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History of Mental Illness: A Cultural Psychiatry Retrospective
History of Mental Illness: A Cultural Psychiatry Retrospective
Description
From the Jacket

Examining “mental illness” in societies where different world views, thought worlds, and habit patterns prevail is ordinarily frowned by social scientists since it involves analysis of phenomena steeped in modern conventions of knowledge. This book contravenes this position giving reasons for and ways of circumventing social science scruples. It formulates and provides details about they systems of healing of conditions of psychiatric interest that would have been found in ancient traditional and early modern period. It draws on the findings of Indian epidemiologists who have surveyed the prevalence and distribution of psychiatric disorders in modern and traditional settings of contemporary India. Their findings support the position that such conditions would have been found in earlier historical epochs.

In the book, information from cultural anthropology is used to formulate ideas and a perspective that encompass salient cultural and historical parameters of India as a sociocultural entity which have stood the test of time. Emphasis is placed on how Indian culture, religion, morality, sociology, and philosophical psychology which shape the world view and habit patterns of Indian peoples everywhere and throughout millennia. This nexus of ideas constituted the ontology and epistemology about psychiatric conditions in earlier historical epochs. It shaped their form, content and meaning and it provided a basis for approaches to healing. Normal and not so normal conceptions about behavior and well being are discussed based on indigenous systems of meaning. The manner in which psychiatric conditions were and still are formulated in the compilations of Caraka, Susruta, Vagbhata, and Bela are reviewed compared along with religious and spiritual viewpoints. Discussion of approach to conditions of psychiatric interest rooted in traditional Indian values provides a basis for critique and plea for broadening the scope and depth of the already vibrant and scientifically compelling psychiatry of contemporary India. The book aims to make modern psychiatry more responsive to India’s understanding of the human condition.

Horacio Fabrega Jr. is a practicing clinical neuropsychiatrist who is Professor of Psychiatry and Anthropology at the University of Pittsburgh. His academic work spans the fields not only of clinical and descriptive psychiatry but also of ethnomedicine, medical anthropology, and cultural psychiatry. He is the author of four books and over one hundred and fifty articles in peer review journals in these fields. He was Director of Medical Student Education Program at University of Pittsburgh School of Medicine for fifteen years. For the last ten or so years his work has encompassed evolutionary psychology and psychiatry, involving theoretical study of the way conditions of psychiatric interest have changed during various phases of Human biological and cultural evolution. India represents case study for this position and the book summarizes it.

Foreword

This is the first book to take a comprehensive look at mental illness in India. It approaches the subject from the perspectives of history and social science and leaves no stone unturned in its attempt to paint a picture of the way mental disorders have historically been understood and treated in India in the past and also in the present. While focusing on India, Fabrega’s book, especially in its historical discussion of the pre-modern period, inevitably includes the whole of South Asia. Crucial to fabrega’s enterprise is the recognition that mental illness is a universal phenomenon that has affected all peoples throughout documented history. What separates one way of understanding and dealing with it from another is the social and cultural environment in which mental illness occurs.

An important part of fabrega’s book examines mental illness in South Asia’s indigenous medical tradition of Ayurveda. Understood from the Sanskrit word unmade, a mental disorder was a behavioural condition in which a person acted as if he were intoxicated. What may be considered as the mental or psychological problem went almost completely unremarked. Another form of mental illness found in ancient South Asia and mentioned in the early medical treatises of Ayurveda was possession. Recently, Frederick Smith has clarified the idea of possession in South Asia by showing that there was both good and bad possession; the former was associated with religious rites and activities, the latter with morbid conditions and the medical tradition of Ayurveda veda. The current work of Fabrega takes us beyond these basic ideas and helps us to understanding mental illness in a much wider context. In other words, his work may be regarded as a psychological reading of South Asian history and culture that will help to deepen and redefine the history and present understanding of psychiatry and psychology in South Asia. It is a most welcome addition to the scholarship in general and to the series Indian Medical Tradition.

Preface and Acknowledgements

The medicine of traditional India represents an early watershed in the worldwide evolution of medicine. In its many compilations Ayurveda explicitly addresses conditions that one may safely construe as of psychiatric interest. Its texts furnish a lens which one can use to discern how such conditions were conceptualized and dealt with a form of sickness within the scholarly, academic medical community of traditional India.

Viewed broadly, Ayurveda ‘psychiatry’ involves only the medical component of the many institutions that India evolved to formulate, understand, and cope with human emotional and behavioural problems. However, this is not to minimize the importance of Ayurveda but to emphasize that a civilization as rich as India’s in areas of science, philosophy, moral exposition, literature, art, social and political theory, and religion exemplified a host of other ‘non-medical’ approaches and solutions to the universal problems of psychological distress, disorder, and social comportment posed by conditions of psychiatric interest. A history of mental illness in India, therefore, involves taking into account not only an understanding of its medicine but also an appreciation of its diverse intellectual and cultural traditions and social practices and institutions outside of medicine per se, for these were also necessarily involved in formulating, appropriating, ‘domesticating’, coping with, and in the final event healing conditions of psychiatric interest.

