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|title=Unmada Nidana

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|keywords=Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha, Psychosis, insanity, mental factors examination, perversion, impairment of decision making, intellectual functions

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|keywords=Unmada, Sanjna Jnana, Amarsha, himsa, Prajnaparadha, Psychosis, insanity, mental factors examination, perversion, impairment of decision making, intellectual functions, charak samhita, ayurveda, psychiatric, psycho somatic disorders.

|description=Nidana Sthana Chapter 7. Diagnosis and etiopathogenesis of psychosis disorders

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=== Introduction ===

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== 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 [[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.

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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 [[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.

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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.

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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.

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~~''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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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.

</div>

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

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==Sanskrit Text, Transliteration and English Translation==

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</div></div>

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I shall ~~now describe~~ the chapter ~~on the diagnosis~~ of ~~''unmada''~~. Thus said Lord Atreya.[1- 2]

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Now we shall expound the chapter "Unmada Nidana" (Diagnosis and etiopathogenesis of psychosis disorders). Thus said Lord Atreya.[1- 2]

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==== Five types of ''unmada~~'' =~~===

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=== Five types of unmada ===

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</div></div>

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There are five types of ''unmada'' such as those caused due to the three ''doshas, sannipata'' (simultaneous vitiation of the three ''doshas''), and exogenous causes. [3]

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There are five types of unmada such as those caused due to the three ''doshas, sannipata'' (simultaneous vitiation of the three ''doshas''), and exogenous causes. [3]

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==== Individuals prone to ''unmada~~'' =~~===

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=== Individuals prone to unmada ===

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This verse describes the qualities of a person prone to getting afflicted with ''unmada'', as well as the conditions that are conducive to the affliction of the disease:

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This verse describes the qualities of a person prone to getting afflicted with unmada, as well as the conditions that are conducive to the affliction of the disease:

*Four types of ''doshika unmada'' quickly manifest in individuals who are fearful, confused and complicated, who do not know societal rules and norms, and who lead erratic lifestyles and dietary habits (unclean, unwholesome, untimely eating habits, as well as neglecting any prescribed dietetic rules). ''Doshas'' in such individuals are in a volatile state and are prone to getting vitiated.

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**the person is subjected to excessive mental trauma / physical assault.

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Such individuals often get afflicted with subclinical mental disorders, leading to unstable intellect because of volatile ''doshas''. When the seat of consciousness, wisdom, and the system that regulates mental activities are badly affected, then all these factors lead to the manifestation of ''unmada''. [4]

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Such individuals often get afflicted with subclinical mental disorders, leading to unstable intellect because of volatile ''doshas''. When the seat of consciousness, wisdom, and the system that regulates mental activities are badly affected, then all these factors lead to the manifestation of unmada. [4]

</div>

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==== Types of cognitive distortions ====

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=== Types of cognitive distortions ===

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</div></div>

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~~''Unmada''~~ is again defined as cognitive distortion pertaining to mind, intellect, consciousness, knowledge, memory, desire, attitude, activities and behavior. [5]

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unmada is again defined as cognitive distortion pertaining to mind, intellect, consciousness, knowledge, memory, desire, attitude, activities and behavior. [5]

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==== Premonitory symptoms ====

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=== Premonitory symptoms ===

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</div></div>

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Following are the premonitory symptoms of ''unmada'':

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Following are the premonitory symptoms of unmada:

*Blankness of thought,

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**Distortion of eyes.

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These are the pre-monitory symptoms of ''unmada'' caused by the vitiation of ''doshas''. [6]

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These are the pre-monitory symptoms of unmada caused by the vitiation of ''doshas''. [6]

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==== Specific features of ''vatika'' type ''unmada~~'' =~~===

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=== Specific features of ''vatika'' type unmada ===

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After the above stage, ''unmada'' manifests. The distinctive features of ''vatika'' type of ''unmada'' are as follows:

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After the above stage, unmada manifests. The distinctive features of ''vatika'' type of unmada are as follows:

*Constant wandering

*Sudden spasm of eyes, eyebrows, lips, jaws, and irregular movements of shoulder, fore-arms and legs;

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*Pacification by factors which are opposite to ''vata''

</div>

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These are the features of ''vatika'' type of ''unmada''. [7-1]

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These are the features of ''vatika'' type of unmada. [7-1]

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==== Features of ''paittika'' type ''unmada~~'' =~~===

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=== Features of ''paittika'' type unmada ===

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are the features of ''paittika'' type of ''unmada.''[7-2]

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==== Features of ''kaphaja'' type ''unmada~~'' =~~===

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=== Features of ''kaphaja'' type unmada ===

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*Pacification by factors which are opposite to ''kapha''

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These are the features of ''kaphaja'' type of ''unmada''.

