This is the second blog about the 114 days I spent at the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India. My previous blog focused on the Perinatal Psychiatry work in outpatient clinics, the mother and baby unit and several inpatient wards.
In this blog, I want to tell you about another Department where I spent a lot of my time: the Integrative Medicine Department (I’ll call it IMD from now on), which focuses on the use of traditional Indian practices such as Yoga therapy (the clinical application of Yoga for treatments) and Ayurveda (a traditional Indian medicine system) with inpatient and outpatient services to treat mental health and neurological issues.
In fact, this was my primary purpose in coming to NIMHANS; I want to develop a prenatal Yoga module for women at risk of postnatal depression with the expertise of Yoga academics, clinical Yoga therapists, and psychiatrists.
The Yoga and Ayurveda buildings are tucked away from the street noise at the back of the campus, and one of the first things that I noticed is that you leave your shoes at the door; everyone is barefoot, which helps to be more grounded to the earth — this I found particularly beautiful!
One of the most impressive things about IMD is the emphasis on patient empowerment, where the patient is consulted and given a very active voice in the treatment process. Patients were encouraged to take an active role in the decisions relating to their treatment plan, with staff members providing education and resources to help them make informed decisions about their health. This focus on patient-centred personalised care was refreshing, a departure from short consultations focused simply on medication prescriptions or medication reviews.
In the IMD, patients undergo treatments incorporating Yoga, Ayurveda, and Western Medicine in perfect harmony, made possible by the treatment teams, including psychiatrists, psychologists, Yoga therapists, and Ayurvedic doctors.
Every day, Monday to Saturday, in the Hatha Yoga Hall or the Patanjali Hall, groups of patients came in for Yoga modules, validated and published in peer-reviewed journals, that had proven benefits for psychiatric and neurological conditions. These applications ranged from clinical depression, Attention deficit hyperactivity disorder (ADHD), migraines, schizophrenia, substance abuse, and general wellbeing, to name a few. In addition to in-person "batch" (group) classes, classes were also delivered online (one of the batches has been going on for over three years!) and on a one-to-one basis.
How are these modules developed, you ask?
The IMD prides itself on being very stringent in its scientific research methods. The Yoga modules are designed based on traditional and contemporary Yoga literature and qualitative inputs from experienced Yoga therapists, and then undergo expert validation. The finalised Yoga modules comprise elements from Hatha Yoga (the modern yoga that is practised through physical postures and other physical practices), usually including slow movements with breathing awareness, loosening exercises, asana (poses), pranayama (breathwork or breathing exercises), and relaxation. Finally, an open-label clinical trial evaluates this Yoga module’s effectiveness. Once peer-reviewed and published, the module is incorporated into clinical practice at NIMHANS.
I mostly attended the depression and anxiety classes, accessible from a physical exercise point of view, and where my presence was less disruptive — in other classes with patients with more severe symptoms, my presence was more destabilising, which I recognised pretty early on. In the modules I attended, I particularly enjoyed the emphasis on chanting and pranayama, which I don’t get to practice much in Yoga classes in studios in the UK.
I was also a part of clinical case discussions and the academic program of the IMD. Every patient on the ward was introduced, discussed, and reviewed in a boardroom with Ayurvedic doctors, psychiatrists, a Yoga professor, and several Yoga therapists. Patients were viewed as physical, mental, emotional, spiritual, and social beings, with each facet considered in the management plan — which incorporated pharmacology, psychology (as in therapy but sometimes also psychoeducation of family members), Yoga therapy, and Ayurveda.
I was particularly in awe of how the Ayurvedic medical system explains mental illness, its manifestations in the body, and how yogic anatomy (the panchakosha model — the different layers of existence) can be addressed for a holistic recovery.
For example, according to Ayurveda, many mental health issues fall within the vata dosha imbalance, vata being related to the air element. Imbalances in the vata element manifest in insomnia, fear, excess fear or worries, sadness, digestion, and appetite issues — common symptoms of depression and anxiety. Moreover, in a very crude way (and apologies for my limited knowledge of Ayurveda), the main site of accumulation of the vata dosha is the intestine, making it a primary treatment site. When I first heard this, I immediately thought, "The gut-brain axis!"
There were specific lifestyle measures (sleep, diet, routine, even relationship advice!), along with Ayurvedic treatments (that may include therapies and medication), that were advised to patients, alongside conventional (Western medicine) treatments such as psychotherapy and psychotropic medication. This harmonious dance between the two medical systems aligns with my view of holistic care.
Before I go, I wanted to share a beautiful moment I witnessed at NIMHANS. On the 26th of January, Republic Day (that celebrates the date on which the Constitution of India came into effect), early in the morning, under the canopy of tall trees, the Integrative Medicine Department performed a Yoga dance, a mix of Yoga poses and dancing to traditional Indian music. This was prepared in secret, and I was so surprised and proud to see the academics and students that carved time from their busy schedule (have I mentioned they work six days a week, 12 hours per day?) to perform for NIMHANS staff and patients.
That same morning, for the best part of two hours, groups of patients, staff, and sometimes mixed groups performed songs, played instruments and danced. The performances were truly spectacular, from a patient playing original ragas (melodic framework for improvisation) in a veena (a traditional Indian musical instrument) to staff re-enacting the challenges of being a working mother using contemporary dance, patients singing solos, all in beautiful traditional clothing, and using thousands of flower petals and confetti for added dramatic effect.
I felt very emotional during the performances; seeing Arts in Health in action (do you remember my work on the community arts for mental health projects, SHAPER program, and Brain Waves study over the last 3.5 years?) made me long for Western societies where singing, dancing, and performing are part of everyday life (at work, too!) and not just an artistic pursuit for those considered exceptionally gifted.
This amazing opportunity to live and work in India for just over three months was supported by the Hannah Steinberg Award, by the British Association for Psychopharmacology, and was only possible with the mentorship and guidance of Professor Carmine Pariante (your ITM Editor-in-Chief) and the incredible professionals at NIMHANS.