Disclaimer: This article represents one professional’s opinion, and does not represent the views of The Temper. It is not a substitute for professional medical, psychotherapy, or counseling advice. Before you change a medical regimen that’s been prescribed to you, always consult a health professional.
I’m a holistic psychiatrist, and a question I often get is: What does that even mean?
It’s basically a term a few rebellious psychiatrists use to describe the way we practice, which is to take the whole person into consideration—including what you eat, how you sleep, your relationships, your connection with nature, creativity, and spirituality. We don’t merely diagnose and medicate; we think globally about what gets out of balance in every corner of your life, so we can gently shift things back into balance to support your wellness.
My training began just like a regular psychiatrist—I went to medical school and then psychiatry residency. Throughout those years I was taught to categorize groups of symptoms as diagnoses, and then treat those diagnoses with meds. And when a patient returned after a few months on their new medication and said she didn’t feel better? I raised her dose or added a second medication. If a patient said he was experiencing side effects from the drugs? I’d often add another medication to address those side effects. And when that second med caused a new side effect, sometimes I’d add yet another.
I found this pharmaceutical dance kept me and my patients feeling very occupied, like we were really doing something to address their suffering. But it was empty work, rarely creating genuine wellbeing. It also created waves of hope and disappointment.
I found this pharmaceutical dance kept me and my patients feeling very occupied, like we were really doing something to address their suffering. But it was empty work, rarely creating genuine wellbeing. It also created waves of hope and disappointment. After a few years of doing things the traditional way, I began to recognize that it rarely made any lasting positive impact on my patients’ overall ability to feel well. My patients were not achieving a sense of wellbeing, and I felt deeply out of alignment with the work I was doing. I knew there had to be a better way.
Toward the end of my psychiatry residency, I began to explore what that better way might be. How could my practice help patients regain authentic wellbeing, so they can live the lives they hope for and make their unique contribution to the world? I no longer wanted to simply patch up people’s symptoms; I wanted to do deeper work that felt in alignment with my own internal truth.
At first, I had more questions than answers. Could it really be right to keep pumping people up with all these meds? It didn’t totally make sense to me that medications are what humans require to feel well.
We’ve been sold a model of mental illness where depression, anxiety, bipolar, and ADHD are hereditary conditions caused by genetic chemical imbalances. Oh, and it just so happens that our good friends in the pharmaceutical industry have just the drugs to correct these imbalances. What luck that we live in the era of Pfizer!
But, I wondered, what if you were born 200 years ago, or in a part of the world without access to the western medical system? Were you just screwed? Did you have to resign yourself to a life of mental illness? I know there are cases of people in history who would have been helped by modern pharmacology. But I suspected that wasn’t the whole story.
These mental illnesses are more common and more chronic in places with more robust mental health systems and more psychopharmaceutical treatment.
As I studied trends of global mental health, I found these genetic chemical imbalances of depression and anxiety are apparently worse in the same parts of the world where we are “lucky” enough to have treatments for them. These mental illnesses are more common and more chronic in places with more robust mental health systems and more psychopharmaceutical treatment. Let that sink in for a minute.
Since we have the “best” pharmaceutical treatments in the US, yet we have such high rates of chronic mental illness, I knew mental wellbeing couldn’t be as simple as treating a genetic chemical imbalance. We’re more medicated than any other nation, yet we’re also sicker. A sinking feeling came over me as I realized the orthodoxy of mental health treatment is in large part driven by financial interests. The pharmaceutical industry insidiously influences research, expert guidelines, treatment algorithms, and the so-called “standard of care.” While the medical-industrial complex is busy getting the population dependent on psychopharmaceuticals, our society has neglected non-medication approaches to mental health.
The way I practice today is almost entirely oriented around the environmental factors that impact mental health. The good news is, unlike genes, we have control over these factors.
This got me wondering, could there be factors that influence mental health beyond genes and medications? The answer is, of course, yes. In fact, the way I practice today is almost entirely oriented around the environmental factors that impact mental health, such as sleep, nutrition, exercise, and connection to nature. The good news is, unlike genes, we have control over these factors.
During my last year of residency, I started pursuing various healing modalities. I studied acupuncture, yoga, nutrition, and functional medicine, which is an approach to health that focuses on resolving the root cause of illness, rather than suppressing symptoms. Eventually, I built a toolbox containing many different ways to support my patients, beyond simply medicating them.
These days, when a patient walks into my office, the first thing I do is ask them to tell me their story, so I can take the whole person into consideration in figuring out what will nudge them toward wellness. What have they been through? What’s on their mind? How do they sleep, what do they eat, and how much physical activity to they engage in? I also ask about their relationships, and whether they find meaning and purpose in their work, do they connect regularly with the natural world, and do they have creative outlets? I ask them whether they have satisfying sexual expression, and if they have a spiritual practice. To me, these are the real determinants of mental wellbeing, not only their genes or what might be going on with their brain chemistry.
