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BRITISH INDIAN PSYCHIATRIC ASSOCIATION


NEWSLETTER

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Contents Inside:
Editorial - Page 1 Message from BIPA Chair Dr. Subodh Dave - Page 2&3 BIPA to collaborate with Indian Association for Geriatric Mental Health - Page 3 My Vision for BIPA - Dr. Sab Bhaumik - Page 4 IGPI & ANCIPS - Page 5 Tribute to Prof. Nitin Purandare Page 5 The CASC New Perspective Page 6 Medication to meditation - A personal Experience - Page 7&8 Obituary - Dr. Harish Gadhvi Page 9 BIPA events pictures - Page 10 Interview: Prof. Thirunavukkarasu - Page 11&12

Editorial
It is that time of the year when we shrug off the lethargy of the winter, adjust our body clocks to the new rhythm of the spring and in preparation of the oncoming summer, raise our expectations and spirits. What could be more exciting than the social milieu that goes with the BIPA AGM, not to speak of the excellent clinical content of the scientic programme that is inherent in the AGM? For this edition of the newsletter, we include contributions which reect the international networks with which BIPA is increasingly being associated. We have also not forgotten some of the issues which continue to be of concern to BIPA, like the low pass rates in the CASC examination amongst trainees from overseas, a substantial proportion of whom are from the Indian subcontinent. We publish an article by Dr. Cherukuri which tries to offer some solutions to this problem. There is also a general perception that psychiatry is too biologically driven and the sole role of the psychiatrist in the multidisciplinary team is to prescribe medication. Dr. Pradeep Chadha's article is very timely to remind ourselves that psychiatrists have a far wider role than that, with the greater breadth of their training. It thus ts in very well with the current debate within the Royal College of Psychiatrists on the role of the psychiatrist within the multidisciplinary team, as well as offering some specic insights which can arise from the cultural heritage of an Indian psychiatrist. This is also reected in the feature which has now become a standard in BIPA newsletters, the e-interview, featuring Prof. Thirunavukarasu, immediate past President of the Indian Psychiatric Society, where he reects on the same problem aficting psychiatrists in India as well. Another innovation is the inclusion of photographs of contributors from this edition of the newsletter, but we apologize that this was not possible for all contributors this time, an oversight for which we take full responsibility as editors. We will endeavour to overcome this shortcoming in future editions. This is also the time to appreciate the efforts of the outgoing members of the Executive committee and prepare to welcome new members and the ofcers. It has already been announced that Subodh Dave nishes his term of ofce and Sab Bhaumik is taking over the Chairmanship. Subodh, in his enthusiasm, introduced several new initiatives that will bring in benets for BIPA members in the short and long term. Our relationship with Indian Psychiatric Society now stands on a rmer footing and BIPA now is an integral part of several international psychiatric societies. A modern constitution for our activities jointly with our sister organizations (BPPA, BAPA, SLPA etc) is under consideration. Our links with BAPIO are rmer than ever before. There will be elections for the rest of the ofce bearers-Vice-Chair, General Secretary, Treasurer, Public Liaison Ofcer as well as other vacancies in the Executive Committee. By the time you read this, the results will be known, be it with or without elections, and the results will be announced at the AGM. The EC will be effective but only in the presence of constructive efforts of the total membership. This has never been in doubt before. No doubt it will continue.

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Long live BIPA

Newsletter Editors:

Dr Piyal Sen Dr Ranjit Baruah

Ranjit K Baruah Piyal Sen

BIPA Chair 2010-2012

Dr Subodh Dave

Message from BIPA Chair


Dear Colleagues, It is two years since I took over at the helm from my illustrious predecessors as Chair of BIPA. You may recall that I had outlined the concept of Fairness and Responsibility as the principle underpinning our vision. While it is you who will nally judge how well BIPA has done in the past 2 years, my own assessment is that it has been a mixed picture. I had outlined 3 key areas where we wanted to make a difference viz. Indo-UK link projects, parity of treatment for UK-trained doctorsand International Medical Graduates (IMGs) and improving mental health care outcomes for BME communities. Indo-UK link projects are vital for two reasons. The new geo-political scenario is leading to reverse migration with more and more psychiatrists heading back. At the same time, India struggles with a manpower shortage in psychiatry in the face of increasing psychiatric morbidity and mortality. BIPA has a key role to play in improving psychiatric outcomes in India. Earlier this year, BIPA conducted a 4 day Train the Trainers Programme in Mumbai at the Seth GS Medical College. This had led to the replacement of a knowledge-focused teaching programme with a common skills and attitudes-focused psychiatric curriculum for undergraduates across 5 medical schools in Mumbai. This is just a start. Next year, the programme will be extended through Maharashtra and Karnataka. Such projects, I believe will produce tangible results but we will need more volunteers with an interest and experience in medical education to make this a successful enterprise. We have cemented our relationship with IPS. BIPA members will get a preferential delegate rate when attending the Annual Conference of Indian Psychiatric Society. BIPA has also been working closely with Indo-American, Indo-Australian, Indo-Canadian and Indo-NewZealand Psychiatric Societies by participating in the Indo Global Psychiatric Initiative. BIPA contributed to the CPD programmes and also took an active part in training a host of trainees from across the globe. BIPA has also signed a Memorandum of Understanding (MoU) with IAGMH (Indian Association of Geriatric Mental Health) paving the way for joint training programmes and hopefully exchange programmes for trainees. A similar model can be extended to other sub-specialties in psychiatry.

