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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 3-7

Self in psychotherapy: An Indian perspective


Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India

Date of Submission28-Nov-2020
Date of Acceptance30-Dec-2020
Date of Web Publication17-Mar-2021

Correspondence Address:
Dr. Jyotsna Agrawal
Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoyppp.ijoyppp_19_20

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  Abstract 


This paper discusses the two ways in which the concept of “self” has been discussed in the Indian tradition and its relationship to suffering and healing. There being outer and inner self, denoted as antaratman and ahamkara respectively, is a common theme across Indian darshana/philosophy, though the exact terms and few nuances differ among them. Ahamkara or the outer self seems to have overlap with concepts such as ego and self from the modern psychology. Kumar's model of Ahamkara (2005) has four main subcomponents: Vaishisthya/individuality, Dwaita bhav/separation, Abhimana/identification, and Kartatva/agency. The article describes the results from multiple studies to support such an Indian model of self, its expansion to include a component of “ripe-ego,” and ahamkara's association with well-being in modern world. It then goes on to discuss the implications of this Indian model of self in the psychotherapy practice along with giving a case example and future directions for further research.

Keywords: Indian psychology, psychotherapy, self, yoga


How to cite this article:
Agrawal J. Self in psychotherapy: An Indian perspective. Int J Yoga - Philosop Psychol Parapsychol 2021;9:3-7

How to cite this URL:
Agrawal J. Self in psychotherapy: An Indian perspective. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2021 [cited 2021 Jun 15];9:3-7. Available from: https://www.ijoyppp.org/text.asp?2021/9/1/3/311401




  Introduction Top


Mental disorders affect almost one in seven people in India, and in less than three decades (between 1990 and 2017), their contribution to the total disease burden has nearly doubled.[1] Nevertheless, access to mental health services is limited. While 150 million Indians are in dire need of mental health intervention, only 30 million have access to such care, which is about one out of every five in need of these services.[1] There is a significant lack of trained mental health professionals in India, where against the actual requirement of around 54,750 such professionals, only about 7,000 are available, which is also concentrated in major cities.[1] Although modern psychotherapy has been reasonably successful in helping people in India, and the entire spectrum and variety of psychotherapies are being practiced currently. Nevertheless, given the time and labor-intensive nature, its impact has been limited, especially considering India's population size. The other limitation of psychotherapy is related to the fact that established treatments may not be fully effective for everyone. For example, in one study 54% of those who responded to cognitive therapy relapsed within 2 years.[2] Some cognitive behavioral therapy components may not fit with some people due to personality, goals, values, resources, and lifestyles. Another finding reported in the literature is that the approaches useful for treating the acute phase are not always helpful in preventing relapse or lead to full recovery.[3] Thus, newer therapeutic modalities, sensitive to and even rooted in the Indian culture, need to be developed and tested. This is especially true since India has a long and rich tradition of psychological ideas, many of which have already seeped into modern psychotherapy through indirect routes, benefiting many. This trend needs to be taken further, especially in the spirit of building local psychological interventions for local problems.


  Culture and Mental Health Top


The ideas related to suffering and abnormality and its expressions and explanations are commonly influenced by culture.[4] Therefore, psychotherapeutic approaches developed in a predominantly Western, individualistic context have been questioned for possible ethnocentricity and limitations in universal applications. When both the client and therapist share a common and culturally normative model of illness and healing, it can lead to nonspecific factors such as better rapport, more acceptance, and shared meaning, thus building the bedrock of good psychotherapy.[5] As Jacob and Kuruvilla[5] have put it succinctly, “psychotherapies are at their weakest when they attempt to provide explanations across cultures (top-down) and are at their strongest when they are used as vehicles for engagement with patients (bottom-up).” Thus, there is a need for culturally sensitive and responsive therapies, which may lend themselves more easily to task-shifting, in a public mental health approach.


