Psychiatry

There is one case found in most versions of the Chapter on Medicine, which is in relation to psychiatric illness. All available versions have reported it as an illness of insanity, except the Theravāda parallel stating that it was caused by a non-human agent. In Āyurveda, insanity and illnesses caused by non-humans are discussed in the branch of bhūtavidyā. In modern medicine, mental disorders are dealt with in the specialty of psychiatry, but there is no scope for any problems caused by non-human entities. Since readers of this thesis are likely to be more familiar with modern medicine and medical specialties than with Āyurveda and its branches, this Buddhist case is examined in this section of psychiarty.

Accounts of this case in the Chapters on Medicine are recorded as follows:

Theravāda:— “At that time a certain monk had a disease caused by a non-human. [His] teacher and preceptor looking after him were not able to heal him. Having gone to a slaughter-house for pigs, he ate raw meat and drank raw blood. His non-human-causing disease subsided. [The monks] informed this matter to the Exalted One. [The Exalted One said:] ‘I allow, monks, [the use of] raw meat and raw blood in [the case of] nonhuman-causing disease.’”^[1]

Dharmaguptaka:—“At that time the Exalted One was in Rājagṛha. Then there was a monk with an illness of insanity. He went to the cow-butchery; [there he] ate raw meat and drank blood. [His] illness was then relieved. Regaining the original mental state, [he] was fearful and cautious. The monks informed the Buddha [about this matter]. The Buddha said: ‘There is no offence [for that monk]. If there are other monks who have such illness [and] they can recover [by] eating raw meat and drinking blood, [I] allow the consumption.’”^[2]

Sarvāstivāda:—“The Buddha was in Śrāvastī. The elder Shiyüe 施越 had an illness of insanity. [He] was told by another [that ‘by] eating raw meat and drinking blood, [your] illness of insanity should be relieved.’ Shiyüe told the monks: ‘I am mad, [and I am] told by another to eat raw meat and drink blood. Now what should I do?’ The monks informed the Buddha about this matter. The Buddha, on this account, convoked the community [of monks]. Having convoked the community, the Buddha knew [this matter] and purposely asked Shiyüe: ‘You really are mad [and you] are told by another to eat raw meat and drink blood, [and you] spoke to the monks [that] “what should I do?”–have you really done these things?’ Shiyüe replied: ‘[I] have really done [these], the Exalted One.’ The Buddha, by means of various reasons, extolled the precepts and praised the observation of precepts. Having extolled the precepts and praised the observation of precepts, [the Buddha] addressed the monks: ‘From today [onwards], if [you] have such illness, [I] allow eating raw meat and drinking blood. [You] should eat [these] at a concealed place and do not let others see [that].’”^[3]

Mūlasarvāstivāda (Sanskrit):—“The occasion was in Śrāvastī. The Venerable Saikata was mad [and] whose mind was deranged. Because of that, he wandered about. … The monks informed this matter to the Exalted One. The Exalted One said: ‘This being so, monks, it should be inquired about for the form of the monk Saikata’s debility.’ Then those [monks] had approached the presence of the physician. ‘Good Sir, [for] the debility just so of this [monk], please point out the medicine.’ ‘Noble one, let [him] utilise raw meat. [He] will become well.’ ‘Good Sir, is that [monk] a cannibal?’ ‘Noble one, it is not possible to become healthy otherwise.’ The monks informed this matter to the Exalted One. The Exalted One said: ‘If the medicine in this way should be served [and] it is not possible to become healthy otherwise, monks, meat should be given.’ The monks thus indeed offered [meat to the sick monk]. He did not eat. The Exalted One said: ‘[The meat] should be given after binding [his] eyes with a strip of cloth.’ [The meat] was given by them. The strip of cloth was released very quickly. Both hands [that] were smeared [with blood] were seen by him. [The meat] was [then] vomited by him. The Exalted One said: ‘[The strip of cloth] should not be released immediately. And if, at that time, it is to be released immediately, then after placing his hands at first in very clean water, the strip of cloth is to be released afterwards.’ He had become well. …”^[4]