Parity between UK-trained and IMGs assumes particular relevance with the advent of revalidation and persistence of poor pass rates of non-UK trained trainees in the MRCPsych examinations. BIPA has contributed to consultations by GMC on issues concerning IMGs. BIPA has appointed Dr. J S Bamrah, the RCPsych Director of CPD as the Director of Revalidation to ensure that BIPA members specically and non-UK trained doctors generally are not disadvantaged by the revalidation process. BIPA worked closely with its sister organisations BPPA, BAPA and SLPA to overturn the Colleges misguided decision to implement a rule retrospectively that would have disadvantaged scores of non-UK trainees (as also exi trainees). BIPAs approach has been to work with the College and we have raised these issues in various College Committees including the College Council. BIPA-led symposia on Diaspora issues at the heart of the College at its International Congress in 2011 and 2012 have introduced these issues to a wider audience and have so far received very good feedback. In September 2011, BIPA organized a national Trainees Conference to discuss and debate issues affecting IMGs. As an action point following this, BIPA in partnership with its sister organisations has commissioned a qualitative study to tease out the issues affecting international trainees.

Improving access and mental health care outcomes for BME communities in the UK is a key target not only for BIPA but also for the NHS. CQUIN targets in most Trusts are being linked to this particular outcome. Last year BIPA organized a half-day conference to discuss ways in which this issue could be taken forward. A couple of action points emerged closer working with voluntary sector and application for charitable status. BIPA will be conducting a survey across mental health trusts examining the status of commissioning in relation to health care outcomes for BME communities. BIPA is supporting the development of BME Volunteer Patient groups to train clinical and non-clinical staff in primary care. Engaging service users directly will be essential if we are to improve patient outcomes for BME groups.

The Future
BIPA faces many challenges. In times of austerity with study budgets squeezed and a general lack of sponsorship, achieving nancial sustainability remains a challenge. Tougher immigration laws, the recruitment crisis in the UK and a booming economy in India mean that the demographic trends of the future members of BIPA is likely to be very different. BIPA has taken a few steps to provide some future proong. Charitable status: BIPAs aims, objectives and activities are charitable. BIPA volunteers do not get any expenses and yet the lack of charitable status has hampered our ability to garner resources that would enable us to deliver our aims more effectively. BIPA is likely to achieve this hopefully later this year. Leadership: BIPA member Prof Dinesh Bhugra, CBE and President-elect of the WPA will take on the mantle of Director of Learning and Leadership in BIPA to ensure that BIPA members are able to provide leadership necessary to tackle the above challenges. Great Partnership Council: The coalition of BPPA, BAPA, SLPA with BIPA will represent over 5000 psychiatrists and with its pooled strength will exercise greater inuence over these challenges. Governance and Engagement: Engagement with memberships is improving with regular updates and the Newsletter. New members of BIPA have made the Indo-UK link project possible. BIPAs transparent governance procedures such as Executive Committee meetings open to members and audited accounts should help Executive Committee members become efcient Trustees of the Charity. It has been a privilege to have served as the Chair of BIPA and it has been even more rewarding to have taken a few baby steps towards realizing BIPAs vision. This would not have been possible without the BIPA team to whom I owe a huge debt of gratitude.

The wise counsel of Dr. Bhaumik and Giri, the ever available mentoring from Dr. Mistry and Dr. Singh, Bhavana annd Krishs infectious enthusiasm, the sheer energy of Sridevi, the hard graft of a range of people -JP, our Webmaster; Ranjit and Piyal, the Newsletter Editors, the Education link team members Mary, Ram, Vijender and Kavita; the trainee prize judges Lena, Ananta and Ajay, Venkat, Nora and Vincent have made it a genuine team effort and it is they who are the real architects of BIPAs successes. Finally, I would be remiss in not thanking the families (including my own) of all the hard-working BIPA members for putting up with long meetings, skype chats and hours of BIPA work at their expense. I am aware that a lot more needs to be done - I leave many unnished tasks but I am sure that the wise and experienced Dr. Bhaumik, our next Chair will take BIPA to new heights. I wish him all the very best.

Subodh Dave, Outgoing BIPA Chair

PROPOSAL FOR COLLABORATION BETWEEN BIPA & IAGMH


A meeting was held at The Hague, Netherlands on 7th September 2011. The participants were Dr. Anand Ramakrishnan (BIPA), Prof. Charles Pinto (IAGMH), Prof. Sarvada. C. Tiwari (IAGMH) and Dr. Vinod Gangolli (IAGMH). The meeting deliberated the close association of BIPA with Royal College of Psychiatrists of UK and its Faculty of Psychiatry of old age and the long established Old Age Psychiatry (Geriatric Psychiatry) services in National Health Service in UK. IAGMH is committed to quality and care of mental health of the older people in India. Prof. Pinto is the current president and its next annual conference (GERON) will be from 29/09/2011 to 1/10/2011 at Mysore. The meeting recalled Dr. Ramakrishnan as a speaker who led a team from Faculty of Old age psychiatry (RCPsych) to participate in GERON 2007. It was proposed to develop the links of BIPA and IAGMH to a more constructive level by establishing a project for BIPA to develop teaching and training modules for IAGMH on various topics related to mental health of older people. It was suggested to develop modules on the following topics, subject to agreement by the Executive committees of BIPA and IAGMH: 1. 2. 3. 4. 5. 6. 7. Normal Ageing, active ageing, life style issues and illness relationship Psychopharmacology in older people Comorbidity physical illnesses, alcohol and substance misuse Late life depression Late onset psychosis Dementia types and stages in dementia, diagnosis and treatment, terminal care, carers support. Others: anxiety, sleep disorders, psychosexual issues in older people.

