Abstract
Contemporary Psychology focuses frequently on the physical and pathological, yet current trends in research show a shift towards the philosophical roots. As points of intersection emerge between the realms of western psychotherapy and the practice of Ayurvedic chikitsa, we take this opportunity to further explore the analogous nature of the Sattvavajay Chikitsa from Ayurveda and Cognitive Behavioral Therapy (CBT) from Western schools of Psychology.
CBT views psychological distress to be caused due to individual perception of events, while Sattvavajay Chikitsa attributes it to both, cognitive as well as psychospiritual drivers of behavior. Both therapies center the client, and the independent management and control of the manas or mind via a number of well-structured techniques and practices. The distinction between the two is found in the additional psychospiritual aspect of Sattvavajay Chikitsa, emphasizing the increase of Sattva Guna within the self, and moving towards overall healthy living.
The present paper attempts to detail these points of intersection and distinction between the two modalities and highlights the scope for integration and development of more holistically informed model of mental health and healthcare. This paper explores wisdom of Ayurveda as a holistic science that is being rediscovered by modern sciences like Psychoneuroimmunology-PNI- and Energy Physics, integrative possibilities with Psychology frameworks like CBT, limitation, and strengths of both.
Introduction
Hinduism- goes back to Santana Dharma. Santana is Eternal, literally, and Dharma is way of life loosely translated. Dharayiti iti dharma- One that sustains, and holds is Dharma. So, Dharma is the way of life that holds us, makes the living sustainable. Ayurveda is Upaveda of Atharva Veda, the last of the Four Vedas from India that hold the oldest cultural and civilizational wisdom.इहखल्वायुर्वेदोनामयदुपाङ्गमथर्ववेदस्य।।Su. Su. 1/6In fact, the first chapter of the Sushruta Samhita Sutrasthana is Vedotpatti – this establishes beyond doubt that the knowledge of ayu contained in the Veda and has its origin there.[i] The major themes covered in Atharva Veda are about discovering Self and living effectively interconnected with Cosmos. Two aims of Ayurveda are to protect health of healthy people and heal the ones who have deviated from health.
Psychology in Santana Dharma is spread over literature of philosophy and medicine both. Positive Psychology, Subjective Well-being and all other constructs from recent development in Western Psychology are included in Vedas, Upanishad, Six Darshana and many other shastras, including Ayurveda. Psychotherapy in Sanatana is not just a treatment once mental illness has developed, it is also to retain the mental health as a positive construct, preventive and proactive in nature.
Psychology in the West went through various waves and transitions, not just geographically by scholars from Germany and other parts of Europe to America, but also in the approach to what is the field of Psychology. The scope of this paper is within the boundary of CBT as Psychotherapy from Modern Psychology and Sattvavajay Psychotherapy from Ayurveda. We need to redefine modern- not necessarily better, more evolved, or effective- modern means more recent in time comparison.
Modern Psychology (Western Psychology) & Psychotherapy
Psychology from the West of India is very recent in comparison to the Vedas. Similar to India, Psychology was certainly belonging to the genre of Philosophy in the other parts of the world too. In 387 BCE, Plato suggested that the brain is where mental processes take place, and in 335 BCE Aristotle suggested that it was the heart. The link is broken when we read textbooks and literature on history of Psychology.
Wilhelm Wundt opened the Institute for Experimental Psychology at the University of Leipzig in Germany in 1879, its opening is usually thought of as the beginning of modern psychology. Wundt is often regarded as the father of psychology.
Psychologyis about Psyche as soul or spirit or consciousness- however, no consensus on what consciousness is in the West. Consciousness is taken more literally in the sense of awareness or attention of the brain and a cognitive process. Psychology is the study of the mind and behavior, according to the American Psychological Association. It is the study of the mind, how it works, and how it affects behavior, and “embraces all aspects of the human experience, from the functions of the brain to the actions of nations, from child development to care for the aged.” Though the definition seems positive, Psychology as a field of study has focused more on pathology of the mind than health. When the word mind is used, the word means brain or processes of the brain, and not mind or manas as understood by Indic Psychology.
