A Clinical Interpretation Of The Term Vishaada W.s.r. To Generalized Anxiety Disorder!

A Clinical Interpretation Of The Term Vishaada W.s.r. To Generalized Anxiety Disorder

Vishaada is a psychological disorder as old as mankind. The Ayurvedic texts have vividly described various mental disorders and psychological disturbances. But the detailed description of these disorders is arbitrary except for Unmada and Apasmara. One such ill-defined and an unexplored term is Vishaada. Its references are so scattered which makes it very difficult for the clinicians to differentiate and diagnose this condition. Ayurvedic researchers have tried to study and compare the symptomatology of Generalized Anxiety Disorder under the umbrella of several psychological entities but there has been a lacuna in establishing a concrete conclusion to establish a comparative modern clinical entity in simulation to Vishaada. Ayurvedic medical literature was carried out. Although this work focuses primarily on Ayurveda, multidisciplinary literature and research have been analyzed along with the philosophical literature that relates to Vishaada. After studying the disorder in detail it was concluded that the psychological and somatic presentation of the disease entity Vishaada is similar to Generalized Anxiety Disorder.

Introduction

Ayurveda is one of the most ancient systems of medicine in the world. It is a science of life, health, and cure based on the eternal laws of nature. This unique Ancient Indian Wisdom has survived vividly down the ages and is flourishing in the present times in newer dimensions attracting the attention globally. According to Ayurveda mental health is a state of sensorial, mental and spiritual well being. The mental ill health is brought about essentially as a result of unwholesome interaction between the individual and his environment.

A wide range of psychiatric conditions has been described in Ayurveda. Primary psychological conditions caused purely by Manasa Doshas, i.e. Rajas and Tamas include Kama, Krodha, Moha, Shoka, Bhaya, Irshya, Vishaada, etc. Moreover, other psychiatric conditions are also described in the classical literature caused by mixed Samprapti including both the Sharirika and Manas Doshas.
In the Ayurvedic classics, Vishaada is not described as a separate disease entity but references regarding Vishaada are found scattered in most Indian classics. A few of earlier done research works have projected the term Vishaada as Depression. But looking into the pathophysiology and symptomatic presentation of Vishaada, this evaluation did not seem to be concrete. On the other hand, ayurvedic researchers have tried to study and compare the symptomatology of Generalized Anxiety Disorder under the umbrella of several psychological entities like Chittodvega, Anavasthittachitta, Attatvabhinivesha, etc. In both the cases, there has been a lacuna in establishing a concrete conclusion to establish a comparative modern clinical entity in simulation to Vishaada.
 

In spite of the scarcity of direct references of Vishaada, the available references have more than sufficient potential to elaborate and establish an understandable disease review of this condition. This is supplemented by the description of Vishaada in Srimad Bhagavad Gita. This description helps in designing the framework of disease Vishaada. Taking into consideration all these facts a hypothesis to understand Vishaada in context of Generalized Anxiety disorder was made and after studying the disorder in detail it was concluded that the psychological and somatic presentation of the disease entity Vishaada is similar to Generalized Anxiety Disorder of modern psychiatry.

Definition and symptomatology of Vishaada

Various authors have derived, defined and interpreted the term Vishaada in different ways. A few of which have been described below
 Shabda Kalpadruma and Vachaspatyam refer to Vishaada as Avasada. Vishaada=Manoavsada=Swakarya Akshamatva=Inability of mind to perform its routine functions effectively (Vachaspatyam).
 Monier Williams gives the meaning of Vishaada as drooping state, lassitude, depression, languor.
Looking into the dictionary meaning of this word it appears that Vishaada resembles depression but having a closer look at other references present in Ayurvedic texts and the epitome of ancient psychology – Bhagavad Gita the symptomatology of Vishaada shows a great resemblance to the features of Generalized Anxiety Disorder.
“Asiddhibhayat vividheshu karmeshu apravritti vishaada” Dalhana defines Vishaada as a condition originated from apprehension of failure resulting into incapability of mind and body to function properly. There is a significant reduction in both the activities. This condition arises out of low self-esteem. Low self-esteem leads to the low-performance expectation which again leads to high anxiety (Udvignata) and reduced effort (Apravritti).

