IJP Mutual Research

Indian J Psychiatry 52, Supplement, January 2010 S56
Address for correspondence: Dr. Dinesh Bhugra,

Department of Health Service and Population Research,
Institute of Psychiatry, Kings College London,
De Crespigny Park, London SE5 8AF, UK.
E-mail: dinesh.bhugra@kcl.ac.uk
DOI: *****
thus making it important to look at the impact factor that
the research in both these countries have on each other.
In an increasingly globalized world, not withstanding
historical research, it is possible that research and service
development ideas will be shared across various countries
and regions. In this article we highlight some of the studies
where an impact has been felt in two major regions of the
world India and Europe, including the UK.
HISTORY
Mills
[1]
had divided the history of Indian psychiatry into
four main periods, 1795 to 1857, 1858 to 1914, 1914 to
1947, and 1947 to the present day, and argued that the
foundations of modern psychiatry in India were laid down
during the British Raj. Parkar et al.
[2]
mentioned three major
revolutions in Indian psychiatry, helping it reach where it is
today. The first revolution occurred when it was believed
that sin and witchcraft led to mental illness; the second
revolution was the advent of psychoanalysis; and the third
was the development of community psychiatry, resulting in
the integration of mental healthcare in the community.
IMPACT OF INDIAN RESEARCH ON UK
There have been several strands of research carried out in
India, which have directly and indirectly influenced research
INTRODUCTION
Over six decades have passed since the British left India.
However, the patterns of healthcare they had established
have remained and indeed influenced the psychiatric system
of modern India and continue to do so. Psychiatry has its
roots as a biomedical discipline in Europe and a history
related to delivery of psychiatric services largely through
asylums. Certainly some facets of psychiatric services and
research and training have changed as a result of changes
in the healthcare policy in the last quarter of a century,
although much more needs to be done. The growing
research strength of Indian Psychiatry can be seen from
the number of paper presentations in various conferences
and the growing number of publications, some of which
have been co-authored by researchers from India and UK,
ABSTRACT
India and UK have had a long history together, since the times of the British Raj. Most of what Indian psychiatry is
today, fnds its roots in ancient Indian texts and medicine systems as much as it is infuenced by the European system.
Psychiatric research in India is growing. It is being infuenced by research in the UK and Europe and is infuencing them
at the same time. In addition to the sharing of ideas and the know-how, there has also been a good amount of sharing of
mental health professionals and research samples in the form of immigrants from India to the UK. The Indian mental
health professionals based in UK have done a good amount of research with a focus on these Indian immigrants, giving
an insight into cross-cultural aspects of some major psychiatric disorders. This article discusses the impact that research
in these countries has had on each other and the contributions that have resulted from it.
Key words: Europe, India, UK, research
Mutual learning and research messages: India, UK, and Europe
Gurvinder Kalra, Dinesh Bhugra
1
Senior Registrar, B.Y.L. Nair Hospital and T.N. Medical College, Mumbai - 400 008, India.
1
Professor of Mental Health and Cultural Diversity, Department of Health Service and Population Research, Institute of
Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
REVIEW ARTICLE
How to cite this article: Kalra G, Bhugra D, Mutual learning
and research messages: India, UK, and Europe. Indian J
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and service delivery in the UK. These can be roughly divided
into research, translation of research into clinical practice,
and impact on service delivery for Indian patients in the UK.
Psychiatric research in India has been carried out by a
number of agencies from central organizations such as
the Indian Council of Medical Research (ICMR) and Council
of Scientific and Industrial Research (CSIR), to academic
institutions such as National Institute of Mental Health and
Neuro Sciences (NIMHANS) Bangalore, All India Institute
of Medical Sciences (AIIMS) Delhi, and Post Graduate
Institute of Medical Education and Research (PGIMER)
Chandigarh, along with NGOs such as Schizophrenia
Research Foundation (SCARF), Sneha, and Sangath. Of the
national organizations, ICMR is the main body in India for
the formulation, coordination, and promotion of biomedical
research, which also supports international collaborations,
including those with the Medical Research Council, UK.
[3]

Mental health research is one of ICMRs thrust research
areas.
Indian psychiatry was put on the world map by the involvement
of centers in Agra and Chandigarh in the two major World
Health Organization (WHO) studies International Pilot
Study of Schizophrenia (IPSS) and Determinants of Outcome
of Severe Mental Disorders (DOSMeD). Both these studies
were the key steps in developing ideas of carrying out
cross-cultural psychiatric research from the 1960s to the
1970s. Both the studies demonstrated that not only did
schizophrenia exist in different parts of the world, but it
had better outcomes in developing countries like India,
Colombia, and Nigeria. This changed the way the world
perceived schizophrenia and psychiatry as a whole in the
Indian perspective. DOSMeD conducted in 1978, replicated
the findings of IPSS. Speculations were made on the reasons
for better outcome in developing countries, focusing on the
role of families and socio-centric societies, which provided
more support, placing lesser demands on the patient. These
studies were the models for subsequent studies by ICMR on
acute psychosis and its outcomes.
Kapur et al.
[4]
followed the development of the Present
State Examination (PSE) model
[5]
to develop their interview
schedule, the Indian Psychiatric Survey Schedule.
ROLE OF RAUWOLFIA
In the 1950s, there was a revolution of sorts in the
approach to psychotic disorders, with the introduction of
the first pharmacological tools specifically aimed at the
management of psychotic patients, with the discovery
of chlorpromazine
[6]
and reserpine. Even as the former
was a substance of chemical synthesis, the latter was an
alkaloid having a natural origin, obtained from the root of
Rauwolfia serpentina.
[7]
Both these drugs have helped the
onset of the psychopharmacological era in the treatment
of schizophrenia,
[8]
although the role of Rauwolfia is often
not discussed. Commonly known as sarpagandha (Sanskrit
name), Rauwolfia has been used medicinally in ancient India
and has found mention in the Hindu texts dating from
around 500 BC, including the Charaka Samhita. Vakil
[9]
had
enumerated some 16 different names of this insanity herb.
The first report on the tranquilizing effects of Rauwolfia,
based on proper research methodology, in India, was in
the 1930s,
[10]
although Western medicine realized its utility
only after the 1940s, with the work of Indian cardiologist
Rustom Jal Vakil.
[11,12]