The wave of Behaviourism dominated for long the thinking of scholars and curriculum. Health Psychology, from the Western perspective is seen as a new field within the larger field of Psychology. The holistic approach shifts the emphasis of health from biomedical to biopsychosocial model. It focuses on health promotion and maintenance; prevention and treatment of illness; the etymology and correlates of health, illness and dysfunction and improvement of health care system. Spirituality is excluded from the evolving models. Ecology and the collective consciousness not yet part of Psychology in the West. Brain centered and role or functioning of mind still to be discovered and accepted. Unfortunately, in India, the entry of Psychology is associated with western Psychology rather than Her own Indic roots and wisdom. Western or scientific psychology was introduced in India in 1905 at Calcutta University[ii]. In 1915 a full-fledged department of psychology was instituted and Girindrashekhar Bose, a practicing Indian physician, became the first recipient of a doctorate in psychology in 1921. In 1922, Bose founded the Indian Psychoanalytic Society. After India became an independent democracy in 1947, premier mental health institutions were set up for providing preventive, curative, and rehabilitative health care. National Institute for Mental Health and Neurosciences (NIMHANS) in Bangalore and Central Institute of Psychiatry in Ranchi were the earliest centres offering higher education in psychiatry, psychiatric social work and clinical psychology. Psychotherapy became an essential component of these qualifications.[iii]
CBT as Psychotherapy
Psychotherapy is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing. Cognitive behavioural therapy (CBT) helps people identify and change thinking and behaviour patterns that are harmful or ineffective, replacing them with more accurate thoughts and functional behaviours. It can help a person focus on current problems and how to solve them. It often involves practicing new skills in the “real world.”
CBT can be helpful in treating a variety of disorders, including depression, anxiety, trauma related disorders, and eating disorders. For example, CBT can help a person with depression recognize and change negative thought patterns or behaviours that are contributing to the depression.[iv]
The first approach to CBT to achieve widespread recognition was rational emotive therapy, originated by Albert Ellis in the mid-1950s. Ellis believed that how we act and how we feel are the result of irrational thinking, and he proposed a number of typical irrational thoughts that people tend to have that will lead to dysfunctional ways of being in the world (e.g., the need to be loved by everyone on the planet, the idea that we must rely on others for our happiness, etc.). His approach was widely used in the latter part of the 20th century and continues to be used today.[v] He introduced the model of -B-C where A is activating incident, B is our belief system and C is the consequence of our reaction to A because of B. A very linear process and based on the belief that we all can and will be able to access the core beliefs which by themselves may not be cognitively available. The ABC model was expanded to refute the beliefs- so D was introduced by the psychotherapist to dispute the belief and then E happens, which is the more Effective outcome.
In 1960s, Aaron Beck developed Cognitive Therapy and moved away from Ellis in some of the methods. Beck stayed away from the use of the word irrational and instead suggested that core beliefs and deep schemas, or embedded ways by which we tend to view the world, lead to dysfunctional behaviors and negative feelings.[vi] Three major levels of cognition that are often identified in the practice of CBT include (1) full consciousness, (2) automatic thoughts, and (3) schema. Full consciousness is defined as a state of full awareness and optimized judgment. In contrast, automatic thoughts are cognitions that flow rapidly in the stream of everyday thinking and may not be carefully examined for correctness or rationality. Usually out of consciousness, they are readily accessible once a person is made aware of them. In recent times, Mindfulness as a practice as become very popular to make a person aware of the automatic thoughts. This is rather a shift from the Rationality model, to bring attention and self-discipline in forefront. The third attribute is schema. Schemas, sometimes called core beliefs. These are a client’s fundamental rules or templates for processing information. These are the scripts or imprints in the person’s mind or psyche.
If psychotherapy is defined as “interpersonal method of mitigating suffering” then many psychotherapeutic systems have existed in India a long time. Unlike Western systems, these have lacked a clinical bias but have provided a more global framework. The future of psychotherapy in both East and West lies in discovering a conceptual framework with universal validity within which ad hoc therapies—for symptom relief, personality development, or interpersonal adjustment—can be developed.
