By Anuradha Gupta, AD

My parents were refugees during India’s partition which triggered riots, the mass migration of almost 15 million people and led to about 2 million deaths. I am a product of what is called the ‘transgenerational transmission of trauma’. My Father then joined the Army and I discovered the debilitating impact of PTSD on people’s health. Did you know, 7 in 10 Americans experience traumatic events and only 6 in 100 develop PTSD. What increases the risk, how can we mitigate it and how can Ayurveda help?

Trauma and PTSD

A survivor of a natural disaster or someone who is abused is traumatized. A bystander or a first responder who works with them could also experience trauma.

Trauma is our response to an overwhelming, harmful, or life-threatening event that we experience or witness. It could impact our mental, physical, social, and spiritual well-being. The immediate response may be shock, or denial. Longer term symptoms could include withdrawal, hyperarousal, anxiety, nightmares, a fight-flight-freeze response, and physical health issues. Trauma can be of many types, for instance, acute, chronic, complex, ACE or adverse childhood experiences (ACE), transgenerational trauma or secondary trauma. It can result in mental health disorders like PTSD (post-traumatic stress disorder), adjustment disorder and ASD (acute stress disorder).

PTSD or Post Traumatic Stress Disorder is a serious, potentially debilitating condition that can result from trauma. It is estimated that 13 million people in the United States currently live with PTSD. This is a psychiatric diagnosis in DSM-5 which was earlier known as ‘shell shock’ because of wars, abuse or accidents. It became an official diagnosis only in 1980.

For a diagnosis of PTSD,

Symptoms must have lasted more than a month
There must be specific symptoms in a cluster,

Re-experiencing symptoms like nightmares
Avoidance behavior
Hyperarousal
Changes in mood or cognition (negative thoughts)
Distress or functional impairment (social or occupational)

PTSD can lead to cascading health issues with physical manifestations like digestive, cardiac, musculoskeletal and respiratory issues, there can be other mental health ramifications like substance use, anxiety, disassociation, and somatization, chronic pain, headaches and fatigue.

Trauma Risk factors, Complementary and Ayurvedic support

There are risk factors prior to trauma, based on the type of trauma and nature of intervention after a traumatic event.
Genetic predisposition, physical and mental health history, immunity, prior trauma, constitution (Doshas and Gunas), age, minority stress and health inequity are prior risk factors.
The type of traumatic event is a major risk factor, for instance, 49% people develop PTSD after rape, and 32% after assault.
Certain identities and professions are more vulnerable. Women are twice as likely to develop PTSD and up to 20% of veterans are diagnosed with it. Ethnic minorities and the LGBTQ+ community are at risk and health inequity may make it harder for them to access healthcare.
If intervention is delayed or self-care is neglected, that can be a risk factor.
Traditional talk therapy and psychotropic medication can help. But studies show they have limitations. Many prefer not to talk about their trauma. Only up to 50% improve with therapy and dropout rates are high (almost 40% for veterans). There is a critical need (https://www.psychologytoday.com/us/blog/feeling-it/202209/breathing-technique-shown-effective-trauma) for alternative approaches.
Complementary and Alternative Approaches include Ayurveda, Marma, yoga, meditation, breathwork (which Ayurveda incorporates), acupuncture, exercise, dietary and lifestyle modifications, mantra and music. In Vedic Philosophy it is believed that the physical and subtle bodies experience trauma and the soul doesn’t, but it carries karma. Samskaras are altered by trauma, disrupting Prana flow. The chikitsa or management is done by re-establishing Prana flow in Nadi’s and Chakra’s. All the Vedic sciences, Vastu, Yoga, Astrology and Ayurveda help in the management of Trauma.
Sky Breath Meditation and Trauma-informed Yoga – Multiple Yale and Harvard studies show that Art of Living’s Sky Breath Meditation has evidence-based efficacy in managing stress, depression and PTSD (it activates vagus nerve, enhances positivity, and immunity). The International Association for Human Values, Art of Living’s sister concern provides free humanitarian assistance and trauma-relief, stress management and long-term rehabilitation in areas of natural and man-made disasters (war zones, shootings, forest fires, post 9/11).
Teaching veterans evidence-based breathing and yogic resilience training through the nonprofit Project Welcome Home Troops led to a significant reduction in PTSD symptoms in a week with results persisting for a year without follow-up care.

“A violence-free society, disease-free body, quiver-free breath, confusion-free mind, inhibition-free intellect, trauma-free memory, and a sorrow-free soul is the birthright of every human being.”

Gurudev Sri Sri Ravi Shankar

Ayurveda mitigates risk factors through,

Prevention – Practices including Yoga build resilience (Conduct/Lifestyle, Sadvritta, Achar Rasayana)
Strengthening the mind (increasing Sattva, reducing the propensity as Khavaigunya)
Ayurvedic epigenetics can alter gene expression (Beej dosha) susceptibility
Holistic, Personalized Graha Chikitsa as Disease Management if PTSD develops

A comparison between Ayurveda and modern medicine approaches is detailed in Table 1, and limitations of modern treatment, in Fig 1.