Rauwolfia contains an alkaloid reserpine, which reduces blood
pressure,
[13,14]
depresses activity of the CNS
[15]
by depleting
catecholamines and serotonin, and acts as a hypnotic.
[16,17]

Although the utility of Rauwolfia in cardiovascular disorders
has been premiered by Vakil, its utility in mental illnesses
can be said to have been popularized by Dr. R. A. Hakim
from Ahmedabad, Gujarat, who studied the effects of
Siledin, a mixture of medicinal plants, including Rauwolfia,
and found it effective in schizophrenic and manic-depressive
disorders.
[8,18]

The early clinical trials with reserpine were carried out by
Davies and Shepherd of the Maudsley Hospital, London,
who found it to be useful in patients with anxiety.
[19]

Altschule
[20]
specifies that reserpine causes significant
clinical improvement in psychiatric disorders such as
schizophrenia, schizoaffective states, delirium tremens,
catatonic syndromes, senile psychosis, and manic psychosis.
Lopez-Munoz et al.
[6]
suggest that this study of Altschule
might have initiated the process of deinstitutionalization
of psychiatric patients. Whether the study initiated
the process or not, it most certainly contributed to the
likelihood that patients could be discharged and could lead
better independent lives outside the asylums.
However, reserpine did not stand the test of time and was
considered inferior with respect to chlorpromazine in the
control of acute psychosis.
[21]
Despite this, other researchers
like Christison et al.
[22]
and Lehman
[23]
have suggested the
use of reserpine as one of the alternative treatments in
refractory schizophrenia. Thus we see the important Indian
contribution to psychiatry with Rauwolfia, which led to
some major research influences between India and the UK.
YOGA AND MEDITATION
Psychiatric research is also rediscovering and validating
many of the ancient mental health practices from
traditional cultures, and the contribution of Indian yoga
in this scenario cannot be ignored. Yoga is an ancient
Indian science, probably the first to recognize the
interconnections between mind and body and the role
this relationship plays in restoring and promoting optimal
health through various postures (asanas), breathing
Kalra and Bhugra : Psychiatric research in India, UK and Europe
exercises (pranayamas), and a cognitive component focusing
on meditation and concentration. The Sanskrit meaning of
yoga is to unite, which may refer to the union of mind
and body through this ancient art. Patanjali, the foremost
exponent of yoga has defined yoga as Chitta vritti nirodha.
Chitta is the mind, which is constantly bombarded with
ideas and thoughts, uncontrolled emotions, and worries,
leading to a whirlpool (vritti), that needs to be controlled
(nirodh) through abhyasa (constant practice) and vairagya, a
state where feelings are not affected by environment, but
by ones own judgment.
Attempts have been made to show that yoga is an evidence-
based treatment in various psychiatric disorders, from as
early as 1960s, by various Indian researchers like Venkoba
Rao,
[24]
Vahia et al.,
[25,26]
Vahia,
[27-29]
Udupa et al.,
[30]
Balakrishna
et al.,
[31]
Sethi et al.,
[32]
Singh and Madhu,
[33]
Lalitha and
Kaliappan,
[34]
Sahasi et al.,
[35]
Prabhakar et al.,
[36]
and Grover
et al.
[37]
NIMHANS is also involved in yoga research for over
three decades now, with ongoing research to assess the
efficacy of yoga in mild cognitive impairment, Attention
Defcit Hyperactivity Disorder (ADHD), and its benefit to the
caregivers of schizophrenia.
[38]
A 68 73% remission rate in the treatment of depression,
regardless of the severity of depression, has been reported
by the use of Sudarshan Kriya;
[39,40]
One study points to its
being as effective as a standard antidepressant drug and
electroconvulsive therapy (ECT),
[41]
and another pilot study
supports its use as an adjunct treatment for depression,
[42]

anxiety disorders,
[43,44]
eating disorders,
[45]
alcohol
dependence,
[46]
and even in schizophrenia.
[47]
Other Indian
research has also shown the efficacy of yoga in post traumatic
stress symptoms.
[48]
Recent research has highlighted
the effects of yoga in chronic pain,
[49]
low back pain,
[50,51]

enhancing brain function,
[52]
resiliency to stress,
[53,54]
and the
overall well-being and optimism in healthy populations,
[55,56]

improving sleep in the institutionalized elderly,
[57]
benefiting
sexual drive,
[58]
and even smoking cessation.
[59]
Grover and
Avasthi
[60]
have suggested including yoga in the Clinical
Practice guidelines of the Indian Psychiatric Society.
However, of late, there has been some criticism pointing to
the methodological limitations of various yoga studies.
[61]
The
role of the patients attitude toward yoga is also important
in predicting the response to treatment as was pointed out
by Grover et al.
[62]
Increasingly in social settings in the UK,
different schools of yoga are flourishing for well-being, and
meditation is being used both in clinical and non-clinical
services. However, not many trials have been carried out.
SPIRITUALITY
Spirituality is distinct from religion and refers to a belief in a
power greater than oneself,
[63]
the transcendent relationship
between the person and a higher being, something that
goes beyond specific religious affiliations.
[64]

All around the globe there is an increased stress on a holistic
approach to patients and their treatments. Indian psychiatric
diaspora have led to exploring spiritual matters with their
patients and the people who care for them. With the
concept of holistic therapy, the therapist now has to deliver
multidimensional care to the patient, with attention to the
physical, mental, emotional, social, environmental, and also
spiritual domains of health. Religion and spirituality are
resources that help patients cope with various life stresses
including that of different illnesses
[65]
such as arthritis
[66]
and
cancer.
[67]

