Welcome readers! Aapka Doctor (आपका डॉक्टर) presents an interview with Dr. Kersi Chavda. Past president of the Bombay Psychiatry Society, he is a Consultant at the PD Hinduja National, Hinduja Healthcare and the Sir H N Reliance Foundation Hospitals. Today with Dr. Amol Tayade, Dr. Kersi Chavda answers some important questions about mental health.

Profile

Dr. Kersi Chavda
Dr. Kersi Chavda
  • Past president of the bombay Psychiatry Society
  • Consultant at the PD Hinduja National, Hinduja Healthcare and the Sir H. N. Reliance foundation hospitals
  • Had been chairperson of the  task force of the  Indian Psychiatric society (IPS) dealing with school psychiatry and counselling
  • Was panel member of the task force of the IPS dealing with ethical boundaries between client and doctor this is now being taken up by the IMC as a guideline across Indian health services
  • Was chairperson of the task force of the IPS dealing with the LGBTQ community. Managed to issue a position statement that was quoted in the landmark judgement by Two of the five learned judges when they repealed Section 377
  • Was Panel member of the IPS task force that laid down clinical guidelines for the treatment of Autism Spectrum Disorders
  • Currently chairperson of the IPS Task Force dealing with College Psychiatry.
  • Been working more than 35 yrs
  • Field of interest is kids.. had been part of the first panel of the Maharashtra government that had laid down concessions for Learning Disabilities in Mumbai
  • On the advisory board of the Mental Health Panel of Project Mumbai 2, a BMC (Brinhanmumbai Municipal Corporation, Municipal corporation of Mumbai) and Maharashtra State Govt enterprise dealing with psychological problems of the MMR (Mumbai Metropolitan Region)

Dr. Amol Tayade: Do you think there has been an acceleration in the awareness that we are creating in the last few years? If yes, then what are the factors?

Dr. Kersi Chavda: I think in last few years there has been an acceleration. First of all, there is more and more awareness. There seems to be more and more education, also we are hoping that if the physical parameters of life that are dealt with, which is food, clothing and shelter, then people can start looking at mental health because if a person is physically unwell then they are not really going to bother too much about going to a psychiatrist. There is an enormous amount of media support and coverage that has come through. A lot of schools and lot of governmental dictates have come and said that schools should have a counselor, so the concept of counselling comes in and once the concept of counselling comes in, there is also a working upwards as a lot of counselors start referring kids who needed doctors for medications and things like that. Newspapers talk about various issues related to mental health. Film stars are another group of personalities who also come out and talk about their own fights with either depression or anxiety or bipolar disorder. So given, all in all, I think it does make a difference to the way we are perceiving the mental health in India.

If any kind of apps like nULTA, any kind of service that nULTA is doing makes a lot of a difference to the population, especially in the far-flung areas then I think that’s certainly something that needs to be recognised, recommended, animated and increased so that the broadening of what nULTA is doing makes a tremendous difference.

Dr. AT: How much do you think factors like economics, arts, politics, and entertainment affect mental health in India?

Dr. KC: Well, I am sure they do. We don’t look at it only in terms of that, we look at it more in terms of genetics and environment, but certainly, things like politics would make a difference. Things like economy make an enormous amount of difference because if you have a person who is doing very well and the economy goes bust and they can’t cope with regular day to day things, then there is no question about the fact that the chances of depression will come in and that because they are depressed, there is also the increased possibility of suicide which we are seeing related to the bank scams that are happening. Entertainment always is beneficial because its a way in which we kind of relax and let go of the stresses that come through, so relaxation is beneficial. Sometimes entertainment causes a lot of discrete as well; so if there is a play you are watching which signifies or which has a rape scene in it or which has a lot of abuse in it, it can trigger off negativity in a person who has passed through the similar kinds of episodes in the past. Art is again something that plays an extremely important role. In fact, there is a whole bunch of things that are related to art therapy. While there has not yet been a double-blind placebo control and checked out, there is no getting away from the fact that especially in case of a kids, art is an extremely useful medium of communication and very often we can see evidence of depression or severe aggression and even sexual abuse through the pictures (and images) that a kid might draw. So it plays a very important role.

Girl stressed and upset
Photo Courtesy: Claudia

Dr. AT: Do you think that intellectual insight can hinder treatment compared to emotional insight? and How do you think we can convert information into emotions and emotion into motivation?