Psychotherapy in India
Ayurveda, as Upaveda of Atharva Veda and Patanjali Yoga Sutras have ocean of wisdom on Psychology and Psychotherapy. However, in this paper we will only explore Sattvavajay as psychotherapy from Ayurveda. The knowledge of Ayurveda is chiefly available in what is known as Brihat Trayee- 3 main texts: Charak Samhita, Sushrut Samhita and Ashtanga Sangraha. Ayurveda’s first objective is Health of Healthy, and only secondary objective is the healing of diseased. स्वस्थस्यस्वास्थ्यरक्षणमातुरस्यविकारप्रशमनंच।। Ch. Su. 30/26
Ayu is life and Veda is Knowledge of how to live life. Hence how to live life healthy is the theme of the shastra. Knowledge of health is a positive construct in Ayurveda where healthy person is one who has balance in physical, psychological, spiritual levels of life.
“sama dosha samaagnischasama dhatu mala kriyaaha|
Prasanna atma indriyamanahaswastha iti abhidheeyate” –Sushruta Samhita
One is in perfect health when the Three doshas ( vata, pitta and Kapha) Digestive fire (digestion, assimilation and metabolism) all the body tissues & components (Dhatus) (the entire physical body) all the excretory functions (the physiological functions of urination and defecation) are in perfect order with a pleasantly disposed and contented mind, senses and spirit.
Ayurveda describes four ways of living life.
हिताहितंसुखंदुःखंआयुस्तस्यहिताहितं।मानंचतच्चयत्रोक्तंआयुर्वेदःसःउच्यते।।
Ch.Su1/41
Now what is good and happy life? What creates bad and unhappy life? Hita is good, however, let us dwell a little on what creates Hita. The root of the word Hita connects it to well-being and love.[vii] A life which is guided by well-being of everyone around, out of love for every entity, animate or inanimate, becomes sustainable. ‘A life of that man is said to be good who is a well-wisher of all creatures. S/He does not long for other people’s goods, he is a teller of truth, he is peace loving, he acts with deliberation, he is not negligent. He is devoted to the three ends: viz. virtue, wealth and enjoyment. He does not let any one end come into conflict with the other two. He is reverential to those who are worthy of reverence, he is a scholarly, scientific and humble character. S/He is partial to the company of elders.
S/He is of well curbed passion, desire, anger, envy, pride and conceit. S/He is constantly given to the charitable acts. S/He is always devoted to austerity, knowledge and tranquillity. S/He is endowed with spiritual insights. S/He is endowed with memory and understanding. S/He is one minded, contemplation of the good in this world and the next. That is which is the opposite nature to this is called as not good or Ahitayu.[viii]Hitayu is life philosophy or worldview which is in harmony with the society and environment. This precedes the Sukhayu, life of happiness. For Ayurvedic Rishis, wellness and well-being of the environment came before personal happiness. Today, positive psychology is talking about social well-being. “Keyes (1998) conceived of a five-component model of social well-being: social integration, social contribution, social coherence, social actualization, and social acceptance. These five elements, taken together, indicate whether and to what degree individuals are overcoming social challenges and are functioning well in their social world (alongside neighbours, co-workers, and fellow world citizens).”[ix]
The nature, constitution and working of mind or manas is very well described in many places in Ayurveda classical texts. Manas is known as subtle and 11th sense organ, which connects the outer world with the internal world through 10 senses. Mind’s nature is to go outward and gets attracted by Artha or objects of pleasure. The five sense organs have a natural tendency to drag the mind to its own attractors, for example, nose to smell and tongue to taste. The memory or association of these arthas become activated and the manas takes us to indulge in them. Senses, in conjugation with manas, do not have the discriminatory power of Viveka Buddhi, and hence may get attracted and indulge in Ahita and create Dukha. These are the references that describe Manas as such-
उभयात्मकमनः (सु. शा. १)
मनोदशेन्द्रियाण्यर्थाःप्रकृतिश्चाष्टधातुकी।
चतुर्विंशतिकोह्येषराशिःपुरुषसंज्ञकः।
करणानिमनोबुद्धिर्बुद्धिकर्मेन्द्रियाणिच। (च. शा. १)
उभयात्मकमत्रमनःसंकल्पकमिन्द्रियञ्चसाधर्म्यात्।
गुणपरिणामविशेषान्नानात्वबाह्यभेदाश्च॥ (सां. का. २७) अन्तःकरणंत्रिविधदशधाबाह्यत्रयस्यविषयाख्यम्। (सां. का. ३३)
Bhut Vidya, Ayurvedic Psychiatry is almost lost in the passage of time, however, Psychotherapy is available for the scholars who seek to expand their practices.
