Jnanadi Bhavas: Fivefold Approach in prevention and management of mental disorders

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

Master Charaka has given five best principles for prevention and effective management of mental disorders. They are also the best remedies to heal the mind and to bring the doshas of mind i.e. rajas and tamas to a state of balance. They are – Jnana, Vijnana, Dhairya, Smriti and Samadhi.

Context and reference

वायुः पित्तं कफश्चोक्तः शारीरो दोषसङ्ग्रहः|
मानसः पुनरुद्दिष्टो रजश्च तम एव च||५७||
There are three kinds of sharira doshas i.e. physical doshas – they are, vata, pitta and kapha. The manasika doshas i.e. mental doshas are two in number – they are, raja and tama. (Charaka Sutra Sthana, Chapter 1, Verse 57)

In the very next verse, Master Charaka provides remedies / treatment for both sets of doshas and hence the diseases caused by them.

प्रशाम्यत्यौषधैः पूर्वो दैवयुक्तिव्यपाश्रयैः|
मानसो ज्ञानविज्ञानधैर्यस्मृतिसमाधिभिः||५८||
The disturbances and imbalances occurring in the physical doshas are pacified by daiva vyapashraya i.e. divine therapies and yukti vyapashraya chikitsa i.e. rational therapies. On the other hand, the mental doshas are treated with the help of –

–        Jnana – knowledge of self
–        Vijnana – scientific knowledge
–        Dhairya – temperance or restraint, courage
–        Smriti – memory and
–        Samadhi – concentration and focus / concentration (Charaka Samhita Sutra Sthana, Chapter 1, verse 58)

Here, it is interesting to see that Master Charaka has not mentioned Sattvavajaya Chikitsa – psychotherapy, the third main type of treatment which Ayurveda has accepted. Later, in Sutra Sthana Chapter 11, verse 54, while mentioning three kinds of treatment modalities i.e. daivavyapashraya, yuktivyapashraya and sattvavajaya chikitsa.

त्रिविधमौषधमिति- दैवव्यपाश्रयं, युक्तिव्यपाश्रयं, सत्त्वावजयश्च| तत्र दैवव्यपाश्रयं- मन्त्रौषधिमणिमङ्गलबल्युपहारहोमनियमप्रायश्चित्तोपवासस्वस्त्ययनप्रणिपातगमनादि,युक्तिव्यपाश्रयं- पुनराहारौषधद्रव्याणां योजना, सत्त्वावजयः- पुनरहितेभ्योऽर्थेभ्यो मनोनिग्रहः||५४||
In this context Charaka gives examples of Daivavyapashraya and Yuktivyapashraya Chikitsa and ends the verse by defining Sattvavajaya Chikitsa as ‘a treatment or approach in which the mind is withdrawn from harmful and unwholesome objects’.

Taking all these contexts in discussion, we can mathematically conclude that the Jnana, Vijnana etc mentioned earlier in chapter 1 are the measures included under Sattvavajaya. He has given examples or measures firstly in chapter 1 and defined Sattvavajaya in chapter 11. He has also mentioned the word Sattvavajaya in the reference given from chapter 11, which he had missed out in chapter 1.

So, the five measures – Jnana, Vijnana, Dhairya, Smriti and Samadi can collectively be considered as components of Sattvavajaya Chikitsa, different measures which can be used to treat the mind and bring it into a state of balance.

So, Jnana etc can be considered as individual therapies contributing towards Sattvavajaya Chikitsa and collectively contributing towards comprehensive mind healing and cure of mental disorders.

So, we will discuss these five components / treatment measures of Sattvavajaya Chikitsa in brief.

Five treatment measures of Sattvajaya Chikitsa

1. Jnana: Spiritual Knowledge / Spiritual Understanding / Insight oriented treatment approach  

Jnana is defined as ‘Adyatma Jnanam’ which means spiritual knowledge or knowing about self. While bringing Jnana as a therapy into play in mental disorders, the person is trained to introspect and look inwards. It is definitely a gamechanger in how a person starts looking at himself and the world around himself. It is very important to introduce the person to himself or herself and the life element or atman in them and the relation of atman with the bigger life energy i.e. paramatma. Jnana, just like its other counterparts, is therapeutic as well as preventive therapy. Jnana also means awareness, conscience, knowledge, wisdom, thought process or intelligence.

Jnana, as a therapy, aims at improving these entities related to mind.

