Psychotherapy in India: Past, Present, and Future J . S. N E K I , D . P . M . ,
F.R.C.
(PSY)*
| New Delhi,
India
If psychotherapy is defined as "interpersonal method of mitigating suffering then many psychotherapeutic systems have existed in India a long time. Unlike Western systems, these have lacked a clinical bias but have provided a more global framework. The future of psychotherapy in both East and West lies in discovering a conceptual framework with universal validity within which ad hoc therapies—for symptom relief, personality development, or interpersonal adjustment—can be developed. 33
INTRODUCTION
Rhys Davis (1), in Dialogues of the Buddha, records a piece of conversation between a mendicant Potthapada and the Buddha in which the former asks the Exalted One a series of questions: Sir, tell me; Is this world eternal? Is the world not eternal? Is the world finite? Is the world infinite? Is the soul the same as the body? Is the soul one thing and the body another? Does one who has gained the truth live again after death? Does he not live again after death? Does he both live again, and not live again after death? Does he neither live again nor not live again after death?
But to each question the Exalted One made the same reply, saying, "that, Potthapada, is a matter on which I have expressed no opinion." "Then what is it the Exalted One has, in fact, determined?" " I have expounded, Potthapada, what is suffering; I have expounded what is the origin of suffering; I have expounded what is the cessation of suffering; I have expounded what is the method by which one may reach the cessation of suffering." If psychotherapy can be defined as "the interpersonal method of mitigating suffering," then the Exalted One can be' said really to have concerned himself with propounding a psychotherapeutic system. However, we today who have different notions of psychotherapy, find it hard to understand in what way the Buddha was a psychotherapist. The Buddha himself alludes to the reason for our confusion. When Potthapada * Professor and Head, Department of Psychiatry, All-India Institute of Medical Sciences, New Delhi, India 110016.
92
P S Y C H O T H E R A P Y I N I N D I A ! P A S T , P R E S E N T , AND F U T U R E
93
asked him "Is it possible, Sir, for me to understand whether consciousness is the man's soul, or the one is different from the other?" the Buddha replied, "Hard is it for you, Potthapada, holding as you do different views, setting different aims before yourself, trained in a different system of doctrine, to grasp this matter." We, today, who have come to hold different views, set before ourselves different aims and have been trained in a different system of doctrine may find it equally hard to grasp the psychotherapeutic systems of Buddha, and for that matter, any of the Indian psychotherapies of yesterday. True, they do not study mind as a clinical entity. Yet, if one knows that they purport to bring about changes in consciousness and our awareness of our feelings, and they also tend to modify our relations with our natural and social surroundings, one cannot but designate' them as "psychotherapies" in a wider sense. Hence, it is important for us to make an effort to understand those well developed psychotherapeutic systems of yesterday that have remained in existence for centuries in India, before one attempts to compare them with the so-called modern psychotherapies of today that form a part of our technological imports from the West. Such an exercise should be considered a logical prerequisite for any attempt at predicting what kind of future psychotherapy is likely to have in India. The "Psychotherapies" of Yesterday All the ancient Indian systems of psychotherapy, despite their variable, and at times even diametrically opposite, techniques, ultimately aim at attainment of liberation. Variously called moksha, turiya, nirvana, and so on, in the respective distinctive vocabularies of these systems and differing somewhat in some details, liberation has been considered a state of release from the throes of time and the cycle of samsara—birth, death, reincarnation, and all the existential exigencies that go with them. In Vedanta and Yoga this is achieved through the awakening of the true "Self," and in Buddhism through the realization that the process of life is not happening to any subject, so that there no longer remains anyone to be reincarnated. Even the Tantrics who, paradoxically, follow the path of sensual indulgence set liberation as their goal. Their use of sexuality is embedded in the actual discipline of liberation. They aim at achieving detachment through satiation of the senses, satiation—even disgust—to be obtained by excessive indulgence. Of all these systems, Yoga and Zen Buddhism are the best developed and the best known. Patanjali Yoga has as its basic tenet, citta vritti nirodha, or control of the flux of mind. Mind is sought to be silenced to the' point of shunya (void) by control of the senses. This state of shunya which transcends the three familiar states of consciousness—waking, dreaming, and dreamless sleep—is
94
AMERICAN J O U R N A L O F P S Y C H O T H E R A P Y
the state' of superconsciousness in which time ceases and the present moment becomes coextensive with eternity. For the practice (abhyasa) of the yogic discipline of mental concentration through control of the senses, a prerequisite' is to be able to have control over the body, its voluntary musculature as well as its involuntary visceral functioning. Those who attend to and develop only the physical aspect of Yoga are the Hatha Yogis; those who concern themselves with the awakening of a mythical serpent power (Kundalini) are the Kundalini Yogis; while those who seek after the ultimate in Yoga are the Mahayogis. "Yoga is evenness of mind," says Krishna in the Bhagav ad-Git a, a. state attained through the practice of control over the senses and action without desire for reward. This last aspect is the distinctive accent of the Yoga of Gita called Karma Yoga (Yoga of action). Love, faith, self-surrender, and sacrifice are also attitudinal aspects of Yoga that received attention in the Gita. The kind of Yoga wherein these emotive attitudinal aspects are developed par excellence is Bhakti Yoga. Whatever the