Beyond the couch

Sarah was 18 when she first saw a psychiatrist for her depression. Antidepressants helped her climb out of the hole she was in. But her depression returned in early 2012, when she was 26. “I was tired and gloomy; I dragged myself to work every day. I didn’t enjoy anything anymore. I’d always loved running, but now I could barely put one foot in front of the other.”

This year, Sarah, who prefers not to reveal her last name, began seeing a psychologist and a psychiatrist who work according to integrative principles. Though she liked her previous psychiatrist and felt safe with him, the integrative approach is more satisfying to her. “It’s more complete,” she says.

 Sarah’s new psychiatrist took blood and diagnosed a lack of vitamin B, which may explain some of her exhaustion; she is now taking supplements. She’s also started walking half an hour each day, until she’s able to run again. On her psychiatrist’s advice, she cut down on carbohydrates and junk food and started eating more vegetables and fish. But Sarah also receives “ordinary” counseling from her psychologist, and her psychiatrist has prescribed the antidepressant Zoloft. Testing has revealed that Sarah’s depression is severe enough that she needs medication for the time being.

It’s been three months since treatment began, and Sarah is beginning to feel like herself again. “I have more energy, and I’m happier. I think that’s from the pills I’m taking and my lifestyle now. By paying attention to my diet, vitamins and exercise, I feel like I can contribute to my own recovery. And that’s awesome.”

Integrative psychiatry attempts to combine mainstream psychiatric treatment protocols, such as counseling and ­medication, with non-mainstream methods that are scientifically proven to be effective. These are treatments such as mindfulness ­training, yoga and nutritional advice. Since the integrative psychiatry movement began in the 1990s, much has changed in psychiatry. Scientific studies increasingly show that these “new” therapies can also reduce psychological distress, leading an increasing number of traditionally educated ­psychiatrists to embrace this therapeutic arena. Additional training expands upon the expertise they learned in school, enabling them to provide patients like Sarah with a balanced range of treatment and counseling protocols.

Andrew Weil is one of integrative medicine’s most famous spokespeople, and not only because he resembles Santa Claus. He has written several influential books on the subject, such as Natural Health, Natural Medicine and Healthy Aging. By complementing mainstream therapies with non-­conventional methods that have a solid scientific basis, integrative psychiatry combines the best of both worlds, he says. And that integration is sorely needed. “When something is wrong with us,” Weil says, “we want a quick fix: a pill that makes us feel better as quickly as possible.”

Not that Weil, who earned both his undergraduate degree in botany and his M.D. at Harvard University, is fundamentally against medication. For severe anxiety, depression and other major psychological disorders, drugs are often necessary, he emphasizes. But we can recover from the milder forms of psychological distress, which are by far the most common, without them. Along with other proponents of integrative psychiatry, Weil—an energetic septuagenarian with eyes that twinkle—recommends organic foods, daily exercise, meditation, breathing exercises, herbal and nutritional supplements and a return to who we are in essence: social and spiritual beings.

Not all of integrative psychiatry’s methods are new. Primitive societies have been passing their knowledge of plants’ healing properties down through the generations for millennia. The people of ancient India knew of meditation’s health-enhancing effect when Western cultures were still digging in the dirt, and the ancient Roman poet Juvenal declared that a sound mind is housed within a sound body. In the fourth century B.C., Hippocrates taught that a poor diet and too little sleep and exercise were at the root of many diseases. Treatment methods such as acupuncture are also centuries older than the field of Western medicine.

Rooted in the scientific method, Western medicine has generated major progress. But it cannot always provide an adequate answer. That’s why even today, many people in the West turn to “alternative” healers when they run out of options in the mainstream medical system. Several studies, including the most recent National Health Interview Survey from 2007, show that at least 40 percent of Americans make use of non-mainstream therapies—often without their doctors’ knowledge. The skepticism, even scorn, that conventional doctors often have for their alternative colleagues can be so immense that patients prefer to keep their forays outside the mainstream to themselves. Conversely, many alternative healers view mainstream medicine with suspicion and sometimes even rejection.