In this therapy, the physician guides the patient or healthy person seeking psychotherapy to develop and improve the insight about themselves. This can be achieved by self-monitoring and evaluating on a regular basis which will in turn help them to adapt to stressful situations.

The knowledge which helps a person to understand and realize that Brahma or absolute atma is the only truth and nothing else is known as Adyatma Jnana, which is an essential part of Jnana therapy. The tool for attaining this Adyatma Jnana according to Master Charaka is ‘Satya Buddhi’ i.e., true knowledge. This true knowledge will help in getting rid of one’s egoism which in turn destroys upadha i.e., untoward desires – which is the root cause of all kinds of miseries. By doing so, the person will get rid of all mental diseases and will also achieve rajas-tamas balance.

Related Reading – ‘Jnana – spiritual knowledge, role in Sattvavajaya Chikitsa’

2. Vijnana: Scriptural / Specific Knowledge / Educative approach

Vijnana is defined as ‘Shastra Jnanam’ which means scriptural or textual knowledge. Vijnana is also scientific knowledge. In Ayurveda, the scriptures and texts are considered as very important testimonials. They represent ‘true and unadulterated knowledge’.

Vijnana is a guide towards attaining this true knowledge. From a mind perspective, it helps in understanding the nuances and subtleties of the mind, the imbalances occurring therein, the stress components – their causes and triggers. It also trains one and improves capability to cope up with stress, negative emotions and mind imbalances.

One gets to learn the paths of indulgence, attachment or engagement or renunciation with respect to worldly pleasures and also to discriminate between good and bad and also imbibe them into their life from Vijnana. The same knowledge will train the persons about the correct ways of responding and behaving to various stimuli.

Vijnana helps in balancing rajas and tamas doshas of the mind. It will also enhance the sattva quality and also help in getting rid of psychological disorders. Vijnana is a therapy falling in the category of sattvavajaya and seeing its benefits it can be correlated with Cognitive Behavioural Therapy.

Different meanings of Vijnana are – comprehension, perception, judgment, profane understanding, discernment or consciousness. And Vijnana aims at enhancing these virtues.

Related Reading – ‘Vijnana – Scriptural, Scientific or Worldly Knowledge – Educative approach and its role in Sattvavajaya Chikitsa’

3. Dhairya: courage, patience, controlling power, patience / Supportive approach

Dhairya is defined as ‘Dhairyan anunati chestasaha’. It means ‘a state wherein one has capacity to maintain a state of mental balance even though he or she is under an immense stressful situation’.  

We can see that persons with alpa / hina sattva i.e. weak minds lack courage and are timid by nature. They tend to blow simple problems out of proportion. They cannot tolerate any kinds of physical or mental diseases or hardships of life. They need constant encouragement, by doctors, family or friends because their courage and tolerance power is too low.

The patient is reassured and counselled regularly as a part of dhairya therapy. The physician should put all possible efforts to replace the negative thoughts of the patient with positive ones. He also should try to channelize the thought process of the patients in a positive direction. Even in modern medicine we can see that counselling is an essential and mandatory part of psychotherapy. This can be equated with the dhairya component or approach of sattvavajaya chikitsa.

The main aim of dhairya therapy will be to calm down the hyper-excitation and disturbances of the mind and also to bring strength, balance and firmness to the mind.

The patience and courage of the patient can be increased with the help of counselling and meditation which are included in dhairya therapy. With the help of this courage, the person would gather courage to tolerate pain, grief and other hardships and challenges that he or she would encounter in their lives.

The sound therapy which is a part of mind healing sessions nowadays, can help in creating positive vibrations to calm down the mind. This will create a pathway towards regeneration of courage and hope in the patient. From the physician or therapist’s perspective, dhairya therapy provides maximum encouragement, empathy and attention to the patient. This therapy creates a trust value and also a matured level of awareness and judgment. It also improves a significant amount of patience and awareness of self-worth.

Related Reading – ‘Dhairya / Aashvasana Chikitsa – reassurance and courage therapy, Role in Sattvavajaya Chikitsa’

4. Smriti: Memory, recall / Cognitive Approach

Smriti is defined as – ‘Smritih Anubhuthartha Smaranam’ which means remembering or recalling the object of past experience. Here, the physician adopts different measures to correct the memory process of the patient and also to enhance and restore the memory.

Memories are files in our subconscious layers. They surface when needed. Some may be good, many may be bad and unwholesome. The physician should also help the patient to get rid of bad and unwanted memories and replace them with new and good memories. They should also be guided how not to create and save memories of bad experiences, to ignore, forgive, forget and move on.