As an initial step, it was agreed to produce a brief Dementia manual by January 2013, to be formally launched at ANCIPS in Bangalore. Dr. Anand Ramakrishnan

MY VISION FOR BIPA


First of all, I wish to thank Dr Subodh Dave for his inspirational leadership and contribution to improve BIPAs image nationally and internationally. I think it will be a hard act to follow. Other BIPA ofcials have played an equally important role in realising many of our dreams and to name a few, I must sincerely thank Giri and Krish for everything that they have done in putting BIPA rst in every activity. I am keen to build on the good work that has already been carried out in the past few years, especially in the area of training and education. You are all well aware of the stresses in the day-to-day practice of psychiatry with the changes in the political and economic landscape of the United Kingdom. BIPA has a signicant role to play in supporting the Diaspora clinicians in this difcult time. BIPA will aim to provide mentoring for its members and through the wide network of experienced people within it holding our hands together, I am condent that we can help our community through this difcult time. The following areas, in my opinion, need particular emphasis: Support for BIPA members in crisis at work place. I aim to establish a support service for our members who need this, allowing them to discuss their needs in condence and providing them with the right support and direction discreetly. Supporting consultants to progress in their career through provision of training and support in key areas of education, research and management. The NHS Pension Scheme is changing and the nancial future for many BIPA members does not look as secure as it was in the past. BIPA will try and endeavour to support its members through provision of good advice and support from colleagues who are aware of better opportunities in these areas through networking and sharing. Leadership is a key area where diaspora psychiatrists need to excel and one of my plans is for the provision of leadership training for those who aspire to become future leaders. Supporting the trainees is another area I feel passionately about. BIPA should put great emphasis on this. BIPA could support for job application and interview techniques which enhances diaspora trainees chances of getting selected to a suitable post. In addition, we aim to develop a web-based culture specic learning tool to enhance the current MRCPsych pass rate for the diaspora trainees. Trainees who are keen to participate in research/audit activities and publish relevant papers will also be supported by the senior researchers within the BIPA membership group. I will work with other diaspora organisations of the Great Partnership in establishing clear links with National Bodies like DoH, GMC, BMA, RCPsych etc. BIPA in this way should play a key role in shaping up the policy directions and decision making at national level. I aim to achieve this through a process of key ambassadors for each national body. We will also continue to improve BIPAs international prole through its links with IPS, American Indian Psychiatric Association, etc with the establishment of key targets that are mutually benecial to the organisations. BIPA will endeavor to have priority based annual plans in each of the aforementioned areas and will measure its achievements against appropriate performance indicators. There will be forward planning for the coming two years with built-in exibility that will allow us to focus our energy and activity on key National issues as they arise. BIPA members need to play leading roles in improving the quality of care provided by the Mental Health services for the BME population in the UK through research and developing models of Service Delivery in partnership with NGOs, user-carers and other key stakeholders. Similar ventures may be carried out in specically targeted areas in India in partnership with the local service providers. Such ventures will be supported through the MoUs and may include joint research/training initiatives with Indian Institutions/ Universities as well. I believe that the ofce bearers role is to represent the views of wider membership and their concerns. Our organisation should be driven by the members and in that respect, each member is expected to make his or her own contributions to BIPA. I will ensure that members have opportunity for it to happen. Finally, I would like to encourage younger members to put themselves forward for key positions in BIPA. The future belongs to the younger generation, who I think are better equipped to cope with the challenges for the coming years through their enthusiasm, motivation and vigour. They in turn will be the pillars for the future development of BIPA in both National and International forums. See you all in June at our AGM.

Professor. Sab Bhaumik

INTRODUCTION TO THE INDIAN GLOBAL PSYCHIATRIC INITIATIVE


The Indian Global Psychiatric Initiative (IGPI) is a distinguished group of psychiatrists from around the world of shared Indian sub-continent ancestry. The IGPI is the umbrella organisation of the federation of Indo-Psychiatry Association across the globe incorporating the Indo-American, Indo-Australasian, British-Indian, IndoCanadian, Indo-New Zealand and the Indian Psychiatric Associations. It represents over 16,000 psychiatrists worldwide. This organisation is a vehicle for psychiatrists who have a desire to contribute to enhancing the capacity and quality of psychiatry and mental health care within India. The Objectives of IGPI are to promote high quality mental healthcare for Indians everywhere, to facilitate networking between psychiatrists of Indian origin and to promote the interest of psychiatrists of Indian origin. The goals are promotion of high quality MH care in India by working with all professional organisations of psychiatrists of Indian origin and advance psychiatric knowledge at all levels (UG, PG and CME), for psychiatrists, non-psychiatrists physicians and non physician MH professionals in India. Currently, the constitution and governance structure are being nalised. IGPI 2012 at the Amrita Institute of Medical Sciences. Cochin, Kerala. India, was held on January 17 and 18, 2012. This was preceded by the 2an training and education fellowship programme for early career psychiatrists on 15th and 16th of January, 2012, where the theme was: "Image of modern psychiatrist: leadership, professionalism and humanism". Dr. Subodh Dave was a key speaker and organiser of this meeting that was attended by more than 45 young psychiatrists from Asia and Australia. The main IGPI meeting was attended by more than 125 psychiatrists from India, USA, UK, Australia, New Zealand and Canada. Prof. M. Keshavan, Prof. R Tandon, Prof. Russell DSouza, Prof. John Oldham (APA President), Prof. Dilip Jeste were a few of the distinguished speakers. Two BIPA members, Dr. Subodh Dave and Dr. Anand Ramakrishnan also spoke in the meeting. The next IGPI meeting will be in the rst week of January 2013. Dr. Anand Ramakrishnan, Treasurer, IGPI