The result of this schism is the loss of important medical information, such as which treatments best match the specific disorder and the individual patient. But it also hides what motivates the patient, what he believes in and what he—literally—will swallow. The importance of that last point cannot be overestimated: Combining mainstream and alternative treatments on one’s own can have undesirable consequences. For example, scientific research indicates that the Pill is less effective when combined with St. John’s wort. But how can a doctor inform his patient of the risk if he doesn’t know she’s taking it? The integrative psychiatrist hopes to alleviate some of these problems by being open to methods from the non-conventional side of the road.

“In integrative psychiatry, you focus not only on removing distress, but also on enhancing the things that are going well, on tapping into a person’s strengths.”

Sandra Went,  integrative psychiatrist

Sandra Went’s integrative psychiatry practice is located in downtown Arnhem in the Netherlands. Three months after Went opened her doors in October 2011, her roster was full, and she had to stop taking new patients. Went named her practice Cedar, for the tree in the yard that catches the light with broadly outstretched branches. The cedar tree, as her website says, is known for absorbing sunlight, which enables the tree to endure in darker times.

Early in the morning in her bright office—windows all the way to the floor, a view of the garden—Went explains why the integrative approach is so beneficial to her patients. She can offer far more types of treatment than doctors practicing mainstream mental health care, she says. She can select the methods that best fit her patients’ needs. “I can tailor my therapy much more closely to the individual now,” she explains.

Went spent the previous six years working in the mainstream mental health care system. Rapidly growing waiting lists exerted—and still exert—enormous pressure to rush patients through the system. Treatment is relatively short, Went feels, and is focused on quick “symptom reduction.” If  a depressed patient feels better after ­several weeks of counseling—with or without medication—treatment is often stopped. That’s unsatisfactory to Went, because she doubts that the patient’s underlying issue has been addressed.

“Integrative psychiatrists want to help patients help themselves,” Andrew Weil says. Not just to get “better” and eliminate distress, but also to achieve an optimal state of health and happiness.

“Many psychological problems are related to the way we deal with stress,” Went says. “Chronic overload in our hectic society can lead to anxiety and depression among those who are susceptible
.” Those issues can often be satisfactorily resolved by the mainstream therapies she offers, such as medication and counseling. But that’s not all Went aspires to do.

“In integrative psychiatry, you focus not only on relieving distress,” Went explains, “but also on enhancing the things that are going well, on tapping into a person’s strengths.” The emphasis on personal responsibility and methods for preventing a relapse are “the greatest difference from mainstream psychiatry,” she says.

The integrative psychiatry movement is growing in the U.S., says Lila Massoumi, the chair of the American Psychiatric Association Caucus on Integrative Medicine. Massoumi believes the growth of integrative psychiatry is a direct reflection of patients’ increasing dissatisfaction with mainstream psychiatric care. Compared to a few decades ago, the use of psychiatric medication in the U.S. has exploded. According to the American Psychological Association, nearly 20 percent of the population is on psychiatric medication. Half of them—roughly 10 percent of all Americans—take antidepressants.

“We turn to drugs much too quickly,” Massoumi says. Mainstream psychiatric medicines absolutely have their place, she emphasizes. But “we’ve gone too far,” she believes. For milder complaints, or to complement mainstream therapies, there is “so much more” a therapist can do.

According to Massoumi, the average psychiatrist hardly has—or makes—the time to get to know the patient and explore suitable solutions together. But there is a countermovement underway, she notes. Many young medical students wanting to specialize in psychiatry are refusing to become “pill doctors.” “Surely there’s a different way, they think. The growing scientific evidence for natural therapies that make patients less dependent with few to no side effects intrigues them.” Massoumi cites attendance at a March 2011 speech she gave on integrative psychiatry to medical students in Detroit as evidence. “It was a Saturday morning, yet 300 students showed up,” she laughs. “And get this: It wasn’t even mandatory.”

