"
"
In 2003, after examining the American psychiatric system for a
year, the President’s Freedom Commission on Mental Health
recommended “a fundamental transformation of the Nation’s
approach to mental health care. This transformation must
ensure that mental health services and supports actively
facilitate recovery, and build resilience to face life’s challenges."
(President’s New Freedom Comm 2003)
Three years later an extensive study covering eight states
revealed that the seriously mentally ill in America now die 25
years earlier than the general public. This is a 10- to 15-year
shorter lifespan than they had less than two decades earlier
(Parks 2006). “We’re going in the wrong direction and have to
change course,” commented lead author Joseph Parks, director
of psychiatric services for the Missouri Department of Mental
Health (Elias 2007).
The Parks report, published for the National Association of
State Mental Health Program Directors, stated: “State Mental
Health Authority (SMHA) stakeholders need to embrace two
guiding principles:
1. Overall health is essential to mental health.
2. Recovery includes wellness.” (Bold, italics, and
underline in original.) (Parks 2006)
These two principles, of course, apply to all psychiatric clients,
not just those in the public health system. The concepts of
“overall health” and “wellness” means we must address the
whole person if we are to improve our chances of facilitating the
recovery of mental health.
Currently most psychiatric treatment attempts to readjust the
individual’s neurological biochemistry through pharmacology.
To a lesser extent, psychotherapy is used to address trauma and
life situations. While these tools have a level of effectiveness and
may be sufficient for some, they collectively fall short of
addressing “overall health.”
This has not escaped the public’s notice. Seeking more effective
healthcare for psychiatric and other medical issues, they have
increasingly turned to other forms of treatment—commonly
referred to as complementary and alternative medicine or CAM.
In 2002, 36% of adult Americans used some form of CAM. If
prayer was included, that number swelled to 62% (Barnes 2004).
By 2007 CAM use had increased 14% (Su 2011).
In psychiatry, 54% of women with depression seek relief
through CAM therapies. Reasons given are a preference for a
“natural approach,” wanting treatments that are congruent with
their own beliefs and values, and experiencing unpleasant side
effects or poor results from orthodox treatment (Wu 2007).
Among psychiatric patients in general, 63% use some CAM
modality (Elkins 2005).
The past decade has also seen a burgeoning of articles in the
psychiatric literature on the use of such CAM treatments as
nutrients (e.g., fatty acids, folate, vitamin D), yoga, light therapy,
acupuncture, and exercise. A cursory search of the same journals
finds that CAM treatments have been discussed for a range of
disorders, including depression, bipolar disorder, schizophrenia,
ADHD, dementia, and obsessive-compulsive disorder (OCD).
What is CAM?
But what does it mean to treat the whole person or overall
health? It means considering the full array of factors that can
impact mental health, including:
− Physical
− Mental
− Environmental
− Spiritual
− Energy influences
It also means therapeutically addressing the individual through
all channels that can affect mental health for the better,
including:
− Physical
− Mental
− Communication
− Perceptual
Each individual is unique. No human physiology is exactly like
another, and no life experience is the same for any two people.
So in our medical literature we almost never find a 100%
response to any treatment. What may be effective therapy for
one individual, such as the adjustment of neurotransmitters,
may be ineffective or deleterious for another.
Even within a single diagnosis such as schizophrenia, the
combinations of possible contributing factors—physically,
genetically, prenatally, and environmentally, just to name a
few—could be almost infinite.
Thus the advantage of the CAM toolbox—a variety of
approaches that account for human individuality and that may
be able to raise overall health sufficiently to tip the scales
toward recovery. If a woman with depression can get a 10%
improvement each with nutrients, diet change, exercise,
acupuncture, and yoga, we have a 50% gain without side effects
and with improved physical health.
While to some psychiatrists CAM may appear to be a random
series of “new age” therapies that whimsically catch media
attention, the larger message that has emerged is that CAM
reminds us to look at the entire individual rather than just the
brain when dealing with psychiatric disorders.
The additional advantage of CAM is that, while pharmacology
can help manage symptoms, it does not necessarily raise overall
health and can, in fact, mask signs that unhealthful conditions
exist. This can worsen health and well-being in the long run. The
CAM approach lets us look at the whole person to increase the
chances of those negative conditions being uncovered.
Treating the Body
It is easily observed that physical health affects mental health.