It should be emphasized that combing the social and cultural fabric of traditional India searching for its understandings and resources for handling conditions of psychiatric interest constitutes an intellectual enterprise that is fraught with intellectual, academic pitfalls. For social scientists and historians to do so is impious: such an enterprise exemplifies the worst of ethnocentrism and anachronism. It reflects not only hubris and arrogance but is also intellectually, philosophically nonsensical. The concepts ‘mental illness’ and ‘psychiatry’ and their representation in the discipline and institution which has evolved around them represent inventions of the modern era and especially its science and medicine as determined by distinct cultural, historical and politico-economic circumstances. How can one presume to realistically discuss something as historically and culturally enmeshed in our history and social fabric as ‘mental illness’ and psychiatry’ are in a different society? Such constructs and what they prefer to and shape are the product of a distinct culture, and historical period. Western and modernist ideas, beliefs, and values about behaviour and medical phenomena represent one of many slants and conceits that human communities have evolved to make sense and handle a universal problem; namely, conditions of psychiatric interest. Other societies and historical mentalities simply did not share the theoretical conceits let alone the political, economic, sociological, and cultural conditions which in today’s modern world have made ‘mental illness’ and ‘psychiatry’ understandable, theoretically meaningful, and also socially problematic.

This book takes into consideration these criticisms and addresses them by drawing on ideas and generalizations based on findings of research from several sciences. It reviews and discusses the implications of the proposition that conditions of psychiatric interest are universal, a proposition supported by diverse lines of research in evolutionary biology, genetics, and comparative epidemiological and clinical psychiatric research. This, it is reasonable to presume that in ancient India conditions of psychiatric interest were on display, there to be observed in their respective cultural attire, and dealt with via meaningful social practices and institutions in other words, while psychiatric conditions are universal they are also shaped, given meaning, and dealt with in cultural terms.

The book builds on the insights of social scientists, especially anthropologists and social historians, who have expounded on the hazards and limitations of comparative research, which are imposed by theoretical problems of cultural relativism and historical anachronism. On the basis of generalizations from studies in cultural medical anthropology and social history of medicine, the argument pursued in this book presumes that all societies and cultures past and present necessarily evolve resources of knowledge and practice in order to cope with behavioural disturbances and breakdowns. The task is to use modern psychiatric and social science insights about sickness behaviour and psychiatric phenomena as a frame of reference for providing a reasonable picture of how conditions of psychiatric interest were formulated and dealt with in a culture and civilization of long ago. This method of procedure is reflected in the subtitle of this book: a cultural psychiatry retrospective means using contemporary generalizations about conditions of psychiatric interest derived from study of contemporary populations of India and elsewhere as a platform on which to examine the past of India as this has come to be understood I diverse disciplines; and bring to light how it formulated and handled psychiatric conditions.

The science and practice of modern clinical neuroscience psychiatry is not just a ‘Western’ achievement. India’s contemporary academic psychiatry is its equal. Indian scientists and psychiatrists are not just found in India’s research and academic, clinical centres, but many, following their training there, have migrated worldwide. The psychiatry research establishments of India and their efforts with respect to research, education, and practice exemplify the best of modern psychiatry worldwide.

India’s contemporary psychiatric establishment is special in that it is embedded in an alive, vibrant history and culture whose accomplishments in medical and mental health related knowledge, scholarship, and practice exemplify an ancestry of millennia and have become legendary. In the span of but a few generations India has had to weather the onslaught of imperialism and colonization by an alien culture and its science, medicine, and politico-economic dynamism. In a context of imposed Westernization and modernization India has had to accommodate to the modern perspective about phenomena of psychiatric interest, and considerably more, of course. India has served as a willing and gifted student and appropriated and even perfected its patron’s wares. But the mixture of intellectual and practical traditions and resources involving sickness and healing, the ancient and the modern, are pulsating realities in the contemporary social, medical scene that do not easily integrate with one another. Thus, one who intends to sort out the history of psychiatric illness in India has to learn what if any residua and realia of its past ideas, beliefs, and accomplishments I this area of knowledge and practice are represented in its contemporary approach to mental-illness.

Looked at differently, India presents one with an opportunity to examine, as though it presented a test case, the cultural evolution of psychiatry. A cultural psychiatry retrospective also involves examining the history of mental illness in India from the standpoint of social and cultural evolution, sorting out what has been retained from the past, what represents the new, and how each of these packages of knowledge and practice relate to one another.

There are many individuals who have provided me with direct, generous assistance in what has been an approximately four-year enter-prise. I would like to thank Drs. Deborah P. Bhattarcharyya, Mitchell Weiss, Dominik Wujastyk, Kenneth Zysk, G. Jan Meulenbeld, Richard Shweder, Joseph Alter, and Mary Ganguli. They have addressed my many annoying queries for material, references, and information; however, they cannot be held responsible for limitations if not deficiencies of my base of knowledge and reasoning. Members of the library staff of Western Psychiatric Institute and Clinic have been uniformly patient, helpful, and generous, and I want to single out David Killinsky who has shouldered the bulk of request. Jane Flanders provided editorial help during early stages of the manuscript. Kendall Stanley has helped me in preparing bibliographies and final manuscripts and my mental health has been kept serviceable as a result of her careful, painstaking work. Friends have provided me with support and encouragement in pursuing something that in today’s academic psychiatry community is viewed at best as peripheral and at worst as trivial and off the main road of relevant and supportable topics having practical significance for clinical care. Among persons who have been encouraging and supportive I include Drs. John Fong, Thomas Detre, and Paul Soloff. I want to express special appreciation of my wife, Joan Rome Sporkin, for being patient with my intellectual obsessionalism and providing me with consistent support and encouragement in the face of my intellectual self-absorption.
This book is dedicated to my grandchildren.