MANAGEMENT OF TRAUMA (Table 1)

LIMITATIONS OF MODERN MANAGEMENT (Fig 1)

Ayurvedic Approach to Trauma and PTSD

Personalized Approach – The Ayurvedic protocol is always individualized. For any Vyadhi (including COVID-19, PTSD and Anxiety), Acharya Charaka has enunciated that we do not need a diagnosis and match the Samprapti with Chikitsa in what is called the Namaste Protocol by Dr Jayarajan Kodikannath. Agni or metabolism and digestion are considered of prime importance in what is now identified as the gut-brain axis.
Advantages of a robust, holistic Manas Shastra – Graha Chikitsa is one of the eight Kayachikitsa Sciences that every Practitioner is trained in. Every assessment includes examining the Manovaha Srotas or mind channel, the doshas, gunas, understanding samskaras, dhi (intellect), dhriti (processing of information) and smriti (memory). Protocols are holistic, natural and long-term with a focus on reducing recurrences, root-cause analysis, lesser side-effects and improving resilience.
Gauging the type of Manovikar – Ayurveda delves deep into mental health conditions and PTSD specifically is a type of Ubhyatmik Vikar where both mind and body are impacted but it presents clinically as a mental illness. (Ref Table 2)
Enhancing Sattva and the use of Medhya Rasayanas – There are multiple approaches we will discuss but this is the primary goal and method of managing trauma.

CLINICAL GROUPING OF MANOVIKAR (Table 2)

PTSD AS A VYADHI

Understanding PTSD is key to its management (refer Fig 3). Here is a broad Ayurvedic analysis,

Agantuja or External Causes - Diseases can have internal or external causes. Trauma is an “Agantuja Manovikar” with external events impacting mental health. Short term imbalances are inevitable. The impact can last longer and cause a Manasika Roga or mental illness. This depends on the nature of the trauma, and the individual’s resilience (their diet, lifestyle and genetic propensity) and state of health.
Impact on Doshas, Gunas, Ojas and Srotas - Trauma aggravates all Doshas starting with Vata which is one of the reasons somatization and pain are often symptoms of PTSD. Vata and Pitta aggravate Rajas, and Kapha aggravates Tamas. The mind alternates between Rajas and Tamas with anger, irritability, and depression. The Ojas or vitality and immunity reduce. The mind and various organ systems continue to go out of balance. It is important to note that in Charaka Samhita Vimanasthana, Manovaha Srotas is not mentioned but in Sharirsthan 1/20, Indriyasthan 5/41 and Chikitsasthan 9/5 its importance has been outlined. We talk of trauma residing at cellular levels and the body ‘keeping score’. In Ayurveda, that makes sense because imbalanced energy principals' impact Dhatus, (tissues) and various Srotas.
Cascading mental, physical, and chronic illnesses – As more Srotas go out of balance, the digestive system gets involved with Agni and Ama impacted. Cardiac, respiratory and other systems can get involved. Impacted Ojas can lead to autoimmune conditions. The way it is understood in western medicine is that stress triggered neuroendocrine hormones lead to immune dysregulation and can lead to these conditions.
Prognosis or Asadhya Roga –It is essential to recognize that this is a chronic and long-term ailment and to reassure the Rogi that it’s a journey that we will walk together.

PTSD AS A VYADHI (Fig 2)

Assessment of PTSD - Mental Assessment/Pariksha

We’ve often asked Rogis, how is your digestion and bowel. We’ve heard of questions regarding reality orientation like, “What year is this? Where are you? Who is the President?”

General Assessment - Like in any ailment, the Trividha Pariksha is used through a detailed, comprehensive intake, through questioning, observation and touch (eg, pulse diagnosis) as required or appropriate.
Inference - Acharya Charaka has described how to examine mental aspects by inference (anumana). For instance, understanding (vijnana) by purposeful action (vyavasaya), courage (dhairya) by fortitude (avisada), Rajas by strength of Attachment (sanga), pleasure (preeti) by sense of satisfaction (tosha), grief (soka) by helplessness (dainya), fear (bhaya) by anguish (visada) etc.
Tool for Unmada Lakshan - Charaka Samhita outlines a tool based on Unmada Lakshana (or signs of mental illness) where the intake can be administered to a Rogi or a relative or caretaker assisting them. This includes understanding,

Habits, temperament, physiological factors and leisure activities
Psychomotor activities - general motor activities, speech, facial expressions, posture
Conduct - personal and social standards
Memory and recall
Mind - Perception, motor & mental control, guesswork, thought process
Intellect - decision making
Orientation/Responsiveness - place, time, response to external stimuli
Desire - food, entertainment, sex etc.

Let’s say a Rogi who is a crisis counselor or a veteran comes for an Ayurvedic consultation. Maybe they have a diagnosis of PTSD or we assess they have trauma. How does Ayurveda view the etiopathogenesis or Samprapti of Trauma and PTSD?

How is Chikitsa or management done?

In Part 2 of this article we will analyze the Samprapti and Chikitsa of Trauma and PTSD and delve into a couple of case studies.

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(I gratefully acknowledge the guidance of Vaidya Princy Prasad and Vaidya Jayarajan Kodikannath, in understanding and outlining these concepts)

List of References

Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment or Ayurveda advice, assessment or management. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition and seek the advice of your Ayurvedic practitioner for any disease management related queries using the Ayurvedic process. Any links to third-party websites are provided as a convenience only and neither the author nor CAAM is responsible for their content.

Ayurvedic Perspective of PTSD Part 1

California Association of Ayurvedic Medicine

Ayurvedic Perspective of PTSD Part 1

Ayurvedic Perspective of PTSD Part 2

California Association of Ayurvedic Medicine