Dhairya / Aashvasana Chikitsa: Reassurance and courage therapy, Role in Sattvavajaya Chikitsa

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Dhairya means courage or giving reassurance. This is not just a gesture or kind hearted approach towards the other person, it forms an important part and parcel of psychiatric therapy. Many people need this and there should be someone, a physician or loved one to adorn this role when the needy is in distress.

Words of courage and assurance will work wonders and seed confidence and courage in the minds of the people who lack that virtue as a part of their nature or while being a victim of long-standing illness, mainly mental disorders and in many instances even for those suffering from chronic physical diseases or psychosomatic diseases.

Definition of Dhairya

Dhairya is defined as ‘Dhairyan anunati chestasaha’ which means maintaining a state of mental balance in spite of the person being under immense stress.

Persons having alpa sattva or hina sattva i.e. weak minds are timid and lack courage. They would magnify simple problems out of proportions and cannot tolerate the hardships of diseases, be it mental, physical or both. Their tolerance power is too low and they need constant encouragement, by doctor, family or friends.

It is very essential to include it as a therapy if comprehensive mind healing needs to be planned.

Dhairya is also called Ashwasana – which means assurance or instilling courage in the minds of the people needing it.

Aim and goal of Dhairya Chikitsa

As already said, dhairya is a therapy all by itself. It aims at instilling the courage in the hearts of those showing the deficiency of the same or those who are of avara sattva i.e. weak minded and providing assurance to them. Therefore, it is a part and parcel of sattvavajaya chikitsa – the Ayurveda aspect of psychotherapy.

It not only instills courage in the person who is in search of that, it also relieves fears and boosts self-confidence and promotes hope. They start seeing light at the end of the tunnel.

The talks and counseling that matters

For this to happen, a clear one-to-one talk with the patient is very necessary wherein the nature of the disease shall be explained to them so that they understand what is going on in them and they develop an insight into the disease. The same approach shall be adopted while explaining the treatment process that they would undergo in the coming days. The reasons for the disease to have developed, for flare ups, for recurrences shall be explained and educated about the preventive measures and cautions they can inculcate into their life so as to keep the disease at bay.

Other meanings of Dhairya

The term Dhairya can be understood as having different meanings. They are –

–        Courage
–        Ensure
–        Assurance
–        Patience
–        Tolerance
–        Mental endurance
–        Mind strength
–        Controlling power

From a therapy perspective it can be read as – encouragement, counseling, supportive therapy and providing assurance.

Dhairya as therapy

As a part of therapy, the patient is reassured and counselled regularly. So, talking to the patient suffering from mental disturbances or ailments at regular intervals and encouraging them into the counseling sessions is the pulp of dhairya therapy.

The physician would put efforts in changing the negative thoughts of the patient to positive thoughts and channelize their thought process in a positive direction. Counselling is an essential part of psychotherapy even in modern medicine and can be equated with the dhairya component / approach of sattvavajaya chikitsa.

Dhairya aims at bringing strength, firmness and balance to the mind by calming down the hyper-excitation of the mind. The counselling and meditation which are included herein help in increasing the patience and courage in the person. The instilled courage helps the person to gather courage to bear pain, grief and other challenges he or she encounters in their lives.

Nowadays, sound therapy is used to attain this goal which can create positive vibrations to calm down the mind leading to regeneration of courage and hope in the patient. The therapy provides maximum empathy and attention to the patient and creates a trust value and also a matured level of awareness and judgment and improves a significant amount of patience and awareness of self-worth.

How to bring the patient in the pathway of dhairya?

Dhairya therapy is needed for those with avara sattva – weak minded and Madhyama sattva – those having moderate mind strength, neither too timid nor too brave. The first step in instilling dhairya in them is to slowly bring them into confidence. This needs a few ‘talk sessions’ or regular counseling. The bridge of trust should be built between the psychotherapist and the patient. The communication initially and seeding of dhairya in the later stage is done through this truss bridge. Things should not be and should not be hurried. The process needs to be gradual. These patients shall be handled in a sensible and sensitive way.

Does a healthy person too require dhairya?

Dhairya is needed for a mentally healthy and stable person too. The stability of the mind depends on the quantum of dhairya he or she has, either naturally inherited or acquired through training and guidance. Persons having dhairya will have undeterred mind and will be of pravara sattva i.e. mentally strong. These people will have their dhi, Dhriti and smriti and also rajas and tamas doshas of mind in a state of balance. They will not be drawn towards prajnaparadha i.e. conscious and obsessive mistakes and sins. Dhairya is a foundation for a stable and healthy mind.

Dhairya as part of mind medicine: According to Master Vagbhata

Master Vagbhata in Ashtanga Hridayam has suggested threefold remedies for mental disorders i.e. dhi – intellectual manipulation which comprises jnana and vijnana, dhairya – which is courage or support therapy wherein courage and confidence is instilled in the mind of the ailing person and atmadi vijnanam – which represents jnana wherein the seeds of self-worth and introspection to find self and spiritual knowledge is instilled in the mind of the person. All these combinedly work towards comprehensive mind healing and provide remedy for mental disorders. While Master Charaka has mentioned Dhairya as a tool or therapy included in Sattvavajaya Chikitsa i.e. psychotherapy, Master Vagbhata too has used it as a tool for mental disorders.