  Psychotherapy in Indian Culture Top


Historically in India, something akin to psychotherapy was done by gurus and healers, both of which required respect and belief.[6] While sick went to healers (e.g., Ayurveda, Siddha practitioners, etc.), gurus predominately focused on psycho-spiritual growth and self-realization of people.[6] Thus, gurus unwittingly played the role of mental health leaders in the larger community, with their teachings having a preventive-promotive mental health effect on their followers. Further, these interventions were often rooted in India's nine major ancient philosophical–spiritual traditions, known as “Darshana” (Samskrit term translated as “seeing” or perspectives), which includes yoga, Vedanta, Buddhism, and Jainism. Balodhi and Chowdhari[7] have summarized a variety of interventions from AtharvaVeda. A thematic review of the field was conducted by the author and it was observed that the varieties of psychological interventions in the Indian tradition could be considered as being spread on a continuum of directive versus nondirective approaches, depicted here as a diagram [Diagram 1].



Here, it is relevant to emphasize that the term yoga has two meanings, one as a specific school of Indian philosophy, which was coded by Patanjali in his Yoga Sutra. Second, this term is also used frequently to denote all those techniques which people practice to find release from their existential sufferings and achieve unity consciousness.[8] In this later usage, yoga may be considered as a collection of inner technologies or “technologies of the self” (Foucault[9]). Some yoga components have been regularly utilized in mental health services, such as body-based “yogasana,” breathing practices (pranayama), and brief meditations. Furthermore, there is sufficient accumulation of supporting evidence on benefits of yoga for various mental health problems, and therefore, it is not discussed here. Nonetheless, the psychological components of yogic tradition related to attitudes, cognitions, emotions, actions, etc., are yet to be fully utilized in these yoga-based interventions. The author considers this to be one important direction in which the field may grow in future. One such psychological aspects is that of ideas related to “self,” and it is discussed in more detail in the current article.


  Self in the Indian Tradition Top


In a thematic review of three yogic texts (Patanjali Yoga Sutra, Bhagavad Gita, and Yoga Vashistha) considered to be core texts,[10] it was found that Self is seen as both outer and deeper.[11] The deeper Self (usually written with capital “S”) has been described as the pure consciousness and unaffected witness within, and terms such as Antaratman and Chaitya-purusha have been used to denote this aspect. This Self is considered as the imperishable spark of Divinity in a being, which remains in oneness and identification with the universal Self and thus is also connected with all others. The Outer self (written with small “s”) is ahamkara, the body-based identity, which encompasses various concepts of modern psychology, such as self, ego, and identity. It has been described using the metaphor of a protecting cover (e.g., pot, house, etc.) for inner space. The outer self is at the level of mind and is created by self-relevant thoughts, feelings, etc.[12] It is limited due to its sense of separation, ownerships, attachments, pride, and feeling of control.[13] Based on Vedantic conceptions, Kumar et al.[13] have described four main components of this outer self as follows:

  1. Vaishisthya/individuality, related to a sense of being unique
  2. Dwaita bhav/separation, with a feeling of being different from others
  3. Abhimana/identification, related to one's associations, belongingness, and possession
  4. Kartatva/agency, about one's sense of doership control and personal efficacy.


An example of this would be a person who is doing well professionally, leading to a strong sense of doership (kartatva) along with an inflated self-image (vaishisthya). He may be attached to his membership of various associations (abhimana) and may also feel different from those in other professions (dvaita bhava). These components may interact with each other to enhance a person's outer self, making him live within his small subjective bubble until there is a problem in his professional life.

The Indian tradition considers ignorance (avidya) as the primary cause of this ahamkara or outer self. This primary ignorance of what is real and unreal in existence makes the mind project ahamkara with its attributes of individuality, identification, agency, etc., Moreover, due to such projection on the deeper Self, it gets concealed. With increasing layers of these projections, the concealing layer gets thicker and it may need more effort to diminish it and access the light of the inner Self. This may explain why people having psychological problems find it so hard to come out of their problems, in spite of a desire to get better and why psychotherapy is time-intensive. This cover of ignorance makes it difficult for a person to notice and acknowledge that the sense of separation, identification, agency, etc., are problematic and holds him back from a healthier state of being.


