Healing from the Source-2: The somatic, psychological, karmic and metaphysical aspects of illness
------ © Dr. Satya Prakash Choudhary
‘Vyadhi' and ‘Roga' are the most common terms for disease or illness in ancient Ayurvedic literature though other words such as vikara, abadha, ‘papa-dukha', amaya, yaksma and gada too have been used. All these terms shed light on the somatic, psychological, karmic and metaphysical aspects of ‘vyadhi' or illness. As Caraka aptly puts it, mind ( manas ) and body ( sarira ) along with the senses ( indriyas ) are the abode or basis ( adhisthana ) of suffering ( vedana) ( Caraka Samhita : IV. I. 136).
The interrelationship between the body and mind
Ayurvedic literature reiterates the interrelationship between the body and mind in its approach to illness as well as health at many places. Though the vitiated doshas, dhatus and malas remain the physiological basis of illness, illness itself is a more complex psychosomatic phenomenon according to Ayurveda . Here I should draw the attention of the reader to a lesser known Ayurvedic concept of ‘manasika' doshas . Everyone is familiar with Vata, Pitta and Kapha as the three doshas . These are the three physiological or ‘saririka doshas'. Though the three doshas are predominantly somatic in their manifestation, because of the oneness of the ‘mind-body' gestalt, they do have a corresponding psychological manifestation too. Ayurveda conceptualizes that apart from these three predominantly somatic doshas , there are two other predominantly psychological doshas too ( mansika doshas )- rajas and tamas . Once again Ayurveda clearly shares common ground with Samkhya-Yoga by invoking the theory of the three gunas in its psychosomatic working model of illness.
Trigunas - The three modes of Nature
According to Samkhya philosophy Nature ( Prakrti ) is constituted by three modes or qualities (gunas) - Sattva, Rajas and Tamas . At the level of Moola Prakrti (Undifferentiated original state of Prakrti ) the three gunas are in equilibrium. The moment this equilibrium is disturbed the gunas are thrown out of balance leading to an unremitting cycle of changes or evolution. Mahat which is the first evolute of Prakrti consists of the three gunas in a constant state of disequilibrium. Sattva is characterized by brilliance, knowledge, equanimity and lightness. Rajas is characterized by movement, dynamism, ambition, attachment and reactivity or raga . Tamas is characterized by ignorance, delusion and inertia, the power of resistance.
“From Sattva is born knowledge, from Rajas craving,
from Tamas arise confusion, delusion and ignorance” --- Bhagavad Gita XIV. 17
These three gunas or qualities decide the nature of everything in the universe. Human beings are classified as Sattvic, Rajasic , or Tamasic according to the predominant quality manifest in them. Even food is classified as Sattvic, Rajasic or Tamasic according to the quality that it imparts to us on eating. Likewise the mind ( manas ) is also subject to the influence of the three gunas . Sattva is a relatively natural and harmonious state of clear consciousness. But the other two gunas - Rajas and Tamas - are the psychological ( manasika ) doshas ( Ashtanga Hrdayam: Sutrasthanam , 1. 21) just as Vata, Pitta and Kapha are the somatic ( saririka ) doshas.
The somatic and the psychological doshas
The word ‘dosha' literally means ‘that which can darken or spoil'. There is an intrinsic possibility in the very nature of the doshas that they could be deranged. Once vitiated or deranged both the somatic as well as psychological doshas can spoil our natural state of harmony thus leading to ill-health.
The body ( sarira ) is the substratum ( adhishtana ) of somatic ( saririka) doshas . When the three somatic doshas are deranged, through an interaction of the doshas, dhatus and malas , somatic illnesses arise. Likewise the mind ( manas ) is the substratum ( adhishtana ) of the psychological ( manasika) doshas ( tamas and rajas ). Due to ‘Prajnaparadha' or erroneous judgment the two psychological doshas predominate and cause various afflicting emotions and/or thoughts like lust ( kama ), craving/greed ( lobha ), delusional thinking ( moha ), jealousy/envy ( irsya ), conceit ( mana ), arrogance ( mada ), grief ( soka ), anxiety ( cittodvega ), and fear ( bhaya ). Ayurveda views these afflictions too as mental afflictions though conventionally they are not considered as mental diseases. These afflictions can lead to mental illness once they cross a threshold. However one has to bear in mind that the classification of the diseases as well as doshas into somatic ( saririka ) and psychological ( manasika ) is not a watertight compartmentalization as many illnesses reveal an underlying interlinked mind-body interaction. Somatic doshas ( vata, pitta and kapha ) are influenced by the psychological doshas just as psychological doshas are influenced by the somatic doshas . For instance worry and grief increase vata , anger increases pitta , too much pleasure increases kapha .
The three causes of illness: A basic approach to the origin of illness
Caraka discusses three factors in the origin of illness ( Caraka Samhita : I. 11. 43).
Asatmendriyartha Samyoga: unwholesome, excessive use of the senses)
Prajnaparadha: Volitional transgression arising from faulty understanding or ignorance
Parinama or kala: seasonal changes in the environment or ecosystem
Caraka mentions these three factors in certain other chapters too though he substitutes the words buddhi and karma for prajnaparadha . Whilst he discusses quite thoroughly various other causes of illness too, the above three factors are part of his basic approach to illness. Other systems of medicine too deal with the first and third causes. However the Karmic origin of illness due to Prajnaparadha is a unique, lesser known and misinterpreted contribution of the ancient Ayurvedic approach. So I will elaborate it further.
‘Prajnaparadha'- the root of all illness
The words ‘Prajna' as well as ‘buddhi' mean ‘intelligence' or ‘wisdom'. Some authors translate ‘buddhi' as ‘intellect'. ‘Buddhi' has also been referred to as ‘sad-asad vivekini' thus denoting the capacity to discern. Erroneous judgment or ‘Prajnaparadha' is at the root of all undesirable actions. In a way the first factor- excessive and unwholesome indulgence of the senses- too stems from erroneous judgment or a lack of discernment. Moreover unwholesome thoughts, speech and actions (these are the triple-fold karma arising from manas or mind, vak or speech and sarira or body) also stem from ‘prajnaparadha' . That is why Caraka reiterates that a wise person does not blame the gods when afflicted with disease as it is the result of one's own karma arising from prajnaparadha ( Caraka Samhita : III. 3. 20). Furthermore even illnesses such as epidemics or natural disasters (all of which are part of the third factor Kala or Parinama ) happen due to adharma and purvajanmakrta karmas or unwholesome karmas of a previous life, both of which again stem from ‘Prajnaparadha' only ( Caraka Samhita : I. 11. 42). Misuse of the powers and faculties of the ‘mind-body' (sarira and manas) results in ill-effects. As already discussed excessive indulgence, self-mortification, forceful repression of natural urges, excessive fear, grief, anger, jealousy, excessive craving, self-conceit, and deluded thinking will all have their harmful effects on a person in the long run and can cause illness. Thus ‘Prajnaparadha' or erroneous judgment or lack of discernment is at the root of all illness directly or indirectly.