Herbal Ghee (ghrta) for the mind and mental health

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Ghee is one of the medicines which the Buddha recognized, and the use of ghrita (ghee) for mental health problems is very common within the Ayurvedic texts, it continues to be regarded as ‘the best drug of oleation’, and assimilates the properties of substances accompanying it. Medical uses of ghrita include drinking it, nasal drops, massaging on the body, bathing in it and various other applications.

Classical Ayurvedic texts give around 20 different recipes for types of herbal ghee recommended for the treatment of mental health problems. Recent initial small scale research in India using randomised placebo controlled clinical trials is beginning to show that the total effect of Brahmi ghee is statistically highly significant compared with placebo for conditions such as depression and anxiety.

Manasa Ayurveda carefully produces our own herbal ghee using special combinations of herbs traditionally recognsised as highly effective for the mind and mental health.

Añjana (collyrium therapy) in Buddhist Ayurvedic Psychiatry

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Añjana refers to instillation of medicine into the eyes and eye ointments. It is listed as ascyotana (eye drops) in the earliest Buddhist teachings, and use of ointments for this purpose was allowed by the Buddha:

I allow, monks, these ointments [añjana]: black collyrium, rasa-ointment, sota-ointment, yellow-ochre, lamp-black
— Vin.I.203

The Ayurvedic texts instruct the use of a dharani (invocation) of a healing Buddha when preparing an añjana (collyrium). Añjana (collyrium therapy) is recognized as a treatment for mental health problems according to Ayurvedic texts and a number of recipes for añjana in the treatment of mental health problems are given.

Contact us to find out more about traditional Buddhist Ayurvedic treatments for the mind, mental health and well-being.

Face-to-face consultation: tounge examination (jihva pariksha)

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Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods also include professional physical health checks. One of the Ayurvedic methods we use is tounge examination (jihva pariksha).

Why do we do this?

The tongue is the only internal organ that can be seen externally. Ayurvedic tongue examination is part of the personal face-to-face consultation for two main reasons:

  1. It enables the therapist to see how the ‘digestive fire’ (agni) is working throughout the body

  2. It clearly shows progress of improvements in health during a therapy programme

According to the ancient practice of Ayurvedic tounge examination (jihva pariksha), different areas of the tongue (marked 1-5 in the diagram above) relate to different organs and areas of the body. Observations in these different areas help to identify current, or potential health issues.

Tongue examination is used not only to enable the Manasa Ayurveda therapist to have a better knowledge of your health, but also to inform of any further questions that may need to be asked.

What happens?

  • You will be asked to put out your tongue with your mouth open for around 20 seconds

  • The Manasa Ayurveda therapist will use a small hand-held examination light to look at your tongue (there is no physical contact with the tongue)

  • Observations made will be written down immediately on a record form

  • For the full examination this process is usually repeated 3-4 times as needed

What do the results mean?

According to Ayurveda, tongue examination can give information about:

  • Your basic body constitution (prakrti)

  • Any general current imbalances within your body (vikruti)

  • How the ‘digestive fire’ (agni) is working throughout the body

  • Current or potential issues with the functioning of certain organs

  • Current or potential health issues in general

Buddhist Ayurvedic Herbs for the Mind and Mental Health

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The Buddha allowed monks, if there was a reason, to prepare medicines using a (lower or small) grindstone, pestle and mortar and sifters, and allowed monks, if there was a reason, to make medical use of whatever there are of medicinal roots, astringent decoctions, medicinal leaves, medicinal fruits, medicinal resins and medicinal salts (Vin.I.201-202).

The most important group of ausadha (drugs) employed within Ayurveda for the treatment of mental health problems, are the medhya rasayanas.

An especially notable herb is haritaki, a type of fruit used in a variety of medicines. Haritaki fruit is a well-known healing substance in both in Buddhist and Ayurvedic medical tradition. Its use with milk and honey is advocated for mental health problems in an Indian Buddhist text preserved in Chinese translation.

In some early Buddhist texts haritaki is thought to represent ‘blessings from unseen realms’. The Buddha Bhaisajyaguru (medicine Buddha), is usually seen holding haritaki in his right hand and the healing properties and affects of haritaki on both body and mind indicate the comprehensive nature of the medicine Buddha’s healing power (p.83, Birnbaum, 1989).

Haritaki is used as an ingredient in some of the therapeutic products available on a not-for-profit basis in our online shop (restricted to Manasa Ayurveda clients only).

Are you sweet enough already?

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In the UK we eat too much sugar, on average 700g or 140 teaspoons a week per person.

Research has shown that a higher sugar intake is associated with worse mental health, but it is not always easy to know when we are eating sugar.

There are lots of different ways added sugar can be listed on ingredients labels. If you decide to reduce the amount of sugar you eat, look out for these ingredients (all of them are sugar!):

  • sucrose

  • glucose

  • fructose

  • maltose

  • fruit juice

  • molasses

  • hydrolysed starch

  • invert sugar

  • corn syrup

  • honey

Face-to-face consultation: taking your blood pressure

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Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods also include conventional physical health checks. One of these checks is of blood pressure.

Why do we do this?

We measure blood pressure so we can see how well this part of your circulatory system is working. Your Manasa Ayurveda therapist will measure your blood pressure during your consultation and during therapy sessions where monitoring is helpful.

A blood pressure that is too low can lead to fainting and falls, whereas a high blood pressure, if untreated for long periods may cause problems such as kidney damage or stroke. We usually cannot tell if our blood pressure is too high as there are no obvious signs and symptoms. The only way we know is by measuring it.

What happens?

We measure blood pressure by hand (manually) for the most accurate readings:

  • We will ask you to sit down with your arm supported on a table. Sometimes we will check your blood pressure laying down or standing up.

