INTEGRATIVE PSYCHIATRY
The Integrative Approach
Mental illness hurts. It’s not easy. One of the hardest parts about feeling mentally and emotionally unwell is that just when you’re at your lowest, that’s when you need to put in the most amount of effort to start feeling better. Dealing with mental illness is a full-time job. Medications can definitely help, especially when things get extreme. Therapy is vitally important as well, but takes time. So, is that all there is? Is there any more that can be done? Absolutely!
There’s actually a lot of benefits in taking an integrative approach to mental health. An integrative (or functional medicine) approach can mean the difference between a bunch of mediocre fixes and a permanent resolution of symptoms. Now, not everyone will find a cure for their mental illness. With an integrative approach, however, at least an individual can gain a better understanding of their symptoms.
More investigation into imbalances in the body and brain can reveal more about how symptoms came to be. That’s big. Being able to connect the dots and understand the “why” is often transformative for individuals suffering with mental illness symptoms. When the symptoms are better understood, this takes control away from symptoms and returns it back to the individual.
Every Illness Tells a Story…
The greatest benefit of an integrative approach is this ownership that comes along with all the efforts towards discussing symptoms, digging into the body, and demystifying the reasons for the onset of symptoms. Recreating the story of how mental illness symptoms came about is a healing intervention in itself.
Here’s a rundown of Justin’s process. It’s a whole-person integrative and functional medicine approach to figuring out the possible root causes of mental health symptoms for each unique individual. It seeks to tell a story.
The integrative approach starts with an inventory of environmental stressors and ends with a review of current mental illness symptoms. Connecting the dots along the way from the environmental stressors, through imbalances within the body, to disturbances in neurotransmitter activity, and finally on to current symptoms is how each person’s unique path toward mental illness is uncovered. It’s a process, which means it takes some time and a lot of work. But, in the end, it tells a story. And, that story is a powerful tool.
The following digram depicts Justin’s approach to assessing an individual’s physical health and how imbalances in the body contribute towards the onset of mental illness symptoms.
Stress = Disease
Starting at the top, life can throw a plethora of environmental stressors at us every day. Some of these stressors are avoidable, some are not. The combined environmental stress we experience places us under pressure. We are under pressure to cope with the environmental stressors so that we can stay balanced. Environmental toxins, imbalanced gut bacteria, poor diets, foods that interact poorly with our system, and all sorts of life stressors conspire in an effort to tip us out of balance.
However, we are gifted with internal stress response systems that can take these stressors head on. We have ways of compensating for the harm these environmental stressors induce on our bodies and brains. Some key compensatory defenses include hormones and tissues that keep our blood glucose levels as even as possible, other tissues (liver, lung, kidneys, skin) that excrete toxins we accumulate, and a massive network of epithelial cells that lines our intestinal tract that brings in the good (nutrients) and keeps out the bad (pathogens, toxin chemical, undigested food particles).
These compensatory mechanisms keep us up and running. When they are doing their thing, we can get on with life reasonably well. Yet, like any defense, these compensatory mechanisms can become overwhelmed - depending on their capacity to respond and and the load of environmental stress they have to deal with at any given time.
Once environmental stressors overwhelm our ability to compensate and cope, the environmental stress spills over into inflammation and oxidative stress. Inflammation is big, vague term. But in this context, it essentially means that our immune system is responding to a perceived attack. The immune response usually takes the form of inflammatory cytokines (messengers) circulating throughout the body. Like good old Paul Revere, inflammatory cytokines spread throughout the body and try to marshal an immune attack against a foreign invader. That’s a good thing when an actual infectious agent has breached the barrier. Unfortunately, this defense system can also become triggered easily and unnecessarily by non-lethal environmental stressors.
Some of the lifestyle stressors of modern-day life (late nights/poor sleep, junk food/highly palatable foods, chronic stress, lack of supportive social connection, toxic air/water/soil, insufficient friendly bacteria due to over sanitization) are not so toxic that they can cause us to become acutely ill, but are just toxic enough to trigger a chronic, low-grade inflammatory response.