Sattvavajay as Psychotherapy
Charaka Samhita is the first known reference where Sattvavajay is mentioned. Sattva in Ayurveda means one of the Triguna Energies that make up the Cosmos and us, as well as manas or mind. ‘Sattva’ represents psyche and ‘Avajaya’ refers to conquest. Thus, Sattvavajay implies control or conquest of mind. सत्त्वावजयःपुनरहितेभ्योऽर्थेभ्योमनोनिग्रहः।[x]Charaka’s definition of Sattvavajay has three terms – Ahita,Artha, and Manonigraha. Ahita we have seen above, artha are the objects of attractions for each Indriya or sense, and Manonigraha is winning over the mind. However, one word that is being neglected in the literature review of the construct of Sattvavajay is Punah, meaning, to do again. This is the word that is extremely critical. The word Punah is giving direction, of a U turn, to go back to the original state of Sattva, from where the person has deviated. So it is not about learning new skills, competency, attitude or behaviour. It is reconnecting with what is our original state of manas- Sattva. The manas, which has the tendency to go outward, also has the will power or Bala to make the manas go inward and restrain itself. Sattvavajay is the support that a therapist gives to the person to inculcate this bala and win over the outward going.
Unfortunately, no further description is available, except, this single verse definition in the entire CharakaSamhita or any other classical texts. However, Todarananda, a reputed scientist of 17th century AD has reused the term Sattvavajay and defined it on similar lines. In additionto Manonigraha, he incorporates Dhidhairyadi vigjnanam (deeper understanding of intellect, fortitude etc.) under the concept of Sattvavajay. अहितेभ्यःसदार्थेभ्योमनोनिग्रहणंतथा।धीधैर्यादिविज्ञानंसत्त्वावजयमुच्यते।(आ.सौ. 2/170)[xi]Todaranand’s work is not easily accessible andresearching on his work can contribute greatly to the field of Bhartiya Psychology. Dhee is buddhi or intelligence which guides us, Dhairya is patience or fortitude, and adi means some more such methods that are vigjnan or scientific. Vagbhatt, a follower of Charaka who presented the knowledge of Ayurveda in very concise manner, also refers to the same for mental health issues or manodosha- धीधैर्यात्मादिविज्ञानंमनोदोषौषधंपरम्. (अ.हृ.सू. 1/26)In explaining the nature of manas, it is very clearly mentioned that we need to transcendent the manas to allow our buddhi or intelligence to play the role, hence Dhee becomes very important in manonigraha. Charaka, in another context has also included Smriti or memory and Samadhi, or mental equanimity as important aspects of mental health. मानसोज्ञानविज्ञानधैर्यस्मृतिसमाधिभिः।(च.सू. 1/58)
In Ayurveda, mental and physical health both are deviation from Buddhi or Pragnya, and hence diseases are called Pragnyaaparadh- result of living again Pragnya. So, all we need to do is bring back the Dhee or Pragnya.
CBT and Sattvavajay – A Comparison
Conclusion and Future Research
Hinduism, as originated from Sanatana Dharma, has oceans of wisdom that can be revisited and applied today to the current crisis of humanity. Modern Psychology is struggling with its own evolution by expanding the boundaries to include positive psychology, neuroscience, Quantum Physics, etc. as interdisciplinary understanding, while Bhartiya Psychology, even when limited to Ayurveda and Patanjali Yoga Sutras, is holistic, inclusive and futuristic. The insights and wisdom from our Rishis is now being rediscovered by Modern sciences.
The limitations are lack of original work in some fields, sutras are coded, and one need not just research ability, but own intuition and sadhana to be able to decode them, integrate with modern language and application orientation. The younger generation, going through Quarter Life Crisis, pandemic, lockdowns, and lack of any future direction, is hungry for deeper meaning and spirituality. Knowledge of Self and manas, Dhee, Dhriti and Smriti are important to create this deeper meaning.
