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==([[Nidana Sthana]] Chapter 7, Chapter on Major Mental Disorders)==

==[[Nidana Sthana]] Chapter 7, Unmada Nidana (Chapter on diagnosis of Insanity and  other mental disorders)==

=== Abstract ===

=== Abstract ===

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The seventh chapter of [[Nidana Sthana]], titled [[Unmada Nidana]], describes the detailed etiopathogenesis  and types of ''unmada roga'' a large class of major mental disorders or psychoses. ''Unmada'', in Sanskrit, literally means frenzy, madness or mental derangement. Thus, ''unmada'' is characterized by a disordered mental state in the faculties of ''manas'' (thought processes), ''buddhi'' (decision making and intelligence), ''sanjna jnana'' (orientation and responsiveness/ consciousness), ''smriti'' (memory), ''bhakti'' (desire), ''sheela'' (habits and character), ''cheshta'' (psychomotor activity ) and ''achara'' (conduct and behaviour). For the clinical diagnosis of ''unmada'', its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter.  

The seventh chapter of [[Nidana Sthana]], titled [[Unmada Nidana]], describes the detailed etiopathogenesis  and types of ''unmada'' a large class of major mental disorders or psychoses. ''Unmada'', in Sanskrit, literally means frenzy, madness or mental derangement. Thus, ''unmada'' is characterized by a disordered mental state in the faculties of ''manas'' (thought processes), ''buddhi'' (decision making and intelligence), ''sanjna jnana'' (orientation and responsiveness/ consciousness), ''smriti'' (memory), ''bhakti'' (desire), ''sheela'' (habits and character), ''cheshta'' (psychomotor activity ) and ''achara'' (conduct and behaviour). For the clinical diagnosis of ''unmada'', its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter.  

'''Keywords''': ''Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha'', Psychosis, insanity, mental factors examination.

'''Keywords''': ''Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha'', Psychosis, insanity, mental factors examination.

=== Introduction ===

=== Introduction ===

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''Unmada'', a major mental disorder, has been known to Ayurvedic practitioners since ancient times in India. In the Vedic period, the disease was thought to be caused due to ''grahas'' or demons, but in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], it is considered a major mental illness. ''Unmada'' as such does not describe a lone clinical entity comparable to a modern diagnostic category, rather it is a group of psychotic disorders. As the psychotic disorders cover almost all the major mental illnesses, the different types and subtypes of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression, and depressive disorders.

''Unmada'', a major mental disorder, has been known to Ayurvedic practitioners since ancient times in India. In the Vedic period, the disease was thought to be caused due to ''grahas'' or demons, but in Ayurveda, it is considered a major mental illness. ''Unmada'' as such does not describe a lone clinical entity comparable to a modern diagnostic category, rather it is a group of psychotic disorders. As the psychotic disorders cover almost all the major mental illnesses, the different types and subtypes of ''unmada'' can be separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression, and depressive disorders.

Thus, ''unmada'' covers a wide range of major mental disorders and is considered synonymous with madness and mental derangement, in which a person loses contact with reality and loses the ability to regulate his actions & conduct according to the norms of the society. When ''doshas'' move upwards in the body into the head, they could cause aberrations in the functioning of ''manas''(mind) while producing ''mada'' (delusional/ intoxicated state) in an individual. The mental status of psychotic patients is vividly described while explaining the clinical aspect of the disease. The description suggests that a patient of ''unmada'' develops derangement of all the activities of ''manas''(mind), ''buddhi''(intellect), ''ahamkara''(ego) and ''indriyas'' (sense organs). The patient develops thought disturbances in the form of abnormalities of ''chintana''(thinking), ''vichara''(discriminating) and ''uha''(analyzing), derangement of memory in the form of ''smriti nasa'' (memory loss.) and ''smriti bhramsha'' (memory impairment), behavioral, social and emotional disturbances in the form of abnormalities of ''achara, dharma'' and ''bhavas'' along with functional derangement of ''indriyas'' which is manifested clinically as disturbed speech and other variants such as incoherence (''abaddha vakyam''), thought blocking (''hridaya shunyata''), loosening of associations, neologism, echolalia etc. and various psychomotor disturbances.