According to psychiatrist Rogier Hoenders, research into the scientific basis of various non-mainstream therapies was long lacking. “There’s been a lot of catching up in recent years. Many psychiatrists are now convinced that the integrative approach has added value.”

Scientific evidence of efficacy is not the only criterion a substance or therapeutic approach must meet in order to be embraced by the integrative psychiatrist. How and why it works must also make sense to the Western physician, Hoenders says. “Doctors have to be able to understand why something works. And because the mental model in Western medicine is so different than, say, the Eastern model, this sometimes presents a problem.”

The way some natural substances such as St. John’s wort work is easy for Western doctors to understand. St. John’s wort increases the amount of serotonin in the brain, just as antidepressants do. But the situation is very different for acupuncture. Several scientific studies show that acupuncture alleviates pain. But there is no model available that satisfactorily explains how and why to Western physicians. “The Eastern model says that acupuncture affects the body’s energy meridians,” Hoenders explains, “but Western doctors don’t believe in energy meridians. So they aren’t easily convinced of acupuncture’s effectiveness, no matter how many positive studies there are.”

Within the field of integrative medicine, Andrew Weil has focused primarily on the effect of diet on our psychological health. Based on the available scientific knowledge, he has developed a food plan based on the traditional Mediterranean diet. Weil calls his plan the anti-inflammatory diet. His reasoning: Much of the food in the West is processed in factories and is too high in fat and calories, so it creates subtle, chronic inflammation in our bodies. That increases our risk of all kinds of psychological disorders, such as Alzheimer’s and depression. By eating correctly—forgoing the bad foods and adding anti-inflammatory herbs such as garlic, ginger, rosemary and thyme—we can make our brains healthier.

But we can also eliminate anxiety, tension and even mild forms of depression by making changes in our social and spiritual lives, Weil says. Establishing contact and maintaining friendships can make us happy—a claim confirmed in studies by famous “happiness researchers” Martin Seligman and Sonja Lyubomirsky. More and more studies, such as one by researchers Nicholas Christakis and James Fowler in 2010, show that being around positive people is especially good for our well-being. Being friends with someone who’s happy, they discovered, raises the chance that we ourselves will be happy by 15 percent.

The way we deal with our feelings for our fellow man also strongly affects our psychological health. According to research from East Carolina University, the abilities to forgive someone and to be grateful reduce stress, and with it blood pressure and heart rate. They also enhance the immune system. The same is true of spiritual experiences, according to research conducted last year at the University of California, Berkeley.

Weil says that being spiritual doesn’t necessarily mean adhering to a religion. Rather, it’s about experiences “in which you transcend yourself.” There are many ways to experience the sensation that there is a dimension greater than yourself. You can make music, for example, or paint (as Sarah was encouraged to do) or spend time in the countryside. Depressed people in particular have often lost this ability, Weil says. They are so focused on themselves and their internal worlds that it can be of immense help to pull them outward—even for just a short while.

“Integrative psychiatrists want to help patients help themselves,” Weil says. Not just to get “better” and eliminate distress, but also to achieve an optimal state of health and happiness. That’s what Weil aspires to in his own life as well. He does yoga and grows his own pesticide-free vegetables in his garden. Though he says he used to wince at the mere mention of sports, a few years ago he began jogging or cycling half an hour every day. “Now I can’t live without it,” he laughs. “If a day goes by without exercise, I just don’t feel good.”

It’s now late in the morning in Arnhem. The light shining into the Cedar office in long rectangles is rich and saturated. Went is eating a leafy green salad with avocado for lunch. She, too, practices what she preaches. In addition to eating healthily, Went engages in mindfulness, swims and does aerobics. She records writing exercises in her journal and spends significant time outdoors. But the thing that has most fulfilled her in the past year, she says, is opening her own integrative practice. “The time and space I now have to truly help my patients become more resilient and happier has made me happier.”