Even in Dickens’ A Christmas Carol, published in 1843, he observed
that one’s senses and perceptions could be altered by the body:
“A little thing affects them. A slight disorder of the stomach
makes them cheats. You [the ghost] may be an undigested bit of
beef, a blot of mustard, a crumb of cheese, a fragment of an
underdone potato.”
The array of physical conditions that can impact mental health
is so vast that many books have been written on the subject and
the topic remains substantially incomplete. We have devoted a
chapter to this subject but, suffice it to say, the importance of
proper physical screening of psychiatric patients cannot be
overemphasized.
Additionally, as Dickens noted, diet plays a significant role in
mental well-being and overall health. Lack of proper nutrition,
food allergies that present with psychiatric symptoms (such as
depression and anxiety), food additives that some individuals are
sensitive to, and an excess of junk food can negatively affect
mood and behavior, sometimes to a pathological level.
Toxic exposures of many kinds can dramatically influence
mood, perceptions, and actions. Pesticides, mercury, gases,
pollutants, lead, and even mycotoxins can all be suspects in
triggering mental disorders. A subset of toxic exposure would
include unwanted effects of medication. Many drugs,
particularly in combination, produce psychiatric symptoms.
Pain can sometimes be a hidden contributor to mental
suffering. Dental issues, back pain, an improperly healed
surgery, a hidden fracture, foot anomalies—any kind of painproducing
ailment—may go unnoticed by the physician, but
shouldn’t. Also, many patients may fail to report the pain due to
their inability to express themselves or because they have
become accustomed to it.
Perceptual issues, particularly hearing and vision impairment,
can often go overlooked by doctor and client, yet they can result
in psychiatric sequelae such as hallucinations, anxiety,
depression, and confusion.
In addition to treating physical disorders, clinicians can use the
body as a channel for therapeutic intervention. A number of
physical treatments have been found to improve mental health.
Numerous nutrient therapies are efficacious for a panoply of
psychiatric disorders. Some treatments, such as omega-3 fatty
acids, have become so commonplace that they are now
considered best practice in mainstream medicine.
Herbal treatments have a role in psychiatric medicine and a
number of them have been reported safe and effective in the
literature.
Exercise has been shown to be very effective as a mood elevator
and lack of exercise can impair the quality of life for any
psychiatric patient as well as retard recovery.
A host of other CAM physical approaches can change mental
and emotional aspect including chiropractic, yoga, acupuncture,
acupressure, breathing exercises, dance therapy, and balance
therapy.
Environmental Influences
In the early 1900s, when psychoanalysis was the dominant force
in psychiatry, Sigmund Freud wrote, “If a man has been his
mother’s undisputed darling, he retains throughout life the
triumphant feeling, the confidence in success, which not seldom
brings actual success along with it.” (Freud 1917)
As time has marched on, however, and research has
accumulated, we have come to see that many environmental
influences—besides one’s parents—can affect the mind. And, of
course, these influences can be positive or negative.
The person’s job can be a risk factor. Many professions use
chemicals that can have toxic effects on the brain, including
farming, metal plating, laboratory work, mining, and certain
types of manufacturing.
Where one lives or where one has recently been can be
important. Toxic waste, a paucity of certain nutrients in the
region’s soil, political upheaval or other environmental threats
can and do make a difference to mental well-being.
Chronic exposure to power lines, for example, has been shown
to increase suicide rates up to threefold in electrical workers
(Wijngaarden 2000). Also, high-density negative ions in the air,
as are seen near waterfalls, produce a 43% improvement in
depression (Terman 2007). Exposure to outdoor greenery as in
parks, meadow, and rural settings causes significant
improvement in symptoms of ADHD (Kuo 2004). A review of
people doing exercise amongst outdoor greenery such as walks
and gardening found that 94% of respondents felt it improved
their mental health and 71% reported decreased depression
(MIND 2007).
Spiritual Matters
A survey of 1144 American physicians found that amongst all
doctors, psychiatrists are the least likely to be religious.
Additionally, nonpsychiatrist physicians who are religious are
less willing to refer their clients to a psychiatrist (Curlin 2007).
By contrast, only 15% of the American population defines itself
as atheist, agnostic, or of no religious affiliation (Kosmin 2008).
