And What Really Is Holistic Psychiatry, Anyway ....
For many years, amongst some circles, psychiatry has received a bit of a bad rap. When I chose psychiatry I did so because I really enjoyed PSYCHOLOGY, but I also knew that everything was connected. I wanted to know how to treat the whole person, not just the mind OR the body. Psychiatry happened to be the specialty that gave me the most time, freedom, and flexibility to explore the spiritual, physical, and emotional nature of a person. Even though I wasn’t managing ALL the details of a patient’s physical health, I could still consider them quite skillfully as a psychiatrist.
Despite having natural abilities and inclination towards psychology and psychiatry, I still struggled initially with my choice of that specialty...because of the bad rap. I actually tried to pursue pediatrics and then family medicine (always hoping to integrate the psychologic piece, somehow, later). I eventually wound my way back to psychiatry, but I noticed that those first few years in residency I tended to not want to tell people what I did...for fear of their judgment. When on planes, at workshops, yoga classes, weddings, and etc. I tended to just say I was a “physician”. The several times I was pressed into saying I was actually a psychiatrist, I got an earful on how awful my profession is/was/could be. 😔
It was upsetting.
I thought about this really deeply after some of those encounters (this is what psychiatrists do best, right?). “Why am I so affected by this negative public opinion of my specialty?” “Do I believe it is true/warranted?” “Am I ashamed of my career?” I ultimately decided that I just didn’t identify with the psychiatry these people were criticizing. I was proud to be the kind of doctor I was. I knew that I was different. I knew I was considering the whole person. I tend (and have always tended) to think about everything going on in a patient’s life and how those factors combine to create a pattern of harmony or distress. I consider family dynamics, hopes, fears, strengths, weaknesses, genetics,physical health, social life, hobbies, spirituality... I was naturally holistic. Whole-istic. So, I stopped telling people I was a psychiatrist. I started saying I was a “holistic psychiatrist”.
The year was 2007.
I was still in residency.
I continued to flesh out what it meant to me to be a holistic psychiatrist over the next few years. (Being a holistic psychiatrist was def not a thing yet, remember...It would be quite a few more years before I met anyone else who called themselves a decidedly holistic psychiatrist.) I had always been interested in the natural ways to improve my own health—mostly vegetarian diet, exercise, sunshine, ample time in nature, pure environments, lots of water, minimizing stress/toxicity (emotional and physical)... And later, in med school, drinking herbal teas, taking vitamins and other supplements, learning about folk remedies and eastern approaches, meditating, and doing yoga. In medical school I read Deepak Chopra’s PERFECT HEALTH book and Andrew Weil’s NATURAL HEALTH, NATURAL MEDICINE alongside my required texts. I also read books about astrology, acupuncture, chakras, shamanism, energy medicine, and other "esoterica" during that time, as well. I actually chose my medical school (U of Michigan) because they had a “Center for Alternative Medicine” (one of the few in the country at that time). A part of me considered this important from the beginning—while most other doctors considered it woo-woo-pseduoscience.
I also chose my residency based on the “relative friendliness” it had towards “complimentary and alternative medicine" (CAM) (U of Arizona). The university homebase of integrative medicine pioneer Andrew Weil, MD had long been open-minded and progressive when it came to “CAM”, most likely due to his presence. One of our psychiatry faculty members had an MD/PhD and lectured regularly on botanical approaches to psychiatric conditions. Several others were trained in mind-body medicine with the Center for Mind-Body Medicine in Washington, DC ( I also had done this training -- between med school and residency). Another faculty member was researching the effect of psilocybin (a hallucinogen) on OCD (obsessive-compulsive disorder). A well-known previous faculty member (Lewis Mehl-Madrona) was a practicing medicine man, in addition to being a psychiatrist. So, there was a strong respect for indigenous healing methods and an awareness of the physical effects of stress, the role of stress on the immune system and mood, and the value of meditation/guided imagery/movement/journaling/art in improving both physical and mental health.
This was my place!!
During residency I sought out extra training and experiences in herbal medicine, nutrition, art therapy, dance therapy, energy medicine, sound healing, meditation, and more. I read voraciously on every topic, every kind of healing that interested me. I also scoured the literature regularly to see what new studies had been done that might legitimize (in the eyes/minds of traditionalist patients or colleagues) what I could feel and see was clearly helpful. I was my first patient. I always tried everything I learned about on myself first. Every practice. Every herb. Every supplement. Every “modality”. If it brought me some relief of stress, some improvement in sleep, some boost in energy, or some improved sense of well-being (and it was well-tolerated), then I considered recommending it.... “integrating it” into my practice.