ANCIPS 2012
A joint session was held with members from IPS (Indian Psychiatric Society Psychogeriatric section) and BIPA members at ANCIPS 2012 at Cochin, Kerala, India on 21/01/2012 with the theme as Pharmacological Management of Moderate to Severe Alzheimers Dementia chaired by Prof. CHARLES PINTO and Prof. K.S. SHAJI. Following speakers contributed to the session 1. Principles of pharmacological management of Alzheimers Dementia- Prof: S.C. Tiwari (IPS) 2. Pharmacological Management of Moderate to Severe Alzheimers Dementia - Dr. A. Ramakrishnan (BIPA) 3. Management of Behavioural and Psychological Symptoms of Alzheimers Dementia - Dr. Pradeep Arya (BIPA). This session was well attended and an active and meaningful discussion followed. Dr. Anand Ramakrishnan,

TRIBUTE TO PROF. NITIN PURANDARE


Professor. Nitin Purandare passed away suddenly over the week end of 26/27th May and his last rights were completed in Mumbai a week later. He is survived by his wife Carolyn and son, Dipesh. Nitin was a graduate of Seth GS Medical College, Mumbai and after coming to the UK enjoyed a stellar academic career. He was a lecturer in Manchester University and was appointed as Professor Prof. Nitin Purandare in Old Age Psychiatry a Chair at the University of Exeter last year. He was a highly talented, respected, able and very approachable clinician and academic who was dedicated to improving the care of older people with mental health problems and particularly those with dementia. He was very supportive of BIPA's educational link project with his alma mater Seth GSMC and was very keen on extending geriatric psychiatry education to medical undergraduates in India. Nitin was a member of a team that made presentations at GERON 2007 with me in India to form links with Geriatric Psychiatric section of Indian Psychiatric Society. Nitin's untimely death has saddened the psychiatric community but I am sure that BIPA will be able to full his dream of improving the awareness of Geriatric Psychiatry in India. BIPA remembers his presentation in our AGM and participation in BIPA activities. We have lost a great friend, colleague and well wisher with a colourful great career in front of him, brutally and untimely snatched away from this world. We join many other colleagues in praying for him and his young family in their most difcult time. Dr. Anand Ramakrishnan

THE CASC: A NEW PERSPECTIVE


It is that time of the year again when applications are lled in by the candidates to sit for the Clinical Skills and Competencies Examination(CASC), the last component of the MRCPsych examination after completing the Papers 1, 2 and 3. The CASC is usually held in Shefeld in England and since 2010 in Hong Kong as well. This is a time of trepidation and anxiety for the rst timers and PTSD symptoms for those who have sat for the CASC before. Enough has been and written about the fallacies of the new system (introduced in 2008) and how the CASC is an Exam that is not favourable to Indian/Asian candidates. I was an overseas candidate (who completed MD psychiatry in India who did not train in the UK) who sat and passed the Exam in 2010 and would like to share my perspective and things that helped me pass the exam in the rst attempt. 1) Managing Anxiety When I rst decided to take up the Exam in 2009, I was warned that the CASC had a dismal pass percentage of 33% and I think a defeatist attitude causes much stress among the trainees. This is something that needs to be altered early on. 3) Classifying the stations: When I started preparing for the CASC, I classied the stations and the entire gamut (including all permutations) was 84. I classied all stations as follows: a. History Taking: Psychosis/Mood disorders/Child/Geriatric psychiatry/Drug and alcohol use b. Information giving: Medication/Psychotherapy/Side effects c. Specialty Psychiatry: Child and adolescent/eating disorders/ Geriatric/Forensic d. Risk Assessment and MSE e. Physical Examination: examining for EPS, CNS, CVS, Thyroid, Fundus Examination f. Angry relative/Difcult patient station

The advantage of classifying stations in this format helps in transferring skills that is used can be used for all similar stations, for example: History taking in a Psychotic patient will use the same principles of obtaining Past history, Family history, Personal As Psychiatrists, we know that stress is counter productive and history and a quick MSE with risk assessment and is the same for diminishes performance of candidates in the Examinations. all such history taking station Many candidates are known to have had panic attacks during Similarly, in information giving stations for medication/ the examination. Hence, work on reducing anxiety levels to psychotherapy, it would be helpful if the candidate reads the increase performance appeared reasonable and necessary. Royal College leaets and does not preach to the patient but 2) Language and Communication Skills: Many Asian /Indian candidates who receive feedback from the Royal College have been asked to improve their Communication skills. This is a generic term and leaves many candidates frustrated I think that, though our education is in English, it is not our rst language and it would be helpful to observe and imbibe certain nuances (but not a fake accent!). This helps not only in improving your communication but also in day to day practice. The following has been useful: has a dialogue. Identify your strengths and weaknesses and work on the stations that are difcult for you. Many trainees ounder in the physical examination station and it would be better to practice them well in advance. 4) Practice makes prefect: It is advisable to start preparation well in advance (at least 2 months) and build up to the exam and it is good to remember that it is like preparing for a marathon. So, practice, practice and more practice. This also strengthens the mental framework that we have for the stations and helps in seamless execution.

a. Peer group feedback of my interviewing skills ( to speak slowly When it does not work, remember that setbacks pave the way for and clearly) us to look at things in a new perspective and as always, keep calm b. Practicing in front of a mirror (really helps to avoid unhelpful and carry on! mannerisms such as frequently saying OK, looking at your notes Good luck to all the trainees! whilst the patient is talking) c. Practicing with your Consultant (if he/she can allocate some Dr.Sathya D Cherukuri MD MRCPsych MRCP (Glasg). time for you) Assistant Professor, Department of Psychiatry, SRM Medical College University, d. Using the Leaets (The Royal College as well as the Mind Treatment Team , Bedford, UK. leaets are quite useful to read)
Email: sathyadc@gmail.com Chennai, India 603203.Currently, working in the Crisis Resolution and Home