Went looks out the window. Her gaze glides over the many shades of green in the gently rolling yard. The cedar tree at its center towers mighty and silent above us. Its roots are deeply anchored in the earth, its leafy veins engorged with sunlight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Solution News Source

Beyond the couch

Sarah was 18 when she first saw a psychiatrist for her depression. Antidepressants helped her climb out of the hole she was in. But her depression returned in early 2012, when she was 26. “I was tired and gloomy; I dragged myself to work every day. I didn’t enjoy anything anymore. I’d always loved running, but now I could barely put one foot in front of the other.”

This year, Sarah, who prefers not to reveal her last name, began seeing a psychologist and a psychiatrist who work according to integrative principles. Though she liked her previous psychiatrist and felt safe with him, the integrative approach is more satisfying to her. “It’s more complete,” she says.

 Sarah’s new psychiatrist took blood and diagnosed a lack of vitamin B, which may explain some of her exhaustion; she is now taking supplements. She’s also started walking half an hour each day, until she’s able to run again. On her psychiatrist’s advice, she cut down on carbohydrates and junk food and started eating more vegetables and fish. But Sarah also receives “ordinary” counseling from her psychologist, and her psychiatrist has prescribed the antidepressant Zoloft. Testing has revealed that Sarah’s depression is severe enough that she needs medication for the time being.

It’s been three months since treatment began, and Sarah is beginning to feel like herself again. “I have more energy, and I’m happier. I think that’s from the pills I’m taking and my lifestyle now. By paying attention to my diet, vitamins and exercise, I feel like I can contribute to my own recovery. And that’s awesome.”

Integrative psychiatry attempts to combine mainstream psychiatric treatment protocols, such as counseling and ­medication, with non-mainstream methods that are scientifically proven to be effective. These are treatments such as mindfulness ­training, yoga and nutritional advice. Since the integrative psychiatry movement began in the 1990s, much has changed in psychiatry. Scientific studies increasingly show that these “new” therapies can also reduce psychological distress, leading an increasing number of traditionally educated ­psychiatrists to embrace this therapeutic arena. Additional training expands upon the expertise they learned in school, enabling them to provide patients like Sarah with a balanced range of treatment and counseling protocols.

Andrew Weil is one of integrative medicine’s most famous spokespeople, and not only because he resembles Santa Claus. He has written several influential books on the subject, such as Natural Health, Natural Medicine and Healthy Aging. By complementing mainstream therapies with non-­conventional methods that have a solid scientific basis, integrative psychiatry combines the best of both worlds, he says. And that integration is sorely needed. “When something is wrong with us,” Weil says, “we want a quick fix: a pill that makes us feel better as quickly as possible.”

Not that Weil, who earned both his undergraduate degree in botany and his M.D. at Harvard University, is fundamentally against medication. For severe anxiety, depression and other major psychological disorders, drugs are often necessary, he emphasizes. But we can recover from the milder forms of psychological distress, which are by far the most common, without them. Along with other proponents of integrative psychiatry, Weil—an energetic septuagenarian with eyes that twinkle—recommends organic foods, daily exercise, meditation, breathing exercises, herbal and nutritional supplements and a return to who we are in essence: social and spiritual beings.

Not all of integrative psychiatry’s methods are new. Primitive societies have been passing their knowledge of plants’ healing properties down through the generations for millennia. The people of ancient India knew of meditation’s health-enhancing effect when Western cultures were still digging in the dirt, and the ancient Roman poet Juvenal declared that a sound mind is housed within a sound body. In the fourth century B.C., Hippocrates taught that a poor diet and too little sleep and exercise were at the root of many diseases. Treatment methods such as acupuncture are also centuries older than the field of Western medicine.

Rooted in the scientific method, Western medicine has generated major progress. But it cannot always provide an adequate answer. That’s why even today, many people in the West turn to “alternative” healers when they run out of options in the mainstream medical system. Several studies, including the most recent National Health Interview Survey from 2007, show that at least 40 percent of Americans make use of non-mainstream therapies—often without their doctors’ knowledge. The skepticism, even scorn, that conventional doctors often have for their alternative colleagues can be so immense that patients prefer to keep their forays outside the mainstream to themselves. Conversely, many alternative healers view mainstream medicine with suspicion and sometimes even rejection.

