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6 Myths About Integrative Psychiatry

6 Myths About Integrative Psychiatry


  • By leveraging the value of physiological assessment, we move closer to the promise of a psychiatry grounded in pathophysiology. The benefits that accrue in the practice of integrative child, adolescent, and adult psychiatry are both professional and personal. View the slides in PDF format. Also see: Integrating Biomedicine and Asian Medicine: Challenges and Opportunities.


  • Fact: Integrative psychiatrists consider both symptom presentation and methods for prevention. This specialty helps psychiatrists search for barriers to health and factors that can support a return to health. Practitioners push deeper into the testing of metabolic, gut, and brain features, which seems more fitting, given our role as physicians. The explosion of findings in the realms of inflammation, microbiome, neuroplasticity, pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS/PANDAS), population nutrition, and epigenetics augurs well as these key areas are targeted for more exploration.


  • Fact: A wide range of non-pharmacological tools support the notion that psychiatric care is more than medication dispensement. Health, healing, and mental health form the bedrock of integrative psychiatry. It is from this ground-level vantage that we can begin to see our treatments, our tools, our tasks, and our patients in a light that fosters healing rather than the absence of symptoms. Integrative medicine seeks first to do no harm. Above all else, we want to protect the mind, body, and spirit of our patients. With proper support and the alleviation of obstacles, the mind, body, or spirit can often heal itself. This is one of the obvious though often overlooked facts of health, especially in the territory of the brain—that care comes best as a support mechanism, not an intervention.


  • Fact: Integrative psychiatry is not anti-medication. By shifting the treatment model away from treating disease and toward supporting health, it understands medication as merely one possible intervention in a spectrum of possible interventions. This means every intervention must be evaluated according to an assessment of health vs illness and safety vs effectiveness. And all too often medications cause some damage in the search for long-term health.


  • Fact: Assessment explores the mind, body, and spirit of each patient. Some believe that no single tool possesses more power to transform our genetic expression than diet and nutrition. For example, our brains are made up of the molecules we ingest, yet you will not find a mention of diet, food, or nutrition in any psychiatric textbook.  Integrative medicine prefers—or is willing to try—health-empowering interventions over the introduction of treatments that might increase dependency or offer only brief, symptomatic relief. For instance, an integrative psychiatrist might offer a patient struggling with anxiety meditation, yoga, or inositol, before benzodiazepines or SSRIs are discussed.


  • Fact: Patients and their families want holistic options. The operative word is “options.” The work of integrative psychiatry offers a deeper and richer connection with each family member, as we listen, assess, and care, while working to foster health in growth and development. Integrative psychiatry embraces, at its core, this central clinical task. It is an effective complement for much of what we do now and a challenge to do better in the future.


  • Fact: The rewards are many—for  the patient, as well as for the physician (eg, burnout prevention). The production-oriented, pharmaceutically driven delivery system in the US feels increasingly heartless; it is frustrating and unrewarding for many practitioners. The unfortunate truths have been most widely documented in adult patients, but the gaps in research and questions about treatment are most challenging among children, adolescents, and young adults, whose developing nervous systems have become a canary in a coal mine. Integrative psychiatry emerged and developed in direct response to some of these growing imbalances.


  • For more information, see The Premise, Practice, and Promise of Integrative Child and Adolescent Psychiatry by Scott Shannon, MD, on which this slideshow is based.

Comments

In your response to Michael below you state one of the reasons you may remove comments include, "comments do not appear to come from mental health professionals". Why do you only allow comments from health professionals? A world of things can be learned from lay persons who have gone through mental health issues, including what works for them, their experiences with a particular therapy, etc. A mental health professional is not the "know-all, see-all, expert on all things related to mental health. If you only want comments from "professionals", you should not allow non-professionals to sign-up to receive your newsletters and emails. It's too bad because all education and experience is a good thing.

Steve @

Hold on.
I wrote three posts critical of integrative psychiatry. All have been removed. Do we have censorship on this site? If we do, I would like to learn the name of the censor.