  Outer Self and Suffering Top


It cannot be emphasized enough that the Indian tradition considers the cause of suffering as living at the outer self-level, and being completely focused on the external world. Thus a person gets trapped in the complexities of the outer self and external world and forgets/ remains ignorant of one's deeper Self. On similar lines, Pandey[14] mentions that “The source of our psychological maladies is an inability to live deeper.” He then adds “with this sense of surface me”, also comes the sense of “not me.” No real unity or harmony with the world around is possible with the ego, only some accommodation, tolerance, and adjustment.[14]

Yogi-mystic Aurobindo[15] considered this outer self as both a helper and a bar. Initially, such ego-sense helps in individuating from the common mass of humanity. Yet, as one progresses further on spirituality, he goes beyond this outer self to find one's inner Self, which is also the center of true individuality. Ordinarily, most people may feel just fine while living at the outer self-level, especially when their lives are going well with its combination of joys and sufferings. Most do not prefer to walk on this path voluntarily until inner or outer circumstances force them to change and grow beyond their outer self.


  Healing and Growth Top


To overcome suffering and to experience psychological growth and healing, the Indian tradition proposes connecting with the ultimate divine reality, first by minimizing and finally by transcending the outer self. This happens in parallel with recognizing and getting closer to the unaffected witness, the deeper Self inside. In the process, one can know the connection between one's own self, the self of others and the universal Self. One can become aware of a sense of oneness and interconnectedness (between the individual and/or the immanent, cosmic and transcendental aspects of Divine). Initially, this may only be an intellectual understanding, but over time with practice, this can become a lived reality. This is especially true since the mind is considered both, like an enemy or a friend (Bhagavad Gita).

On the one hand, the six enemies of lust or desire (kama), anger (krodha), greed (lobha), attachment (moha), arrogance or pride (mada), and jealousy (matsarya), when given free play, can strengthen the outer self. On the other hand, the mind can also help when it consciously chooses to grow, (considered as ripe ego by Paramahamnsa (as documented by Shraddhananda[16]), and finally dissolves itself and the outer self in the universal consciousness. Mystic Paramhansa[17] had used the metaphor of “salt doll” which dissolves in the ocean water to describe such dissolution of the outer self. This may result in “oceanic feeling,” a term coined by Romain Rolland (in his letter to Freud) to describe the feelings of oneness with the eternal reality, as experienced by mystics like Paramahamnsa (cited from Wikipedia.[18]


  Pathways to Healing Top


Multiple yogic pathways are given in the Indian tradition, the trimarga of jnana, bhakti, and karma, being the three main broad paths.[19] Each path can dissipate the outer self, bring forth the inner Self, and result in wisdom and clarity. This requires some separation from our daily preoccupations with the external world, along with de-identifying from the outer self, (ahamkara), and self-observation and analysis. It is an experiential journey in a broad time-space framework (across births), with a belief that no effort is lost.[20] Simultaneously, one needs to discover a harmonious way of coexistence with the world till one realizes a deep oneness and interconnectedness with the entire creation, since the same divinity is present in all. This can be achieved by following specific social-ethical codes (such as satya, ahimsa, asteya, brahmacharya, aparigraha), by cultivating positive interpersonal attitudes (bhavana or brahmavihara of maitri/friendliness, mudita/appreciation, karuna/compassion, and upeksha/equanimity), while also working towards social welfare (lokasamgraha) as discussed in both Bhagavad Gita and Patanjali Yoga Sutra.


