Mrs.S -Story

We are delighted to report on a patient with hydrocephalus after a stroke who has shown remarkable improvement over a period of 12 months with the help of our comprehensive care program- physiotherapy, psychology, speech therapy, and Ayurveda. The patient had suffered a stroke that resulted in hydrocephalus, which is a condition where there is an accumulation of cerebrospinal fluid in the brain.

The patient was initially unable to move her limbs and had great difficulty speaking; she was essentially wheel chair bound and had very limited mobility requiring considerable assistance for all activities. Being a former athlete and regular swimmer, she also experienced depression and anxiety due her disability. When she came to Buddhi Clinic, several months of physiotherapy delivered to her as a mono-therapy had not resulted in much improvement and she remained very disabled.

However, with the help of our team of healthcare professionals including the physiotherapist, psychologist, speech therapist, and Ayurvedic-Natturopathy practitioners, the patient began to show signs of improvement.

Physiotherapy helped the patient regain strength in the limbs and improve her mobility. Psychology sessions helped her cope with the emotional struggles of being physically impaired and unable to speak, and provided her with the tools to manage depression and anxiety. Speech therapy helped her to gradually regain her ability to communicate effectively.

Ayurveda played a significant role in the patient’s recovery as well. Our Ayurvedic practitioners prescribed external therapies that helped improve muscle tone, blood flow, overall mobility, alertness and motivation. Our holistic practitioners also recommended dietary and lifestyle changes that supported the patient’s overall health.

Through treatment the patient was under the care and supervision of our allopathic doctors who provided guidance on medication and therapy. Indeed, at the end of the first cycle of intensive therapy, the clinical note said:

Making good progress in therapy. She is now able to walk with limited support although she tends to be forward propulsive. Speech is present, expressive and appropriate with word finding difficulties being evident. She has problems with spontaneous speech. Family recognise that she is progressing well and report increased alertness, attempts to initiate action but also some confabulation. Utilisation behaviour observed.”


Plan: Therapy to continue for another full cycle.

With continued comprehensive care, with all four specialists remaining involved and the dedicated support of her spouse and caregivers, Mrs. S improved significantly. She was able to walk without assistance and perform daily activities first with little support and later independently. Her speech also improved, allowing her to communicate more effectively with others. At the end of one year of regular care, the clinical note was …

“Has made very good progress, is self ambulant, communicative, with improving ADL. Swallows well, speaks clearly, diet is diverse. Walking in the swimming pool (with suitable guidance and support) as well as cooking (used to be accomplished in this) and table top weaving (was a clothes designer before) discussed as OT.”


Plan: Therapy to continue with aforementioned focus

 Our combination of physiotherapy, psychology, speech therapy, and Ayurveda proved to be highly effective for this stroke patient with hydrocephalus who has also remained stable in medical management not requiring further surgical intervention. It is evident that a sustained, comprehensive and multidisciplinary program can help even those with serious neurological conditions and considerable disability, make significant progress towards regaining their independence and improving their quality of life.

Mr. Keerthi V
Senior specialist- Physical therapy


Back to the Hills

In October of 2010, I was introduced to an elderly lady admitted under Dr. Ennapadam S Krishnamoorthy and Dr. Rema Raghu in the Intensive Care Unit of one of our admitting hospitals.  She was 88 years old, and had just suffered a stroke, which affected her mobility greatly.   

I was assigned to lead our therapy team to assist in her recovery. On her part, I found her determined to get better too. Thence started my fascinating and enduring journey with Mrs. A.  

Our Buddhi Clinic team started working with her and in the intensive phase, the comprehensive therapy delivered to her included physiotherapy (electrotherapy, manual therapy and exercise therapy, each session lasting one hour), holistic external therapies using a combination of Ayurveda, Naturopathy & Acupressure, and psychological supportive care including relaxation training. All this was delivered along with allopathic (modern medical) treatment, first in the ICU, then in the hospital room and finally after discharge at her home.

With these comprehensive therapies, Mrs. A began to recover from the effects of her stroke. So much so that after the initial 5-6 week period of intensive therapy, the step down care became physiotherapy alone.  As her physiotherapist, I was introduced to her large extended family, whose support and care she enjoyed. During her therapy sessions she liked to speak about her family members and their support, all of which played a major role in her recovery.  She thus not only shared her family with me, her hospitality, love and care was very moving. 

Mrs. A. was someone who usually spent the summer months at a hill station where she had a beautiful property.  Unfortunately, that year, because of her illness, she was unable to undertake her summer trip.  However, her determination to get better and cooperation with therapy and rehabilitation was such, that she could, quite quickly, stand and walk again.  So much so, that the very next summer, she was able to go back to her favourite hill station, and walk in the hills again. A big salute to her!

Mr. D.Jerald M Yuvaraj                                                                                                                                      
MPT(NEURO); MIAP; MS; MAPP; MSC; DCM ; MHSC (NEURO)                                                                                         
HOD & Senior specialist-Physical therapy.


How Tai Chi and Related Practices Can Prevent Both Falls and Cognitive Decline

Prof. Peter Wayne introduced the lecture by referring to the holistic approach offered by the Ancient Medical systems of healthcare as compared to Modern Medicine. The ancient systems  aimed at treating the whole person and enhancing the interconnection between physiological bodily systems. Tai Chi, takes an ecological view, as compared to the modern mechanistic view. Modern Medicine, though highly specialized, tends towards reductionism, perception of fragmentation of the body and healthcare, and the more recent Precision Medicine studies it at a molecular level, all these approaches sometimes ‘missing the forest for the trees’.

Tai Chi is an internal Chinese martial art practiced for defensive training, health benefits and meditation and has practitioners all over the world from Asia to the Americas. Tai Chi’s approach is to integrate mind–body function through multimodal interventions that  strengthen,  even as they relax  body and mind. It is the key to reduce muscle stress, improve motor coordination and create greater sensory awareness. The whole spread of these multimodal interventions include aerobic exercise, dynamic structural integration, active relaxation of mind and body, enhancing awareness, mindfulness and focused attention, consolidating intention, beliefs, expectations, natural free breathing, social and community interactions and  philosophical, spiritual and ritualistic outlook, all within a set time-frame – an integrative approach ‘with a smooth, sustained flow, like wading through water’. Qigong is an allied  system to Tai Chi  to cultivate and balance life energy for health and wellbeing.

Prof. Wayne stressed that cognitive decline and falls in the elderly constitute a major Public  Health concern.  Falls can result in irreversible health consequences and add substantially to the economic burden on health care system. In this scenario, traditional approaches to preserve cognitive function, delay cognitive decline and prevent falls in the elderly may have a  role to play. Towards this goal, Prof. Wayne presented  studies which provided evidence base to prove the efficacy of Tai Chi and Qigong.

