When I started my Psychiatry residency, a lot of things didn’t make any sense to me. We used to have case conferences where one of the residents presented a detailed workup of a patient. Discussions will go on. A big chunk of the discussions used to be about nailing the right diagnosis in accordance with ICD 10 or DSM 5. The funny part was each consultant used to have a different diagnosis for the same patient. When it comes to treatment these diagnostic labels didn’t really matter. We always used to treat the symptoms. My ADHD brain couldn’t handle this and in one of those case conferences I blurted out what’s the point of all this if we are ultimately treating the symptoms. Then I was made aware by the seniors and consultants that “ICD 10 is the Bible” of psychiatry and there is no way I’m gonna clear this residency without following that path.
Later in my residency, I came across a small paragraph in Kaplan & Sadock’s Synopsis of Psychiatry ( which is a standard textbook we study during our Psychiatry residency.) It was about Integrative Psychiatry which highlighted the importance of treating the patient holistically rather than giving just diagnostic labels.
We have a hostile approach towards medical practitioners from different disciplines in Kerala. That goes both ways. We have psychiatry residents groups where if you say anything about alternative medicine you’ll get bashed. But at the same time, “Cure” is something we don’t talk about in psychiatry, Especially with regard to diseases that belong to the psychotic spectrum. It’s understandable why patients look for alternative options. The issue here is many practitioners from other disciplines whom patients go to don’t have a good understanding of psychiatric conditions. Many of them go in the line of Allopathic medicines are bad, it has side effects, you’ll become a zombie, Stop using those and we will give you our medications which don’t have any “Side effects”. Then patients have to choose between 2 options. Which most often results in patients having another problematic episode.
The idea of an Integrative Physician, someone who knows the limitations of their basic disciplines with a fair understanding of treatment options and the philosophy of other disciplines is the need of the hour. This is what The NIMHANS model of Integrative medicine is about.
I was lucky enough to get Post doctoral fellowship in Integrative Psychiatry at NIMHANS. Being an apex institute of mental health and neurosciences in India, the focus is given to integrative management of psychiatric and neurological diseases. We have an Integrative medicine OPD where renowned physicians from Modern medicine, Ayurveda, Yoga, and Naturopathy sit together and see the patients. They share their understanding of the patient’s conditions in their respective specialties. Together they propose an integrative management plan for the patients. I was surprised to see experienced physicians from other disciplines telling patients allopathic medicines are needed since they will help with managing the acute situations that patients came with. In the same way, senior psychiatrists were recommending patients lifestyle modifications, Yoga, and Ayurvedic treatment methods to manage the conditions in the long term. Being in this department for 3 months I have seen patients getting benefited from Yoga and Ayurvedic treatment methods, which they wouldn’t have if they have opted for just one of these disciplines.
A shift from this-or-that to this-and-that is what integrative approach is about
B.Holla et.al 2021
One of the main challenges I have noticed in implementing this sort of setting in Kerala was the tendency to associate ancient Indian practices like Ayurveda and Yoga with religion, political party, and nationalism. NIMHANS model has done a good job in decoupling Medicinal aspects of these disciplines from the whole political scene. State-of-the-art research done here on the Integrative approach gives the much sought scientific evidence.
You can read about the ongoing research here.