Michael @

To "Michael,"

We reserve the right to remove user feedback for reasons that include but are not limited to: comments are not accompanied by accurate information (such as the registrant’s real name, title, and institution); comments do not appear to come from mental health professionals; comments are discourteous or unproductive and potentially interfere with another member’s use and enjoyment of the Services. We invite criticism on an objective and factually verifiable basis and ask registrants to exclude personal commentary about an author’s expertise or motive. According to our Terms of Service, UBM Medica websites are primarily for health professionals to weigh in on issues related to medicine, in this case, psychiatry.

Thank you,
Psychiatric Times Editors

PsychTimes @

Thank you for the reply. It might be my erroneous impression but I felt the rules might have been applied unevenly. About a month ago, one of the readers repeatedly questioned my professional (psychiatric) credentials and competency without any editorial interference. I did not respond to the insinuations understanding that it might happen in passionate debates. The last I checked, the attacking post was still there.

It is indeed the editor's prerogative to remove any post for any reason. Shielding the articles (and by extent their authors) from fair criticism would do more disservice to the readers, in my opinion. There might be a reason why some of the contributors choose partial anonymity. In the recent years, we have observed an increase of intolerance and occasional vindictiveness toward the dissent (not on the pages of the PT, however). It is hard to gauge subtleties in a response, all within the acceptable norm of conversation, and second-guess the tolerance of the editors. One can only try. Nevertheless, quoting Christopher Hitchens, I believe that an assertion without evidence deserves no reverence. One might disagree.

Psychiatric Times is a fine example of good professional journalism and I am under the impression it could tolearate strong opinions from the readers. But I respect your decision and hope that the editors will continue to be objective and impartial in their approach to the readers' comments and not allow personal preferences and sensitivities to influence their editorial decisions.

Cordially,

Psychiatric Times Reader

Michael @

Integratve psychiatry may be the ultimate "GOLD" standard that would provide the greatest benefit for the patients. One problem with implementing this is the majority of patients can't afford it. We can't even provide basic mental health care to many who need it. We hear of people wanting to limit gun rights due to the few people who carry out atrocities but you don't hear the powers that be advocating better mental health care as an alternative. Myth 5 states patients and families prefer "natural remedies" when some would prefer to get any help. There are many in the mental health field trying to serve the patients in a holistic or integrative way but are restricted due to bureaucratic restrictions. These restrictions include the 15-30 minute restrictions and number of patients to be seen in a day. It is in these clinical situations that a large majority of the population find their only mental health care options.

Betty @

Great article, doc. Appreciate it--keep researching and writing.

Dave Skaer (Dr. Boo)

David @

Where do you expect Psychiatrists do find the time to do this when we are only given 15-20 minutes to see a patient (30 at most), to see assess a patient, order meds, and complete the electronic record? You are either in private practice fee-for-service, or you are living in a fantasy world, Dr. Marcus Welby.

WILLIAM @

EEG gives a good predictor of medication response.

Gary @

fMRI and genetic testing has far surpassed EEG. EEG use by psychiatry does nothing and is a thing of the past.

Steve @

Then WHY, WHY, WHY, are fMRI's and genetic testing more readily and easily available????? There's STILL very much guess work occurring and valuable lost time!!

Stephanie @

Thank you for this excellent reminder. I work closely with the PCP in our community. I do this first because so many of my patients have a myriad of medical conditions that contribute in some way to their psychological condition. Second, there may be unrecognized medical conditions that have psychological components as part and parcel of the illness. Third, of course, I need the prescribing provider to coordinate, adjust and monitor medication for my patients. Although I routinely contact psychiatrists and other specialists outside our small community in an effort to coordinate efforts but it is rare that they respond to my call. I can only assume they are too busy or do not think such coordination is important. I hope your article will help in this regard.
Sarah Edwards, PhD, LCSW

Sarah @

I practice Comprehensive and Integrative Psychiatry. I am already at the level where Psychiatry is grounded in Pathophysiology.