Mūlasarvāstivāda (Chinese):—“The place of the occasion was as [described] above. At that time there was the Venerable Saikata [who] was then afflicted with insanity. He roamed around.... On this account, the monks went to [and] informed the Buddha then. The Buddha said: ‘Monks, on behalf of the monk Saikata, [you] should consult his physician for [the purpose of] treating [his] insanity.’ Then the monks went to the physician’s place [and] asked: ‘Good Sir, there is a monk [who] is afflicted with such illness. [Please] prescribe medicine for [him].’ They physician said: ‘It is appropriate to consume raw meat. He will certainly recover.’ A monk replied: ‘Good Sir, is that monk a meat-eater?’ The physician said: ‘Noble one, this is the medicine for treating insanity. Apart from this medicine, other [medicines] cannot heal.’ The monks informed this matter to the Buddha then. The Buddha said: ‘If the physician says that this is the medicine [and] other [medicines] cannot heal, [then you] should provide raw meat.’ At that time the monks thus gave raw meat [to Saikata]. That monk saw [the raw meat] and [he] refused to eat [it]. The Buddha said: ‘[You] should cover [his] eyes with something, and then give [the raw meat to him] for consumption.’ Then that monk, due to that, was given [raw meat]. [The monks] removed [his] [eye-]covering thing immediately. The sick monk, however, saw blood on his hands. He therefore vomited. The Buddha said: ‘[You] should not remove the binding thing at once. [You should] wait till he has finished eating, washed [his] hands, [and other] savoury food and drink are specially placed [in front of him], then [you] can remove that [eye-]covering [and] binding [thing]. [You] then tell him [that] “you should eat this delicious food, [and your] illness will be relieved.”’”^[5]

These records tell us that there was a monk–who was insane or was possessed by a non-human–had to eat raw meat and drink blood. His condition was relieved after he had such consumption. The Samantapāsādikā gives a short annotation on this: “Ate raw meat and drank raw blood–that monk did not eat or drink; the non-human, having eaten and drunk, had gone away. Because of that, it is said: ‘his non-humancausing disease subsided.’”^[6]

We will now discuss these two conditions–non-human-causing disease and insanity–in the Āyurvedic lore. There are different types of non-human-causing diseases due to different non-human beings: the Caraka Saṃhitā and the Suśruta Saṃhitā have listed eight while the Aṣṭāṅga Hṛdaya Saṃhitā eighteen (Caraka Saṃhitā Cikitsāsthāna 9. 16-21; Suśruta Saṃhitā Uttarasthāna 60. 3; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 4. 3). A person is seized by a non-human because of sinful acts in his/her present life or previous lives, residing in a deserted house or forbidden place, engaging in improper religious rituals, not observing vows and conduct, abusing the preceptors, and so on (Caraka Saṃhitā Nidānasthāna 7. 14; Suśruta Saṃhitā Uttarasthāna 60. 5; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 4. 3-8). Treatment for these diseases requires religious rituals, acts, and objects–such as incantation, sacrifices, observance of vows and conduct, wearing a talisman, and so on; as well as medicated ghee or oil–prepared with drugs and animal substances (e.g. dung, urine, bile, skin)–for drinking, application to eyes and/or nose, inhalation of smoke, massage, bathing, and sprinkling over the body (Caraka Saṃhitā Cikitsāsthāna 9. 23, 33; Suśruta Saṃhitā Uttarasthāna 60. 28-55; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 5. 2-53).