  • A cuff is placed on your upper arm.

  • The cuff is tightened and you will feel tightening.

  • The air is then slowly let out of the cuff.

  • Your Manasa Ayurveda therapist will then place a stethoscope on your arm just below the cuff and listen to your pulse whilst the air is being let out.

  • It is best to do this three times to get the most accurate reading.

  • The therapist will tell you the result and write it down on a chart.

What do the results mean?

  • Blood pressure is measured in millimetres of mercury (mmHg). Ideally blood pressure should be lower than 120/80 mmHg.

  • The first number is called the systolic blood pressure. It is the highest level your blood pressure reaches when your heart beats.

  • According to Ayurvedic principles a systolic blood pressure of less than 95mmHg may be associated with vāta, whereas a systolic blood pressure of over 130mmHg may be associated with pitta.

  • The second number is called the diastolic blood pressure and is the lowest level your blood pressure reaches as your heart relaxes between beats.

  • From your blood pressure, your pulse pressure (PP) can be calculated (systolic – diastolic) and this is pressure is known as bala (force) according to ancient Ayurvedic understanding.

We can make helpful suggestions to help you manage high or low blood pressure using an Ayurvedic approach, including diet, exercise, sleep and meditation practices and may also recommend that you inform your GP so that they also remain informed of your health condition.

Face-to-face consultation: checking the amount of oxygen in your blood

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Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods also include professional physical health checks. One of these checks is of the oxygen levels in your blood.

Why do we do this?

The amount of oxygen in our blood is affected by such things as smoking asthma or dehydration. We need to know if the blood is carrying enough oxygen throughout your body, but particularly to your brain and heart.

What happens?

We take an estimate of the amount of oxygen in your blood (also called oxygen saturation) by placing a small device (called a pulse oximeter) on one of your fingers. The device shines a light through one side of your finger and a detector measures the light that comes through the other side. Blood cells that are full of oxygen absorb and reflect light differently than those with not enough oxygen. Anything that absorbs light can give a false reading (such as dark nail varnish). Also movement can give a false reading so you will be asked to keep your hand still while the oximeter is clipped to your finger. Your Manasa Ayurveda therapist will tell you the result and record your results on a chart.

What do the results mean?

Normal readings are 94-100%. If your reading is below this we may advise that you also inform your GP.

The amount of oxygen in your blood may be related to various factors including your respiratory system. The lungs are the organs that receive oxygen that we breathe in through our nose and mouth.

According to Ayurveda, the lungs are an important site of kapha dosha, the force in the body which is governed by the elements of water and earth. Most disorders of the respiratory system are a result of imbalanced kapha dosha.

From an Ayurvedic view, oxygen is closely related to the subtle force of prana (vital life force). Breathing exercises which increase oxygen would also increase prana and vice versa. It is said that in the form of oxygen, prana takes its energy, or that oxygen is a manifestation of prana and that prana is most easily sensed in breathing. But prana is considered more subtle than the breath or the oxygen contained in the air. Prana is not oxygen, but is in oxygen (and also food). Prana is a life force that is in all things.

Face-to-face consultation: cholesterol levels

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We recommend that all adults should get a cholesterol check – no matter what your age or how healthy you feel
— Heart UK, the cholesterol charity

Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods also include professional physical health checks. One of these checks is of your total cholesterol levels.

Why do we do this?

Cholesterol is a type of fat. The body needs cholesterol to help make certain vitamins and hormones and can make enough cholesterol of its own. We also get extra cholesterol from the foods we eat.

Too much cholesterol can lead to serious problems like heart disease. A high intake of animal fats such as meat, eggs and cheese are the main cause of excess cholesterol. It’s not just eating too much fat that causes high cholesterol; smoking contributes to it, as does having high blood pressure, diabetes, or an underactive thyroid. Also, some medications such as antipsychotics may increase cholesterol levels.

What happens?

  • A cholesterol test strip is inserted into the testing meter

  • The tip of one of your fingers is cleaned and dry

  • The tip of your finger is massaged

  • Your finger is pricked using a sterile lancet and a drop of blood squeezed onto the test strip

  • The meter reads the test strip

  • You are given some cotton wool to clean your finger

  • Your Manasa Ayurveda therapist will tell you the result and record it on a chart

What do the results mean?

This test measures total cholesterol (TC), this refers to the overall level of cholesterol. As a general guide a healthy total cholesterol level should be below 5mmol/L.

The total cholesterol level found in our test will provides a general guide, and informs will inform our recommended therapies and dietry suggestions, but it’s not just total cholesterol that’s important…

‘Good’ and ‘bad’ cholesterol (HDL & LDL) - an Ayurvedic perspective

Blood carries cholesterol around the body on proteins known as high density lipoproteins (HDL) or ‘good cholesterol’, and low density lipoproteins (LDL) – ‘bad cholesterol’.

HDL cholesterol helps your body, but LDL cholesterol can cause blood vessels to become narrowed or blocked, leading to serious health problems and six in ten adults in the UK have LDL cholesterol levels which are too high.

From the ayurvedic perspective, LDL (the harmful kind of cholesterol) is caused by ama, or toxins in the fat tissue. Ayurveda explains ‘simple ama’ as a sticky, foul-smelling waste product of improper digestion which can block the channels of the body, such as the arteries.

When this ‘simple ama’ is present for a very long time and is not flushed from the system it can lead to amavisha, a more reactive, dangerous type of ama. When this starts to spread throughout the body, it can mix with the body tissues (dhatus) and waste products (malas). Once amavisha mixes with the fat tissue, it is said to lead to problems such as high cholesterol, heart disease, stroke and high blood pressure.

