Integrative Psychiatry

Our Mission

What is Integrative Psychiatry and why is it important?

The transition from life to death and the interaction between body and mind continue to elude modern science.Essentially, both are related to the same phenomenon:  the abstract element animating the human body.  Once gone, we turn from a living, thinking and feeling entity, to a lifeless collection of cells.

We are all intuitively aware of the link between our thoughts and feelings and our physical body.  For example, worrying about next week's surgery (something that has not happened yet and in that sense occurs only in your fantasy) can cause some very real physical sensations. Your mouth gets dry, your pulse races, your hands shake slightly, you may feel "butterflies" in your stomach, tightness in your chest, your breathing becomes heavier, you may even feel dizzy or what is often referred to as "spaced out".  In other words, a single thought triggered all these physical symptoms   This is true for all normal life events, from the way we get aroused by an erotic picture or story, to the elevation of blood pressure when we get angry and numerous other daily examples of how the abstract part of our existence affects the physical one.

In fact, far from being revolutionary, the body/mind connection has been intuitively, but not fully understood by many throughout human history. For centuries, moods were attributed to particular bodily functions. Depression was ascribed to an accumulation of "black bile".  Hysteria (roughly corresponding to anxiety disorder) was thought to be a female state of mind caused by movements of the uterus. Those examples and other associations between body and mind, while factually untrue, signified an awareness of that connection.

In modern medicine, there is now a greater understanding of how the body responds to certain moods and feelings, as well as how the opposite can be true; how moods and feelings can affect bodily functions.  We now know that clinical depression manifests itself by the disturbance of sleep and appetite, sexual dysfunction, fatigue and inability to concentrate.  We know that stress is a major contributor to cardiovascular disease and most probably to cancer.  We understand the connection between the autonomic nervous system and anxiety.  We know that hormonal changes before menstruation can cause major mood impairment.   It is therefore indisputable that our mind, the least physical aspect of our existence, can affect the body our most physical aspect of our existing.  And of course this can happen the other way around as well.

Unfortunately, contemporary medicine is often practiced with surprising disregard to the body/mind influences.  Psychiatrists, despite being physicians, seldom consider the entirety of the body as part of their practice. Conversely, all other medical disciplines pay little attention to the effects that our thoughts and feelings have on our body.

Perhaps the major reason for the evolution of this unfortunate dichotomy is that prior to 1950's and the advent of psychiatric medications, psychiatry had evolved as a philosophical profession rather than a medical one. Psychiatrists used to spend their time debating abstract notions such as the relationship between the Ego and the Id, with little regard to the arena in which those philosophical concepts operate; namely the brain.  Accordingly, physicians treated psychiatry as an orphan discipline, more fluff than substance, and not as part of the western, organic-based medicine.

Furthermore, it is important to consider the elusive nature of the brain. The advent of modern medicine that has afforded a formidable progress in our understanding of anatomy, physiology, pathology and disease formation, has all but passed psychiatry by. Despite heroic efforts on the part of neuroscientists, the intricate details of how the brain works are still as mysterious to us, as they were a hundred years ago.  The brain, especially the more abstract aspects of memory, thoughts, feelings and the myriad of psychiatric conditions remain for the most part elusive and poorly understood. Understandably, rather than "waiting" for the brain to become comprehensible, medicine has forged ahead without it.  As a result, the idea that medical models can be explained without fully understanding the role that the brain plays, has become a prevailing principle in contemporary medicine.  This means that contemporary medicine is not fully grounded in the full understanding of science, but rather on simple convenience.  I think of this as the "looking under the lamppost" phenomenon of medicine.  

The consequences of this artificial division between thoughts, feelings, brain and body are far from trivial.  While stress is increasingly recognized as a major risk factor to a host of conditions from infertility to stroke to certain cancers (to name but a few), other conditions such as autoimmune, endocrine and metabolic disorders that straddle the (nonexistent) boundary between the psychiatric and the medical are all but ignored.  Sadly, isolating the parts of what is actually a highly integrated whole, has led to compromised care at best and grave morbidity and mortality at worst.  

