What Is Holistic Psychiatry?

Holistic medicine is the art and science of healing that addresses the whole person – body, mind, and spirit

Holistic medicine considers a person's life's environmental, nutritional, physical, emotional, spiritual, and lifestyle components. The 2007 National Health Interview Survey revealed that approximately 38 percent of adults used complementary and alternative medicine. In total, 83 million adults spent $33.9 billion out-of-pocket for these services, and those numbers have likely increased (American Holistic Health Association, 2018).

Functional or holistic psychiatry is an emerging approach to mental healthcare that emphasizes the underlying biological, psychological, and social factors contributing to mental health issues. It considers the unique genetic, environmental, and lifestyle factors influencing each individual’s mental health. Functional psychiatry is an approach to mental illness that considers the whole individual when treating psychiatric conditions like depression or anxiety.

This approach is not really new. Sir William Osler, one of the most famous English physicians of the 19th-century, believed the future of medicine should include an understanding of the influence of the mind over the body and its interdependence. Benjamin Rush, considered the father of American psychiatry, firmly believed in the holistic approach to medicine.

George Engel, the famous psychiatrist of the twentieth century, was born into a family of famous physicians. His uncle Manny was the preferred internist for New York elites, including George Gershwin and Fanny Brice. Engel was trained early in the biological basis of medicine. However, he realized that biology alone could not explain all illnesses, including his mother's.

Mrs. Engel was a dramatic woman who suffered from multiple physical complaints that were far out of proportion to any physical findings. She was diagnosed as a “hysteric” because no biological basis could be found for her physical symptoms. Even her famous brother Manny was at a loss to explain the basis for her many disorders. Her son George was determined that it was his “destiny to solve the problems Uncle Manny could not.”

Later in his training as a psychiatrist, Engel proposed the biopsychosocial model of illness. The principles of Engel’s model included the biological, psychological, and social dimensions of an individual’s life and the understanding that individuals suffer as a whole, not as isolated organs. Physicians, therefore, should use a holistic approach regarding illness, including the patient’s emotional state and environment.

How We Use This Model Today

The biopsychosocial model was used to develop new treatment approaches for chronic pain patients, affecting approximately 50 million Americans. The costs of treating pain and lost productivity range from seventy to one hundred billion dollars annually.

Traditionally, pain research focused on sensory modalities, and neurological transmissions were identified only on a biological level. For example, the experience of pain was conveyed directly from your skin to your brain without consideration of psychological or social factors. This was called the reductionist or biomedical view of pain.

A biopsychosocial model of pain includes the physical perception of pain and the psychological and social aspects that contribute to symptoms. This theory helped researchers understand how individuals experience different pain types and develop treatment strategies.

So, what influences your perception of pain?

• Emotions. Negative emotions like anxiety, depression, and chronic stress can increase pain. Once you’re in the cycle of depression and pain, for example, it can be difficult to know whether your depression is making your pain worse or whether your pain is worsening your depression. They may each influence the other. Therefore, it’s important to acknowledge the link between mental health and chronic pain.
• Brain disorders. Your brain is the processing center for pain, so if part of the brain isn’t working correctly, you might not healthily process pain. People with schizophrenia, for example, often don’t perceive pain the same way as those without this disorder. This was horrifically illustrated for me when as a second-year psychiatry resident, I was called to the emergency room to evaluate a young man diagnosed with schizophrenia. In a psychotic state, he had mutilated his genitals and arrived in the ER holding them in a bag.
• Stronger signals. An old wive’s tale suggests you should rub the affected spot if you hurt yourself. This is a great example of “closing the gates” of pain. When your brain perceives a secondary stronger signal, such as pressure, it pays less attention to an initial painful one. My dentist demonstrated this to me one day when I needed a novocaine shot. She gave me the shot without causing any pain because she first put pressure on the inside of my cheek for a few minutes before inserting the needle loaded with an anesthetic. I was amazed at the difference. The sensation of pressure overrode the sensation of the needle entering my skin.
• Drug use. Prescription medications, as well as illegal drug use, affect the way your body processes and perceives painful stimuli. Opioids, often prescribed for pain, usually have a strong “gate-closing” effect. However, overusing opioids can cause a rebound effect and increase pain sensitivity over time.
• Central sensitization. People with chronic pain often experience heightened pain responses to nearly everything. If you live with chronic pain daily, your nervous system develops an abnormal response to everyday stimuli. Clothing may hurt, and walking may be too painful to bear. In other words, things that seem innocuous and theoretically shouldn’t be perceived as painful are the reality for those with conditions like rheumatoid arthritis or fibromyalgia. In these disorders, the body’s pain gates are left wide open, often requiring medical assistance to shut down again.

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There are other proven differences in how individuals perceive and respond to pain. Devising a “one size fits all” approach simply would not, and does not, work effectively.

How has this changed how I practice today?

The past year while working on this blog, I started writing a book about disorders that have their basis in the brain and the rest of the body. I have learned a great deal, making me a better physician. My initial consultations with patients have taken a much more comprehensive approach to mental health and overall health. Let’s face it, if I cut off your head, could you continue to function? Obviously, not. So, to only consider mental health at the expense of overall health makes no sense. I started practicing more holistic psychiatry. To that end, my new approach to evaluating and treating psychiatric issues (which most always include overall health issues) is the following pneumonic: MENDS.

• M stands for medication. Is medication appropriate to resolve a patient’s symptoms? If so, what is the evidence to support that decision?
• E stands for exercise. In a previous post, I wrote about the mood-elevating effect of regular exercise. It is clearly beneficial for overall health but can also change the level of your brain’s neurotransmitters—the chemicals in your brain that are intimately involved in mood and behavior.
• N stands for nutrition. There is a direct connection between your brain and your gut. If the environment of your gut biome is out of balance, it will take a toll on your brain function and vice versa.
• D stands for the Hindu word Dhyana. It means contemplation and meditation. There is abundant evidence to support the use of meditation, yoga, breathing techniques, and exercises such as Tai Chi to improve physical and mental health.
• S stands for sleep. Disordered sleep is connected to multiple health issues, including cardiac, gastrointestinal, and immune health. Improving your sleep will lead to an overall benefit to your health.

Functional psychiatry is an approach to mental health that takes a holistic view of the individual, considering all aspects of their life, including physical health, nutrition, lifestyle, and environmental factors. Functional psychiatrists focus on identifying and addressing the underlying imbalances and root causes of mental health issues to promote long-term healing and well-being. They offer a comprehensive and personalized approach to mental health that can lead to improved quality of life and long-term well-being.

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