
Reference: SC: Psychology
Holistic Systems and Cognitive Therapies
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Indian Medical Psychology (1st Century Onward):
The Ayurvedic Framework
Ancient Indian medicine developed sophisticated understandings of mental illness centuries before the Common Era, but the classical texts were composed and systematized during the early centuries CE. The Charaka Samhita and Sushruta Samhita (composed in their current forms during the 1st-2nd centuries CE, though based on much earlier oral traditions) contain detailed expositions of mental disorders.
The primary Ayurvedic category for major mental disorders was unmada, literally meaning “frenzy, madness, or mental derangement”. The Charaka Samhita defined unmada as “the excessive wandering of the intellect, mind, and memory,” a condition that encompassed what modern psychiatry would classify across multiple diagnostic categories including various forms of psychosis, severe mood disorders, and organic mental syndromes. The text specified that unmada was “brought on by the consumption of impure food, blasphemy, and mental shock”, reflecting a biopsychosocial understanding that integrated dietary, spiritual, and traumatic etiologies.
Ayurvedic medicine classified unmada into five subtypes based on which of the three fundamental physiological principles (doshas) were vitiated. Vataja unmada resulted from vitiation of the vata humor (associated with movement and the nervous system), pittaja unmada from vitiation of pitta (associated with metabolism and transformation), kaphaja unmada from vitiation of kapha (associated with structure and lubrication), sannipataja unmada from simultaneous vitiation of all three doshas, and agantuja unmada from exogenous causes including possession by supernatural entities. This classification system demonstrated remarkable sophistication, recognizing that similar behavioral presentations could arise from fundamentally different pathophysiological processes.
The Ayurvedic understanding of mental illness was deeply integrated with its model of personality and consciousness. Mental health was understood to depend upon the balance of the trigunas—three fundamental qualities of mind: sattva (harmony, goodness, clarity), rajas (passion, activity, restlessness), and tamas (inertia, darkness, ignorance). “Improving Sattva and achieving a balance between Rajas and Tamas are necessary for mental well-being”. The hrdaya (emotional heart and seat of intellect) was identified as the origin point where aggravated doshas would travel into the mental channels, “subsequently causing an imbalance within the mind”.
Treatment approaches combined pharmacological, psychological, and spiritual interventions. The Charaka Samhita prescribed that “the mind should be treated with knowledge, specific knowledge, restraint, memory, and concentration”. Therapeutic methods included herbal medicines, dietary modifications, massage (abhyanga), fumigation (dhuma), music therapy, and psychotherapeutic interventions. For unmada caused by loss of something the patient loved, “he is made to regain a similar object. Simultaneously, he is consoled with pleasing assurances of friends as a result of which he becomes free from the ailment”. For unmada caused by emotions—“passion, grief, fear, anger, exhilaration, jealousy and greed”—physicians employed “exposure of the patient to mutually contradictory psychic factors” to restore equilibrium.
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Buddhist Psychology (1st-5th Centuries):
Cognitive Approaches to Mental Suffering
Buddhism developed a comprehensive psychological system that distinguished between general human suffering (dukkha) and specific mental illnesses. The Buddha himself “distinguished between two kinds of illness (rogo): physical illness (kāyiko rogo) and mental illness (cetasiko rogo)”. The Buddha attributed mental illness to “the arising of mental defilements (Kleshas) which are ultimately based on the unwholesome roots (three poisons) of greed, hatred, and confusion”.
From the Buddhist perspective, “everyone who is not an awakened being is in some sense mentally ill”—as the Buddha stated in the Pali canon, “those beings are hard to find in the world who can admit freedom from mental disease even for one moment, save only those in whom the asavas mental fermentations are destroyed”. This radical claim did not pathologize normal human experience but rather established enlightenment as the standard of perfect mental health. The Buddhist approach to mental suffering was fundamentally therapeutic and pragmatic—rather than metaphysical speculation, Buddhism offered “a method of cleansing the stream of consciousness from ‘contaminations’ and ‘defilements’”.
