The 10 Principles of Integrative Psychiatry

To me, anyone who is too far on one side of the fence -- either wanting to throw a pill at any negative emotion, or wanting to blame medications for all of society's ills -- seems to be missing the point. Instead of taking an extreme view, I strive to take a wise, balanced, and integrative approach.
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I didn't set out to become an integrative psychiatrist.

Like most doctors out there, I went through medical school and residency learning a "disease-based" approach of how the human body works. First, I learned what "normal" was. Then, I learned all the ways normal could go wrong. I was given the task of recognizing, diagnosing, and treating symptoms and diseases.

Even at the time, though, I couldn't help but wonder: What about the person with the symptoms or disease? Who is she? What's her story? What went wrong with her body, heart or mind that brought her to my office?

Questions like these drew me to psychiatry, a field where doctors actually have a reasonable amount of time to talk to patients and hear their stories. But even in psychiatry, we have a diagnostic manual that focuses on all the things that can go wrong with the mind, instead of learning from and being inspired by people who live particularly happy and balanced lives.

So, over time, the focus of my writing shifted away from traditional psychiatry and psychology toward a positive view of psychiatry, where optimizing wellness is just as important as treating illness.

When I first made this shift, I got a lot of comments from people ready to cheer me on for eschewing traditional psychiatric treatments, such as medications. These people were disappointed to learn that I am not anti-medication, and certainly not anti-psychiatry. I didn't go to school studying medicine and biology for my entire adult life only to throw out a vast body of scientific literature and personal experience indicating that traditional treatments can be very helpful.

To me, anyone who is too far on one side of the fence -- either wanting to throw a pill at any negative emotion, or wanting to blame medications for all of society's ills -- seems to be missing the point.

Instead of taking an extreme view, I strive to take a wise, balanced, and integrative approach. So what does integrative psychiatry mean, anyway?

1. Optimal mental wellness is the goal -- not just the absence of disease. It's not enough to be "not depressed" or "not anxious." Why do we think this is a good enough place to stop? Happiness, fulfillment, and joy in everyday life should be the bar we set.

2. Relationships have a healing power. I mean both an individual's personal relationships and social support networks, which are crucial in overall health and well-being, as well as that individual's relationship with his or her psychiatrist.

I have therapy patients who seem to benefit from our relationship more than any other intervention I do. Being heard and cared for is important. Really important.

3. The body, mind, and environment operate as a whole. You can not treat symptoms without understanding the context in which those symptoms arose. Why are you feeling anxious? What is happening in your life, your work, your relationships, your body? All of these factors should be understood and addressed.

4. The money is in prevention. It's not about waiting for a disease to happen and then putting a Band-Aid over it. It's about promoting a healthy mindset (whether through diet, exercise, meditation, spirituality, cultivating relationships, etc.) in order to make problems less likely to arise and give you more capacity to deal with them when they do.

5. We all have an innate healing power. Our natural state of being is healthy, not sick. This is good news! It means that if you feel unhappy, or stuck, or restless, you need only to identify the obstacles that are keeping you from healing, and then remove them.

6. Treatment modalities should be integrated. Hence "integrative" psychiatry. The best of conventional medical and psychiatric diagnostic techniques and treatments can be combined with alternative strategies such as mindfulness, supplements, acupuncture, massage, and other complementary approaches.

7. We have personal responsibility for our health and happiness. You may not find this piece in the definition of integrative psychiatry elsewhere, but to me it's essential. Joy, happiness and fulfillment are not things that some psychiatrist or therapist can give you. You must decide that these are goals worth striving for and be willing to let go of negative habits to get them.

8. Individuality should be honored. Not all bodies or minds work the same, and we all have different treatments and techniques that resonate with us. To the utmost degree possible, a person's preferences should be a crucial factor in determining what strategies are used to help him or her.

9. The practitioner must teach by example. I'd be a pretty big hypocrite if I went around telling people to take my (metaphorical) medicine if I didn't take it myself. I'm far from perfect and have my own bad habits, but I strive to live a healthy life and practice the principles I preach.

10. All life experiences are learning opportunities. Even -- or maybe especially -- the bad ones. I know that the points in my life when I've failed the biggest or suffered the most have been when the most important realizations have come. These experiences should be honored instead of ignored or minimized.

As you can see, integrative psychiatry is not about prescribing St. John's Wort instead of Prozac, but is rather an entire approach for striving for mental health and wellness.

And yes, I prescribe Prozac, too.

Elana Miller, MD writes at Zen Psychiatry. She is a psychiatrist who's passionate about integrating western medicine with eastern philosophy to help people live fuller and happier lives. To get more articles on improving your health and happiness, join her weekly newsletter.

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