Foreword vii
Preface and Acknowledgementsix
1. What a Cultural History of Psychiatry Involves1
Introduction 1
Civilizations as Objects of Study3
On Choosing India for a History of Psychiatric Phenomena4
Theoretical Background and Conceptual Frame of Reference7
Hazards of Searching for Psychiatric Phenomena in Pre-Modern India12
The Civilization of India as a Subject for Study16
The Civilization of India as a Subject for Study16
Proto-history of India: Harappan Societies of the Northwest19
General Characteristics of Early Indian Societies21
The Emergence of Hindu Civilization23
Towards an Evolutionary Slant on Psychiatric Phenomena28
Tracking Psychiatric Conditions across a Terrain of Cultural History31
Dealing with the Enchantment and Fascination of India’s Approach to Mental Life
2. Historical and Cultural Overview38
Introduction: Psychiatric Phenomena as Symbolic and Behavioural Material38
Psychiatric Phenomena in India’s Cultural and Social History Why and how religion matters39
Indian Societies in General Context44
Hinduism, the Caste System, and Gender in Indian Societies Preliminary considerations- A brief resume of the history of Hinduism- The scope of Hinduism’s influence of human psychology-Hinduism and the system of social organization in India - Family, tribe and sectarian affiliation - Social relations as gendered phenomena - Historical factors influencing relations between the sexes - Comment
On The Periodization of Indian History60
Introduction - Proto-history and the pre-Vedic phase - Early or ancient India - Social organization and life in early India - Foundations of India’s medieval quest for immortality and perfect health - Early medieval India
3. Social Life in Historical Context77
Vedic People77
Hindu Thought Worlds and Habit Patterns78
Toward the Classical Era of Indian Civilization83
Ancient India as a Setting for Psychiatric Phenomena86
Significance of Urbanization for Understanding Psychiatric Phenomena91
The Social Fabric of Early Medieval Societies95
Introduction - Religious institutions
The Late Medieval Period100
Social Change in India during the Modern Period 101
General introduction - Social change in small communities of India - Studying social change in Indian civilization as a whole - Social change and psychiatric phenomena during the modern era
4. Demography and Public Health116
Introduction116
Why Demography and Public Health Matter117
Notes on the historical Demography of India123
Historical Representations of Public Health in India 127
Historical Changes in Public Health in India132
Public Health in India Today135
Psychiatric Conditions in the Context of Public Health137
Searching for Psychiatric Conditions in Ancient and Medieval Indian Populations140
5. Finding Psychiatric Conditions in Contemporary India145
Introduction145
Why Culture Matters in Understanding Psychiatric Conditions Comment146
Incidence and Prevalence of Psychiatric Disorders in Contemporary India150
Introduction - Limitations of rationale and approach - Estimate of mental illness in the US - Psychiatric disorders in Indian communities
Psychiatric Conditions in an Indian Village Setting
Comment
168
Spirit Possession and Treatment in an Islamic Religious Sanctuary 177
Spirit Possession and Treatment in a Hindu Religious Sanctuary 180
Cultural views of Psychiatric Conditions in Contemporary Calcutta and Sinhalese Villages183
Concluding Comment187
6. Mental Illness in Ancient Indian Communities191
Introduction 191
Early Evolution of Naturalistic Medicine in India 192
Introduction - Epistemological boundaries and the paradigm shift - Indian medicine from a distance - Medicine of the pre-Vedic period - Early Vedic medicine
Psychiatric Phenomena in Vedic Society: The Atharvaveda204
Introduction - The Atharvaveda - Medicine and psychiatry in the Atharvaveda - Getting behind and under textual material - Clues about the early cultural psychology of Vedic people - Looking beyond Vedic medicine toward Ayurveda - The Dharmasastra - Comment
The Bhagavadgita228
Introduction - How and why the Bhagavadgita appealed - What the Bhagavadgita reveals and addresses - The Bhagavad-gita as a statement about and healing of human misery - Putting Hindu tradition in social context- Caveat of limitation
Traditional India and Materialization of Psychiatric Phenomena239
How the Indigenous Psychiatry of India Worked242
7. Evolution of Medicine and Psychiatry in Traditional India 246
Introduction 46
India’s Early History of Medicine and Psychiatry: General Considerations247
Philosophy, Spiritual Healing and the Science of Medicine: Commonalities and Differences249
The Transition from Vedic Medicine to Ayurveda Summary Comment253
Influence of Medicine in the Buddhist Community and Monastery on Ayurveda257
The Academic, Scholarly, and Scientific Medicine of India General considerations259
A Naturalistic Focus on Sickness263
The Systematic Character and Comprehensiveness of Ayurveda265
Representation of Fevers in the Carakasamhita Comment267
Psychiatric Considerations270
Representations of psychiatric condition in the Carakasamhita
Clinical Description of Insanity and Related Conditions in the Carakasamhita274
Insanity - Accidental or exogenous insanities - Comment - Conditions featured by sexual manifestation - Alcohol problems in the Carakasamhita
Representation of Disease in the Susrutasamhita286
General remarks - Fever - Predominantly ‘organic’ insanity in the Susrutasamhita - ‘Metaphysica’ diseases (caused by possession of spirits) in the Susrutasamhita
Epilepsy in the Susrutasamhita295
Vagbhata’s Astangasamgraha298
General introduction - Conception and classification of disease - Approaches to disease in children - Formulation of fevers - Formulation of neuro-psychiatric condition - Astanga-samgraha’s formulation of epilepsy - Astangasamgraha’s formulation of insanity - Comment
Bhelasamhita309
Bhela on irregular fever - The nature of insanity - The treatment of insanity - Bhela on epilepsy309
Bhela on irregular fever - The nature of insanity - The treatment of insanity - Bhela on epilepsy
