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Pain and difficulty are necessary components of human life. And different parts of the world have found their own methods of overcoming these difficulties. One paper discusses the difference in pain perceptions and how they may vary across cultures; while also touching on the need for this awareness by clinicians, to allow for an undercurrent of understanding between patient and provider (Free, 2002). As an aspiring psychiatrist, who comes from a Cuban household, I am aware of the importance of culture in an individual’s life and how that could impact their access and retention in treatment. During this trip in India, I seek to experience one of India’s ancient, indigenous system of healing: Ayurveda. John Hopkins University explains that in the system of ayurveda, disease stems from imbalances in an individual’s consciousness and it addresses these stresses through lifestyle modifications or other natural therapies. Rather than treating the disease, ayurveda focuses on regaining internal balance inside an individual.
Specifically, I am particularly interested in learning about Ayurveda’s role in mental health and other psychiatric disorders. When discussing pain, we often picture the sharp stinging stemming from a fresh wound, or perhaps an abdominal cramping after eating possibly expired food, but I am particularly interested in the pains which cannot be seen, mental diseases and other afflictions of the mind. What role, if any, does Ayurveda play in the rehabilitation and treatment outcomes of individuals with mental and other psychiatric disorders?
About 25% of U.S. adults are reported to suffer from a mental health disorder, per given year (Mental Health Disorder Statistics, 2023). When compared to other high-income nations, the U.S. sees higher rates of mental health diagnoses, mental health outcomes, the highest suicide rate and a lower supply of mental health providers (only about one-third of primary care practices include mental health providers) (“Mental Health Conditions and Substance Use,” 2020). One U.S. based longitudinal study in high-risk adolescents found that mood disorders were correlated with increased health problems, including: infectious disease, respiratory problems, and issues with weight (Aarons et al., 2008).
Shedding light on the need for mental health care in the U.S. (and the rest of the world population) as mental health affects more than just the mind, having plenty of repercussions for an individual’s health.
Western medicine, including that which is practiced in the U.S., places emphasis on an individualistic and a biomedical perspective on illness and mental health. By looking at medicine through a different lens and observing how another country and culture of people practice medicine can offer an interesting perspective which we have not considered before. Especially considering that our current model, despite the bountiful resources and pharmaceutical interventions available to us, is continuously plagued with mental health disorders. Consider the concept of “community-care” in developing countries, one nonprofit StrongMinds trained individuals to lead group therapy sessions to battle depression in women, in a group and community setting these women learned to develop strategies to overcome their depression. Another such program can be found in India, the organization Sangath, also trained individuals to become counselors to combat severe depression (Samuel, 2022). A study analyzed the potential impact of this program and it found that in individuals with moderately severe to severe depression, the program outperformed the control (Patel et al., 2017). Of course, this does not question the role which mental health providers play in treating mental illness, but it does begin to shed light on complementary interventions employed by cultures outside one’s own to bolster our own medical system.
One such concept which may prove useful is the holistic practice of Ayurveda and how it may help counterbalance aspects which are lacking in the western practice of medicine in addressing mental health issues. One study in rats observed how intermittent fasting, in addition to Ayurvedic herbs, aided in reducing anxiety. The control group was allowed to eat freely, one experimental group was deprived of food for an entire day and then ate at liberty every alternate day, and the last experimental group was placed on the alternating food schedule and Ayurvedic herbal extracts at liberty as well. It found less neuroinflammatory responses, stress responses and anxiety-like behaviors in the experimental group exposed to the herbal intervention (Singh et al., 2017). Suggesting to the clinical potential of Ayurvedic practices in reducing anxiety (and in future possibly alleviating other mental illnesses).
During my time abroad, I will seek to meet with ayurvedic practitioners, especially with ayurvedic psychiatrists to learn their approach to mental health, and how their training influences their practice. I would hope to be able to interview them, and learn how the medical system works in Mysore, and to learn what possible barriers to treatment they face in their country. Possible concerns in seeking this treatment in the language barrier between the clinician and myself. As a bilingual individual, I understand that some words or concepts are heavily tied to language, and their translation may not fully encapsulate the full picture of an idea. However, I will do my best to clarify and ask questions to elucidate an understanding of the ideas which the provider and I are communicating to each other.
By gaining an insight into the Indian, and Ayurvedic, system of medicine and mental health, it will teach me about culturally sensitive mental health treatment and the diversity within clinical models across cultures. This information will allow me to become a more well-informed mental health clinician in the future who can learn to adapt to differences in cultures, and it will serve as practice in being a student in medicine constantly keeping an eye out for new promising treatment methods and appraising them through a scientific and therapeutic lens.
