Child care in ancient India: A life span approach

Malavika Kapur

In the contemporary scene, developmental psychology or the life span approach is the longitudinal study of the entire life span of an individual. The salient features of developmental psychology are:

1. Life span approach
2. Focus on developmental continuities and discontinuities
3. Sensitivity to the contexts in terms of gender, social class, culture and other proximal and distal variables
4. The perspective that bio-psycho-social variables interact in a dynamic yet holistic manner and determine the individual's behavior

Western psychology drawing mainly from philosophy has always been anchored to the Cartesian dualism of the body and the mind. Scientific parsimony and specialization are considered essential for scientific advancement. In contrast, the ancient Indian approach is holistic. It proposes that the universe and man within it function as an interactive and a dynamic system.

In the present paper, an attempt is made to examine the pediatric texts in Ayurveda and the Dharmashastras (Deshpande, 1936 and Kane, 1941) from a contemporary developmental perspective. Ayurveda is the “science of life” and is a medical system, which has its roots in the Vedas. “Kaumarabhratya” or the care of the children is one of the eight branches of Ayurveda. Though origins of Ayurveda are mythical, the medical compilations of the works of Charaka, Sushruta, and the Vagbhatas, the younger and the elder, form the basis of sound clinical practice dating back to 1500 to 2000 years. These compilations (Samhitas) have sections on health of women and care of the children (Bhattacharya, 1956, Lakshmipathi and Rao, 1955, Sharma and Bisajacharya., 1953, Singhal and Singh, 1953 and Valiathan 2003). Kashyapa Samhita is the treatise wholly devoted to the care of the children along with the care of the expectant and the nursing mother (Kumar, 1999 and Tewari, 2002). The focus is equally on the psychological and the physical care of the children. In addition, these medical texts include certain “rites of passage” or the samskaras. The approach, Thus is holistic as childcare encompasses total care of the body and mind of the infant and the mother and addresses the societal concerns and expectations. The samskaras are briefly mentioned in the Ayurvedic texts, but elaborated upon in the dharmashastras.

Health and disease in ancient India will be examined from a life span approach in the present paper. Illustrations will be given from the biological, psychological, and socio-cultural realms as revealed from the various childcare practices in ancient India. These practices reflect the sensitivity to the developmental continuities and are highlighted below:

Care of the expectant and the nursing mother

In the Ayurvedic texts, the care of the baby begins even before conception. Prospective parents are instructed about the right diet, rituals, prescribed behavior and psychological attitudes, along with prescriptive sexual practices conducive to the birth of a healthy infant. To facilitate it, the rite of ‘gharbadharana’ is described with a complex set of instructions. Gender preference for the male offspring is indicated in a general set of instructions, and a specific rite named ‘pumsavana’ in the third or fourth month of pregnancy. ‘Jatakarma’ is a rite that has medical, psychological, and cultural practices associated with the birth. The instructions for cleaning, feeding, and neonatal care are mostly similar to the ones in current pediatric practice. Psychological sensitivity is revealed in describing the new born as being exhausted from the birth trauma and the advice of the anointment of `bala’ oil as a remedy.

The various propitiatory and warding off rituals reflect ancient cultural practices. In addition, stage-wise description of the status of the newborn is illustrated in the description of the ‘seizure’ by the ‘grahas’ on a day-to-day basis.  An exceedingly detailed description of the physical and the psychological status of the infant reflect essentially a developmental approach. Several warding off and propitiatory rituals are carried out to protect the infant and the mother and these are essentially based on cultural beliefs. Most of the medical treatises too subscribe to the malevolent supernatural and invisible forces called the ‘grahas’. These are not the zodiac signs, though the same term is used. Serious illnesses of the children are attributed to the seizure by the ‘grahas’. It is difficult to determine whether the notion of seizure by the grahas was originally a product of folk healing practices or the Ayurvedic medical practice. However, the various syndromes attributed to ‘graha’ etiology do confirm to current pediatric syndromes, reflecting the clinical acumen of the ancient physicians.