  Empirical Research Top


Multiple studies have been conducted using a mixed-method approach, to understand the concept of self in modern times. The model of ahamkara based on Vedantic literature was validated by the emergent themes, in one of our mixed-method studies.[21] It is reported that the research participants had self-construal themes on the lines of individuality, separation, agency, and the belongingness aspect of the identification, as per the Ahamkara model.[13],[21] Further, a new category of spiritual/transpersonal self-construal also emerged, which was in line with what Paramhansa spoke as “ripe ego.”[16],[21] Further, both qualitative and quantitative results from multiple studies have reported that ahamkara is higher in young adults, men, and single people, and it decreases with age, although different components seems to have different trajectories.[21],[22],[23],[24]

Overall, ahamkara is associated with lower well-being; however, it differs with different subcomponents. Sense of identification to specific groups and things (belongingness) was associated with lower well-being, individuality (higher in men) had mixed results related to positive and negative affect, and agency (higher in men and middle age) was usually associated with higher well-being.[21],[22],[23],[24] In one study,[24] ahamkara was positively correlated with wisdom. Such mixed results support the comment by Aurobindo[15] that the ego can be both, a helper and a hurdle. The yogic traditions acknowledges that a healthy ego is required initially, since a moderate amount of ahamkara helps in managing life demands and allows a person to function in the transactional world. However, the natural trajectory seems to be that outer self diminishes with age.

When a person consciously practices the yogic pathway, resulting in psychos-piritual growth, the ahamkara-driven self-focus decreases. This stage is similar to the idea of “quiet ego” in mainstream psychology. One study[23] reported that such quiet ego was negatively correlated with individuality aspect of ahamkara and positively correlated with character strengths. This brings up the next question regarding, how to quieten the ego? The community adults responded that for a healthier state of self, a person needs to decrease preoccupation with oneself, decrease their sense of separation, not diminish others, give importance to others, and focus on developing positive qualities and spirituality within.[23]


  Clinical Implications Top


The larger goal of psychotherapy can go beyond just removing symptoms and getting closer to one's true Self, the healer within as per the Indian tradition.[14] Still most psychotherapists may not feel competent enough to work on such a broad and long term goal. Thus, balancing various outer self/ahamkara components in the psychotherapy practice may be attempted. The need for balance in the outer self arises, since a heightened sense of separation may lead to conflicts with others. Excessive individuality may make a person come across as selfish and self-absorbed. In contrast, strong attachments can make one prone to intense grief, and a high sense of agency may make it challenging to absorb failures. Thus, working on all these will improve the mental health of a client in psychotherapy. Developing a spiritual self or “ripe ego” may likely help in such situations, even if it is mostly cognitive and not experiential, initially. Interestingly, the metaphor of “ripe” has often been used in the Indian tradition (e.g., in Mahamrutanjaya mantra) to denote a state of readiness for higher consciousness. Future research can also study the operations of the subcomponents of outer self or ahamkara in different mental illnesses.

In addition, strengthening of the outer self may be required in some cases, such as in psychosis. In one such case, a young woman suffering from delusional memory developed insight through meta-cognitive therapy, which then made her vulnerable to shame and distress about her past behavior and soon led to another relapse. An innovative therapeutic approach was then undertaken, focusing on strengthening the outer self's different components and connecting it with time and space. In the Indian tradition, the sense of time, space, and context (desh, kaal, paristhiti) are secondary components supporting one's outer self in a transactional world. Time and space have also been linked to a sense of ego boundaries.[25] Given the client's delusional memories, it was considered essential to also work with time and space in this case. The patient showed improvement after a few sessions and was discharged. However, more research evidence is required for this hypothesis that strengthening the outer self may have therapeutic effects.


  Summary Top


Based on the insights from the Indian tradition and the texts, an interconnected model of self, which has outer, deeper, and interconnected aspects, may be considered for psychotherapy. In addition, an attempt should be made to balance the sub-components of the outer self. This may be useful since even in modern India, those giving less importance to the outer self seems to have higher well being over time. Psychotherapy, which gives importance to the deeper self, relational harmony, and balance, may be a better approach in the Indian context.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A, et al. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990-2017. Lancet Psychiatry 2019;7:148-61.  Back to cited text no. 1
    
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24.
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  In this article
   Abstract
  Introduction
   Culture and Ment...
   Psychotherapy in...
   Self in the Indi...
   Outer Self and S...
  Healing and Growth
  Pathways to Healing
  Empirical Research
   Clinical Implica...
  Summary
   References

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