Bhugra and Osbourne
[68]
discuss how psychiatrists are
not trained to deal with religious and spiritual issues
because they feel that they may be working outside the
limits of their capability, pointing out how essential
it is for psychiatrists to be honest and open about
discussing these issues with the patients. Kumar
[69]

points out how Complementary and Alternative Medicine
(CAM) is more popular owing to its holistic approach.
To this point, Verghese
[65]
suggests propagating the
biopsychosociospiritual model in our psychiatric
approach, including religious concepts, in psychotherapy.
Again, in the UK, increasing emphasis is being placed on
a holistic approach of managing patients and assessment
of spiritual needs is a key aspect of that.
Ravinder Lal Kapur was among the past few psychiatrists
who had a special interest in spirituality, which led him to
research the lives of rishis and sadhus in the Himalayas and
extrapolate his findings to mental health issues.
[70]

Philosophy in India is essentially spiritual, with the
spiritual motive dominating Indian life. Transcendental
meditation (TM), yoga therapy, and prayer are almost
universally known techniques that form a part of many
traditional psychotherapeutic practices still practiced in
India.
[71]
These are a way to develop an individuals inner
self, with some people having turned to spirituality as a
healing balm for their aching hearts.
[72]
Older literature
mentions the effectiveness of meditation on anxiety
states,
[73]
tension headaches,
[74]
and drug abuse.
[75]

Carrington and Ephron
[76]
have used TM as an adjunct to
psychoanalysis and analytically oriented psychotherapy,
and have found that it reduces tension and anxiety with
improvement in psychosomatic conditions. Studies
have also shown that spiritual and religious beliefs help
in stress reduction,
[77]
pain management,
[78]
recovery
from illness,
[79]
and in overcoming disability.
[80,81]
In a
collaborative three-center study, Verghese et al.
[82,83]

have shown that those patients who spent more time
in religious activities tend to have a better prognosis.
Considering similar research in the UK, in a British
epidemiological study by Brown and Prudo, it has been
found that church going and active religion are protective
of the vulnerability for depression.
[84]

UK RESEARCH ON INDIA
Of the research carried out by UK psychiatrists of Indian
origin based in the UK, but with a research focus on
India, Patel
[85]
has led the way on developing strategies of
providing mental healthcare by non-psychiatrists, which
includes anyone working in a healthcare setting, or who
works with people who are mentally ill, but has not been
trained specially for the same. These strategies have proved
useful for community health workers, primary care nurses,
and the social workers in developing countries. Patel
[86]
has
also suggested new roles for psychiatrists especially from
the low- and middle-income countries, in designing and
managing various mental health interventions, building
clinical capacity, supervision and quality assurance, and
providing referral pathways and research. Patel and Bloch
[87]

have pointed out how the scarcity of mental health legal
provisions and inadequate clinical services in the low- and
middle-income countries has led to compromised mental
well-being in the community.
Some of the psychiatric conditions where UK research
studies have focused on India are illustrated herewith. This
is in no way a comprehensive review, but it is a selective
review.
EXPRESSED EMOTION
The finding that Expressed Emotion (EE), a measure of family
environment, is associated with the course of psychiatric
disorder has generated a great deal of clinical and research
interest in it as an important risk factor. The 1978 study
of WHO, namely, DOSMeD, reported 54% households in
Denmark and only 23% households in Chandigarh to be
high in EE. In the latter center, urban families had a higher
EE than rural families. Similar findings were reflected in
the study by Leff et al.,
[88]
who found a significantly lower
proportion of high-EE relatives in the Chandigarh sample
and hence a better outcome as compared with a London
sample.
Cheng
[89]
had raised important questions asking if EE
could be considered an etic phenomenon and suggested
that EE assessment needed to be recalibrated in different
cultures. The sick role played by an Indian person with
schizophrenia and the familys response may have
certain emic characteristics. It is possible that the various
components of EE (Critical Comments, hostility, emotional
over-involvement) in relatives of mentally ill in India may be
different from their Western counterparts. In this context,
Wig et al.
[90]
have found that the rating of critical comments,
hostility, and positive remarks can be transferred from
English to Hindi without distortion, but not the remaining
two scales of over-involvement and warmth. Wig et al.
[91]

have also measured the components of EE among two
samples of relatives of frst-contact patients from Aarhus
(Denmark) and Chandigarh (India) and found that the Danes
were very similar in most respects to samples of British
relatives, whereas, the Indian relatives expressed signifcantly
fewer critical comments, fewer positive remarks, and less
over-involvement. There are problems with these studies and
with the approach, as no normative data were collected, and
without knowing what is normal in a given population it is
diffcult to ascertain the true levels of EE.
DELIBERATE SELF HARM
Examining episodes of self-harm over a one-year period in
an area of London, Bhugra et al.
[92]
confirmed that women
from the Indian subcontinent had the highest overall rates,
especially in the younger age group, and this was attributed
to social and cultural stress.
[93]
Subsequently Bhugra and
Hicks
[94]
showed that the community could be educated and
their knowledge of depression could be increased by using
educational pamphlets on depression and suicide, especially
if they were developed with the help of the community.
EATING DISORDERS
Eating disorders like anorexia nervosa are usually seen in
Euro-American societies, which lay emphasis on slimness
and body image.
[95]
However, Bhugra et al.
[96]
hypothesized
that a clash between a traditional culture and adopted
culture may heighten the risk for eating and body image
disturbances in susceptible individuals. This clash described
by Bhugra et al.
[96]
may probably be important in the future
due to the effects of globalization in India, with the Indian
society being influenced by Western culture.
COMMON MENTAL DISORDERS
According to Kirmayer and Minas,
[97]
globalization affects
psychiatry in three main ways: through its effects on the
forms of individual and collective identity, through the
impact of economic inequalities on mental health, and
through the shaping and dissemination of psychiatric
knowledge. This latter method is important in the Indo-UK
context, considering the large number of Indian psychiatrists
who have migrated to the UK, either temporarily or
permanently, and are now involved in sharing of the
psychiatric knowledge.
The large numbers of Indians residing in the UK have
provided the researchers with a special set of population
sample of ethnic minority. This has encouraged research
on mental health issues in them such as the study by Bhui
et al.
[98]
that has found more depressive ideas in the Punjabis
living in London, compared to the English general practice
attendees; but they are no more likely to have somatic
symptoms than the English patients.
[99]
In an earlier study
on depression in Indian women in London, Jacob et al.
[100]