These days, when a patient walks into my office, the first thing I do is ask them to tell me their story, so I can take the whole person into consideration
This is so critical, this listening—I encourage patients to tell me everything, whether it takes 20 minutes or two hours (or several sessions). Conventional psychotherapists do this as well. There is something immensely therapeutic about feeling heard, witnessed, seen, validated, and understood. In our culture, we’re so distracted with our phones and our hyper-busy lives, not to mention uncomfortable holding space for big emotions and vulnerability, that we rarely create an open-ended, safe setting for each other to tell our stories. Sometimes my office is the only safe container for some of my patients to fully process their life experiences.
Then, depending on what my patient tells me, my approach to treatment may start with food, sleep, gut healing (rebalancing the population of bacteria in their guts, which is associated with mood and physical health), or something else entirely, such as energy work or acupuncture. If it makes sense, I’ll also recommend diet changes and supplements such as turmeric to address inflammation. I also advise people to spend more time pursuing various forms of pleasure.
Diet is a significant factor in why most of my patients are not well, so I do some education around how to eat a real food diet (and what that really means). For some, we do a more intense elimination diet, such as Whole30, especially if someone is planning on tapering off a psychiatric medication (eating a nutrient-dense, non-inflammatory diet is one of the best ways I know of disburdening the body to allow for a smoother medication taper). We’ll also examine the relationship between a person’s symptoms and their consumption of caffeine, alcohol, and sugar—I don’t make any friends with this one.
I also always focus on sleep, since most of us don’t get sufficient quantity of or quality sleep, and it’s essentially the best medicine available. For many people, it’s difficult to fall asleep and stay asleep, so we focus on strategies, like getting the phone out of the bedroom, limiting caffeine to the morning, going to bed earlier, and taking a spoonful of almond butter before bed (since healthy fats prevent an overnight blood sugar crash, which can wake you from your slumber), to make it easier for the body to fall into a deep sleep.
Finally–and this is important—we focus on building pleasure, joy, and fulfillment into life. Treating mental health is not just about avoiding the bad; it’s equally important to practice radical acceptance and gratitude, and to seek pleasure today in whatever form comes easily and joyfully. For some people, this means spending time in nature, playing with dogs, cuddling, making art, self-pleasure, a more present and vulnerable act of sexual expression with a partner, or simply dancing.
A big disclosure: Because these tactics are a significant departure from traditional psychiatry which typically relies on the prescription of meds to treat patients, I want to give you some context about the holistic psychiatry stance on medication. Every holistic psychiatrist has a slightly different philosophy about conventional psychopharmacology. My personal philosophy is that if it’s working for you, that’s great. If you’re taking it but you have second thoughts, side effects, or some other reason that makes you want to experiment with going off medication, I make myself available to support patients on that journey, and arm them with as many tools as possible to make that process go as smoothly as it can (though it’s important to note this can be a very difficult process, and it should never be attempted without the close support of a mental health practitioner).
My most passionate stance when it comes to medication is that if you’re experiencing mental health symptoms and you have not yet tried medications, I love to show people the diet and lifestyle modifications that can address their symptoms at the root and obviate the need for meds. This is not to say medications are the wrong choice. But people should at least know they have options.
Another important issue to address with regard to holistic psychiatry is affordability and accessibility. When you see a conventional psychiatrist who is working in-network with insurance providers, their path to earning a living is to see as many patients as they can manage. Usually, this translates to brief appointments. Brief appointments usually translate to walking out with a prescription, because what else can you really accomplish in 15 minutes? That’s not enough time to go deep and effect genuine transformation or coach someone on lifestyle changes.
In contrast, as a holistic psychiatrist, I practice slow medicine.
I want to know as much as I can about my patients, and I want to patiently hold space to allow people to experience deep transformation in my office. My initial consultation is two hours long. As you might guess, that gets expensive. Especially when you consider that holistic psychiatry requires additional training above and beyond the four years of medical school and four years of psychiatry residency, it incurs extra liability because these practice is on the outskirts of the “standard of care,” there are only a few of us practicing in this way (low supply), and there is a tidal wave of need for this approach (high demand). This leads to major accessibility issues. And that’s if you’re lucky enough to live somewhere that holistic psychiatrists practice, which could be counted on one hand.
A few practitioners, including myself, have created online programs to meet the demand and improve the accessibility and affordability. These online programs are a fraction of the cost of seeing a holistic psychiatrist individually, and achieve many of the same goals, with the added benefit of creating community. However, I recognize that even this option is a privilege. I encourage my patients to speak to their insurance about what kind of reimbursement you receive for out-of-network mental health care. That will give you a sense of how much it will cost you.
Since beginning to practice holistic psychiatry, I find my patients don’t simply return to me with a shoulder shrug saying, “I guess things are better, I’m crying less.” We haven’t simply patched up their symptoms, we’ve effected deep transformation. They’re not just not-crying, they’re thriving. And I find this new approach to my career immensely fulfilling.
It’s not without challenge and stress, but at least I’m working together with my patients to truly understand what makes them tick, what’s out of balance, and what we can shift in their lives so they can feel well. Mental health is never simple, but making even the smallest improvement in someone’s mental wellbeing is incredibly gratifying for everyone involved.