1Tinetti’s (2003) was one of the early observational studies on ‘prevention of falls in the elderly’. She provides guidelines for management of elderly above 75 years with a history of a previous fall. She lists the conditions which have been shown to increase the subsequent risk of falling which need to be investigated : “arthritis; depressive symptoms; orthostasis; impairment in cognition, vision, balance, gait, or muscle strength; and the use of four or more prescription

medications”. An exercise regimen to improve gait balance and muscle strength have been suggested by her.

2Logghe et al (2010) conducted a meta-analysis  to study the effects of Tai Chi on fall prevention,    fear of falling and balance in older people. Randomized controlled trials published between 1988 and January 2009 were included and compared with non-exercise controls.  Nine trials (representing 2203 participants) were included in the analyses, where compared with exercise controls, Tai Chi participants showed notable improvement. Linking the cognitive and the affective, in elderly who have experienced a fall earlier, (sometimes with less serious sequelae), revealed that a lasting concern about falling, results in  an individual avoiding activities that he/she remains capable of performing. Ironically, this is a key factor that leads to falling in the future.

3Fuzhong Li  (2016) conducted a study with the objective of evaluating the impact a fall prevention intervention in the community senior centers in Oregon The method followed was a single-group design. It was to evaluate the Tai Chi and Quigong or Tai Ji Quan Moving for Better Balance (TJQMBB) program adopted, with population reach, implementation, effectiveness, and maintenance .The study population was from  36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month post-intervention follow-up. The program resulted in a 49% reduction in the total number of falls and improved physical performance, providing evidence base to conclude that TJQMBB is an effective public health program that can be broadly implemented  for primary prevention of falls among community-dwelling older adults.

As a follow up to the previous study, 4Fuzhong Li et al (2018) conducted a single-blind, 3-arm, parallel design, randomized clinical trial over a 3 year period in Oregon with the objective of studying the therapeutic efficacy of Tai Chi and Qigong  or Tai ji Quan (TJQ) intervention versus multimodal exercise routine among older adults at high risk of falling. ‘TJQ Moving for Better Balance’ (TJQMBB), developed on the classic concept of Tai Chi was studied against a multimodal exercise (MME) program and a stretching exercise routine in reducing falls, as an intention-to-treat assignment. 670 who had fallen in the preceding year, or had impaired mobility, consented and were enrolled. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. It was concluded that among community-dwelling older adults at high risk for falls, a therapeutically tailored Tai Chi Qigong balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.

Normal gait depends not only on musculo-skeletal efficiency and co-ordination, but on cognitive stimulation of the prefrontal cortex, executive function, showing the interdependence of cognition and motor function which is more obvious with the process of ageing. 5 Verghese et al (2013) in their study ‘Motoric Cognitive Risk Syndrome (MCR) and the Risk of Dementia’   correlate gait speed and cognitive function, and the risk of future dementia. MCR syndrome is a more recently recognised predementia syndrome, characterized by cognitive complaints and slow gait in older individuals without dementia or prior history of mobility disability. MCR syndrome provide a clinical approach to identify individuals at high risk for dementia, (especially vascular dementia)  and offer the benefit of preventive  intervention. There is MRI evidence to show that after 40 weeks of Tai Chi training in non-demented individuals there is an increase in total brain volumewhich isreflected in an improvement in cognitive performance. 

6Wayne et al (2022) conducted a meta-analyses  of Tai Chi’s benefits to cognition observable in the brain. Studies included in the analyses had detailed cognitive testing records. The study supports small to moderate, but clinically relevant improvements in executive function following 10 weeks to 1 year of Tai Chi training in cognitively intact adults. The effect sizes were equivalent to those reported following other exercise and cognitive training.

To introduce a cognitive function accompanying gait, a dual task of thinking or talking while walking was studied. Walking with counting backward as a dual task was tested. With Tai Chi training, dual task walking improves more than with routine exercise regimen. This showed benefit when employed on patients with Parkinson’s disease. Prof. Wayne, as a matter of interest, pointed out that Boston Tai Chi experts have greater regular gait rhythm when challenged with dual cognitive task than those without such training.

 Tai Chi training can reduce both chronic pain and depression. In a study  7Quixadá (2022) showed that Qigong training positively impacts both posture and mood in breast cancer survivors (BCS) with persistent post-surgical pain (PPSP). Pain catastrophizing has been shown to increase the risk of developing PPSP in BCS. With a 12-week Qigong mind-body training program for BCS, most of the participants who improved in measures of fatigue also improved their vertical head angle. The severity of the pain decreased and the vertical spine angle improved. Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCS. This training could be applied to other chronic medical conditions with interdependence of posture, affect and complex interactions between trauma, pain, and impaired psychosocial function. Qigong enabled participants to reconnect mind and body and this is best brought out by quoting from an excerpt from a BCS participant of the study:  “How you feel about your body is a challenge after you’ve had breast cancer. … [But] mind and body have to be interconnected. All of it together [in Qigong] relaxes you and helps you stretch out a little bit, calm you down, help you think about your body in a different way, and trust your body to get inside yourself in a different way.”

Research toward an embodied cognition framework for mind-body has been suggested by 8Osypiuk, (2018). Contemporary and traditional mind-body practitioners describe their interventions (including Qigong) as enhancing interoceptive and proprioceptive bodily awareness, connecting body schema and body image and creating the sense of the minimal and implicit self. A unitary conceptualization of body and mind has been elaborated by  Shunrya Suzuki  9(Suzuki, 1970), a  Zen Buddhist teacher in  ‘Zen Mind, Beginner’s Mind’ and how the right posture in itself leads to attaining the right state of mind.  He suggests that if your mind is empty, it is always ready to receive anything; it is open to everything. In his all -encompassing wisdom  he states that in the beginner’s mind there are many possibilities; in the expert’s mind there are few.

Prof. Wayne summed up the efficacious role that Tai Chi and Qigong training can play in areas of cognition and gait in the elderly. Some of the references in the lecture have been provided below for easier accessibility.


The Future of Integrative Medicine in India


On 11th May 2023, in a significant development, a Memorandum of Agreement (MoA) was signed between the Indian Council of Medical Research (ICMR), under the Union Ministry of Health and Family Welfare, and the Union Ministry of Ayush, (Ayush standing for Ayurveda, yoga, unani, siddha and homeopathy), to promote and collaborate on integrative health care and research. The MoA will enable both parties to jointly establish Ayush-ICMR Centres for Advanced Research in Integrative Health at the All India Institutes of Medical Sciences (AIIMS), in India. Inpatient and outpatient services will be established in the new Integrated Medicine departments of all 23 ‘functioning’ AIIMS which earlier served only as Ayush service departments. The studies will  extend to areas of public health as well. This initiative is planned to place integrative medicine  on a firmer footing  and for it to justifiably gain wider acceptance.