MEDICATION TO MEDITATION - A PERSONAL EXPERIENCE IN WESTERN PSYCHIATRY


I have lived in Ireland for over 21 years. For last 16 years, my work in psychiatry has involved a drugless form of psychiatry. This is the story of my evolution from a medically orientated psychiatrist to a spiritually orientated drugless psychiatrist. Never having worked in psychiatry in India, my rst experience in psychiatry was in Dublin hospitals. I was excited. My rst impression of working in St. Brendans Hospital and St.Vincents Hospital, Fairview, Dublin, were both exciting and disappointing at the same time. It was exciting to learn the western concepts of diagnosis and labelling mental illnesses. It was disappointing to see that psychiatry did not offer any healing or cure. During my rst few months, I remember asking a senior consultant about what percentage of people suffering with schizophrenia had she seen return to normal life, in her whole career. After avoiding the question a few times she reluctantly gave a gure of 5%. It was a shock for a novice like me. The initial impression that psychiatry did not have all the answers became apparent. I can vividly remember the times and events that changed my outlook towards psychiatry and mental health. The rst event that changed my way of looking at psychiatry was when I was assigned to work with Professor Emeritus Ivor Browne. Prof. Browne had many adversaries in the psychiatric world in Ireland. He is a staunch indophile. He loved India and always had a spiritual approach to mental issues. His approach to mental health and mental illnesses was (and still is) considered to be out of this world by most Irish contemporaries. My rst experience of witnessing regression in hypnosis was with him. In one of Prof. Brownes regression therapy session I witnessed a female patient experiencing six life times of history of sexual abuse. At the end of the session, Prof. Browne was candid enough to look at the whole experience with scepticism. He looked at me and asked -what do you think? Was that imagination or reality? In my view, it is the hallmark of a true scientist. He could question each observation. A scientist needs to have the ability to explore the unknown with an open mind without carrying any prejudices. The second experience I had with Prof. Browne was when I learnt EMDR (Eye Movement Desensitization & Reprocessing) in 1992. Francine Shapiro had had her rst paper published on this topic a few years earlier.There was a young female inpatient with a history of childhood sexual abuse in St. Brendans Hospital. She was always difcult, aggressive and hostile towards the medical staff. Prof. Browne demonstrated EMDR to me when working with this patient. Two days later, when I saw her again her hostility, aggression and anger was subdued. She was crying at that time. She was not on any medications. I was awe struck. For me it was nothing short of magic. I was aware that even psychiatric medications took longer to subdue an aggressive patient. I started to question the mechanism involved in the process of psychotherapy. The striking common message for me in both these experiences was the possibility of helping the sufferers of mental illnesses without medication. The methods had to be explored. I saw hope. The mechanism had to be discovered. Little did I know that my journey to explore the unknown path had just begun. As time went on, the fact that trauma was very important in most psychiatric histories was becoming evident to me. I observed that most adult psychiatric conditions were treated for their symptoms but the underlying stories of trauma were ignored for their emotional value. Is there a physiological mechanism working that could be understood which could help undo the effects of trauma? What and how did trauma affect the body? These questions were emerging in my mind. As I researched into traumatic stress, two facts struck me. One day, I was reading a paper published in the American Journal of Psychiatry on the effects of relaxation and increased tension training in expectant mothers. This paper described an experiment done on two groups of expectant mothers. One group was taught how to relax during labour. The other group was taught how to increase tension in the body before relaxing. The outcome of the study was that the second group was more relaxed during labour. This paper in my view highlighted the interaction between sympathetic and parasympathetic arousal experiences. Autonomic nervous system thus grabbed my attention. The other issue that caught my attention was the fact that abreaction and catharsis were acknowledged as healing therapies. For those of us who have seen these working, a person goes through an emotional climax with anger or fear before becoming calm. This awareness was another example of the interplay of the two components of the autonomic nervous system. By this time, hypnosis had started to intrigue me as a therapeutic tool. Hypnosis can be described like a spice that can be added to any cuisine of psychotherapy. The spice is not the whole food. Therapy is done in hypnosis. Hypnosis is not therapy in itself. It can be applied to almost all forms of psychotherapy modalities. By 1996, I was a trained hypnotherapist having undergone formal training. Many of my Irish psychiatric colleagues were still fearful of the word hypnosis. But I learnt a few core elements about hypnosis. I learnt that hypnosis was not an altered state, that no one could be hypnotized against their free will and that hypnosis was no more than focussed attention. Interestingly, in hypnosis, catharsis, abreaction and relaxation are all accepted and acceptable and they work on sympathetic and parasympathetic systems. Around the same time, I was on call one weekend, with my mentor, Dr. Brian McCaffrey, Consultant Psychiatrist and Medical Director. An agitated patient with a history of post traumatic stress disorder, following his traumatic life in Northern Ireland troubles, was in a padded cell. The nursing staff members were insisting on increasing the patients medications.

Dr.McCaffrey and I went to see the patient. You are angry. Arent you, said Dr. McCaffrey to the patient as soon as he entered the room. I saw the patient becoming calm in next few seconds. This made me change my thinking on psychiatry once again. I learnt that what we call psychiatric illnesses in the West could also be called emotional expression in India. As soon as the anger of the patient subsided, he became calm. What Dr. McCaffrey could deal with words in seconds, could also have been treated or subdued with psychiatric drugs. In Ireland at that time (it happens even now), psychotherapy was frowned upon by the psychiatric establishment as a treatment modality. I had realized that my curiosity could not be satised by known psychiatric formulations and that I had to continue to learn on my own, without help from anyone.

help people change themselves using the sympatheticparasympathetic interplay and imagery. If it enabled them to reduce medications and if it went against all the known norms of psychiatry, it was still worth doing it.