The result of this schism is the loss of important medical information, such as which treatments best match the specific disorder and the individual patient. But it also hides what motivates the patient, what he believes in and what he—literally—will swallow. The importance of that last point cannot be overestimated: Combining mainstream and alternative treatments on one’s own can have undesirable consequences. For example, scientific research indicates that the Pill is less effective when combined with St. John’s wort. But how can a doctor inform his patient of the risk if he doesn’t know she’s taking it? The integrative psychiatrist hopes to alleviate some of these problems by being open to methods from the non-conventional side of the road.

“In integrative psychiatry, you focus not only on removing distress, but also on enhancing the things that are going well, on tapping into a person’s strengths.”

Sandra Went,  integrative psychiatrist

Sandra Went’s integrative psychiatry practice is located in downtown Arnhem in the Netherlands. Three months after Went opened her doors in October 2011, her roster was full, and she had to stop taking new patients. Went named her practice Cedar, for the tree in the yard that catches the light with broadly outstretched branches. The cedar tree, as her website says, is known for absorbing sunlight, which enables the tree to endure in darker times.

Early in the morning in her bright office—windows all the way to the floor, a view of the garden—Went explains why the integrative approach is so beneficial to her patients. She can offer far more types of treatment than doctors practicing mainstream mental health care, she says. She can select the methods that best fit her patients’ needs. “I can tailor my therapy much more closely to the individual now,” she explains.

Went spent the previous six years working in the mainstream mental health care system. Rapidly growing waiting lists exerted—and still exert—enormous pressure to rush patients through the system. Treatment is relatively short, Went feels, and is focused on quick “symptom reduction.” If  a depressed patient feels better after ­several weeks of counseling—with or without medication—treatment is often stopped. That’s unsatisfactory to Went, because she doubts that the patient’s underlying issue has been addressed.

“Integrative psychiatrists want to help patients help themselves,” Andrew Weil says. Not just to get “better” and eliminate distress, but also to achieve an optimal state of health and happiness.

“Many psychological problems are related to the way we deal with stress,” Went says. “Chronic overload in our hectic society can lead to anxiety and depression among those who are susceptible
.” Those issues can often be satisfactorily resolved by the mainstream therapies she offers, such as medication and counseling. But that’s not all Went aspires to do.

“In integrative psychiatry, you focus not only on relieving distress,” Went explains, “but also on enhancing the things that are going well, on tapping into a person’s strengths.” The emphasis on personal responsibility and methods for preventing a relapse are “the greatest difference from mainstream psychiatry,” she says.

The integrative psychiatry movement is growing in the U.S., says Lila Massoumi, the chair of the American Psychiatric Association Caucus on Integrative Medicine. Massoumi believes the growth of integrative psychiatry is a direct reflection of patients’ increasing dissatisfaction with mainstream psychiatric care. Compared to a few decades ago, the use of psychiatric medication in the U.S. has exploded. According to the American Psychological Association, nearly 20 percent of the population is on psychiatric medication. Half of them—roughly 10 percent of all Americans—take antidepressants.

“We turn to drugs much too quickly,” Massoumi says. Mainstream psychiatric medicines absolutely have their place, she emphasizes. But “we’ve gone too far,” she believes. For milder complaints, or to complement mainstream therapies, there is “so much more” a therapist can do.

According to Massoumi, the average psychiatrist hardly has—or makes—the time to get to know the patient and explore suitable solutions together. But there is a countermovement underway, she notes. Many young medical students wanting to specialize in psychiatry are refusing to become “pill doctors.” “Surely there’s a different way, they think. The growing scientific evidence for natural therapies that make patients less dependent with few to no side effects intrigues them.” Massoumi cites attendance at a March 2011 speech she gave on integrative psychiatry to medical students in Detroit as evidence. “It was a Saturday morning, yet 300 students showed up,” she laughs. “And get this: It wasn’t even mandatory.”

