A Literary Review on The Utility of Music (Geetam) In The Management of Sadhakapittakrita Manasa Vikaras

INTRODUCTION

Manas in the context of disease is referred as satwa in Ayurveda. Manasavikaras develop in the background of involvement of rajas and tamas , affecting either manas alone or manas with shareera. The role of manovahasrotas has been identified in the pathology of manasavikaras. The vatadidoshas affect manas when it gets deprived of satwaguna and gets afflicted with rajo and tamogunas. The concept of mental health is identified as mere absence of Manasarogas.

SADHAKA PITTA

Hridaya is the sthana of sadhaka pitta. Accomplishment of aspirations (manoratha) by means of buddhi, medha, abhimana (ahankara) is an important function of sadhaka pitta . Aspirations are addressed as the purusharthas, which are directed in the form of Dharma, Artha, Kama and Moksha. Bahyagrahana and smarana are the most important phenomenon which mediates for the achievement of aspirations through sadhaka pitta. Another major function involves manifestation of states like shourya, bhaya, krodha, harsha, moha, prasadaetc. Hence the functions of sadhaka pitta can be summarized as abhiprarthita manoratha sadhana, bahyagrahana, smarana and shouryadi karana which are analysed as follows.

Abhiprarthita manoratha sadhana (Purushartha sadhana)

Purusharthas are the main objectives of life as explained in the science of Ayurveda. They give us a direction for our life and act as the motivational drive for the survival. They form a combination of conditioned behavior, homeostatic drive and survival instinct which formulate the abhiprarthita manorathas. The basic force required to achieve these aspirations is none other than sadhaka pitta, which functions through two important mechanisms i.e. Iccha and dwesha. Iccha is the force of desire and dwesha is the force of aversion which forms the potential for the manifestation of manasavikaras. Thus Iccha and dwesha can be understood for Reward and punishment systems of the brain respectively. Hence the entity of sadhaka pitta can be understood for the neurotransmitters associated with the functioning of Reward and the Punishment centers of the brain.

The reward system is a collection of brain structures and neural pathways that are responsible for reward-related cognition, including associative learning (primarily classical conditioning and operant reinforcement), incentive salience (i.e., motivation and desire), and positively-valence emotions, particularly emotions that involve pleasure. (e.g., joy, euphoria and ecstasy). The brain structures that compose the reward system are located primarily within the cortico-basal gangliathalamo-cortical loop. The basal ganglia portion of the loop drives activity within the reward system. Most of the pathways that connect structures within the reward system are glutamatergicinterneurons, GABAergicmedium spiny neurons (MSNs), and dopaminergicprojection neurons. Dopamine is responsible for regulation of motor behavior, pleasure related to motivation and also emotional arousal. It plays a critical role in the reward system. The reward and punishment centers are responsible for the behavioral and emotional changes in human beings. They are concerned with the affective nature of sensations i.e. reward (satisfaction/pleasant) and punishment (aversion/painful). Hence Indulgence and avoidance behavior is dependent on the functions of these centers. Attainment of purusharthas (motives) through reward (Iccha) and punish (dwesha) pathways occurs with the mediation of two important cognitive processes i.e. bahyagrahana and smarana. Hence reward and punish related cognition is an important function of sadhaka pitta which involves Incentive & Aversive salience (Bahyagrahana) and associative learning in the form of classical conditioning and operant reinforcement (Smarana).

Bahyagrahana (Motivational salience)

Sadhaka pitta causes accomplishment of motivational desires (abhishtita manorathas) through approach and avoidance behaviors towards the desires. This functional component can be considered for bahyagrahana. Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal. Motivational salience is composed of two component processes that are defined by their attractive or aversive effects on an individual's behavior relative to a particular stimulus which include incentive salience and aversive salience. Incentive salience is the attractive form of motivational salience that causes approach behavior, and is associated with operant reinforcement, desirable outcomes, and pleasurable stimuli. Aversive salience is the aversive form of motivational salience that causes avoidance behavior, and is associated with operant punishment, undesirable outcomes, and unpleasant stimuli

Smarana (Learning and Conditioning)

Another important cognitive function of sadhaka pitta in achieving motives is smarana which can be understood for various conditioned reflexes which depend on previous experience. Rewarding stimuli can drive learning in both the form of classical conditioning (Pavlovian conditioning) and operant conditioning (instrumental conditioning). In classical conditioning, a reward can act as an unconditioned stimulus that, when associated with the conditioned stimulus, causes the conditioned stimulus to elicit both musculoskeletal (in the form of simple approach and avoidance behaviors) and vegetative responses. In operant conditioning, a reward may act as a reinforcer in that it increases or supports actions that lead to it.

