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The Premise, Practice, and Promise of Integrative Child and Adolescent Psychiatry

The Premise, Practice, and Promise of Integrative Child and Adolescent Psychiatry

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Reasons to consider incorporating integrative careTABLE. Reasons to consider incorporating integrative care

If integrative child and adolescent psychiatry seems unclear, this is because its foundation is not well understood. Reviewing the evidence base of integrative child and adolescent psychiatric treatments offers only a limited understanding of this rapidly growly field. Instead, one must look at the philosophical foundations and the deeper motivations behind this paradigm shift to orient oneself to this emerging field. Using ADHD as an example, the broader context and utility of some of the most commonly used tools and techniques will be explored in this article.

The principles

For the past few years, there has been a growing hunger for a different perspective in psychiatry. Our profession is in crisis on many levels. From the vagaries of our diagnostic system to the limited evidence documenting efficacy for our riskiest medications, the concerns are myriad and well known. But here are a few more: Our reductionist model finds itself increasingly left behind by the expanding scientific potential in emerging arenas such as epigenetics and neuroplasticity. 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 example, in child psychiatry, we have no unified philosophical foundation to call upon or guide our work when we encounter a patient outside DSM diagnostic criteria. The extraordinary complexities of the human brain and behavior have led to this, but the profoundly eclectic mix of models of diagnosis and treatment shares almost no philosophical foundation. This impasse has increasingly pulled us into a narrow, pharmacologic system of care that focuses our attentions on pathology.

But often, we have no framework for what “health” means. What is mental health, for instance? How does our understanding of mental health inform care and treatment? It seems an obvious question, but the premise of mental health is missing from almost all major psychiatric textbooks and from psychiatric training in general. How can we treat or understand mental illness, in any sort of sophisticated, scientific way, if we don’t know what state we are attempting to return the patient to? Without this kind of bilateral framework, we are left with strategies that target the superficial relief of disparate symptoms but fail to restore patients to health.

The concepts of health, healing, and mental health form the bedrock of integrative psychiatry. It’s 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. Sadly, there are no perfect treatments, which is why in integrative medicine we sometimes select a safe intervention over a more effective but risky one. With each intervention, you have to ask yourself, are you moving the patient closer to health, and at what potential cost?

Faced with the same patient, a conventional psychiatrist and an integrative psychiatrist will sometimes create different treatment models. The philosophical foundations of the 2 (fighting illness vs supporting health) are in stark contrast and filter treatment choices accordingly. One example of the vast difference is the emphasis integrative medicine places on gut health and diet that much mainstream science now considers a primary influence on mental health.1-4 In fact, I’d wager that no single tool possesses more power to transform our genetic expression than diet and nutrition.


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