To reach where I am, you have to continuously learn and fuse knowledge and skills from neuroscience, psychology, psychiatry, neuroendocrinology, endocrinology, psychoneuroimmunology, immunology, rheumatology, gastroenterology, nephrology, general medicine, biochemistry, and nutritional science. All of this is within the domain of psychiatry.

In many ways the term "integrative" is incorrect but necessary for others to understand since it is a commonly used term. However all of these fields are a part of psychiatry. They are not separate. They are within psychiatry. This is why I use "Comprehensive" in the description of what I do.

I use the same evaluative skills, labs, and treatments endocrinologists, immunologists, rheumatologists, and general medicine physicians use. When patients see me, it is like seeing six specialists in one appointment. I see psychiatry as the top medical field once you include the full body of medicine within it.

I evaluate patients from a comprehensive multi-specialty point of view to determine the pathophysiology of their illness. The treatment then becomes clearer - though more complicated. Generally, to cause a mental illness, one needs a stack of pathologies to cause a person to fail in function.

With an understanding of a patient's pathophysiology, I don't play roulette in treatment. I minimize trial and error. When the pathophysiology of mental illness is addressed, patient's can more predictably regain their health. This make me and my patients so much happier than in the past.

A big hurdle in doing comprehensive-integrative work is that the psychiatrist has to be willing to treat patients using all of the skills and techniques he or she can gain from the other specialties. For example, I do endocrine treatments. I treat diabetes. How ironic is that psychiatry causes diabetes with many treatments but usually isn't willing to treat it.

To do comprehensive work, don't get limit yourself to using only psychiatric medications. Luckily, psychiatry as experimented a lot with alternative treatments. For example, in Kaplan and Sadock's Comprehensive Textbook of Psychiatry - the big edition - even statins are looked upon as alternative antidepressant treatments. Some treatments like thyroid hormone are part of the standard psychiatric toolkit.

A comprehensive-integrative psychiatrist are not purely a witness like the usual psychosomatic medicine psychiatrist. A comprehensive-integrative psychistrist practices Clinical Psychosomatic Medicine.

The closest medical specialist to this form of psychiatry is a double-specialty psychiatrist-family physician. But with the two fields completely fused into one and with a deeper knowledge than a family physician would have in both fields.

I am a clinician, not an academic. The primary motivating force is to help my patients become healthy.

Long ago, I realized psychiatric medications are simply not enough to achieve mental health and wellness. Psychiatric medications kept people's head above the water - keeping them from drowning. But they were not enough to lift patients higher. Psychiatric medications are only one component of treatment. More had to be done.

Does it take a lot of work? Yes. What I do is very mentally labor intensive. Every appointment is like a championship chess match in the amount of information I have to process and evaluate. There are over 700 pieces of information to track. I don't do 15 minute med checks. A one hour appointment is my standard for follow up but there is enormous work packed in. Some patients need longer appointments. The initial evaluation is usually 2 hours, but more complex patients need 4 or more hours. With a large caseload, the work hours are long. The one reward is that when patients are healthier, they don't need to see me as often. Even if they are in crisis, they rapidly stabilize and move forward.

Studying is intensive. But it is fun exploring this wide-open deep field. As far as I know, I am the only one who goes as deeply as I am to understand comprehensive psychiatry. I learning something new all the time. Every 3 months, I notch up a level in knowledge and I have been doing this form of psychiatry for nearly 2 decadess. Recently I focused on studying nephrology to gain most of the skills of a nephrologist since I gained new patients with renal problems. It is a lot of fun figuring out how it affects mental health. Being able to talk with a local nephrologist at his level is a lot of fun.

I am a physician doing classic medicine - history, physical exam, lab testing, review of systems, etc. with every evaluation - but from the point of view of multiple specialists in one.