distinctive accents within the various brands of Yoga— whether control over somatic and visceral functioning, or over mental processess, or awakening of hidden energies within, or attainment of tranquility of emotive states, or even of the state of superior consciousness—each one of these can be seen to be of psychotherapeutic import. While Yoga is a method of self-culture leading to a discovery of the "self," Vedanta is the discipliné of discovering the unity of the field. I t proclaims that we discover our true "self" to be the self of the universe, Tat tvam asi (That thou art!). As such, the subject-object duality is a mere illusion. So too is the multiplicity in the entire phenomenal world. The One (Brahma) is playing a game (maya) and pretending to be many. All the woes and miseries of the world have arisen from taking this differentiation as real—differentiation between one thing and another, and especially between " I " and "thou." The answer lies in dispelling this avidya (ignorance) through jnana (true knowledge). While Vedanta emphasizes the unity of the field, Buddhism emphasizes the unreality of the ego. Ego is not a vital functioning of the organism. I t is, as Alan Watts (2) puts it, "abstracted by social influence from memories; it is the hypothetical substance upon which memory is recorded, the constant which endures through all the changes of experience. . . . It is just this which is lost in death. Oneself as a story comes to an end, which shows that the ego is in every sense a story." Buddhism has no difficulty in conceiving consciousness without an ego. In fact, in all the three psychotherapeutic systems described above, Yoga, Vedanta, and Buddhism, consciousness is deemed capable of transcending its ego condition. In all higher forms of consciousness, the ego disappears— 1
P S Y C H O T H E R A P Y I N INDIA*. P A S T , P R E S E N T , AND F U T U R E
95
this is clearly so because there remains nobody to witness it. Contrast it with what Jung (3) said, "So long as there is awareness of something, there must be somebody who is aware." Contrast it also with Freud who did not see the ego as an inappropriate adaptation. He only saw its self-contradictory nature as a social convention, but never saw that it could be altogether dispensed with and consciousness conceived without the duality of subject and object. That, then, is the distinctive face of the Indian psychotherapies of yesterday. Despite their variations, they spell the same common theme'. However, their concern is "suffering" as a generality, as afflicting all of mankind, and not essentially as a particularity, as the particular affliction of a given patient. In lack of clinical accent, then, they stand in contradistinction to the Western psychotherapies of today. Another common feature of these ancient therapeutic systems is their esoteric nature—their tenets and practices have been considered mysteries of the highest order that cannot be made accessible to any except the most worthy (adhikarin). Thus they have remained the exclusive domain of the spiritual elite and the people in general have remained bereft of their benefits. This social cleavage having become culturally accepted, has in turn made its imprint on the personality prototype within the culture. The Indian ego has essentially become a dual structure: vyavaharik ego and parmarthik ego —the two are coexistent but seldom get to be integrated. The Advent of Modern Psychotherapy While these traditional systems have been in existence for a long time, modern Western Psychotherapy is only a recent phenomenon. I t came to be introduced into India during the second decade of the present century. Girindrasekhar Bose was its harbinger, as the first Indian psychoanalyst and the founder of the Indian Psychoanalytic Society. Bose, in fact, had developed his own theory of opposite wishes and had treated his patients through an analytic method not very different from that of psychoanalysis even before he had become' familiar with Freud and his contributions. In some very important respects Bose's theory differed from Freud's, although on many basic points there was a close correspondence between them. One' of his main departures from Freud was in the area of ego psychology. He also differed with Freud regarding the "Oedipus" situation and "the wish to be female" in Hindu male patients. His findings in this respect have been confirmed by many writers, including Kelman (4), both in India and among Hindus in the United States. In 1921 Bose started his correspondence with Freud and sent him his book The Concept of Repression. Freud appreciated the book and was "glad to testify to the' correctness of its principal views and the good sense appearing in it." His surprise was great that psychoanalysis !
96
AMERICAN J O U R N A L O F P S Y C H O T H E R A P Y
should have met with so much interest and recognition in this far off country! Sinha (5), who gives a historical account of the development of psychoanalysis in India, describes in full measure' Bose's contributions. The Indian Psychoanalytic Society, as recently as 1971, had as many as 34 trained psychoanalysts as its full members, and another 27 were receiving training. However, the field of influence of the Society has not extended beyond the two largest cosmopolitan cities of India—namely, Calcutta and Bombay. In Bombay, Emilio Servido, an Italian psychonanalyst, held sway from 1937 to 1947 when he went back to Rome. Keki Masani, now settled in England, has been thé most influential of the Bombay group of psychoanalysts for years. From Delhi, Professor Satyanand, the present author's predecessor at the All-India Institute of Medical Sciences, made some theoretical contributions. He formulated what he calls "Soul Analysis" and expounded it in a number of publications (6-8). However, for most people his works are difficult reading. His basic premise is Kleinian psychotherapy which he has sought to extend and adapt to thé needs of an indigenous clientele by attempting to weld into it some traditional Indian concepts and incorporating material from Indian mythology, folklore, and scriptures. The practice of modern psychotherapy in India, has by no means been the analytic kind; it has mostly been an "incidental," "common-sense," "supportive," and "superficial" kind, not conforming consistently to any particular school, but subserving expediency in the treatment of psychiatric patients and employed mostly as an adjunct to somatotherapy. Hoch (9) who reviewed Psychotherapy and Psychoanalysis in India in 1965 observed, "while most psychiatrists are carrying on some type of psychotherapy, at least of a supportive type, only a small number of orthodox analysts can be found in India, mostly in Calcutta and Bombay. Most of them seem to trace their authentic Freudian pedigree to Dr. G. S. Bose of Calcutta. . . . Others received their initiation from Col. Berkeley Hill, the former Superintendent of Ranchi Hospital for Mental Diseases. The school of C. G. Jung, who himself spent a few weeks in India in 1938, has, as far as I know, only one authentic and fully trained representative in India." It would be no exaggeration to say that modern Western psychotherapy has not been able to take root in India. Hoch (9) states, " I n general, it seems to be difficult for Indians who have received psychotherapeutic training abroad to apply thé methods learned by them in the Indian setting. Quite a few of them get discouraged and turn back to the country where they received their training." It is my view that the failure of Western psychotherapy to take root in India springs from various causes. One major factor undoubtedly rests with certain characteristics of the patient population. A majority of our patients are illiterate. Hence any sophisticated and intellectualized therapy is inap-
P S Y C H O T H E R A P Y I N INDIA : P A S T , P R E S E N T , AND F U T U R E
97
propriate for them. They are poor—any prolonged and expensive therapy is beyond them. They consider somatic symptoms alone as justification for consulting a doctor. Thus they present themselves with somatic symptoms even when afflicted primarily with emotional disorders. They are also steeped in the folkloristic belief about the etiology of those symptoms and have certain specific expectancies from the attending physician. They expect him to bring about a quick relief of their suffering— whether by the use of medicines, incantations, mantras, or whatever. They expect their doctor to be able to know much more about them than he is told—hence they do not feel especially inclined to give him full information and are not particularly careful about its accuracy. They tend to guard their family secrets rather jealously and easily resort to conscious or unconscious denial in response to questions about delicate family matters. However, that is not all. Even when one has an educated, financially secure, and well-motivated Indian patient in therapy, it is often difficult to carry out orthodox Western psychotherapy with him if he is steeped in traditional Indian values. Any insistence at making the orthodox Western psychotherapy work with him would necessitate preliminary brainwashing of the patient. In fact, every psychotherapeutic system entails: 1. A body of concepts about the psyche and how events happen therein (psychodynamics); 2. A mode of establishing a therapeutic relationship (transference) ; 3. A vocabulary shared by the patient as well as the therapist—and this includes not only the discursive idiom but also myth and folklore; and 4. A body of techniques for manipulating dynamics within the psyche. Every psychodynamic system relates itself to the ethnodynamic and sociodynamic systems from which it springs, to which it has relevance, and within whose universe alone it remains valid. As such, every psychotherapeutic system has a specific cultural universe of validity. Outside that it may not be abte to function at all. I t is this lack of cultural relevance that makes orthodox Western psychotherapies especially ineffective in India because neither the psychodynamic concepts and metaconcepts, nor the style and significance of therapeutic relationship, nor even the precise techniques of manipulating the psyche appear culturally relevant here. I t is this realization, then, that makes one wonder about the future of psychotherapy in India. Future of Psychotherapy Let me briefly examine what has happened to Western psychotherapy in the West before I turn to the future of psychotherapy in India. In the West, psychotherapy started as a clinical discipline—that is how it happens to be called psychotherapy—with a focus on the individual patient. The neo-Freudians sought to relate the individual to his sociocultural setting
98
AMERICAN JOURNAL OF P S Y C H O T H E R A P Y
and treat him not as a clinical isolate but as a part of the cultural setting. However, their basic premise was that culture was a collective effort to create a more or less efficient solution to the problem of survival. The new neoFreudians, especially Brown (10), Marcuse (11), and Rieff (12) have focused their attention on mutability of culture and social change. They seem to hold that culture is not an efficient collective solution to the problems of survival, but is "a system of symbols which may exist quite independent of, and even in opposition to, principles of efficient adaptation." As such, the cultural context is gradually giving way to a transcultural or universal context. The orthodox Western psychotherapy with its narrow focus on the' individual patient functioned reasonably well so long as it confined itself to the dyadic clinical setting. However, when its findings were generalized and affirmed as applicable' to all—normal as well as abnormal individually as well as collectively—that none too salutory results seem to have ensued. In fact, La Pierre (13) in his book The Freudian Ethic ascribes the "devastation" of the American character to the effects of this ethic. The West, especially America, has shown indications that it is gradually turning now to those psychotherapeutic systems which started not with the misery of a given man, but the misery of mankind as a whole. Just as the Eastern psychotherapeutic systems lacked the clinical bias, the Western systems have lacked a universal framework for which they now seem to be groping. The future of psychotherapy, then, whether in the East or the West, is going to be the same. And that is, first finding out a psychotherapeutic system with universal validity