reported a low sensitivity (17%), but a high specificity (91%) in
the doctors recognition of the condition. Similarly, Bhugra
et al.
[101]
pointed out that Punjabi women, in a focus group in
London, recognized the English word depression, but the
older ones used terms such as weight on my heart / mind,
or pressure in the mind. The symptom of sinking heart,
found in women from north India was also noted among
Punjabis in the UK.
[102]
Studies in the UK found that South
Asian immigrants, which included Indian and Pakistani
individuals had lower rates of depression than the general
UK population.
[103]
However, a later study by Bhui et al.
[104]

in the UK, using a culturally adapted measure, found higher
levels of depression among Punjabi immigrants, particularly
women, compared with their white counterparts in the UK.
This underscores the need for culturally adapted measures,
to tap expressions of distress, the so called idioms of
distress that may otherwise go unreported. Bhugra and
Mastrogianni
[105]
had enumerated some such idioms of
distress.
RESEARCH INSTRUMENTS
Universalism and relativism are the two key debates in
cross-cultural psychiatric research. This debate refers to the
use of either etic or emic instruments for the recognition and
evaluation of mental illness. The etic issue of application
of various diagnostic instruments on Indian patients is
not a recent one, most of these being developed in the
West. However, newer culturally relevant and appropriate
instruments are being added, albeit at a slower pace, in the
Indian research armamentarium, for example the Indian
Disability Evaluation and Assessment Scale (IDEAS, 2002)
developed by the Rehabilitation Committee of the Indian
Psychiatric Society,
[106]
which has been recommended to
measure psychiatric disability in four illnesses, namely,
Schizophrenia, obsessive compulsive disorder (OCD),
bipolar disorder, and dementia.
[107]
Other such instruments
include the SCARF Social Functioning Index,
[108]
Amritsar
Depressive Inventory,
[109]
and the like.
The Present State Examination (PSE) developed by Wing
et al. (1974),
[5]
from the Social Psychiatry Research Unit
of the UK Medical Research Council, is probably the
most widely used instrument to record the mental state
examination, and has given investigators a useful tool
for reliably eliciting and recording symptoms of current
psychopathology, if any. Schedules for Clinical Assessment
in Neuropsychiatry (SCAN), originally called PSE, is a set of
tools created by WHO, aimed at diagnosing and measuring
mental illness, and can be used with either ICD-10 or DSM-
IV, and includes the tenth edition of the PSE as one of its
core schedules. The entire SCAN interview consists of an
exhaustive 1,872 items, with most patients needing only
parts of the interview.
The PSE and SCAN aim to provide comprehensive, accurate,
and technically specifiable means of defining, eliciting,
describing, and classifying clinical phenomena in order to
make comparisons, and can be used to enhance clinical
work and education and advance knowledge, through its
use in epidemiological and psychosocial research.
[110]
These
two instruments are the result of attempts to construct
a simple glossary of symptom definitions and to give a
structure to the way a clinical interview is to be conducted.
These instruments have been extensively used in several
population samples,
[111]
including some Indian studies,
[112]

and they provide an opportunity of applying uniform
criteria across different centers in the world, thus making
cross-cultural comparisons easy. The Hindi version of PSE
has been extensively used in India, from the time of the IPSS
study in the 1960s.
[113]

