What is “Integrative” Psychiatry?
A brief introduction
Integrative medicine combines the best practices of conventional western medicine with effective healing modalities which have not fully reached acceptance in the medical mainstream, with a specific focus on patient choice in decisions about treatment. This approach also aims to address root causes of imbalances that cause symptoms, as opposed to only medicating symptoms away.
One of the biases in the medical mainstream is an over-reliance on medical research showing short-term effectiveness of treatments with an underemphasis on potential risks, especially long-term ones. The FDA requires only very short-term safety studies in order to approve drugs for use in the USA. For example, SSRIs such as Prozac, which have been available now since 1987, have been shown to be effective in the short term in many studies. But it took many years for us to see that there are risks to taking an SSRI long-term, such as SSRI induced bipolar disorder and possibly even diabetes. Since 2009, however, even mainstream, larger, peer-reviewed studies of antidepressants show that they are effective only in the more severe cases, and should not be prescribed for mild to moderate depression. In my opinion, this new information about antidepressant medication validates the integrative perspective. Each person is a unique ecology of physiological cycles, biochemical signals, thought patterns, and developmental imprinting, all of which interact in a complex homeostasis.
Perhaps the most glaring short-fall of conventional medicine in general and psychiatry specifically is in the area of identifying and resolving chronic stress and trauma. Growing up without emotional safety or physical safety can cause life-long effects on brain function and has been clearly linked to higher risks of stress-related disease in adulthood. We now have many well-executed studies showing how adverse childhood events predict a wide variety of adult diseases. Integrative medicine seeks to address the roots of chronic stress as well as its effects, aiming for long-lasting health and not simply masking symptoms.
Another aspect of the integrative approach is a willingness to go “outside the box” within good clinical judgement. Some therapeutic approaches are difficult to “prove” effectiveness with standard medical research protocols. Because we are all unique individuals, one person may have a terrific response to a treatment that doesn’t work at all for someone else. I believe that even if the medical “proof” isn’t there (yet), the real proof is in each individual’s response and benefits from treatment. Having said that, the less data, the more risk that a treatment approach won’t be effective.
Integrative healers are on the look out for new therapies, and are often practicing them before they have been accepted in the mainstream. A great example is eye-movement desensitization and reprocessing (EMDR), a very effective somatic psychotherapy for trauma recovery. EMDR was introduced in the early 1990’s and its effectiveness was quickly recognized and many psychotherapists trained in it and used it well before anyone in conventional medicine accepted it. When I trained in EMDR in 2001 there were only a handful of psychiatrists using it in Colorado. Now almost all psychiatrists accept it as a first-line treatment for post-traumatic stress disorder. EMDR’s widespread acceptance began with professionals using it without medical proof, trusting what their patients said about how it worked for them. Later on, several positive double-blind studies conducted in the early 2000’s confirmed what was being seen in our practices.
Modern American medicine is generally disappointing both to patients and to doctors. There is not enough time to tell doctors everything that needs to be said nor is there enough time for doctors to really listen to patients. Most psychiatric follow-up visits are 15 minutes or less, much like primary care. At a recent medical education event I attended, the physician speaker described primary care as “seven complaints in seven minutes for seven bucks [i.e. reimbursement].” To effectively put the pieces of a puzzle together, several things are needed. First, time to tell the doctor enough. Second, the doctor must be listening without trying to race to a medication recommendation for the patient’s complaint: she must instead be attuned to the way the pieces of information provide clues to root causes. In this way, a comprehensive treatment which synthesizes all of the information can take shape, one which alleviates suffering and targets healing root causes.