and then within its framework devising minor ad hoc therapeutic subsystems—whether for the relief of symptoms, or personality development, or straightening out adjustment problems. The trouble with ancient Indian psychotherapies is that they are shrouded in mystical and pseudomystical terminologies. Of these they must be divested and much of their a priori assumptions tested before they can provide a valid framework for a universal psychotherapeutic system. The current experimental work on transcendental meditation and the newer interpretations and modern applications of Yoga and Zen Buddhism in therapeutic work in Eastern as well as Western centers and the gradual realization in the West that Western psychotherapy, like Christianity, is not necessarily legitimate export cargo will pave the' way for the desired synthesis. The future of psychotherapy in India, then, lies in moving toward the attainment of such a synthesis. What is required is not a chauvinistic defense of Indian systems of psychotherapy, but a readiness to re-examiné them with a scientific outlook (and describe the conclusions in scientific terminology), and to explore the indications and limitations of their application as therapeutic weapons. Some
P S Y C H O T H E R A P Y I N I N D I A ! P A S T , P R E S E N T , AND F U T U R E
99
pioneering work already seems to have started in this regard. The physiologic effects of Yoga, for example, have been studied by Anand et al. (14), and Wenger and Bagchi (15). The physiologic correlates of Zen meditation have likewise' been studied by Kasamatsu and Hirai (16) in Japan and of transcendental meditation by Allison (17) and Wallace (18), among others, in the United States. The clinical application of Patanjali Yoga in certain psychosomatic disorders has been investigated by Vahia et al. (19). Gell¬ horn and Kiely (20) have reported beneficial effects of transcendental meditation and Zen in "anxiously depressed, impulse-driven adolescents and young adults formerly dependent upon psychedelic or other dangerous drugs." There is reason to believe, according to Gellhorn and Kiely that these techniques may also be useful clinically in the treatment of "psychosomatic tension states, anxiety, and phobic reaction." The same authors have observed autonomic and somatic function changes in meditation and in certain other techniques such as autogenic training, progressive relaxation, and systematic desensitization. I have commented elsewhere (21) on the cultural relativism of the' techniques and concepts of psychotherapy. Cultures are more or less expressive. The Western psychotherapist with such techniques as free association, dream interpretation, and working through is a product of an overly expressive culture, while the guru with his meditational, contemplative and other "mindquieting" methods is an evolute of a "suppressive" culture where emphasis is on self-disciplining rather than on self-expression. As such, the therapeutic relationship in India will have to have the guru-chela relationship as its model. Unlike' surgery, psychotherapy cannot be expected to have universally uniform techniques. This is because psychotherapeutic techniques are not pieces of hard technology but ways of soft communication. They have to be culturally relevant. Hence the idiom of any psychotherapeutic system has essentially to conform to the myths, legends, beliefs, and languages of the people with whom it is to be practiced. SUMMARY
Western psychotherapy, as it is, is hardly applicable to the multitudes in India—except for a handful of Westernized Indians living in large cosmopolitan cities. The future of psychotherapy in India, though hard to predict, can be seen to lie in discovering the strengths (and weaknesses) of her traditional psychotherapeutic techniques and elaborating them more scientifically into clinically serviceable therapeutic systems. These' systems, of necessity, would make use of the native metapsychologic concepts and idioms for communication with people for whom these concepts and idioms already constitute a part of folklore. 1
100
AMERICAN JOURNAL OF P S Y C H O T H E R A P Y
REFERENCES
1. Rhys Davids, T . W. Dialogues of the Buddha, Vol. 1. Oxford University Press, London, 1899. 2. Watts, A. Psychotherapy, East and West. Mentor Books, New York, 1963. 3. Jung, G. G. Psychology and Religion. Collected Works, Vol. 2. Routledge & Kegan Paul, London, 1958. 4. Kelman, H . Helping People. Science House, New York, 1971. 5. Sinha, T . G. Development of Psychoanalysis in India. Ind. J. Psychoanal., 47: 427, 1956. 6. Satyanand,
The
D.
Objective
Method
of Dream
Interpretation.
Northern
India Printing & Publishing Co., Lahore, 1947. 7.
.
Preliminary
analysis). 8.
.
Notes on the Findings
of Soul
Analysis
(Total
Psycho¬
Published by the Arthur, 1951.
Dynamic
Psychology
of the Gita
of Hinduism.
Oxford and India
Book House, New Delhi, 1972. 9. Hoch, E . M.
Psychotherapy and Psychoanalysis in India (unpublished).
10. Brown, N. O. Life Against Death. Vintage Books, New York, 1959. 11. Marcuse, H . Eros and Civilization. Beacon Press, Boston, 1955. 12. Rieff, P.
Freud:
The Mind
of the Moralist.
Harper & Row,
1961.
13. L a Pierre, R. The Freudian Ethic. Duell, Sloan & Pierce, New York, 1957. 14. Anand, B. K., Chhina, G . S., and Singh, B. Some Aspects of Electroencephalographic Studies in Yogis. /. Electroencephal. Clin. Neurophysiol., 13:452, 1961. 15. Wenger, M. A. and Bagchi, B. K . Studies of Automatic Functions in Practitioners of Yoga in India. Behav. Science 6:312, 1961. 16. Kasamatsu, A. and Hirai, T . An Electroencephalographic Study on the Zen Meditation (Zazen). Folia Psychiat. Neurol. Jap., 20:316, 1966. 17. Allison, J . Respiration Changes During Transcendental Meditation. Lancet, 1:833, 1970. 18. Wallace, R. K., Benson, A., and Wilson, A. F . Physiological Effects of Transcendental Meditation. Science 167:1751, 1970. 19. Vahia, N. S., Doonga Ji, D. F . , and Deshmukh, D. K . A Deconditioning Therapy Based Upon Concepts of Patanjali. Int. J. Soc. Psychiat. 18:6166, 1972. 20. Gellhorn, E . and Kiely, W. F . Mystical States of Consciousness: Neurophysiol o g y and Clinical Aspects. /. Nerv. Ment. Dis., 154:399, 1972. 21. Neki, J . S. A Reappraisal of the Guru-Chela Relationship as a Therapeutic Paradigm.