EUROPEAN LINKS
Learning from the experience with UK, one can say
that research and training collaboration should also be
encouraged and supported between the European Union
and India. The relation between European and Indian
psychiatry dates back to the 1850s, when Hoenigberger,
a German doctor employed by Maharaja Ranjit Singh of
Punjab, established a lunatic asylum in Patiala, Punjab.
This was followed by a time when separate asylums
for European mentally ill were established, and various
therapies like insulin coma therapy, hydrotherapy, and
various hormone extracts developed in Europe and England
were industriously being followed in India. Today, there are
many Indian immigrants in various countries in Europe who
provide researchers with a unique ethnic sample. Migration
research similar to the UK has been done in the Netherlands
and the incidence of psychotic disorders was found to be
high among immigrants living in neighborhoods where
their own ethnic group comprised of a small proportion of
the population,
[114]
similar to the UK studies.
Most of the psychiatric classifications originated in nineteenth
century Europe as also the study of phenomenology. They
were based on many philosophical concepts, which were
not widely accepted in developing countries. One such
example included the unconscious motivation of symptoms.
This was criticized by psychiatrists from India, China,
Indonesia, and the WHO, at the International Conference
on the Diagnosis and Classification of Mental Disorders
held in Copenhagen in 1982.
[115]
Today, van Os,
[116]
from
Netherlands has proposed to introduce the diagnosis of
Salience syndrome analogous to the functional-descriptive
term Metabolic syndrome, to replace all current diagnostic
categories of psychotic disorders in DSM V and ICD 11. One
has to now wait and see whether history repeats itself!
There is not much literature on the research links between
Europe and India. Homeopathy developed in Germany has
influenced Indian care giving in a significant way; being
practiced in India for more than a century and a half now and
is recognized as one of the National systems of medicine,
providing healthcare to a large number of people. This
system of medicine was imported into India from Germany,
where Samuel Hahnemann was the major proponent of this
practice. It takes a holistic approach to the patient using
a single substance to treat the whole person (physical,
mental, and emotional) and then allowing healing to take
place. This system views all symptoms (physical, mental, and
emotional) as signs of the body trying to heal.
[117]
In recent
decades, homeopathy has been used increasingly for the
treatment of medical and mental illnesses,
[118]
but there is
little information about the outcomes from case reports or
controlled studies. Similarities may exist between the basic
principles of homeopathy and modern psychiatry, including
the postulated role of self-healing and a possible microdose
effect of treatments that permit the subsequent use of low
doses to elicit therapeutic responses.
[119]
However, a review
of 19 articles on Complementary and Alternative Medicine
(CAM) by Thachil et al.
[120]
found that none of the CAM studies
showed efficacy in psychiatric disorders like depression.
The Unani system of medicine also known by various
names including Al-Tibb-Al-Arabi, Al-Tibb-Al-Unani, Al-Tibb-
Al-AaShaab, and so forth, owes its origin to Greece, with
its theoretical framework based on the teachings of
Hippocrates. It was introduced in India by Arabs. Unani
physicians have all mentioned psychiatric disorders, namely,
delirium, melancholia, hysteria, insomnia, and so on. They
have mentioned Quwwat-e-nafsaniya, the psychic faculty,
as one of the important faculties in the human body and
have also described the causative factors, clinical features,
and even the differential diagnoses of psychiatric disorders
along with their management.
[121]
The Unani system of
medicine is based on the humoral theory, which mentions
four humors: Blood, Phlegm, Yellow bile, and Black bile.
Every person has a unique humoral constitution, which
represents the healthy state of the person with the humors
in relative equilibrium. The dominance of one humor
determines the Mizaj (temperament) of the individual,
which represents the metabolic constitution, psychological
makeup, and behavioral pattern of an individual. It
is expressed as sanguine, phlegmatic, choleric or a
melancholic temperament.
[122]
The dominance of phlegm or
black bile determines phlegmatic or melancholic characters,
respectively. Excess of humors produces diseases; for
instance, black bile induces depression, while excess of
yellow bile leads to hysteria and manic disorders. The aim
of the Unani practitioner is to restore the normal mizaj of
the person, through pharmacotherapy and suggestion or
cognitive therapy. University pharmaceutical laboratories
(such as Hamdard in Delhi and the Tibbiya College in Aligarh),
as well as some private ones, offer some traditional drugs
for disorders such as mania, hysteria, melancholia, sleep,
and sexual disorders. However, this branch of medicine is
rarely practiced today.
[123]
Links between Europe and India
are increasing as more joint research projects are being
planned and carried out. How these affect the service
delivery remains to be seen.
CONCLUSIONS
The world is changing rapidly and the challenge will be to
keep pace with the latest research from the West and in
the process give Indian psychiatric research a face of its
own. There is also a need to raise the skills and capacity
for research, by more collaborative efforts between the
two countries. An even bigger challenge in doing research
in India is dealing with the severely limited resources.
We must not only continue to generate great ideas and
knowledge, but also get better at exploiting them and
exploiting ideas from elsewhere, to harvest greater benefits
for the society. In order to maintain Indias position in the
face of increasingly severe global competition in research,
the government should adopt a clear, long-term vision for