Religion plays a major role in the lives of a great many, and it
can have profound effects on the mental health of its adherents.
Individuals can suffer great anxiety and depression over a
religious issue, be it guilt from transgressions, abortion,
infidelity, pornography addiction, dishonesty, child abuse,
divorce or other weighty matters. Fear of going to hell or being
excommunicated can become an obsession. They may not think
to mention such things to a psychiatrist since he is a doctor and
not a priest/pastor/rabbi.
People of Eastern faiths have additional issues and traditions
that could trouble them and that are worth exploring.
The simple question “Do you go to church?” or “Do you have a
spiritual practice?” could open the floodgates to information and
insight into the case as well as an avenue of recovery for the
individual. Such a person could benefit from religious counseling
perhaps more so than any other form of treatment.
Addressing the Mind
Traditional treatment of mental and emotional issues involves
psychotherapy, some form of practitioner-patient interchange
that allows the client to discuss trauma and life issues with the
hope of unburdening the individual to some degree or leading
him/her towards solutions for the issues he/she faces.
But other approaches have emerged—many from Asia—that
provide a different look at the mind and living which offers
therapeutic benefits.
The concept of mindfulness or being in the present has been
imported from India, China, and neighboring regions and
encourages quieting the mind rather than engaging it or delving
into it continuously for solutions.
This practice of quieting thought can have many forms,
including physical actions such as breathing exercises or taking
walks and has become a popular method for calming anxiety,
reducing obsessive thought, and relieving depression.
Therapy Through Perceptions
Our perceptions—sight, hearing, smell, etc.—provide a channel
for accessing cerebral activity and processes. Numerous
modalities have arisen that utilize these pathways to manipulate
mental processes in often simple but powerful ways
Aromatherapy has been used effectively to calm and improve
behavior. Lavender oil, for example, reduces agitation in 60% of
dementia patients (Holmes 2002).
Music therapy takes many forms, from listening to music to
performing it. It has been found helpful for many disorders and
diminishes symptoms of schizophrenia (Talwar 2006) and
depression (Maratos 2008).
Neurofeedback is another treatment that functions through
sight and sound. While numerous forms of the therapy exist,
they generally consist of clients looking at lights or video
screens programmed to shift brain wave patterns. Earphones
may be used with accompanying sound. Among other things, it is
effective for depression, anxiety and obsessive-compulsive
disorder (Hammond 2005) and symptoms of ADHD (Arns 2009).
Light therapy is now an established remedy for Seasonal
Affective Disorder and is a simple option to medication for some.
Massage therapy is a combination of touch and muscle
manipulation that can have a relaxing effect. It has been found
to significantly reduce symptoms of depression (Hou 2010) and
anxiety disorder (Sherman 2010).
The Importance of Hope
Hope is an essential element of recovery. Patients and caregivers
who have hope have less depression and more reason to believe
they will succeed (Cheavens 2006).
A patient who is given one therapy as his only option can lose
all hope if it fails. Many psychiatric patients live lives of quiet
desperation, suffering side effects from meds they dislike but
feeling they have no other choice.
A client who is told there are other possible modalities of
treatment—such as CAM therapies that can boost chances of
symptom reduction or recovery—is given hope.
Even if a treatment fails, if other options are on the horizon,
this expectation can keep a patient working toward wellness and
putting one foot in front of the other on the road that may lead
to partial or full recovery. It can even cause the patient to make
improvements in his lifestyle as he strives to do his part in the
recovery effort.
For many, hope is the most powerful medicine of all.
Summary
Of all the fields of medicine, few require as holistic a view as
psychiatry. So many variables can impact mental and emotional
function—and so many approaches can improve it—that the
psychiatrist of today is hard-pressed to keep abreast of the
investigational and therapeutic tools at his disposal.
Additionally, the societal push which has created the demand
for CAM is a desire for greater wellness and overall health. This
means that pharmaceutical treatments in psychiatry, which can
bring with them dramatic side effects such as metabolic
syndrome, renal failure, anorgasmia, and obesity, are being
reevaluated by some as to whether they should always be a first
and only form of treatment.
In pursuing true recovery and wellness, the CAM approach
offers the practitioner a large arsenal of options for
progressively working towards a state of wellness for his client.