Following our general test of total cholesterol you may wish to have a further, more in-depth test to determine your specific HDL and LDL levels, particularly if your total cholesterol level is above 5mmol/L. Heart UK, the cholesterol charity provides helpful information on this.

Face-to-face consultation: weight and height

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Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods also include professional physical health checks. One of these checks is on your weight and height.

Why does this matter?

Being a healthy weight helps to control our blood pressure and blood glucose (sugar) levels, and helps reduce the risk of heart disease and diabetes. It is not unusual for people to gain weight when first starting medicines for mental health problems.

To check if you are a healthy weight for your height, your body mass index (BMI) can be calculated. This is an estimate of body fat. The higher your BMI is, the higher your risk for certain diseases such as heart disease, high blood pressure and type 2 diabetes.

What happens?

Your Manasa Ayurveda therapist will measure your weight (in kilograms) and height (in metres).

Your BMI is worked out by dividing your weight by your height

Then dividing the number you get from this by your height again to give you a BMI score

Your therapist will tell you the results and record it on a chart

What do the results mean?

Your BMI score gives you an idea if you need to take action about your weight.

There are slightly different guideline depending on your ethnic group. Most of the research about the health effects of BMI scores has been carried out with people from an Asian background. The World Health Organisation (WHO) and the Department of Health recommend that people from an Asian background need to take action when their BMI score is slightly lower than people from a white European background.

Underweight (you may need to put on weight):

Asian population: Below 18.5

White European population: Below 18.5

Normal (this is generally ideal, you should aim to stay this way):

Asian population: 18.5-23

White European population: 18.5-24.9

Overweight (it may be a good idea to try to stop further weight gain or lose some weight):

Asian population: 23-27

White European population: 25.0-29.9

Obese (losing weight will improve your health):

Asian population: 27.5 and above

White European population: 30.0 and above

BMI and Ayurvedic body type

Rotti et al. (2014) completed a study which found that people with certain Ayurvedic body types (prakruti) are naturally more likely to have a higher or lower BMI. People with a lower BMI (less than 20) are most likely to have a vāta body type, and people with a higher BMI (greater than 25), are most likely to have a kapha body type. So different people may naturally have a higher or lower BMI.

Face-to-face consultation: waist size

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Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods also include professional physical health checks. One of these checks of your waist size.

Why do we do this?

Research has shown that people with a vāta body type may be more likely to naturally have a lower BMI and people with a kapha body type may be more likely to naturally have a higher BMI. So a larger or smaller overall body size may not always be related to potential health problems.

Rather than just measuring overall body size, in recent years experts now think that measuring waist size may be a better way to predict if we are at risk of getting diabetes and cardiovascular disease. This is because fat stored around our middle is unhealthier than overall body fat.

What happens?

  • A Manasa Ayurveda therapist will wrap a tape measure around your waist.

  • To accurately measure this, the tape measure is wrapped around your waist halfway between the top of the hip bone and the lowest rip (it usually crosses your belly button)

  • You will be asked to breathe out and hold your breath whilst the therapist takes the measurement

  • They will tell you what the results are and record this on a chart

What do the results mean?

The higher the waist size, the more at risk of developing heart disease and diabetes in the future. As with BMI scores, there are different guidelines depending on your gender and ethnicity.

Asian women: take action if your waist size is 80cm (31.5in) and above

White European women: take action if your waist size is 80cm (31.5in) and above

Asian men: take action if your waist size is 90cm (35in) and above

White European men: take action if your waist size is 94cm (37in) and above

If you fall into this risk category and would like help to reduce your weight and waist

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Herbal tea for the current state of your body & mind

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The use of herbal teas as beverages, as substitutes or alternatives for coffee or tea, has become very common. Yet without proper understanding of constitution and condition, the use of such herbal teas may not be entirely health promoting.

Following your personal consultation we can recommend, blend and send the perfect herbal tea for the current state of your body and mind...

Face-to-face consultation: taking your temperature...

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Our Manasa Ayurveda consultations are undertaken by registered healthcare professionals and as well as using traditional Ayurvedic methods, can also include physical health checks which are used within NHS hospitals. One of these checks is taking temperature.

Why do we do this?

According to Ayurveda, body temperature can be affected by the three “doshas”. For example, an excess of “pitta” is often connected with more heat in the body, and this may be associated with symptoms such as, acne, heartburn, skin rashes and diarrhoea. Temperature can also be affected if you have an infection, by taking certain medicines, if you are dehydrated and if you are very emotional. We need to know if your temperature is too low, normal or too high, because this can help us plan the therapies we offer.

What happens?

A professional Manasa Ayurveda therapist will take your temperature during the face-to-face consultation. We will check your temperature using an electronic thermometer which is placed in your ear for a few seconds. Your therapist will write down what the result is on the chart. During your therapy programme we may continue to monitor your temperature if this is found to be an especially important factor for you.

What do the results mean?

Normal temperature is around 35-37°C. According to Ayurvedic principles, cooler temperatures may be associated with aggravation of vāta and warmer temperatures associated with aggravation of pitta.

Developing mental wellbeing through seeing things as they are: a traditional Buddhist Ayurvedic perspective

Western mental health professionals are now increasingly adopting mindfulness-, acceptance- and compassion-focused therapy approaches which ‘present concepts derived from Buddhist psychology as separate from the philosophical context from which they have emerged’ (p.18, Tirch et al. 2016). Research into the clinical utility of Buddhist-derived interventions (BDIs) has increased greatly over the last decade, and continues to grow: 

‘...although clinical interest has predominantly focused on mindfulness meditation, there also has been an increase in the scientific investigation of interventions that integrate other Buddhist principles...’ (Shonin et al, 2014). 