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These are the features of ''kaphaja'' type of unmada.

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Features of ''sannipatika'' type ''unmada'':

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Features of ''sannipatika'' type unmada:

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In the ''unmada'' caused by the combined vitiation of all the three ''doshas'', all the symptoms mentioned above are simultaneously manifested. This type of ''unmada'' is considered to be incurable. [7-3]

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In the unmada caused by the combined vitiation of all the three ''doshas'', all the symptoms mentioned above are simultaneously manifested. This type of unmada is considered to be incurable. [7-3]

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==== Management of ''unmada~~'' =~~===

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=== Management of unmada ===

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Modalities of treatment of the three types of curable ''unmada'' are:

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Modalities of treatment of the three types of curable unmada are:

*Oleation, fomentation, emesis, purgation, ''asthapana'' enema, ''anuvasana'' enema

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Thus it is said :

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A competent physician should selectively employ the above-mentioned therapies to treat the curable types of ''unmada'' caused by the vitiation of ''doshas'' as per the fundamental principles of the prescribed therapy. [9]

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A competent physician should selectively employ the above-mentioned therapies to treat the curable types of unmada caused by the vitiation of ''doshas'' as per the fundamental principles of the prescribed therapy. [9]

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==== Exogenous ''unmada~~'' =~~===

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=== Exogenous unmada ===

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The type of ''unmada'' having etiology, premonitory symptoms, signs and symptoms, pain and favorable therapeutics (''upashaya'') different from those of the types of ''unmada'' caused by the vitiation of ''doshas'' are known to be of exogenous type. Some scholars hold the view that this type of ''unmada'' is caused by the effect of the activities of the past life. Lord Atreya considers intellectual errors as the causative factor of this condition. Due to intellectual errors, the patient disregards the Gods, ascetics, ancestors, ''gandharvas, yakshas,'' ''rakshasas, pishachas,'' preceptors, elders, teachers and the other respectable ones. He also resorts to undesirable and inauspicious (or blasphemous) activities. The gods etc. cause ''unmada'' in him because of his own inauspicious activities. [10]

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The type of unmada having etiology, premonitory symptoms, signs and symptoms, pain and favorable therapeutics (''upashaya'') different from those of the types of unmada caused by the vitiation of ''doshas'' are known to be of exogenous type. Some scholars hold the view that this type of unmada is caused by the effect of the activities of the past life. Lord Atreya considers intellectual errors as the causative factor of this condition. Due to intellectual errors, the patient disregards the Gods, ascetics, ancestors, ''gandharvas, yakshas,'' ''rakshasas, pishachas,'' preceptors, elders, teachers and the other respectable ones. He also resorts to undesirable and inauspicious (or blasphemous) activities. The gods etc. cause unmada in him because of his own inauspicious activities. [10]

</div>

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==== Premonitory symptoms of exogenous ''unmada~~'' =~~===

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=== Premonitory symptoms of exogenous unmada ===

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</div></div>

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The premonitory symptoms of exogenous ''unmada'' are as follows:

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The premonitory symptoms of exogenous unmada are as follows:

*Desire for inflicting injury upon the gods, cows, brahmins and ascetics;

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*Abuse and incitement of the gods etc. in dreams.

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~~''Unmada''~~ manifests soon after the occurrence of these premonitory symptoms. [11]

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unmada manifests soon after the occurrence of these premonitory symptoms. [11]

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The various divine entities unleash their wrath on the individual as follows:

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*Godly spirits cause ''devonmada'' (divine ''unmada'')

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*Godly spirits cause ''devonmada'' (divine unmada)

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*Preceptors, elders, adepts and ascetics cause ''unmada'' by their curse

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*Preceptors, elders, adepts and ascetics cause unmada by their curse

*Ancestors by manifesting themselves;

*''Gandharvas'' by their touch;

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*''Pishachas'' by seizing and riding the host.[12]

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==== Symptoms of exogenous ''unmada~~'' =~~===

