Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
KevinMD
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking
KevinMD
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking
  • About KevinMD | Kevin Pho, MD
  • Be heard on social media’s leading physician voice
  • Contact Kevin
  • Discounted enhanced author page
  • DMCA Policy
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • Group vs. individual disability insurance for doctors: pros and cons
  • KevinMD influencer opportunities
  • Opinion and commentary by KevinMD
  • Physician burnout speakers to keynote your conference
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Primary care physician in Nashua, NH | Doctor accepting new patients
  • Privacy Policy
  • Recommended services by KevinMD
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The biggest mistake doctors make when purchasing disability insurance
  • The doctor’s guide to disability insurance: short-term vs. long-term
  • The KevinMD ToolKit
  • Upgrade to the KevinMD enhanced author page
  • Why own-occupation disability insurance is a must for doctors

Should we consider an integrative psychiatry model?

Elana Miller, MD
Conditions
November 29, 2013
Share
Tweet
Share

As a psychiatrist who is passionate about integrative mental health treatments, I was excited to spend five days recently in St. Petersburg, Florida for the annual conference of the American Board of Integrative and Holistic Medicine.

At the conference, I learned that even more than I previously realized, our ecosystem and environment have a profound effect on our happiness and wellness, and can either give us easy access to good food and healthy activities, or add toxins and contaminants to our already stressed bodies. I learned about botanical and herbal treatments for anxiety and insomnia, including lemon balm, skullcap, and hops.

I learned that apart from considering obvious medical conditions that could contribute to my patients’ psychiatric symptoms (thyroid dysfunction, anemia), I should evaluate for more subtle physiologic disturbances, such as vitamin and mineral deficiencies, adrenal hormonal dysfunction, and even heavy metal toxicities.

But as I sat in the audience listening to physicians renowned in their respective fields in integrative medicine — speaking mostly to internal medicine and family medicine physicians — I was most struck realizing that, “Hey, psychiatrists already know a lot of this stuff.”

We should take time with our patients, and listen to their stories? Obviously. Dysfunctional social environments can lead to physical disease? Yup, seen that before. Our patients are much more than the sum of their organs and diagnoses? No kidding.

What gives me pause, though, is that the field of psychiatry is rapidly shifting, and not necessarily in a good direction. In an attempt to fight negative stereotypes that psychiatry isn’t “real medicine,” some leaders and researchers in the field are seeking to become even more reductionistic in their approach toward patients.

Your child has autism? Let’s find exactly what genes are causing it, and what medications will treat it. Have bipolar disorder? Let’s see what absurdly complex pharmacological regimen we can prescribe you. Schizophrenia? Let’s see if we can develop a lab test for it.

As Thomas Insel, the director of the National Institute of Mental Health (NIMH), famously lamented in the weeks before the DSM-5 came out, “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure … Patients with mental illness deserve better.”

But — we have to ask — is reducing mental illness to a gene study and a lab test really what patients deserve? Is this more important than listening to their stories and understanding the social and psychological environment in which their symptoms developed and are maintained?

Let’s talk about chronic medical illnesses such as Type II diabetes and heart disease, which doctors can definitively diagnose through lab tests and cardiac studies. Has this really helped us treat these conditions? We prescribe medications and put in stents, but do we effectively address the underlying environmental and lifestyle causes of these illnesses? Are these becoming smaller problems over time, or bigger ones? We’re spending more money, but are we getting better outcomes?

Don’t get me wrong — if I needed acute care, like antibiotics or surgery, I’d get myself to a doctor as soon as possible. I question, though, if the reductionistic, disease-based, allopathic model that psychiatry is increasingly trying to emulate is really the best option to treat chronic, complex conditions such as mental illnesses.

After seeing what the integrative medicine physicians speaking at the conference have been able to accomplish with their most treatment-resistant patients, I’m even more convinced that there’s a better way.

Some of the earliest pioneers in medicine understood this better than we do now. As Florence Nightingale said, “The needs of the spirit are as crucial to health as those individual organs which make up the body.” And Sir William Osler, often referred to as the father of modern medicine, pointed out, “The human heart has a hidden want which science cannot supply.”

ADVERTISEMENT

Ironically, science is now showing us just how true these words are. Did you know that when 10,000 men were followed for development of heart disease, whether or not they answered “yes” or “no” to the question, “Does your wife show you her love” predicted the developed of angina over the next five years? Or that a similar study showed a wife’s love impacted the developed of ulcers?

Did you know that after receiving cardiac catheterization, patients who weren’t married or didn’t have a close confidant were three times more likely to die over the next five years? Or that those purposefully exposed to the cold virus (yes, people actually volunteered for this study) who had weaker social relationships were four times more likely to develop cold symptoms?

Connection matters. Social support matters. Love matters. The relationship between doctor and patient matters.

So in our well-meaning pursuit of a better scientific understanding of mental illness and mental health, we need to be careful not to ignore the heart, not to ignore the spirit, not to ignore the patient’s story.