There are concerns over the rapidity at which mindfulness has been extracted from its traditional Buddhist setting and introduced into psychiatric treatment domains, and writing on innovations and advances in Cognitive Behaviour Therapy (CBT), Huxter (2007) has suggested that: 

‘...attempts to distil and separate mindfulness from Buddhism run the risk of losing the skill knowledge and conceptual framework that this tradition offers... attempts to reinvent the wheel, without reference to earlier models are, perhaps a retrograde step’ (p.53, Huxter, 2007). 

Although psychiatric nosology has continued in Europe since the mid-eighteenth century CE, definitions of mental health problems still remain subject to debate, with no definition accepted within Western psychiatry to specify the precise boundaries for the concept of mental disorder. 

This article focuses upon buddhi vibhrama (impaired or deranged buddhi) as one of the defining features of mental health problems according to a traditional Buddhist Ayurvedic perspective. It also introduces the trilakṣaṇa (three marks of existence) which have an important place in addressing mental health problems as part of ‘cognitive therapy’ (vipassanā-paññā) in the practice of Buddhist Āyurvedic Counselling and Psychiatry (BĀCP).

According to premodern Buddhist and Āyurvedic texts mental health problems may arise as impairment, disturbance, loss, destruction, distortions or in other ways. In the Ayurvedic classical texts, mental health problems (in particular unmāda - a term often translated as mental disorder) are characterised as the impairment, disturbance, loss, destruction, distortions etc. of various mental processes or factors. Problems associated with buddhi (intellect) and smṛti (memory/mindfulness) are most frequently mentioned. 

Buddhi (intellect) is the ability to understand correctly, it is the discriminative function, that which knows, and is one of the inner instruments of cognition. Buddhi vibhrama (impaired or deranged buddhi) is a condition wherein ‘perverted’ judgments are made.

Mental health problems are understood as conditions in which buddhi ‘loses its balance’ and buddhi vibhrama is specifically and directly associated with mental health problems from the Ayurvedic perspective. 

Examples of disturbed buddhi are given in the classic Ayurvedic text, the Caraka Samhita: 

‘If something eternal is viewed as ephemeral and something harmful, as useful and vice versa, this is indicative of the impairment of intellect. For the intellect normally views things as they are’ (CS.Sar.I.99).

What does it mean to clearly see things as they are? 

The Ayurvedic classical text, the Caraka Samhita offers a clear answer to this in a very important passage. This passage in the classical Ayurvedic literature makes explicit reference to the Buddhist teaching of the three marks of existence (trilakṣaṇa) in what Wujastyk (2012) has described as ‘completely Buddhist terms... taken directly from the Buddhist meditational and doctrinal milieu’ (p.35, Wujastyk, 2012). Below two different transalations of the original Ayurvedic Sanskrit are given: 

‘Any thing that has a cause constitutes misery [duḥkha (Pāli:dukkha)]; it is alien [anātman (Pāli:anattā)] and ephemeral [anitya (Pāli:aniccā)]. It is not produced by the Soul (Atman); but one has got a feeling of its ownership until one has got real knowledge to the effect that this is something different from him; and is not his own. As soon as one knows it, he gets rid of all (miseries)’ (CS.Sar.I.152-153). 

‘Everything that has a cause is pain [duḥkha], not the self [anātman] and impermanent [anitya]. For that is not manufactured by the self. And in that arises ownership, as long as the true realization has not arisen by which the knower, having known “I am not this, this is not mine”, transcends everything’ (CS.Sar.I.152-153; p.41, Wujastyk, 2012). 

Within the Buddhist tradition, at an advanced stage of mindfulness practice (satipaṭṭhāna) insight (vipassanā) into the three marks of existence (trilakṣaṇa; Pāli:tilakkhaṇa) is purposefully developed: 

  1. sabbe saṅkhārā aniccā (all saṅkhāras (conditioned things) are impermanent)

  2. sabbe saṅkhārā dukkha (all saṅkhāras are unsatisfactory)

  3. sabbe dhammā anattā (all dharmas (conditioned or unconditioned things) are not self)

According to Ayurveda, the term prajñāparādha (violation of good judgement) can be defined in terms of impairment in buddhi (intellect), dhṛti (constancy/patience/steadfastness) and smṛti (memory/mindfulness). Prajñāparādha is closely connected with avidyā (ignorance) and foundational for the arising of mental health problems. From the Buddhist perspective avidyā is essentially ignorance of (a failure to grasp directly) the three marks of existence:

‘Perceiving permanence in the impermanent [aniccā], 

perceiving pleasure in what is suffering [dukkha], 

perceiving a self in what is non-self [anattā],

and perceiving attractiveness in what is unattractive, 

beings resort to wrong views, 

their minds deranged [khitta-citta],

their perception twisted [vi-saññino]’ (AN.IV.49). 

Reference to the three marks of existence (trilakṣaṇa) in classical Ayurvedic medical texts in association with mental health problems, suggests that whilst this understanding of mental health problems is informed by the Buddha’s wisdom, knowledge of the three marks of existence need not be restricted or confined uniquely to Buddhism. A recent study in Australia focused on ‘putting Buddhist understanding back into mindfulness training’ found that an understanding of the trilakṣaṇa (three marks of existence) contributed to improving well-being and reducing distress among both Buddhists and non-Buddhists cross-culturally (Jarukasemthawee, 2015). 

Buddhist Āyurvedic Counselling and Psychiatry (BĀCP), is a new subject in Buddhist studies, developed and introduced by Prof. Sumanapala Galmangoda in Sri Lanka at the Nāgānanda International Institute for Buddhist Studies (NIIBS) in Manelwatta, Kelaniya. Prof. Sumanapala Galmangoda (Royal Pandit, Senior Professor and Director, Postgraduate Institute of Pāli and Buddhist Studies, University of Kelaniya) is an Āyurvedic doctor, specialist in Buddhist Abhidhamma and a respected authority on the ‘traditional cultural approaches’ to promoting mental well-being which have been practiced in South-East Asia for centuries and continue to be valued (p.15, WHO, 2009; p.39, WHO, 2012). 