supporting the research base, and for deriving economic
and social benefits from that investment.
REFERENCES
1. Mills J. The history of modern psychiatry in India, 1858-1947. Hist
Psychiatry 2001;12:431-58.
2. Parkar SR, Dawani VS, Apte JS. History of psychiatry in India. J Postgrad
Med 2001;47:73-6.
3. Highlights of ICMR: activities and achievements. Available from: http://
www.icmr.nic.in/highlights.htm [last accessed on 2010 May 29].
4. Kapur RL, Kapur M, Carstairs GM. Indian Psychiatric Survey Schedule.
Soc Psychiatry 1974;9:71-6.
5. Wing JK, Cooper JE, Sartorius N. Measurement and classifcation of
psychiatric symptoms. An instruction manual for PSE and CATEGO
program. Cambridge: Cambridge University Press; 1974.
6. Lopez-Munoz F, Alamo C, Rubio G, Cuenca E. Half a century since
the clinical introduction of chlorpromazine and the birth of modern
psychopharmacology. Prog Neuropsychopharmacol Biol Psychiat
2004;28:205-8.
7. Bhatara VS, Gupta S. History of Rauwolfa serpentina. Can J Psychiatry
1997;42:777-8.
8. Lopez-Munoz F, Bhatara VS, Alamo C, Cuenca E. Historical approach to
reserpine discovery and its introduction in psychiatry. Actas Esp Psiquiatr
2004;32:387-95.
9. Vakil RJ. Rauwolfa serpentina in the treatment of high blood pressure; a
review of the literature. Circulation 1955;12:220-9.
10. Sen G, Bose KC. Rauwolfa serpentina, a new Indian drug for insanity and
high blood pressure. Ind Med World 1931;2:194-201.
11. Vakil RJ. Clinical trial of Rauwolfa serpentina in essential hypertension.
Br Heart J 1949;2:350-5.
12. Isharwal S, Gupta S. Rustom Jal Vakil. His contributions to cardiology. Tex
Heart Inst J 2006;33:161-70.
13. Shamon SD, Perez MI. Blood pressure lowering effcacy of reserpine for
primary hypertension. Cochrane Database Syst Rev 2009;4:CD007655.
14. Goenka AH. Rustom Jal Vakil and the saga of Rauwolfa serpentina. J Med
Biogr 2007;15:195-200.
15. Bhatia BB, Kapur RD. Pharmacological actions of alkaloids of Rauwolfa
serpentina. Benth. Part I, neo-ajamaline and iso-ajamaline. Indian J Med
Res 1944;32:177.
16. Muller JM, Schlittler E, Bein HJ. Reserpin, Der sedative Wirkstoff aus
Rauwolfa Serpentina (Benth). Experientia 1952;8:338.
17. Bein HJ. Zur Pharmakologie des Reserpin, eines neuen Alakaloids aus
Rauwolfa Serpentina (Benth). Experientia 1953;9:107.
18. Hakim RA. Indigenous drugs in the treatment of mental diseases. VI
Gujrat and Saurashtra Provincial Medical Conference, Baroda (India):
Marzo; 1953. p. 14-6.
19. Davies DL, Shepherd M. Reserpine in the treatment of anxious and
depressed patients. Lancet 1955;2:117-21.
20. Altschule MD. Use of chlorpromazine and reserpine in mental disorders.
New Eng J Med 1956;254:515-9.
21. Maurel H, Wilhelm M, Spielmann JP. Les indications psychiatriques de la
reserpine (etude preliminaire). LEncephale 1956;S:749-55.
22. Christison GW, Kirch DG, Wyatt RJ. When symptoms persist: choosing
among alternative somatic treatments for schizophrenia. Schizophr Bull
1991;17:217-45.
23. Lehman HE, Ban TA. The history of the psychopharmacology of
schizophrenia. Can J Psychiatry 1997;42:152-62.
24. Venkoba A. Some ancient Indian concepts of mind, insanity and mental
hygiene. Ind J Hist Med 1964;11:13.
25. Vahia NS, Vinekar SL, Doongaji DR. Some ancient Indian concepts in
the treatment of psychiatric disorders. Br J Psychiatry 1966;112:1089-96.
26. Vahia NS, Doongaji DR, Jeste DV, Kapoor SN, Indubala A, Nath SR.
Further experience with therapy based on concepts of Patanjali in the
treatment of psychiatric disorders. Indian J Psychiatry 1973;15:10.
27. Vahia NS. A therapy based upon some concepts prevalent in India. Indian
J Psychiatry 1969;2:7-14.
28. Vahia NS. Experience in the management of psychiatric and psychosomatic
disorders with yoga. J Yoga Inst 1972;18:5.
29. Vahia NS. A deconditioning therapy based upon concepts of Patanjali.
Indian J Psychiatry 1973;18:61.
30. Udupa KN, Singh RH, Yadav RP. Certain studies on psychological and
biochemical response to the practice of Hath Yoga in young normal
volunteers. Indian J Med Res 1973;61:237-44.
31. Balakrishna V, Sanghvi LD, Rana K, Doongaji DR, Vahia NS. The
comparison of psychophysiological therapy with drug therapy. Indian J
Psychiatry 1979;19:87-91.
32. Sethi BB, Trivedi JK, Anand R. A comparative study relative effectiveness
of biofeedback and shavasana in tension headache. Indian J Psychiatry
1981;23:142-5.
33. Singh V, Madhu A. A study of the effect of yogic practices on certain
psychological parameters. Indian J Clin Psychol 1987;14:80-3.
34. Lalitha, Kaliappan KV. The effcacy of yoga therapy in treatment of migraine
and tension headaches. J Indian Acad Appl Psychol 1987;13:95-100.
35. Sahasi S, Mohan D, Kacker C. Effectiveness of yogic techniques in the
management of anxiety. J Person Clin Stud 1989;5:51-6.
36. Prabhakar S, Varma SK, Grover P, Chopra JS. Role of Yoga in the
treatment of psychogenic headache. Neurol India 1991;39:11-8.
37. Grover P, Varma VK, Pershad D, Verma SK. Role of yoga in the treatment
of neurotic disorders: current status and future directions. Indian J
Psychiatry 1994;36:153-62.
38. Dissertations and projects. Available from: http://www.nimhans.kar.nic.in/
yoga/pg003.html [last accessed on 2010 May 30].
39. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish
MG, Shetty TK, Subbakrishna DK, et al. Therapeutic effcacy of sudarshan
kriya yoga (SKY) in dysthymic disorder. NIMHANS J 1998;16:21-8.
40. Naga Venkatesha Murthy PJ, Janakiramaiah N, Gangadhar BN,
Subbakrishna DK. P300 amplitude and antidepressant response to
Sudarshan Kriya Yoga (SKY). J Affect Disord 1998;50:45-8.
41. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish
MG, Subbakrishna DK, Vedamurthachar A. Antidepressant effcacy of
Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison
with electroconvulsive therapy (ECT) and imipramine. J Affect Disord
2000;57:255-9.
42. Uebelacker LA, Tremont G, Epstein-Lubow G, Gaudiano BA, Gillette T,
Kalibatseva Z, et al. Open trial of Vinyasa yoga for persistently depressed
individuals: evidence of feasibility and acceptability. Behav Modif
2010;34:247-64.
