Smriti meditation: a tool for diagnosis and management of psychosomatic diseases: a clinical observation study
Professor of Ayurveda, Institute of Oriental Medicine, Peoples Friendship University of Russia, Moscow.
Web of causation of diseases are well narrated in Ayurveda classics. Intellectual error is identified as prime cause of disease and its role in the manifestation of psychosomatic diseases is well explained in charaka samhita. Smriti, exploration of memory is suggested as one of the five components of psychotherapeutic techniques in the managing the psychic components of diseases. A modified version of smriti is developed as a guided – interactive meditation and tested for its therapeutic efficacy. A clinical observational study conducted in 104 patients is reported in this article. The finding of the observational study shows that smriti meditation can be an effective tool in identifying the cardinal reason for psychosomatic disease. Also the study observed that the emotional component of the disease could clear off so that further somatization of the disease can be prevented. Study observed the potential of smriti meditation in curing many psychosomatic symptoms.
Key words: Smriti, Meditation, Ayurveda, Psychotherapy, psychosomatic medicine
Advantage of meditation practice in physical and mental health was well known to ancient sages of India. Ayurveda – ancient Indian system of medicine has well recognized the psychosomatic causation of disease manifestation. Ayurveda has adopted meditation as a tool in the management of diseases of psychological origin. In recent times some studies have conducted to understand the efficacy and mode of action of meditation in psycho somatic diseases. Majumdar M et al studied 21 persons for the effects of an 8-week meditation-based program in mindfulness1. The result showed effective and lasting changes especially in psychological distress, well-being, and quality of life. Changes were of moderate-to-large effect sizes. Another study by Rubia.K concludes that there is evidence in reduction of stress-related autonomic and endocrine measures after meditation, while neuroimaging studies demonstrate the functional up-regulation of brain regions of affect regulation and attention control. Clinical studies show some evidence for the effectiveness of Meditation in disorders of affect, anxiety and attention2.
Some attempts were made to combine meditation and psychotherapy to bring better effect in the management of psychosomatic diseases. Bogart G in a review article concludes that Meditation may, in some cases, be compatible with, and effective in, promoting the aims of psychotherapy—for example, cognitive and behavioral change, or access to the deep regions of the personal unconscious3. Craven JL states that improved understanding of meditation will contribute to an increased acceptance and use of these practices as aids to psychotherapeutic change and will facilitate meaningful research regarding meditation4.
Considering the increased prevalence of psychosomatic diseases it is most essential to develop better techniques which can penetrate into deep subconscious. This may help to identify the root cause, formulate a better diagnosis, and root out the disease causation. Hence this can be serving as a curative method or as a secondary prevention to further progression of the disease
Present study is to report some observation made in the management of psychosomatic disorders using smriti meditation – a modified version of Ayurveda psychotherapy technique.
Ayurvedic approach of psychotherapy
Ayurveda identified intellectual error as the prime cause for diseases. Diseases can be of physical and psychic in nature. Physical humours like Vata, Pita and Kapha are the basis of physical diseases and mental humours like Rajas and Tamas are causative factors for mental disorders. Physical diseases are treated based on logically framed elemental theory. Mental humours are managed with satvavajaya treatment. Satvavajaya treatment is the psychotherapy technique in Ayurveda.
Jnana (knowledge), Vijnana (analytical knowledge), Dhairya (Courage for sensory control) Smriti (memory) and Samadhi (Meditation) are the key approaches in Satvavajaya treatment to resolve psychological problems.
Jnana is spiritual counseling to acquire the true knowledge of human nature on the basis of wisdom from upanishads and other philosophical scriptures. The path of Jnana yoga gives a true knowledge of individual consciousness and its oneness with universal consciousness to its practitioner. The person who could fully convince the truth of Non-dualism (advaida) i.e., knowledge of oneness between individual consciousness and universal consciousness can never be affected by psychic disorders. This helps the person to get out of the fear of death, fear of departing of beloved, dissolves the hatred, anger, greed, sorrow and jealousy. Hence the self-confidence and love evolves.
Application of the concept of jnana is possible only in persons who are intellectually evolved. In mundane psychic conflicts of ordinary human being application of vijnana is recommended. The word ‘vijnana’ means critical knowledge. In the context of psychic disorders a proper analysis of the problem is needed to help the individual to rectify his mistake. Correction of the intellectual error to discriminate between right and wrong is known as vijnana. A well-structured counseling is highly useful in looking at the issue from different dimensions and seeking appropriate remedial measures to resolve the problem. In this the person should get the knowledge of his freedom to choose among three options viz., 1) to do, 2) not to do or 3) can do something else. This will help the person to look at the issue from different perspectives. Finally the person could change the attitude to a different dimension to find an appropriate solution to the problem.