Do I know my limits? Yes - I have to. The knowledge set I am working with is too large to know. I will work with the specialists who do their field day in and day out. But I have more fun understanding what they do and how it relates to my patients. And I am my patients' advocate. They will often seek my opinion before deciding on following another specialist's treatment.

Too bad the biological psychiatry movement in the 1990s failed to produce a psychiatry-primary care specialty. Essentially I had to create it within the umbrella of psychiatry.

I am so much happier where I stand. I have healthier patients that I could have accomplished with standard psychiatry. It is more predictable that patients will improve.

Through word of mouth, my practice is huge and is worldwide in scope. I have patients who fly in from other states and countries to see me. Through the miracle of the internet, people will talk to each other and will travel to find the best physician for their health problems.

I don't take insurance. I am paid out of pocket. The more time I spend with a patient, the more I am paid. Paperwork, preauthorization, etc. is paid for. Often patients will prepay their appointments. Comprehensive and integrative work is well paying.

Romeo @

The chances of finding a psychiatrist motivated to apply such a high minded labor intensive model outside of an academic position situated in a major metropolis is vanishingly small. Likewise are the odds of most practicing psychiatrists devoting the time and effort necessary for developing a comprehensive and deep understanding of their patients and their situations.
In that context, presentations like this strike me as jejune, grandiose, and sanctimonious.

Andrew

Andrew @

No one in an academic position would do comprehensive-integrative psychiatry.

Academics demands specialty knowledge from which you can publish.

Comprehensive-integrative psychiatry is born outside of academics. It is born out of necessity to improve the lives of patients by those psychiatrists who have not become lazy and formulaic-cookbook in their thinking.

Unfortunately true, this is a small subset of modern psychiatrist.

This is forced upon young psychiatrists by the attitude that psychiatrists should lose their clinical skills - e.g. forgo physical exams, lab testing, treatment of physical health problems which they did as residents - once they graduate from their residency. For example, when I worked in a psychiatric hospital in private practice, I was told the family physician or internist on staff would do the physical exams. My point of view is how would they know what to look for that matters to mental health? They don't. They aren't trained in psychiatric medicine. They wouldn't know how to do a psychiatrically oriented physical exam. So I continued to do my own exams.

Romeo @

I disagree. Models such as this seem likely to provide improved circumstances for both clinicians and patients.

Samuel Gary @

Ironic that I find your reply be to jejune in describing this kind of integrative psychiatry as grandiose and sanctimonious. I work as a mental health therapist and deeply appreciate the rare psychiatrist or other medical doctor who is willing to learn and apply their knowledge to help people who live with complex challenges. Sure, I could try to refer a client to several healthcare professionals and hope that their care could or would be coordinated. But that would be jejune of me to even consider. It would never happen. Yet I realize based on my own always growing exploration of several of these disciples that often there may be far more benefit from an integrated approach. So I applaud this kind of integrative psychiatry.

Maarten @

seriously? this is simply what us osteopathic psychiatrists (and all DOs for that matter) have been doing since the late 1800s! i applaud the allopathic population for seeing the value to this paradigm and invite all to talk to a DO if you need any pointers. downside is if you are practicing in the trenches (inpatient, cmhc, act team) insurance won't pay for anything but the standard rx and therapy

CJ @

An important advantage of an integrative/holistic approach is that it shifts the emphasis from caregiver-centricity of allopathic medicine to placing the primary responsibility of maximizing well-being on the person seeking help. This makes teamwork between the caregiver and "patient" a key process instead of health care being the primary province of health care providers with help seekers the passive recipients.
This reverses the implicit collusion between providers and help seekers that reduces help seekers tresponsibilities and enhances providers importance and incomes.

Thomas @

I am not a "provider". I am a physician. "Provider" is a word that the insurance industry conjured into existence to diminish our role in health care. And I'd love to see some enhancement of my income. I accept insurance in my private practice unlike most other private practice psychiatrists in my location.. Cut me a break

Darlene @

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