References
Aarons, G. A., Monn, A. R., Leslie, L. K., Garland, A. F., Lugo, L., Hough, R. L., & Brown, S. A. (2008). Association Between Mental and Physical Health Problems in High-Risk Adolescents: A Longitudinal Study. Journal of Adolescent Health, 43(3), 260–267. https://doi.org/10.1016/j.jadohealth.2008.01.013
Free, M. M. (2002). Cross-Cultural Conceptions of Pain and Pain Control. Baylor University Medical Center Proceedings, 15(2), 143–145. https://doi.org/10.1080/08998280.2002.11927832
Mental Health Conditions and Substance Use. (2020). www.commonwealthfund.org. https://doi.org/10.26099/09ht-rj07
Mental Health Disorder Statistics. (2023, February 1). Johns Hopkins Medicine. https://hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics
Patel, V., Weobong, B., Weiss, H. A., Anand, A., Bhat, B., Katti, B., Dimidjian, S., Araya, R., Hollon, S. D., King, M., Vijayakumar, L., Park, A., McDaid, D., Wilson, T. J., Velleman, R., Kirkwood, B. R., & Fairburn, C. G. (2017). The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. The Lancet, 389(10065), 176–185. https://doi.org/10.1016/s0140-6736(16)31589-6
Samuel, S. (2022, November 28). The future of mental health care might lie beyond psychiatry. Vox. https://www.vox.com/the-highlight/23402638/mental-health-psychiatrist-shortage-community-care-africa
Singh, H., Kaur, T., Manchanda, S., & Kaur, G. (2017). Intermittent fasting combined with supplementation with Ayurvedic herbs reduces anxiety in middle aged female rats by anti-inflammatory pathways. Biogerontology, 18(4), 601–614. https://doi.org/10.1007/s10522-017-9706-8
As part of the health documentary my groupmates and I selected to perform, we interviewed Stanly Kizhakeparambil Varghese and Parashuram Mynkanalli Lingegowda. They are the co-founders of Odanadi Home for Victims of Human Trafficking, an NGO which supports victims of sexual violence and human trafficking, especially women and children. They offer a multitude of programs aimed at helping human trafficking victims rehabilitate and re-integrate to society. This includes offering them housing to reside free of cost to them and offering them practical vocational skills which may be applied to obtaining a job once they choose to move on from the center (e.g., training as a beautician, artist, etc. ).
Varghese held a lecture for my classmates and I, where he discussed the work that he does, the history in starting the organization, and other outreach and advocacy efforts which he engages in to bring attention to human trafficking in India (and worldwide). He commented that, in the world of human trafficking, the women are just an instrument, and the problem lies in deeper, murkier waters.
I asked what he believed were some causal factors of human trafficking, to which he surprisingly responded: cultural mindset and gender inequality/violence. He agrees, of course, that poverty is also a major motivating factor and that women and children from rural areas face certain monetary hardships which might be an incentivizing pull factor of human trafficking. However, Varghese admitted that there is a certain stigma attached to gender, notably the female body and intimacy. Although in recent times, there have been notable efforts such as education about gender and sexual differences, there is not enough necessary conversations about sex being held. Varghese remarks that this mindset manifests in the view of women as objects, part of the demand and supply chain as opposed to proper human beings.
During his lecture, mentioned something quite surprising. He remarked about the benefit which yoga can have in the world of human trafficking. My understanding about yoga and its potential for positive impact was expanded during this trip; Varghese explained that yoga is a way of life, aimed at connecting the mind, body, and soul. In his vision, he seeks to use yoga to educate individuals change restrictive mindsets and raise awareness about human trafficking (as well as avenues of rehabilitation for affected victims).
I share Varghese's sentiments that yoga can offer much help, not just to the general society, but in a smaller scale by improving the quality of life of the affected victims. Attending his lecture and having the benefit of interviewing him about the work he has done with Odnani has allowed me to grow in my understanding of civic responsibility, professional development, social considerations, and future intellectual pursuits. Seeing the effort of both co-founders and how far Odandi has come has elucidated to me that you can start from humble beginnings and good intentions, and grow to eventually to make an impact in your community. Little drops of water, make a mighty ocean. One small thing can become something great. As such, up to us to advocate for those who don’t have a voice. We would want the same help, so it is up to us to take a step to help this in anyway we can. Intellectually and more practically, his interview has made me more interested in the possible benefits of yoga as it relates to healing (e.g., mental illnesses and trauma). It would be interesting to see how it could play out as a possible research idea, and I definitely will be exploring to learn more on the topic.
Professionally, this trip has led to me questioning and re-evaluating my career choices. It has made me more sure that I want to help re-habilitate and heal others. I want all the tools in my arsenal: talk therapy, pharmaceutical treatments, and alternative methods as well. Yoga has been one tool which has helped me in my emotional, spiritual, and personal life. I would like to continue being a student of the practice and maybe a teacher one day to give others another tool for their tool box.