According to modern psychiatry, anxiety is defined as a phenomenon which is characterized by a state of apprehension or unease arising out of anticipation of danger. It is well reported that patients with generalized anxiety disorder appear to have autonomic hypo responsiveness[8] which does not necessarily mean that the patient is suffering from depression.
“Vishaado anushtheyo atmanam ashaktatajananam.” In this definition, Chakrapani comments that Vishaada is a feeling of incompetence to accomplish or perform the desired work.

To perform well or to achieve a goal, one needs a moderate amount of anxiety to anticipate and apprehend the consequence of a decision or behavior. But when a person is unable to cope up with this stress it leads to a feeling of incompetence to accomplish the desired goal and leads to an intense disagreeable state, associated with an undefined threat to one‟s physical and psychological self. Subjectively patient use words such as tense, panicky, terrified, jittery, nervous, wound up, and apprehensive.

Generalized anxiety disorder is characterized by a pattern of frequent, persistent worry and anxiety that is out of proportion to the impact of the event or circumstance that is the focus of the worry. For getting a clear picture of Vishaada it is important to review the literature available in the acclaimed book of psychological counseling since ages i.e. Bhagwad Gita

In the first chapter of Bhagwad Gita named as „Arjuna Vishaada Yoga‟, when Arjuna sees most of his relatives, friends, and elders lined opposite to him in the war he develops Vishaada which is specified by the Vishidayantee process. Due to this Vishaada, he develops certain symptoms presented below which are quite similar to symptoms of Generalized Anxiety Disorder. As a result of this disorder, he develops dejection and flight reaction. For which Lord Krishna begins psychological counseling and clears his misconceptions one by one.

A clear understanding of each symptom of Vishaada mentioned by Shri Krishna is Bhagwad Gita provides a platform for understanding the presentation of symptoms in Generalized Anxiety Disorder.

In the Ayurvedic classics, Vishaada is not described as a separate disease entity but references regarding Vishaada are found scattered in most Indian classics. It may be due to Pravara sattva and comparatively less stressful lifestyle of our ancestors that Vishaada has not been described as a separate disease entity in our classics. But realizing the nuisance value of this condition Acharya Charaka has included it in the “Agrya Samgraha” as “Vishado Roga Vardhanaanaam”. In spite of the scarcity of direct references to Vishaada, the available. references have more than sufficient potential to elaborate and establish an understable disease review of this condition. This is supplemented by the description of Vishaada in “Srimad Bhagvad Gita”.This description helps in designing the framework of disease Vishaada.
A few of earlier done research works have projected the term Vishaada as Depression. But looking into the pathophysiology and symptomatic presentation of Vishaada this evaluation did not seem to be concrete. On the other hand ayurvedic researchers have tried to study and compare the symptomatology of Generalized Anxiety Disorder under the umbrella of several psychological entities like Chittodvega, Anavasthittachitta, Attatvabhinivesha, etc. In both the cases there has been a lacuna in establishing a concrete conclusion to establish a comparative modern clinical entity in simulation to Vishaada.

Taking into consideration all these facts a hypothesis to understand Vishaada in context of Generalized Anxiety disorder was made and after studying the disorder in detail it was concluded that the psychological and somatic presentation of the disease entity Vishaada is similar to Generalized Anxiety Disorder of modern psychiatry.