ICMR proposes to strengthen evidence-based research capacity of the team. Research methodology needs a face lift even at undergraduate levels in India. Establishing a working committee of experts and workshops and training programs across the centres will enhance the co-learning process and organizational stability. ICMR plans to update The National Ethical Guidelines for Biomedical and Health Research Involving Human Participants’ 2017 with a developed comprehensive section on Integrative Medicine ethics, based on research inputs from the newly established ICMR-Ayush centres.

Can an Integrated System of Medicine Work?

The Hindu Podcast  Can an Integrated System of Medicine Work?on 19th May,2023,(follow podcast link and write up given here), featured Dr.Cyriac Abby Philips, Senior Consultant and Clinical Scientist in Hepatology, Rajagiri Hospital, Kochi, opposing the move and Dr. Ennapadam S. Krishnamoorthy, Founder and Neuropsychiatric Consultant, Buddhi Clinic, Chennai, as the proponent. Buddhi Clinic offers Neuropsychiatric care and management by a multidisciplinary team following the modern medicine approach, and integrates it with some non-pharmacological therapies. The host, Ms. Zubeda Hamid, initiated the dialogue seeking  the two consultants’ views on the above Union Government initiative. They had diametrically opposite view in some areas of Integrative Medicine, but came together in one voice on  randomised controlled trials as gold standard and the standardisation of formulations critical to uniformity of dosage. Dr.Philip’s misgivings were based on the side effects of some Ayush medications, and the very rare hepatotoxicity with liver injury as an adverse event. The NIH, USA, has expressed concern over cases of heavy metal poisoning with Ayurvedic formulations.

The dramatic global growth of the Traditional Complementary and Alternative Medicine (T-CAM) movement during the last 3 decades is also a people’s movement to seek alternative therapies to relieve unrelenting pain or to have possible respite from the travails of chronic illness. It also comes with the realization that though modern medicine offers evidence-based healthcare, the latest technologies, and has no substitute in emergency care, it does not have all the answers and 20% of patients can be non-responders. CAM is a global phenomenon, WHO reporting that 80% of the global population have opted for it at some stage in their life. In this context, foreign governments and regulatory bodies also appear to have accepted the call for broader approaches to healthcare. The latest global collaborative move in this direction, is the signing of the MoU and  onsite launch of WHO Global Centre for Traditional Medicine, Jamnagar, India, which  took place between the Ministry of Ayush and WHO on 21st April 2022, to establish  WHO – GCTM, with India as the host country. It is planned to start functioning by mid-2024. This new ‘pluraristic approach’ to healthcare goes with the caveat that all new, potentially useful healthcare interventions, must establish their safety, quality and efficacy.

The overall aim of drug standardization is to ensure the quality, efficacy and uniformity of the products, in terms of their chemical and biological properties. Ayurvedic formulations are designed and manufactured based on unique principles of Ayurveda pharmacology, many of which exert a multi-drug-multi-target mode of action effect, due to the presence of several bioactive molecules in its natural form. This is different from the single-drug-single-target action of modern molecular drugs. This complicates evidence-based research in herbal formulations, and even standardization can be difficult. The active medicinal molecule may be isolated through chromatographic methods, but the identification and role of the other bioactive molecules may remain unknown.

There are several peer-reviewed international journals on Integrative Medicine. Two leading Indian online international journals, both open access, peer-reviewed, quarterly publications are:  Journal of Ayurveda and Integrative Medicine, established in 2010, (published jointly by The Institute of Trans-disciplinary Health Sciences and Technology and The World Ayurveda Foundation and published on Elsevier) and   Indian Journal of Integrative Medicinewhich started publication about 4 years back.

Integrative Health Research must aim at a transdisciplinary approach. ‘Transdisciplinary’ involves the integration and transformation of fields of knowledge from multiple perspectives in order to define, address, and resolve complex  problems, the integration transcending individual disciplines.  National Health Policy (2017) in ‘Mainstreaming the Potential of AYUSH’ puts focus on sensitizing practitioners of each system to respect the strengths of the other.

There is a wealth of wisdom and ancient traditions which can be incorporated  sensibly and safely, for the well­being of the human race. A systematic, goal-directed  approach, (within time frames), under the Union Government umbrella, with comfortable levels of funding, common training programs, pooling the multicentre data of clinical findings under intention to treat in  standard method against Ayush approaches, longitudinal studies, phytochemical analysis, all under a strong leadership and committed stakeholders, must yield results. The challenge is to ‘modernize’ Ayush and make it relevant and contextual and to  create a  robust  interface between Ayush and modern science. The strength of ancient systems lie in promotive and preventive health, treatment of NCDs,  regenerative medicine and mind-body science in mental health. Not to be forgotten is the in situ conservation of wild gene pools of medicinal herbs and the benefits of integrative research reaching the poor of our country.


Dr. Krishnamoorthy Srinivas 90th Birthday Memorial Lecture


The Dr. Krishnamoorthy Srinivas 90th Birthday Memorial Lecture Webinar was delivered on 15th  February, 2023 by Prof. Christopher Mathias, under the auspices of Buddhi Clinic, Chennai. Mrs. Krishnamoorthy Srinivas, Prof. ES Krishnamoorthy,  Founder-Director of Buddhi Clinic and his team were present at the clinic venue. It was fitting that Ms.Aparna Rajagopal, a lawyer by training, (with over a decade of dedication to her animal sanctuary and sustainable animal farm, Beejom in Noida), opened the proceedings with old, fond memories and a daughter’s perspective of a ‘good friend’ and a doctor father. For family and close friends, it was an event to honour the life of a loved one, and to professional colleagues, Srinivas’  legacy of  commitment and excellence in medical care.

