Psychiatric disorders: An overview

 Psychiatric disorders are recognized by AYUSH since ancient times. In India, in about 1400 BC psychiatric nosology was described by scholars of Ayurveda. Similarly, psychiatric nosology well described in Unani medicine since its beginning. Evidence shows that around 2600 BC, melancholia and hysteria were known in Egypt and Sumaria.  Mental health is discussed as a separate branch in Unani medicine under the heading of Amraze Nafsani.

Mental health can be defined as emotional, psychological, and social well-being. In recent years awareness of the people towards the importance of mental health has increased. As the global burden of mental disorders like anxiety, depression, obsessive-compulsive disorder, etc. are increasing day by day affecting people from all socioeconomic background and culture. Mental ill health not only affects suffers rather it also affects and disturbs the family and society. About 20% of patients attaining all healthcare facilities, worldwide are poses symptoms of mental health. it is expected that this data will be worse in the future due to urbanization, changes in lifestyle, and extensive use of technology.  It is the need of the hour to prevent and control these disorders and save humanity from suffering. 

The Unani system of medicine is an integral part of AYUSH. It is based on the humoral theory of Hippocrates (ca. 460-357 BC) of Cos. According to him, health is a result of the balance between four humours Dam(blood), bulgham(phlegm), safra (yellow bile), and sauda (black bile), and disease is due to a breach in the balance of these four humours.  Hippocrates describes madness as Mania and Melancholia (depression/ excitement) due to qualitative and quantitative defects in black bile. He also states that melancholy madness presents as genius (i.e. modern concept of bipolar creativity).

Galen (129-216 AD) redefines humorual theory of Hippocrates and states that Mania: A disease of yellow bile. Black bile is also responsible for various types of psychological diseases.

Soranus (Greek: AD98-138) states that Mental illness is caused by: "continual sleeplessness, excesses of venery, anger, grief, anxiety, or superstitious fear, a shock or blow, intense straining of the senses and the mind in the study, business, or other ambitious pursuits"

Arataeus of Cappadocia (contemporary of Galen, 150-200 C.E.)

• Descriptions of mental disorders (depression, mania, melancholy, bipolar disorders) and epilepsy
• “one believes himself a sparrow; … or they believe themselves a grain of mustard, and tremble continuously for fear of being eaten by a hen.”

Latter Arabic medical scholars Zakaria Razi, Ibn Sina, and others gave more emphasis on mental health and describe its etiology, sign, symptom, treatment, and complications in their writings. In the Unani system of medicine, the qualitative and quantitative defect in sauda (black bile) is considered the etiology of mental disorders.  Ibn Sina (980 - 1037) describes that the disorders of masarik (associated) organs of the brain like the stomach, and uterus distemper the normal mizaj (temperament) of the brain. The bukharat (vapors) from these organs reaches the brain and cause increased hararat and yabusat (hot and dryness) in the temperament of the brain and resulting in melancholic disease. Similarly, Ibn Hubl (1121-1213AD) describes that dominance of ghair tabayi sauda in the body with the admixture of blood and rooh e nafsani (mental/ psychic sprit) causes kadurat (dimness),  taariki (gloominess), baroodat (coldness), and yaboosat (dryness) which distemper the rooh and results in mental functional disorder. Suda is synthesized by the liver, stored in the spleen, and reaches the brain via blood vessels. If suda becomes putrefied, it causes obstruction and impedes in Rooh-e-Nafsani resulting in impaired cognitive functions. When the peritoneum is involved then melancholia is called malikholiya miraqi. Ehtarkhe safra cause mania as ehtarkhe sauda and blood causes Malikholiya. Bulgham rarely causes malikholiya.

A wide variety of symptoms is exhibited by patients with mental disorders. Initially, patients feel sadness and loneliness. With the progress of the disease, symptoms become worse. Delusion, hallucination, and impaired judgment occur. The severity of symptoms varies from patient to patient. The patient remains silent and may feel giddiness and tinnitus. Social and psychological relation disturbs including sexual relations. Patients feel different types of fear. A suicidal and homicidal tendency may develop. Symptom of mental disorders depends upon the khilt (humour) involved in the disease. If dam(blood) is involved in etiology patients produce sportive and think exhilarant. If Safra (yellow bile) is involved patients are hyperactive and hard-working. Balgham produces gloomy and lethargic symptoms. Whereas if a mental disorder is caused by distemper of sauda then symptoms are more severe and patients are violent.

As per to Unani system of medicine environmental factors and lifestyle play an important role in health and disease. These are described under the heading of asbabe sitta zarroria (essential for health). Asbabe sitta zarroria are six in number- hawa (enviromenta air),maqool wa masroob (diet and drinks),  harkat wa sukun badni(rest and motion of body), harkat wa sukun nafsani (menta rest and busyness), nuom wa yalza (sleep and awakens) and ihtebash wa istefrag (accumulation and elimination). Optimum quality and quantity of these essential factors main the state of health and its disturbance cause disease. In the present scenario, faulty dietary habits and lifestyle are a major contributory factors for ill health including ill mental health. And hence, modification in these asbabe sitta zarroria play preventive and curative role in mental health. Production of sauda enhance by the diet of barid- yabis (hot and dry) temperament, excessive physical and mental activity, and lack of proper sleep. Accumulation of morbid matter especially distemper sauda causes mental disorders hence these should be avoided. Fresh air and a healthy environment should be maintained. Mood-refreshing activities like sports, music, and social interaction should be promoted.   

Treatment of mental disorders is mentioned in the classical Unani text in detail. These treatments are based on etiology and type of mental disorder. Specific treatment is mentioned for a specific disorder. Melancholia is caused by the combustion of the four humours, which ultimately produce gair tabaye sauda (distemper sauda). Hence, fasd (phlebotomy) of the saphenous or cephalic vein is recommended for istefragh (elimination) of sauda.  Drug with munzij and mushil (purgative) for sauda is used in the line of treatment.  The regime which produces tarteeb (moistness) in the body should be adopted, for this purpose hamam (bath) with sweet water is better. Hamam motadil (modrate bath) with Nelumbo chamomile, Lactuca sativa, and matricaria chamomile medicated is recommended.  Aromatic flowers for smell and aromatic medicated oil may be used unction on the scalp to induce tarteeb. A sauda-producing diet such as dry meat, beef, the meat of camel, donkey, etc, and salty spicy food be avoided.

Melampus (1400 B.C.) about 200 years before the Trojan War. Melampus was the mythological son of Amythaon and Eidomeni.