Insanity manifests as “the perversion of mind, intellect, consciousness, knowledge, memory, desire, manners, behaviour and conduct” (Caraka Saṃhitā Nidānasthāna 7. 5). The Caraka Saṃhitā lists five types: three caused by each of the humours, one by the combination of all humours, and one by an exogenous cause of non-human origin. The Suśruta Saṃhitā and the Aṣṭāṅga Hṛdaya Saṃhitā state six types: four due to humours (as in the Caraka Saṃhitā), one due to mental distress (from fear, loss of wealth or beloved ones, and so on), and one due to poison (Caraka Saṃhitā Nidānasthāna 7. 3; Suśruta Saṃhitā Uttarasthāna 62. 4-5; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 6. 1). Causative factors include those which aggravate humours (such as unsuitable diets or activities), psychological reasons, improper religious acts, sinful deeds, presence of other diseases, poisons, and so forth. These lead to aggravated humours, which then enter the heart region (the abode of mind) and obstruct the mind-channels causing mental derangement (Caraka Saṃhitā Nidānasthāna 7. 3-4; Cikitsāsthāna 9. 4-5; Suśruta Saṃhitā Uttarasthāna 62. 3; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 6. 1-6). Therapeutic measures include alleviation of aggravated humours (by means of emesis, purgation, enema, head evacuation, etc., after preliminary procedures of application of oil and perspiration); smoking therapy;fumigation; application of medicines via collyrium or snuff; anointment of body; massage; bloodletting; suitable foods and drinks for heart and channels (e.g. ghee, gruel, flour, etc.); various psychological means (such as consoling, assuring, cheering, restraining, frightening, and so on) if necessary; and treatments for nonhuman-causing insanity as mentioned above (Caraka Saṃhitā Nidānasthāna 7. 8-9; Cikitsāsthāna 9. 24-33; Suśruta Saṃhitā Uttarasthāna 62. 1428; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 6. 18-22, 46-58).

In modern medicine, there is no teaching of any diseases caused by nonhumans or supernatural power because it is beyond the scope of natural sciences. Here we will not discuss this area with respect to modern medicine. Rather, the case in the Chapters on Medicine will be interpreted through psychiatry, based on the limited information available from the sources. The accounts tell us that a monk had an illness of insanity. He wandered about and was told by “another” to eat raw meat and drink blood for relieving his condition (as mentioned in the Sarvāstivāda source). He recovered by doing so. Here, “another” could be a physician as per the Mūlasarvāstivāda Bhaiṣajyavastu, or a non-human being as in the Theravāda Bhesajjakkhandhaka, or a hallucination or delusion per se that can occur in psychosis. We cannot be certain which one it was, for there is no clear description to determine that. Then, his roaming around suggests that he had behavioural disturbance. Common medical causes of disturbed behaviour are delirium (acute confusional state), acute psychosis (e.g. schizophrenia), personality disorder, and drug/alchohol intoxication (Bourke and White 2012, 1159, box 23. 3). Furthermore, an important piece of information is that: his coniditon was relieved by eating raw meat and drinking blood. This suggests that the monk’s condition was probably associated with diet or, be more precise, with nutritional deficiency resulting in his illness. This is highly possible if we take into consideration that, at the Buddha’s time, Buddhist monks (and nuns) lived by almsbegging and many of them had only one meal per day. They also often travelled from place to place. Hence they would have a lot of physical exercise but a limited diet. Amongst the aforementioned reasons of disturbed behaviour, delirium can be brought about by many causes including vitamin deficiencies of vitamins B1 (thiamine), B3 (niacin), or B12 (cobalamin) (Bourke and White 2012, 1188, table 23. 28). For these three vitamins, B1 and B3 can be absorbed from animal and vegetal foods; the only source of vitamin B12 for humans is foods of animial origin (such as meat, fish, eggs, and dairy products), but not those of plants (Hoffbrand 2012, 862; Murphy, Wainscoat, and Pasi 2012, 381). Since the sick monk recovered by consuming meat and blood, it points to that he likely had a deficiency of vitamin B12. Hence, based on the data in the Chapters on Medicine and the knowledge of modern medicine, this case would probably be a condition of delirium caused by vitamin B12 deficiency.

In brief, a case of insanity or non-human-causing disease is recorded in most of the Chapters on Medicine. Āyurveda has teachings on both illnesses and remedies for them. In modern medicine, there is no coverage for diseases pertaining to non-humans. Insanity, referring to mental derangement, can be a clinical manifestation of various psychiatric disorders. For this Buddhist case, it could be delirium due to vitamin B12 deficiency as analysed above.

Footnotes and references:

[1]:

Theravāda Vinaya Piṭaka I. 202-203: “tena kho pana samayena aññatarassa bhikkhuno amanussikābādho hoti. taṃ ācariyupajjhāyā upaṭṭhahantā nāsakkhiṃsu ārogaṃ kātuṃ. so sūkarasūnaṃ gantvā āmakamaṃsaṃ khādi āmakalohitaṃ pivi, tassa so amanussikābādho paṭippassambhi. bhagavato etam atthaṃ ārocesuṃ. anujānāmi bhikkhave amanussikābādhe āmakamaṃsaṃ āmakalohitan ti.”