43. Telles S, Gaur V, Balkrishna A. Effect of yoga practice session and a yoga
theory session on state anxiety. Percept Mot Skills 2009;109:924-30.
44. Saeed SA, Antonacci DJ, Bloch RM. Exercise, yoga and meditation for
depressive and anxiety disorders. Am Fam Physician 2010;81:981-6.
45. Carei TR, Fyfe-Johnson AL, Breuner CC, Brown MA. Randomized
controlled clinical trial of yoga in the treatment of eating disorders. J
Adolesc Health 2010;46:346-51.
46. Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, Subbakrishna
DK, Sureshbabu SV, et al. Antidepressant effcacy and hormonal effects
of Sudarshan Kriya Yoga (SKY) in alcohol dependent individuals. J Affect
Disord 2006;94:249-53.
47. Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy
as an add-on treatment in the management of patients with schizophrenia-
a randomized controlled trial. Acta Psychiatr Scand 2007;116:226-32.
48. Telles S, Singh N, Joshi M, Balkrishna A. Post-traumatic stress symptoms
and heart rate variability in Bihar food survivors following yoga: a
randomized controlled study. BMC Psychiatry 2010;10:18.
49. Teets RY, Dahmer S, Scott E. Integrative medicine approach to chronic
pain. Prim Care 2010;37:407-21.
50. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing
yoga, exercise, and a self-care book for chronic low back pain: a
randomized, controlled trial. Ann Intern Med 2005;143:849-56.
51. Kanodia AK, Legedza AT, Davis RB, Eisenberg DM, Phillips RS. Perceived
beneft of Complementary and Alternative Medicine (CAM) for back pain: a
national survey. J Am Board Fam Med 2010;23:354-62.
52. Bhatia M, Kumar A, Kumar N, Pandey RM, Kochupillai V. Electrophysiologic
evaluation of Sudarshan Kriya: an EEG, BAER, and P300 study. Indian J
Physiol Pharmacol 2003;47:157-63.
53. Sharma H, Sen S, Singh A, Bhardwaj NK, Kochupillai V, Singh N.
Sudarshan Kriya practitioners exhibit better antioxidant status and lower
blood lactate levels. Biol Psychol 2003;63:281-91.
54. Hartfel N, Havenhand J, Khalsa SB, Clarke G, Krayer A. The effectiveness
of yoga for the improvement of well-being and resilience to stress in the
workplace. Scand J Work Environ Health 2010 in press.
55. Kjellgren A, Blood SA, Axelsson K, Norlander T, Saatcioglu F. Wellness
through a comprehensive yogic breathing program-A controlled pilot trial.
BMC Complement Altern Med 2007;7:43-51.
56. Conboy LA, Wilson A, Braun T. Moving beyond health to fourishing: the
effects of yoga teacher training. ScientifcWorldJournal 2010;10:788-95.
57. Chen KM, Chen MH, Lin MH, Fan JT, Lin HS, Li CH. Effects of yoga on
sleep quality and depression in elders in assisted living facilities. J Nurs
Res 2010;18:53-61.
58. Brotto LA, Mehak L, Kit C. Yoga and sexual functioning: a review. J Sex
Marital Ther 2009;35:378-90.
59. Bock BC, Morrow KM, Becker BM, Williams DM, Tremont G, Gaskins
RB, et al. Yoga as a complementary treatment for smoking cessation:
rationale, study design and participant characteristics of the Quitting-in-
Balance study. BMC Complement Altern Med 2010;10:14.
60. Grover S, Avasthi A. Views about clinical practice guidelines of the Indian
Psychiatric Society: a survey of psychiatrists in India. Indian J Psychiatry
2009;51:127-33.
61. Uebelacker LA, Epstein-Lubow G, Gaudiano BA, Tremont G, Battle CL,
Miller IW. Hatha yoga for depression: critical review of the evidence
for effcacy, plausible mechanisms of action, and directions for future
research. J Psychiatr Pract 2010;16:22-33.
62. Grover P, Varma VK, Verma SK, Pershad D. Relationship between the
patients attitude towards yoga and the treatment outcome. Indian J
Psychiatry 1987;29:253-8.
63. Reed P. An emerging paradigm for the investigation of spirituality in
nursing. Res Nurs Health 1992;15:349-57.
64. Peterson EA, Nelson K. How to meet your clients spiritual needs. J
Psychosoc Nuts 1987;25:34-9.
65. Verghese A. Spirituality and mental health. Indian J Psychiatry
2008;50:233-7.
66. Miller JF. Coping with chronic illness. FA Davies: Philadelphia, 1983.
67. Johnson SC, Spilka B. Coping with breast cancer: the roles of clergy and
faith. J Religious Health 1991;30:21-33.
68. Bhugra D, Osbourne TR. Spirituality and Psychiatry. Indian J Psychiatry
2004;46:5-6.
69. Kumar S. The relevance of spirituality in medical profession. Indian J Urol
2002;18:207-12.
70. Bhide AV. Kapur RL (1938-2006). Indian J Psychiatry 2006;48:277-8.
71. Sharma S. Psychiatry, colonialism and Indian civilization: A historical
appraisal. Indian J Psychiatry 2006;48:107-13.
72. Varma LP. Yoga meditation and mysticism. Indian J Psychiatry
1979;22:293-304.
73. Drucette LC. Anxiety and transcendental meditation as an anxiety reducing
agent: Hamilton, Canada, McMaster University, 1972.
74. Benson H, Malveila BP, Graham JR. Physiological correlates of meditation
and their clinical effects. Headache 1973;13:23.
75. Shafl M, Lavely R, Jaffe R. Meditation and the prevention of alcohol
abuse. Am J Psychiatry 1975;132:942.
76. Carrington P, Ephron HS. Meditation and psychoanalysis. J Am Acad
Psychoanal 1975;3:43.
77. Krause N, Van Tran T. Stress and religious involvement among older
blacks. J Gerontol 1989;44:S4-13.
78. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation
for the self-regulation of chronic pain. J Behav Med 1985;8:163-90.
79. Levin JS. How religion infuences morbidity and health: refections
on natural history, salutogenesis and host resistance. Soc Sci Med
1996;43:849-64.
80. Idler EL, Kasl SV. Religion among disabled and nondisabled persons I.
cross-sectional patterns in health practices, social activities, and well-
being. J Gerontol B Psychol Sci Soc Sci 1997;52:S294-305.
81. Idler EL, Kasl SV. Religion among disabled and nondisabled persons II:
attendance at religious services as a predictor of the course of disability. J
Gerontol B Psychol Sci Soc Sci 1997;52:S306-16.
82. Verghese A, John JK, Rajkumar J, Sethi BB, Trivedi JK. Factors associated
with the course and outcome of schizophrenia: Results of a two year follow
up study. Br J Psychiatry 1989;154:499-503.
83. Verghese A, John JK, Rajkumar J, Sethi BB, Trivedi JK. Factors associated
with the course and outcome of schizophrenia: results of a fve year follow
