Hallucinations in the classical Indian system of Ayurveda: A brief overview.

The ancient Indian system of medicine "Ayurveda" is a compendium of various health related theories and practices and explained the abnormal state of mind, i.e., psychopathology in various contexts. Hallucinations were deemed abnormal. In Ayurvedic classics, hallucinations were called false perceptions (mithyajnana), illusions (maya), infatuations (moha), or confusion (bhrama). Hallucinations were not independent but a symptom of mental disorder (manasa roga). Hallucinations of different sensory organs were observed and explained. These symptoms could be observed in patients suffering from any illness of tridosha origin, organic disease or psychiatric disorder. False perceptions observed in patients were used as tools to understand the prognosis of the condition. This article may help provide preliminary insight and encourage interdisciplinary study toward understanding one of the main symptoms of schizophrenia.

INTRODUCTION

History is like a screen in which the past lightens the present and the present brightens the future.[1] As a fast developing country, India's pride is in its rich history, traditions and philosophies with its ideologies, requirements and support system different from western counterparts.[2] The traditional Indian system of medicine “Ayurveda” is not only a herbal tradition, but a science with a comprehensive approach to life along with fundamental principles of diagnosis and treatment. Ideally, the significant contributions of Ayurveda should be synthesized with modern science. Ayurveda scholars were reputed for philosophical theories of psychological disorders.[3] When explored, we recognize the richness, comprehensiveness and intense possibility of paradigms and wisdom contained in this ancient Indian literature, and its potential to enrich our professional knowledge.[4] Indian psychiatrists are increasingly open to the incorporation of Ayurvedic concepts in practice.[2] As we move forward, we need to identify, maintain, and communicate ancient Indian concepts.[5]

Hallucinations have fascinated human beings down the ages, and were sometimes regarded as messages from god, or as spiritual or religious visitations. However, the ancient Indian treatment system of Ayurveda was surprisingly modern in its interpretation of this phenomenon. In Ayurveda, a hallucination is something that is perceived. Perception, known as “jnana” cannot be achieved without involvement of the mind (manas).

CONCEPT OF MIND (MANAS) IN AYURVEDA

Ayurveda regards life as the combination (samyoga) of body (sharira), organs of conation and cognition (indriya), mind (satva), and soul (atma).[6] But for practical purposes, the mind (manas) and body (sharira) were separately defined and their entity and doshas separated. Bodily doshas (sharirika doshas - vata, pitta, kapha) and mental doshas (manasika doshas - rajas, tamas) mutually affect each other.

As per Ayurveda, the mind has immense potential along with its attributes of conscious and creative energy.[4] According to Charaka the father of Ayurveda, manas is the entity responsible for observation and thinking. The word manas is derived from the root word “mana – jnane,” “mananat – manah.” Manas in Sanskrit, means to know, think, believe, imagine. The mind is inactive (achetana) by itself but gets activated (chetana) by the self or soul (atma or atman). Although beyond sensory perception (it cannot be seen or felt), it is a material substance (dravya), since it has both quality (guna) and action (karm) coexistent within itself. It is the internal organ for perception. Manas links the soul (atma) with sense organs and their sensory objects such as sound, touch, shape, taste, and smell. The soul (atma) is the basis of all experience, while mind (manas) is only the instrument of experience.[6] Mind is the mediator between soul (atma) and sensory organs (indriyas). Our ancient Indian system emphasized the theory of unity of body and soul and explained how to deal with mental health problems using a psychosomatic approach.[1] Any disease produces psychological as well as physical symptoms, which were described together.

The psychopathology of the mind was understood in terms of their trigunas and tridosa.[7] The concept of sadhaka pitta (one of the five sub type of pitta dosha) appears to be psycho physiological. The vitiation of one of the bodily humors - vata dosha is said to cause delirium (pralapa), insomnia (nidra nasha), etc., “Pitta” vitiation caused confused state of mind (bhrama) and unconsciousness (murchha). “Kapha” vitiation caused excessive sleep (ati nidra) and dullness (avasada).

CONCEPT OF TRIGUNA (QUALITIES OF MIND)

The mind (manas) has three operational qualities known as trigunas. Trigunas specifically indicate the psychological traits - satva, rajas and tamas. The ordinary classification of mental states such as thinking, feeling, and willing could be explained within the scope of triguna.

Satva refers to “sat,” mind, reality, truth, pure quality. “Satvam prakashakam” means, “that which enlightens.” Satva is indicated by knowledge acquisition, analyzing, satva is the nature of harmony in various forms.

