Mental Hygiene and Social Health

The perspective of ancient Indian medical science on health, as we have noted in chapter 4, was not restricted to physical aspects alone. It was all-encompassing with consideration of psychological and ethical issues as well. Physical health has a close correlation with mental health, while an individual has also a social existence. The ability to form good relationships with other people and the ability to maintain those relationships are issues of social health. The nature an individual’s relationship with his/her family members, friends, acquaintances and others has a bearing on his/her physical and emotional health, which in turn determines the social health. Consequently, we find that the texts contain recommendations for moulding an individual’s ethical behaviour.

Unethical behaviour is caused by the immoral urges of the mind. Hence, it is necessary to suppress those mental urges that are generative of rashness and evil deeds, and thereby restrain their verbal and physical manifestation.^[1] The malevolent urges of the mind are greed, grief, anger, vanity, shamelessness, jealousy, attachment and malice.^[2] The verbal manifestations of these emotions are rudeness, back-biting, falsehood, and speaking inappropriately.^[3] On the other hand violence to others, adultery, theft, persecution, etc. are the harmful physical manifestations.^[4] The virtuous, who are free of all vices of mind, speech and action obtain happiness and enjoy the fruits if virtue (dharma), wealth (artha) and desire (kāma).^[5]

The principles of sadvṛtta help to maintain health and control the sense faculties. The sense faculties (indriyāṇi) get vitiated by inappropriate utilization of their respective objects, which are audition, touch, vision, taste and smell. Therefore, when there is excessive or wrong or absence of utilization of the objects, the sense faculties and the mind (sattva or cetas) are disturbed occasioning abnormal behaviour.^[6] Normalcy can be restored by avoidance of harmful acts and performance of beneficial ones wherein lies the importance of ethical conduct. The principles of sadvṛtta do not embody only good values and moral principles but incorporates several other concerns, such as practical measures for preventing health hazards, social customs and conventions, good habits, relations within and outside the family, desirable type of friends, regulation of sexual behaviour, etc.,–in fact it covers the entire gamut of human life. Here we shall look at some of its salient aspects of the rules for healthy and virtuous living other than the rules of personal hygiene (which have already been mentioned).

Good practices for mental and spiritual health that prevent psychological disturbances:

1. Paying respects to the gods, cows, brāhmaṇas, preceptors, the elderly, saints and ācāryas;
2. Offering oblation to the fire; performing sandhyā twice a day and other prescribed rituals;
3. Wearing good herbs;^[7]
4. Reciting mantras, oblations to the gods and offerings to the departed ancestors, teachers, guests and dependants before taking meals.^[8]

One should also:

5. Endeavour to develop self-control (vaśyātmā) and be virtuous (dharmātmā);
6. Have envy for the cause but not for the outcome of actions (hetāvirṣyuḥ phale nerṣyuḥ);
7. Have no worry (niścintaḥ) and fear (nirbhīkaḥ);
8. Endeavour to be bashful (hrimān), wise (dhīmān), enthusiastic (mahotsāḥ), clever (dakṣaḥ), forgiving (kṣamāvān), virtuous (dhārmika), have faith in the Vedas (āstika), and see good things with a peaceful disposition (praśamaguṇadarśī);
9. Be truthful (satyasaṃdhaḥ) and give up impatience;
10. Endeavour to remove causes of passion and apathy (rāgadveṣa-hetunāṃ hantā).^[9]
11. Adopt only such of the means of livelihood which are not opposed to virtue.^[10]
12. Avoid slackness and endeavour to act on time;
13. Avoid taking up any activity without examination;
14. Abstain from being slavish to the senses and should not allow the fickle mind to roam;
15. Endeavour to restrain anger, joy, grief, pride (in achievements) and despair (in loss);
16. Should not lose spirit (na vīryaṃ jahyāt);^[11]
17. Abstain from inclination towards wine, gambling or prostitutes (na madyadyūtaveśyāprasaṅga-ruciḥ syāt).^[12]

Apart from personal conduct, sadvṛtta is concerned with the regulation of social conduct. The principles of exemplary conduct intended to guide an individual in his social interactions. Some of these overlap with those mentioned for good mental and spiritual health.

Here, we mention some of the salient ones:

1. Avoidance of speaking against the king; criticism of the gods, brāhmaṇas and ancestors;^[13]
2. Paying respects to teachers, brāhmaṇas, the elderly, etc.
3. To be the first to greet on meeting people (pūrvābhibhāṣī) with cheerfulness;
4. Protecting the afflicted;
5. Practice of charity;
6. Protecting people in affliction (durgeṣu abhyupapattā);
7. Speaking beneficially, at the appropriate time, words that are measured and pleasant;^[14]
8. Friendliness to all creatures (sarvaprāṇiṣu bandhubhūtāḥ); reconciliation those who are angry; consolation of the frightened; protection of the deprived (dīnānāmabhyupapattā);
9. To be compromising in nature and tolerant of unpalatable words of others;^[15]
10. To refrain from taking over or coveting what belongs to others; feelings of hatred; sinful activities; disclosure of others” faults or secrets;
11. To avoid the unvirtuous, traitors to the king, madmen, fallen persons, abortionists, mean and vile persons; women, friends and servants of bad conduct;^[16]
12. To take care of the servants (nābhṛtabhṛtyāḥ);^[17] etc.

