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Overcoming Depression OVERCOMING DEPRESSION Patients’ experiences with psychiatric and ayurvedic settings Maja Kolarević OVERCOMING DEPRESSION: Patients’ experiences with psychiatric and ayurvedic settings MAJA KOLAREVIĆ LJUBLJANA 2017 OVERCOMING DEPRESSION: Patients’ experiences with psychiatric and ayurvedic settings dr. MAJA KOLAREVIĆ Reviewers: dr. Barbara Potrata, dr. Lilijana Šprah, dr. Mojca Zvezdana Dernovšek Proofreader: Ana Furlan Layout design: Martin Lah, LAGU DESIGN Publisher: Inštitut Karakter / Institute Karakter E-book Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID=293698304 ISBN 978-961-94373-0-8 (epub) ISBN 978-961-94373-1-5 (pdf) ISBN 978-961-94373-2-2 (mobi) ISBN 978-961-94373-3-9 (ibooks) Način dostopa (URL): http://karakter.si/media/Overcoming_Depression.pdf TABLE OF CONTENTS GLOSSARY VIII ACKNOWLEDGEMENTS X PREFACE 1 INTRODUCTION 18 I CHAPTER PSYCHIATRY IN THE 20TH AND 21ST CENTURIES: PARADIGMS OF UNDERSTANDING AND TREATMENT OF DEPRESSION 23 Brief history of depression 24 Depression within the biological, social and psychodynamic model 27 Psychopharmacological revolution, DSM and antipsychiatry 29 Birth of Major Depression – depression as a biomedical disease 32 Major Depression in the light of anthropology 34 Depression as a bio-psychosocial disorder 36 II CHAPTER PSYCHIATRIC PRACTICE IN SLOVENIA: THE UNDERSTANDING AND TREATMENT OF MAJOR DEPRESSION 39 Look into history 40 Slovenia affected by transition 43 Understanding and treatment - between socialism and capitalism 45 III CHAPTER DEPRESSION IN THE CONTEXT OF AYURVEDIC MEDICINE 49 Ayurvedic medicine through history 50 Biomedicine and Ayurveda in India today 52 Basic concepts of Ayurvedic medicine 54 Understanding depression and mental health problems 57 Diagnosis of Psychiatric Disorders 61 Models of treatment 62 IV CHAPTER CULTURAL-POLITICAL ATTITUDE TO COMPLEMENTARY METHODS AND AYURVEDIC MEDICINE IN SLOVENIA 67 The rise of complementary and alternative medicine (CAM) 68 Biomedicine and complementary medicine compared 70 Yes to alternative? 72 V CHAPTER DEPRESSION BETWEEN THEORY, PRACTICE AND PATIENT EXPERIENCE 77 The prevalence of depression 78 Why are we depressed? 82 Descriptions of depression 94 Symptomatology 95 Individual responsibility 97 Between objectivity and subjectivity 102 VI CHAPTER QUALITY OF PROFESSIONAL HELP AVAILABLE TO A PERSON FIRST FACED WITH DEPRESSION 107 Help-seeking behaviour 108 First visit - offered help 110 Role of NGOs 114 Why Ayurveda? 115 VII CHAPTER THE COURSE AND OUTCOME OF TREATMENT 117 Doctor-patient relationship 118 The role of the patient 123 Cooperation of relatives 128 Problems of treatment 131 Changes under psychiatric and Ayurvedic treatment 139 The evaluation of psychiatric and Ayurvedic care 141 The ability to control and maintain a stable mood 142 VIII CHAPTER PERSPECTIVES OF AYURVEDIC MEDICINE IN SLOVENIA 147 Ayurvedic medicine from India to Slovenia 148 Psychiatrists’ attitude toward CAM and Ayurvedic medicine 152 The spiritual aspect of treatment 155 Treating depression naturally 157 The need for cooperation 158 CONCLUSION 161 REFERENCES 173 POVZETEK 189 INDEX 191 GLOSSARY Abhivinesha, the fifth klesha, is the senseless fear (of death) or the fear of the unknown. Abhyanga is a whole-body massage with medicinal oils. Agni or “fire” are enzymes responsible for digestion and metabolism. Asmita, the second klesha, is an exaggerated egoism where the ego is the center of the world. Avidya, the first klesha, is a wrong knowledge or subjective perception. Dhatus are tissue elements; there are seven categories. Doshas are bioenergetics principles that govern psychosomatic functioning. There are three doshas: vata, pitta, and kapha. Each dosha is compound of two elements and has three aspects: subtle, physical and morbid. Dwesha, the fourth klesha, is an exaggerated reluctance or the feeling that something is not wanted anymore. Gunas or mind-sets are natural psychological tendencies or three energies (sattva, rajas, and tamas) in the brain and the main factors affecting the mental state and health of the individual. Kapha dosha is formed from earth and water and is the bioenergetic principle of binding and lubricating. Klesas or afflictions area specific chain of five unconscious mental constructs. They are a source of emotional pain and suffering. Malas is by-products of digestion and metabolism. Nasya is a nasal administration of medicinal oils. Panchakarma therapy (PKT) is one of the fundamental concepts of Ayurvedic disease management that eliminate toxic materials (vitiated doshas) from the body in order to cure a disease. Pitta dosha is a combination of fire with a minute amount of water and manifests in living organisms as the bioenergetic principle of heating or