As a psychiatrist who is passionate about integrative mental health treatments, I was excited to spend five days recently in St. Petersburg, Florida for the annual conference of the American Board of Integrative and Holistic Medicine.
At the conference, I learned that even more than I previously realized, our ecosystem and environment have a profound effect on our happiness and wellness, and can either give us easy access to good food and healthy activities, or add toxins and contaminants to our already stressed bodies. I learned about botanical and herbal treatments for anxiety and insomnia, including lemon balm, skullcap, and hops.
I learned that apart from considering obvious medical conditions that could contribute to my patients’ psychiatric symptoms (thyroid dysfunction, anemia), I should evaluate for more subtle physiologic disturbances, such as vitamin and mineral deficiencies, adrenal hormonal dysfunction, and even heavy metal toxicities.
But as I sat in the audience listening to physicians renowned in their respective fields in integrative medicine — speaking mostly to internal medicine and family medicine physicians — I was most struck realizing that, “Hey, psychiatrists already know a lot of this stuff.”
We should take time with our patients, and listen to their stories? Obviously. Dysfunctional social environments can lead to physical disease? Yup, seen that before. Our patients are much more than the sum of their organs and diagnoses? No kidding.
What gives me pause, though, is that the field of psychiatry is rapidly shifting, and not necessarily in a good direction. In an attempt to fight negative stereotypes that psychiatry isn’t “real medicine,” some leaders and researchers in the field are seeking to become even more reductionistic in their approach toward patients.
Your child has autism? Let’s find exactly what genes are causing it, and what medications will treat it. Have bipolar disorder? Let’s see what absurdly complex pharmacological regimen we can prescribe you. Schizophrenia? Let’s see if we can develop a lab test for it.
As Thomas Insel, the director of the National Institute of Mental Health (NIMH), famously lamented in the weeks before the DSM-5 came out, “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure … Patients with mental illness deserve better.”
But — we have to ask — is reducing mental illness to a gene study and a lab test really what patients deserve? Is this more important than listening to their stories and understanding the social and psychological environment in which their symptoms developed and are maintained?
Let’s talk about chronic medical illnesses such as Type II diabetes and heart disease, which doctors can definitively diagnose through lab tests and cardiac studies. Has this really helped us treat these conditions? We prescribe medications and put in stents, but do we effectively address the underlying environmental and lifestyle causes of these illnesses? Are these becoming smaller problems over time, or bigger ones? We’re spending more money, but are we getting better outcomes?
Don’t get me wrong — if I needed acute care, like antibiotics or surgery, I’d get myself to a doctor as soon as possible. I question, though, if the reductionistic, disease-based, allopathic model that psychiatry is increasingly trying to emulate is really the best option to treat chronic, complex conditions such as mental illnesses.
After seeing what the integrative medicine physicians speaking at the conference have been able to accomplish with their most treatment-resistant patients, I’m even more convinced that there’s a better way.
Some of the earliest pioneers in medicine understood this better than we do now. As Florence Nightingale said, “The needs of the spirit are as crucial to health as those individual organs which make up the body.” And Sir William Osler, often referred to as the father of modern medicine, pointed out, “The human heart has a hidden want which science cannot supply.”
Ironically, science is now showing us just how true these words are. Did you know that when 10,000 men were followed for development of heart disease, whether or not they answered “yes” or “no” to the question, “Does your wife show you her love” predicted the developed of angina over the next five years? Or that a similar study showed a wife’s love impacted the developed of ulcers?
Did you know that after receiving cardiac catheterization, patients who weren’t married or didn’t have a close confidant were three times more likely to die over the next five years? Or that those purposefully exposed to the cold virus (yes, people actually volunteered for this study) who had weaker social relationships were four times more likely to develop cold symptoms?
Connection matters. Social support matters. Love matters. The relationship between doctor and patient matters.
So in our well-meaning pursuit of a better scientific understanding of mental illness and mental health, we need to be careful not to ignore the heart, not to ignore the spirit, not to ignore the patient’s story.
In an integrative psychiatry model, let’s consider the diagnosis and potential pharmaceutical treatments, while not forgetting that these are only endpoints of the problem. Let’s also look at the roots — factors like social relationships, past trauma, work environment, subtle physical and nutritional dysfunction, ecological and environmental exposures, activity level, as well as a patient’s spirituality, meaning, and life purpose. And let’s make our relationship with our patients its own healing force.
I, personally, think this is what our patients deserve.
Elana Miller is a psychiatrist who blogs at Zen Psychiatry.