Comment : The View of Psychiatric Practice in the Siddha
System of Medicine315
What do Ayurveda Texts Suggest about Psychiatric Phenomena in traditional India? 317
General considerations - Psychiatric conditions in the population of traditional India - Bhutas and the evolution of indigenous psychiatry in India
On the Accomplishment of Ayurvedic Psychiatry322
Final comment 325
Appendix:
Characteristics of Psychiatric Condition in the Carakasamhita328
8. The Scope of Mental Health Practices in Traditional India335
Introduction335
Theory and Classification of Mental Disorders in Ayurveda 338
A Critical Look at Ayurvedic Psychiatric Constructs and Principles343
Introduction - Psychiatry as an Ayurvedic medical discipline - Commonalities and complexities in psychiatric knowledge - Ontology of personality and its pathologies - A neuropsychiatric focus in Ayurveda
Visualizing Evolution of Ayurvedic Psychiatry 355
Psychiatric Practice as an Outgrowth of Philosophy361
Soteriological and Cultural Psychology of Health and Sickness363
Influence of Theosophical Traditions in India’s Indigenous Psychiatry367
Medical Validity in Ancient India 373
Introduction - The elite scholarly sector as a locale of valid medical practice - The popular medical sector - What does medical validity mean anyway? - Conceptualizing the medical validity of Ayurveda
India’s Indigenous Psychiatry Covers more than Ayurveda389
Visualizing Cultural Change of Psychiatric Phenomena396
9. Influence of Cultural Psychology on Psychiatric Conditions401
What Is Cultural Psychology and Why Is It Important?401
Background - Cultural psychology - Why cultural psychology is relevant to the study of psychiatric phenomena Prolegomenon: Is a Relational Epistemology India’s original Cultural Psychology?407
Genealogy and the Scope of Indian Cultural Psychology414
The Cultural Psychology of Moral Behaviour in India 416
More on Cognitive Aspects of Indian Cultural Psychology420
Comment on the moral fabric of Indian conditions of psychiatric interest
Ideological Self and Self in Action: Aspects of Indian Culture Psychology426
Developmental and Intrapsychic Aspects of Indian Cultural Psychology432
Introduction - Psychoanalytic configuration of Indian personality - Psychoanalytic formulations of Indian life course - Psychoanalytic interpretations of gender differences - Female identity: complementary observations - Cognition and Indian cultural psychology - More on the cultural psychology of Ayurveda
Indian Cultural Psychology as a Refractive Medium for Psychiatric Phenomena455
10. An Odyssey through Indian Systems of Psychiatry462
Prolegomenon: Mental Health Practices of India’s Forest Peoples462
Early Expression of Indian Civilization 471
Introduction - Life in the subcontinent and the advent of the Aryans - Towards classical Hinduism - Mental health during the period of ascetic reform
The Transition into the Classical Era 482
Comment
Juridical and Legal Constraints on Ayurvedic Psychiatric Care in Ancient and Classical India484
Introduction - The sociology and legality of Ayurvedic practice - Implications involving traditional practice of Ayurvedic psychiatry
Ayurveda as a System of Social Regulation491
Psychiatric Stigma in Ancient State Societies of India496
Spiritual and demonic residues - The moral burden of conditions of psychiatric interest
A Snapshot of Medieval Indigenous Psychiatry through an Ayurveda Lens501
Tibetan Ayurvedic medicine - Comment
Cultural Diversity and Medical Practice in the Medieval Era505
Introduction - Societies and populations
Untangling the Roots of Psychiatric Phenomena during the Medieval Period512
Introduction - Practical and popular religion and medicine-Yoga, Tantra and Siddha - Comment
Religious Behaviour and the Fabric of Psychiatric Conditions in India518
Introduction - Possession states in India
Religion, Madness, and Spirit Possession as Historical Templates for Psychiatric Condition 523
Introduction - Holy madness
Comment on Religion and Psychiatric Condition529
Medieval Indian Medicine and the Islamic Influence 530
Introduction - General background - Alchemy and the Siddha tradition - The Islamic influence in medicine - Unani medicine
Interaction and Competition among Scholarly Traditions540
Medieval Medicine and Psychiatric Conditions 543
11. Modern Psychiatry in India549
Introduction549
Milestones and Landmarks of Modern Psychiatry’s Spread into India: A Brief Excursus551
Introduction - Pre-Independence Indian psychiatry - Early post-Independence psychiatry in India
Putting India on the Road to the Modernization of Psychiatry559
Science as a Cultural Force in Modernization562
Colonial Medicine as a Modernizing Force - Where Was Colonial Psychiatry?565
Modern Psychiatry in Indian Society569
Introduction - Barriers to a regime of colonialist medicine and psychiatry - Impact of modern psychiatry in India - Obstacles encountered
Indian Psychiatric Conditions through the Prism of Modern Psychiatry581
Traditional Psychiatric Conditions in Modern Attires586
Introduction - Spirit possession through a clinical lens - A cultural phenomenology of psychiatric conditions? - Opportunities for clarifying a theory of psychiatric condition - The influence of indigenous formulations of self and body - Comment
Can an Authentic Indian Construction of Psychiatric Condition Emerge? 602
Clash of Traditions: Psychiatric Treatment in Uttar Pradesh 609
Aging and Dementia in India617
Social relationships and old age - Aging and dementia Concluding Comment626
12. Tensions Surrounding the Application of Modern Psychiatry628
Contestation between Rival Traditions of Medicine and Human Welfare628
The ‘Old’ Indigenous Psychiatry in the ‘New’ Clinical Neuroscience Regime632
A Brief Excursus: Two Snapshots of Modern Psychiatry in India646
Efforts Directed at Constructing an Authentic Modern Indian Psychiatry650
Comment Can Psychiatry in India Preserve the Vision of Its Cultural Tradition?657
A Socially Responsive Psychiatry in India661
What the Cultural Evolution of Psychiatry in India Teaches664
Summary Comment669
Bibliography672
Index712