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=== Symptoms of exogenous unmada ===

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</div></div>

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Characteristics of a patient afflicted with exogenous ''unmada'' are:

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Characteristics of a patient afflicted with exogenous unmada are:

Untimely, uncertain and uncalled for manifestations superhuman strength, valor, manliness, enthusiasm, power of understanding and retention, memory, spirituality, logical and scientific knowledge and power of speech. [13]

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Persons get afflicted by ''unmada'' caused by godly spirits, ascetics, ancestors, ''gandharvas, yakshas, rakshasas, pishachas,'' preceptors, elders and adepts in the following circumstances, places and time:

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Persons get afflicted by unmada caused by godly spirits, ascetics, ancestors, ''gandharvas, yakshas, rakshasas, pishachas,'' preceptors, elders and adepts in the following circumstances, places and time:

*In the beginning of sinful acts;

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Insulting ''dvija'' (twice born), preceptors, Gods and divinities, ascetics and the learned;

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Thus, described were some circumstances in which a person attracts the wrath of gods, divinities, and the sages and gets afflicted with ''unmada''. [14]

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Thus, described were some circumstances in which a person attracts the wrath of gods, divinities, and the sages and gets afflicted with unmada. [14]

</div>

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</div></div>

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~~''Unmada''~~ is caused by the above mentioned agents with the following objectives:

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unmada is caused by the above mentioned agents with the following objectives:

#as a consequence of one’s sinful acts

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#to make the individual pay obeisance to Gods

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The prognosis of ''unmada'' can be judged from the characteristic features of the patient. When the intention of the afflicted agents is to inflict injury, then the patient enters into fire, sinks into water, falls into a pit, provokes others to hurt him, strikes himself with weapons, whips, sticks, brick bats, his own fist etc. He may also adopt to such other means of killing himself. This type of ''unmada'' is incurable.

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The prognosis of unmada can be judged from the characteristic features of the patient. When the intention of the afflicted agents is to inflict injury, then the patient enters into fire, sinks into water, falls into a pit, provokes others to hurt him, strikes himself with weapons, whips, sticks, brick bats, his own fist etc. He may also adopt to such other means of killing himself. This type of unmada is incurable.

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The other two types of intentions i.e. for affection/love/pleasure or to offer prayer give rise to variants of ''unmada'' that are curable. [15]

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The other two types of intentions i.e. for affection/love/pleasure or to offer prayer give rise to variants of unmada that are curable. [15]

</div>

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==== Treatment of exogenous ''unmada~~'' =~~===

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=== Treatment of exogenous unmada ===

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</div></div>

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For the curable variants of exogenous ''unmada'', the prescribed therapies are:

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For the curable variants of exogenous unmada, the prescribed therapies are:

*Incantation of ''mantras'',

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*Taking a vow, performing religious duties, penance, fasting, blessings, obeisance and pilgrimage. [16]

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==== Role of ''dosha'' in causing various types of ''unmada~~'' =~~===

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=== Role of ''dosha'' in causing various types of unmada ===

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</div></div>

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In the following verses, the five types of ''unmada'' have been explained. [17]

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In the following verses, the five types of unmada have been explained. [17]

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The ''unmada'' of five types can be further classified as endogenous or exogenous or as curable or incurable. At times, due to the combination of etiological factors (of endogenous and exogenous types), these could also manifest in hybrid forms. Such forms would exhibit a combination of both the types of ''unmada'' in their premonitory as well as actual symptoms. However, it is important to note that:

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The unmada of five types can be further classified as endogenous or exogenous or as curable or incurable. At times, due to the combination of etiological factors (of endogenous and exogenous types), these could also manifest in hybrid forms. Such forms would exhibit a combination of both the types of unmada in their premonitory as well as actual symptoms. However, it is important to note that:

*Combination of the incurable types or of the curable and incurable types result in an incurable condition.