In a one to one interview the physician seeks clarification on the desire of patient for correction and the achievement of goal. Then create an atmosphere to express the problem freely. Allow the person to express and explore all possible solutions from different angle based on the above mentioned 3 options. Finally physician should be able to help the client to choose most appropriate solution emerged out of his on intuition. Then the person can come out with a proper plan of conscious implementation and set a time frame to achieve the goal.
Despite being settled the problem logically or philosophically, the instinctive behavior may not be corresponding to the solution. Mind always seeks pleasure. For that mind gets attached to sensory faculties. Sense faculty has the tendency to attract its objects. This gives temporary pleasures. When one seeks for more pleasure it turned to be addiction. That will lead to behavioral changes like over eating, under eating, addiction to smoking, over indulgence in sex and alcohol. Ayurveda identified that the inability to control the sensory faculties is one of the three major etiological factors for somatic diseases. This illustrates the etio-pathogenesis of psychosomatic diseases. Dhairya is the will power to restraint the mind from attaching to sensual objects. The text Charaka samhita advocates Yoga practices for the control over the sensory faculties.
On a keen observation of the instinctive behavior the root cause can be traced in deep subconscious. It can be evolved out of unfulfilled desire for some objects that was denied to the person. It can be a behavior to mask some painful emotions that carry deep inside. This kind of behavior can also be provoked by the impressions carried over from the life events (Karmaphala). From childhood we collect many impressions from our surroundings. They are registered in the memory with an attached emotion. There are positive and negative impressions. These impressions are mainly from our parents, close relatives, friends and environment. The negative impressions mask the true nature of consciousness. These negative impressions stored in our emotional memory causes many psychic problems like phobia, arrogance, guilt, persecution feeling, loneliness and melancholia. In fact this may not be our true nature. Clearance of these negative emotions is possible through smriti technique. Smriti means memory. Smriti techniques help us to deepen to the subconscious to get real time awareness of the memory of emotions. Recognitions of the root cause of the emotion dissolves them to create a new impression.
As a result of the continued awareness of the emotions the person experience dissolution of emotions either by the expression of them or by a change in the attitude. This brings a deeper relaxation and calmness to mind. In classical Yoga practices this stage is achieved by regular practice of pranayama and pratyahara. At this point of calmness practice of meditation brings a thoughtless silent state easily. Often the person can experience a glimpse of Samadhi. It can be a preliminary stage of Samadhi. Even that short span of Samadhi has a powerful healing power. Repeated practice of smriti technique clears negative emotions and impressions from the sub conscious mind. This creates extreme calmness so that the person could reach the higher realms of Samadhi, a state of absolute happiness.
Dhaira, Smriti and Samadhi are introspective practice. It needs a prolonged period of practice to get into the smriti by the person himself. During diseased condition this will be difficult to achieve due to the emotional resistance. Smriti meditation is a technique developed to facilitate the process of introspection. It is a guided interactive technique to induce deep trance in meditation. In meditation expansion of internal awareness is the prime task. Patanjali, who propounded yoga philosophy himself, mentioned 9 hindrances starting from disease that prevents the deepening of internal awareness5. Here some suggestions along with savasana are used to guide the person to get into the trance. Once the person gets into the trance an interactive method is used to deepen the awareness into memory (Smriti) as explained in the Ayurveda classical text-Caraka Samhita6.
Subject is asked to lie on a comfortable couch in supine posture. Instructions are given to relax all the musculature staring from toes to the head to attain a state of deep relaxation in Savasana pose9. Verbal pacing and leading techniques are used to induce altered state of consciousness. Guidance is given to observe sensory oriented experience followed by internally oriented experience. Once the subject experiences the altered state suggestions are given to observe some forms or experiences to recollect memories. Further with interaction to the patients gradually guide the person to deep emotional memories. During this phase subject may have some emotional out bursts. This helps to clean the negative emotions which blocks deep trance. As the negative emotions clears subjects gradually transcend to deeper layers of consciousness, a preliminary state of Samadhi. After a period of thoughtless silent stage subject will returns to mundane state often with a revelation. This revelation often helps to realize the root cause of some of the emotional and physical problems. This recognition itself will be a partial solution to these problems and helps in healing.
In repeated practice of meditation when all the emotions settle down, mind becomes tranquil, all thoughts stop and then the person transcends to more subtle layer of existence. In this state there is a harmony between body and mind. Many healing processes at bodily and mental levels are taking place.
Series of cases in which smriti meditation was used as a treatment method is verified and taken for the observational study.
Study design: Descriptive study – case series
Case records of clinic “Atreya Ayurveda”, Moscow during the period from 26-06-11 to 30-04-2014 are compiled. 104 subjects (83 F and 21 M ; age group ranging from 12-69 years) those who undergone smriti meditation under the guidance of the author were reviewed. Duration of the meditation is 90 to 120 minutes. Changes after 1-3 meditations in 2-4 weeks period were taken into consideration.
In most of the cases the cardinal reason for the emotional component of the disease was revealed to the subject. In a good number of the cases the revelation happened as a surprise.