Eminent senior members of the Indian Neuroscience fraternity participated in the Webinar to honour the memory of Prof. Krishnamorthy Srinivas – Prof. P. Satish Chandra, former Vice Chancellor of National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Prof. Man Mohan Mehndirattha, Former Director and Professor, Department of Neurology, Gobind Ballabh Pant Institute of Medical Education, New Delhi  and Prof. AV Srinivasan, Emeritus Professor, Tamil Nadu Dr MGR Medical University. AV Srinivasan, who was one of Dr. Srinivas’ earliest DM (Neurology) students and later associated closely as a professional colleague, spoke at some length about his guru. He traced  the professor’s   long years of training in the UK and later in Canada, the pioneering effort in establishing Neurology as a superspecialty in India, building a small  department of Neurology in the well served Community Medicine centre-Voluntary Health Services (VHS) Medical Centre, Chennai, (later a multispecialty hospital), bringing world Neurology to India through the endowment lectures and interaction with the Indian Neurology groups, medical students and the lay audience, and his distinguished national and international awards and honours. The note of appreciation  summed up the professor’s legacy- Dr. Srinivas, teacher, researcher, administrator, but always a clinician; a family man, with admiration for his devoted wife Padma and the achievements of his two children- Prof. ES Krishnamoorthy  and Ms. Aparna Rajagopal and their respective spouses. Prof. Krishnamoorthy Srinivas followed Prof. Christopher Mathias achievements in the UK in the field of ANS with interest and could not deny a sense of pride in his Indian origin. The  prestigious lectures he has delivered worldwide include (under the ‘Srinivas umbrella’) the 3rd Prof. K Srinivas lecture, Chennai (2005); K. Gopalakrishna lecture, Chennai (2006); and TS Sinivasan Conclave Lecture, NIMHANS, Bangalore (2015), 35th TS Srinivasan Gold Medal Award and Endowment Oration, Chennai (2015).

Prof. Christopher Mathias MBBS, LRCP&S, DPhil, DSc, FRCP, FMedSci

Institute of Neurology, University College London ,
National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

Neurovascular and Autonomic Medicine, The Lindo Wing,
Imperial College NHS Healthcare Medicine at St. Mary’s Hospital, London, UK

Graduating with a record of academic excellence from St. John’s Medical College, Bangalore, India, in 1972 and receiving the State Award for Academic Distinction, Mathias set foot in the UK with a Rhodes scholarship to Oxford University. What followed was his trail-blazing career trajectory in the field of Neurovascular and Autonomic Medicine. In 1987 he was awarded the Fellowship of the Royal College of Physicians, London, in 1995 the Doctorate of Science (DSc) in the Faculty of Science at London University and In 2001 he was elected to the Academy of Medical Sciences (FMedSci). In 1991 he founded Clinical Autonomic Research, the first medical journal dedicated to clinical autonomic neuroscience. He is Senior Co-Editor, with Sir Roger Bannister, of Autonomic Failure: a Textbook of Clinical Disorders of the Autonomic Nervous System, which is in its 5th edition in 2014.

Prof. Mathias was Clinical Service and Research Director of two leading NHS and academic departments in London, the Pickering (Neurovascular Medicine) Unit at St. Mary’s Hospital, and the Autonomic Unit at the National Hospital for Neurology and Neurosurgery, Queen Square. The centers were amalgamated in 2014, and are now based at Queen Square. He is Emeritus Professor of the Institute of Neurology since 2014. In 2014 he founded the Autonomic & Neurovascular Medicine Centre at the Hospital of St. John & St. Elizabeth, incorporating the latest techniques and with experienced autonomic personnel.
Prof. Mathias has served on many national and international committees. He was a founding member of the Clinical Autonomic Research Society of Great Britain (Secretary, 1982-1986, Chairman, 1987-1990). He was Foundation President of the European Federation of Autonomic Societies (1998 to 2004). He has served on international task forces (EFNS, American Spinal Injuries Association) and on consensus groups (such as the American Autonomic Society 1996 and American Academy of Neurology, Boston 2007). He was a Trustee of Stoke Mandeville in the Spinal Research (2017-2019).He has been Chair of the Autonomic Group of the Ehlers-Danlos International Consortium, the Ehlers-Danlos Society from 2018.
In the Dr Krishnamoorthy 90th Birthday Memorial Lecture, Prof. Christopher Mathias recollected the warm welcome he had received from Prof. Srinivas when he visited India and discussions on the luminaries Srinivas trained with while in the UK.

Prof. Christopher Mathias traced the history of the development in the field of ANS in the UK, much of which he had witnessed in a key central position as clinician-researcher with the most eminent pioneers in this then somewhat neglected field (Prof. Sir John Spalding, Prof. Stanley Peart and Prof Roger Bannister, to name a few) and in the best UK centres with focus on ANS studies. He took the audience through his professional journey, with fascinating historical references interwoven with the scientific details of his 5 decade long contribution in the ANS field.

Falling Humans, Failing Neurons: Meeting the Challenge of Autonomic Dysfunction

“Faints, falls, fits, flutter, funny turns” was the intriguing list presented by Prof. Christopher Mathias at the outset of his lecture, indicating clinical presentations of autonomic dysfunction with its challenge of falling humans, often pointing to failing neurons. Central to the lecture was the neurovascular and neurohormonal aspects of ANS, stretching from basic knowledge to ‘new millennium disorders’ in this burgeoning field.

Mathias referred to the sympathetic and parasympathetic components of the Autonomic Nervous System (ANS) and the wide range of involuntary control exerted by these components on visceral body functions, often working in opposite directions in their role of homeostatic regulation. Signs and symptoms of autonomic involvement may be related to impairment of cardiovascular, gastrointestinal, urogenital, thermo-regulatory, sudomotor, and pupillomotor autonomic functions.

 Postural  hypotension or orthostatic hypotension (OH) ranging from ‘dizziness’ to syncope , may have multiple causes which  may  be related to  the  heart, brain or    ANS. It may be fixed, as in autonomic failure, or intermittent, as in autonomic-mediated syncope or postural tachycardia syndrome (PoTS). Autonomic –mediated syncope may occur in even superfit persons, such as in vaso-vagal syncope which is the ‘more common form’ of fainting episodes.

OH cuts across several neurovascular ANS conditions. In the normal upright position adopted by the human, the cardiovascular system comes under the influence of gravitational forces, with a fall in pressure above heart level. This exposes the brain to impaired perfusion if adequate adaptive mechanisms are not in place. The heart is unable to achieve adequate perfusion pressure independently and that is where the ANS come to the aid, by monitoring the BP and heart rate. Afferents from the heart, lungs, large vessels and baroreceptors feed information to the brain. The parasympathetic regulation of heart rate (HR) is through the vagus to the heart. There is a parallel sympathetic outflow. Sympathetic output also stimulates release of noradrenaline, which hormone constricts the blood vessels. OH occurs when mechanisms for the regulation of orthostatic (standing) BP control fails. Standing, in normal subjects, results in a fall in blood pressure and this fall is sensed by baroreceptors.  The initial fall in BP is corrected by an increase in heart rate and total systemic resistance with noradrenaline release causing vasoconstriction. Regulation by baroreceptors is also dependent on normal blood volume, and defenses against excessive venous pooling.