Sattvavajay is just one of the psychotherapies from Ayurveda. There are many that can be researched and applied scientifically, along with Yogic Psychotherapy. Mind or psyche is still puzzling to modern psychologists, and Ayurveda and Yoga can integrate the wisdom of both for holistic healing. We are not just rational or cognitive human beings, we are also emotional, spiritual and need the Logos in our life. Modern Psychology courses can integrate the wisdom from Ayurveda and Yoga, not just offer an elective where the integration is missed out.
[i] V. Vasudevan, Ayurvedatatvaprakashini, Aug 2000, AVP, Coimbatore, India, 1
[ii]Prasadrao, P. S. D. V., & Sudhir, P. M. (2001). Clinical psychology in India. Journal of Clinical Psychology in Medical Settings, 8(1), 31-38.
[iii]Bhatt Gayaitri, Encountering Culture: Psychotherapy and Counselling Practice in India, Parivartan.org
[iv]Laxman ji Yadav1& J.S. Tripathi3 & Richa Rani Yadav2, Expanding horizons of satvavajaya chikitsathrough EMDR&CBT, IJRAR- International Journal of Research and Analytical Reviews, VOLUME 5 I ISSUE 4 I OCT.– DEC. 2018
[v]Rice, Robert H. (2015). “Cognitive-Behavioral Therapy.” The SAGE Encyclopedia of Theory in Counseling and Psychotherapy 1, 194-199.
[vi]Ibid.
[vii]Bhagwat GoMandal, (1987) part 9, page 9199, second edition, Praveen Prakashan, India
[viii]Bhagwat Pranav, http://ayurgoa.com/article/ayurvedic-concept-of-life
[ix]Gallagher et al. (2009, p. 1027), The Science of Wellbeing and Positive Psychology, Wellbeing, Recovery and Mental Health, ed. Mike Slade, Lindsay Oades and Aaron Jarden. Published by Cambridge University Press, 2017
[x] Ch su 11/54
[xi] Dr. A. R. V. Murthy, Rationale of Ayurvedic Psychiatry, Chaukhamba Orientalia, 2009, Varanasi, India, page 14
References for the Comparisons
9 CBT Techniques for Better Mental Health. Healthline. Retrieved online at https://www.healthline.com/health/cbt-techniques
Shukla Vidyadhar &TripathyRavi Dutt, (2002) Charak Samhita, 2nd Edition, Vol. 1, page 447, Sutra 30/26, Chaukhamba Sanskrit Pratishthan, Delhi, India
Belaguli, G., & Savitha, H. P. (2019). An empirical understanding on the concept of Sattvavajaya Chikitsa (Ayurveda Psychotherapy) and a mini-review of its research update. Indian Journal of Health Sciences and Biomedical Research (KLEU), 12(1), 15.
Cognitive Behavioural Therapy. Mayo Clinic. Retrieved online at https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
Fenn, M. K. Byrne. M.(2013). The key principles of cognitive behavioral therapy. InnovAiT, 6 (9), 579, 585.
O’Donohue, W. T., & Fisher, J. E. (Eds.). (2008). Cognitive behavior therapy: Applying empirically supported techniques in your practice. John Wiley & Sons.
Sarma D. R., Ali K., Sarmah J. (2016). An Ayurvedic Perspective to Cognitive Behavioural Therapy vis-a-vis Satwavajaya Chikitsa. International Journal of Ayurveda and Pharma Research. 4(5):42-45
Tripathi, J. S. (2012). Dimensions of Sattvavajaya Chikitsa (Ayurvedic psychotherapy) and their clinical applications. Ann Ayurvedic Med, 1, 31-38.
What is cognitive behavioral therapy? American Psychological Association. Retrieved online at https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.
Dhoriyani DD. (2014). Dissertation work on Applied Concept of Sattva, Sattvabala and its Promotion through Sattvavajaya and Yuktivyapashraya. Department of Basic Principles, IPGTRA, Gujarat Ayurveda University;
Bagali, S. S., Baragi, U. C., & Deshmukh, R. A. (2016). Concept of Satwavajaya Chikitsa (Psychotherapy). Journal of Ayurveda and Integrated Medical Sciences, 1(01), 56-63.
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