Back to roots.

Psychiatry is presently not as ostracized as it once used to be, confined to asylums.

Now a days you may even find psychiatrists invited to public functions.

A welcome change but likely to be short lived.

Read on -
#stigma has always been a huge problem for psychiatry.

We got mental health away from Shamans but managed to get stigma in the process.

Persons with mental illness were always feared and hated. Hence confined to asylum, away from sanitized life of people.
Anything perceived as threatening (mentally ill, free thinking women, disenfranchised minorities, political opponents, sexual minorities) was labelled as "madness/character flaw/unsoundness" etc and sent to asylum to spend rest of their life.
Psychiatrists worked in such places. Looking after those who were unwanted by the world. They made sense of this madness.

As medicine progressed, neurological basis were discovered and most importantly, prescriptions could be written to achieve "cure".
History of psychiatry shows that as soon as something is discovered to be -
1. Treatable by talk therapy (depression, anxiety, relationship issues, etc.)
2. "neurodevelopmental" to be treated with some medicines but largely support (autism, ADHD, intellectual retardation)
3. Effectively treatable with medicines (epilepsy, movement disorders)

It is moved to mainstream medicine and treated by psychologists, pediatricians and physicians/neurologists.
Stigma continues to work strongly in society but MORE PROMINENTLY in medical doctors.
They are afraid of serious mental illnesses that involve losing "sanity".

That means - schizophrenia/psychosis/bipolar disorder.
In India almost no non-psychiatrist doctor knows about
Phenomenology and mental status examination. So they think psychiatrists just talk with people and give labels.

As we develop more effective medical and non-medical therapies for various ills of brain and mind,
psychiatry is headed back to asylum, its birthplace.
A psychiatrist is trained in "bio-psycho-social" model to look after all aspects of mind-brain-body-self-others complex.

We are gradually handing over care of mentally ill to part-specialists because it is less stigmatizing (though not necessarily any cheaper or better).
This leaves care of only seriously ill to psychiatrists and psychiatric nurses.

Sometimes in asylums, sometimes in community (not necessarily integrated with society).

"Mindless psychiatry" and "brainless psychology" is often rightly criticised.
Now we have entered era of "narrative based mental health"

Where does it stand as science? How does it serve society? Is getting rid of multidimensional model specialists a really good idea?

Are throwing away baby with Pharma bathwater?
I leave you to think and comment on this rapidly turning tide of twenty first century mental health.

Comments welcome.
Abusers will be ignored.

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More from @docbhooshan

21 Dec 20
#Healthcare #India
#BMR ( Basics में राडा) (chaos at basic level)


2 essential components of healthcare are a doctor and a patient. Everything depends on how this fundamental relationship works. Similar to hoe mother-child relationship defines humanity (or mammals)
All knowledge and further directions of prevention, cure and healing; all other healthcare personnel and other agencies exist to support this most fundamental relationship that is the reason of existence of everything "healthcare".
So it is natural that we put a proper label and work category to this relationship. This label will decide everything that goes into and around it.

This is FIRST PRINCIPLE of healthcare.
Read 16 tweets
9 Dec 20
Appropriate anger has already been expressed about this comment in all media and suitable explanation and retraction done already. But I want to look at this as citizen.

North America and Europe have democracy for long time. They had chance of rebuilding their countries through two devastating world wars.

Their building was done before world became aware of rights of endogenous people, environment protection and corporate giants.
Only large country that managed scorching pace of growth and pulling population out of poverty in modern times is China. They are not democracy and there is no word for human rights in their language.
Read 10 tweets
7 Dec 20
Perspective changes decision making.


18 month old child is brought in by parents as they suspect autism.
Pediatrician saw the child 3 months ago and advised them to wait till second birthday.

Parents were worried so they self referred to me.
Should the parents consult me without knowledge of their regular pediatrician?
(Hearing test is already done. Normal.)
When I meet the family, child has definite delay in speech related milestones. All other milestones are fine. signs of autism are absent.

Parents ask a pointed question - "are you sure my child does NOT have autism?"

What are my choices -
Read 14 tweets
27 Oct 20

First year of psychiatry residency teaches some valuable life lessons.

Here is a real life story about fighting delusions and living with them as it applies to today.
I worked in a municipal hospital during my urban internship stint. There was once a week Psychiatry OPD started by resident medical officer Dr Shirole and visiting consultant Dr Thombare (unfortunately, both have now passed away). I had already expressed my interest in Psychiatry
So I was allowed attend this OPD.
Dr Thombare wanted me to learn about symptoms of mind so he asked to talk a patient in detail. He allocated a middle aged man as my patient.
He was on treatment for years and was considered a "stable" patient.
Read 15 tweets
10 Oct 20
Thank you for your generous response to this tweet.

I am currently writing a blog post on this so I will share link as soon as ready.

Sharing some salient points via a thread here.
1. A doctor who is available nearby, in person and on phone, 24*7, has good acumen to solve most regular issues and contact with consultants to solve more complicated ones - golden age of family doctors
Important condition - this doctor should come really cheap.
2. This was good in metros till 20-30yr ago. Still works in areas that are semi urban or rural.
Read 21 tweets
5 Oct 20
When you approach a doctor with some problem, you are vulnerable. You will readily accept "intervention/treatments".

Sometimes your doctor wil send you away without offering intervention/treatments. Because -
1. It is normal occurrence. No disease.
2. Your misconceptions need correction not your body.
3. It is a self limiting condition.
4. Intervention will make it worse. Better to wait and let it disappear.
5. Too early to identify precise problem. Not enough data. Better to wait for more data to emerge.
6. You get hassled by small issues, need to learn to live with some as long term health strategy.
And some more.

Such doctors are pure gold. Cherish them.

They are turning away a willing to investigate/get treatment patient because they are ethical.
Read 6 tweets

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