*Combination of curable types results in curable conditions that should be treated using a combination of therapies. [18]

</div>

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==== Responsible factors for ''unmada~~'' =~~===

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=== Responsible factors for unmada ===

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</div></div>

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Neither gods, nor ''gandharvas'', nor ''pishachas'' nor ''rakshasas'' afflict a person who himself is free from misdeeds. The primary cause of ''unmada'' in an individual is the consequences of his own misdeeds and not other agents like the gods etc. [19]

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Neither gods, nor ''gandharvas'', nor ''pishachas'' nor ''rakshasas'' afflict a person who himself is free from misdeeds. The primary cause of unmada in an individual is the consequences of his own misdeeds and not other agents like the gods etc. [19]

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</div></div>

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If the primary cause of ''unmada'' is misdeeds of the individual, then how could the causation of these exogenous ''unmada'' be attributed to divinities? Misdeeds committed already cannot be undone, but good deeds can pacify or neutralize the effects of these exogenous factors. [20]

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If the primary cause of unmada is misdeeds of the individual, then how could the causation of these exogenous unmada be attributed to divinities? Misdeeds committed already cannot be undone, but good deeds can pacify or neutralize the effects of these exogenous factors. [20]

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</div></div>

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Prayers to the Gods etc. and resorting to wholesome dietary and lifestyle habits act as antidotes to the misdeeds of the individual. Thus, the choice either to avert or get afflicted with ''unmada'' rests with the individual himself. [23]

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Prayers to the Gods etc. and resorting to wholesome dietary and lifestyle habits act as antidotes to the misdeeds of the individual. Thus, the choice either to avert or get afflicted with unmada rests with the individual himself. [23]

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==== Summary ====

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=== Summary ===

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In summary, types of ''unmada'' and their etiology, premonitory symptoms, symptoms, curability or otherwise, and their modes of treatment have been described in this chapter. [ 24]

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In summary, types of unmada and their etiology, premonitory symptoms, symptoms, curability or otherwise, and their modes of treatment have been described in this chapter. [ 24]

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Thus ends the seventh chapter on diagnosis of ''unmada'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [24]

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Thus ends the seventh chapter on diagnosis of unmada in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [24]

−

==~~= ''~~Tattva Vimarsha~~'' /~~ Fundamental Principles===

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== Tattva Vimarsha(Fundamental Principles)==

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*The ''unmada'' pathology involves psychic ''dosha'' (''rajas'' and ''tamas'') and body ''doshas'' ( ''vata, pitta'' and ''kapha'').

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*The unmada pathology involves psychic ''dosha'' (''rajas'' and ''tamas'') and body ''doshas'' ( ''vata, pitta'' and ''kapha'').

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*The individuals with low mental strength and emotionally unstable with the mind afflicted repeatedly by desires, anger, greed, excitement, fear, attachment, exertion, anxiety and grief are more prone for ''unmada''.

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*The individuals with low mental strength and emotionally unstable with the mind afflicted repeatedly by desires, anger, greed, excitement, fear, attachment, exertion, anxiety and grief are more prone for unmada.

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*Improper diet and lifestyle play important role in causing ''unmada''. Therefore these shall be checked in management.

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*Improper diet and lifestyle play important role in causing unmada. Therefore these shall be checked in management.

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*~~''Unmada''~~ involves cognitive distortion pertaining to mind, intellect, consciousness, knowledge, memory, desire, attitude, activities and behavior. These factors shall be assessed to determine severity of disease, management protocol and prognosis.

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*unmada involves cognitive distortion pertaining to mind, intellect, consciousness, knowledge, memory, desire, attitude, activities and behavior. These factors shall be assessed to determine severity of disease, management protocol and prognosis.

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*The ''dosha'' dominance shall be assessed for deciding the protocol for management of ''nija''(endogenous) ''unmada''.

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*The ''dosha'' dominance shall be assessed for deciding the protocol for management of ''nija''(endogenous) unmada.

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*Intellectual error is the basic cause of exogenous ''unmada''.

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*Intellectual error is the basic cause of exogenous unmada.

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*Exogenous ''unmada'' is characterized by untimely, uncertain and uncalled for manifestations, superhuman strength, valor, manliness, enthusiasm, power of understanding and retention, memory, spirituality, logical and scientific knowledge and power of speech.

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*Exogenous unmada is characterized by untimely, uncertain and uncalled for manifestations, superhuman strength, valor, manliness, enthusiasm, power of understanding and retention, memory, spirituality, logical and scientific knowledge and power of speech.

*The diagnosis of exogenous type is based upon clinical presentation resembling with specific extra-human factors mentioned in the text.

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*The treatment of exogenous ''unmada'' includes psycho-spiritual therapies.

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*The treatment of exogenous unmada includes psycho-spiritual therapies.