Mathias arrived at Worcester College in 1972 with a Rhodes scholarship from Oxford, and as graduate awardee, was offered work on animals in basic sciences. But he had hoped to be engaged in human studies, and preferably in Cardiology. When he showed his disappointment, John Walker, the college tutor suggested that he approach Prof. John Spalding in the Department of Neurology at  Churchill Hospital, who was engaged in research on humans on cardiovascular control linked with ANS.

Prof John Spalding took Dr. Mathias on as supervisor in 1973 at Churchill Hospital   Prof. Spalding was an active member of the Oxford team in the early 1950s that developed the East Radcliffe ventilator following a visit to Copenhagen at the epicentre of one of the world’s most devastating polio epidemics. He was convinced that in the acute phase of severe polio, other than the respiratory distress, the autonomic dysfunction was serious and called for urgent attention. Prof. Spalding wished to expand the scope of understanding the ANS role with similar studies on tetanus on the ventilator. Dr. John Corbett, after being awarded his doctorate, was on the verge of leaving for Ibadan and Lagos, Nigeria for this study. As there were not many cases available in the UK, Mathias hoped to get the required cohort for the study by joining the team. Marked autonomic instability with violent autonomic disturbances, severe hypertension and tachycardia, alternating with hypotension and bradycardia was the clinical picture in severe tetanus. Though “it was an amazing experience, it was difficult to record results in an organized manner” said Mathias.  Back in the UK, he got Prof. Spalding’s nod to continue similar ANS studies in tetraplegics and quadriplegics. Prof. Hans Frankel had taken  over from Prof. Ludwig Guttmann as Director, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury. Dr. Mathias worked alongside with Prof. Frankel on several significant studies with the crucial clinical approach, taking into account the site and completeness of the spinal lesion.

In his lecture Mathias touched on Sir Ludwig Guttmann’s committed pioneering work at Stoke Mandeville from 1944, with several war casualties with spinal injuries being admitted. He had converted Stoke Mandeville into a centre for comprehensive care in spinal injury patients, and to this day it is run as a national centre of unmatched excellence. Today’s world Paralympics Games (which follows the Olympics in the same arena since 1960), had its humble beginnings as ‘Stoke Mandeville Games’ for Guttmann’s patients and he was the initiator of this and saw it reach such heights of recognition.

In one of the studies at Stoke Mandeville, in head up tilt on control subjects, the upright position produced a normal response. However, in high spinal cord lesion patients, (with no sympathetic outflow) the BP fell markedly, as there was no noradrenaline release.  There was a rise in the HR as the vagus was intact, but did not succeed in bringing up the BP. Were there other substances involved in BP control was the question that researchers faced – perhaps  prostaglandins, acetylcholine or renin-angiotensin. Prof. Stanley Peart was the expert on the renin-angiotensin-aldosterone system, from its clinical role to laboratory isolation and purification of angiotensin. Mathias approached him and through Christiansen (in a specialized Denmark laboratory), levels of a range of relevant substances was measured. Renin levels went up and rolled back, and aldosterone a little later, as it is dependent on angiotensin II. This suggested that the sympathetic nervous system was not the sole factor in BP control. Renin release and other mechanisms were involved, perhaps with the kidney as the source. Suprapubic tap resulted in BP rise and renin release. The conclusion drawn was that in tetraplegic patients, renin release during head-up tilt may occur independently of sympathetic nervous activity and is probably largely dependent on activation of renal vascular receptors. The renin-angiotensin-aldosterone system plays an important role in regulating blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure. For the first time this saw linking of the pathophydsiological lesion with the substances involved.

In a subsequent study, noradrenaline was infused through an intrarterial line in the arm or lower limb, an invasive procedure, to make it possible to monitor BP and HR continuously. Circulating noradrenaline during infusion did not significantly differ between the tetraplegics and the controls. However, over a wide range of doses by infusion, the blood pressure rose much more in the tetraplegics than in the controls. The findings indicate that tetraplegic subjects have an enhanced pressor response, as seen in the supersensitivity to the infused noradrenaline.

 Mathias did a stint in General Medicine between 1976 to 1979 at London and Portsmouth, paving the way to his MRCP, which was awarded in 1978. Following this period, Prof. Sir Stanley Peart suggested that Mathias continue in the ANS field. In 1978 he was awarded the Wellcome Trust Senior Clinical Research Fellowship. He had the honorary post as clinical assistant to work with Sir Stanley Peart at St. Mary’s Hospital and Medical School, University of London near Paddington, (the hospital where Sir Alexander Fleming discovered penicillin).

The Medical Unit at St. Mary’s was the hub of activity then, and a major study that Mathias was involved in, was ‘Neurogenic and renovascular hypertension-central and peripheral mechanisms in renal artery stenosis’ The underlying mechanism in renovascular hypertension involves decreased perfusion to the kidney and activation of the renin-angiotensin-aldosterone (RAAS) pathways to  elevate blood pressure by direct peripheral effects ( from increased afferent renal nerve activity) and probably through stimulation of sympathetic activity, which may  result from the central effects of angiotensin-II. The chronic ischemia produced by the obstruction of renal blood flow leads to changes in the kidney and  secretion of renin, the renin angiotensin –aldosterone system playing  a role.  Angiotensin  is responsible for vasoconstriction and release of aldosterone which causes sodium and water retention, thus resulting in secondary hypertension or renovascular hypertension as demonstrated experimentally  in patients with renal artery stenosis. The neurogenic components maintaining hypertension in renal artery stenosis are largely dependent on renal ischaemia, as revascularization by surgery, ameliorates or cures the hypertension in the majority of the patients studied. Denervation of the peripheral blood vessels by ablation demonstrated marked reductions in blood pressure in patients with resistant hypertension and elevated renal sympathetic nerve activity.

In 1984 Mathias was awarded a Wellcome Trust Senior Lectureship in Medicine, held jointly between St. Mary’s and the Institute of Neurology, working with Professor Sir Stanley Peart and Sir Roger Bannister till 1992. The  collaborative  study was on disorders with progressive autonomic failure –Parkinson’s disease, Multiple System Atrophy and Lewy Body disease, with cohorts for each one of these conditions.  Pure autonomic failure (PAF) which often presents with orthostatic hypotension, reduced heart rate variability, anhydrosis, erectile dysfunction, and constipation, without motor or cognitive impairment, was also studied.

