Most Popular Choices
Share on Facebook 214 Printer Friendly Page More Sharing

Integrative Mental Health and Health Care Reform

By       (Page 1 of 1 pages)   1 comment
Follow Me on Twitter     Message Lewis Mehl-Madrona
Become a Fan
  (35 fans)
A recent conference in Arizona on Integrative Mental Health highlighted how poorly our current mental health care system is working. The conference was full of passion for changing our system and for incorporating nutrition, exercise, yoga, and psychotherapy into our work to improve effectiveness. More time with people is necessary and health care reform needs to reimburse that time. Indigenous mental health ideas show us that the community is more important than our Western model ever realized as are our social relations.

Amidst the drama of the passage of health care reform (as minimal as it was), the high point of my health care week was attending the University of Arizona's conference on Integrative Mental Health at the Biltmore Hotel in Phoneix, Arizona. What opulence and luxury! What amazing photographs of Arizona and its afficionados of the 1920s and 30s! Coupled with photographs of its architect, Frank Lloyd Wright, pre-war women uniformly hatted and sitting around the swimming pool in full regalia, scenes of the hotel's construction set in an empty desert, and photos of U.S.Presidents since before Roosevelt, over 700 people came together to consider what integrative mental health care should be.

On our way to dinner at Andy Weil's newest venture, True Food, I marveled at how the desert had changed since the Biltmore was built. Empty desert has been replaced by condominiums, golf courses, mansions, and manicured lawns. Phoenix has far exceeded the capacity of the land to sustain it. Eventually this harsh reality will catch up to its ever expanding population.

The conference was fabulously replete with interesting speakers. Many people were turned away because of the lack of further capacity to accommodate registrants. Apparently reforming contemporary mental health care is an idea whose time has come.

The conference was initially funded by the Ted and Dr. Roberta Mann Foundation of Minneapolis, Minnesota. At the speaker's dinner on Sunday night, I was privileged to meet the Manns and to sit at the table with some of their board members, along with my good friend, Anne-Marie Chiasson, who teaches energy medicine for the Arizona Center for integrative Medicine and manages their medical student programs. Anne-Marie is a member of our Coyote Institute's Board of Directors and it was fun to catch up and to plan our next Mexico caper in January, 2011, when we will again mount a week-long healing camp for learning about and from traditional healers.

I was thrilled to have been invited to talk about indigenous models of mind and mental health and to do a Tuesday evening ceremony. I will highlight my presentation after discussing some of the other talks that I was able to attend. There were too many concurrent sessions to hear everyone, and, in these situations, I usually attend the talks of those I know best to show respect, to show support. I know others who prefer to attend the talks of those they don't know so as to make new connections. I suspect that it is an indigenous tendency to show solidarity with those we already know.

Dr. Victoria Maizes began the conference with introductions and thank yous. I have known her since 2001 when I started interacting with the Arizona Center, and was happy to see her again. We hadn't been in the same room since I left for Saskatchewan in the summer of 2005. Then came Andrew Weil, who needs no introduction, having graced the cover of Time magazine twice and being a regular guest on Larry King Live. Andy, whom I have known for over 20 years, brilliantly summarized the purpose of the conference as creating a vision for a new, integrated mental health arising like the phoenix from the ashes of our contemporary Western system, which isn't working. People continue to suffer. Despite enormous expenditures (mostly on pharmaceuticals), people given the diagnosis of schizophrenia, faire no better today than they did in 1905. Two meta-analyses have recently shown that antidepressants are no better than placebo for depression despite their widespread use and costliness. Sole reliance on a biomedical model for mental health is not working. These insights have been well described in many sources (Whitaker's book, Madness in America, for example), but Andy summarized them in a convincing and powerful manner. Next came Dr. Krasniack, former Chair of Psychology at the University of Arizona in Tucson who offered the science behind Buddhist meditation, his preferred personal practice. As his presentation so aptly demonstrated, the science exists to support Buddhist meditation as a souce of healing for suffering. He compared cognitive behavior therapy with the awareness of the Four Noble Truths, all of which tell us that it is our attachment to particular outcomes or events that explains our suffering, little else. We either want what we don't have or don't want what we have, but either way, dwell the gap between where we are and where we wish to be to the detriment of our lives. He was also quite convincing. Next came Dr. Bernard Biteman, who talked about the healing power of psychotherapy and the common factors inherent in the psychotherapeutic relationship. His insights were similar to the views of the elders whom I have documented. I spoke next and will summarize my presentation at the end.

