Understanding the nature and implications of brain injuries plays a key role in formulating therapeutic techniques that can guide brain recovery appropriately.

Charumati Raghavan, our next pathbreaker, Neuropsychologist, runs her own private practice, as well as collaborates with researchers to improve cognitive tests and rehabilitation methods that can then be used for patients with brain injury.

Charumati talks to Shyam Krishnamurthy from The Interview Portal about the need for more Neuropsychologists in the country, to work in a concerted way to improve awareness regarding the need for early intervention, diagnosis and rehabilitation of cognitive functions.

For students, while the sky is the limit in terms of the possibilities, the basics start with our own brain, and learning how to empower it. Currently, there are only about 50 neuropsychologists for the billions of people in our country. So, the scope and need for this discipline to become mainstream is tremendous !

Charumati, what can you tell us about your background?

I am Charumati Raghavan. I grew up in Mumbai and have always been surrounded by a lot of people, noise and chaos. From the very early days, I grew up observing people from all walks of life, different cultures and backgrounds in crowded markets and trains. I have had an innate desire to connect with them in deep and meaningful ways. So I knew quite early on that I would like to work in an area where I could foster a fundamental connection with people.

What did you do for graduation/post graduation?

I did my Bachelors in Psychology from St. Xavier’s College, Mumbai. For post graduation, I had several sub-specialties in Psychology available to me. I chose Clinical Psychology. This was a challenging area to work in and I was keen to delve more deeply into understanding brain function in patients who were struggling with disorders such as schizophrenia and clinical depression. Hence I completed another postgraduate degree in Brain Imaging and Cognitive Neuroscience from the University of Birmingham, UK. I went on to do a PhD in Experimental Psychology from the University of Oxford. My dissertation was on understanding how to rehabilitate patients experiencing attention related difficulties due to stroke. I was looking to use advanced technology (transcranial magnetic stimulation) to answer this question, which in turn also made me understand how accessible the brain could be to rehabilitation efforts. 

What were some of the drivers that made you choose such an offbeat, unconventional and unique career?

Neuropsychology is at the intersection of cognitive sciences, clinical psychology and neuroscience. In short, it is exciting to learn about the brain’s ways of functioning – how we learn, how we remember, what we choose to pay attention to, how we solve problems, how we plan and make decisions, why we behave the way we do or feel the way we do? It is empowering to use this knowledge to make a meaningful difference in our own as well as other peoples’ lives. 

I have had four main influencers whose guidance has shaped my career path. In my Masters’ in Clinical Psychology at Mumbai University, my Professor, Dr. Anuradha Sovani gave us, her students, the opportunity to witness firsthand how difficult life could be if your brain worked differently from the majority. This was such an eye opening experience and formed a big part of my motivation to work with people who need this level of intensive help. Another influential mentor was Dr. Urvashi Shah, a senior neuropsychologist at KEM hospital, Mumbai. She showed me the path forward and my aspirations crystallized under her guidance; she taught me how to formally evaluate brain function, the importance of clinical observations and counselling skills to be able to help families and doctors in making key decisions. When I decided to take the leap into Neuroscience in the UK, a degree in Humanities from India did not equip me to understand the physics, science and statistics that I needed. Even my style of writing answers was so different from that required in the sciences. Needless to say, I was initially overwhelmed! At such a critical juncture, another wonderful mentor, Dr. Pia Rotshtein, patiently introduced me to the fascinating world of Neuroscience in words and ways that I could understand. She taught me academic skills and helped with personal insights that have shaped my career in a big way. Finally, Prof Glyn Humphreys, my PhD supervisor, empowered me to believe that no idea was small if it was rooted in theory, observable in reality and supplemented by the motivation to make lives better. He continues to be my role model, even after his unfortunate and unexpected demise.

I continue to have wonderful colleagues, senior neurologists, psychiatrists and therapists who step in with their valuable advice and support. Working together as part of a team is critical to this job role and to aid in materializing aspirations into actions that can benefit others.