In 1987 Prof. Mathias was awarded the Fellowship of the Royal College of Physicians, London (FRCP). Interdisciplinary studies in nocturnal polyuria, post prandial hypotension, exercise-induced hypotension and Dopamine beta hydroxylase deficiency were the studies that followed.

 In May 1991 the University of London conferred on Prof. Mathias the title of Professor of Neurovascular Medicine, held between St. Mary’s Hospital Medical School and the Institute of Neurology, British Postgraduate Medical Federation, London. He was Clinical Service and Research Director of two leading NHS and academic departments in London, the Pickering (Neurovascular Medicine) Unit at St. Mary’s Hospital, and the Autonomic Unit at the National Hospital for Neurology and Neurosurgery, Queen Square. These were tertiary referral centres serving the entire United Kingdom, also with international referrals. He pioneered the creation of clinical autonomic scientists, developments in laboratory autonomic testing, and with autonomic nurses, developed and streamlined autonomic diagnosis, investigation and treatment of many autonomic conditions.

That same year, Prof. Mathias founded the first medical journal dedicated to clinical autonomic neuroscience and served as editor till 1995, and continued as co-editor till 2013.  Another important publication in Dec. 2001 was, of Autonomic Failure: a Textbook of Clinical Disorders of the Autonomic Nervous System, as Senior Editor, with Sir Roger Bannister.

In1995 Prof. Mathias was awarded the Doctorate of Science (DSc) in the Faculty of Science at London University. In2001 he was elected to the Academy of Medical Sciences (FMedSci). It was in recognition of Prof. Mathias’ contribution to ‘information of enormous value to both physiology and medicine in his work on supposedly rare disorders’.

In Feb. 2001, the analysis of 641 patients between 1992-1998, with recurrent syncope and presyncope, after cardiac, neurological, and metabolic causes were  excluded, was published. Autonomic aetiology was diagnosed in 310 cases on the basis of clinical features and screening autonomic tests. Orthostatic hypotension and confirmed chronic autonomic failure was the diagnosis in 31 (4·8%) patients; neurally-mediated syncope was diagnosed in 279 (43·5%).  Most of this group had vasovagal syncope (227 [35%]); other causes including carotid sinus hypersensitivity (37 [5·8%]), and a group of 15 (2·3%) were associated with rarer causes such as micturition syncope. 331 cases were of a miscellaneous, non autonomic group, rare cardiovascular causes like systemic hypotension, arrhythmias, or drugs, contributing to syncope in 53 cases; vestibular dysfunction in 32 and epilepsy in 11 cases of non-autonomic neurological causes. In 56 a psychiatric cause was thought to be contributory and in 179, the syncope was of unknown cause.

Progressively, there was an exponential rise in clinical referrals to the Neurovascular and Autonomic unit from 500 cases earlier to about  5000 cases and the various factors responsible for this increase was analysed. The above study brought to focus the significant role of autonomic testing in syncope and presyncope for evidence-based diagnosis, and management. Autonomic testing equipment and specialised laboratory tests had progressively improved and expanded their scope. Aside from this, the journal Clinical Autonomic Research, started in 1991, had gained in recognition and had established itself as the official international journal of the American Autonomic Society, the Clinical Autonomic Research Society of Great Britain, and the European Federation of Autonomic Societies and this led to referrals from outside the country as well. ‘New millennium autonomic disorders’, like PoTS required specialty diagnosis and management and new innovative approaches were employed. Prof. Stanley Peart’s leadership and expertise,- “His uncanny prescience about new millennium autonomic disorders” as Prof. Mathias put it, contributed immensely to the progress in the field.

PoTS, a rare clinical syndrome characterized by an increase in heart rate of at least 30 beats per minute on standing, and orthostatic intolerance, In PoTS, standing brings on symptoms such as palpitations, lightheadedness, brain fogging, and fatigue. It is a  major cause of orthostatic intolerance  especially in the young. 13-40 years, with greater prevalence in the female sex. Symptoms are often exacerbated after food ingestion, exertion and heat. The onset of PoTS often is linked to a triggering stressful event, followed by a long period of bed rest. Patients with PoTS are trained to live with the condition and avoid precipitating factors. The most common associated condition is the joint hypermobile form of Ehlers-Danlos syndrome.

 Prof. Mathias was involved in functional autonomic brain imaging studies with Prof. Hugo Critchley at the Wellcome Neuroimaging Lab at Queen Square from 2002.  Dr Critchley’s  research focused primarily on mind-body-brain interactions and he had published widely on emotion, autonomic psychophysiology, and interoception. Many autistic and  ADHD individuals struggle with awareness and response to interoceptive signalling of the  state of the inside body and the  ability to identify, understand and respond to them, which is so crucial  to survival.

The coupling of cognitive and emotional behaviour with sympathetic arousal was studied. with Prof. Criitley. One such .fMRI study to examine regional brain activity associated with autonomic cardiovascular control was during performance of effortful cognitive and motor tasks (which involves stress). 3 patients with focal damage of the anterior cingulate cortex (ACC), while they performed these tasks, had abnormal autonomic cardiovascular responses and blunted autonomic arousal to the mental stress, unlike in the 147 normal subjects tested in identical fashion, where the ACC supports generation of associated autonomic states of cardiovascular arousal.

Prof. Christopher Mathias is Emeritus Professor of the Institute of Neurology  since  2014. He founded the Autonomic & Neurovascular Medicine Centre at the Hospital of St. John & St. Elizabeth incorporating the latest techniques and with experienced autonomic personnel.  


Spirituality and Mindfulness: A Pathway to Positive Mental Health


Throughout history, spirituality and mindfulness have been intertwined with the pursuit of mental well-being. Recognizing the profound connection between the mind, body, and spirit, this blog explores how spirituality and mindfulness can offer a solid foundation for achieving positive mental health.

Understanding Spirituality

Spirituality, at its core, is a deeply personal journey of understanding one’s purpose, connection, and place in the universe. It transcends religious beliefs and delves into the essence of human existence. For many, spirituality offers a sense of belonging, a higher purpose, and a guiding force that brings inner peace and clarity.

The Role of Mindfulness

Mindfulness is the art of being present, fully aware of our thoughts, feelings, and surroundings without judgment. Rooted in ancient meditation practices, mindfulness enables individuals to gain control over their reactions, reduce stress, and foster a deeper sense of connection with themselves and the world around them.

Spirituality and Mindfulness in Therapy

With the increasing acceptance of holistic approaches in modern therapy, many mental health professionals are integrating spirituality and mindfulness into their practices. These techniques are used to help patients confront trauma, deal with anxiety, or find a deeper sense of purpose and meaning. Such an integration has shown promising results, with many individuals finding greater resilience and inner strength.