Following a discussion session among us and the audience led by Dr. Weil, we heard an overview of the science behind integrating CAM (complementary and alternative medicine) therapies with psychiatry which was given by Dr. James Lake, another friend of mine. James lives and practices in Monterey, California, and was until recently the Chair of the American Psychiatric Association's Caucus on CAM in Psychiatry. I was convinced that good evidence existed for some nutritional therapies and for Chinese Medicine (though I had been convinced before the meeting). Then I heard Dr. Charles Popper speak about high-dose, high-potency vitamin therapy for bipolar disorder, which was exciting since I do this as well. It always feels better when someone else confirms independently what we believe. Then I had the opportunity to be interviewed by my colleague and fellow Lakota, Dr. Tierona Low Dog, the director fot he Arizona Center's Fellowship program for practicing physicians interested in integrative medicine. The interview was for their new web-based course on spirituality. My day ended by listening to Dr. Jon Kabat-Zinn, also a long acquaintance, talk about his research on mindfulness meditation in medical settings. I have long been impressed with his work and have attempted to bring mindfulness meditation into the settings in which I work.

On the second day of the conference, I heard an amazing talk by an NIH scientist on the benefits of omega-3 fatty acid. I had already known that EPA (eicosapentanoic acid) was the main ingredient needed by the brain even though DHA (the other prominent omega-3 in fish oil) has the highest concentration in the brain. We saw convincing evidence for EPA's role in reducing violence in jails and prisons, for improving attention, for reducing psychotic statess, for preventing schizophrenia, and more. I also learned more than I had previously known about the detrimental effects of soybean oil, which has come to be 18% of the American diet in one fast food form or another. We learned that vegeterians have great difficulty obtaining omega-3's, since they can't be synthesized to any degree from other fatty acids and vegetables don't have the omega-3's needed by our brains. Then Dr. Lake, Dr. Pam Pappas, a homeopathic psychiatrist from Scottsdale, Arizona), and a physician from Jefferson Medical College in Philadelphia discussed how to manage an integrative mental health practice, hopefully profitably. Amy Weintraub, with whom I used to share patients in Tucson, and the author of Yoga for Depression, talked about (obviously) the benefits of yoga for mental health. Studies continue to accumulate to support those practices.

What was so exciting about the conference was not the information presented, but the passion with which people came together to envision a different system for mental health care than what we have today. Information comes and goes, but passion matters. In that conference, we had the passion needed for change. What will happen next is anyone's guess, but we were united in our belief that the current reliance on medications is not reducing the suffering that people feel. We need more human interaction. We need more community, more time to spend with people, and different ways of gettng reimbursed that honor time with people instead of drugs. We need to be able to improve people's nutrition, provide vitamin and fish oil supplementation, do yoga, meditation, chi gong, and offer more types of psychotherapies than we currently do. The world's traditional medicines also have much promise.

My presentation explored indigenous models of mind and mental health, particularly the model of the Lakota people, which I have explored perhaps the most extensively, though most North American ways of seeing mind and mental health are similar. Across North America, we find the concept of relational mind that mind itself is created through relationship and that we are the totalization of all of our relationships. Within these views, the community is the basic unit of study, and not the individual. Individuals are seen as canaries in a "social mine," becoming ill in service to the entire community. One person's illness is sign that the entire community is ill. When one is sick, all must come together to help heal that illness.

I discussed the Lakota concepts of the dimensions of mind: nagi, nagila, woniya, and sicun. Nagi is the closest that Lakota comes to the English concept of mind. Nagi is the totalization of all beings who have contributed to you and all the stories that have formed you and are living through you. Nagi is like the biological concept of swarm. It is a swarm of beings and their stories that surround you and make you who you are. Nagi is your legacy. It is most similar to the European philosopher, Mikhail Bakhtin's, concept of relational mind. Bakhtin spoke about the mind as a "cacophony of different voices,each vying for supremacy, each taking charge at one time, and acquiescing at another time. Nagila is the divine spark within us and the part of us who resides in the spirit world. Woniya is that which makes our blood go around and around and makes our air go in and out. Sicun is our presence, what is left behind when we leave a room.

The importance of concepts such as these is that they show us an entirely different view of mind and mental health than those of the standard, Western world. If we are working within these concepts, we must work much more with community-based interventions and the social relationships of those who have mental illness. Human contact becomes all the more important. I will write more about this in future articles.

Supported 1   Inspiring 1   Valuable 1  
Rate It | View Ratings

Lewis Mehl-Madrona Social Media Pages: Facebook page url on login Profile not filled in       Twitter page url on login Profile not filled in       Linkedin page url on login Profile not filled in       Instagram page url on login Profile not filled in

Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
Go To Commenting
The views expressed herein are the sole responsibility of the author and do not necessarily reflect those of this website or its editors.
Writers Guidelines

Contact AuthorContact Author Contact EditorContact Editor Author PageView Authors' Articles

Most Popular Articles by this Author:     (View All Most Popular Articles by this Author)

Drug Abuse Prevention; Why do the American media avoid discussing research findings? (22738 views)

Day 12 of the Australian Journey (13740 views)

To Do and Not To Be (11648 views)

Narrative Concepts (11331 views)

The Inflammatory Theory of Depression (10629 views)

Pain, Part 2 (9828 views)

Total Views: 79914

To View Comments or Join the Conversation:

Tell A Friend