How did you plan the steps to get into the career you wanted? Or how did you make a transition to a new career? Tell us about your career path

After my first Masters’ in Clinical Psychology, I worked with patients with epilepsy, some of who were suitable candidates to undergo brain surgery to help control their seizures. In due course, I felt that I wanted to study more about the brain-why did seizures happen, what was the relation with behaviour, how could taking out a part of the brain affect our abilities, and most importantly, can the brain recover post injury? What can I do to help it function better? How can I enable families to support their loved ones better? I knew that unless I was able to learn enough about the brain, I would always feel like I did not know enough to help the patients that I worked with. So I decided to pursue a Masters’ in Neurosciences. At this point, the idea was excellent, but I had not realized what a steep learning curve I was in for! I had to work extra hard, read a lot of books and scour the internet for resources on how neuroimaging could help with understanding the brain’s functions (EEG, fMRI, etc.), learn in detail about the brain’s anatomy and function, as well as basics of physics, math and programming. I even enlisted my older brother Sridhar’s help (a topper in the sciences and a software professional at the time!). 

Cognitive neuroscience is a huge area, and the number of imaging techniques are varied and constantly evolving.When I was at Birmingham, I volunteered as a participant for as many research studies as I could! Apart from giving me some extra cash, I also got exposure to various aspects of neuroscience in a very short period of time. I had three dissertations to do as part of this Research Masters’ AND to add to that, I got a part time job as a research assistant in one of the language labs. Through these experiences, I was able to gain first hand knowledge and insights on what I enjoyed, as well as what was not my cup of tea! At the end of the year, I cleared my Masters’ and my self-confidence got a huge boost at this point! Although I was originally keen on returning to India post this Masters, post my experience at Birmingham, I decided to apply for a Doctoral degree for more research experience and to continue my journey as a student.

This Masters’ had also given me a glimpse into recent advancements in techniques that not just help us understand what might change in a brain post injury, but also potentially enlist this knowledge to improve life for patients. So, when I got the opportunity to do a funded PhD involving rehabilitation with stroke patients, I jumped on the opportunity. I used brain imaging, conventional tests and spent hours interacting with patients learning about their difficulties and experiences. After this PhD was complete, I knew that it was finally time to return to India and resume my clinical practice. The only difference though is that I now knew that clinical practice would need to go hand in hand with research. By advancing our knowledge through research, we can make more effective contributions to our patients. By improving our practice, we can in turn contribute to knowledge in the field that can benefit others. So I currently give equal importance to both my clinical practice and research work in neuropsychology.

How did you get your first break? 

I got my first job through interviewing for the position of a Clinical Psychologist with a company in Mumbai. After 9 months, I decided to approach Dr. Urvashi Shah as an intern at KEM hospital. For the first few years, I dedicated myself to learning as much as I could through observation, discussions and helping with cases. Following that, I got a fully paid position and was also able to have a small scale independent practice.

Once I returned from the UK, I relocated to Pune (since my family had moved here). I had no contacts in Pune, so I started to spread the word that I was back and willing to re-start. I started with Dr. Sudhir Kothari, a prominent and senior Neurologist at Poona hospital. I had patient referrals, but only enough to span 2-3 days a week. I was grateful for this slow start to be honest, because I realized how much more learning had to come my way in terms of different types of neurological difficulties (dementias, movement disorders, encephalitis, multiple sclerosis, stroke, head injury, epilepsy) and related challenges in diagnosis and care. I started freelancing as a peer reviewer at Cactus Communications at this time to keep myself financially afloat. With time, my ideas formulated, my experience with clinical work and teaching neuropsychology helped me to have more focused career goals in what I call my ‘second innings’ career-wise. 

What were some of the challenges you faced? How did you address them?

The first real challenge when I started about 15 years ago, was that neuropsychology was not a well- known discipline in India. Hence job opportunities were few and not well-paid. Things are different now; the discipline is well-recognized as a contributor to the diagnosis and care of people with various brain injuries such as stroke, epilepsy, dementia, head injury, etc. Colleges have now introduced neuropsychology as a subject in their syllabus. This is in keeping with the growing popularity of the discipline across the world.

A second challenge is the lack of sensitivity towards problems that accompany brain injury. Oftentimes, cognitive problems, i.e. difficulty with attention, memory, learning ability, thinking are invisible; and yet, they can significantly affect our lives at home and performance at work. Sensitizing people, families, schools and workplaces to the impact of such injuries, encouraging early evaluations to identify problems with memory and other functions, forms a big part of my current endeavors. I do this through seminars, panel discussions, teaching and engaging with others on social media platforms. I believe that knowledge building is the first step towards sensitizing and more importantly, eliminating any stigma and biases that such conditions may bear. Engaging with the community and enabling postgraduate students to spread awareness about cognitive health is a part of my attempt to overcome this challenge.

Where do you work now? What problems do you solve?