Thus, ''unmada'' covers a wide range of major mental disorders and is considered synonymous with madness and mental derangement, in which a person loses contact with reality and loses the ability to regulate his actions & conduct according to the norms of the society. When ''doshas'' move upwards in the body into the head, they could cause aberrations in the functioning of ''manas''(mind) while producing ''mada'' (delusional/ intoxicated state) in an individual. The mental status of psychotic patients is vividly described while explaining the clinical aspect of the disease. The description suggests that a patient of ''unmada'' develops derangement of all the activities of ''manas''(mind), ''buddhi''(intellect), ''ahamkara''(ego) and ''indriyas'' (sense organs). The patient develops thought disturbances in the form of abnormalities of ''chintana''(thinking), ''vichara''(discriminating) and ''uha''(analyzing), derangement of memory in the form of ''smriti nasa'' (memory loss.) and ''smriti bhramsha'' (memory impairment), behavioral, social and emotional disturbances in the form of abnormalities of ''achara, dharma'' and ''bhavas'' along with functional derangement of ''indriyas'' which is manifested clinically as disturbed speech and other variants such as incoherence (''abaddha vakyam''), thought blocking (''hridaya shunyata''), loosening of associations, neologism, echolalia etc. and various psychomotor disturbances.

''Unmada'' is classified into two broad categories: ''nija''(endogenous), or those caused by internal imbalance of ''dosha'' i.e. ''vata'', ''pitta, kapha'' and ''sannipataja'', and ''agantu nimitta'', i.e., those caused by exogenous factors. Sushruta (S. ut.62/4-5) and Vagbhatta - both are of the opinion that ''unmada'' is of six types, of which four are due to ''doshas'', the fifth is ''madyaja'' (like intoxications) and sixth is ''vishaja'' (poison-based or poison-like). Both have described the ''agantuja unmada'' separately as the condition of ''amanushopasarga'' (due to affliction of supra-human power) and ''bhuta badha'' (due to affliction of demons), under the heading ''amanusopasarga pratishedha'' (treatment of affliction of supra-human power) and ''bhuta badha pratisedha'' (treatment of affliction of demons) respectively. The body of knowledge within [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] dedicated to psychiatry underscores the advancement in scientific knowledge on this subject that existed thousands of years ago.

''Unmada'' is classified into two broad categories: ''nija''(endogenous), or those caused by internal imbalance of ''dosha'' i.e. ''vata'', ''pitta, kapha'' and ''sannipataja'', and ''agantu nimitta'', i.e., those caused by exogenous factors. Sushruta (S. ut.62/4-5) and Vagbhatta - both are of the opinion that ''unmada'' is of six types, of which four are due to ''doshas'', the fifth is ''madyaja'' (like intoxications) and sixth is ''vishaja'' (poison-based or poison-like). Both have described the ''agantuja unmada'' separately as the condition of ''amanushopasarga'' (due to affliction of supra-human power) and ''bhuta badha'' (due to affliction of demons), under the heading ''amanusopasarga pratishedha'' (treatment of affliction of supra-human power) and ''bhuta badha pratisedha'' (treatment of affliction of demons) respectively. The body of knowledge within Ayurveda dedicated to psychiatry underscores the advancement in scientific knowledge on this subject that existed thousands of years ago.

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===Sanskrit Text, Transliteration and English Translation===

===Sanskrit Text, Transliteration and English Translation===

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

As the present chapter deals with the psychopathogenesis and diagnosis of ''unmada'', the fundamental approach of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] in the etiopathogenesis of psychiatric diseases needs to be discussed. Charaka considers violation of dietetic rules as an important causative factor for ''unmada''. Both body and mind are affected by diet. ''Unmada'' occurs in individuals taking diet in manners forbidden by the dietetic rules, consuming improper dietary articles, food articles that are unclean and ill prepared, incompatible and vitiated. According to Chandogya Upanishad, quality of mind depends upon the food taken by the individual. Once digested, the food is divided into three components – gross (''sthula''), medium (''madhyam'') and (''sukshma''). The subtle portion of the food nourishes the mind. Bhagavad Gita also opines that the ''sattvika, rajasika'' and ''tamasika'' types of ''buddhi'' (intellect) is derived from the characteristics associated with the type of diet. Thus, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] considers that incompatible, vitiated food articles affect the physical as well as mental state of an individual, predisposing him to psychiatric illnesses in general, if he is already harboring other causative factors.