Slowly, over the years, I’ve built a very solid experience-base (personally and with patients) for a wide variety of herbal remedies, dietary changes, behavioral changes, practices, modalities, and even ways of thinking that promote healing. I also continue to check in with PubMed (NCBI health research database) a few times a month to see what is new, especially regarding things I’m really loving or seeing great response for or hearing about from patients or colleagues.
I’ve also been teaching. It’s a wonderful way to learn, as everyone knows!! Shortly after residency graduation (2009), I was asked to teach “Holistic Approaches to Psychiatry” for the Integrative Medicine Elective Rotation (through Andrew Weil’s program) at the U of A Medical School. It was to be a completely evidence-based powerpoint lecture 1.5 hours long. I created the talk and proceeded to give it many of the following years (last session was April 2017) until I moved to San Diego in June 2017. I also designed "Eco-Psychology", "Stress & Spirituality", and "Healing Power of Creativity" classes for the U of A. I gave a modified version of my "Holistic Psychiatry" lecture to the UCSD Family Medicine residents in Sept 2017 and the UCSD Psychiatry residents in April 2019, as well.
For me, holistic psychiatry is a way of expressing my unique personality in my work. I practice what is true for myself.
Holistic medicine offers me a way of being fully authentic within my career, which I think is a buffer for burnout (but that’s another topic). (Shining our own light fully is restorative, protective, and healing to mind, body, and spirit!!💛) Holistic/integrative psychiatry considers all aspects of health and how they combine to create a certain pattern or picture of dysfunction or wellness. It is also about using natural approaches (sometimes in conjunction with more “traditional” (western) treatments/pharmaceuticals). I personally tend to call a blending between allopathic psychiatry and holistic psychiatry “integrative”. (So, for example, when a patient is on Celexa and rhodiola, Venlafaxine and holy basil, etc.) I usually reserve the term “holistic psychiatry” for those approaches that are 100% natural. Minor distinction (most people use them interchangeably), but it helps me explain the spectrum of holistic providers out there today when I am talking with patients or students.
For 3 years after residency graduation I practiced “Integrative Psychiatry”-- prescribing psychiatric meds (cautiously, slowly, gently) alongside more holistic mental health options. I opened and ran my own 5-room healing center in historic downtown Tucson that quickly grew to a be a wonderful resource for the community. During the time I had the center, I grew my knowledge and experience-base of how things interacted together. I also, as mentioned, would read studies, blogs, chat rooms, books, and basically any thing I could find to learn as much as possible about the supplements I was recommending and how they may behave in the body when combined with psychiatric meds.
In the beginning I pursued holistic medicine because it helped me personally and fit with my naturally integrative, collaborative, mosaic-style worldview. But, it turns out that it also helps a great many other people, some of whom are disillusioned with western medicine. Others simply aren’t getting the results that they want. Still others just really value natural approaches. Prevalence studies show that up to 50 or 60% of patients are using complementary and alternative methods. Anxiety, depression, and insomnia are the three top reasons patients seek holistic treatments. All psychiatric concerns! Generally, if the natural, integrative approach strongly resonates with someone, they most likely find their way to it relatively early in life. BUT, unfortunately, those “natural fans” include just a small percentage of doctors. And because CAM is an approach that appeals to a large percentage of patients, it is essential that physicians learn about it. And those physicians who want to provide evidence-based medicine may benefit from realizing that holistic medicine now IS evidence-based medicine.
Holistic and integrative approaches are an attempt to return to what is intrinsically “healing” in life while still incorporating modern advances where they are needed or desired.
So, holistic psychiatry, the way I do it, is about bringing my full personality and passions into my work. I've always said that I was kind of on the "buffet approach" to life. I love to sample all the things!! Holistic medicine lets me do this. I incorporate what really helps, and I leave what doesn't (but with my gratitude and respect, because it may help someone else!!). Holistic medicine is inclusive, rather than exclusive. Fundamentally, that is how LOVE is. And I am for love! So, open your heart and mind and be amazed and inspired by the R A I N B O W of healing options that exists...just waiting to be welcomed into your life.