To what extent should a patient’s view on his or her ailments influence treatments given by doctors? Take the case of depression in the UK’s South Asian community: a GP trained in the ‘biomedical model’ of disease may not understand the patient’s perceptions, rooted in quite different concepts and potentially influenced by the Ayurvedic tradition. The resulting culture clash can be frustrating for patient and doctor alike.

Dr Sangeeta Patel, a GP in south London and lecturer at St George’s Hospital, is exploring this phenomenon from a cultural and historical perspective, by examining the descriptions and treatments of distress set out in traditional Indian medical texts. "I want to start looking at Asians’ own understandings of distress – which is not the same as the biomedical model of depression – and to approach it from their own perspective, based on their cultural history."

She will ask groups of Gujarati women living in England to describe their experiences and symptoms of distress, and will then compare the descriptions with the patterns of distress depicted in Ayurvedic and Vedic texts.

Central to Ayurveda is the concept of balance and the three humours – wind, water and fire, which govern movement, cohesiveness and metabolism, respectively. Studies of patients attending psychiatric and neurological clinics in India have shown that many related their distress to imbalance in these humours. From the traditional Hindu perspective, distress is seen as a very contextual experience, often related to imbalances between the body and environment, social, physical and spiritual.

The Ayurvedic tradition has long underpinned Indian approaches to medicine, points out the Wellcome Library’s Dr Dominik Wujastyk, a leading authority on the history of Asian medical thinking. This vast body of writings by physicians on health and living – which dates back to 400 BC and continued to be written up until the 19th century – contains elaborate writings on health and therapies.

It is still very much a living tradition. Ayurvedic medicine is still practised in India and its ideas are in common circulation and constantly reinforced. People who originate from South Asia often draw on these traditional classifications when making meaning of their illness and seeking help from their doctor.

But it is a radically different approach to Western medicine, points out Dr Patel. "Depression is increasingly treated as if it is a disease, a concrete entity with a reality of its own, such as chicken pox, which gives everybody the same symptoms, and therefore standard treatments – antidepressants or cognitive behaviour therapy – should be equally applicable to all."

Applying psychiatric categories from one culture to another is not always appropriate, she suggests. The context in which psychological distress arises may differ markedly between cultures, and diagnostic and treatment concepts from one culture may be entirely alien to an individual from another culture.

Studying for a Master’s in anthropology enabled her to compare the Western medical model with other medical systems. "I started to realise where the limits of European biomedicine are. This was reinforced by my work as a GP, in which I found that the models of depression used don’t fit everybody."

Her Asian patients were a case in point: "Some Asian patients don’t think that they’ve got depression per se, in terms of something separate from themselves and their lives. Their distress is often a response to the difficult situation in which they find themselves. As they see it, the interaction between their situation and their body is causing some kind of imbalance. When you treat it as if it’s a disease, it can distract from the causes of their problems, the things that made them feel this way – the root of their distress – as they see it.

She hopes the study will produce direct benefits for patients and GPs alike and smooth communication and understanding. "I’m hoping to develop a tool that GPs can use in practice, to start to understand what their Asian patients are talking about. It will enable them to recognise their patients’ idioms of distress and hopefully provide a way of negotiating a common understanding between doctors and patients, in what has become a quite highly pressured environment."

She sees the potential to benefit general practice more generally. "I don’t think that all GPs can have a full understanding of Ayurvedic medicine, nor is that appropriate. The plan is to slightly change the context. I want GPs to use this tool to consider how much more there is outside the European medical model; to start to challenge the medical approach and their own notions of what depression is."

See also

• Oriental Manuscripts: Introduction to this collection in the Wellcome Library
• First blood: Article on Indian blood donors – another project funded through the Fellowships for Clinicians and Scientists scheme
• Indian psycho: Article on the portrayal of mental illness in Hindi cinema

External links

• Department of General Practice and Primary Care: St George’s Hospital Medical School