Dinesh Bhugra: Loving the sound of breaking glass

Thinking differently from the start

“What makes people so different, if everyone has roughly the same anatomy and physiology?” It’s a question that struck Dinesh Bhugra in his second year of medical school, while cycling to his student accommodation on a bright morning in 1970 in Pune, India.

Bhugra, now 67, was born in 1952 and grew up in the industrial town of Yamuna Nagar in northern India. His Hindu parents had immigrated there from Pakistan during the 1947 India-Pakistan partition violence. “They had only the clothes on their backs,” he says.

At age 16 he won the prestigious National Science Talent Search scholarship, awarded to only 100 students throughout India, which would fund his education through to the completion of a PhD. “This was not good enough for my parents,” he says: they believed that he should aim for medicine. More than 10 000 people applied for just 120 seats at the Armed Forces Medical College in Pune.1 To his father’s joy, Bhugra was selected for admission. “It provided me with an interesting set of values and discipline and taught me to think outside of the box, while sticking to order and focusing on work.” he says.

But his questions on the body-mind intersection were not answered in the classroom, so he spent his spare time reading Freudian theories and Greek, Egyptian, and Indian histories of medicine. He tried to work in other medical specialties: “They didn’t feel right,” he recalls. As places in psychiatry in India were limited he sought a new life in the UK, embarking on psychiatry training in Leicester in 1981, which he says felt like “coming home.”

Curious psychiatrist to world leading academic

Early on in Leicester, Bhugra heard a disturbing story in the doctors’ mess. An Indian colleague, who was six months ahead in his clinical training, was told to look for a job elsewhere after a white senior leader told him that “we have to look after our own.” He Bhugra knew then that he had to leave.

In 1986 he secured a training post at the Maudsley Hospital in London. He spent his evenings studying for a part time masters in sociology, followed by a second masters in social anthropology—deepening his understanding of “what makes people so different.” He completed his PhD thesis on schizophrenia rates in different ethnic groups in southwest London.2 His findings showed higher rates among migrant groups, as he had expected, but with intriguing differences between groups: a higher incidence than in white people was found in all African-Caribbean women under 30, for example. In Asian women, however, a higher incidence was found only in women over 30. This suggested social and cultural differences, not biological ones.

As a researcher, Bhugra came up against challenges. He played a central role in putting together a multi-million pound grant, but at the last stage his name was taken off the application. He was told that he would not be required, “as there were no Asian patients.”

He faced personal challenges as well. After moving to the UK he came out as gay to his family. “My father was really upset, but my mother was more pragmatic, and her response was to ask who will look after me in my old age,” he says. He was faced with a “double minority effect” in India and then in the UK, having to “work harder to achieve” and to prove himself. He describes coming out as gay as “creating another bit of otherness.”

Subodh Dave, now a consultant psychiatrist at the Royal Derby Hospital, first met Bhugra shortly after moving to the UK in 1997, and the two worked together to improve outcomes for international graduates. Bhugra implemented sessions to support orientation to the NHS and won the support of his co-workers. “He remembers people’s names and doesn’t stand by himself,” recalls Dave. “He is able to influence other people in making bigger things happen.”

In 2016, during his tenure as president of the World Psychiatric Association, he led a survey of 193 UN member countries on discrimination against people with mental illness.3 It revealed striking findings regarding marriage, voting, and employment rights and was published as part of the Social Justice for the Mentally Ill report.4 That report spurred the development of a bill of rights by the World Psychiatric Association, calling for governments to give equal rights to people with mental illness, which he launched at the UK House of Lords and which is supported by 60 organisations to date. “It was one of my proudest moments,” he recalls.

Championing mental health, medical students, and doctors

In 2016, students of African heritage at Cardiff University School of Medicine complained about the portrayal of a black university lecturer at the medical school’s annual satire show. The show featured homophobic, racist, and misogynist content, with students “blacking up” to portray the professor. The incident prompted a police investigation, and 32 medical students were suspended.

Bhugra was invited to lead the Independent Review Panel into Racial Equality at Cardiff and provided 13 key recommendations, from equality and diversity training to the importance of teaching about cultural change. He says that one of his biggest realisations from that review is that “people are not aware of how their actions can cause pain to others.” He adds, “Other medical schools definitely have similar issues. Cultural competency should begin from day 1 of medical school.”

Although he has often faced challenging situations alone, he has always strongly advocated providing support for doctors’ mental health and believes that the challenges doctors face nowadays are “unparalleled.” When he was invited to be BMA president elect in 2017 he persuaded the BMA to conduct a survey of 4300 doctors.5 The findings were “horrific,” suggesting that 80% of UK doctors and medical students were at high risk of burnout.

Bhugra lives in Brixton with his partner of 37 years. Although he retired from academic medicine in 2014, he continues in numerous governance positions. Having previously helped to conduct a mental health review of medical students in 12 countries that revealed poor results, he will be extending the survey to 25 countries to study any cultural variation. He firmly believes that medical students should be taught to care for their mental health. And this work continues alongside a busy schedule of writing books and teaching—400 scientific papers and 37 books to date.

Over the years, Bhugra has discovered that what makes people different is complicated: genetics, social determinants, and culture all contribute. But one thing that’s clear to him is that psychiatry must move away from the traditional view that the mind and body are distinct entities. “Every condition has an aspect of mental health,” he says, giving the example of how diabetes and depression are difficult to treat when they occur together. That conclusion has fuelled his ambition to incorporate mental health services into holistic medical care.

What keeps him going? “Always have fun in what you are doing; if you are not having fun something needs to change,” he says. “It also keeps me out of mischief.”