BĀCP encompasses both Anusāsanī (instruction, teaching, advice, counselling - which can include therapeutic application of sīla (behavioural therapy), Samatha-samādhi (mental therapy) and Vipassanā-paññā (cognitive therapy)) and yukthivyapāsraya (logic-based physio-pharmacological therapies). The strong theoretical basis of Buddhist Āyurvedic Counselling and Psychiatry (BĀCP) makes it more than the sum of its parts. In practice it is a complex psycho-physical intervention and combines different treatment methods. 

Buddhi vibhrama is impaired or deranged intellect, it is a condition in which distorted judgments are made due to a distorted view of how things are. This is a defining part of mental health problems, but also something we are all subject to.

Both the classical Ayurvedic texts and Buddhist texts agree that buddhi vibhrama can be identified in ‘perceiving permanence in the impermanent’, ‘perceiving pleasure in what is suffering’, and ‘perceiving a self in what is non-self’. 

Buddhist Āyurvedic Counselling and Psychiatry (BĀCP) includes cognitive therapy (vipassanā-paññā) as one of its holistic therapeutic approaches. This entails developing awareness of the trilakṣaṇa (three marks of existence) as a therapeutic intervention. Research in Australia found that an understanding of the trilakṣaṇa (three marks of existence) can contribute to improving well-being and reducing distress among both Buddhists and non-Buddhists cross-culturally. Manasa Ayurveda therapists are now introducing BĀCP in the UK and developing an understanding of the three marks of existence is an important part of their therapeutic programmes.

Our Clinical Practice: Buddhist Ayurvedic Counselling and Psychiatry (BACP; Galmangoda, 2015)

Mental health problems represent the largest single cause of disability and sickness absence in England and accounted for 70 million sick days in 2007. One in four adults experience at least one diagnosable mental health problem in any given year, mental health problems have been estimated to cost the UK economy around £105 billion a year, and people with mental illness die on average 15-20 years earlier than those without, often from avoidable causes.

Developing and implementing new and better interventions for mental health and wellbeing is a top priority. Mindfulness-based, compassion-focused and other Buddhist-derived interventions (BDIs) for mental health are increasingly adopted, and some individuals prefer mindfulness-based interventions that more closely resemble a traditional Buddhist approach.

Buddhist Āyurvedic Counselling and Psychiatry (BĀCP; Galmangoda, 2015)

Buddhist Āyurvedic Counselling and Psychiatry (BĀCP; Galmangoda, 2015) is a new subject in the area of Buddhist Studies, developed in Sri Lanka over the past decade, and its practice has been recognized and valued by the World Health Organisation (p.15, WHO, 2009; p.39, WHO, 2012).

Whilst BĀCP theory remains grounded in premodern Buddhist and Āyurvedic texts, Manasa Ayurveda is now introducing BĀCP in England as a newly developing intervention for mental health and wellbeing.

Theory & treatment methods

According to BĀCP theory, mental health problems are defined in terms of affected mental functions. In particular (but not exclusively) functions relating to intellectual discriminative function (buddhi) and the capacity for memory and mindfulness (smṛti).

Mental health problems have many causes and conditions including both physical and mental factors. The symptoms according to premodern Buddhist and Āyurvedic texts have some agreement with those recognized within the ICD-10/DSM-5.

In BĀCP, indicated treatment plans are established and interventions targeted through case formulation based on assessment which draws upon specific theoretical constructs (e.g. tridoṣa, triguṇa, triakuśalamūla, khandhas). Treatment methods in BĀCP include traditional Āyurvedic physical therapies, behaviour and situation change (e.g. through diet and lifestyle counselling), and methods for developing concentration and insight into reality (through a more personally tailored approach to mindfulness and meditation training).

Evidence-base

Although currently there appear to be no published Randomised Controlled Trials (RCTs) on BĀCP protocols, some small scale RCTs have been conducted (mostly in India) on Āyurvedic treatment methods for mental health (included within BĀCP).

To establish the evidence base, RCTs are required on specific treatment methods, but importantly also on BĀCP protocols. In addition, alongside service user feedback, in England consistent use of standard clinical outcome measures in routine clinical practice (e.g. the CORE-OM; Evans et al., 2000) will enable practice-based evidence to be gathered.

Process

Manasa Ayurveda has modelled a process for the delivery of BĀCP in England using a treatment protocol originally developed in collaboration with international experts in Sri Lanka. Current BĀCP clinical practice in England is based on this protocol and mental health service users in England (from a range of ethnic, cultural and religious backgrounds) have given positive feedback on their experience of BĀCP. Further protocol development by Manasa Ayurveda (based on clinical practice in England) continues.

Psychosis and the Three Refuges

The following article on 'Psychosis and the Three Refuges' is, for the most part, an account of recovery from periods of 'psychosis' in relation to a Buddhist practice. It was originally published in The Middle Way: Journal of the Buddhist Society.

The Three Refuges are also known as the Three Jewels

The Three Refuges are also known as the Three Jewels

 

Psychosis sounds scary. It is the name of a 2010 horror film based on a serial killer who “unleashes his blood lust”. The first thing people often ask, when I tell them I work with people who have psychosis is: “aren’t you scared?” So what can psychosis have to do with the Three Refuges (the Buddha, Dharma and Sangha)?   

Psychosis

In psychiatry psychosis is sometimes used as a synonym for ‘severe mental disorder’ and according to the mental health charity, Mind, there is actually more chance of being killed by lightning than by someone with a mental illness.  Most narrowly defined, psychosis is simply the presence of delusions and/or hallucinations. 

