Abstract

Introduction

I would like to begin with a few acknowledgements of the individuals and institutions that have led me here to be on this platform before you. I request your indulgence. My parents, Shobha and Mahendra Parikh, have been a major influence throughout my life. I am fortunate to be part of an extended family of more than 30 doctors. Some of them were not particularly thrilled when I announced my career choice on joining medical college and opting for it on graduation. However, my parents encouraged me to pursue my dreams. Firuza, my wife who I met in medical school has been beside me for 23 years and has been a constant source of encouragement and support. Our three children, Swappy, Manu and Nikki make everything worthwhile. As a medical student, I always looked up with admiration to my senior Dr. Ajai Singh who was then a resident in psychiatry. He encouraged me wholeheartedly. Dr. Dinshaw Doongaji has extended a profound influence on many of us. I owe him much for whatever I have accomplished in my career. Likewise, Dr. Robert G. Robinson at the Johns Hopkins Medical School has mentored my foray into Neuropsychiatry.

I am also grateful to the institutions that have shaped me, The St. Xavier's High School, The St. Xavier's College, The G.S Medical College, and the K.E.M. Hospital in Bombay followed by the Johns Hopkins Medical School and Hospital in Baltimore and currently the Jaslok Hospital and Research Centre where I am fortunate to be a consulting Neuropsychiatrist.

My dear colleagues, I consider myself so fortunate to be practicing psychiatry in today's era and to be a member of our Society. Today, you have conferred upon me the honour of being your President. Thank you.

Neuro-Imaging, Undergraduate Psychiatry, Destigmatisation

In Mumbai, Psychiatry has indeed come a long way from its humble beginnings about 50 years ago. Today, we are in an era of evidence-based medicine with quantifiable parameters for thought, mood and behaviour. These in turn can be correlated with structural and physiological changes in the brain through imaging modalities such as computerised tomography, magnetic resonance imaging, single photon emission computerised tomography, brain electrical activity mapping and PET. Neuroimaging techniques have correlated structural changes in the cortical and subcortical regions of the brain with the prevalence and severity of schizophrenia, mood disorders and dementias. However, the mere availability of these technologies does not in itself necessarily transform the quality of mental health care in any country. So much depends on the quality of knowledge, experience and dedication of the individuals handling these machines and interpreting their data. Furthermore, we have to always be wary of the dehumanizing potential of excessive reliance on technology.

In India, there has been a tradition of high quality psychiatric education at the postgraduate level in medical institutions throughout the country. However, a lot needs to be done to enhance the quality of undergraduate education. The current undergraduate medical curriculum makes allowance for a 4-week rotation through Psychiatry Departments which is inadequate for students to get well-acquainted with the discipline. There is marginal significance for psychiatry in the theoretical curriculum. Let us collectively work towards bringing about a greater emphasis on undergraduate education in psychiatry. This would surely inspire some of the brightest medical students to consider taking up psychiatry as a career.

We also need to work on the ongoing task of destigmatising mental disorders. Although considerable progress has been made from the days of the ‘lunatic asylums’, thanks in part to the advent of psychopharmacology, we still have considerable work to do before psychiatric disorders are as accepted as are other medical disorders. Interestingly, the recent advances in the imaging modalities and the correlation between cerebral anatomy, physiology and biochemistry with psychiatric disorders are likely to have a profound impact on destigmatising them.

I see amongst us, assembled here today, many young colleagues, some of who are residents in training. We should encourage them into academics: research and/or teaching. In doing so, we will ensure that the progress that has been made in our profession in India will surge ahead in the years to come. As a professional body, we need to incentivise psychiatric research through grants and awards for high quality research.

Yes, psychiatry has come a long way in India. I am thrilled to be here today as a witness and a beneficiary of this progress. I am optimistic that with the talent and dedication that we have in our Society, it will continue to accelerate this development. In doing so, we will ensure greater acceptance of psychiatric disorders, greater accessibility of care and a greater quality in the treatment modalities.

Note Added In 2015

As I look back to nearly two decades following this 1997 Address, it may be pertinent to reflect on the manner in which psychiatry has developed as a discipline in India. While we have not advanced as rapidly as nations which have a head start over India, we have made considerable progress along the lines discussed in the Address. The use of brain imaging technologies has become widespread in all the urban areas of the country. Access to technology and even to basic psychiatric care in rural areas of our country, compounded by the recent spate of farmer's suicides, are issues that need to be urgently addressed. Unfortunately, the depth and length of undergraduate education in psychiatry has not moved along desired lines. The destigmatisation of psychiatry has progressed considerably in urban areas, yet considerable progress is needed especially in rural India. Over the past two decades, psychiatric research output has accelerated both in terms of Indian research done and published, in national as well as international journals.

Concluding remarks [See also Figure 1: Flowchart of the Paper]

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Figure 1

Flowchart of the Paper

I consider myself fortunate to be a part of the exciting developments in psychiatry in India and am grateful to the members of the Bombay Psychiatry Society for electing me as their President.

Psychiatry has made considerable advances in India over the past few decades. These will be accelerated with the advent of brain imaging techniques in our country. Our increasing understanding of psychiatric disorders will help us destigmatise them. However, we have considerable work to do before psychiatric disorders are accepted as medical sicknesses.

We should encourage the brightest medical students to take up psychiatry as a career. In order to accomplish this, we need to improve the quality of undergraduate medical education in psychiatry. Finally, if we are to continue developing psychiatry in India, we should encourage our colleagues to conduct high quality research studies.

Take Home Message

Although psychiatry has made considerable advances in India, particularly with the advent of newer brain imaging technologies, much work remains to be done. Destigmatisation of psychiatric disorders should be accelerated. Undergraduate medical education in psychiatry should be enhanced and quality research encouraged.

Questions That This Paper Raises

1. Has improvement in brain imaging techniques increased our understanding of the underlying basis of psychiatric disorders? Which are the most promising areas for the future?

2. How do we leverage our understanding of psychiatric disorders to destigmatise psychiatric illnesses? Which will be the core strategies in this direction?

3. How does one enhance the quality of medical undergraduate education in psychiatry? Are there any models to learn from that have already been successfully implemented?

4. How does one encourage both academic and non-academic psychiatrists to conduct, or get involved in, quality research?

About the Author

Rajesh Parikh MD is the Director of Medical Research and Hon. Neuropsychiatrist at the Jaslok Hospital and Research Centre, Mumbai, India. He trained at the K.E.M. Hospital, Mumbai and the Johns Hopkins University School of Medicine, Baltimore.

He has over 150 publications in journals such as Lancet, American Journal of Psychiatry, British Journal of Psychiatry, Archives of General Psychiatry, Archives of Neurology and Stroke and has written 20 book chapters.

He has lectured at the Harvard Medical School, the Johns Hopkins University School of Medicine, and the Institute for Research in Neuroscience and Neuropsychiatry in France.

Dr. Parikh has had a distinguished academic record with several awards including the Bombay Psychiatry Society President's Award thrice, the B.N. Lulla Oration Award and the Tilak Venkoba Rao Award of the Indian Psychiatry Society. He has won over 200 awards in activities as diverse as photography, painting, quizzing. writing and debating.

Footnotes