History of Mental Illness: A Cultural Psychiatry Retrospective

Item Code:
IHJ009
Cover:
Hardcover
Edition:
2009
Publisher:
Motilal Banarsidass Publishers
ISBN:
9788120833708
Size:
9.8 inch X 6.5 inch
Pages:
744
Price:
$75.00   Shipping Free - 4 to 6 days
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From the Jacket

Examining “mental illness” in societies where different world views, thought worlds, and habit patterns prevail is ordinarily frowned by social scientists since it involves analysis of phenomena steeped in modern conventions of knowledge. This book contravenes this position giving reasons for and ways of circumventing social science scruples. It formulates and provides details about they systems of healing of conditions of psychiatric interest that would have been found in ancient traditional and early modern period. It draws on the findings of Indian epidemiologists who have surveyed the prevalence and distribution of psychiatric disorders in modern and traditional settings of contemporary India. Their findings support the position that such conditions would have been found in earlier historical epochs.

In the book, information from cultural anthropology is used to formulate ideas and a perspective that encompass salient cultural and historical parameters of India as a sociocultural entity which have stood the test of time. Emphasis is placed on how Indian culture, religion, morality, sociology, and philosophical psychology which shape the world view and habit patterns of Indian peoples everywhere and throughout millennia. This nexus of ideas constituted the ontology and epistemology about psychiatric conditions in earlier historical epochs. It shaped their form, content and meaning and it provided a basis for approaches to healing. Normal and not so normal conceptions about behavior and well being are discussed based on indigenous systems of meaning. The manner in which psychiatric conditions were and still are formulated in the compilations of Caraka, Susruta, Vagbhata, and Bela are reviewed compared along with religious and spiritual viewpoints. Discussion of approach to conditions of psychiatric interest rooted in traditional Indian values provides a basis for critique and plea for broadening the scope and depth of the already vibrant and scientifically compelling psychiatry of contemporary India. The book aims to make modern psychiatry more responsive to India’s understanding of the human condition.

Horacio Fabrega Jr. is a practicing clinical neuropsychiatrist who is Professor of Psychiatry and Anthropology at the University of Pittsburgh. His academic work spans the fields not only of clinical and descriptive psychiatry but also of ethnomedicine, medical anthropology, and cultural psychiatry. He is the author of four books and over one hundred and fifty articles in peer review journals in these fields. He was Director of Medical Student Education Program at University of Pittsburgh School of Medicine for fifteen years. For the last ten or so years his work has encompassed evolutionary psychology and psychiatry, involving theoretical study of the way conditions of psychiatric interest have changed during various phases of Human biological and cultural evolution. India represents case study for this position and the book summarizes it.

Foreword

This is the first book to take a comprehensive look at mental illness in India. It approaches the subject from the perspectives of history and social science and leaves no stone unturned in its attempt to paint a picture of the way mental disorders have historically been understood and treated in India in the past and also in the present. While focusing on India, Fabrega’s book, especially in its historical discussion of the pre-modern period, inevitably includes the whole of South Asia. Crucial to fabrega’s enterprise is the recognition that mental illness is a universal phenomenon that has affected all peoples throughout documented history. What separates one way of understanding and dealing with it from another is the social and cultural environment in which mental illness occurs.

An important part of fabrega’s book examines mental illness in South Asia’s indigenous medical tradition of Ayurveda. Understood from the Sanskrit word unmade, a mental disorder was a behavioural condition in which a person acted as if he were intoxicated. What may be considered as the mental or psychological problem went almost completely unremarked. Another form of mental illness found in ancient South Asia and mentioned in the early medical treatises of Ayurveda was possession. Recently, Frederick Smith has clarified the idea of possession in South Asia by showing that there was both good and bad possession; the former was associated with religious rites and activities, the latter with morbid conditions and the medical tradition of Ayurveda veda. The current work of Fabrega takes us beyond these basic ideas and helps us to understanding mental illness in a much wider context. In other words, his work may be regarded as a psychological reading of South Asian history and culture that will help to deepen and redefine the history and present understanding of psychiatry and psychology in South Asia. It is a most welcome addition to the scholarship in general and to the series Indian Medical Tradition.

Preface and Acknowledgements

The medicine of traditional India represents an early watershed in the worldwide evolution of medicine. In its many compilations Ayurveda explicitly addresses conditions that one may safely construe as of psychiatric interest. Its texts furnish a lens which one can use to discern how such conditions were conceptualized and dealt with a form of sickness within the scholarly, academic medical community of traditional India.

Viewed broadly, Ayurveda ‘psychiatry’ involves only the medical component of the many institutions that India evolved to formulate, understand, and cope with human emotional and behavioural problems. However, this is not to minimize the importance of Ayurveda but to emphasize that a civilization as rich as India’s in areas of science, philosophy, moral exposition, literature, art, social and political theory, and religion exemplified a host of other ‘non-medical’ approaches and solutions to the universal problems of psychological distress, disorder, and social comportment posed by conditions of psychiatric interest. A history of mental illness in India, therefore, involves taking into account not only an understanding of its medicine but also an appreciation of its diverse intellectual and cultural traditions and social practices and institutions outside of medicine per se, for these were also necessarily involved in formulating, appropriating, ‘domesticating’, coping with, and in the final event healing conditions of psychiatric interest.