Dr. KC: Well, that’s a tough one. Ok, so when we look at insight, I do believe it’s important both intellectual and emotionally for insight to work out for proper treatment and proper acceptance of treatment to take place. It probably would be very difficult for a person who is intellectually not very good to understand the nuances associated with whatever he is passing through. But at the same time we would also see that if a person is too intellectual and kind of tweezes everything emotionally that is happening to them and get in too obsessive a mode and into details of everything, it might actually cause more harm than good. Emotional insight is the most important thing. Once a person has emotional insight and knows what they are experiencing is related to something that’s happening in the brain and something that is a part of an absolute disease or disorder occurring with them, emotionally accepts it and goes ahead with the treatment then we often see that recovery is very very effective. Information can be turned into emotion and then into motivation, by allowing that, there should be a positivity associated with the acceptance and frankly by not looking at Doctor Google because Doctor Google has something that causes an enormous amount of problems. Everything that you look up Doctor Google ends up either with cancer or death, or it gives you an enormous amount of side effects even when things like that do not exist, and we must remember that Doctor Google is 10 or 12 years old while a lots of us have been Doctors for 30 and 40 years and that over here the experience has been much much more than something that you just read about.

Everything that you look up Doctor Google ends up either with cancer or death

Dr. AT: How do you think Mental Health consultations should be carried out in an online setup?

Dr. KC: There are a lot of legalities associated with it and I personally would like at least once or twice for it to be a face to face consult. Because there are lots of things to look at in a face to face consultation which may not be possible in an online one. Once there is some amount of rapport built up, once there are some ideas to what is happening, once there is an initial face to face consult, it might be possible taking a lot of things into account to have an online consult. This is normally done when you have, say a good rapport with somebody and you have been seeing them for a while, they changes their place of work or their place of residence and they don’t want to go through the trouble of finding another doctor, at such situations it might be useful to do an online consult; at the same time I personally want for the patient to find a local doctor because in case of an emergency you cannot hop onto a plane and come and find me, therefore its better to find somebody local specifically in terms of emergencies. Again if there are situations where the person is at risk either to himself or to somebody else, it is essential to find somebody close by. So certainly online makes sense especially when you are at a farther place where there is not too much of an access to a mental health professional but it comes with its own caveats and its own conditions, and there should be no shortcut to that.

Dr. AT: Self improvement and coaching business are booming in India and taking the shape of an industry. Do you think it has any implications on the mental health situation in the country?

Dr. KC: No, I really don’t know what they are talking about, so it’s difficult for me to comment. Many years ago when I was a kid we would talk in terms of you know going to a personality improvement seminar, then it became self-help seminar where you look inside and say that I am doing this wrong and doing that wrong. Then it became self groups then it became personal coaching and now you are talking about this. So this is probably more and more refinement of what was already there and anything that helps a person do better I think is good, but don’t know the details and the nuances of what they talking about, so it’s difficult for me to comment more on that.

Dr Kersi Chavda clinic photo

More and more poor people, more of the economically disadvantageous are seeking help which is wonderful

Dr. AT: Do you think there is any apparent difference in approaches to Doctors for mental health problems when compared amongst higher, middle and lower strata of society?

Dr. KC: No, I think it’s across the spectrum, the only thing that might be there is that if you are a celebrity and very high up and you might not want it to be very open. So, for example, a person who is a celebrity may not want to come into a hospital OPD because there are so many people, so they would prefer a private consultation at their own house or might come to my private consultation with a request that nobody should be around, which is fairly ok. For a poor person, of course, they don’t have that luxury; more and more poor people, more of the economically disadvantageous are seeking help which is wonderful. I think maybe the economically disadvantageous person is more trusting, so they accept things more at face value. So a person who is economically well to do might have a whole bunch of questions; both of which have their advantages and disadvantages.