In an integrative psychiatry model, let’s consider the diagnosis and potential pharmaceutical treatments, while not forgetting that these are only endpoints of the problem. Let’s also look at the roots — factors like social relationships, past trauma, work environment, subtle physical and nutritional dysfunction, ecological and environmental exposures, activity level, as well as a patient’s spirituality, meaning, and life purpose. And let’s make our relationship with our patients its own healing force.

I, personally, think this is what our patients deserve.

Elana Miller is a psychiatrist who blogs at Zen Psychiatry.

Prev

Poverty can make you sick

November 29, 2013 Kevin 44
…
Next

Stop pursuing self-pay patients as a windfall opportunity

November 29, 2013 Kevin 13
…

Tagged as: Psychiatry

< Previous Post
Poverty can make you sick
Next Post >
Stop pursuing self-pay patients as a windfall opportunity

ADVERTISEMENT

More by Elana Miller, MD

  • So I am still here. I live to fight another day.

    Elana Miller, MD
  • These stunning photos take you on a physician’s cancer journey

    Elana Miller, MD
  • a desk with keyboard and ipad with the kevinmd logo

    8 ways to better support someone dealing with cancer

    Elana Miller, MD

More in Conditions

  • The necessity of getting lost to find yourself

    Michele Luckenbaugh
  • Medical bankruptcy: the hidden cost of U.S. health care

    Richard A. Lawhern, PhD
  • Tobacco treatment neglect: Why 25 million smokers are left behind

    Edward Anselm, MD
  • Music and brain plasticity: How sound rewires your mind

    Marc Arginteanu, MD
  • Why Medicare must cover atrial fibrillation screening to prevent strokes

    Radhesh K. Gupta
  • Frailty and functional decline: Why diagnosis is not enough

    Gerald Kuo
  • Most Popular

  • Past Week

    • Why Medicare must cover atrial fibrillation screening to prevent strokes

      Radhesh K. Gupta | Conditions
    • Why medical school DEI mission statements matter for future physicians

      Aditi Mahajan, MEd, Laura Malmut, MD, MEd, Jared Stowers, MD, and Khaleel Atkinson | Education
    • The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

      Brian Hudes, MD | Physician
    • Teaching joy transforms the future of medical practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Celiac disease psychiatric symptoms: When anxiety is autoimmune

      Carrie Friedman, NP | Conditions
    • When diagnosis becomes closure: the harm of stopping too soon

      Ann Lebeck, MD | Physician
  • Past 6 Months

    • Will AI replace primary care physicians?

      P. Dileep Kumar, MD, MBA | Tech
    • What is the minority tax in medicine?

      Tharini Nagarkar and Maranda C. Ward, EdD, MPH | Education
    • Why the U.S. health care system is failing patients and physicians

      John C. Hagan III, MD | Policy
    • Alex Pretti: a physician’s open letter defending his legacy

      Mousson Berrouet, DO | Physician
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
  • Recent Posts

    • Business literacy empowers physicians to lead sustainable health systems [PODCAST]

      The Podcast by KevinMD | Podcast
    • The necessity of getting lost to find yourself

      Michele Luckenbaugh | Conditions
    • Physician resilience: Why systems matter more than heroism

      Harvey Castro, MD, MBA | Tech
    • Medical bankruptcy: the hidden cost of U.S. health care

      Richard A. Lawhern, PhD | Conditions
    • Tobacco treatment neglect: Why 25 million smokers are left behind

      Edward Anselm, MD | Conditions
    • Music and brain plasticity: How sound rewires your mind

      Marc Arginteanu, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why Medicare must cover atrial fibrillation screening to prevent strokes

      Radhesh K. Gupta | Conditions
    • Why medical school DEI mission statements matter for future physicians

      Aditi Mahajan, MEd, Laura Malmut, MD, MEd, Jared Stowers, MD, and Khaleel Atkinson | Education
    • The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

      Brian Hudes, MD | Physician
    • Teaching joy transforms the future of medical practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Celiac disease psychiatric symptoms: When anxiety is autoimmune

      Carrie Friedman, NP | Conditions
    • When diagnosis becomes closure: the harm of stopping too soon

      Ann Lebeck, MD | Physician
  • Past 6 Months

    • Will AI replace primary care physicians?

      P. Dileep Kumar, MD, MBA | Tech
    • What is the minority tax in medicine?

      Tharini Nagarkar and Maranda C. Ward, EdD, MPH | Education
    • Why the U.S. health care system is failing patients and physicians

      John C. Hagan III, MD | Policy
    • Alex Pretti: a physician’s open letter defending his legacy

      Mousson Berrouet, DO | Physician
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
  • Recent Posts

    • Business literacy empowers physicians to lead sustainable health systems [PODCAST]

      The Podcast by KevinMD | Podcast
    • The necessity of getting lost to find yourself

      Michele Luckenbaugh | Conditions
    • Physician resilience: Why systems matter more than heroism

      Harvey Castro, MD, MBA | Tech
    • Medical bankruptcy: the hidden cost of U.S. health care

      Richard A. Lawhern, PhD | Conditions
    • Tobacco treatment neglect: Why 25 million smokers are left behind

      Edward Anselm, MD | Conditions
    • Music and brain plasticity: How sound rewires your mind

      Marc Arginteanu, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Should we consider an integrative psychiatry model?
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...