up study. Br J Psychiatry 1990;32:211-6.
84. Brown GW, Prudo R. Psychiatric disorders in a rural and an urban
population: etiology of depression. Psychol Med 1981;11:58.
85. Patel V. Where there is no psychiatrist: a mental healthcare manual.
London, RCPsych Publications, 2003.
86. Patel V. The future of psychiatry in low- and middle-income countries.
Psychol Med 2009;39:1759-62.
87. Patel V, Bloch S. The ethical imperative to scale up healthcare services for
people with severe mental disorders in low and middle income countries.
Postgrad Med J 2009;85:509-13.
88. Leff J, Wig NN, Ghosh A, Bedi H, Menon DK, Kuipers L, et al. Expressed
emotion and schizophrenia in north India. III. Infuence of relatives
expressed emotion on the course of schizophrenia in Chandigarh. Br J
Psychiatry 1987;151:166-73.
89. Cheng AT. Expressed emotion: a cross-culturally valid concept ? Br J
Psychiatry 2002;181:466-7.
90. Wig NN, Menon DK, Bedi H, Ghosh A, Kuipers L, Leff J, et al. Expressed
emotion and schizophrenia in north India. I. Cross-cultural transfer of
ratings of relatives expressed emotion. Br J Psychiatry 1987;151:156-60.
91. Wig NN, Menon DK, Bedi H, Leff J, Kuipers L, Ghosh A, et al. Expressed
emotion and schizophrenia in north India. II. Distribution of expressed
emotion components among relatives of schizophrenic patients in Aarhus
and Chandigarh. Br J Psychiatry 1987;151:160-5.
92. Bhugra D, Desai M, Baldwin D. Attempted suicide in West London, I.
Rates across ethnic communities. Psychol Med 1999;29:1125-30.
93. Bhugra D, Baldwin DS, Desai M, Jacob KS. Attempted suicide in West
London, II. Inter-group comparisons. Psychol Med 1999;29:1131-9.
94. Bhugra D, Hicks MH. Effect of an educational pamphlet on help-seeking
attitudes for depression among British South Asian women. Psychiatr Serv
2004;55:827-9.
95. Gordon RA. Anorexia and bulimia: Anatomy of a social epidemic.
Cambridge, UK: Basil/Blackwell; 1990.
96. Bhugra D, Bhui K, Gupta KR. Bulimic disorders and sociocentric values in
North India. Soc Psychiatry Psychiatr Epidemiol 2000;35:93.
97. Kirmayer LJ, Minas IH. The future of cultural psychiatry: an International
perspective. Can J Psychiatry 2000;45:438-46.
98. Bhui K, Bhugra D, Goldberg D, Dunn G, Desai M. Cultural infuences
on the prevalence of common mental disorder, general practitioners
assessments and help-seeking among Punjabi and English people visiting
their general practitioner. Psychol Med 2001;31:815-25.
99. Bhui K. Epidemiology and social issues. In: Bhugra D, Cochrane R,
editors. Psychiatry in Multicultural Britain. London: Gaskell; 2001.
100. Jacob KS, Bhugra D, Lloyd KR, Mann AH. Common mental disorders,
explanatory models and consultation behavior among Indian women living
in the UK. J R Soc Med 1998;91:66-71.
101. Bhugra D, Baldwin D, Desai M. Focus groups: implications for primary and
cross-cultural psychiatry. Prim Care Psychiatr 1997;3:45-50.
102. Bhugra D, Gupta KR, Wright B. Depression in north India- a comparison
of symptoms and life events with other patient groups. Int J Psychiatry
Clin Prac 1997;1:83-7.
103. Bhui K. Common mental disorders among people with origins in or
immigrant from India and Pakistan. Int Rev Psychiatry 1999;11:136-44.
104. Bhui K, Bhugra D, Goldberg D, Sauer J, Tylee A. Assessing the prevalence
of depression in Punjabi and English primary care attenders: the role of
culture, physical illness and somatic symptoms. Transcult Psychiatry
2004;41:307-22.
105. Bhugra D, Mastrogianni A. Globalisation and mental disorders: overview
with relation to depression. Br J Psychiatry 2004;184:10-20.
106. IDEAS (Indian Disability Evaluation and Assessment Scale) - A scale for
measuring and quantifying disability in mental disorders, Indian Psychiatric
Society; 2002.
107. Thara R. Measurement of psychiatric disability. Indian J Med Res
2005;121:723-4.
108. Padmavathi R, Thara R, Srinivasan L, Kumar S. SCARF Social Functioning
Index. Indian J Psychiatry 1995;37:161-4.
109. Singh G, Verma HC, Verma RS, Kaur H. A new depressive inventory,
Amritsar Depressive Inventory. Indian J Psychiatry 1974;16:183-8.
110. Wing J. SCAN and the PSE tradition. Soc Psychiatry Psychiatr Epidemiol
1996;31:50-4.
111. Orley J, Wing JK. Psychiatric disorders in two African villages. Arch Gen
Psychiatry 1979;36:513-20.
112. Sood A, Singh P, Gargi PD. Psychiatric morbidity in non-psychiatric
geriatric inpatients. Indian J Psychiatry 2006;48:56-61.
113. Wig NN, Menon DK, Srinivasamurthy R. Hindi version of Present State
Examination: problems of translation and application in Indian setting.
Indian J Psychiatry 1982;24:309-17.
114. Veling W, Susser E, van Os J, Mackenbach JP, Selten JP, Hoek HW.
Incidence of psychotic disorders in immigrants correlates with ethnic
density of neighborhoods. Ned Tijdschr Geneeskd 2010;154:A1767.
115. Jain S. Psychiatry and South Asia. In: Bhugra D, Ranjith G, Patel V,,editors.
Handbook of Psychiatry: a South Asian perspective, 1
st
ed. New Delhi:
Byword Viva Publishers Private Limited; 2005.
116. van Os J. A salience dysregulation syndrome. Br J Psychiatry
2009;194:101-3.
117. Gray B. Homeopathy: Science or Myth? Berkeley, California, North
Atlantic Books, 2000.
118. Lake J. Textbook of Integrative Mental Healthcare. New York: Thieme;
2006.
119. Davidson J. Psychiatry and Homeopathy: Basis for a dialogue. Br
Homeopath J 1994;83:78-83.
120. Thachil AF, Mohan R, Bhugra D. The evidence base of complementary
and alternative therapies in depression. J Affect Disord 2007;97:23-35.
121. Ghazala J, Anwar M, Siddiqui MA. Perception of psychiatric disorders in
the Unani system of medicine- a review. Eur J Int Med 2009;1:149-54.
122. Rafatullah S, Alqasoumi S. Unani medicine: an integral part of health care
system in Indian subcontinent Eur J Int Med 2008;1(1):39-40.
123. Speziale F. Tradition and modernization of Islamic Psychiatric care in the
subcontinent. IIAS Newsletter 2003;30:11. Available from: http://www.iias.
nl/nl/30/IIAS_NL30_11.pdf [last accessed on 2010 June 10].
Source of Support: Nil, Confict of Interest: None declared

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