Rajas refer to “raja” stain, passion, agitation. “Rajas cha pravartakam” means, rajas is the initiator of thought, which gets converted to an action by desire, effort and memory. Rajas is the nature of pain.

Tamas refers to “tama,” darkness, ignorance (moha) and is indicated by an inability to perceive, laziness. “Tamah niyamakam” means it controls or regulates the active satva and rajas. Tamas is in the nature of delusion.

Charaka says that the mind is a diverse disposition of these trigunas which function in mutual combination. The predominance of any one of them leads to a particular psychological constitution or predisposition - the pure sattvik, passionate rajasik and the ignorant tamasik.[6] A psychological balance of all three is essential for a healthy state of mind. When satva is predominant mental outlook is healthy. Mental and emotional disturbances arise when rajas is predominant. Mental state is depressed, dull, and perverse when tamas is predominant. The predominance of one or other qualities in a person at any given time determines his mental state at that time.

Charaka hypothesized that rajas and tamas are pathogenic and produce mental disorders.[6] However, satva, comparable to the concept of “superego” is not a dosha. The intellectual, aesthetic and moral states of mind are included in satva. The cognitive functions pertaining to memory, conception, judgment and reasoning all belong to satva. Rajas is prominently responsible for the state of feeling and egoistic emotional states of mind like fear, anger, hope, envy, forethought, self-importance, hate etc.[6] Tamas is primarily related to biological and instinctive aspect of an individual. Feelings like hunger, thirst and involuntary primitive and acquired conations which include reflex, instinctive, casual and habitual functions belong to tamas. Auditory, visual, tactile, olfactory and gustatory sensations also may be related to tamas. Tamas is known as “avaraka,” i.e., it has the characteristic of veiling or covering or concealing (i.e., it is unconscious). Due to tamasik characteristics (visadatmaka-depressive), unfulfilled urges and wishes once present in our mind are forced into unconsciousness which may subsequently result in mental disorders.

According to Ayurveda, sadhaka pitta (one of the five types of pitta dosha) is deemed to be essentially responsible for higher mental faculties and emotional states as mentioned in Sushruta Samhita, Vagbhata (Ashtanga Hridaya)[11] and Charaka Samhita, “Another treatise Kashyapa Samhita is of the same opinion.[12] This is located in hridaya (seat of mind) and is responsible for the feelings of fear (bhaya), courage, bravery, valor (shourya), anger (krodha), happiness (harsha), intelligence (buddhi), medha, and self-esteem (abhimana). Sadhaka pitta performs its functions by dispelling the kapha (one of tridosha, which is responsible for dullness) and ignorance (tamas) of the hridaya and thus enables manas to perceive things clearly.

FUNCTIONS OF THE MIND

Ayurveda has differentiated our organs into organs of perception (jnanendriya) namely auditory (shabda), tactile (sparsha), vision (roopa), taste (rasa), olfactory (gandha) and organs of execution (karmendriya) namely speech (vak), hands (pani), foot (pada), excretion (payu), sexual (upastha). Mind has been given the special status as ubhayendriya,[8] meaning organ of both perception and action. According to Ayurveda, although the mind (manas) is responsible for sensory perception, it has specific functions of its own. They are thinking (chintya), analysis (vicharya), speculation (uhya), distinct thought (dhyeya) and decision (sankalpa).[6]

The Upanishads provide descriptions of theories of perception, thought, consciousness, and memory. Prakriti is described, which can be considered as equivalent to personality in modern psychiatry.[7]

Ancient Indian psychology emphasized the significance of concentration and considered it means for perception of truth. The yoga system of philosophy dealt in depth with both theory and practice related to mental health.[1] As per philosophy of yoga,[9] the mind or manas performs two types of functions namely observable (paridrishta) and inferable (aparidrishta). Manas has five sub functions (vritti) under observable functions (paridrishta). They are comprehension (pramana), to oppose (viparyaya), thinking of options/thinking by examples (vikalpa), sleep (nidra) and memory (smriti). These functions may produce five bad emotions (klesha) “unintelligence” (avidya), unhappiness (asmita), aggression (raga), hatred (dvesha) and obsession (abhinivesha). Except nidra, the other four indicate mental functions. A mentally healthy individual has strong smriti (memory) and pramana (comprehension).

Inferable functions (aparidrishta) consist of seven subfunctions namely self-discipline (nirodha), righteousness (dharma), culture (sanskara), effectiveness (parinama), inclination for sustenance (jeevana) difficulty (klishta) and strength (shakti). These can be understood by inference or by reading treatises.