Role of Chikitsa Chatushpada in instilling Dhairya

The four limbs of the treatment contribute effectively towards dhairya therapy when they operate in a synchronous way. A wise and compassionate physician will keep encouraging and counseling the patient until he regains total mental health. A cooperative patient who has submitted himself and invested his trust in the physician who is treating him will find purpose and meaning in participating in the support therapy he is getting and will put all efforts in conquering his fears and regain sanity of mind. The caretakers including the family and friends and nursing staff at hospital will provide the desired mental and emotional support towards comprehensive healing of the patient. The medicines, diet and lifestyle changes and therapies, with their effective healing action will instill courage in the mind of the patient and boost confidence day by day and help him or her to conquer their mental ailments.

Methods and measures to instill Dhairya

Regular counseling – The mind of the patient should be strengthened by regular sessions of counseling. The ‘talk therapy’ is also a part and parcel of counseling. The talks with the feeble-minded client should be invited to talk. Talks can happen at clinical setup, over phone, video conferencing or regular texting. This will make the patient think that there is someone to take care of them and they will stay assured. Gradually, the length of intervals between sessions shall be increased after assuring that the patient’s confidence, courage and self-belief is in the right and positive direction. Once the person is enriched with courage and confidence, he or she may not require these sessions. From there on they would handle their life and challenges and problems coming their way. They would also learn to tolerate pain and misery, and the symptoms of disease.

Jnana-Vijnana-Dhairya Combo therapy – The awareness that host should always be in control of situations and the disease is just a guest, a small and negligent disturbance, and that they are an important part of the creation (this knowledge comes from Jnana therapy combined with Vijnana and Dhairya therapies) will help them in conquering the mental disorders and also to enjoy mental health and happiness.

Mind diversion – The person should be given options for diverting his mind and indulgence in something which pleases him or her and give them happiness and keep them away from stressful situations, people, places, causes and triggers. New situations and conditions of living may create a new mindset which is free from stress and fear. Many times, a change of workplace, living place, new people and friends in life, new neighborhood, new patterns of work and renewed way of living will instill new courage, confidence and endurance in the mind and will create a different and new personality of the same person. This simply means replacing old incompatible ones with new compatible ones.

Stress management – Stress would gradually eclipse not only the happiness of the person, but will also make the person mentally weak. The person will start losing patience and courage. The wrong decisions taken with this mind frame will lead the person towards doing prajnaparadha – obsessive mistakes and sins. This will trap the person in the guilt complex if he commits those mistakes again and again with mind not being sane and the though process being unclear. This leads to repeated failures in all actions undertaken. Gradually he will develop fear of failing in his decisions and action taken on such decisions. These people need professional counseling and encouragement as a part of dhairya therapy. People can also find themselves in similar awkward situations in personal and familial relationships, where people around are stressful and the person loses courage in fighting these battles. Dhairya therapy will help in management of stress, fear, anger and many other mental fluctuations.

Fight or flight response – One needs dhairya to fight or fightback. But all situations are not tailormade to rush in and give a fight. It is to take a flight in many such situations. To take a flight instead of taking to fight also needs an attitude to think that way and moreover one needs courage backed up with experience and knowledge of differentiating between fight and flight and which one to do when. One should be trained to understand that flight is a situation not to be shy of, rather it is a defense mechanism which helps one to purchase time for better preparation to combat similar such situations in future. To win, one needs courage. To lose and still smile and make an unheard declaration ‘Okay, I will come back stronger, I have lost a war, I will come back and win the battle’ needs too much courage. One who knows how to do this and do it often will win situations in life. It is the responsibility of the physician to guide and counsel the patient about this.

Support Therapy – Dhairya therapy itself is a support therapy. The effect and impact of this therapy should be such that the patient should feel that he or she has been supported from all directions, they are safe, enveloped and guarded. The words that the physician or psychiatrist plants in the mind of the patient should get deep rooted in his or her subconscious level and should be engineered to support and encourage the person. These are saved in the form of strong memories. These memories will surface when the person needs them the most with the voice within telling ‘don’t worry, you can do it’. The person should also be encouraged to create groups of like-minded friends and loved ones who can selflessly support him, be it in family or at workplace or schools. Similarly, they should know that they have a doctor and medical team who cares for them and they are his or her greatest support system.

Relation with other therapies of Sattvavajaya Chikitsa

Blending of other therapies included under Sattvavajaya Chikitsa i.e. Psychotherapy with Dhairya – instilling courage i.e. Jnana – spiritual knowledge, Vijnana – scriptural knowledge, Smriti – re-toning the memory process and Samadhi – meditation will magnify the results by many folds in terms of healing the mind in a comprehensive way, treating the mental disorders and re-establishing mental balance.