Community and Collective Well-being

As individuals embark on their spiritual and mindful journeys, many seek solace in communities that share similar beliefs and practices. Such communities, be it meditation groups, spiritual retreats, or discussion circles, provide a platform for shared learning, mutual support, and collective growth. The feeling of connectedness amplifies the positive impact on mental health.

Challenges and Mindful Solutions

While spirituality and mindfulness offer a plethora of benefits, it’s crucial to understand that they are not one-size-fits-all solutions. Some may struggle with certain meditation techniques or grapple with spiritual dilemmas. In such instances, adapting practices to suit individual needs, seeking guidance, or even combining these approaches with other therapeutic interventions can yield the best results.


Spirituality and mindfulness, when understood and practiced authentically, can be powerful allies in the quest for mental well-being. With their grounding principles, they offer tools to navigate life’s challenges, foster inner growth, and cultivate a sense of peace and purpose. In the realm of mental health, they indeed present a pathway paved with positivity and hope.

The present moment is filled with joy and happiness. If you are attentive, you will see it.

Explanation to the quote

Renowned Vietnamese monk and Zen master Thich Nhat Hanh’s quote beautifully encapsulates the essence of mindfulness. It suggests that happiness and contentment are accessible in the here and now, but it requires our active attention and presence to perceive and embrace them.


The Interplay of Spirituality, Gurus, and Mental Health


Spirituality has always been a significant component of human existence, with many seeking solace, meaning, and guidance in it. Over time, spiritual gurus have emerged as guiding lights, helping individuals navigate their spiritual journey. This blog delves into the deep relationship between spirituality, gurus, and mental health, shedding light on how they interconnect and influence one another.

The Role of Spirituality in Mental Well-being

Spirituality often provides a framework for understanding life’s purpose, giving individuals a broader perspective on their existence. For many, it becomes a source of strength during challenging times, offering solace and inner peace. People find hope, resilience, and an understanding of themselves, making spirituality an integral component in fostering mental well-being.

The Influence of Gurus

Spiritual gurus have played pivotal roles in guiding individuals on their spiritual paths. These gurus, with their wisdom and teachings, have not only shared knowledge about spiritual truths but also provided practical insights for daily living. By imparting teachings that promote self-awareness, mindfulness, and compassion, gurus help individuals lead balanced lives, which in turn, positively impacts their mental health.

Balancing Modern Life with Spiritual Pursuits

In today’s fast-paced world, the challenge often lies in balancing modern life demands with spiritual pursuits. Seeking guidance from spiritual gurus can be immensely beneficial in this aspect. They offer practical wisdom to integrate spirituality into daily routines, ensuring that individuals remain grounded while managing the stresses of contemporary life.

The Global Rise of Spiritual Communities

As the world becomes increasingly interconnected, spiritual communities are burgeoning across the globe. These communities provide a sense of belonging, offering spaces where individuals can collectively explore spirituality and its relationship with mental health. Being part of such a community can offer additional support, shared experiences, and collective wisdom that can further enhance an individual’s spiritual journey and mental well-being.

Potential Pitfalls: Discernment is Key

While the spiritual realm has numerous benefits, it’s essential to approach it with discernment. Not all teachings or practices resonate with everyone, and it’s crucial to find what aligns with one’s beliefs and values. Additionally, while many gurus are genuine in their intentions, there are those who might exploit followers. It’s vital to exercise caution and ensure that one’s spiritual journey remains authentic and personal.


Spirituality, gurus, and mental health are intricately intertwined. While spirituality offers a profound understanding of life, gurus provide guidance, ensuring that individuals can navigate their spiritual journeys efficiently. However, discernment is crucial to ensure that the spiritual path remains genuine. With the right balance, spirituality can indeed be a potent tool for mental well-being.

The wound is the place where the light enters you.

Explanation of the quote:

This quote by the revered Persian poet Rumi emphasizes the importance of facing our challenges and vulnerabilities. In the context of spirituality and mental health, it signifies that our moments of struggle can become openings for spiritual insights and healing. By embracing our wounds, we allow the light of understanding, growth, and spirituality to illuminate our being.


The Synchronous Dance of the Mind and Body: A Neuropsychiatric Exploration


The concept of the mind and body being intertwined entities isn’t novel. Yet, the intricate dance they perform, especially when influenced by practices like yoga and mindfulness, remains a subject of immense fascination. It has long been speculated that what affects the mind also impacts the body. The term “synchronous” aptly encapsulates this interconnection. But how deeply does this connection run? And what are the physiological implications when the mind, body, and soul harmoniously align? Let’s journey through the landscape of neuropsychiatry to unveil these answers.

1. The Synchronicity Between Mind and Body:  

Our brain, the central command hub, orchestrates myriad physiological functions. Every emotion, thought, or mental activity finds a corresponding ripple in the body. This “synchronicity” implies that when the mind is calm and aligned, the body too achieves a state of equilibrium.

2. The Power of Practice Yoga and Mindfulness:  

Yoga and mindfulness are more than mere physical and mental exercises. They represent a holistic approach to wellbeing. Their efficacy isn’t just a testimonial but backed by robust scientific evidence. For instance, consistent yoga practice is shown to positively influence blood pressure, pulse rate, and even blood sugar levels. It’s an affirmation that a calm mind can indeed nurture a healthy body.

3. Impacts on Vital Organs:  

Yoga’s comprehensive approach engages not just the skeletal muscles but also vital organs. It facilitates improved circulation, better organ function, and efficient detoxification. This results in enhanced overall health, ensuring the organs function at their optimal level. 

4. The Autonomic Nervous System (ANS) Connection:

The ANS acts as a bridge between the brain and the body, specifically linking the emotional centers of the brain with our internal organs. This system plays a pivotal role in our stress responses, modulating our fight or flight reactions. Engaging in practices like yoga and mindfulness tunes the ANS, promoting a state of relaxation and balance, further solidifying the synchronous relationship between mind and body.

5. The Broader Implications for Health and Wellbeing:  

Considering the mutual influence the mind and body exert on each other, it’s clear that nurturing mental health will invariably benefit physical health. This insight reshapes our approach to wellness, underscoring the importance of integrated health practices that cater to both mental and physical domains.


The age old adage, “Healthy mind, healthy body,” isn’t just a saying; it’s a neuropsychiatric reality. The synchronicity between our mental processes and physiological functions reveals a profound interconnectedness. By understanding and respecting this relationship, we not only enhance our wellbeing but also deepen our appreciation for the intricate design of the human existence.