With an understanding of the therapeutic tools at his disposal,
the clinician’s—and the client’s—chances of success are
markedly improved.
year, the President’s Freedom Commission on Mental Health
recommended “a fundamental transformation of the Nation’s
approach to mental health care. This transformation must
ensure that mental health services and supports actively
facilitate recovery, and build resilience to face life’s challenges."
(President’s New Freedom Comm 2003)
Three years later an extensive study covering eight states
revealed that the seriously mentally ill in America now die 25
years earlier than the general public. This is a 10- to 15-year
shorter lifespan than they had less than two decades earlier
(Parks 2006). “We’re going in the wrong direction and have to
change course,” commented lead author Joseph Parks, director
of psychiatric services for the Missouri Department of Mental
Health (Elias 2007).
The Parks report, published for the National Association of
State Mental Health Program Directors, stated: “State Mental
Health Authority (SMHA) stakeholders need to embrace two
guiding principles:
1. Overall health is essential to mental health.
2. Recovery includes wellness.” (Bold, italics, and
underline in original.) (Parks 2006)
These two principles, of course, apply to all psychiatric clients,
not just those in the public health system. The concepts of
“overall health” and “wellness” means we must address the
whole person if we are to improve our chances of facilitating the
recovery of mental health.
Currently most psychiatric treatment attempts to readjust the
individual’s neurological biochemistry through pharmacology.
To a lesser extent, psychotherapy is used to address trauma and
life situations. While these tools have a level of effectiveness and
may be sufficient for some, they collectively fall short of
addressing “overall health.”
This has not escaped the public’s notice. Seeking more effective
healthcare for psychiatric and other medical issues, they have
increasingly turned to other forms of treatment—commonly
referred to as complementary and alternative medicine or CAM.
In 2002, 36% of adult Americans used some form of CAM. If
prayer was included, that number swelled to 62% (Barnes 2004).
By 2007 CAM use had increased 14% (Su 2011).
In psychiatry, 54% of women with depression seek relief
through CAM therapies. Reasons given are a preference for a
“natural approach,” wanting treatments that are congruent with
their own beliefs and values, and experiencing unpleasant side
effects or poor results from orthodox treatment (Wu 2007).
Among psychiatric patients in general, 63% use some CAM
modality (Elkins 2005).
The past decade has also seen a burgeoning of articles in the
psychiatric literature on the use of such CAM treatments as
nutrients (e.g., fatty acids, folate, vitamin D), yoga, light therapy,
acupuncture, and exercise. A cursory search of the same journals
finds that CAM treatments have been discussed for a range of
disorders, including depression, bipolar disorder, schizophrenia,
ADHD, dementia, and obsessive-compulsive disorder (OCD).
What is CAM?
But what does it mean to treat the whole person or overall
health? It means considering the full array of factors that can
impact mental health, including:
− Physical
− Mental
− Environmental
− Spiritual
− Energy influences
It also means therapeutically addressing the individual through
all channels that can affect mental health for the better,
including:
− Physical
− Mental
− Communication
− Perceptual
Each individual is unique. No human physiology is exactly like
another, and no life experience is the same for any two people.
So in our medical literature we almost never find a 100%
response to any treatment. What may be effective therapy for
one individual, such as the adjustment of neurotransmitters,
may be ineffective or deleterious for another.
Even within a single diagnosis such as schizophrenia, the
combinations of possible contributing factors—physically,
genetically, prenatally, and environmentally, just to name a
few—could be almost infinite.
Thus the advantage of the CAM toolbox—a variety of
approaches that account for human individuality and that may
be able to raise overall health sufficiently to tip the scales
toward recovery. If a woman with depression can get a 10%
improvement each with nutrients, diet change, exercise,
acupuncture, and yoga, we have a 50% gain without side effects
and with improved physical health.
While to some psychiatrists CAM may appear to be a random
series of “new age” therapies that whimsically catch media
attention, the larger message that has emerged is that CAM
reminds us to look at the entire individual rather than just the
brain when dealing with psychiatric disorders.
The additional advantage of CAM is that, while pharmacology
can help manage symptoms, it does not necessarily raise overall
health and can, in fact, mask signs that unhealthful conditions
exist. This can worsen health and well-being in the long run. The
CAM approach lets us look at the whole person to increase the
chances of those negative conditions being uncovered.
Treating the Body
It is easily observed that physical health affects mental health.
