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Thursday, May 6, 2010

Ayurveda and the Mind

According to David Frawley in Ayurveda and the Mind: The Healing of Consciousness:

“To be healthy is important but health is not an end in itself. It is not enough merely to prolong our lives and have better energy to do the things we want. We must consider what we are using our energy for and why. The quality of awareness is the real fruit of what we do (p. 9).”

In Frawley’s estimate, mental health (or awareness) serves as the basis of all other health. And yet, more often than not, the majority of a practitioner’s time is spent on the physical health of a client. What, then, is the place of mental health in modern Ayurvedic practice, particularly in the West? What is the role of practitioner in this aspect of wellness and healing? And what would it look like to integrate mental health as a key component of treatment in contemporary Ayurvedic practices?

Purpose of Paper
Ayurveda acknowledges four levels of healing to include 1. treatment of disease 2. prevention of disease 3. enhancement of life and 4. development of awareness. As previously stated, much emphasis is often placed on the first three levels of healing in the contemporary practice of Ayurveda in the West. However, there is less emphasis on the fourth level of healing: development of awareness.

The purpose of this paper is to explore this level of healing to identify and articulate how this process can be better integrated into the modern practice of Ayurveda in such a way as to empower clients to not only prevent and treat disease, but to transcend the types of experiences that lead to disease in the first place. More specifically, this paper asserts the importance of a more psychological approach to health as opposed to the typically physical or physiological approach to health that is commonly practiced in Ayurveda in the West. Given that the full scope of Ayurvedic practice includes both the physical and mental diseases, we have to look at the mind and consciousness in order to truly understand Ayurveda and be effective practitioners.

Ayurveda and Human Psychology
Why does the psychological dimension of health need to be considered equally (or perhaps even more than) the physiological dimension of health? According to Ayurveda, disease is caused by three factors: 1. doshic imbalances 2. rajas and tamas of the mind and 3. karmic impressions. Ostensibly, these three factors are inter-related and inform and impact one another. There is a general thread of connection between the three. Typically, doshic imbalances occur as a result of rajas and tamas of the mind (which leads to poor decision/choice-making in one’s life). Further, rajas and tamas of the mind is often caused due to karmic impressions from past and current lives. The legacy of our karmic samskaras directs how we will comport ourselves in our lives.

In looking at the aforementioned “domino effect” what becomes clear is that the state of our mental health impacts our physical health. When an individual is unable to have a certain mental discipline and hence, makes poor lifestyle and dietary choices, physical illness inevitably follows.

As previously mentioned, Ayurveda in the West often focuses on working with and educating a patient on how to modify diet and lifestyle in order to treat and prevent disease. However, it is equally important for practitioners to understand human psychology and the how the mind works in order to ensure effective communication with the client and to ensure appropriate adherence to treatment..

How we deal with a pitta person who may be prone to irritation and anger will be different from how we relate to an anxiety-prone vata person. Dealing with a passive kapha dominant individual will also be tempered by an understanding of his/her psychology. Specifically, understanding the psychology and mental make-up of these different types of “constitutions” will significantly impact how we make our recommendations and whether they will have any impact, and if they are even appropriate to begin with.

Ayurvedic practitioners must have the counseling skills to both understand a client’s psychology and to help patients implement the necessary changes to effect well-being. Generally, Ayurvedic treatment fails because the practitioner has not properly understood the patient’s psychology to ensure that the patient will stay with the necessary treatment plan. Further the practitioner has not adequately examined the types of mental/thought patterns the individual repeatedly engages in that cause the poor choice-making to begin with.

Ayurveda and Western Psychology
According to a 2005 study by the U.S. Centers for Disease Control and Prevention (CDC), of the 2.4 billion drugs prescribed in visits to doctors and hospitals in 2005, nearly 118 million were for anti-depressants. In fact, according to the same government study, antidepressants have become the most commonly prescribed drugs in the United States above drugs to treat high blood pressure, high cholesterol, asthma, or headaches (Cohen, CNN Website)

It is clear that, in the United States, there is more psychological pain and illness than physical illness. Sadly, although modern medicine is well-equipped to treat physical disease, it is less effective at treating mental and emotional illness.

In fact, according to the same CDC study, depression has become a public health issue. It is estimated that 25% of Americans will have a major episode of depression in their lifetime, and that a startling 8% of adolescents will experience a major depressive episode. Added to the epidemic-like nature of depression are other mental/emotional illness such as attention deficit disorder, anxiety disorders and obsessive compulsive disorders. In response to the mounting occurrence of these illnesses, we have seen the increasing production of psychotropic drugs for treatment, many of which are addictive and also have very real (and detrimental) side-effects.

The good news is that Ayurveda -- with its grounding in Vedic/Samkhya philosophy and its understanding of the mind -- is well-positioned to help individuals move through the debilitating experiences of these mental/emotional illnesses, without the use of any pharmacological intervention. The tough news is that Ayurvedic practitioners have to be ever more educated and knowledgeable about the importance of human psychology, given the current state of mental affairs in the U.S. and throughout the West (and in rapidly Westernizing socieities).

Many patients who seek out Ayurveda are also seeking out some psychological or spiritual assistance. Often, they come to alternative modalities when they have exhausted their other options. And they specifically seek out Ayurveda because of its grounding in spiritual philosophy. As such, these patients will expect that the Ayurvedic practitioner can address not only physical issues, but emotional, psychological and spiritual issues as well. And as a consequence, the role of Ayurveda in mental health becomes all the more important.