The dictionary meaning of the word Vishaada is misguiding and leads us to a wrong simulation of this condition with Depression but having a closer look at other references present in Ayurvedic texts and the epitome of ancient psychology – Bhagavad Gita the symptomatology of Vishaada shows a great resemblance to the features of Generalized Anxiety Disorder.
Dalhana defines Vishaada as a condition originated from apprehension of failure resulting into incapability of mind and body to function properly which is quite similar to the definition of anxiety given by modern psychiatry i.e. a phenomenon which is characterized by a state of apprehension or unease arising out of anticipation of danger.This condition arises out of low self-esteem. Low self-esteem leads to low-performance expectation which again leads to high anxiety (Udvignata) and reduced effort (Apravritti). It is well supported by the fact that patients with generalized anxiety disorder appear to have autonomic hypo responsiveness which does not necessarily mean that the patient is suffering from depression.
Chakrapani comments that Vishaada is a feeling of incompetence to accomplish or perform the desired work. To perform well or to achieve a goal, one needs a moderate amount of anxiety to anticipate and apprehend the consequence of a decision or behavior. Subjectively patient use words such as tense, panicky, terrified, jittery, nervous, wound up, and apprehensive. When a person is unable to cope up with this daily stress it leads to a feeling of incompetence to accomplish the desired goal and leads to an intense disagreeable state, associated with an undefined threat to one‟s physical and psychological self.
Gangadhara and Arundatta describes Vishaada as “Sarvada manah khedah” and “Dukhkhitvam” respectively which similar to definition of Generalized anxiety disorder which is characterized by a pattern of frequent, persistent worry and anxiety that is out of proportion to the impact of the event or circumstance that is the focus of the worry.
Although various authors have tried to interpret Vishaada in their own way but Bhagwad-Gita the essence of Vedic Literature shows us the path to interpret this condition and providing the base of understanding Generalized Anxiety Disorder in context of Vishaada. Arjuna got anxious when he saw his relatives with whom he had to fight. To motivate him the Bhagavad-Gita is preached in the battle field Kurukshetra by Lord Krishna to Arjuna as counseling to do his duty while multitudes of men stood by waiting. Arjuna faced the problem of conflict between emotions and intellect. Due to this Vishaada he develops certain symptoms presented below which are quite similar to symptoms of Generalized Anxiety Disorder. As a result of this disorder he develops dejection and flight reaction. For which Lord Krishna begins psychological counseling and clears his misconceptions one by one. This reference from Gita puts a clear picture for the framework of disease Vishaada.
On the other hand, various authors have tried to interpret Vishaada as Depression due to a lot of similarities in the list of presentations. Anxiety and depression have a lot of similarities and both can manifest with feelings of hopelessness, agitation, feeling withdrawn, fatigue, lack of ambition, inability to enjoy things that used to bring pleasure, fear of the future, inability to cope with stressful situations, etc. It is also true that anxiety and depression often co-exist, in fact persons with actual anxiety disorders almost always have a degree of depression, along with it and persons with clinical depression also commonly have co-existing anxiety.GAD has been said to represent a residual phase of chronic depression (Nisita et al., 1990).

Generalized Anxiety Disorder is one such disorder where a patient commonly experiences a mix of both anxiety symptoms and depression symptoms. They may at times have stronger manifestations of depression and at other times, stronger manifestations of anxiety, while at other times, they are both about even in manifestation.

In a nutshell, we can say that Vishaada cannot be termed as Depression because of the following reasons

1) A major distinguishing feature of depression that is often listed as one of its major symptoms is “profound sadness”. In Vishaada a person has spells of emotion, that causes them to have crying spells etc., but it is not the same profound sadness that is more chronically severe with depression.

2) A major feature of Vishaada is the “fear emotion”, which can be the bewildering type, such as severe anxiety attacks or panic attacks or can be the chronic lingering type that manifests as severe worry and apprehension. The chronic worry aspect of anxiety, is what is most often mistakenly referred to as depression, when it is actually a fear emotion (fear of the future, fear about health, finances etc.) and though it is not in the depression category, can result into depressive symptoms, due to the prolonged periods of stress it causes.

3) Vishaada is an anxiety disorder whereas Depression is a mood disorder.

4) In Vishaada the individual does not suffer from suicidal tendencies unlike in depression.

5) It is emphasized by Acharya Charaka that “Vishaado Roga Vardhananam”.Anxiety has been regarded as causing various other diseases, not depression.

Therefore we can infer that Vishaada is not Depression and it can be compared with Generalized Anxiety disorder. Various authors have tried to use these terms at ease often contradicting each other as to the exact meaning of the term but it is important to keep in mind the clinical implications along with the literary meaning in order to understand the term efficiently. Hence, it can be concluded that Vishaada can be compared with Generalized Anxiety disorder based on the references available and the similarity in clinical presentations of both the conditions.