transformation. Prakriti is individual’s constitution given at birth; it can be physical (saririka) and mental (mansika) prakriti. VIII Raga, the third klesha, is an exaggerated attachment or the wish for something we need to have again. Rajas guna is the activity of the mind. Sattva guna is balanced and calm. Ayurveda tends to increase sattva. Shirodara is a technique of streaming of medicinal oils on the forehead. Svedana is a herbalized steam treatment. Tamas guna is darkness, inertia and ignorance. Unmada is a general term for all mental disorders in Ayurveda. Vata dosha is a combination of space and air, manifesting as the bioenergetic principle of expansion and movement within any living organism. Vikrti refers to the current imbalance or altered state of doshas in the body and mind representing a deviation from prakriti. IX ACKNOWLEDGEMENTS This book is the result of a processed doctoral dissertation, Depression between biomedicine and ayurvedic medicine – a case of patient experiences in Slovenia. Thanks go to my mentors, Lilijana Šprah and Barbara Potrata for priceless help, guidance, patience, confidence and consistent professional and institutional support in writing my dissertation. I also thank the members of the Commission for doctoral dissertation defense, Mojca Zvezdana Dernovšek, Lisbeth Maria Fagerstrom and Rajko Muršič. I thank Mojca Zvezdana Dernovšek and Marjanca Prek for helping me to recruit patients. I thank Lisbeth Maria Fagerstrom for immediately support when the third member of Commission rejected cooperation at the time when she needed to submit the evaluation. I thank Rajko Muršič for all the proposals, which will certainly lead me in the further research. Many thanks to my interviewees, which I have changed the names in order to ensure anonymity in the book, for sharing their life stories and giving me some of their precious time; without their participation this study would not be possible. I also thank to all psychiatrists, Ayurvedic doctors and therapists in Slovenia and India. To ensure their anonymity I cannot thank by name, but because of that I am no less grateful. I also thank the European Union, European Social Fund, which together with the Ministry of Higher Education, Science and Technology gave me the Scholarship and financed my PhD study. Many thanks to my dear parents for great support, morally and financially. Thank you for the collaboration in making the chapter about healthcare system in Yugoslavia. Your detailed explanation and illustration was very helpful for my understanding those days. And special thanks to my dear Mom! Without you neither the dissertation, neither the book would not have been written. Many thanks also to Danijel Bandelj, Maja Kohek, Simona Glazer, Tina Strelec, Tea Vizinger, Mišo Bračič, Miha Drofenik, for debates, readings, patience and technical help. Finally, thanks go also to my lector, Ana Furlan for detailed reading and for spending hours on the skyp for discussing the content that it would not be lost or mistranslated. Thank you all! X PREFACE According to Okely, the anthropologist’s past is relevant only insofar as it relates to the anthropological enterprise, which includes the choice of area and study, the experience of fieldwork, analysis and writing (Okely, 1992: 1). The anthropologist has to change or superimpose new experience, gained during fieldwork, upon past embodied knowledge and come to terms with a changing self-embodied knowledge in new context (Okely, 1992: 16). As the research process has been made transparent, personal experience is being transformed into public, accountable knowledge (Finlay, 2002: 210). In this manner the full research history (insofar there is space) is offered as both a confessional tale and a transparent account of the research. Why depression, why Ayurveda? Growing up with a depressed person experiencing also other co-morbidities (borderline personality disorder, addiction and as such, being extremely complicated) encouraged me as well as the selection of the topic for my research. Towards the end of my teen years, the situation worsened, suicidal thoughts became more frequent, and hospitalizations in a psychiatric facility as well. After numerous hospitalizations and medication therapies, the situation did not change significantly. For many years, I avidly sought different solutions and in my early twenties I developed a very negative attitude towards psychiatry – only a sheer volume of prescribed medications, with no effect in the long run. In addition to that, the reasons for the depression and its understanding were alien and all blurred. Today my attitude to the psychiatry has changed, as well the understanding of depression. While studying anthropology at the undergraduate level,
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