Knowledge (buddhi) is achieved in two ways. One is memory based knowledge (smriti) and another is experience based knowledge (anubhava). Memory (smriti) is defined as recollection of seen, heard and experienced things and develops due to eight reasons: perception of cause (nimitta grahanat), visual perception (roopa grahanat), similarity (sadrashya), contrast (viparyaya), mind getting in contact with objects (satvanubandha), practice (abhyasa), constant thinking (jnana yoga), repetitive listening (punah shruta).[6]

Experience based knowledge (anubhava) is of two types, true experience (yathartha) and false experience (ayathartha). True experience (yatartha anubhava) is again of four types - as told by reliable/authoritative people (aptopadesha), one's own sensory perception (pratyaksha), inference (anumana), and comparison (upamana). False experience (ayatartha anubhava) is of three types namely, doubting or suspicion (samshaya), illusion (viparyaya) and hypothetical argument (tarka).[13]

Hallucination is an illusional (viparyaya) type of false experience (ayatartha anubhava), i.e. experience based knowledge (jnana) according to Ayurvedic explanations.

DESCRIPTION OF MENTAL DISORDER

Charaka observed that rajas and tamas are two factors which affect the mind and they produce symptoms of mental disorder. While describing pathogenesis of a mental disorder “atatvabhinivesha” (comparable to obsessive compulsive disorder), Charaka says the mind (manas) and intellect (buddhi) get clouded with increase of rajas and tamas. Hridaya (seat of manas) is disturbed by an imbalance of doshas (tridosha). The man who has become stupid and weak in intelligence tends to formulate incorrect judgments concerning true and false, good and harmful. This state of mind is referred to as pramoha (delusion).[6]

Charaka describes eight essential psychological factors that are negatively affected in various ways in all psychiatric disorders. They are mind (manas), cognition (buddhi), orientation and responsiveness (samjna jnana), devotion (bhakti), habits (sheela), psychomotor activity (chesta) and conduct (achara).[6]

Over activation of rajas (action) or tamas (inertia) causes the mind to lose balance which in turn affects tridosha (vata, pitta, kapha). When this balance is totally lost, the result is a mental disorder, or if it tilts in any one direction conditions such as anger, anxiety, and nervousness occur, which are normal emotions but exhibited in an intensive manner. The doshas as they accumulate as toxins have negative emotional components like vata expressed as fear, pitta as anger and kapha as attachment. Vata dosha in particular has strong psychological implications because the mind is part of the field of vata.

HALLUCINATIONS IN UNMADA

Unmada covers a wide range of symptoms and is synonymous with insanity, mania, mental derangement, mental disorders etc., Charaka defined unmada or mental disorder as instability of mind (manas), intellect (buddhi), deranged perception of all sensory stimulus or loss of orientation of time, situation and place (sanjna jnana), memory (smriti), inclination (bhakti), mannerism (sheela), activities (chesta) and conduct (achara).[6] All these terms were applied to that disordered state of mind in which an individual lost his power of regulating his actions and conduct according to the rules of the society. As per modern classifications, the term covers all the psychotic disorders.

While explaining the prodromal symptoms of unmada, “svanah karnayoh” is one symptom. This indicates false perception of sounds or noise (auditory hallucination). The term is not explained in detail thereafter.[6] In Charaka Samhita, “indriyasthana” (section on signs of life and death), chapter I – Varna Swareeyam Indriyam, Adhyaya – deals with arishta lakshana. Arishta lakshana are the entities, some related others unrelated to the patient, which forecast imminent death. These entities should to be examined by the physician to find out remaining span of life through direct perception (pratyaksha), inference (anumana), authoritative statements (upadesha).[6] These signs – and many others not mentioned here-may be related to complexion, voice, smell, taste, touch, vision, auditory, olfactory, gustatory, tactile perceptions of the patient. These may be observed in patients suffering from any illness of tridosha origin, somatic or psychiatric.