It should be emphasized that combing the social and cultural fabric of traditional India searching for its understandings and resources for handling conditions of psychiatric interest constitutes an intellectual enterprise that is fraught with intellectual, academic pitfalls. For social scientists and historians to do so is impious: such an enterprise exemplifies the worst of ethnocentrism and anachronism. It reflects not only hubris and arrogance but is also intellectually, philosophically nonsensical. The concepts ‘mental illness’ and ‘psychiatry’ and their representation in the discipline and institution which has evolved around them represent inventions of the modern era and especially its science and medicine as determined by distinct cultural, historical and politico-economic circumstances. How can one presume to realistically discuss something as historically and culturally enmeshed in our history and social fabric as ‘mental illness’ and psychiatry’ are in a different society? Such constructs and what they prefer to and shape are the product of a distinct culture, and historical period. Western and modernist ideas, beliefs, and values about behaviour and medical phenomena represent one of many slants and conceits that human communities have evolved to make sense and handle a universal problem; namely, conditions of psychiatric interest. Other societies and historical mentalities simply did not share the theoretical conceits let alone the political, economic, sociological, and cultural conditions which in today’s modern world have made ‘mental illness’ and ‘psychiatry’ understandable, theoretically meaningful, and also socially problematic.

This book takes into consideration these criticisms and addresses them by drawing on ideas and generalizations based on findings of research from several sciences. It reviews and discusses the implications of the proposition that conditions of psychiatric interest are universal, a proposition supported by diverse lines of research in evolutionary biology, genetics, and comparative epidemiological and clinical psychiatric research. This, it is reasonable to presume that in ancient India conditions of psychiatric interest were on display, there to be observed in their respective cultural attire, and dealt with via meaningful social practices and institutions in other words, while psychiatric conditions are universal they are also shaped, given meaning, and dealt with in cultural terms.

The book builds on the insights of social scientists, especially anthropologists and social historians, who have expounded on the hazards and limitations of comparative research, which are imposed by theoretical problems of cultural relativism and historical anachronism. On the basis of generalizations from studies in cultural medical anthropology and social history of medicine, the argument pursued in this book presumes that all societies and cultures past and present necessarily evolve resources of knowledge and practice in order to cope with behavioural disturbances and breakdowns. The task is to use modern psychiatric and social science insights about sickness behaviour and psychiatric phenomena as a frame of reference for providing a reasonable picture of how conditions of psychiatric interest were formulated and dealt with in a culture and civilization of long ago. This method of procedure is reflected in the subtitle of this book: a cultural psychiatry retrospective means using contemporary generalizations about conditions of psychiatric interest derived from study of contemporary populations of India and elsewhere as a platform on which to examine the past of India as this has come to be understood I diverse disciplines; and bring to light how it formulated and handled psychiatric conditions.

The science and practice of modern clinical neuroscience psychiatry is not just a ‘Western’ achievement. India’s contemporary academic psychiatry is its equal. Indian scientists and psychiatrists are not just found in India’s research and academic, clinical centres, but many, following their training there, have migrated worldwide. The psychiatry research establishments of India and their efforts with respect to research, education, and practice exemplify the best of modern psychiatry worldwide.

India’s contemporary psychiatric establishment is special in that it is embedded in an alive, vibrant history and culture whose accomplishments in medical and mental health related knowledge, scholarship, and practice exemplify an ancestry of millennia and have become legendary. In the span of but a few generations India has had to weather the onslaught of imperialism and colonization by an alien culture and its science, medicine, and politico-economic dynamism. In a context of imposed Westernization and modernization India has had to accommodate to the modern perspective about phenomena of psychiatric interest, and considerably more, of course. India has served as a willing and gifted student and appropriated and even perfected its patron’s wares. But the mixture of intellectual and practical traditions and resources involving sickness and healing, the ancient and the modern, are pulsating realities in the contemporary social, medical scene that do not easily integrate with one another. Thus, one who intends to sort out the history of psychiatric illness in India has to learn what if any residua and realia of its past ideas, beliefs, and accomplishments I this area of knowledge and practice are represented in its contemporary approach to mental-illness.

Looked at differently, India presents one with an opportunity to examine, as though it presented a test case, the cultural evolution of psychiatry. A cultural psychiatry retrospective also involves examining the history of mental illness in India from the standpoint of social and cultural evolution, sorting out what has been retained from the past, what represents the new, and how each of these packages of knowledge and practice relate to one another.

There are many individuals who have provided me with direct, generous assistance in what has been an approximately four-year enter-prise. I would like to thank Drs. Deborah P. Bhattarcharyya, Mitchell Weiss, Dominik Wujastyk, Kenneth Zysk, G. Jan Meulenbeld, Richard Shweder, Joseph Alter, and Mary Ganguli. They have addressed my many annoying queries for material, references, and information; however, they cannot be held responsible for limitations if not deficiencies of my base of knowledge and reasoning. Members of the library staff of Western Psychiatric Institute and Clinic have been uniformly patient, helpful, and generous, and I want to single out David Killinsky who has shouldered the bulk of request. Jane Flanders provided editorial help during early stages of the manuscript. Kendall Stanley has helped me in preparing bibliographies and final manuscripts and my mental health has been kept serviceable as a result of her careful, painstaking work. Friends have provided me with support and encouragement in pursuing something that in today’s academic psychiatry community is viewed at best as peripheral and at worst as trivial and off the main road of relevant and supportable topics having practical significance for clinical care. Among persons who have been encouraging and supportive I include Drs. John Fong, Thomas Detre, and Paul Soloff. I want to express special appreciation of my wife, Joan Rome Sporkin, for being patient with my intellectual obsessionalism and providing me with consistent support and encouragement in the face of my intellectual self-absorption.
This book is dedicated to my grandchildren.