As the present chapter deals with the psychopathogenesis and diagnosis of ''unmada'', the fundamental approach of Ayurveda in the etiopathogenesis of psychiatric diseases needs to be discussed. Charaka considers violation of dietetic rules as an important causative factor for ''unmada''. Both body and mind are affected by diet. ''Unmada'' occurs in individuals taking diet in manners forbidden by the dietetic rules, consuming improper dietary articles, food articles that are unclean and ill prepared, incompatible and vitiated. According to Chandogya Upanishad, quality of mind depends upon the food taken by the individual. Once digested, the food is divided into three components – gross (''sthula''), medium (''madhyam'') and (''sukshma''). The subtle portion of the food nourishes the mind. Bhagavad Gita also opines that the ''sattvika, rajasika'' and ''tamasika'' types of ''buddhi'' (intellect) is derived from the characteristics associated with the type of diet. Thus, Ayurveda considers that incompatible, vitiated food articles affect the physical as well as mental state of an individual, predisposing him to psychiatric illnesses in general, if he is already harboring other causative factors.

Secondly, psychiatric illnesses with special reference to ''unmada'' are not only associated with the vitiation of ''manas doshas'' but there is vitiation and provocation of ''sharira doshas'' as well. It points to the fact that though psychiatric illnesses are associated with subtle pathological changes at the bio-energetic level, they are also simultaneously accompanied by qualitative as well as quantitative changes/imbalances in the neurotransmitters and other bio-chemicals at the physical level. Thus, the normal psychological processes as well as the psychopathologies, operate simultaneously at multiple levels (biological, bio-energetic) and also at subtler levels where the intangible thought processes start appearing in the relatively tangible field of bio-energy. All this needs extensive exploration using the available scientific tools.

Secondly, psychiatric illnesses with special reference to ''unmada'' are not only associated with the vitiation of ''manas doshas'' but there is vitiation and provocation of ''sharira doshas'' as well. It points to the fact that though psychiatric illnesses are associated with subtle pathological changes at the bio-energetic level, they are also simultaneously accompanied by qualitative as well as quantitative changes/imbalances in the neurotransmitters and other bio-chemicals at the physical level. Thus, the normal psychological processes as well as the psychopathologies, operate simultaneously at multiple levels (biological, bio-energetic) and also at subtler levels where the intangible thought processes start appearing in the relatively tangible field of bio-energy. All this needs extensive exploration using the available scientific tools.

#Finally, the term ''achara'' refers to personal and social conduct measured by misbehavior, quarrel, disrespect to elders and other respectable and other similar activities by a psychiatric patient.

#Finally, the term ''achara'' refers to personal and social conduct measured by misbehavior, quarrel, disrespect to elders and other respectable and other similar activities by a psychiatric patient.

Some exogenous causative factors of ''unmada'' along with their mode of psychiatric infliction in a person have been enumerated below. However, these details are taken with contemporary assumptions, experiences and clinical practices applicable to a particular disease. Many of these beliefs and practices are still extant in many parts of the world. One of the bodies of practices in this field of study, ''Bhutavidya'', was one of the eight branches of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. The diagnosis of these  exogenous factors is based upon the clinical features, behavior patterns and time of affliction. These factors are being studied well under the purview of demonology, parapsychology. The beliefs regarding ghosts, demons are noted and studied to know exact mechanism behind them. However psychiatrist caution to rule out any other mental disorder first before labeling it as a demon. The negative energies in the cosmos may be regarded in view of exogenous factors causing ''unmada''. ''Rajas'' and ''tamas'' are responsible for negativities, while ''sattva'' for positivity. Therefore these must be considered as psycho-dynamic factors to be treated.   

Some exogenous causative factors of ''unmada'' along with their mode of psychiatric infliction in a person have been enumerated below. However, these details are taken with contemporary assumptions, experiences and clinical practices applicable to a particular disease. Many of these beliefs and practices are still extant in many parts of the world. One of the bodies of practices in this field of study, ''Bhutavidya'', was one of the eight branches of Ayurveda. The diagnosis of these  exogenous factors is based upon the clinical features, behavior patterns and time of affliction. These factors are being studied well under the purview of demonology, parapsychology. The beliefs regarding ghosts, demons are noted and studied to know exact mechanism behind them. However psychiatrist caution to rule out any other mental disorder first before labeling it as a demon. The negative energies in the cosmos may be regarded in view of exogenous factors causing ''unmada''. ''Rajas'' and ''tamas'' are responsible for negativities, while ''sattva'' for positivity. Therefore these must be considered as psycho-dynamic factors to be treated.   

Last but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of ''unmada'' are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.

Last but not the least, there is a clear message in the chapter that every individual is himself responsible for his wellbeing, happiness and miseries. The behavioral tendencies and lifestyles adopted by the individual are based on his own choices and all types of ''unmada'' are the result of intellectual blasphemy by the individual himself – be it endogenous or exogenous.