Herein, as a part of therapy, in smriti, the patient is helped to withdraw and extract the bad memories and hidden conflicts from deep within, which may be mighty harmful in the long run and expel them permanently. By constantly doing this with will or being guided, the person will learn to cope up with his or her problems and will try to keep away from the bad and negative emotions, stimuli or triggers and develop a sense of positivity within.

Only if the person remembers the real nature of things, he can get rid of his memories. There are eight causes for improvement of Smriti in a positive direction. This can be readily practiced as a therapeutic measure if the person has low memory and if he or she requires memory to get rid of their diseases. Smriti is also needed to follow the instructions given by the physician towards regularly taking medicines, lifestyle changes, behavioural changes, what to do and what not to, which is the base for total recovery from any ailment.

5. Samadhi: Concentration, restraining the mind, meditation / Psycho-philosophical approach

Samadhi is defined as ‘Vishayebhyo Nivruthya Atmani Manaso Niyamanam’ which means ‘restraining the mind and detaching it from its association with worldly objects and diverting it towards the atma so as to have it under spiritual control and also meditating on the spiritual dimension of one’s personality’.

The main intention and goal of samadhi is to get detached from various temptations of trivial nature, unwholesome attractions, attachment with undesired things and various kinds of stressors, to make the person to realize the importance of self and self-worth and diverting the mind inwards towards the inner self and making an association with the inner self.

Samadhi is considered as the ultimate stage in Yogic practices. It is a state of achieving and being in a state of unwavering concentration.

As a treatment, Samadhi can be included in treating the diseases. The goal will be to minimize the mental fluctuations and reduce the wavering of mind. This will ultimately lead to enhancement of focus and establishment of a tranquilized mind. The stage of Samadhi can be achieved by diverting the senses i.e. indriyas towards and into the mind i.e. manas so as to achieve a stage of still and balanced mind. This ultimately leads to complete destruction or cessation of all kinds of vikaras – diseases and dukhas – grief.

To sum up

The five treatment measures detailed above are highly effective in treatment of mental disorders and form integral components of Sattvavajaya Chikitsa – the Ayurveda version of Psychotherapy. They not only heal the mind but will also instill courage, patience, calmness, confidence and balance in the mind and will keep the rajas and tamas factors in a state of balance. They will also enhance the sattva attribute of the mind.

Therefore, sattvavajaya chikitsa with these five treatment measures included under its umbrella is highly beneficial in prevention and cure of mental disorders and balancing the mental attributes. It also strengthens the mind and changes the perspective of thinking, making decisions and dealing with not only mental but also psychosomatic disorders. It is of the highest ordeal and approach in dealing with weak minded people.

Among these five entities the successive ones are said to be highly beneficial than the previous in that order. So, Vijnana is better than Jnana, Dhairya is better than Vijgnana, Smriti is better than Dhairya and Samadhi is better than Smriti. With this, we can understand that Samadhi is the ultimate tool in handling mental disorders through Sattvavaja Chikitsa and it encompasses the qualities of all the other Jnana etc methods. On the other hand, Jnana is considered as having lesser benefits and privileges in comparison to the other four measures.

So, the ideal way of planning Sattvavajaya Chikitsa and implementing it is making ideal and customized combinations of two or more of these approaches or taking all five in consideration so as to provide comprehensive and complete benefit in dealing with the mind imbalances as and when needed. As individual approaches, they form ideal therapies but when effectively combined, the results will be unparalleled and more stable.

So, all these five steps of Sattvavajaya Chikitsa help in balancing the mental symptoms and normalize the physiological functions. This is achieved by the balance of doshas, hormones or neurotransmitters that is brought about by their implementation. These five aspects of Sattvavajaya Chikitsa as specified by Master Charaka contain in them all the other therapies advised for treating the imbalanced mind and the diseases caused by them. We can also tell that the basics and fundamentals of the entire modern psychiatry can be included into these five therapies which constitute the Sattvavajaya Chikitsa.

Sattvavajaya Chikitsa and these five measures should be considered and implemented in comprehensive treatment of mental disorders mainly, but also should be included in the treatment of physical and psychosomatic disorders. This is because body and mind are the two sides of the same coin. When one is disturbed, it disturbs the other one. Similarly, when the mind is healed, the body too gets healed and the vice versa is also true. Ayurveda clinical practice is not complete without considering ‘the mind balance’ and for this to achieve, Sattvavajaya Chikitsa is the most important and mandatory tool.