Physicians and nurses are servants of the highest order. On completion of medical training physicians take the Hippocratic oath and nurses take the Nightingale Pledge. In reciting these sacred vows, we take on the mantle of healer, we dedicate our careers to the alleviation of human suffering. Since the beginning of recorded history, a shared conviction among healers trained in disparate traditions has led to more effective, safer and more compassionate ways to care for the ill. In Western biomedicine we often use the words ‘disorder’ and ‘treatment’ to describe ideas and techniques that often mitigate symptoms but seldom address the root causes of suffering. In the Western tradition patients are not regarded as people but as carriers of disease. One of the great luminaries of Western medicine, Sir William Osler, said
“The good physician treats the disease; the great physician treats the patient who has the disease.”
When you encounter each patient as a person you will see their symptoms more clearly. This practice will deepen your understanding of the nature and causes of suffering; it will call on your analytical judgement and intuition, and achieve better results than the converse approach of seeing a patient as a gathering of ‘disorders,’ diagnostic codes or entries in an electronic medical record.
The concepts and techniques of integrative medicine in mental health care provide answers to widespread dissatisfaction among the general public, patients, physicians and nurses over the inadequacies of the current model of care and the limited effectiveness and safety problems of conventional treatments. Integrative psychiatry is essentially the judicious use of modalities from conventional biomedicine and alternative approaches—i.e., all approaches that do not conform to the narrow purview of contemporary biomedicine. Integrative medicine—and by extension, integrative psychiatry—is personalized medicine, because its principal objective is to identify those approaches most suited to the history, symptoms and preferences of each unique patient. Emerging findings show that integrative care yields better results than so-called ‘standard care,’ is arguably more cost effective and personalized, and results in greater patient and provider satisfaction. In the coming decades integrative psychiatry will gradually eclipse the current model of mental health care, more so in developed world regions. Future commentators will remark on psychiatry as practiced today as informed by the hegemony of the pharmaceutical industry and naïve, simplistic understandings of the complex causes of mental illness. Seen from the lens of future science contemporary ‘biomedical’ psychiatry will be regarded as anachronistic—and a deeply troubled period in the history of medicine.
We are living in unprecedented times. The Covid-19 pandemic has resulted in a dual crisis in public health and the economy that is affecting hundreds of millions of people. As I write in September 2020, U.S. fatalities have just passed the 200,000 mark, there is still no coherent national initiative addressed at prevention or risk mitigation, and a second possibly more virulent wave could befall this and other countries within weeks. The magnitude of the crisis seems to be increasing daily and some TV pundits warn that the pandemic and the economic crisis will become the ‘new normal.’ If such prognostications turn out to be even partly correct you will soon be facing complex challenges that physicians, nurses and institutions of medicine have never before faced. You will be called on to be both compassionate and creative, to come up with innovations just to get the job done—namely, providing care that is effective, safe, and available to uninsured and low-income patients. The concepts and practical tools on integrative psychiatry will help you to navigate these challenges relying on your expert knowledge in integrative psychiatry and a rigorous systems approach to personalized medicine.
In my 30-year journey as a physician I have found that my patients are often my ‘best books’ through words, gestures or shared silences. When you sit with a patient there is an opportunity for an encounter—listening with both heart and mind—paying attention to spoken words while honoring your intuition. Always remember, as physicians and nurses our sworn sacred duty is to care for our patients in the name of alleviating suffering. In doing so you will see each patient as a person, you will be more compassionate and your understanding of the causes of suffering will be deeper. This is the difference between ‘treating’ a patient and guiding a person toward ‘healing.’
James Lake, MD