Meditation came to my attention at the time I was experimenting with sympathetic-parasympathetic feedback mechanism. I realized that meditation and hypnosis had many similar effects at therapeutic and physiological levels. Incidentally, hypnosis is one of the most researched alternative therapy modalities. Both of them directly and indirectly worked with autonomic nervous system. If we let go of the complexities of the receptor system, the whole theory of mental illnesses revolves around the imbalance between the stimulatory (sympathetic) and inhibitory (parasympathetic) systems. If the imbalance between In 1996, I set up my private practice in Dublin calling myself a the two can occur as a result of genetic inuence and the medical psychotherapist, a profession that I had created. I environment in nature, is it not possible to create a balance was aware that I had to chose between continuing to prescribe between them naturally? medications or to nd another drugless way to help my clients. I chose the latter. Very soon I started to get clients asking The challenge was to develop a system or protocol that could help me to help them come off psychiatric medications with psychiatric sufferers come off medications successfully and safely psychotherapy. In 1997, my rst book -The Stress Barrier-was after the medications have served their purpose. It became obvious published in Dublin. It was based on my experiences dealing with that almost all psychotherapeutic processes were aggressively emotions and how we suffer with bottled up emotions. A Professor marketed by individuals and institutions as if they could solve in psychiatry, in Ireland, challenged me in a radio interview based every psychiatric problem. Each of the psychotherapy techniques on my statement that depressed people can successfully be helped has their own usage and limitations. All of them affect the to come off medication with psychotherapy. The day after the autonomic nervous system in some form or the other. If the interview, my practice picked up. I was busier than ever in my psychotherapy process is like an elephant then each system is followed by blind men (and women) who describe the elephant work. by touching on only one part of the elephants body. There is It became apparent to me that the sympathetic and obviously a need to bring together all the major schools of parasympathetic systems were somehow involved in a feedback psychotherapy. mechanism like we commonly see in the endocrine system. Primal screaming by Arthur Janov was an acknowledged method in Sixteen years and many thousands of hours later, my clients, my which sympathetic tension was allowed to increase before a person peers and the web have been my teachers. I have had the relaxed. The theory of paradoxical effect of drugs also opportunity to develop a protocol of psychotherapy using caught my attention. This effect was propounded by Zuckerman breathing meditation, medication and imagery that has given me and Zuckerman. This effect meant that when sympathetic system an insight into mind-body-spirit connection. Till date I have kept was stimulated or aroused, it caused relaxation, as happens when a the methodology close to my heart. BIPA has given me a chance stimulant is given in hyperactivity syndrome. When the to discuss and teach the methods to those who would like to learn. parasympathetic system was stimulated, a person became In 2011, I had presented a workshop on brief Grief Therapy that was received very well by the members of BIPA. If any physically more active, as happens in autism. members of BIPA are interested in doing research on this In the year 2000, a psychiatric conference in London was methodology, they are welcome to get in touch with me. organized by World Forum on Mental Health. I presented a paper in it. Its title was Drugless Psychiatry- Physiological Explanations The last story is about my time when I was working in the of Clinical Experiences. After the presentation, only three doctors addiction clinic in Dublin. I remarked to a female nursing approached me (out of an odd 70 100 who were in attendance) colleague that in all the years that I have spent in psychiatry, I had to ask me questions. One was Dr. Rohtagi from Glasgow. The learnt that each one of the patients who come in through the door other person was Dr. Bannerjee from Australia and the third feels unloved. Her response was- Oh Dr. Chadha! Only if person was a doctor from Sri Lanka. It makes perfect things could be that simple. Years later, I can say with condence scientic sense was the remark made by Dr Rohtagi at that now that things ARE that simple. time. But for me the message was clear- western psychiatry was (References available on request) closed to change (even if you were in the Royal College of Psychiatrists). Working scientically without medication was still Dr. Pradeep K. Chadha. unthinkable. Address: 5,Grove Garden, Verdemont, Blanchardstown, Dublin 15. Phone: Since I worked in private practice and not afliated to any 0035318242666. University or any research group. I had to stop looking for approval from the western psychiatric system. The alternative for Email: drpkchadha@gmail.com me was either to give up or to continue developing a protocol to URL: www.drpkchadha.com

LATE DR HARISH GADHVI


Dr Gadhvi passed away recently while holidaying in India. Dr. Gadhvi was born and brought up in Gujarat. His family had roots in Kutch region of Gujrat. He graduated from BJ Medical College, Ahmedabad. He then moved to UK to pursue a career in Psychiatry. Having joined the Nottingham Junior Training Rotation he became a senior registrar in Oxford training scheme and was appointed as a consultant in General Adult Psychiatry in mid 1980s. He worked in Chestereld where he took on the role of Clinical Director in its infancy before moving to Claybury Hospital in East London in early 1990s. He was instrumental in the development of community based services and CMHT in his catchment area. This assisted successful closure of a long stay mental hospital. He was a key gure in establishing Nasebery Court - a community based unit which provides inpatient and other services in North East London. He had special interest in Transcultural Psychiatry and had organised several regional and national conferences. He was one of the founding members of BIPA with great vision and held the distinction of the 2nd Chairman of BIPA.