Delusions, as understood in psychiatry, are beliefs that are clearly false and that indicate an abnormality in the affected person's content of thought. Hallucinations in psychosis are often auditory, hearing voices is a well known example. They can also be visual, and some people with psychosis experience strong smells or have sensations on or under the skin when nothing is actually there as far as other people are concerned. 

Whilst some of us may have a greater predisposition, all of us can potentially experience psychosis. The British Psychological Society (2000) has estimated that around 10-15% of the general population experience what could be described as psychotic phenomena, and most are neither distressed, nor seek help. Studies have shown that all sorts of beliefs Western psychiatry might see as delusions (including beliefs in magic, aliens, telepathy and spiritualist beliefs) are actually extremely common in the general population (Peters et al. 1999). 

Psychosis may be triggered by many things including stress, traumatic life events, drug use or even Buddhist practice. Buddhism traditionally that such experiences can arise in the practice of zazen. The Japanese term makyo, roughly “diabolic phenomenon” from “ma” (akuma), “devil” and kyo, “phenomenon, objective world” is used to describe such hallucinatory or delusional experiences in this practice. VanderKoor (1997) describes the example of Sara, who on a Buddhist meditation retreat had intense makyo. Following the retreat she was hospitalized and received antipsychotic medication.

Although I have a specific qualification in interventions for psychosis and around 7 years experience in working with others with these experiences, my most direct understanding comes not from training, work or study, but from personal first-hand experience of psychosis both within and without the mental health system. 

My first experience of psychosis, when eighteen, was thought by psychiatrists to have been a reaction to stress and bereavement. In 1996 I began reading books on religion and Zen and believed that I was making a 'breakthrough'. My presentation quickly led to a psychiatric hospital admission. The following are extracts from my personal health records of the time: 

...he is acutely psychotic, with paranoid delusions... hospital treatment is the only option...
— Record of receipt of medical recommendation(s) and formal admission to hospital
...it became necessary... for police to handcuff him and force him into the ambulance where he was strapped to a stretcher...
— Mental Health Act 1983 Social Circumstances Report 

In hospital I was further restrained and heavily medicated with antipsychotic injections by force. Fortunately the admission was brief and once discharged I stopped all medication after about 6 weeks. Since then over a number of years, at times of stress, I experienced brief psychotic symptoms. I chose not to disclose these symptoms to medical professionals at the time and navigated my way through, getting on with my life without subsequent compulsory psychiatric hospitalisations or forced injections.

During 1999-2000, whilst at university, I had a period of experiencing what a nurse described as “anxiety attacks”. The nurse recommended abdominal breathing. This worked for me and reminded me of the Zen books I had read over the previous few years, so I decided to try the practice of zazen (seated meditation). Later in 2002 I formally became a lay Buddhist at a Jukai ceremony and now consider the Three Refuges as vital to my personal recovery. 

The Three Refuges are the Buddha (meaning both the historical Buddha and the Eternal Buddha Nature), the Dharma (the teaching of the Buddha and of our own Buddha Nature), and the Sangha (those who follow the Buddha and those who seek, long for and know the Eternal) (Schomberg, 1996).

The Three Refuges

The Buddha

Mindfulness was originally integrated into Western healthcare in the late 1970s by Kabat-Zinn; he describes mindfulness as: “paying attention in a particular way: on purpose, in the present moment and non-judgementally” (Kabat-Zinn, 1994 p.4). In healthcare the importance of presenting mindfulness as secular and distinct from Buddhism is frequently emphasised; psychologists now often present mindfulness as something from psychology or something that Kabat-Zinn ‘came up with’. In fact he was a student of Zen Master Seung Sahn (Streitfeld, 1991) and recent healthcare treatments such as Dialectical Behaviour Therapy (DBT; Linehan et al., 1991; Linehan et al., 1993) and Mindfulness-Based Cognitive Therapy (MBCT; Segal et al, 2002) also have a basis in adaptations of Buddhist teachings (Welch et al., 2006; Gilpin, 2006). The Dalai Lama has stated: 

...what we are trying to do here is to see, among the age old meditative practices, aspects which can be adapted into the domain of health...
— The Dalai Lama (2005)

Studies are now beginning to support the use of Mindfulness practices drawn from Buddhism in the clinical treatment of psychosis (Abba, et al, 2006; Bach and Hayes, 2002; Chadwick, 2006; Gaudiano and Herbert, 2006). Paul Chadwick (2005; 2006), for example, is a clinical psychologist who has drawn on the teachings of Ajahn Sumedho (1992) and now advocates relating mindfully to unpleasant psychotic sensations; with a clear, open and gentle awareness of whatever is present. 

Daishin Morgan, Abbot of Throssel Hole Buddhist Abbey in England, sees the therapeutic and enlightenment aims of meditation as on one continuum. He reminds us that whilst it is good to see some of the benefits of Buddhist practice made available to those who might not otherwise find them, the fundamental aim of Buddhist practice goes much further (Morgan, 2004). 

Koshin Schomberg (1996a), Abbot of North Cascades Buddhist Priory in the USA, teaches that, in Buddhist training, difficulty in accepting the full religious implications of meditation can be an obstacle: Buddhism is a religion, and requires us to have real faith. This faith is not a matter of professed creed or belief. It is the faith that there is That which is a true Refuge and that we can find this Refuge through meditation and training. 

In my own life, this practice is more than just a technique for changing my relationship to unpleasant experiences; zazen is directly taking Refuge in the Buddha. 

The Dharma

Whilst I was in hospital with psychosis, I was convinced that the world and all that relates to it had ceased to exist – nothing was real. All that remained was an illusion, placed there by the devil to keep me bonded to false reality and ultimately in hell. I also believed that various people including my family were in fact this devil in disguise attempting to keep me in bondage.  