Incorporating Psychology into the Western Ayurvedic Practice
Although Ayurveda has a very strong grounding in Vedic philosophy, there is little information immediately available that links Ayurveda and psychology. Scattered passages exist in books such as the Charaka Samhita and Sushruta Samhita, however, they are poorly organized and not directly relevant to the issues that practitioners encounter. As a consequence, most practitioners are left to “piece together” a psychological profile based on limited understanding. Clearly, there is more work to do to link Ayurveda and psychology, particularly as they apply in a Western context. Fortuntely, there is ample evidence to suggest that yoga, meditation and pranayama are three key ways to create the link between Ayurveda and psychology.

Yoga & Ayurveda
One area where significant work has been done is linking Ayurvedic psychology with yoga. In Patanjali’s Yoga Sutras and in the Bhagavad Gita, ashtanga yoga is fully articulated as a means of working with the mind and hence, calming chitta. The Ayurvedic concept of enhancing a client’s sattva for stability, harmony and virtue is primarily an outgrowth of classical yoga. In fact, according to Frawley, yoga is a form of psychological inquiry, and as a consequence, Ayurvedic practice must incorporate the practice of yoga. (American Institute of Vedic Studies Web Site)

Presently, most Ayurvedic and yoga practitioners engage in their arts without intersecting with one another. Ayurveda must be properly integrated with the practice and philosophy of yoga to have a fully developed psychological grounding and to be able to adequately treat imbalances of the mind.

Meditation & Ayurveda
Ayurveda is based on the Samkhya model of the mind in which the mind is divided into four “entities.” Most significant is “chitta” which is considered the entity that experiences mental disturbances. It is essentially the conditioned mind, or the mind of memory. The other “entities” include buddhi (the higher discriminating intelligence), manas (external sensory perception) and ahamkara (ego).

In order to calm chitta and develop mental health, it is essential to develop buddhi, manage manas and decrease ahamkara. In this way, we are able to foster right thought and action that ultimately leads to right life, lifestyle and livelihood. Key to increasing buddhi is the practice of meditation, which must also be integrated into the Ayurvedic treatment program in order to achieve overall patient wellness. Ayurvedic practitioners must be trained in and conversant in various forms of meditation and how to fold them into an overall treatment program for a client.

Pranayama & Ayurveda
As previously articulated, healing the mind can be achieved through the practices of yoga and meditation. Another key practice for healing the mind is pranayama which consists of a variety of breathing techniques. Since prana (or life force) is at a deeper level of awareness than the cognitive mind, we have to turn to that very level in order to actually reach the mind. Any treatment of doshic imbalances is necessarily a treatment of pranic imbalance; therefore, diet modifications, herbs and panchakarma are also essential aspects of pranic healing, and hence, mental healing.

It is critical for Ayurvedic practitioners to be well-versed in the art of pranayama and how it can be incorporated into treatment programs in order to ensure a comprehensive therapy. Without an emphasis on these types of practices, practitioners run the risk of addressing the physical symptoms and then sending the patient back into a very rajasic lifestyle and world that continuously disturbs the mind and mental peace. Without a sense of this peace, there is little hope that an individual can maintain a steady state of good health; moreover, it creates a challenging environment for the individual to make the right choices that engender positive health to begin with.
Beyond the Mind
Through this paper, I have attempted to demonstrate the importance of understanding and examining the mind in order to truly bring about wellness within the Ayurvedic model. That being said, there is even a limitation to that approach. If we only stay at the levels of mind and body, we lose the true essence of what it is that Ayurveda can help us achieve, and that is a connection with our highest self. At the end of the day, Ayurvedic practitioners need to be able to help patients move their mental energy towards Sattva and past the boundaries of body and mind to access the true self (the Atman or the soul) in order to find peace and harmony. Only then can healing be created and sustained.

Through the practices of yoga, meditation and pranayama, we begin to open doors and are able to peek into a different way of being – a way that promises a greater degree of stability, wisdom and presence. As Vasant Lad says: "Without identification, justification, evaluation and notification, you can see a clear-cut gap between two thoughts, a space between two memories, a distance between two emotions. In that space there is a door. Enter into that door." (p.5)

Given our lifestyles and the environments in which we live, we have completely lost our way towards that door. We are surrounded by so much “noise” around us that has penetrated within us and created significant disturbances inside. We are unable to distinguish the things that matter from the things that don’t.

“Identification, justification and evaluation have become the survival skills in our world of complexity and fragmentation, of inter-dependence and individuality. Those are the core-skills we learn at school, and later in life we perfect them to become 'successful'. Letting go of those qualities of the mind seems like suicide.” (Kowalski, Blue Emperor Web Site)

At the same time, we are beginning to come back to our senses, one by one, to realize that we can turn down the volume. We can find our way back to the doorways and portals that lead us to tranquility and quiescence. Through meditative and yogic practices, we are able to return to ourselves, to our true nature.

Ayurveda, with its comprehensive scope, is uniquely poised to integrate yogic ad meditative practices, along with physical therapies, to treat the entire person. It is incumbent upon us as practitioners, then, to understand these practices and to practice them ourselves in order to be role models. Further it is essential that we also understand how to incorporate such practices into our treatment offerings in order to offer a more holistic approach to healing. Without such an approach, we run the risk of becoming a fad no more sustainable or enduring than botox injections. The world (particularly the West) is calling for a more complete approach to our overall wellness, and Ayurveda is ultimately ideally positioned to heed that call, as long as we as practitioners truly understand what it means to heal the whole person: body, mind AND spirit.

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