Dr. Harish Gadhvi

In spite of his health issues, Dr. Gadhvi was always dedicated to his work. He had maintained keen interest in teaching and training locally, regionally, nationally and internationally. He was a visiting Professor at University of Jaipur until his untimely death. He was an excellent trainer, clinical and educational supervisor. He served his Trust in a variety of capacity. To name a few positions, he was Clinical Lead for Adult services, Appraiser, Chair of Division etc. He was always willing, keen and ready to help others. In 1995 Drs Gadhvi and Chaparala returned from USA having attended the APA conference. They had the occasion of attending the Indo-American Psychiatric Association (in existence since 1984) session and meeting Dr. Manoj Shah, a founder member and then President of IAPA. Both felt enthused to set up something similar in UK. Dr. Gadhvi had his contacts in the London area and Dr. Chaparala in the Birmingham area. In July 1995, the Birmingham 4 (Drs Baburao Chaparala, Thakor Mistry, Vinod Singh and Mohan George) had the rst working lunch meeting at JJs Restaurant in liaison with Dr Gadhvi. Preliminary thoughts on forming an Association were explored and some of the rst ideas were recorded. Further 3 months of discussions and invitations led to the rst Steering Committee of the Association 20th October 1995, at Johnathan Restaurant in Birmingham. 18 Consultant Psychiatrists out of the 30 invited attended and gave further shape to the idea/constitution of the Association with further regular 3 monthly meetings thereafter over the next 18 months before the nal ofcial launch of BIPA as a national organization on 1st March 1997, in London. His Excellency, Dr. L M Singhvi, then The High Commissioner of India, was the Guest of Honour. Dr. Gadhvi served BIPA as the rst Vice-Chair, then became the Chair between 1999-2001. Later, he served on as an active Executive Committee member and for many years took on the mantle of the International Liaison Ofcer. Dr. Gadhvi, with his contacts in Indian Psychiatric Society(IPS) and IAPA (Indo-American Psychiatric Association), from the beginning, established an active relationship with respective ofcials and helped set up Memorandum of Understanding(MOU) between the three organizations and foster an ongoing exchange in educational and research meetings. The start of the BIPA led International Meetings, with rst in Goa(2001), goes to his credit too. After nishing his International Liaison post, Dr. Gadhvi continued to be active with yearly Regional meetings of BIPA held in London. BIPA owes a great deal to Dr. Gadhvi for his vision, commitment and dedication, and active involvement in BIPAs birth, development and growth as an organization. He will be missed sorely. May his family and friends have the solace of his fond memories. He is survived by wife(a GP), two daughters and a son. Two of his children are lawyers and one is a doctor in UK.

Dr. Ashok Patel, Dr. Navin Savla, Dr.Thakor Mistry

Tribute to Dr. Nalini


BIPA conveys deep condolences to Dr. Bapuji Rao Velagapudi for the sudden demise of his wife Dr. Nalini Velagapudi. Bapuji Rao has served BIPA in various capacities since its inception. Dr. Nalini was greatly liked in the BIPA fraternity and she was a regular attendee at BIPA conferences. Her presence will be deeply missed by BIPA.

Dr. Seshagiri Rao Nimmagadda.

BIPA Annual conference 2011

BME Meeting 2011 AGM 2011

ANCIPS & IGPI - 2012

INTERVIEW WITH PROF.M.THIRUNAVUKARASU


Prof.M.Thirunavukarasu, known as Thiru is currently the Head of the Department of Psychiatry, SRM Medical College and Research Centre, SRM University, Kattankulathur, Chennai, India. He spoke to us regarding the mental health challenges we face and ways to tackle them in the Asian region. He is the current Zonal representative for Southern Asia, (Zone 16) of the World Psychiatric Association and was the President of the Indian Psychiatric Society from 2011-2012. Interview conducted by Dr.Sathya D Cherukuri, Assistant Professor, Department of Psychiatry, SRM Medical College. Prof.M.Thirunavukarasu Let us start from the beginning, tell us about your training.

I joined as a resident in the Government Mental Hospital, Kilpauk in Madras (now called Chennai) after the completion of my

