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What is Integrative Psychiatry and why is it important?

Rami Kaminski, MD

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 interaction between the abstract and the physical.  Complex physiological interactions animate the human body. Once they stop, we turn from a living 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 could trigger 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.

Far from being a revolutionary concept, the body/mind connection has been intuitively presumed, if not well 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 false, signified an awareness of that connection.

In modern medicine, there is a growing understanding of how the body responds to certain moods, and conversely 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 chronic stress is a major contributor to cardiovascular disease and most probably to genetic mutations and 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 most abstract aspect of our existence, can affect our most physical aspect of our existence, and vice versa.

Unfortunately, contemporary medicine is often practiced with surprising disregard to the body/mind influences. Psychiatrists, despite being physicians, often don’t consider the entirety of the body as part of their clinical consideration. Conversely, other medical disciplines pay cursory attention to the effects that our thoughts and feelings have on our body. One decisive reason for the evolution of this mind/body dichotomy is that psychiatry evolved as a philosophical rather than medical discipline. Psychiatrists used to consider abstract notions such as the Ego and the Id, with disregard to the physical brain where presumably those concepts operated. Accordingly, physicians treated psychiatry as an orphan discipline, more fluff than substance, and not as part of the Western, organic-based medicine.

In all fairness, the lack of understanding how the mind and body connect is due to the brain’s elusive nature rather than lack of trying. The formidable progress of medical research 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 abstract functions such as memory, thoughts, emotions and mood, remain poorly understood. As a result, medical models have been developed without consideration of the “mind aspects” such as cognition, emotions and memory. Assuming that one can have a “comprehensive picture” while omitting the contribution of our mind, is plainly misguided. This is a blatant reduction for convenience – a “ searching under the lamppost” phenomenon of medicine – akin to saying, “we do not know how the brain works so we will do without it”.

The consequences of this artificial division between thoughts, feelings, brain and body are far from trivial.  While stress  and chronic anxiety are increasingly recognized as a major contributor 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.

At the Institute for Integrative Psychiatry we view bridging the unnecessary gap between psychiatry and medicine, as an urgent and timely endeavor. The continued hyper-specialization of medicine and psychiatry, the pressures of market forces, and the lack of public awareness to this important “missing link” in our healthcare approach, all converge to further compartmentalize modern medicine.  Without thoughtful, science- based efforts to reverse this trend, medicine would continue on the path of specialists for specific organs, or function, circling around each patient, with no coordination between them.  Ever mounting costs, suboptimal treatments and growing morbidity are already dominating American healthcare.

TIIPS consists of healthcare professionals committed to improving the way we treat our patients.

We pursue this goal by the following efforts:

  1. Focus on conditions where an Integrative approach to the body and mind is essential to recovery and maintenance of good health.
  2. Reviewing current research 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. Interacting with the public through publications, lectures and seminars.
  6. Increasing public awareness through the Institute’s web site.
  7. Conducting workshops to educate stake holders.
  8. Presenting our unique model for treatment of addictions.

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 claim any deep understanding of the brain. In fact, the brain could conceivably remain elusive 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 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 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 search for 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 and clarify their effects on health, recovery and well-being.  While similar observations have been made sporadically throughout medical history, we set out to advance a coherent, encompassing approach to such integration, and help medicine recognize and incorporate that crucial “missing link”. Our guiding principle is to optimize currently available treatments, as obviously those who suffer need answers now.

TIIPS focuses on the following areas:

  1. Stress and cardio-vascular disease.
  2. Stress and neuroendocrine (hormonal) changes as they pertain to female 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. Brain degenerative disorders and psychiatric conditions (with emphasis on Parkinson, Multiple Sclerosis and Movement Disorders
  9. Psychiatric medications and their effects on general health.
  10. Addiction as a key example for interactions between biology, behavior and psychological aspects.  

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 pertinent scientific data, as well as reviewing all related therapies and treatments. We focus on the most promising information and treatments, as well as those that have been proven to work. We aim to present to the general public the most valid points in easy to understand, free of jargon concepts. Where appropriate, we explain scientific data and treatments that are controversial without any prejudice, so that we can help the public make up their mind independently.

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