Int. Ment. Health. Res. Newsletter,
16:2,
1974.
F.R.C.
(PSY)*
| New Delhi,
India
If psychotherapy is defined as "interpersonal method of mitigating suffering then many psychotherapeutic systems have existed in India a long time. Unlike Western systems, these have lacked a clinical bias but have provided a more global framework. The future of psychotherapy in both East and West lies in discovering a conceptual framework with universal validity within which ad hoc therapies—for symptom relief, personality development, or interpersonal adjustment—can be developed. 33
INTRODUCTION
Rhys Davis (1), in Dialogues of the Buddha, records a piece of conversation between a mendicant Potthapada and the Buddha in which the former asks the Exalted One a series of questions: Sir, tell me; Is this world eternal? Is the world not eternal? Is the world finite? Is the world infinite? Is the soul the same as the body? Is the soul one thing and the body another? Does one who has gained the truth live again after death? Does he not live again after death? Does he both live again, and not live again after death? Does he neither live again nor not live again after death?
But to each question the Exalted One made the same reply, saying, "that, Potthapada, is a matter on which I have expressed no opinion." "Then what is it the Exalted One has, in fact, determined?" " I have expounded, Potthapada, what is suffering; I have expounded what is the origin of suffering; I have expounded what is the cessation of suffering; I have expounded what is the method by which one may reach the cessation of suffering." If psychotherapy can be defined as "the interpersonal method of mitigating suffering," then the Exalted One can be' said really to have concerned himself with propounding a psychotherapeutic system. However, we today who have different notions of psychotherapy, find it hard to understand in what way the Buddha was a psychotherapist. The Buddha himself alludes to the reason for our confusion. When Potthapada * Professor and Head, Department of Psychiatry, All-India Institute of Medical Sciences, New Delhi, India 110016.
92
P S Y C H O T H E R A P Y I N I N D I A ! P A S T , P R E S E N T , AND F U T U R E
93
asked him "Is it possible, Sir, for me to understand whether consciousness is the man's soul, or the one is different from the other?" the Buddha replied, "Hard is it for you, Potthapada, holding as you do different views, setting different aims before yourself, trained in a different system of doctrine, to grasp this matter." We, today, who have come to hold different views, set before ourselves different aims and have been trained in a different system of doctrine may find it equally hard to grasp the psychotherapeutic systems of Buddha, and for that matter, any of the Indian psychotherapies of yesterday. True, they do not study mind as a clinical entity. Yet, if one knows that they purport to bring about changes in consciousness and our awareness of our feelings, and they also tend to modify our relations with our natural and social surroundings, one cannot but designate' them as "psychotherapies" in a wider sense. Hence, it is important for us to make an effort to understand those well developed psychotherapeutic systems of yesterday that have remained in existence for centuries in India, before one attempts to compare them with the so-called modern psychotherapies of today that form a part of our technological imports from the West. Such an exercise should be considered a logical prerequisite for any attempt at predicting what kind of future psychotherapy is likely to have in India. The "Psychotherapies" of Yesterday All the ancient Indian systems of psychotherapy, despite their variable, and at times even diametrically opposite, techniques, ultimately aim at attainment of liberation. Variously called moksha, turiya, nirvana, and so on, in the respective distinctive vocabularies of these systems and differing somewhat in some details, liberation has been considered a state of release from the throes of time and the cycle of samsara—birth, death, reincarnation, and all the existential exigencies that go with them. In Vedanta and Yoga this is achieved through the awakening of the true "Self," and in Buddhism through the realization that the process of life is not happening to any subject, so that there no longer remains anyone to be reincarnated. Even the Tantrics who, paradoxically, follow the path of sensual indulgence set liberation as their goal. Their use of sexuality is embedded in the actual discipline of liberation. They aim at achieving detachment through satiation of the senses, satiation—even disgust—to be obtained by excessive indulgence. Of all these systems, Yoga and Zen Buddhism are the best developed and the best known. Patanjali Yoga has as its basic tenet, citta vritti nirodha, or control of the flux of mind. Mind is sought to be silenced to the' point of shunya (void) by control of the senses. This state of shunya which transcends the three familiar states of consciousness—waking, dreaming, and dreamless sleep—is
94
AMERICAN J O U R N A L O F P S Y C H O T H E R A P Y
the state' of superconsciousness in which time ceases and the present moment becomes coextensive with eternity. For the practice (abhyasa) of the yogic discipline of mental concentration through control of the senses, a prerequisite' is to be able to have control over the body, its voluntary musculature as well as its involuntary visceral functioning. Those who attend to and develop only the physical aspect of Yoga are the Hatha Yogis; those who concern themselves with the awakening of a mythical serpent power (Kundalini) are the Kundalini Yogis; while those who seek after the ultimate in Yoga are the Mahayogis. "Yoga is evenness of mind," says Krishna in the Bhagav ad-Git a, a. state attained through the practice of control over the senses and action without desire for reward. This last aspect is the distinctive accent of the Yoga of Gita called Karma Yoga (Yoga of action). Love, faith, self-surrender, and sacrifice are also attitudinal aspects of Yoga that received attention in the Gita. The kind of Yoga wherein these emotive attitudinal aspects are developed par excellence is Bhakti Yoga. Whatever the distinctive accents within the various