MBBS course. In 1977, I joined the Diploma in Psychological Medicine course in the same institution and completed the course successfully in 1979. In the same year, I was selected for the MD Psychiatry which I completed successfully in March 1981. The Kilpauk Mental Hospital was attached to Madras Medical College, which was afliated to the University of Madras. So my training in psychiatry was continuously for 5 years in the bicentenary institution. I was trained under famous doyens of psychiatry like Dr. Saradha Menon, Dr. O. Somasundharam, Dr. M. Vaidhyalingam, Dr. V. Ramachandran, Dr. Peter Fernandez, etc. For a very short spell of 6 months I worked as senior resident in psychiatry in the department of JIPMER, Pondicherry under Professor Subha Thiruvedhi where I obtained good exposure of Liaison psychiatry. With a blend of experience in institutional psychiatry and General hospital Psychiatry, I took up the teaching post in Madras Medical College since 1981. Then, in 1988, I had Post Doctoral Fellowship training as a Fulbright scholar in Washington University, St. Louis, Missouri, of United States of America. During that time, I had an opportunity to watch and interact with faculties like Samuel B. Guze, Collinger, and Collin Louis etc. I got an opportunity to visit Butler Hospital, Providence, attached to Brown University, Research Institute on Alcoholism in Buffalo and Toronto of Canada. During this period, I had an opportunity to visit the Master and Johnsons Institute on Human Sexuality Institute for a few days. This period of training and exposure to alcoholism and chemical dependency, as well as sexual medicine, kindled my interest in substance abuse and sexual dysfunction. With the above said formal training in psychiatry, I was continuously working as a teaching faculty in various capacities and levels for more than 30 years. Indian Psychiatry is undergoing tremendous changes and the Indian Psychiatric Society has been instrumental in bringing about these changes. What are the changes to the IPS during your term as president from 2011 to 2012? During my tenure, I was able to materialize a long cherished dream of acquiring our head quarters in NCR, New Delhi. Another thing which was dear to my heart is to bring meaningful role for psychiatry in the under graduate curriculum.But it is till not materialized as expected, but the current president Dr. Roy is at it .I hope he will succeed in this mission. I suggested and requested the BIPA to nominate the president of IPS as an Honorary Fellow of BIPA, which has materialized and I am happy to say that I am the rst president of Indian Psychiatric Society to be nominated as Honorary Fellow of BIPA and I am thankful to the executive members of BIPA. It was a momentous occasion when you were elected as the Zonal Representative for Southern Asia at the World Psychiatric Association Congress held in Buenos Aires in September, 2011. Tell us about your current role as WPA representative in Southern Asia. The WPA is representing the world, but 2/3rd of the population of the world is from Asia. In Southern Asia zone there is a mixture of developed and under-developed countries. So WPA is more obligated to do many things in Southern Asia. Now, we have the President elect Dr.Bhugra in the EC who is born and brought up from Asia. Treatment gap is also more pronounced in Southern Asia. Some countries do not even have mental health policies. To solve this, the agenda will be bringing mental health care to primary care level through general health care. To achieve this, the only answer is to bring bonade and formal training of psychiatry for the under-graduate medical students. Most of the developed countries have practice guidelines which they can afford. But most countries in Southern Asia, the majority do not have practice guidelines (some have in principle but not in practice) because of the reason that is known to everybody. I am requesting the WPA to bring in a guideline which can be followed in all these underprivileged countries or at least lean on those guidelines. In that direction, I might work to get it materialized.

There has been a lot of interest in your concept of the mind called Manas. What is the relevance of Manas to the changing face of psychiatry world wide? Mind has been philosophized for couple of millenniums which cannot be questioned and argued reasonably. The utility value of mind is not of much use in the current teaching and educating in psychiatry. All erstwhile faculties always teach normal anatomy, physiology and then go to pathology. But in psychiatry, we go the other way round; we fear to talk about mind and mental health. We have to dene or at least describe what we are dealing with and what we are about it. To a common man, we have to tell, what we are treating and what we are aiming at. Mental health is not only the absence of mental illness. Time has come, the people are asking, aiming and working for promoting mental health and staying mentally healthy even in the absence of mental illness. Only one or two diseases have stigma, like in any other specialty. So, utilitarian concept of Manas as well as mental health has been proposed without being at loggerheads with the existing mind. I am sure that most of the people may not be able to accept Manas so easily, but the concept of mental health is very well appreciated. I am sure that a day will be there where we can measure the mental health and make people to stay in mental health even in the absence of mental illness. Mental health promotion is still at a nascent stage. What can BIPA and IPS do to improve mental health in India? India is a rich country in culture and heritage. We have more Indian Psychiatrists in UK than in India. All our brothers and sisters who are in the UK are well qualied and well trained. They can contribute by extending their valuable time to sensitize, bring awareness and if possible teach and collaborate their expertise to our Indian colleagues. Indian Diaspora regularly visit their homeland and during that time they can spend a couple of days disseminating their knowledge and expertise in that area. If this effort is routed through Indian Psychiatric Society it will be very much feasible and possible in a larger extent. Mental health in India faces many challenges. What are the current challenges facing psychiatrists in India? Non-pharmacological treatment and rehabilitations are not properly taught to the young psychiatrists of India. They are not exposed properly also. So, the psychiatrists in India are more attuned towards biological modes of treatment. Quite a few are successful in nonpharmacological methods also. But they are self-styled without any policy or practice guidelines. So, if the psychiatrists of India get an opportunity to get training and exposure in UK in the earliest part of their career, they will be very much qualied technically to deliver the results in the goal of promoting mental health globally. The world is shrinking at a fast pace with the advent of technology and the same technology can be used to help improve the quality of life of the people aficted with mental illnesses. Thank you for speaking to us, Prof. Thiru. It has been an extremely informative session and I am sure many Psychiatrists from BIPA will be inspired by your comments and nd ways to collaborate with their counterparts in India and thus promote mental health in the Asian region. Dr.Sathya D Cherukuri,

BIPA Annual Conference 2012 Organising Committee members


Subodh Dave, Seshagiri Rao Nimmagadda, A N Ramakrishnan, S Nagraj, Sabyasachi Bhaumik, Bhavana Chawda, J P Rajendran, Ananta Dave, Satheesh Gangadharan, Sridevi Sira Mahalingappa. Thanks to Lynn Churcher, Venkatesh Muthukrishnan, Kavita Dutta Das and Juhi Sharma.

New BIPA Executive Committee


Chair: Professor. Sab Bhaumik Vice Chair: Dr. Seshagiri R Nimmagadda Secretary: Dr. Anand Ramakrishnan Treasurer: Dr. Bhavana Chawda Public Relations Ofcer: Dr. Ananta Dave Joint Secretary: Dr. Sridevi Sira Mahalingappa

Executive committee members


1) Dr. Ankush Singhal 2) Dr. Arun Chidambaram 3) Dr. Kavita Dutta Das 4) Dr. Mina Bobdey 5)Dr.Venkatesh Muthukrishnan (extending his term) 6) Dr. Abrar Hussain 7) Dr. Sathya Cherukuri 8) Dr. Sindhura Mohan 9) Dr. Juhi Sharma 10) Dr.Ashwani Kumar 11) Dr. Santosh Mudholkar

Visit us online for the latest updates and presentations: www.bipa.org.uk