We have referred to some the salient aspects of the prescribed code for regulating an individual’s principles and habits as well as his behaviour within the larger societal space. Perhaps here we may surmise that the ancient physicians had some awareness of nature of psychological and social influences on physical well-being and longevity. In recent years there has been growing understanding of the remarkable sensitivity of health to the social environment.^[18] It is now accepted that social support and good social relations make an important contribution to health;^[19] however, the objective of the above guidelines of the classical physicians was to develop self-restraint by exercising control of the senses, and to create a peaceful disposition by avoiding conflict with those in superior positions as well as with peers.

We have noted that both Caraka and Suśruta counsel refrainment from criticism of the revered persons-king, brāhmaṇas, teachers and the elderly. On the other hand, advice like maintaining a friendly attitude towards all (except those of bad conduct), abstaining from insulting anybody,^[20] not bearing ill will towards anyone by remembering insults (nāpavādamanusmaret),^[21] being modest and so on, are intended towards cultivating good relations with all. It is noteworthy that the directive to be respectful attitude towards brāhmaṇas has been mentioned at least thrice in this context by Caraka, but only once by Suśruta. Caraka also censures spitting and blowing of the nose during the course of religious rites, studies, religious offerings and auspicious acts. Other than public places, spitting and voiding in front of the wind, fire, the moon, the sun, brāhmaṇas and teachers is disapproved.^[22] The specific mention of brāhmaṇas and teachers is important. Similar disapproval appears in the normative literature wherein it is declared that if a man urinates in the direction of a fire, the sun, a cow, a brāhmaṇa, the moon, water, or twilight, his intelligence will be destroyed.^[23] Other places that should not be soiled are river, road, cowdung, ploughed land, field sown with seeds and a grassy patch.^[24]

We also read in the Caraka Saṃhitā that whatever else is not spoken here but is revered elsewhere as a virtuous act, that is also acceptable to Lord Ātreya.^[25] This evidently refers to the Dharmaśāstric regulations of conduct that practitioners of the medical school of Ātreya should uphold. Such a declaration does not occur in Suśruta’s compendium; rather there is a general recommendation to abide by the instructions of the superiors and elders (guruvṛddānumatena).^[26]

Taking all things into consideration, the guidance on good conduct is intended for developing a peaceful, compassionate, happy and positive attitude to life, which, it is believed, can prevent or rather minimize sufferings of the mind and the body.

Footnotes and references:

[1]:

Caraka Saṃhitā Sūtrasthāna 7.26.

[2]:

Caraka Saṃhitā Sūtrasthāna 7.27.

[3]:

Caraka Saṃhitā Sūtrasthāna 7.28.

[4]:

Caraka Saṃhitā Sūtrasthāna 7.29.

[5]:

Caraka Saṃhitā Sūtrasthāna 7.30.

[6]:

Caraka Saṃhitā Sūtrasthāna 7.15-16.

[7]:

Caraka Saṃhitā Sūtrasthāna 8.19.

[8]:

Caraka Saṃhitā Sūtrasthāna 8.20.

[9]:

Caraka Saṃhitā Sūtrasthāna 8.18.

[10]:

Suśruta Saṃhitā Sūtrasthāna 45.104.

[11]:

Caraka Saṃhitā Sūtrasthāna 8.27.

[12]:

Caraka Saṃhitā Sūtrasthāna 8.25; Suśruta Saṃhitā Cikitsāsthāna 24.101. Suśruta, however, advises refraining from excess consumption of liquor (madya-ati-sevā).

[13]:

Suśruta Saṃhitā Cikitsāsthāna 24.98.

[14]:

Caraka Saṃhitā Sūtrasthāna 8.18.

[15]:

Caraka Saṃhitā Sūtrasthāna 8.18.

[16]:

Caraka Saṃhitā Sūtrasthāna 8.19.

[17]:

Caraka Saṃhitā Sūtrasthāna 8.26.

[18]:

R. Wilkinson and M. Marmot, (Eds.), Social determinants of Health: The Solid Facts, WHO, Copenhagen, 2003 (second edition), p.7.

[19]:

R. Wilkinson and M. Marmot, (Eds.), Social determinants of Health, p.22.

[20]:

Caraka Saṃhitā Sūtrasthāna 8.25.

[21]:

Caraka Saṃhitā Sūtrasthāna 8.27.

[22]:

Caraka Saṃhitā Sūtrasthāna 8.21.

[23]:

Vasiṣṭha Dharmasūtra, 5.11.

[24]:

Vasiṣṭha Dharmasūtra, 5.12.

[25]:

Caraka Saṃhitā Sūtrasthāna 8.35.

[26]:

Suśruta Saṃhitā Cikitsāsthāna 24.89.