−

*No other factor can afflict a person who is free from misdeeds. The primary cause of ''unmada'' in an individual is the consequences of his own misdeeds and not other agents like the gods, etc.

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*No other factor can afflict a person who is free from misdeeds. The primary cause of unmada in an individual is the consequences of his own misdeeds and not other agents like the gods, etc.

*Misdeeds that are committed already cannot be undone, but good deeds can pacify or neutralize the effects of exogenous factors.

*All the diseases are caused due to intellectual errors. The Gods, ancestors or demons shall not be blamed for any disease. One should hold himself responsible for his happiness and miseries. Therefore, one should follow the path of welfare without apprehensions.

−

==~~= ''~~Vidhi Vimarsha~~'' /~~ Applied Inferences===

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== Vidhi Vimarsha (Applied Inferences) ==

−

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. Charak 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.

+

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. Charak 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.

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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.

Thirdly, entire thought processes, attitudes, emotional experiences, desires and behaviors of an individual, which are relatively intangible, have the capacity to bring about qualitative as well as quantitative changes in the ''manas'' and ''sharira doshas, agni,'' and ''ojas''. These psychological factors are also capable of bringing about structural as well as functional changes in the ''dhatus'' (body tissues), ''malas'' (biological byproducts and wastes) and ''srotasas'' (macro and micro-channels). These are some of the most fundamental considerations. which needs special attention.

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The eight psychological and behavioral factors are described here that get imbalanced when the individual is afflicted with mental diseases. These factors are- ''manas, buddhi, sanjna jnana, smriti, bhakti, sheela, chesta'' and ''aachara''. This provides a basis for objectively and empirically assessing the mental functions of a patient afflicted with ''unmada''. Using this understanding, Ayurvedic institutions have been able to create a rubric to analyze patients and conduct various mental health studies. A three-stepped approach to creating such a scale is as follows:-

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The eight psychological and behavioral factors are described here that get imbalanced when the individual is afflicted with mental diseases. These factors are- ''manas, buddhi, sanjna jnana, smriti, bhakti, sheela, chesta'' and ''aachara''. This provides a basis for objectively and empirically assessing the mental functions of a patient afflicted with unmada. Using this understanding, Ayurvedic institutions have been able to create a rubric to analyze patients and conduct various mental health studies. A three-stepped approach to creating such a scale is as follows:-

#In depth study of various definitions, synonyms, commentaries available on the eight factors.

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#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.

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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.

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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.

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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.

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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.

</div>

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==== Table 1: Behavioral and psychological manifestation of ''triguna'' ====

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=== Table 1: Behavioral and psychological manifestation of ''triguna'' ===

{| class="wikitable"

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==== Table 2:Predominance of ''raja'' and ''vata'' ====

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=== Table 2: Predominance of ''raja'' and ''vata'' ===

{| class="wikitable"

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|}

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==== Table 3:Predominance of ''raja'' and ''vata'' ====

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=== Table 3:Predominance of ''raja'' and ''vata'' ===

{| class="wikitable"

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|}

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==== Table 4:Predominance of ''tamas'' and ''kapha dosha'' ====

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=== Table 4:Predominance of ''tamas'' and ''kapha dosha'' ===

{| class="wikitable"

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|}

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==== Table 5:Predominance of ''Raja'' and ''Pitta dosha'' ====

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=== Table 5:Predominance of ''Raja'' and ''Pitta dosha'' ===

{| class="wikitable"

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==== Table 6: Predominance of ''Raja'' and ''Vata'' ====

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=== Table 6: Predominance of ''Raja'' and ''Vata'' ===

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==== Case Paper Format Points ====

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=== Case Paper Format Points ===

The format for the clinical assessment of ''manovahasrotas'' or The psychiatric assessment:

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#Personality: is defined as the sum of those characteristics that make a person into individual he is. These characteristics include behaviour, both actions and reactions; attitude to self; ways of relating to others, both socially and sexually, attitude to authority, level of independence, mood, fantasy life, religious beliefs and moral altitudes and interests and hobbies.

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===== The mental status examination =====

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==== The mental status examination ====

#Appearance: note unusual modes of dress, use of makeup etc. very helpful for evaluation of ''bhootonmada'' and ''vataja unmada''

#Activity and behavior: Gait, gestures, co-ordination of bodily movements. ''akshibhruvaushthamsahanvagrahastapadangavikshepanamakasmat''

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