Shauryadi karana (Valence)

Another important function of Sadhaka pitta is the emotional behavior in the form of shauryadi bhavas which represent positive and negative valence. Positive valence can be considered as the outcome of Iccha whereas negative valence can be considered as the outcome of dwesha. Valence or hedonic tone, is the affective quality referring to the intrinsic attractiveness or goodness (positive valence) or averseness or badness (negative valence) of an event, object, or situation.Hence the hedonic tone is responsible for feelings, affect, certain behaviors of approach and avoidance, goal attainment or nonattainment, and conformity with or violation of norms. Emotions of anger and fear have negative valence. Joy has positive valence.

Sadhakapittakrita Manasavikaras

The manasa vikaras categorized as Iccha and Dwesha based come under the perview of sadhaka pitta vikaras.Thus, Reward system disorders are Iccha based manasa vikaras and Punishment system disorders are Dwesha based manasa vikaras. The following table depicts sadhaka pittakrita manasa vikaras. 

Sadhaka pitta in akupitavastha (normal state) leads to shubha (equilibrium) of hridaya and manovaha srotas through normal states of shouryadi bhavas. In kupithavastha (pathological state) it leads to ashubha (disorder) in hridaya and manovaha srotas. Thus iccha and dwesha based manasavikaras will develop in the presence of pittaprakopaka and manasavikarakara nidana along with hridaya and manovahasroto dusti. Hence sadhakapittakrita manasa vikaras can be depicted for the psychiatric conditions associated with abnormal states of motivational salience. Lack of motivation, Anhedonia, Addiction, Paranoia are few conditions which can be considered for the category of above said manasavikaras.

Lack of motivation or drive is associated with dysfunctional motivational salience whereas Anhedonia (reduced capacity to feel pleasure) reflects blunted incentive salience. On the other end of the spectrum, heightened incentive salience that is narrowed for specific stimuli is characteristic of behavioral and drug addictions. Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. The two properties that characterize all addictive stimuli are that they are reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., they are perceived as being inherently positive, desirable, and pleasurable). In the case of fear or paranoia, dysfunction is associated with elevated aversive salience.

Shabda Chikitsa:

An Acess To Manas Shabda is an Indriyartha of Shrothrendriya. Manas has a significant role in controlling Indriyas. Hence in manasavikaras the control of manas is possible by utilizing shabda as a manipulative technique. The administered shabda for intervention should bring down the distress caused by these illnesses in the patient.

Geetam: A Pittadoshopakrama

Music is termed as Geetam (Ganam) in the literature of Ayurveda. Vocal or Instrumental mode of application of music is advised. Listening to music has been highlighted. Soothening music compatible to a person has to be selected. Geetam is a form of Adravya chikitsa. Adravya chikitsa is the therapeutic application of various biological principles or phenomenon in the form of noninvasive techniques. The clinical utility of music is implied to conditions caused due to afflicted Pitta dosha. Music can be employed as a main therapy or a regimen complimenting other treatment methods. Music Therapy

Music therapy

is an interpersonal process in which the therapist uses music and all its facets - physical, emotional, mental, social, spiritual and aesthetic - to help the client better, recover or maintain health.

Research On Music

Functional neuroimaging studies on music and emotion show that music can modulate activity in brain structures that are known to be crucially involved in emotion, such as the amygdala, nucleus accumbens, hypothalamus, hippocampus, insula, cingulate cortex and orbitofrontal cortex. Exposure to music also significantly increased serum calcium levels and neostriatal Dopamine levels thus causing a reduction in blood pressure. Auditory stimuli in the form of exposure to melodic music, increases Dopamine levels and the release of Serotonin in the Caudate - putamen, Nucleus accumbens & the areas linked to reward system in Rat forebrain suggesting that the music had a direct impact on monoamine activity in these brain areas.

DISCUSSION

The domain of influence of Geetam is over pitta dosha. Pitta exerts its functions over body as well as manas. Music corrects the lakshanas of Indriyadourbalyata and Alpanidrata produced as a result of pitta vitiation in the body. The vikrita pitta lakshanas of krodha, moha are resolved by music. Sadhaka pitta functions are updated in the form of upgrading the functions of buddhi and medha. Thus, music stabilizes the neurotransmitters responsible for the production of dysfunctional reward and punishment neural pathways. Music being a therapeutic sound acts on manovaha srotas. In manasavikaras, this is a unique approach of utilizing shabda as an intervention method. The principles of Harshana and Vismarana can be delivered through music therapy. Harshana implies to de-stressing the patient through release of specific neurotransmitters like dopamine. When reward areas are stimulated parasympathetic nerves are stimulated causing relaxation of body and mind. Sadhakapitta afflicted disorders are related to conditioned reflex related to motivational salience. Vismarana leads to changing or decoding the conditioned reflexes and their reinforcement which have led to dysfunctional motivational salience.

CONCLUSION

Sadhakapittakrita manasavikaras develop due to pathophysiological changes with respect to bahyagrahana and smarana of sadhaka pitta functions which manifest in terms of dysfunctional motivational salience. Music is a upakrama for pittapradhana vikaras and shabda chikitsa is a unique intervention for manasa vikaras. Thus, music can be utilized to manage manasa vikaras of sadhakapitta origin.