In the symphony of life, the mind and body play harmonious tunes, each influencing the other’s melody.

Explanation of the Quote:  

This quote encapsulates the essence of the interconnected relationship between the mind and body. Just as instruments in a symphony contribute to the overall performance, the mind and body, in tandem, shape our overall health and wellbeing. Their harmony is integral to our holistic wellness.


Vulnerability and Spirituality: Discovering Faith in Uncertain Times


Religion and spirituality, for centuries, have acted as sanctuaries during life’s tumultuous storms. Their appeal in moments of vulnerability can be observed across cultures and epochs. But what prompts this spiritual inclination? Is it merely an emotional response to uncertainty, or is there a complex neuropsychiatric mechanism at play? By understanding this interplay, we can appreciate the profound depth of human resilience and adaptability.

1. Vulnerability and Spiritual Exploration:  

Throughout human history, moments of vulnerability have often led individuals towards deeper introspection, with many finding refuge in spirituality or religion. This isn’t just a random phenomenon; neurologically speaking, the brain’s default mode network, responsible for introspection, becomes increasingly active during times of stress or reflection. Thus, in moments of emotional or physical turmoil, there’s a natural inclination to seek understanding and solace, often within spiritual realms.

2. Life Milestones and Changing Beliefs:  

Life’s milestones, like marriage or the birth of a child, frequently usher in profound shifts in our spiritual beliefs. The transition from the audacious disbelief of youth to a growing sense of spirituality in adulthood can be associated with the brain’s evolving chemistry. For instance, increased levels of oxytocin, a hormone that strengthens bonding and emotional connection, can amplify the depth and intensity of religious experiences. This hormonal shift can lead individuals to perceive and appreciate the profundities of spiritual and religious practices, valuing them as crucial support systems.

3. Uncertainty and Spiritual Tendencies:  

An interesting observation is the pronounced religious inclination among individuals whose lives are marred by unpredictability. This isn’t merely a psychological response. The brain’s amygdala, which plays a vital role in processing emotions, especially fear, becomes hyperactive under chronic stress. Seeking spiritual solace can, therefore, be viewed as an adaptive mechanism to counteract this heightened emotional response, restoring emotional and cognitive equilibrium.

4. Religion as a Pillar of Hope:  

In life’s bleakest hours, particularly when faced with health challenges, many find solace in religious beliefs. This isn’t just a mere psychological crutch. Neuropsychiatric studies indicate that dopamine, a neurotransmitter linked with pleasure and reward, becomes more active during spiritual experiences. This provides individuals with a sense of contentment, inner peace, and hope, reinforcing their faith and empowering them to navigate adversities with renewed vigor.

5. The Societal Fabric and Spirituality:  

Beyond individual experiences, religion and spirituality have historically provided a societal framework, binding communities together. Communal celebrations, rituals, and traditions not only offer personal solace but also foster social cohesion, reinforcing collective identity and shared purpose. This communal aspect of religion also plays a vital role in mental wellbeing by creating support systems and fostering a sense of belonging.


Religion and spirituality’s allure, particularly during challenging phases, isn’t just a sociocultural phenomenon. It’s deeply rooted in the intricate interplay of our neurological and emotional frameworks. By understanding this delicate balance, we gain insights into humanity’s ageold strategies for resilience and coping, reminding us of our profound ability to find hope in despair.

In the orchestra of life’s uncertainties, spirituality emerges as the harmonious note, bringing solace to the soul.

Explanation of the Quote:  

The metaphorical reference to an orchestra underscores life’s complexity. The harmonious note signifies spirituality’s role in introducing balance, peace, and direction amidst life’s cacophonies, highlighting its timeless importance in human experience.


The Interplay of Mental Health, Belief Systems, and Self-Identity


The human psyche is a vast, intricate web of beliefs, perceptions, and experiences. Each individual’s journey through this mental landscape is unique, sometimes touching the very core of their identity and self worth. Our beliefs, particularly those associated with spirituality or religiosity, often serve as an anchor, providing a sense of purpose and stability. Yet, in the realm of neuropsychiatry, where do we draw the line between a deep seated belief and a symptom of a mental illness? Can the two even coexist harmoniously?

1. The Shaman with Schizophrenia:  

The narrative of the individual identifying as a shaman provides a compelling start. Living with schizophrenia a condition where one’s perception of reality can be skewed her identification as a spiritual guide or healer raises intriguing questions. Is her self perception a manifestation of her mental condition, or does it stem from a deeper spiritual awakening?

2. Neuropsychiatry’s Stance:  

From a clinical viewpoint, the immediate reaction might be to treat such beliefs as symptoms. However, this approach might not always be fair or accurate. The shaman’s psychiatrist displayed a commendable level of understanding and acceptance, highlighting that patient centered care should take precedence over rigid medical dogmas. Nonetheless, there lies the ever present risk of a patient’s mental state deteriorating if left unchecked.

3. Religiosity: A Coping Mechanism or Way of Life?  

The inherent human need to understand and make sense of our existence has, throughout history, led to the development of countless religious and spiritual practices. For many, these aren’t mere coping strategies but deep rooted ways of life. This is not to deny that some individuals might turn to religion as a means to manage stress, grief, or trauma.

4. The WHO’s Holistic Approach to Health:  

The World Health Organization’s definition of health, encompassing physical, mental, social, and spiritual dimensions, sheds light on the intrinsic bond between spirituality and overall well being. This holistic approach implies that for optimal health, one cannot ignore any of these facets. Particularly in the face of growing life experiences and challenges, many individuals turn to spirituality for answers and solace.

5. The Evolution of Spiritual Needs:  

As individuals journey through life, their spiritual needs might evolve. Youth, often being a phase of exploration and self definition, might not always resonate deeply with spirituality. However, as one grows older and navigates more of life’s challenges, the appeal of spiritual guidance often grows stronger, underlining the dynamic nature of human spirituality.


The delicate interplay between religiosity, personal beliefs, and mental health presents both challenges and opportunities for neuropsychiatry. While it’s paramount to ensure that an individual’s mental health isn’t compromised, it’s equally crucial to respect and understand their personal spiritual journey. After all, the realms of the mind and spirit are vast and often interconnected, requiring a nuanced, compassionate approach.

Spirituality and the mind are intertwined threads, creating a tapestry of human experience that defies mere categorization.

Explanation of the Quote:  

The quote emphasizes the deep connection between an individual’s spiritual beliefs and their mental processes. Instead of viewing them as separate entities or in opposition, it’s beneficial to understand them as integrated aspects of the human experience, each enriching and shaping the other in myriad ways.