Foreword vii
Preface and Acknowledgementsix
1. What a Cultural History of Psychiatry Involves1
Introduction 1
Civilizations as Objects of Study3
On Choosing India for a History of Psychiatric Phenomena4
Theoretical Background and Conceptual Frame of Reference7
Hazards of Searching for Psychiatric Phenomena in Pre-Modern India12
The Civilization of India as a Subject for Study16
The Civilization of India as a Subject for Study16
Proto-history of India: Harappan Societies of the Northwest19
General Characteristics of Early Indian Societies21
The Emergence of Hindu Civilization23
Towards an Evolutionary Slant on Psychiatric Phenomena28
Tracking Psychiatric Conditions across a Terrain of Cultural History31
Dealing with the Enchantment and Fascination of India’s Approach to Mental Life
2. Historical and Cultural Overview38
Introduction: Psychiatric Phenomena as Symbolic and Behavioural Material38
Psychiatric Phenomena in India’s Cultural and Social History Why and how religion matters39
Indian Societies in General Context44
Hinduism, the Caste System, and Gender in Indian Societies Preliminary considerations- A brief resume of the history of Hinduism- The scope of Hinduism’s influence of human psychology-Hinduism and the system of social organization in India - Family, tribe and sectarian affiliation - Social relations as gendered phenomena - Historical factors influencing relations between the sexes - Comment
On The Periodization of Indian History60
Introduction - Proto-history and the pre-Vedic phase - Early or ancient India - Social organization and life in early India - Foundations of India’s medieval quest for immortality and perfect health - Early medieval India
3. Social Life in Historical Context77
Vedic People77
Hindu Thought Worlds and Habit Patterns78
Toward the Classical Era of Indian Civilization83
Ancient India as a Setting for Psychiatric Phenomena86
Significance of Urbanization for Understanding Psychiatric Phenomena91
The Social Fabric of Early Medieval Societies95
Introduction - Religious institutions
The Late Medieval Period100
Social Change in India during the Modern Period 101
General introduction - Social change in small communities of India - Studying social change in Indian civilization as a whole - Social change and psychiatric phenomena during the modern era
4. Demography and Public Health116
Introduction116
Why Demography and Public Health Matter117
Notes on the historical Demography of India123
Historical Representations of Public Health in India 127
Historical Changes in Public Health in India132
Public Health in India Today135
Psychiatric Conditions in the Context of Public Health137
Searching for Psychiatric Conditions in Ancient and Medieval Indian Populations140
5. Finding Psychiatric Conditions in Contemporary India145
Introduction145
Why Culture Matters in Understanding Psychiatric Conditions Comment146
Incidence and Prevalence of Psychiatric Disorders in Contemporary India150
Introduction - Limitations of rationale and approach - Estimate of mental illness in the US - Psychiatric disorders in Indian communities
Psychiatric Conditions in an Indian Village Setting
Comment
168
Spirit Possession and Treatment in an Islamic Religious Sanctuary 177
Spirit Possession and Treatment in a Hindu Religious Sanctuary 180
Cultural views of Psychiatric Conditions in Contemporary Calcutta and Sinhalese Villages183
Concluding Comment187
6. Mental Illness in Ancient Indian Communities191
Introduction 191
Early Evolution of Naturalistic Medicine in India 192
Introduction - Epistemological boundaries and the paradigm shift - Indian medicine from a distance - Medicine of the pre-Vedic period - Early Vedic medicine
Psychiatric Phenomena in Vedic Society: The Atharvaveda204
Introduction - The Atharvaveda - Medicine and psychiatry in the Atharvaveda - Getting behind and under textual material - Clues about the early cultural psychology of Vedic people - Looking beyond Vedic medicine toward Ayurveda - The Dharmasastra - Comment
The Bhagavadgita228
Introduction - How and why the Bhagavadgita appealed - What the Bhagavadgita reveals and addresses - The Bhagavad-gita as a statement about and healing of human misery - Putting Hindu tradition in social context- Caveat of limitation
Traditional India and Materialization of Psychiatric Phenomena239
How the Indigenous Psychiatry of India Worked242
7. Evolution of Medicine and Psychiatry in Traditional India 246
Introduction 46
India’s Early History of Medicine and Psychiatry: General Considerations247
Philosophy, Spiritual Healing and the Science of Medicine: Commonalities and Differences249
The Transition from Vedic Medicine to Ayurveda Summary Comment253
Influence of Medicine in the Buddhist Community and Monastery on Ayurveda257
The Academic, Scholarly, and Scientific Medicine of India General considerations259
A Naturalistic Focus on Sickness263
The Systematic Character and Comprehensiveness of Ayurveda265
Representation of Fevers in the Carakasamhita Comment267
Psychiatric Considerations270
Representations of psychiatric condition in the Carakasamhita
Clinical Description of Insanity and Related Conditions in the Carakasamhita274
Insanity - Accidental or exogenous insanities - Comment - Conditions featured by sexual manifestation - Alcohol problems in the Carakasamhita
Representation of Disease in the Susrutasamhita286
General remarks - Fever - Predominantly ‘organic’ insanity in the Susrutasamhita - ‘Metaphysica’ diseases (caused by possession of spirits) in the Susrutasamhita
Epilepsy in the Susrutasamhita295
Vagbhata’s Astangasamgraha298
General introduction - Conception and classification of disease - Approaches to disease in children - Formulation of fevers - Formulation of neuro-psychiatric condition - Astanga-samgraha’s formulation of epilepsy - Astangasamgraha’s formulation of insanity - Comment
Bhelasamhita309
Bhela on irregular fever - The nature of insanity - The treatment of insanity - Bhela on epilepsy309
Bhela on irregular fever - The nature of insanity - The treatment of insanity - Bhela on epilepsy
Comment : The View of Psychiatric Practice in the Siddha