The Institute for Integrative Psychiatry views bridging the unnecessary gap between these disciplines as an urgent and timely endeavor.  The continued hyper-specialization of medicine and psychiatry, the pressures of market forces, and the unawareness of the public to this important "missing link" to their health, all converge to further compartmentalize contemporary medicine.  Without thoughtful, science- based efforts to reverse this regrettable trend, medicine would continue on the slippery slope path it has already assumed.  Ever mounting costs, suboptimal treatments and growing morbidity and mortality are already dominating American healthcare and are threatening to eternalize the current trajectory.  

The Institute consists of renowned physicians, academicians and healthcare professionals, all of who are committed to make a positive contribution to the way we treat our patients.  

We intend to achieve this goal by the following efforts:  

1. Identifying areas where an Integrative approach to the body and mind is essential to recovery and maintenance of good health.  
2. Reviewing current research and compiling a state-of-the-art database regarding the connection between stress and medical conditions.
3. Reviewing research and clinical data concerning psychiatric medication, their interaction with other medication, short and long term effects, and how to minimize side effects.  
4. Reviewing current research into the interaction between alternative and traditional medicine models and their roles on the body/mind integrative approaches (e.g., the notion of healing, guided imagery, biofeedback and nutrition).
5. Publishing position papers on needed changes in Healthcare policy.
6. Soliciting suggestions from opinion leaders in the fields of Medicine and psychiatry.
7. Developing "Best Practice" models to improve delivery of care.
8. Interacting with the public through publications, lectures and seminars.  
9. Increasing public awareness through the Institute's web site.
10. Conducting workshops to educate healthcare professionals.
11. Fostering collaborative relationship with medical schools across the nation to promote Integrative approaches in the delivery of medical treatment.

We believe that once addressed in a scientific, responsible and comprehensive manner, the notion of Integrative approaches to medicine and psychiatry will become self-evident.  We do not purport to claim any deep understanding of the brain. In fact, the brain could conceivably remain an unsolved mystery for a very long time.  But Integrative Psychiatry is not about unlocking the workings of the brain.  Rather, it proposes to examine and integrate the dialogue between the brain and the body in health and illness.  Ultimately, we don't need to know how the brain works.  We can simply focus on what we already know about the way thoughts and feelings influence the body and vice versa.  For instance, we know that premenstrual hormonal changes cause irritability and depression in women.  We do not know exactly how this happens (i.e., how mood and thoughts are influenced by hormonal changes).  However, we do know that it does happen and we can therefore appreciate the fundamental connection that occurs.  Indeed, after millennia of misunderstanding or ignoring the monthly emotional suffering of countless women, the recognition of the phenomenon has finally resulted in research and effective treatments, even if the exact mechanisms within the brain still remain largely unsolved.  

By focusing on the interplay between the brain and the body, we can identify numerous cross influences (i.e., the influence of the body on the thoughts and feelings and vice versa) and their effects on health, recovery and well-being.  While similar observations have been made sporadically throughout medical history, we intend to put forward a coherent, encompassing approach to such integration, and help medicine recognize and incorporate that crucial "missing link".  The guiding principle is "optimizing currently available treatments" rather than looking for new ones.

In the first 3 years of the Institute we would concentrate on the following areas:

1. Stress and cardio-vascular disease.
2. Stress and neuro-endocrinal (hormonal) changes (particularly as they pertain to infertility).
3. The connection between the digestive system and the brain.
4. Sexual dysfunction in male and female.
5. Thyroid dysfunction and mood disorders.
6. Autoimmune disorders and their effects on the brain.
7. The brain/body connection and the relationship with sleep disorders and insomnia.
8. The autonomic nervous system in depression and anxiety.
9. Brain degenerative disorders and psychiatric conditions (with emphasis on Parkinson, Multiple Sclerosis and movement disorders)
10. The connection between strep throat OCD and tic disorders in children. (PANDAS)
11. Psychiatric medications and their effects on general health.  

We have selected the topics listed above mostly because of their prevalence in the general population as well as the existence of a large body of related scientific and popular data.   Our intention has been to carefully evaluate all the data that exists in English, Spanish and French, as well as evaluate all related therapies and treatments.   We will focus on the most promising information and treatments, as well as those that have been proven to work.  We will then reach a consensus about the most valid points and translate them to the general public in easy to understand concepts that don't include incomprehensible jargon. Where appropriate, we will explain scientific data and treatments that are controversial without any prejudice, so that we can help the public make up their mind independently.