Buddhist texts identified five major hindrances (nivarana) that prevent mental cultivation and contribute to psychological distress: sense desire, hostility, sloth-torpor, restlessness-worry, and doubt. The therapeutic methodology for removing negative or intrusive thoughts, detailed in the Vitakkasanthana Sutta (MN 20, “The Removal of Distracting Thoughts”), prescribed five cognitive techniques that strikingly anticipate modern cognitive-behavioral therapy:
- Focus on an opposite or incompatible thought or object
- Ponder the perils and disadvantages of the thought and its harmful consequences
- Ignore the thought and distract oneself through another activity
- Reflect on the removal or stopping of the causes of the target thought
- Make a forceful mental effort to suppress the thought
Nagarjuna (c. 150-250 CE), founder of the Madhyamaka school of Mahayana Buddhism, revolutionized Buddhist philosophy and psychology through his concept of sunyata (emptiness). Nagarjuna’s philosophy functioned as “linguistic therapy: it uses language to reveal how language deceives us”. He argued that mental and emotional turmoil arises from clinging to conceptual elaborations (prapancha)—fixed ideas about the nature of reality, self, and phenomena. These conceptualizations “do not accurately reflect how the world actually is” and generate suffering because we mistake linguistic constructs for reality.
Nagarjuna demonstrated through rigorous dialectical analysis that all phenomena, including mental states and the self, lack intrinsic existence (svabhava). This “cognitive default” of projecting substantial existence onto things reflects “our tendency to become attached to things, reflecting a need for solidity and permanence, forever frustrated by the certainty of death”. The therapeutic goal was not to replace deluded thinking with a correct philosophical view but rather to let go of all fixed conceptual positions. “Our emotional and mental turmoil is replaced by a beatitude or serenity (shiva) that cannot be grasped but can be lived”.
Vasubandhu (fl. 4th-5th century CE), philosopher and co-founder of the Yogacara school, developed a sophisticated psychological system centered on consciousness and its transformations. Vasubandhu elaborated the theory of eight types of consciousness: the five sense consciousnesses, empirical consciousness (mano-vijnana), a self-aggrandizing mentality (manas), and the alaya-vijnana (storehouse consciousness). The storehouse consciousness explained psychological continuity and the mechanisms of karmic conditioning—the “seed” (bija) of each experience is “stored subliminally and released into a new experience,” providing “a quasi-causal explanation for the functioning of karmic retribution”.
Vasubandhu’s analysis revealed that what we take to be an external objective world is actually constructed within consciousness itself. “We are fooled by consciousness into believing that those things which we perceive and appropriate within consciousness are actually outside our cognitive sphere”. This insight—that “cognition takes place only in consciousness and nowhere else”—anticipated by over a millennium Western philosophical idealism and phenomenology. The therapeutic implications were profound: suffering could be addressed by transforming the very basis of consciousness. “Buddhism is a method of cleansing the stream of consciousness from ‘contaminations’ and ‘defilements’”, achieved through ashraya-paravritti (overturning the basis) whereby consciousness (vijnana) is gradually transformed into unmediated cognition (jnana).
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Chinese Medical Psychology (1st-10th Centuries):
The Integration of Emotion and Physiology
Traditional Chinese Medicine developed during the Han Dynasty (206 BCE-220 CE) and flourished through the Tang Dynasty (618-907 CE), creating a comprehensive system for understanding the relationship between emotional states and physiological processes. The foundational text, the Huang Di Nei Jing (Yellow Emperor’s Inner Classic), described the Shen (spirit or consciousness) as residing in the Heart and governing consciousness. The Shen concept evolved from a mystical force into “a clinical entity in Traditional Chinese Medicine (TCM), influencing diagnostics and treatments for emotional and mental imbalances”.
Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage, c. 200 CE) built upon this foundation, addressing “how external pathogens can disrupt the Shen, leading to symptoms like delirium or restlessness”. The text emphasized that “the Heart is the sovereign of all organs and represents the consciousness of one’s being. It is responsible for intelligence, wisdom, and spiritual transformation”.
Chinese medicine conceptualized mental disorders as arising from disruptions in the flow of qi (vital energy) and imbalances among the internal organ systems. “According to Chinese medicine theory, MDD major depressive disorder is mostly characterized by emotional disorders and stagnation of qi, which leads to a loss of regulation of the liver, a loss of function of the spleen, and a loss of nourishment of the heart”. The system recognized both external emotional factors (worry, fear, anger) and internal factors (the qi of the organs being easily disturbed) as contributing to mental illness.
Treatment modalities integrated herbal pharmacology with emotional and spiritual interventions. Classical formulas like Xiao Yao San (Free and Easy Wanderer Powder), first recorded during the Song Dynasty (960-1127 CE) but based on earlier traditions, have been “used in the treatment of psychiatric disorders for thousands of years”. The formula’s eight herbs were designed to address liver qi stagnation, a fundamental pattern underlying many emotional disorders. Chinese physicians documented successful treatments of hysteria, insomnia, and depression using these formulas, with detailed case records surviving from the medieval period.
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