After looking at a landscape painting on the hospital wall for some time, I had a sudden belief that it was a window into the true reality beyond the devil’s illusion – a window into heaven. In order to show trust in God, I stood upright and allowed myself to fall backwards hoping to land in the heavenly reality shown in the painting. As I allowed myself to fall backwards my head hit the edge of a table. I lay on the floor, my head now bleeding. “Look at the blood” said the nursing staff around me, “What blood?” I answered, defying what I believed were the devil’s attempts to bind me.

Knowing what is real and what is not can be especially difficult when experiencing psychosis. For me, taking Refuge in the Dharma, the Buddhist teachings (which reject both extremes of eternalism and nihilism), provides a source of stability and confidence. In particular the teaching of the Buddhist precepts; beginning with “Cease from evil”, provides an anchor in the midst of the changing conditions of daily life, and an essential guide to action no matter what may happen (or appear to happen). Even within psychosis the Dharma, and in particular the teaching of the precepts, provides an anchor.      

The Sangha

Buddhism is more than mindfulness with bells, gongs and incense, but it is no cure for psychosis. At the completion of my final exams at university I had been practicing zazen for a while, but nevertheless became psychotic again, believing that I was being spied on by government agents: 

When I was out I noticed that someone looked at me and touched their ear. This was a message that they had an ear piece and were listening to me. In a pub, believing I was being listened to by government agents, I began reading from my passport; hoping this would help give me protection:

Her Britannic Majesty’s Secretary of State requests and requires in the name of Her Majesty all those whom it may concern to allow the bearer to pass freely without let or hindrance, and to afford the bearer such assistance and protection as may be necessary

As I read this I looked across the pub and could see that a woman was touching her ear looking at me and smiling. I then knew that she could hear me through an ear piece and was a spy. There was also a television on in the pub, the news was on and I could see that there was a riot in another part of the country. This riot was connected to the things that were happening to me and it became clear that I was now on a secret government mission. The woman’s smile was a signal that I would indeed have "assistance and protection as may be necessary" on this mission...

Around this time I had a number of other unusual experiences and then decided that it may be beneficial to practice zazen (something I had not done for a while). So I sat down in my room, but attempting to practice whilst in this psychotic state was like getting hit by a mental tsunami. For a moment I saw just how incredibly unsettled my mind was and this was very disturbing. This disturbance inspired me to check out my recent experiences, with a Buddhist Monk in a local Zen temple. My intention was to ask the Monk what his opinion was of these beliefs and experiences. On my way to the temple I had various further experiences such as receiving messages from inanimate objects. I also felt elated and believed that this could be a spiritual experience. I intended to share all this with the monk in the temple. 

When I entered the temple I was invited to join meditation. We first read a scripture together but when it was time to move I stayed put. I was then told that meditation was over and was offered a cup of tea. 

Responding to my unusual perceptions and experiences, I began to act in a chaotic way in the temple, and was eventually asked to leave. On my way out I explained that I had come to find out if the monk thought I should see a psychiatrist and he said that he thought I should. Being advised by the monk to see a psychiatrist challenged my psychotic beliefs and helped to bring me back down to earth.  Fortunately this challenge gave me enough insight to move in the direction of recovery without actually seeking medication or hospitalisation at the time. In the next few weeks, having completed my exams, I attended my graduation ceremony and returned to my parents’ home for a while. 

For many, in the face of an unsatisfactory mental health system, it can be tempting to seek alternatives in Buddhism. Taking Refuge in the Sangha means trusting in and seeking the advice of those who follow the Buddha. Over 2000 years before Florence Nightingale, who is seen as the founder of the nursing profession, Buddhist teachings set forth the qualities of a good nurse in the Anguttara Nikaya. The Buddha stated: "Whoever, O monks, would nurse me, he should nurse the sick" and Buddhism has begun to enrich contemporary Western nursing. 

Even so, Buddhist centres which are not set up as treatment clinics or hospitals cannot be expected to function as such and in relation to psychosis the most essential role of the Sangha may indeed be to continue pointing those in need in the direction of professional healthcare providers.    

Psychosis and the Three Refuges

In reality, unlike the movies, psychosis is not about “unleashing blood lust”, in fact sometimes it is not scary at all, but it can be deeply disturbing for both those who directly experience it and their families. One does not need to be a Buddhist to practice mindfulness, and it may be helpful to people in getting grounded and letting go of disturbing sensations or thoughts; however, Buddhism goes much deeper and I believe that not only mindfulness, but the Buddha, Dharma and Sangha have been essential to my staying well after psychosis.  

Finally, the Three Refuges do not offer a miracle cure for psychosis which can be rolled out through the healthcare system in a secularised form. There are perhaps as many routes to recovery as there are people.

Aldridge, M.A. (2011) Psychosis and the three treasures, The Middle Way: Journal of the Buddhist Society, 86:3
 

"Meditation is only one aspect...": An Interview with Prof. Wasantha Priyadarshana

Dr. Wasantha Priyadarshana is Head of the Department of Buddhist Culture at the Postgraduate Institute of Pali & Buddhist Studies, University of Kelaniya, Sri Lanka.

In this interview he explains some of the principles which underpin Buddhist Ayurvedic Counselling & Psychiatry (BACP) which is used by Manasa Ayurveda. 