Evolution of the mind

According to Charaka, in the third month of pregnancy, formation of the head takes place, along with the perception of pleasure and pain. Consciousness emerges in the fourth month. It is believed that the fetus is endowed with mind (manas) and wakes up from the sleep or subconscious state in the fifth month. The dawn of cognition occurs in the sixth month. The eighth month is considered critical as the total energy (ojas) is in a flux for both the mother and the child, which causes oscillation between joy and sorrow. The speculation that the fetus has emotions, intelligence, and consciousness predates some contemporary findings on the development of the brain. Currently, it has been discovered by developmental psychologists (Gopik, Meltzoff and Kuhl, 1999) that the infant arrives into the world pre-wired for acquisition of cognitive and language skills and a temperament underlying an emotional predisposition. However, even a few decades back the infant’s brain was described as a “clean state” and as characterized by “booming buzzing confusion.” The development of various faculties may not be scientifically valid but that Charaka’s assumption that they developed in the fetal stage is indeed remarkable.

The mother and the child as a symbiotic unit

The physical and psychological care of mother and infant are carried out under the assumption that the two form a symbiotic unit. There are a number of do's and don'ts for the expectant and nursing mother. These range from right diet, sleep, psychological states, to the various behavioral manifestations and social interactions. The expectant and nursing mother are warned about dire outcomes, on the physical and psychological status of the infant, if these strictures are disobeyed. An interesting aspect of these Ayurvedic texts is the detailed description of the characteristics (physical and psychological) of the mother or the wet nurse (as it was a common practice to hire a wet nurse, if mother is not available to breast feed). There are extensive descriptions of different types of breast milk, healthy or otherwise. Such descriptions are absent in current pediatric texts. Currently, there has been empirical evidence to support adverse effects on the infant, of the exposure of the mother to pollution, drugs, alcohol, and nicotine. The relationship between the quality and quantity of the milk and health of the infant and the mother needs to be examined empirically.

Inheritance of physical and psychological predispositions:

The concepts of ‘tridosha’ and ‘triguna’ are central to Ayurvedic practice. These physical and psychological predispositions are present at birth and even beyond it. The tridosha consist of vata, pitta, and kapha and are physical predispositions. Of the trigunas, rajas and tamas are the psychological traits that contribute to physical ill health, while sattva is a predisposition to well being. An individual is seen as a product of inheritance of various components of the gunas and doshas. These are the endogamous factors, but they interact with the various physical and psychological factors in the environment. The ayurvedic system upholds the notion that drugs and other treatments interact differently amongst people with different doshas and gunas. Varying combinations of doshas and gunas causes diseases. Hence, the treatment too needs to be varied accordingly. In contemporary medical practice, apart from bodyweight and age, other individual differences are often seen as side effects of drugs. There is a need to empirically examine the individual differences to responses to treatments according to the predisposition as understood by the gunas and the doshas.

The construct of temperament in ancient Indian thought was examined empirically by Kapur et al... (1994, 1997) based on triguna from the Samkhya tradition. The temperamental profile with 17 items was used to provide a theoretical model based on ancient Indian thought, which consists of sattva, rajas, and tamas, and to validate them empirically with a study of normal and disturbed children. Malhotra, Malhotra, and Randhawa (1983) had used the Thomas and Chess model on Indian samples. Experience of the author and her colleagues revealed that the Thomas and Chess model was difficult for Indian mothers to understand. For the sake of scientific parsimony, western workers have used narrow band of traits. While the western models include only biological predisposition, the triguna model includes the biological as well as psychosocial dispositions. The dimensions measured in the Triguna Temperament Schedule are: manageability, trust, dependence, sleep, appetite, activity level, morality, emotionality, sociability, and aggression. These dimensions go beyond the western conceptualization of temperament. The study demonstrates that some of the major constructs proposed in the ancient Indian texts, lend themselves to empirical inquiry, as may be seen below.

The sample consisted of 50 normal nursery school children, screened for behavior problems and handicaps, and 30 children with psychiatric disturbance in the age range of four to six years. Both groups were administered the temperament section of Developmental Psychopathology Check List (DPCL) by Kapur (1995). The interviewer asked the mother to rate on a three-point scale, indicating, mostly, somewhat, or not at all,whether the child displayed the behavior stated in the checklist. The results showed that 26 of 50 of the normal preschoolers had sattvic (good natured and well adjusted) temperament, 14 were predominantly rajasic (high-strung/active), 5 were tamasic (torpid/dull), and rest of the five had no predominance of any particular predisposition. The clinical population of 30 children had three sub groups: one with emotion/learning disorders, one with hyperkinesis/conduct disorders, and one with autistic disorders. The three groups, despite the small size of the sub samples, showed distinct profiles. The autistic group had the highest degree of disturbance, with hyperkinesis/conduct disorder in the middle, and the learning/emotion disorder group showing least degree of disturbance. The groups did not differ on the dimensions of sleep and appetite. The group with emotion/learning disorder had high sociability in the family context and low verbal aggression. Activity level and physical aggression was high in the conduct disorder group. Comparison of the 50 normal and 30 disturbed children reveled that normal group was easily manageable, dependable and trustworthy while the disordered group had higher activity level, emotionality (angry/irritable than cheerful/happy) and sensitivity only towards self.

