50 chapter
In my fi rst meeting with Dr. Sundaran in 1994 at the GAMH, I realize
in retrospect, I essentially asked him to summarize the theory and practice of
ayurvedic psychiatry for me, and rather than repudiate my naïve, overbroad
request, he made a thorough attempt to answer it. Th e following depiction
of the etiology and treatment of psychopathology is compiled from this and
subsequent meetings with Dr. Sundaran. He began by describing personality
formation, which is important for understanding the development of unmada
(mental disorder). His explanation started at the earliest moments of develop-
ment, outlining the six factors that contribute to personality formation in utero:
(1) father’s sperm, (2) mother’s ovum, (3) the mother’s diet while pregnant,
(4) activities of the mother while pregnant, (5) particular characteristics of the
uterus and (6) climate of the region where the birth occurs. At a later meeting,
Dr. Sundaran added that the dauhridaya, or “two hearts,” period in pregnancy
contributes signifi cantly to the development of personality. Th e “two hearts”
refers to the fetal heart and the mother’s heart, and it is suggested that the desires
of the mother during this period are transferred to the child. Dr. Sundaran enu-
merated additional factors that aff ect the development of the personality after
birth: (1) one’s religion, (2) type of family or communal group, (3) place—such
as topography or rural or urban residence, (4) environment—including climate,
soil, nature of foods grown in the region, (5) age and (6) other details, such as
education level, the character of one’s friends and travel experiences. Th us, like
anthropologists, ayurvedic psychiatrists emphasize social context in explaining
the development of the individual personality.
Dr. Sundaran went on to explain that there are two basic types of unmada:
those related to exacerbated dosas—excess or insuffi ciency of vata, pitta or
kapha resulting in mental and somatic problems—and those related to per-
sonality disorders, which involve specifi c aberrant behaviors. Most patients
at the Government Ayurveda Mental Hospital offi cially received dosa-related
diagnoses including: vatotmadam, characterized by manic behavior, hyper-
activity, running away from home and delusions; pittotmadam, which mani-
fests in behaviors such as outbursts of anger, acts of violence, overeating and
drinking excessive amounts of water; and kaphotmadam, wherein the patient
is lethargic, gloomy and passive. Dr. Sundaran also explained that graha diag-
noses, which are specifi c types of behavioral disorders ranging from megalo-
maniacal behavior to acting like particular animals, are rarely used and few
specialists know how to diagnose these problems. Two additional diagnoses
used by people treating psychopathology in ayurveda that do not fi t into either
the dosa-related or graha categories are bhayam, a state characterized by fear
or a general phobia, and vishadam, which is akin to the allopathic category
“depression” and is caused by external factors such as shock. Vishadam is similar