Even in Dickens’ A Christmas Carol, published in 1843, he observed
that one’s senses and perceptions could be altered by the body:
“A little thing affects them. A slight disorder of the stomach
makes them cheats. You [the ghost] may be an undigested bit of
beef, a blot of mustard, a crumb of cheese, a fragment of an
underdone potato.”
The array of physical conditions that can impact mental health
is so vast that many books have been written on the subject and
the topic remains substantially incomplete. We have devoted a
chapter to this subject but, suffice it to say, the importance of
proper physical screening of psychiatric patients cannot be
overemphasized.
Additionally, as Dickens noted, diet plays a significant role in
mental well-being and overall health. Lack of proper nutrition,
food allergies that present with psychiatric symptoms (such as
depression and anxiety), food additives that some individuals are
sensitive to, and an excess of junk food can negatively affect
mood and behavior, sometimes to a pathological level.
Toxic exposures of many kinds can dramatically influence
mood, perceptions, and actions. Pesticides, mercury, gases,
pollutants, lead, and even mycotoxins can all be suspects in
triggering mental disorders. A subset of toxic exposure would
include unwanted effects of medication. Many drugs,
particularly in combination, produce psychiatric symptoms.
Pain can sometimes be a hidden contributor to mental
suffering. Dental issues, back pain, an improperly healed
surgery, a hidden fracture, foot anomalies—any kind of painproducing
ailment—may go unnoticed by the physician, but
shouldn’t. Also, many patients may fail to report the pain due to
their inability to express themselves or because they have
become accustomed to it.
Perceptual issues, particularly hearing and vision impairment,
can often go overlooked by doctor and client, yet they can result
in psychiatric sequelae such as hallucinations, anxiety,
depression, and confusion.
In addition to treating physical disorders, clinicians can use the
body as a channel for therapeutic intervention. A number of
physical treatments have been found to improve mental health.
Numerous nutrient therapies are efficacious for a panoply of
psychiatric disorders. Some treatments, such as omega-3 fatty
acids, have become so commonplace that they are now
considered best practice in mainstream medicine.
Herbal treatments have a role in psychiatric medicine and a
number of them have been reported safe and effective in the
literature.
Exercise has been shown to be very effective as a mood elevator
and lack of exercise can impair the quality of life for any
psychiatric patient as well as retard recovery.
A host of other CAM physical approaches can change mental
and emotional aspect including chiropractic, yoga, acupuncture,
acupressure, breathing exercises, dance therapy, and balance
therapy.
Environmental Influences
In the early 1900s, when psychoanalysis was the dominant force
in psychiatry, Sigmund Freud wrote, “If a man has been his
mother’s undisputed darling, he retains throughout life the
triumphant feeling, the confidence in success, which not seldom
brings actual success along with it.” (Freud 1917)
As time has marched on, however, and research has
accumulated, we have come to see that many environmental
influences—besides one’s parents—can affect the mind. And, of
course, these influences can be positive or negative.
The person’s job can be a risk factor. Many professions use
chemicals that can have toxic effects on the brain, including
farming, metal plating, laboratory work, mining, and certain
types of manufacturing.
Where one lives or where one has recently been can be
important. Toxic waste, a paucity of certain nutrients in the
region’s soil, political upheaval or other environmental threats
can and do make a difference to mental well-being.
Chronic exposure to power lines, for example, has been shown
to increase suicide rates up to threefold in electrical workers
(Wijngaarden 2000). Also, high-density negative ions in the air,
as are seen near waterfalls, produce a 43% improvement in
depression (Terman 2007). Exposure to outdoor greenery as in
parks, meadow, and rural settings causes significant
improvement in symptoms of ADHD (Kuo 2004). A review of
people doing exercise amongst outdoor greenery such as walks
and gardening found that 94% of respondents felt it improved
their mental health and 71% reported decreased depression
(MIND 2007).
Spiritual Matters
A survey of 1144 American physicians found that amongst all
doctors, psychiatrists are the least likely to be religious.
Additionally, nonpsychiatrist physicians who are religious are
less willing to refer their clients to a psychiatrist (Curlin 2007).
By contrast, only 15% of the American population defines itself
as atheist, agnostic, or of no religious affiliation (Kosmin 2008).
Religion plays a major role in the lives of a great many, and it
can have profound effects on the mental health of its adherents.