Differentiating normal temperament from those typical of psychiatric disorders is of crucial importance, not only for assessment but also for management. The findings of the present study, however, need to be examined in larger samples, across time (stability), age, gender, disorder, and cultural contexts. The present assessment tool may be used for such studies. The relationship between temperamental traits and psychopathological conditions needs to be examined. Questions such as, whether certain temperamental traits predispose a child to a specific disorder, whether the temperament is an early manifestation of a full-blown disorder later, whether temperament and psychopathology share a common root, remain unanswered. Another question that needs to be answered is, whether sattvic temperament is a protective factor against psychopathology, as claimed in Ayurveda. The above empirical study of temperament, based on the triguna model, holds promise for research in the Indian context, not only in the study of psychopathology but possibly to study temperament as a mediating factor in the interaction between child rearing practices and psychosocial development.

Developmental approach and child care practices

Childcare practices were calibrated to suit the developmental trajectories in the feeding, medical, and cultural practices. Kashyapa divides the period of child's life up to 16 years into 3 stages:

1. Garbhastham (fetal stage), further divided into 10 stages for each month of pregnancy.
2. Balya (infancy and early childhood), which consists of ksheerapaka (drinks only milk), ksheerannada (takes milk and solids).
3. Kaumaram, up to 16 years (takes only solids).

Balya and kaumaram are important phases of the life cycle. The texts clearly prescribe the quantity and quality of diet to be given. For example, the amount of butter to be fed to the infant is what he/she can hold in the closed fists. Similarly, the amount of drugs too, is given in a developmentally appropriate fashion. For example, for a one month old, the amount is one "gunja" with an additional gunja for the additional month. One year old is given 12 gunja, 60 at the age of sixteen, and full dose to be given subsequently (one gunja is equivalent to 18 mustard seeds or 4 grains of paddy or 2 grains of wheat or 3 grains of barley). The graha invasion too is described on day-to-day, week-to-week or month-to-month basis in the various texts.

Samskaras or rites of passage

The samskara are widely practiced cultural rituals, which contribute to promote the achievement of developmental tasks. While the gunas and doshas reflect inherited predispositions, the samskaras are socially sanctioned rituals carried out at the developmentally appropriate stages. The gunas and doshas represent nature, while samskaras represent nurture.

There are seventeen samskaras in the life span of the individual, of which ten are in childhood. The first three are gharbhadharana, pumsavana, and simanatonnoyana, which are carried out before birth. These are essentially rituals relating to the prospective mother and father before the birth of the infant.

The seven childhood samskaras and their role in promoting the milestones of development are described in table 1 (Kumar, page 91, 1999).

The above samskaras though are socially sanctioned have medical, psychological and sociocultural significance. These are instituted in a time sequence for the optimal physical and psychological development in each physical and the developmental phases in the life cycle of a child. While gharbhadharana and pumsavana are steeped in myths and social connotation that a healthy child, especially a male child, is desired. Simantonnayana is a ritual, which gives a special status to the woman who bears the fetus successfully until the risks of abortion or miscarriage has receded at the seventh month of pregnancy. The rituals aim at protecting her, keeping her safe and happy in order to promote the healthy development of the fetus. This is a special time in the life cycle when the woman is offered special status and comfort of the maternal home following the ceremony. The ritual highlights the need to promote emotional tranquility in the expectant mother and its relation to healthy development of the child. This, perhaps, needs to be examined empirically in the contemporary context.

The seven samskaras after birth of the infant as seen in Table 1 have specific significance to the life stages of the infant. Each of these could be examined empirically from medical, psychological (cognitive, memory, emotional, social development), socio-cultural, or anthropological perspectives. The samskaras vary according to age, gender, and caste, representing the very essence of contemporary developmental approach.