Table I. Revelation of cardinal reasons
|Reason||No. of patients||Percentage|
|2||Concern of health of close relatives||7||6.7|
|3||Stress at work place||11||10.57|
|5||Conflict with spouse/partner||28||26.9|
|6||Conflict with parents||12||11.53|
|7||Conflict between parents||10||9.61|
|8||Losing love (Loneliness)||8||7.69|
|10||Conflict with relatives and friend||7||6.73|
|12||Sadness of separation||2||1.92|
|13||Fear of disease||3||2.88|
As shown in the table I conflict with spouse is the prime reason for the majority of cases (28). This is followed by conflict with parents (12) and stress at work place (11) childhood trauma (9). In some subjects there are multiple reasons. In many cases there are interrelations between reasons. For example childhood trauma can be a reason for conflict with parents and further it can cause depressive mood. Again this depressive mood may cause conflict with spouse. In certain cases it is observed that emotional conflicts are arranged in layers in deep subconscious. When the realization of most dominant conflict is occurred it opens up another cause which is the root cause of the previous one. Hence in certain severe conditions repeated meditation is needed to uproot the principle cause.
The significant observation is that in most of the cases when the subject concentrate and meditate on the physical diseases it provokes some emotions like sadness, anger, fear, guilt, feeling of offence, hopelessness, indecisiveness, jealousy and loneliness. Also it is observed that focusing on some emotion it turned out to be physical discomfort. Some of the commonly expressed relation between emotions and physical feelings are given in the table II
|1||Sadness||Chest pain, Body pain, Nasal blockage, dyspnea|
|2||Anger||Burning sensation, itching, arthritic pain, increased body temperature|
|3||Fear||Irritable Bowel, gas formation, coldness of body, dyspnea, Palpitation|
|4||Guilt||Bolus in the throat|
|5||Offence||Discomfort in the throat, Heaviness in the chest|
|6||Hopelessness||Tiredness of the body, heaviness of the body|
|7||Indecisiveness||Head ache, insomnia|
|8||Stress at work||Head ache, insomnia, neck pain, low back pain|
In majority of the cases the recognition of the root cause of the problem itself will be half of the solution. Hence many of such symptoms will relieve at the end of the meditations. Changes of the major symptoms are given in the table III.
|2.||Gastro intestinal problems||15||10||5|
|10.||Lack of libido||2||1||1|
|11.||Sub febrile condition||2||2|
|23.||Recurrent Respiratory infection||2||2|
Most frequently presented symptoms are insomnia, G.I problems (like irritability bowel syndrome, gas formation, gastritis, and stomach pain), head ache, anxiety, depressive mood, irregular menstruation, irritability and arthritic pain. In most of the cases there were remarkable reliefs. Certain changes in the objective parameters were observed as an outcome of meditation. Biochemical analysis showed positive dynamics in thyroid hormone, rheumatoid factor, testosterone, estrogen and prolactin in some of the patients.
Majority of the subjects were female. This is a typical representation of population approaching Ayurveda treatment in Moscow. Also it is observed that females have less resistance and inhibitions to get into the meditation than men. The meditation process is influenced by many factors like skill of guiding doctor, calm atmosphere, desire of the subject to solve the problem, duration of practice, frequency and health condition of the subject. In the present study some of the patients were taking Ayurveda medicines as add-on therapy. Those subjects who have undergone repeated meditation for 5-10 times reported persistent positive changes physically and psychologically.
The ancient wisdom of Ayurveda identifies that there is a close association of body and mind in manifesting diseases. Hence the majority of diseases are psychosomatic in origin. Recognizing disease pathology at a level of mind will be useful to prevent them before manifesting it at physical level. Hence it is very important to promote practice of meditation as a primary prevention in controlling psychosomatic diseases. The sense of health awareness should not be limited as intellectual awareness, but much subtler spiritual awareness.
Many diseases have a nature of hibernation. Diseases like asthma, epilepsy, migraine are occasionally appears and disappears. It shows that the triggering factor is much subtler. In cases of cancer even the removal of the cancerous cells will not stop the diseases dynamics. Later it appears as secondary. In such cases a meditation can helpful as a diagnostic tool identifying the primary cause of the disease at a subtler level.
Ayurveda and Yoga proclaims that Samadhi is the state of absolute health. In Sanskrit term for health is swastha, means soul is in its own place. There are trillions of tissues in our body with different life span and different functions. They all behave like individual entity with their tissue intelligence. Still they all serve the human body harmoniously to fulfill the goal of the soul. When soul is been dragged by sense faculties to sensory objects tissues loose there integrity and behave disharmoniously. Ayurveda considers this state as aswastha or ill-health. Samadhi is a practice to bring back the soul to its place through meditation.
Biol Psychol. 2009 Sep; 82(1):1-11. doi: 10.1016/j.biopsycho.2009.04.003. Epub 2009 Apr 23.
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