This book is a rich roadmap on how to bring discipline and direction to integrative medicine.
by James H. Lake, MD; Springer, 2019
284 pages; $24.99 (paperback)
Reviewed by Leslie Korn, PhD, MPH
If integrative medicine for mental health is full of rich potential and opportunity, it is also the wild west of clinical care today. James Lake, MD, and his latest book, An Integrative Paradigm for Mental Health Care: Ideas and Methods Shaping the Future, is the sheriff who has come to town to put things in order and bring discipline and direction to the practice.
In this remarkable book, Lake’s observations set the stage for a new paradigm of mental health. He writes: “Psychiatry as presently conceptualized and practiced fails to adequately address the core causes and meanings of mental illness.”
From this opening salvo, Lake contends that integrative medicine is the wave of the future. This is especially true if we are to effectively treat the diverse challenges our patients present. He implores us to recognize the limitations of current practices and provides a roadmap for improving care.
As a scientist-clinician and philosopher, Lake elegantly describes challenges to the dominant scientific methods, with its emphasis on the knowable and verifiable. He concludes that with “conventional approaches, there is no methodology capable of testing postulated relationships between the causes of symptoms and psychological models.”
An Integrative Paradigm for Mental Health Care is no ordinary treatise on mental health. In 9 chapters, Lake guides us through a thoughtful analysis of the foundations for integrative practice while focusing on the philosophical underpinnings of medical treatment, both East and West. Describing how the Western mind and Eastern mind conceive and identify evidence for illness patterns differently, Lake does not privilege one over the other.
The challenge of integrative medicine is not in the therapies per se, even as Lake provides the evidence (or lack thereof) for their use but in their personalization and integration. Lake reminds us that half of all individuals with a psychiatric diagnosis do not respond (or do so only partially) to psychotropics. As an adjunct, he offers an approach to evaluating the role of vitamins and nutrients like folate and essential fatty acids.
Lake also addresses nonbiological methods. Faith, intuition, and the energetic traditions of the East, they have long been trying to find a way back into medical practice. Lake devotes a chapter to the study of consciousness and its inclusion in health care. Lake’s exploration of consciousness theories provides a basis for understanding anomalous cognition, subtle energy information transfer. While common occurrences and the subject of numerous scientific studies, these experiences remain on the fringe of scientific exploration, the often nonquantifiable effects of prayer and intention on health and healing. Grappling with these states of consciousness has an implicit import for understanding states of extraordinary consciousness that are often labeled pathological precisely because we do not understand them.
Integrative medicine is growing. University centers, specialty conferences, private practices, psychedelic medicine, and mental health nutrition are emerging. Yet clinical standards of integrative medicine for mental have remained ill-defined, until this book, recalling Richard Rorty, PhD’s suggestion, “If the body had been easier to understand, no one would have thought we had a mind.”1
An Integrative Paradigm for Mental Health Care is a valuable guide, worth revisiting again and again. The book’s structure makes it easy to digest by providing abstracted tables and key points with each chapter. Whether via a glance at a table or chart, or in deep dive, Lake walks us through nearly every conceivable pathway toward integrating diverse methods and practices.
The clinical core of the book provides clinicians with guidance for the conduct of integrative methods and the application of methods that are considered essential to the repertoire of integrative medicine. Providing guidelines for a comprehensive assessment is foundational and functional; without a thorough analysis, treatment is incomplete or ineffective. Each of Lake’s recommendations focus on efficacy and reducing risk, for example suggesting that one biological method should be tried one at a time.
Replete with case vignettes, Lake explores complex cases with comorbidities and guides clinical decisions. Lake’s final chapter is devoted to short- and long-term forecasts of where mental health treatment is moving, with a discussion of technologies including brain-computer interface, neuroprosthetic devices, nanotechnologies, and gene editing, all of which will virtually replace, he predicts, pharmaceuticals. Lake provides a companion website that offers numerous online resources on integrative medicine and mental health, including tools to help clinicians develop individualized integrative treatment plans.
This book is of immense value to practitioners of integrative approaches in addition to newcomers. Above all, it answers the questions the curious and skeptic alike ask, “but where is the evidence?” Lake answers all this and more.
Dr Korn is a licensed psychotherapist and an integrative medicine clinician, scientist, educator, and author specializing in the intersection of trauma, nutrition, and chronic physical illness. Find more on her website: https://drlesliekorn.com.
1. Rorty R. Philosophy and the Mirror of Nature. Princeton University Press; 1979:239.