We learn more and more about less and less, until we know everything about nothing”
Consider the following case.
Ms A has had recurring headaches for several years. They seem to come and go on their own accord. She has been to a doctor who diagnosed her with migraines and tension headaches, and prescribed pain killers, and specific medications for migraines. They helped for a while but her headaches returned. Then on the recommendation of a friend, she consulted a homeopath who gave her Arnica and nux vomica – they seemed to help for a month, but then her headaches returned as bad as they ever were.
She saw an Ayurvedic physician who recommended meditation, a satvic diet, and shirodara. This helped her quite a bit for a while, and her headaches reduced in intensity for about a month, but then they returned as bad as ever.
Around this time, she began to notice that she would wake up feeling tired every morning. Her fatigue affected her work, and she began taking time off from work.
At this point, she was taking three different medications for her headache (Topiramate, Aspirin, and Ketorolac). She noticed a decrease in her overall appetite, although this was accompanied with an increased craving for sweets. She didn’t sleep well, and her energy levels were low.
When she went back to her doctor, he noted down her symptoms, “headaches, insomnia, anxiety, poor appetite, fatigue. “I think you should see a psychiatrist,” he said, noting down the emotional symptoms.
“I am depressed because of my headaches, otherwise I would be fine. Get rid of my headaches and my mood will be fine. I don’t need to see a psychiatrist. Refer me to a better neurologist,” she said.
What is the real issue here? Does she have a physical disorder – Migraine? Or a mental disorder – Anxiety?
This artificial separation of mind and body is the reason that people often find it hard to get satisfactory solutions for many chronic conditions.
As the medical system becomes more specialised, it also becomes more fragmented.
Does Ms A seek western medicine, or other systems of medicine? And if she does seek a doctor’s help, should she get help from a neurologist, or a psychiatrist? Or some other professional?
The mind and body are, in fact, one, and each system of medicine helps us understand the issue better.
Western medicine gives us insights about the parts- the organs the cells that constitute the whole, while eastern systems of medicine study the entire mind-body system as a whole, and how this interacts with the world around it.
Due to the nature of modern medicine, and the complexity of the human condition, every system of medicine can only have a partial view of the problem.
In order to truly understand the condition, it is best to integrate a study of the mind and body, from a western as well as eastern perspective.
Integrative Medicine combines several concepts and schools of thought to arrive at a coherent and scientifically validated method of healing.
This includes Western medicine (allopathic medicine), Chinese Medicine, Ayurveda, Acupuncture, Massage Therapy, Bodywork, Yoga, healing touch, and meditation.
In the old story about the blind men and the elephant, each man only perceives an aspect of the animal, but to see the entire elephant, all the perspectives have to be integrated.
In a similar manner, the integrative medicine practitioner has a multidimensional understanding of the imbalance or disorder, by seeing the symptom or the problem through the eyes of different schools of medicine and healing.
So, each aspect of Ms A’s condition has to be explored and treated.
While from a more conventional medical perspective, the diagnosis is mixed migraine and tension type headache, a more detailed and individualised approach is required for optimal health.
Her headache is only the tip of the iceberg. The issues include emotional, lifestyle and physical factors interacting to create and perpetuate the problem.
a. Physical: She has tension of the neck and temporalis muscles and fascia, causing nerve compression and pain. She is unable to sleep well and has been eating too many sweets and drinking more than four cups of coffee daily. She has stopped exercising and spends most of her time looking at a screen.
b. Emotional factors: She is facing stress at work due to a new manager, and increasing workload. She has to commute to work for over an hour everyday. Her husband who is also working hard and is stressed, has become emotionally unavailable to her. Her child is studying for her board exams. All these issues are compounding her stress and anxiety.
c. Spiritual: In recent months she has begun to wonder about the meaning of life, and the reason for existence, and worries about her aging parents, as well as her own mortality.
These issues are not independent but rather they interact with each other. Her emotional stress worsens the muscular tension, the unhealthy lifestyle and the insomnia, which further amplified her emotional stress. Her headache therefore is a culmination of multiple variables that are mutually dependent.
So in this case, using an integrated approach her treatment includes the following:
Increasing her awareness of stress and how it is being held in her breath and body.
Starting myofascial therapy (a form of physiotherapy) to release the tension in her muscles and connective tissue.
Yoga, which includes asanas, pranayama and meditation to help increase felexibility and also to increase awareness of the connect between her emotions, breath and body. Yoga will also decrease the stress response in her brain.
Talk therapy for stress management and to improve communication patterns with her husband and at work.
Meditation to ease tension
Ayurvedic treatment including shirodhara, an ancient treatment for insomnia and anxiety.
Biofeedback training to relax the temporalis muscles and neck muscles.
Optimising her nutrition and dealing with cravings for sweets.
Ms A was not only cured of the headaches, but also felt even better than she ever had before. Her self-esteem improved, she slept well, she became more assertive and her relationship with her husband and family improved.
Integrative Medicine does not replace conventional medical care. For example, if you have a heart problem, you should still see a cardiologist.
However for many chronic conditions, an integrative approach is essential to achieve health and healing.
An integrative approach goes beyond symptoms, beyond dogmas, to understand the whole person using all the knowledge and tools available, and to help the person not only get rid of the symptoms, but to achieve their highest level of functioning.
– Dr Shyam Bhat is the founder of Nirvikalpa: The Mind-Body Centre. He has postgraduate training and American Board certifications in Internal medicine (medicine of the body) Psychiatry (medicine of the emotions and psyche), and Psychosomatic medicine (the interface between mind and body). Dr Bhat integrates this with an understanding of Yoga, eastern philosophy, Ayurveda and other systems of healing and has been called the pioneer of Integrative medicine and holistic psychiatry in India. Dr Bhat is also a trustee at the Live Love Laugh Foundation, founded by Deepika Padukone, to increase awareness and decrease stigma around depression.