol and growth hormone levels) and core body temperature in BD have been
reported in early studies, suggesting an involvement of the circadian system in the pathophysiology of the disease28-
35. People suffering from BD show an abnormal sleep-wake cycle, in particular a reduced need of sleep and
abnormal sleep architecture36; moreover, sleep disturbances are often prodromal to BD relapse37, and sleep length
was found to be prodromal to mania or hypomania phases38, and is one of the main symptoms considered by the
DSM-IV of both mania and depression. In addition to this evidence, many genetic studies imply that mutations in a
number of clock genes are associated with BD39.
 
Quite unsurprisingly, the treatment of BD with antipsychotic drugs stabilizes the circadian rhythms seen in the
amplitude of temperature rhythms, plasma melatonin, cortisol secretion levels40, although an enhanced salivary
cortisol response to waking is still present in euthymic individuals41.
 
Due to the strong impact of circadian rhythm dysfunction on mood disorders, many protocols are being developed to
treat psychiatric disorders, and in particular BD, with chronotherapies, treatments specifically designed to regulate
the circadian rhythms of a person, including re-establishing a good synchronization between the external light-dark
cycle and internal rhythms.
 
The main therapeutic resource of chronotherapies is the regulation of sleep and light exposure. Sleep deprivation has
been widely demonstrated to have a quick, but temporary, antidepressant effect, that can manifest even after 24
hours or one night of complete sleep deprivation14,42. In depressed subjects, this treatment would “reset” the clock,
ameliorating ,symptomatology. In BD subjects, however, sleep deprivation could ameliorate depressive symptoms,
but could trigger mania as well43. In a recent paper, the use of sleep deprivation was administered in conjunction
with other chronotherapies, such as bright light therapy, and sleep advance phase. Bright light therapy was
administered the day after the sleep deprivation night for three consecutive days, while following a sleep deprivation
night subjects were exposed to sleep phase advance, to reset the sleep time around 10 PM. The combination of these
therapies was shown by the authors of the paper to have a fast and long-lasting anti-depressive effect without
triggering mania44.
 
Morning bright light therapy was attempted in depressive phases of BD, but in the vast majority of cases it would
trigger mania; however, a higher dose of midday bright light was found beneficial45.
 

Similarities between Ayurveda knowledge and new western traditional medicine approaches to BD

The first striking feature that surprises us when comparing the Ayurvedic description of unmada and the more recent diagnosis and classification of BD symptoms is the similarity between these two disciplines, developed in times so far from each other. Typical vata symptoms that have been described in ancient texts and have a counterpart in modern psychiatric diagnosis methods (e.g. DSM-IV) include, for example, continuous irregular speech, excessive talking or “pressure of speech” (satatamaniyanam ca gira and bahubhasita), hyperactivity and inappropriate behaviors such as excessive smiling, laughing, or dancing (abhiksnasmitahasitanrtyagitavadi), abusive and
dangerous behavior (vikrosa). Similarly, pittaja unmada symptoms such as impatience (amarsa), anger (krodha), violence (samrambhaschasthane), raised temper (rosa), sleeplessness (vinidra) are also present in the description of BD in the DSM-IV. Both vata and pitta symptoms are translated as manic manifestations of the disease. Also when considering kaphaja unmada symptoms it is possible to find similarities to the DSM-IV diagnosis criteria for BD, such as psychomotor retardation (stillness and sluggishness) (alpacankramana and sthanamekadese), lacking of energy (alpamati), hypersomnolence (swapnanityata)46.
 
The main goal of chronobiology is to re-establish a physiological and personal routine in sleep and eating behaviors. This is of particular importance for a disorder as highly variable as BD in which, depending on the phase of the disease, a patient may sleep less than 3 hours per night and forget to eat, or oversleep and overeat. The same principles are considered fundamental in the management of vata-driven pathologies when samana vayu is vitiated, focusing the treatment by also improving a constant routine around sleep and eating habits20. 
 
In addition, in BD, Ayurvedic principles can offer a mechanism behind the validity and failure of certain chronotherapies. Sleep deprivation therapies used to treat depression were demonstrated to be a non-effective treatment for BD, triggering mania in a high percentage of volunteers, despite the finding that in major depression the treatment did not have side effects. Effective vata-reducing practices improve rest and sleep time, therefore sleep deprivation would exacerbate vata vitiation and symptoms. On the other hand, BD symptoms were ameliorated when patients were treated with 14 hours of bedtime in the night in total darkness, that can be considered a vatapacifying
technique, since people with vata vitiation are extremely sensible to stimuli (“loud music or noise”20). A similar example is the bright-light therapy used in treating BD patients that was found to be effective to treat depression without triggering mania if administered during mid-day, a moment of high pitta, important for properly digesting the light.
 

Conclusions

All reported evidence points out that the proper management of the life-threatening disease BD is still a challenge for modern psychiatry; however, the new concept of chronobiology is helping physicians with novel therapies, such as dark and light therapy, sleep deprivation and sleep phase advance therapy. Similar concepts of ad-hoc life-style changes were already suggested from early in the Common Era by Ayurvedic practitioners for the treatment of specific disorders. The ancient, yet current, Ayurvedic knowledge can be extremely important for the proper application of chronotherapies, resulting in a more personalized and affordable treatment to counterbalance subjective imbalances in BD. Taken together, chronotherapies and Ayurveda could be a new keystone in the
treatment of BD.

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