As Dr. Wasantha Priyadarshana explains, this approach encompasses more than simply mindfulness: "we can use not only meditation, but also other aspects..." It is a comprehensive system and encompasses methods of:

  • Sila (behavioural therapy)

  • Samatha-Samadhi (mental therapy)

  • Vipassana-Panna (cognitive therapy)

The Foundations of Mindfulness

Mindfulness has become a ‘billion-dollar business’ in the West (Wiecznsner, 2016). Growing research indicates that as a cognitive therapy, it works, and Western mental health professionals have begun to use and evaluate its efficacy as a clinical intervention for people with psychosis. The connection of mindfulness with Buddhism has occasionally been acknowledged in this context, but traditional Buddhist approaches to mental health and healing have, for the most part, been ignored in the West, perhaps dismissed as among the “trappings” of Buddhism.

As a result there are now growing concerns over the rapidity at which ‘mindfulness’ has been extracted from its traditional Buddhist setting and introduced into psychiatric treatment domains. As stated by Huxter (2007) on this matter:

Attempts to reinvent the wheel, without reference to earlier models are, perhaps a retrograde step
— Huxter, 2007

Sri Lanka has been a centre of Buddhist scholarship and learning since the introduction of Buddhism in the third century BCE and historically Buddhism and traditional medicine, particularly Āyurveda, in Sri Lanka have been closely related (Liyanaratne, 1995).

Whilst attending the sick, the Buddha explained the satipatthanas (four establishings of mindfulness) (SN.36.7,8) and when the Venerable Anuruddha was gravely ill he explained that through his practice of the satipatthanas: “...arisen bodily painful feelings do not persist obsessing my mind” (SN.52.10).

The satipatthanas (four foundations (or establishings) of mindfulness) forms an important part of our therapeutic programmes. The Satipattana Sutta and Maha Satipattana Suta are the most ancient known discourses on the practice of mindfulness.

The Satipattanas form the basis of our approach to 'cognitive therapy' which is an important part of our Manasa Ayurveda therapy programmes.

In the recording here, Ven. Dr Omalape Sobhita Maha Thero is chanting the Maha Satipatthana Sutta (the Buddha's discourse on the four foundations of mindfulness). 

The recitation of this Sutta is traditionally offered to those who are suffering from physical or mental health problems...

Daivavyapasraya (spiritual therapies) - Drawing upon the New Testament

Daivavyapāsraya (spiritual therapies) are a well recognised part of the Ayurvedic approach to treatment for mental health problems.

One method of daivavyapāsraya is dharma-vākya (religious quotations). As with other spiritual therapies suggested within Ayurveda, this approach is not confined to any one religion.

Bible.jpg

For those of a Christian background who are feeling anxious or disturbed, many New Testament passages in the Bible offer comfort and reassurance. For example:

Job 6:1-14

Isaiah 38:10 – end; 52:13 – 53:5

Lamentations 3:1-33

Mark 4:35-41; 5:1-20; 15:34

Luke 7:11-23; 11:1-13; 14:1-2; 14:27;15:11-end

John 10:7-21; 11:1-44; 14:1-21

Romans 12:15; 15:17

1 Corinthians 12:22

Revelation 21:1-4 and 21:22 – 22:5

Psalms 17:1-2 & 15; 22; 23; 25; 39; 40; 69; 90; 102; 116

Ayurvedic Spiritual Therapies: Resources for Health and Healing

Manasa Ayurveda therapies include daivavyapāsraya which is often described as 'spiritual therapies'. Ayurveda is not bound to any religion and is not itself part of religion so its recommendations for health through spiritual practice can benefit those of any or no faith. For example, for Muslims, such an approach may centre around the Quran, whilst Christians can find sources of inspiration for healing within the Bible : 

قُلْ هُوَ لِلَّذِينَ آمَنُوا هُدًى وَشِفَاء

And declare (O Muhammad) that [the Quran] is a guidance and healing for the believers
— al-Fussilat, 41:44
My son, attend to my words; incline thine ear unto my sayings. Let them not depart from thine eyes; keep them in the midst of thine heart. For they are life unto those that find them, and health to all their flesh.
— Proverbs 4:20-22

The Āyurvedic classical text, the Aṣṭāñga Hṛdayam was written by Vāgbhata, an Āyurvedic doctor who happened to be a convert to Buddhism. This foundational classic Ayurvedic text advises the use of specific mantras and dhāraṇīs (recitations) mentioning ‘Avalokita’ and ‘Natha’, referring to the Bodhisattva Avalokiteśvara, and Acala-Natha (Achalanatha; Lord Immovable) (AH.Utt.V.49-51).

Acalanatha is especially efficient in removing all kinds of obstacles which lie in the way of one’s undertaking, religious or otherwise. His other title is “the great destroyer of hindrances”. The Pali suttas make reference to the Buddha’s ‘unshakable’ liberation and being ‘steadfast’ (e.g. AN.6.45; AN.3.84; AN.3.103; MN.I.357). To further inspire and illustrate this quality of immovability, imagery was used in an early sutta of ‘the pillar in the king's frontier fortress’, with a ‘deep base… securely planted, immobile and unshakable’ (AN.7.67). Use of imagery to represent the quality of immovability seen within the early Nikayas may have provided the basis for the adoption of iconography now associated with Acalanatha, and which is described in the Maha-Vairocana-Abhisambodhi Tantra:

…He holds a sword and a noose, his plaited hair hangs from the left of his head, he is well adorned and one of his eyes squints. He abides amidst his own light, wrathfully seated upon a rock. His face is creased with anger, and he has a robust youthful form
— MVA.II.40

To embody the qualities of Achalanatha, the Maha-Vairocana-Abhisambodhi Tantra advises mental recitation of the mantra of Acalanatha and use of His mudra (as well as other ritual practices) (MVA.XI.85). The Ayurvedic Aṣṭāñga Hṛdayam also mentions the therapeutic use of dhāraṇīs invoking 'Natha' and the popularity of Achalanatha has spread internationally. The video below, made in England, includes contemporary English versions of dhāraṇīs calling upon Achalanatha.