A few days ago, I was sitting next to my wife on the couch reading Spark: The Revolutionary Science of Exercise and the Brain written by John Ratey, a professor of Psychiatry at Harvard University. As the title states, it goes well beyond the adage that exercise is good for you, and takes a much deeper, and more scientific look at how research in this area can be (and is in certain places) used to address all kinds of everyday needs.
I found myself saying out loud, “Now this what psychiatry should be doing.” By psychiatry, I didn’t just mean those positioned only in academia, but more those who are delivering services to patients on a daily basis. This morning, in reading Dr. Hickey’s thought-provoking article on the field of psychiatry and reflecting more on Dr. Deacon’s creative NIMH Mad Libs post, I again found myself thinking more about the field of psychiatry in general. Beneath all of the criticisms regarding questionable science and potential harmful effects inherent in the current psychiatric model, it seems there is an equally important question: Just how is the practice of psychiatry relevant and practical in our daily lives?
As a spouse, a father, a member of a large extended family, and as just a human being, it is difficult for me to separate my life as a pediatric psychologist from my personal life. Like everyone else, there are certain basic functions that need to be executed in order to provide a framework to keep myself healthy, including psychologically.
Psychiatry by its nature seems to be the profession best posed to ask the following question: “What factors (unlimited) may be contributing to your psychological difficulties?” And more importantly, “What factors may contribute to your psychological health?” Unfortunately, all medical professions, including the field of psychiatry, have long struggled to be defined by what goes wrong (pathology), and not what can go right (resiliency). In doing so, as noted by Dr. Hickey, we look at psychological difficulties as a disease, and not necessarily a conglomeration of various features which may lead someone to become significantly impaired and/or distressed in the self-professed important aspects of his or her life.
In 2011, Dr. Robert Walsh published a seminal article in American Psychologist entitled Lifestyle and Mental Health. In this article, he detailed the various ways that many lifestyle factors can be directly linked to a person’s psychological adjustment. That same year, the Monitor on Psychology published its December edition with the cover that read “New Research on the Link Between Exercise and Mental Health.” Details of the article indicated that exercise alone could be a powerful form of treatment for mental health issues, rivaling medication and therapy.
Meanwhile, studies continue to pour in about the negative effects of poor diet on mental health. Two headlines in 2013 published through Medscape indicate the following: Stop the Pop: Soda Linked to Aggression, Inattention in Kids and Early ‘Junk Food’ Exposure Risks Kids’ Mental Health.
In the world of sleep research, we finally are coming to realize just how important somnolence is for mental health, and uh, everything, as was noted in a recent article in Scientific Americanposted on MIA. And large meta-analyses (e.g., Koenig, McCullough, Larson, 2001) have consistently indicated the potential buffering effects of spirituality and religion, which seems rather important since 90% of the world’s people are involved in some type of spiritual endeavor. The relevant tie-ins to mental health and our daily life are endless, and for anyone that has ever engaged in clinical practice, it becomes supremely obvious just how important these factors are.
I realize that, for many, this is all old news. But what isn’t old news is why many in the practice of psychiatry and, to be frank, in my own field, are not truly engaged in this research in a way that matters to the families that come see them. What I really want in a psychiatrist (or prescribing pediatrician or family physician) whether as a parent or patient is someone who can — and will — speak intelligently, honestly, compassionately and hopefully about how many different factors may be affecting our physical health. Beyond the social, spiritual, and psychological factors, I want a psychiatrist who will take the time to consume the research, screen patients thoroughly, and then speak in layman’s terms about a plan that would incorporate changes to a patient’s daily life that could improve their mental health.
Beyond my immediate urges to decrease symptoms and appease the participating parties, I really want to know if physical factors – such as sleep, hormonal issues, fitness, media/technology exposure, etc., and beyond – are integral in the anxiety or attention problems that are presenting themselves. When I have worked with psychiatrists that practice this way, it is a real joy, but I must admit that my experiences in this type of collaboration have been rather limited.
What I do not want is a 15-minute appointment to start the trial and error process of seeing which medication might work, without considering all other options — first and ongoing. Once this happens, years and decades of the revolving medication circuit often go by without really knowing what has gone wrong. To me, it is the true integration of physicality and psychology where psychiatry could uniquely shine again. It is where I can hear highly qualified medical students saying “You know, I really could see psychiatry as a very rewarding and interesting field to pursue.” Until then, I have to admit that many prospective students will likely look at the field as one-sided and unrewarding.
In saying all this, I want to be clear that psychotropic medications may at times be necessary to alleviate psychological issues that persist. As Robert Whitaker clearly indicated and profiled in Anatomy of an Epidemic, medications used strategically and in a time-limited manner may provide a much-needed boost to a more healthy existence. But when prescriptions occur on the front end, with little or no attention to the myriad factors that may actually be creating a situation of poor mental health, then the profession stops being a scientific, deductive practice; instead becoming simply a disseminator of concoctions that may or may not work — especially in the long-term. Imagine, though, if the field of psychiatry, both in research and practice, devoted less attention and financial resources to developing new medications and uncovering hypothetical biological underpinnings, and more on how what we do everyday can help make us feel better. Wow . . . just how relevant would that be!
But in the interest of full disclosure, we know that many barriers exist to this beautiful possibility. The first is that psychiatrists, like many of us with advanced degrees, have to be willing to live on the salaries that we earn, and not small fortunes we pursue through sponsored ventures and triple-booked patients. We must be willing to unwed ourselves from parties that may cloud the truth. As a father of six, I realize that no money ever seems enough in these uncertain times, but we all must acknowledge the role that greed plays in obscuring reality.
Secondly, we have to stop giving in to the pleas and demands and anxiety of our patients, of parents, and schools. We must have the fortitude to let all know that this may take some time, and the insight and knowledge to provide other options as we search for clarity. More than any profession, the reality of “fix my child now” is never more real than for my psychiatric colleagues, and for that, I sympathize with them.
Finally, though, the field of psychiatry, as all fields, must find great joy in reaching the true pinnacle of becoming a complete profession. As Ireneus once said, “The glory of God is man fully functioning.” It seems this would be the glory of any profession, and in helping others realize this in themselves.
Years ago, shortly before I enrolled in graduate school, I had my first real exposure to the psychiatric world, as a mental health technician in a local inpatient unit. Every morning, we would meet as a team to discuss the youth on our unit and these meetings were usually led by one of the psychiatrists on staff. Almost as he was walking into the meeting, I could hear him proclaim to other staff, “He is definitely a Buspar kid” or a “Zoloft kid” or any other medication-hinged name.
This was long before I had any adequate knowledge about clinical practice. But I distinctly remember to this day the dehumanizing effect that discomforted me. I couldn’t help but think that this “Zoloft kid” was a boy who had only slept for five hours a night, whose parents had both used drugs and had spent time in prison. He had been sexually abused by his older cousin, and he struggled with school due to a reading disorder. But most of all, he was a kid — one in need of great care and understanding — one uniquely important to the human race in ways that I would never understand.
When psychiatry, or any other profession for that matter, ignores critical aspects of humanity, it is destined to fail. The failure of the medical model is that it seems to largely confine itself to only one dimension of our being, and fails to truly embrace just how our social, psychological, and spiritual existence blend with our physical selves to create one person. And in doing so, it departs from the relevant things in our daily lives, those that involve being a spouse, a father, a brother, a friend, a worker, and most importantly, one human being uniquely positioned in the entire human race. It loses its calling, its relevance, and its face in the mirror.