SOME HALLUCINATIONS MENTIONED IN AYURVEDA

In Charaka Samhita, indriyasthana chapter IV, indriyaneekam Indriyam Adhyaya, Charaka states that as these sensory organs transcend all the senses they should be examined directly by the treating physician. The perception pertaining to the sense organs which is abnormal and arisen without any apparent cause is indicative of death:[10]

The patient who sees the sky as solidified like earth or sees the earth like the sky, or both in contradiction attains death (shloka/7)

One who sees air moving in the sky but does not visualize the burning fire should be taken for lost (shloka/8)

If one sees a net in clear flowing or stagnant water where there is no net, his life span is ended (shloka/9)

While awake, if one visualizes ghosts and various demons or some other bizarre things, he is unable to live (shloka/10)

One who sees the normal colored fire as blue, lusterless, black or white dies on the seventh night (shloka/11)

If one sees rays of light without clouds, if one sees clouds in the sky though not there or if one sees lightning when there are no clouds, he attains death (shloka/12)

If one sees the sun or moon, like an earthen vessel covered in black cloth, he will not live long (shloka/13)

If a diseased person or healthy person visualizes solar eclipse or lunar eclipse though it is not there, it indicates death (shloka/14)

If one sees the sun during the night and moon during daytime, smoke rising without fire or lusterless fire in the night, he is going to die (shloka/15)

One who is about to die, sees bright objects as devoid of brilliance, or non-brilliant objects as brilliant and sees all objects devoid of their normal characteristics (shloka/16)

A person who is about to die, sees all objects as deformed, of different color, in different numbers without an apparent cause (shloka/17).

If a person sees nonvisible objects or does not see the visible ones, he dies soon (shloka/18).

One who hears sounds when there is none or does not perceive the real sound should be considered to be dead (shloka/19)

If one is not able to hear the fire burning sound when both ears are closed with fingers, then he should be considered to have very little life span left (shloka/20)

If one perceives good smell and bad smell in contrary, or does not perceive the smell entirely should be considered to have completed his life span (shloka/21)

If one does not perceive the taste even in the absence of any kind of inflammation in the mouth or perceives altered taste, he should be considered to die soon (shloka/22)

If one perceives touch sensations such as hot-cold, coarse-smooth, and soft-hard in an opposite way (contrarily), he is about to die (shloka/23)

Super sensory perceptions without any rigorous penance (tapas) or methodical yoga, indicate death (shloka/24)

If one perceives all senses correctly in spite of incapability of sense organs, it indicates death (shloka/25)

If a healthy person contrary to his intellect repeatedly perceives abnormal sensations though there is no object of stimulus, it indicates death (shloka/26).

Chapter 28 entitled Panchaendriyartha pratipattinam adhyaya of the Sushruta Samhita Sutrasthana (section of fundamentals) deals with clinical aspects related to the five senses. A reference is made to abnormal sensations (hallucinations), which when seen in persons indicate death:[8]

Patient hears different noises which are actually not there, pertaining to divine worship, like verses of gods (patha), singing (geeta), noise of musical instruments (vadya) being played by celestial beings (siddha, kinnara, gandharva, etc.). Sometimes hears the noise of roaring of the sea, which is absent If hears the noise of forest while he is in the middle of the city or hears noises of the city while he is in a quiet place, if he starts loving noises which he hated earlier and gets angry with earlier loved noises (shloka 4-6)

Perceives hot objects as cold ones and cold objects as hot ones. He feels his feet are covered with sand and mud even though they are perfectly clean. Sometimes he feels that he is dirty and flies are attracted to him even though he has taken a bath and is clean (shloka 7-10)

If he perceives tastes opposite to what actually is eaten. Sweet tastes like sour, etc. If he likes tastes which are not advisable to him or he cannot perceive the taste at all (shloka 11-12)

If he perceives good smell as bad and dirty smell as good, if he cannot perceive the smell of burning lamp or cannot perceive any kind of smell at all even though he is not suffering from olfactory related diseases (shloka 13-14)

If the person sees stars sparkling in the sky during daytime, sees bright sun in the sky during the night and moon during daytime. Even though, the sky is clear of clouds, if he sees lightning and rainbows he dies within 3 months (shloka 15-16)

If the person perceives heat/cold, time, season and direction as opposites to the real, if he sees everything covered in smoke without suffering from any eye ailments

In the well-lit place if the person sees things as if submerged in water, if he sees the earth in eight lines, if the person is not able to see the stars namely the Arundhati constellation and Dhruv (North Star) and different galaxies, one must understand his life span is over

If a person is not able to see his own shadow, if he sees his normal limb as deformed or feels he has lost his limbs he will die

If the person sees the spirits of dogs, crows or eagles, if he sees celestial bodies (yaksha, rakshasa, pishacha) and horrifying things, he will definitely die

If a person sees the normal colored fire as peacock blue, lusterless, black or white, then death is certain.

CONCLUSION

During ancient times, severe mental disorders could probably not be treated effectively hence death was thought to be inevitable. The above mentioned instances may not end in death today with effective diagnosis and management. What is important is that these false sensory perceptions were noted, studied and were given great importance as an indicator of prognosis of diseased condition in Ayurveda.