Dr. AT: I know you for the last 4 years now and I have seen you in conferences and meetups that you are very proud and confident of Indian doctors. There is no colonial hangover that I see around you. How is that?
Dr. KC: I think we must realise that when I talk of having a heavy OPD, we talk of 30-50 patients in a day, some of my colleagues even see more than a hundred patients a day (I don’t know how they manage, but they are managing it). In General Hospitals, of course, our OPDs are huge. Just taking that into account the amount of experience that we have and the whole spectrum of experience that we have is gigantic. When people abroad talk about heavy and exhaustive OPDs, they talk about up to 6 & 7 patients in a day. Looking at that, just because the amount of patients that we see, it almost goes without saying that our experiences would be so much more and that our capabilities would be so much more as well. Unfortunately, there are always issues related to procedure vs shortcuts, experience vs evidence and all of that which have to be looked at. But under the tutelage, under the mentorship of somebody who is good, there is absolutely no getting away from the fact that the average Indian doctor is a terrific human being, extremely experienced, normally very good at his work; which is why it’s not even surprising that there is this WhatsApp message going around which I hope is based on evidence that in Britain, patients who visit doctors there especially who are from Indian subcontinent land up having fewer complications than those who come from other parts of the world. And I think that NHS would collapse if Indian doctors would not be there. That’s a big statement that they are making. So I do believe that we are a terrific bunch of people, we are normally very intelligent and to make our mark we have to study hard, do a lot of things and we are good. (Laughs)

Dr. AT: How would you describe an Indian psychiatrist?

Dr. KC: Well, I guess an Indian psychiatrist would be somebody who is passionate about making a difference to the mental health of people in India. You got to realise that 40-50 years back doctors were proud to take up cardiology (as a post-graduation speciality), today we are at a stage where a huge bunch of us are extremely proud of being psychiatrists, we are extremely confident that the future belongs to psychiatry. I am not willing to listen to people who talk about psychology or psychiatry as something which is not up to the level of the other spectrums of medicine. We are thrilled to bits that you know when a person finishes his MBBS, a lot of the toppers now take up psychiatry which means that they have also realised that there is a huge future in it, and that you do not have to be apologetic about it, and that the future is in the mind and mind refers to psychiatry.

Dr. AT: On a lighter note, which books are you reading now?

Dr. KC: You know I am a gym junkie. So, I am reading a lot of stuff related to muscle building through mobile phone apps. I have asthma and DISH and other problems also and a lot of people told me to not exercise and I said to hell with it and I continued exercising and I am reading a lot related to that and its helping. Another thing that I try to read about is stuff related to sometimes biographies, sometimes if I am just in a very ‘duh’ kind of mood then I read the old drawing Wallaces and P G Wodehouse’s, they just are so relaxing after reading your medical journals.

I am turning 60 next year but as a Bawa, I am a teenager.

Dr. AT: This question is very important for our readers. Have you yourself experienced any mental health problems?

Dr. KC: Of course I have. We all pass through anxiety and depression. There were times when I was wondering whether I should be on some medications also, and so I was toying with it and maybe I will in the future and I haven’t yet gone onto it but its a possibility. I come from a very bad genetic background so I have had people in the family who have committed suicide, those who have been depressed and we know that genes play an important role, and given the fact that I am aware of all of this I look at these things with a little more serious than when I didn’t have the information. We have all passed through times when we wondered whether its worthwhile being alive, you know that existential crisis to feel that it doesn’t make sense to do what we are doing. Sometimes when we don’t get the response professionally or personally and we start wondering at the futility of it all. But fortunately, I am a fairly big optimist. So, I go ahead with life and I have a lovely circle of friends where we laugh and joke and we fool around. I have an extremely supportive family, my wife is extremely supportive, my kid is, my in-laws are too. I lost my parents; they used to be extremely supportive. I work out a lot and that’s something that helps and when I am down I try to sit quietly for a while and try to bring things back to normalcy, and it works. I am turning 60 next year but as a Bawa, I am a teenager.

Dr. AT: What are your thoughts on nULTA?

Dr. KC: I have always believed that technology is going to be at the forefront of the deliverance of all kinds of health to our population which is too vast and the number of doctors that we have is just too small. If any kind of apps like nULTA, any kind of service that nULTA is doing makes a lot of a difference to the population, especially in the far-flung areas then I think that’s certainly something that needs to be recognised, recommended, animated and increased so that the broadening of what nULTA is doing makes a tremendous difference. I do believe that India has the potential to be a superpower but it will never be one if mentally we don’t do things for our population that are at risk. So, you guys are doing a great job.

Disclaimer: The above statements do not necessarily reflect the official policy or position of nULTA.