One unexpected finding was a deeper cultural understanding; being raised in Miami you are often exposed to lots of cultures however they may be intermingled with American culture. Seeing how a rural community lives, and earns their living for an entire month has showed me importance of keeping culture in mind when in both personal and professional spaces. Cultures influence the values and expectations we hold, which in turn guide us towards certain beliefs and actions. Making space for cultural sensitivity and awareness fosters deeper understanding between people.
Introduction to Ayurveda by Dr. Dr. Anil Kumar Dixit
Dr. Anil Kumar Dixit is an Ayurvedic physician and instructor. He obtained a Bachelors in Ayurveda Medicine and Surgery, and his Doctor of Medicine from Mysore University in 1991. He has been an instructor at JSS Medical College since 1997. In his lecture, Dr. Anil Kumar Dixit introduces the concept of ayurveda, introducing it as the science and art of life and healing. He posits that the purpose of ayurveda is to promote health in the healthy by taking a holistic approach when managing health concerns; it is a method of prevention and target the root causes of illnesses, as opposed to eliminating symptoms.
~~One of the key preventative measures is lifestyle, reflected by our daily regimes. There are plenty of recommendations from this system including when is an ideal time to wake up to natural home remedies for illnesses or other conditions.
During the lecture, I was particularly interested in what ways Ayurveda intersected with mental health, and I inquired about how ayurveda could be used to address mental health concerns.
Ayurveda seeks to establish a harmony between the mind, body, and soul which takes into account an individuals physical, emotional and spiritual needs. Upon my question, Dr. Dixit explored the properties of the mind and a soul, and pointed out how they are immaterial in nature (distinct from the brain). It is an interesting organ as it is capable of feeling both in relation to and without the presence of any sense faculties (he gave the comparison of tasting a bitter coffee which may not appeal to us compared to waking up one morning and feeling as though it will be a good day, both are situations which the mind is feeling; there does not necessarily have to be any sensory input). He proceeded to point out how our default option is to treat mind related issues with molecules, which, he argues, is quite peculiar. To what end can pharmaceutics resolve issues with the immaterial mind?
Say you feel bad without clear stimulation or reason, as occurs with depression, what is the source of this infliction? Does anything occur without a cause, he poses?
Within ayurvedic understanding, depression began and can be treated through the sense organs. Dr. Dixit explains how depression may have initially begun through the sense organs, but through time the feeling lingers without any input present. Consider a child who was maltreated by a parent, initially they may have been reprimanded for a certain action which created a feeling within the child. As time passes, the child may see the parent and the feelings arise, then the child thinks of the punishment and feelings arise. At a certain point, the negative feelings linger within the child without any additional input. Once again, Dr. Dixit poses, how can a molecule help this child?
[1] As the initial problem occurred through the sense organ, ayurveda states that it should be addressed through the sense organs, which offers a channel into the mind. To ease depression, one should focus on what once made you happy. It can be as simple as a flavor of coffee you really enjoyed, try it once more and take it in through your sense organs: the chocolatey aroma, slightly bitter taste, and the warm porcelain sharing heat to the tips of your fingers. It will not magically solve your problems with a one-time cup of Columbian coffee, but each time you engage your sensory faculties it is small progress in healing the mind and the soul.
[2] One of the more interesting concepts which I have gained from this trip, is the power of experience. Unlike allopathy, ayurveda does not have the have the same body of literature supporting its practice. All the different lectures and conversations I have had with Ayurvedic doctors and similar professionals have helped me see and understand the positive impact which Ayurveda has had in the lives of many. Should its merit be discounted for lack of evidence to date? This analysis and review postulates that ayurveda is an ancient science with principles which may hold validity in today’s day and age, however, there is an imperative need for a modernization and evidence in support of the practice.
This talk has been quite transformative in many ways. For one, it forced me to view mental health and the manner in which we treat it in a new, unexpected way. Coming from a western model of medicine, I often understood depression through the lens of a chemical imbalance, but ayurveda proposes a model geared towards a sensory and more holistic understanding of an individual and their experiences. Even in cases where depression may run in the family, Dr. Dixit states that it can be improved with lifestyle management. As is the case of an individual with familial history of diabetes, it can be managed with proper diet and activity.
There is an imperative need for research within Ayurveda, particularly what it has to offer individuals mental and physical health. Doing so may help two-fold; by reducing stigma of this intervention model in Western societies and to build a scientific basis and body of literature analyzing this ancient system. This experience has helped me gain a greater understanding of Ayurveda and see firsthand the extensive training and knowledge which it’s practitioners undergo. I resonate with the idea of treating an individual holistically and searching for the root cause of an issue as opposed to treating the symptoms. Going back home I wish to observe other western allopathic perspectives on this traditional eastern system and compare the two. There is a middle ground to be reached, with both sides having key takeaways to draw from the other.
[1] Ways of bridging scientific evidence for Ayurveda: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230501/
[2] Healing through the senses: https://chopra.com/articles/healing-through-the-5-senses
[3] Ayurveda and MDD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186000/
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