brands of Yoga— whether control over somatic and visceral functioning, or over mental processess, or awakening of hidden energies within, or attainment of tranquility of emotive states, or even of the state of superior consciousness—each one of these can be seen to be of psychotherapeutic import. While Yoga is a method of self-culture leading to a discovery of the "self," Vedanta is the discipliné of discovering the unity of the field. I t proclaims that we discover our true "self" to be the self of the universe, Tat tvam asi (That thou art!). As such, the subject-object duality is a mere illusion. So too is the multiplicity in the entire phenomenal world. The One (Brahma) is playing a game (maya) and pretending to be many. All the woes and miseries of the world have arisen from taking this differentiation as real—differentiation between one thing and another, and especially between " I " and "thou." The answer lies in dispelling this avidya (ignorance) through jnana (true knowledge). While Vedanta emphasizes the unity of the field, Buddhism emphasizes the unreality of the ego. Ego is not a vital functioning of the organism. I t is, as Alan Watts (2) puts it, "abstracted by social influence from memories; it is the hypothetical substance upon which memory is recorded, the constant which endures through all the changes of experience. . . . It is just this which is lost in death. Oneself as a story comes to an end, which shows that the ego is in every sense a story." Buddhism has no difficulty in conceiving consciousness without an ego. In fact, in all the three psychotherapeutic systems described above, Yoga, Vedanta, and Buddhism, consciousness is deemed capable of transcending its ego condition. In all higher forms of consciousness, the ego disappears— 1
P S Y C H O T H E R A P Y I N INDIA*. P A S T , P R E S E N T , AND F U T U R E
95
this is clearly so because there remains nobody to witness it. Contrast it with what Jung (3) said, "So long as there is awareness of something, there must be somebody who is aware." Contrast it also with Freud who did not see the ego as an inappropriate adaptation. He only saw its self-contradictory nature as a social convention, but never saw that it could be altogether dispensed with and consciousness conceived without the duality of subject and object. That, then, is the distinctive face of the Indian psychotherapies of yesterday. Despite their variations, they spell the same common theme'. However, their concern is "suffering" as a generality, as afflicting all of mankind, and not essentially as a particularity, as the particular affliction of a given patient. In lack of clinical accent, then, they stand in contradistinction to the Western psychotherapies of today. Another common feature of these ancient therapeutic systems is their esoteric nature—their tenets and practices have been considered mysteries of the highest order that cannot be made accessible to any except the most worthy (adhikarin). Thus they have remained the exclusive domain of the spiritual elite and the people in general have remained bereft of their benefits. This social cleavage having become culturally accepted, has in turn made its imprint on the personality prototype within the culture. The Indian ego has essentially become a dual structure: vyavaharik ego and parmarthik ego —the two are coexistent but seldom get to be integrated. The Advent of Modern Psychotherapy While these traditional systems have been in existence for a long time, modern Western Psychotherapy is only a recent phenomenon. I t came to be introduced into India during the second decade of the present century. Girindrasekhar Bose was its harbinger, as the first Indian psychoanalyst and the founder of the Indian Psychoanalytic Society. Bose, in fact, had developed his own theory of opposite wishes and had treated his patients through an analytic method not very different from that of psychoanalysis even before he had become' familiar with Freud and his contributions. In some very important respects Bose's theory differed from Freud's, although on many basic points there was a close correspondence between them. One' of his main departures from Freud was in the area of ego psychology. He also differed with Freud regarding the "Oedipus" situation and "the wish to be female" in Hindu male patients. His findings in this respect have been confirmed by many writers, including Kelman (4), both in India and among Hindus in the United States. In 1921 Bose started his correspondence with Freud and sent him his book The Concept of Repression. Freud appreciated the book and was "glad to testify to the' correctness of its principal views and the good sense appearing in it." His surprise was great that psychoanalysis !
96
AMERICAN J O U R N A L O F P S Y C H O T H E R A P Y
should have met with so much interest and recognition in this far off country! Sinha (5), who gives a historical account of the development of psychoanalysis in India, describes in full measure' Bose's contributions. The Indian Psychoanalytic Society, as recently as 1971, had as many as 34 trained psychoanalysts as its full members, and another 27 were receiving training. However, the field of influence of the Society has not extended beyond the two largest cosmopolitan cities of India—namely, Calcutta and Bombay. In Bombay, Emilio Servido, an Italian psychonanalyst, held sway from 1937 to 1947 when he went back to Rome. Keki Masani, now settled in England, has been thé most influential of the Bombay group of psychoanalysts for years. From Delhi, Professor Satyanand, the present author's predecessor at the All-India Institute of Medical Sciences, made some theoretical contributions. He formulated what he calls "Soul Analysis" and expounded it in a number of publications (6-8). However, for most people his works are difficult reading. His basic premise is Kleinian psychotherapy which he has sought to extend and adapt to thé needs of an indigenous clientele by attempting to weld into it some traditional Indian concepts and incorporating material from Indian mythology, folklore, and scriptures. The practice of modern psychotherapy in India, has by no means been the analytic kind; it has mostly been an "incidental," "common-sense," "supportive," and "superficial" kind, not