Individuals can suffer great anxiety and depression over a
religious issue, be it guilt from transgressions, abortion,
infidelity, pornography addiction, dishonesty, child abuse,
divorce or other weighty matters. Fear of going to hell or being
excommunicated can become an obsession. They may not think
to mention such things to a psychiatrist since he is a doctor and
not a priest/pastor/rabbi.
People of Eastern faiths have additional issues and traditions
that could trouble them and that are worth exploring.
The simple question “Do you go to church?” or “Do you have a
spiritual practice?” could open the floodgates to information and
insight into the case as well as an avenue of recovery for the
individual. Such a person could benefit from religious counseling
perhaps more so than any other form of treatment.
Addressing the Mind
Traditional treatment of mental and emotional issues involves
psychotherapy, some form of practitioner-patient interchange
that allows the client to discuss trauma and life issues with the
hope of unburdening the individual to some degree or leading
him/her towards solutions for the issues he/she faces.
But other approaches have emerged—many from Asia—that
provide a different look at the mind and living which offers
therapeutic benefits.
The concept of mindfulness or being in the present has been
imported from India, China, and neighboring regions and
encourages quieting the mind rather than engaging it or delving
into it continuously for solutions.
This practice of quieting thought can have many forms,
including physical actions such as breathing exercises or taking
walks and has become a popular method for calming anxiety,
reducing obsessive thought, and relieving depression.
Therapy Through Perceptions
Our perceptions—sight, hearing, smell, etc.—provide a channel
for accessing cerebral activity and processes. Numerous
modalities have arisen that utilize these pathways to manipulate
mental processes in often simple but powerful ways
Aromatherapy has been used effectively to calm and improve
behavior. Lavender oil, for example, reduces agitation in 60% of
dementia patients (Holmes 2002).
Music therapy takes many forms, from listening to music to
performing it. It has been found helpful for many disorders and
diminishes symptoms of schizophrenia (Talwar 2006) and
depression (Maratos 2008).
Neurofeedback is another treatment that functions through
sight and sound. While numerous forms of the therapy exist,
they generally consist of clients looking at lights or video
screens programmed to shift brain wave patterns. Earphones
may be used with accompanying sound. Among other things, it is
effective for depression, anxiety and obsessive-compulsive
disorder (Hammond 2005) and symptoms of ADHD (Arns 2009).
Light therapy is now an established remedy for Seasonal
Affective Disorder and is a simple option to medication for some.
Massage therapy is a combination of touch and muscle
manipulation that can have a relaxing effect. It has been found
to significantly reduce symptoms of depression (Hou 2010) and
anxiety disorder (Sherman 2010).
The Importance of Hope
Hope is an essential element of recovery. Patients and caregivers
who have hope have less depression and more reason to believe
they will succeed (Cheavens 2006).
A patient who is given one therapy as his only option can lose
all hope if it fails. Many psychiatric patients live lives of quiet
desperation, suffering side effects from meds they dislike but
feeling they have no other choice.
A client who is told there are other possible modalities of
treatment—such as CAM therapies that can boost chances of
symptom reduction or recovery—is given hope.
Even if a treatment fails, if other options are on the horizon,
this expectation can keep a patient working toward wellness and
putting one foot in front of the other on the road that may lead
to partial or full recovery. It can even cause the patient to make
improvements in his lifestyle as he strives to do his part in the
recovery effort.
For many, hope is the most powerful medicine of all.
Summary
Of all the fields of medicine, few require as holistic a view as
psychiatry. So many variables can impact mental and emotional
function—and so many approaches can improve it—that the
psychiatrist of today is hard-pressed to keep abreast of the
investigational and therapeutic tools at his disposal.
Additionally, the societal push which has created the demand
for CAM is a desire for greater wellness and overall health. This
means that pharmaceutical treatments in psychiatry, which can
bring with them dramatic side effects such as metabolic
syndrome, renal failure, anorgasmia, and obesity, are being
reevaluated by some as to whether they should always be a first
and only form of treatment.
In pursuing true recovery and wellness, the CAM approach
offers the practitioner a large arsenal of options for
progressively working towards a state of wellness for his client.
With an understanding of the therapeutic tools at his disposal,
the clinician’s—and the client’s—chances of success are
markedly improved.
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