I currently work as a Psychologist who specializes in Neuropsychology, primarily at Poona hospital and at Jupiter hospital in Pune. I also have my own private practice. Alongside, I collaborate with researchers in the UK to improve cognitive tests and rehabilitation methods that can then be used with people in India in a cost- and access- efficient manner.

Typically, patients are referred to me by neurologists and psychiatrists. They either have a known brain related injury like stroke, epilepsy or head injury and are struggling to cope with everyday life, work and relationships post injury. Sometimes people going through some form of memory loss refer themselves to me for an evaluation. My job is to try to identify if these are early signs of a neurological problem such as dementia. Sometimes, paper-pencil/ computerized cognitive tests can pick up problems even before MRI scans and other imaging do. A big part of my job is to communicate these findings to doctors, support staff and families. Educating people about the difficulties that the patient may go through and to mutually find ways of managing these difficulties at home is an important part of a neuropsychologist’s job. Further, counselling patients and families to maximize their existing strengths, help them to understand the nature of the brain injury and what to expect, and wherever possible, guide rehabilitation of brain functions is also a part of my current practice. 

Often times, doctors in busy practice don’t have the time to provide ongoing support to patients, despite being inclined to do so. At the same time, not every counsellor, clinical psychologist and psychotherapist is equipped to understand the nature and implications of brain injuries enough to be able to give the required support to patients and guide their families. Hence, the role of a neuropsychologist is essential both in terms of having the knowledge as well as the skills to be able to guide care of patients with brain injury. For e.g. different types of brain injury can cause different types of problems with learning and memory. A stroke due to disrupted blood supply to the front of the brain versus the back of the brain can have a very different profile of cognitive deficits. So knowledge of brain’s anatomy, function, theories of cognitive function and therapeutic techniques to cater to each unique individual and unique family is critical. Neuropsychology is a niche area; invisible cognitive deficits are often times much more challenging to address if there aren’t enough specialists who can guide brain recovery appropriately. Worse still, one could miss out on recovery opportunities due to lack of awareness or being misguided, making the role of a neuropsychologist even more essential for patients with brain injuries and their families. 

All of the above requires knowledge of multiple disciplines such as neuroscience, psychology, cognition, therapy, rehabilitation as well as needs one to be fundamentally genuine in their care for people. Empathy, listening skills, flexibility of thought, and problem solving skills are critical to being able to perform this job well. Additionally, effective communication skills and patience also help when it comes to dealing with clients with cognitive limitations. Finally, it is important to acknowledge that as far as the brain is concerned we are all  students and maybe will never know everything that there is to know. However, if you enjoy the learning and discovery process, this field certainly has a lot to offer!

How does your work benefit society?

Neuropsychology is now a thriving discipline. Across the world, many different departments (e.g. robotics, IT, engineering) often work together to improve the practice and delivery of services with the advent of technology. Technologies such as virtual reality, electromagnetic stimulation, new brain imaging techniques have improved avenues for both research and practice in the field.

While the sky is the limit in terms of the possibilities, the basics start with our own brain, and learning how to empower it. Currently, there are about 50 neuropsychologists for the billions of people in our country. So, the scope and need for this discipline to become mainstream in our country is tremendous. It is important to improve access to neuropsychologists in the country, and to work in a concerted way to improve awareness regarding the need for early diagnosis and rehabilitation of cognitive functions. Practicing neuropsychologists can help to empower by making society self-aware, enabling them to take care of their own health, seek support in time for loved ones with brain related issues and improve the care and enablement for people with conditions such as stroke, dementia and other brain conditions. 

Tell us an example of a specific memorable work you did that is very close to you!

What I am doing right now, working with postgraduate students to improve service provision via research, teaching them what I know, and learning from them about how to use technology and social media to access more people is particularly leaving an imprint on my mind. 

Your advice to students based on your experience?

Sometimes things take their time coming, but never give up on the idea that you will find your place under the sun sooner or later. 

Future Plans?

More research, engagement with the community and more clinical practice! My dream is to be a part of an India where people understand the need to be more mindful about their brain health and can access cognitive tests and rehabilitation digitally, even if they are based in very remote parts of India. I am looking to connect with people who can help me conduct cognitive health camps and brain awareness talks in remote areas of the country.

A personal career and research goal of mine is to continue my PhD work on rehabilitation of cognition in stroke using transcranial magnetic stimulation in India.  To this end, I am looking to connect with others who can support this endeavour to bring advanced cognitive rehabilitation techniques to India and help me make access to these aids mainstream and feasible for our masses.