System of Medicine315
What do Ayurveda Texts Suggest about Psychiatric Phenomena in traditional India? 317
General considerations - Psychiatric conditions in the population of traditional India - Bhutas and the evolution of indigenous psychiatry in India
On the Accomplishment of Ayurvedic Psychiatry322
Final comment 325
Appendix:
Characteristics of Psychiatric Condition in the Carakasamhita328
8. The Scope of Mental Health Practices in Traditional India335
Introduction335
Theory and Classification of Mental Disorders in Ayurveda 338
A Critical Look at Ayurvedic Psychiatric Constructs and Principles343
Introduction - Psychiatry as an Ayurvedic medical discipline - Commonalities and complexities in psychiatric knowledge - Ontology of personality and its pathologies - A neuropsychiatric focus in Ayurveda
Visualizing Evolution of Ayurvedic Psychiatry 355
Psychiatric Practice as an Outgrowth of Philosophy361
Soteriological and Cultural Psychology of Health and Sickness363
Influence of Theosophical Traditions in India’s Indigenous Psychiatry367
Medical Validity in Ancient India 373
Introduction - The elite scholarly sector as a locale of valid medical practice - The popular medical sector - What does medical validity mean anyway? - Conceptualizing the medical validity of Ayurveda
India’s Indigenous Psychiatry Covers more than Ayurveda389
Visualizing Cultural Change of Psychiatric Phenomena396
9. Influence of Cultural Psychology on Psychiatric Conditions401
What Is Cultural Psychology and Why Is It Important?401
Background - Cultural psychology - Why cultural psychology is relevant to the study of psychiatric phenomena Prolegomenon: Is a Relational Epistemology India’s original Cultural Psychology?407
Genealogy and the Scope of Indian Cultural Psychology414
The Cultural Psychology of Moral Behaviour in India 416
More on Cognitive Aspects of Indian Cultural Psychology420
Comment on the moral fabric of Indian conditions of psychiatric interest
Ideological Self and Self in Action: Aspects of Indian Culture Psychology426
Developmental and Intrapsychic Aspects of Indian Cultural Psychology432
Introduction - Psychoanalytic configuration of Indian personality - Psychoanalytic formulations of Indian life course - Psychoanalytic interpretations of gender differences - Female identity: complementary observations - Cognition and Indian cultural psychology - More on the cultural psychology of Ayurveda
Indian Cultural Psychology as a Refractive Medium for Psychiatric Phenomena455
10. An Odyssey through Indian Systems of Psychiatry462
Prolegomenon: Mental Health Practices of India’s Forest Peoples462
Early Expression of Indian Civilization 471
Introduction - Life in the subcontinent and the advent of the Aryans - Towards classical Hinduism - Mental health during the period of ascetic reform
The Transition into the Classical Era 482
Comment
Juridical and Legal Constraints on Ayurvedic Psychiatric Care in Ancient and Classical India484
Introduction - The sociology and legality of Ayurvedic practice - Implications involving traditional practice of Ayurvedic psychiatry
Ayurveda as a System of Social Regulation491
Psychiatric Stigma in Ancient State Societies of India496
Spiritual and demonic residues - The moral burden of conditions of psychiatric interest
A Snapshot of Medieval Indigenous Psychiatry through an Ayurveda Lens501
Tibetan Ayurvedic medicine - Comment
Cultural Diversity and Medical Practice in the Medieval Era505
Introduction - Societies and populations
Untangling the Roots of Psychiatric Phenomena during the Medieval Period512
Introduction - Practical and popular religion and medicine-Yoga, Tantra and Siddha - Comment
Religious Behaviour and the Fabric of Psychiatric Conditions in India518
Introduction - Possession states in India
Religion, Madness, and Spirit Possession as Historical Templates for Psychiatric Condition 523
Introduction - Holy madness
Comment on Religion and Psychiatric Condition529
Medieval Indian Medicine and the Islamic Influence 530
Introduction - General background - Alchemy and the Siddha tradition - The Islamic influence in medicine - Unani medicine
Interaction and Competition among Scholarly Traditions540
Medieval Medicine and Psychiatric Conditions 543
11. Modern Psychiatry in India549
Introduction549
Milestones and Landmarks of Modern Psychiatry’s Spread into India: A Brief Excursus551
Introduction - Pre-Independence Indian psychiatry - Early post-Independence psychiatry in India
Putting India on the Road to the Modernization of Psychiatry559
Science as a Cultural Force in Modernization562
Colonial Medicine as a Modernizing Force - Where Was Colonial Psychiatry?565
Modern Psychiatry in Indian Society569
Introduction - Barriers to a regime of colonialist medicine and psychiatry - Impact of modern psychiatry in India - Obstacles encountered
Indian Psychiatric Conditions through the Prism of Modern Psychiatry581
Traditional Psychiatric Conditions in Modern Attires586
Introduction - Spirit possession through a clinical lens - A cultural phenomenology of psychiatric conditions? - Opportunities for clarifying a theory of psychiatric condition - The influence of indigenous formulations of self and body - Comment
Can an Authentic Indian Construction of Psychiatric Condition Emerge? 602
Clash of Traditions: Psychiatric Treatment in Uttar Pradesh 609
Aging and Dementia in India617
Social relationships and old age - Aging and dementia Concluding Comment626
12. Tensions Surrounding the Application of Modern Psychiatry628
Contestation between Rival Traditions of Medicine and Human Welfare628
The ‘Old’ Indigenous Psychiatry in the ‘New’ Clinical Neuroscience Regime632
A Brief Excursus: Two Snapshots of Modern Psychiatry in India646
Efforts Directed at Constructing an Authentic Modern Indian Psychiatry650
Comment Can Psychiatry in India Preserve the Vision of Its Cultural Tradition?657
A Socially Responsive Psychiatry in India661
What the Cultural Evolution of Psychiatry in India Teaches664
Summary Comment669
Bibliography672
Index712
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