A Little Bit On Fire
This results in us always being a little bit on fire inside. The body is always in a state of creative destruction. Cells and tissues need to be retired and broken down so they can be regenerated again. If we are unhealthy or imbalanced in any way however, the destruction outpaces the regeneration. This is called oxidative stress. Inflammation react to oxidative stress, spreading throughout the body, and gravitating towards areas of oxidative stress. Oxidative stress promotes further inflammation (to respond to the dead and dying cells that are now seen as dangerous as foreign invaders). Oxidative stress and inflammation disturb nutrient absorption and can also impair the energy generating powerhouses in our cells - mitochondria. When mitochondria slow down, this breeds more oxidative stress and inflammation.
And so the vicious cycle continues… until we find a way to let up off the pressure from environmental stressors (heal the gut, avoid toxins, eat better, get some sleep, find a way to relax and enjoy our relationships). One we get that break, our compensatory defenses can kick back into full gear. If the waters are calm enough, we can return to a state of more optimal health. If we don’t get that break, we continue to drown in downward spiral of immune over-reaction and impaired healing.
How does that effect us? Well, it depends. The consequences of ongoing inflammation and oxidative stress, slowed down mitochondrial energy production, nutrient deficiencies, and subsequent hormonal imbalances will be different for all of us. Some may not feel much. Some may experience symptoms in the body, like stomach upset, skin rashes, weight gain, or achy joints. Some may only experience mental and emotional symptoms… exhaustion, brain fog, desire to isolate, a racing mind. One reason for this is that everyone possesses a distinct genetic make up. The environmental pressures we face will push on whichever genetic weakness or trigger belongs uniquely to us.
Finally, all these chemical imbalances in our body eventually make their way to our brains. Psychiatry generally believes that mental illness symptoms are mediated by disturbances in neurotransmitters. Although generally true, this is somewhat of an oversimplification. What does seem to be true, however, is that when we do not have the right nutrients, enough energy, inadequate hormonal signaling, or too much unnecessary inflammation in our brain, our neurotransmitter systems become disturbed.
What are some of the important disturbances? Let’s cover a just a few examples. Nutrient deficiencies can lead to either deficient or excessive neurotransmitter activity, as key vitamins and mineral are needed by specific enzymes to manage the creation, action, and destruction of common neurotransmitters like serotonin, dopamine, norepinephrine, glutamate, and GABA.
Impaired mitochondrial energy production means the brain’s frontal cortex (part that helps us be fully functioning adults) doesn’t retain sufficient energy to do it’s job - keeping us focused on the task at hand and quieting dark and stormy emotions that well up from within. Inflammation and oxidative stress overstimulate our excitatory neurons, thus overstimulating our brains and leading to depression, anxiety, and scattered thinking. There’s a lot more interconnections that can impair our thinking and negatively effect our moods. It all makes a difference.
Making Things Better
In conclusion, the body is always seeking balance. Extremes are unsustainable for the long term. The body knows that it can swing towards extremes for a time. But it is always seeking to find its way back to the middle, so that the next time it becomes stressed, or pushed to the extreme, it can cope. The ability to cope is critically important.
Mental illness symptoms exist on a spectrum. Even those who have not been diagnosed with an official mental illness disorder can, and likely have, experienced symptoms to some degree. Our brains were designed to handle stress, but they also have the capacity to experience sadness, anger, fear, distraction, and even psychosis (loss of touch with reality). It’s just human to feel things and experience symptoms.
The point of treatment is to lessen the intensity of these symptoms so that we can cope, find meaning, and get on with life. This whole-person, integrative, functional medicine approach is about lessening the intensity of symptoms. It’s not about making them go away completely. No body-focused intervention could do that because we’ll still be stuck with the general stress that comes with living life. But, with this approach, we can make things better.