conforming consistently to any particular school, but subserving expediency in the treatment of psychiatric patients and employed mostly as an adjunct to somatotherapy. Hoch (9) who reviewed Psychotherapy and Psychoanalysis in India in 1965 observed, "while most psychiatrists are carrying on some type of psychotherapy, at least of a supportive type, only a small number of orthodox analysts can be found in India, mostly in Calcutta and Bombay. Most of them seem to trace their authentic Freudian pedigree to Dr. G. S. Bose of Calcutta. . . . Others received their initiation from Col. Berkeley Hill, the former Superintendent of Ranchi Hospital for Mental Diseases. The school of C. G. Jung, who himself spent a few weeks in India in 1938, has, as far as I know, only one authentic and fully trained representative in India." It would be no exaggeration to say that modern Western psychotherapy has not been able to take root in India. Hoch (9) states, " I n general, it seems to be difficult for Indians who have received psychotherapeutic training abroad to apply thé methods learned by them in the Indian setting. Quite a few of them get discouraged and turn back to the country where they received their training." It is my view that the failure of Western psychotherapy to take root in India springs from various causes. One major factor undoubtedly rests with certain characteristics of the patient population. A majority of our patients are illiterate. Hence any sophisticated and intellectualized therapy is inap-
P S Y C H O T H E R A P Y I N INDIA : P A S T , P R E S E N T , AND F U T U R E
97
propriate for them. They are poor—any prolonged and expensive therapy is beyond them. They consider somatic symptoms alone as justification for consulting a doctor. Thus they present themselves with somatic symptoms even when afflicted primarily with emotional disorders. They are also steeped in the folkloristic belief about the etiology of those symptoms and have certain specific expectancies from the attending physician. They expect him to bring about a quick relief of their suffering— whether by the use of medicines, incantations, mantras, or whatever. They expect their doctor to be able to know much more about them than he is told—hence they do not feel especially inclined to give him full information and are not particularly careful about its accuracy. They tend to guard their family secrets rather jealously and easily resort to conscious or unconscious denial in response to questions about delicate family matters. However, that is not all. Even when one has an educated, financially secure, and well-motivated Indian patient in therapy, it is often difficult to carry out orthodox Western psychotherapy with him if he is steeped in traditional Indian values. Any insistence at making the orthodox Western psychotherapy work with him would necessitate preliminary brainwashing of the patient. In fact, every psychotherapeutic system entails: 1. A body of concepts about the psyche and how events happen therein (psychodynamics); 2. A mode of establishing a therapeutic relationship (transference) ; 3. A vocabulary shared by the patient as well as the therapist—and this includes not only the discursive idiom but also myth and folklore; and 4. A body of techniques for manipulating dynamics within the psyche. Every psychodynamic system relates itself to the ethnodynamic and sociodynamic systems from which it springs, to which it has relevance, and within whose universe alone it remains valid. As such, every psychotherapeutic system has a specific cultural universe of validity. Outside that it may not be abte to function at all. I t is this lack of cultural relevance that makes orthodox Western psychotherapies especially ineffective in India because neither the psychodynamic concepts and metaconcepts, nor the style and significance of therapeutic relationship, nor even the precise techniques of manipulating the psyche appear culturally relevant here. I t is this realization, then, that makes one wonder about the future of psychotherapy in India. Future of Psychotherapy Let me briefly examine what has happened to Western psychotherapy in the West before I turn to the future of psychotherapy in India. In the West, psychotherapy started as a clinical discipline—that is how it happens to be called psychotherapy—with a focus on the individual patient. The neo-Freudians sought to relate the individual to his sociocultural setting
98
AMERICAN JOURNAL OF P S Y C H O T H E R A P Y
and treat him not as a clinical isolate but as a part of the cultural setting. However, their basic premise was that culture was a collective effort to create a more or less efficient solution to the problem of survival. The new neoFreudians, especially Brown (10), Marcuse (11), and Rieff (12) have focused their attention on mutability of culture and social change. They seem to hold that culture is not an efficient collective solution to the problems of survival, but is "a system of symbols which may exist quite independent of, and even in opposition to, principles of efficient adaptation." As such, the cultural context is gradually giving way to a transcultural or universal context. The orthodox Western psychotherapy with its narrow focus on the' individual patient functioned reasonably well so long as it confined itself to the dyadic clinical setting. However, when its findings were generalized and affirmed as applicable' to all—normal as well as abnormal individually as well as collectively—that none too salutory results seem to have ensued. In fact, La Pierre (13) in his book The Freudian Ethic ascribes the "devastation" of the American character to the effects of this ethic. The West, especially America, has shown indications that it is gradually turning now to those psychotherapeutic systems which started not with the misery of a given man, but the misery of mankind as a whole. Just as the Eastern psychotherapeutic systems lacked the clinical bias, the Western systems have lacked a universal framework for which they now seem to be groping. The future of psychotherapy, then, whether in the East or the West, is going to be the same. And that is, first finding out a psychotherapeutic system with universal validity and then within its framework devising minor