[2]:

Taishō Tripiṭaka 1428. 868b5-9: “爾時世尊在王舍城。時有顛狂病比丘，至殺牛處食生肉飲血，病即差。還復本心，畏慎。諸比丘白佛，佛言：「不犯。若有餘比丘有如是病，食生肉飲血病得差者聽食。」”

[3]:

Taishō Tripiṭaka 1435. 185a7-15: “佛在舍衛國。長老施越狂病，受他語：「噉生肉、飲血狂病當差。」施越語諸比丘：「我狂受他語噉生肉飲血，我今當云何？」諸比丘以是事白佛。佛以是因緣集僧，集僧已，佛知故問，問施越：「汝實狂受他語噉生肉飲血，語諸比丘：『我今當云何？』汝實作是事不？」答言：「實作。世尊！」佛種種因緣讚戒、讚持戒，讚戒、讚持戒已，語諸比丘：「從今日若有如是病，聽噉生肉、飲血，應屏處噉，莫令人見。」”

[4]:

Gilgit Manuscripts III. 1.ix-x: “śrāvastyāṃ nidānam | āyuṣmān saikata unmattaḥ kṣiptacittastenāhiṇḍate |... etat prakaraṇaṃ bhikṣavo bhagavata ārocayanti | bhaga(vānāha | evaṃ sati bhikṣavaḥ saikatasya bhikṣorglānyanirūpaṇāya praṣṭavyam | atha te vaidyasakāśamupasaṃkrāntāḥ | bhadramukha asyaivamevaṃ) ca glānyam | bhaiṣajyaṃ vyapadiśa | ārya āmamāṃsaṃ paribhuñjatu | svastho bhaviṣyati | bhadramukha kimasau puruṣādaḥ | ārya na śakyamanyathā svasthena bhavitum | etat prakara(ṇaṃ bhikṣavo bhagavata ārocayanti | bhagavānāha | yadyevaṃ bhaiṣajyaṃ sevitavyam | na śakyamanyathā svasthena bhavitum | māṃsaṃ dātavyam | bhikṣavastathā) evānuprayacchanti | na khādati | bhagavānāha | akṣiṇī paṭṭakena baddhvā dātavyam | tairdattam | atiśīghraṃ paṭṭako muktaḥ | tena hastau liptau dṛṣṭau | tena vāntam | bhagavānāha | (sadyo na moktavyaḥ | atha cet sadyomoktavyastadā tasya hastau tadagrataḥ suśuddhe pā)nīye sthāpayitvā paścāt paṭṭako moktavyaḥ | sa svasthībhūtaḥ |...”

[5]:

Taishō Tripiṭaka 1448. 2c7-25: “緣處同前。時有具壽西羯多苾芻，遂患風瘨，隨處遊行...以此因緣，時諸苾芻往白世尊。佛言：「諸苾芻，當為西羯多苾芻問彼醫人，為療風疾。」時諸苾芻往醫人處，問曰：「賢首！有一苾芻，患如是病，可為處方。」醫人曰：「宜服生肉，必當得差。」苾芻報曰：「賢首！彼苾芻可是食肉人耶？」醫人曰：「聖者！此是治風病藥。除此藥已，餘不能療。」時諸苾芻以緣白佛。佛言：「若醫人說此為藥，餘不能療，應與生肉。」時諸苾芻便與生肉，彼人眼見而不肯食。佛言：「應以物掩眼，然後與食。」時彼苾芻緣與，即除掩物，然病苾芻見手有血，遂便歐逆。佛言：「不應即除繫物。待彼食訖，淨洗手已，別置香美飲食，方可除其掩繫，而告之曰：『汝應食此美食，病可得差。』」”

[6]:

Samantapāsādikā V. 1090: “āmakamaṃsañ ca khādi āmakalohitañ ca pivīti, na taṃ bhikkhu khādi na pivi, amanusso khāditvā ca pivitvā ca pakkanto, tena vuttaṃ tassa so amanussikābādho paṭippassambhī’ti.”