Holistic approach to health, disease and their management

The phenomenology of health and disease has been extensively dealt in the various samhitas for children, adults, and elderly. The life span approach is applicable at all stages. The important aspect of an Indian perspective is the notion of indivisibility of the body and mind, man and universe. The assumption is that body and mind interact and so does the individual and his universe (physical or otherwise). Health or disease is a product of inherited psychological and physical predispositions and of the environment, in terms of age, gender, caste, diet, life style, season, and drugs (along with the presumed supernatural influences). It can be seen that the concept of holistic psychology can be gleaned from folk psychology, ayurveda, dharmashastras apart from Upanishads and related treatises. In contrast, the Western developmental psychology has gradually emerged in the last few decades. Karl Jaspers in 1923 (English translation 1963) had fully elaborated the importance of the approach to a scientific study of phenomenology as hampered by prejudice, which are false (philosophical, theoretical, somatic, psychologising and intellectualizing false analogy and medial prejudice) and enhanced by presuppositions that are true. However, mainstream psychologists in the West did not take up these insights subsequently. It is in recent decades that developmental psychologists have taken notice of the overlap and interaction between the domains of physical, cognitive, language, emotional, social, sexual and moral development and in therapeutic practices (Greenspan and Leiberman 1994, Slade and Wolf 1994). Health psychology examines the interaction among physical, psychological and social contexts in which the individual lives. The holistic and multifactorial approaches to the understanding of individuals are slowly making inroads into health psychology and developmental psychology in the West.

Simplistic and parsimonious research anchored to straight-jacketed theories can only provide a partial insight to a complex phenomenon of the mind of man. The study of mind of the child is even more difficult. The study of the child may be seen as a precursor to the study of the adult. This is exemplified in Kashyapa Samhita by a statement that Kaumarabharatya is the most important branch of Ayurveda.

Multiple causation as an explanatory model for health, disease and their management

The phenomenology of health and disease has been dealt extensively in the various samhitas. The holistic approach necessarily leads to multiple etiological explanations and consequently to multiple methods of treatment. The management strategies cover a wide range of practices ranging from appropriate diet, life style, drugs, bathing, massage, fomentation, and fumigation. All these are calibrated to suit the individual's guna and dosha. These treatment strategies are evolved and modified to suit the stages of development from infancy to old age. The healing practices also include prayers, rituals, meditations, chants, sacrifices, and social prescription of behavior. The treatments are determined by time (season), constitution of the individual and developmental stage. Context appropriateness is the key to effective treatment. The dynamic interaction amongst various components is considered crucial. Is it possible to empirically examine such a complex system?

Feasibility of empirical studies

The holistic approach adopted by ancient Indian thinkers offers a stark contrast to the scientific parsimony of western science. However, the study of complex systems has been attempted in the ‘general systems theory’ and in ‘health psychology’ and ‘chaos’ theory. It does not necessarily mean that what cannot be broken into smaller units and examined cannot be studied. Whatever has been found effective needs to be studied using appropriate innovative methods. For example, psychoanalysis has not lent itself for empirical validation but has provided insights of great merit in clinical practice. If one believes that what is useful and effective needs to be studied, suitable methodologies along the lines of that employed in chaos theory have to be evolved.

The following are some of possible areas to be explored:

1. Triguna and Tridosha: The author has carried out a preliminary study of triguna and its relation to child psychiatric disorders as described earlier. The study can similarly be done across gender, age, class, and cultures. The tridoshas too, could be similarly examined in health and illness in a pediatric setting.
2. Effects of drug regimes, diet, life style on health and illness. Especially of interest are the suggested methods of promotion of health. For example, in childhood, effect of carrying out the samskaras, feeding, drug, and practices to promote physical growth and enhancement of cognitive, language and memory functions can be empirically examined
3. The study of mother-child symbiosis especially in the context of breast-feeding, diet, life style can be examined.
4. An examination of multiple causation and management practices in health and illness is needed. It is of interest to note that in Ayurveda, a complex regimen is recommended for particular conditions while a group of conditions may have the same regime. The cause and effect is not a simple chain of interactions.

The approach to knowledge and understanding childcare in Ayurveda is holistic. The biological, psychological, sociological, and cultural approaches are seen as mutually inclusive. The study of the infant adopted finely calibrated developmental approach with inherited tendencies in dynamic interaction with samskaras and child rearing practices. Childcare is embedded in the care of the mother, as they are a symbiotic unit. In short, the preventive, promotive, and curative components are necessarily seen together in childcare practices. The holistic approach has the contemporary life cycle approach embedded within and goes far beyond it.

References