ad hoc therapeutic subsystems—whether for the relief of symptoms, or personality development, or straightening out adjustment problems. The trouble with ancient Indian psychotherapies is that they are shrouded in mystical and pseudomystical terminologies. Of these they must be divested and much of their a priori assumptions tested before they can provide a valid framework for a universal psychotherapeutic system. The current experimental work on transcendental meditation and the newer interpretations and modern applications of Yoga and Zen Buddhism in therapeutic work in Eastern as well as Western centers and the gradual realization in the West that Western psychotherapy, like Christianity, is not necessarily legitimate export cargo will pave the' way for the desired synthesis. The future of psychotherapy in India, then, lies in moving toward the attainment of such a synthesis. What is required is not a chauvinistic defense of Indian systems of psychotherapy, but a readiness to re-examiné them with a scientific outlook (and describe the conclusions in scientific terminology), and to explore the indications and limitations of their application as therapeutic weapons. Some
P S Y C H O T H E R A P Y I N I N D I A ! P A S T , P R E S E N T , AND F U T U R E
99
pioneering work already seems to have started in this regard. The physiologic effects of Yoga, for example, have been studied by Anand et al. (14), and Wenger and Bagchi (15). The physiologic correlates of Zen meditation have likewise' been studied by Kasamatsu and Hirai (16) in Japan and of transcendental meditation by Allison (17) and Wallace (18), among others, in the United States. The clinical application of Patanjali Yoga in certain psychosomatic disorders has been investigated by Vahia et al. (19). Gell¬ horn and Kiely (20) have reported beneficial effects of transcendental meditation and Zen in "anxiously depressed, impulse-driven adolescents and young adults formerly dependent upon psychedelic or other dangerous drugs." There is reason to believe, according to Gellhorn and Kiely that these techniques may also be useful clinically in the treatment of "psychosomatic tension states, anxiety, and phobic reaction." The same authors have observed autonomic and somatic function changes in meditation and in certain other techniques such as autogenic training, progressive relaxation, and systematic desensitization. I have commented elsewhere (21) on the cultural relativism of the' techniques and concepts of psychotherapy. Cultures are more or less expressive. The Western psychotherapist with such techniques as free association, dream interpretation, and working through is a product of an overly expressive culture, while the guru with his meditational, contemplative and other "mindquieting" methods is an evolute of a "suppressive" culture where emphasis is on self-disciplining rather than on self-expression. As such, the therapeutic relationship in India will have to have the guru-chela relationship as its model. Unlike' surgery, psychotherapy cannot be expected to have universally uniform techniques. This is because psychotherapeutic techniques are not pieces of hard technology but ways of soft communication. They have to be culturally relevant. Hence the idiom of any psychotherapeutic system has essentially to conform to the myths, legends, beliefs, and languages of the people with whom it is to be practiced. SUMMARY
Western psychotherapy, as it is, is hardly applicable to the multitudes in India—except for a handful of Westernized Indians living in large cosmopolitan cities. The future of psychotherapy in India, though hard to predict, can be seen to lie in discovering the strengths (and weaknesses) of her traditional psychotherapeutic techniques and elaborating them more scientifically into clinically serviceable therapeutic systems. These' systems, of necessity, would make use of the native metapsychologic concepts and idioms for communication with people for whom these concepts and idioms already constitute a part of folklore. 1
100
AMERICAN JOURNAL OF P S Y C H O T H E R A P Y
REFERENCES
1. Rhys Davids, T . W. Dialogues of the Buddha, Vol. 1. Oxford University Press, London, 1899. 2. Watts, A. Psychotherapy, East and West. Mentor Books, New York, 1963. 3. Jung, G. G. Psychology and Religion. Collected Works, Vol. 2. Routledge & Kegan Paul, London, 1958. 4. Kelman, H . Helping People. Science House, New York, 1971. 5. Sinha, T . G. Development of Psychoanalysis in India. Ind. J. Psychoanal., 47: 427, 1956. 6. Satyanand,
The
D.
Objective
Method
of Dream
Interpretation.
Northern
India Printing & Publishing Co., Lahore, 1947. 7.
.
Preliminary
analysis). 8.
.
Notes on the Findings
of Soul
Analysis
(Total
Psycho¬
Published by the Arthur, 1951.
Dynamic
Psychology
of the Gita
of Hinduism.
Oxford and India
Book House, New Delhi, 1972. 9. Hoch, E . M.
Psychotherapy and Psychoanalysis in India (unpublished).
10. Brown, N. O. Life Against Death. Vintage Books, New York, 1959. 11. Marcuse, H . Eros and Civilization. Beacon Press, Boston, 1955. 12. Rieff, P.
Freud:
The Mind
of the Moralist.
Harper & Row,
1961.
13. L a Pierre, R. The Freudian Ethic. Duell, Sloan & Pierce, New York, 1957. 14. Anand, B. K., Chhina, G . S., and Singh, B. Some Aspects of Electroencephalographic Studies in Yogis. /. Electroencephal. Clin. Neurophysiol., 13:452, 1961. 15. Wenger, M. A. and Bagchi, B. K . Studies of Automatic Functions in Practitioners of Yoga in India. Behav. Science 6:312, 1961. 16. Kasamatsu, A. and Hirai, T . An Electroencephalographic Study on the Zen Meditation (Zazen). Folia Psychiat. Neurol. Jap., 20:316, 1966. 17. Allison, J . Respiration Changes During Transcendental Meditation. Lancet, 1:833, 1970. 18. Wallace, R. K., Benson, A., and Wilson, A. F . Physiological Effects of Transcendental Meditation. Science 167:1751, 1970. 19. Vahia, N. S., Doonga Ji, D. F . , and Deshmukh, D. K . A Deconditioning Therapy Based Upon Concepts of Patanjali. Int. J. Soc. Psychiat. 18:6166, 1972. 20. Gellhorn, E . and Kiely, W. F . Mystical States of Consciousness: Neurophysiol o g y and Clinical Aspects. /. Nerv. Ment. Dis., 154:399, 1972. 21. Neki, J . S. A Reappraisal of the Guru-Chela Relationship as a Therapeutic Paradigm.
Int. Ment. Health. Res. Newsletter,
16:2,
1974.