According to psychiatrist Rogier Hoenders, research into the scientific basis of various non-mainstream therapies was long lacking. “There’s been a lot of catching up in recent years. Many psychiatrists are now convinced that the integrative approach has added value.”

Scientific evidence of efficacy is not the only criterion a substance or therapeutic approach must meet in order to be embraced by the integrative psychiatrist. How and why it works must also make sense to the Western physician, Hoenders says. “Doctors have to be able to understand why something works. And because the mental model in Western medicine is so different than, say, the Eastern model, this sometimes presents a problem.”

The way some natural substances such as St. John’s wort work is easy for Western doctors to understand. St. John’s wort increases the amount of serotonin in the brain, just as antidepressants do. But the situation is very different for acupuncture. Several scientific studies show that acupuncture alleviates pain. But there is no model available that satisfactorily explains how and why to Western physicians. “The Eastern model says that acupuncture affects the body’s energy meridians,” Hoenders explains, “but Western doctors don’t believe in energy meridians. So they aren’t easily convinced of acupuncture’s effectiveness, no matter how many positive studies there are.”

Within the field of integrative medicine, Andrew Weil has focused primarily on the effect of diet on our psychological health. Based on the available scientific knowledge, he has developed a food plan based on the traditional Mediterranean diet. Weil calls his plan the anti-inflammatory diet. His reasoning: Much of the food in the West is processed in factories and is too high in fat and calories, so it creates subtle, chronic inflammation in our bodies. That increases our risk of all kinds of psychological disorders, such as Alzheimer’s and depression. By eating correctly—forgoing the bad foods and adding anti-inflammatory herbs such as garlic, ginger, rosemary and thyme—we can make our brains healthier.

But we can also eliminate anxiety, tension and even mild forms of depression by making changes in our social and spiritual lives, Weil says. Establishing contact and maintaining friendships can make us happy—a claim confirmed in studies by famous “happiness researchers” Martin Seligman and Sonja Lyubomirsky. More and more studies, such as one by researchers Nicholas Christakis and James Fowler in 2010, show that being around positive people is especially good for our well-being. Being friends with someone who’s happy, they discovered, raises the chance that we ourselves will be happy by 15 percent.

The way we deal with our feelings for our fellow man also strongly affects our psychological health. According to research from East Carolina University, the abilities to forgive someone and to be grateful reduce stress, and with it blood pressure and heart rate. They also enhance the immune system. The same is true of spiritual experiences, according to research conducted last year at the University of California, Berkeley.

Weil says that being spiritual doesn’t necessarily mean adhering to a religion. Rather, it’s about experiences “in which you transcend yourself.” There are many ways to experience the sensation that there is a dimension greater than yourself. You can make music, for example, or paint (as Sarah was encouraged to do) or spend time in the countryside. Depressed people in particular have often lost this ability, Weil says. They are so focused on themselves and their internal worlds that it can be of immense help to pull them outward—even for just a short while.

“Integrative psychiatrists want to help patients help themselves,” Weil says. Not just to get “better” and eliminate distress, but also to achieve an optimal state of health and happiness. That’s what Weil aspires to in his own life as well. He does yoga and grows his own pesticide-free vegetables in his garden. Though he says he used to wince at the mere mention of sports, a few years ago he began jogging or cycling half an hour every day. “Now I can’t live without it,” he laughs. “If a day goes by without exercise, I just don’t feel good.”

It’s now late in the morning in Arnhem. The light shining into the Cedar office in long rectangles is rich and saturated. Went is eating a leafy green salad with avocado for lunch. She, too, practices what she preaches. In addition to eating healthily, Went engages in mindfulness, swims and does aerobics. She records writing exercises in her journal and spends significant time outdoors. But the thing that has most fulfilled her in the past year, she says, is opening her own integrative practice. “The time and space I now have to truly help my patients become more resilient and happier has made me happier.”

Went looks out the window. Her gaze glides over the many shades of green in the gently rolling yard. The cedar tree at its center towers mighty and silent above us. Its roots are deeply anchored in the earth, its leafy veins engorged with sunlight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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