I came across this small clip on YouTube and thought it was timely for all that is happening in the world now! There is so much confusion about everything that is offered in mainstream medicine.
“To be or not to be…”
Take an antidepressant or not? Take the vaccine or not? Wear a mask or not???
We are living a conflict ridden existence. No wonder, anxiety is so high across all age groups. But, why is there so much confusion?
In this article, I will limit myself to my “lane” – psychiatry and antidepressants. From the beginning of my foray into psychiatry, the specter that these medications are not very effective (or even worse, that they increased the risk of suicide) always loomed. It was acknowledged as a problem for children and teenagers, but not for adults. Every few years, this specter would raise its head (even for adults) only to be squashed down temporarily.
When it happened one too many times, I was forced to take note and do a bit of investigation of my own.
And so I began an informal study of my own. In working with patients experiencing suicidal ideation, I would simply ask for the timeline – when did depression symptoms start, when did they experience suicidal thoughts, when did they start an antidepressant, when was their first suicide attempt, etc. I began to see a trend. Patients reported having mostly hopelessness and passive death wishes (“life is hard, I wish I was dead” or “I wish my life ended”) prior to starting an antidepressant. But invariably after starting an antidepressant, some of them would experience intrusive active suicidal ideas which would translate into attempts on occasion. This was not universal. But, at least, there was a subset of patients, this was happening to.
It became clear to me that I could no longer believe that antidepressants did not increase risk of suicide in adults even though “peer reviewed” psychiatry journals wanted me to think so.
Now, we are seeing new articles point to the phenomenon of AD induced risk for suicide, also in “peer reviewed” journals ?.
Let’s look at another example.
When I started residency here in 2005, I was alarmed to see that opiates were used so freely. Based on my learning and experience in India, where opiates were used only intra-operatively or for terminally ill patients, I was perplexed at first. In various rotations as an intern, I was told that pain is a fifth vital sign and treating pain (with opiates of course) was of paramount importance. I began to observe some patients abusing the system. I was also very worried about the risk of addiction (“iatrogenic” a.k.a. physician or treatment induced) that these patients were being exposed to.
The interesting thing is that I saw the derision that nurses/physicians/interns were having about this (eye roll when a patient complains of pain and asks for more pain meds). It was like an open secret. But why did no one do anything about it? Because “peer reviewed” (or I should say, industry sponsored peer-reviewed) studies were clearly showing that treating pain with opiates was very necessary for the overall recovery of the patient. Also, patient satisfaction reviews were the proverbial sword of Damocles looming over physicians’ heads.
My aim in writing this article is not to dismiss the rigor and science of “peer reviewed” articles. But to alert us all that we must still observe, and especially question, when our subjective experience is pointing in new and interesting directions. We must not abandon our innate sense of curiosity and wonder.
Overall, in line with ecologist Allan Savory’s view point, we have to understand that the existing body of science and knowledge is but a reflection of our times, understanding and tools at our disposal to understand reality, our world and our material existence.
“If you would be a real seeker after truth, it is necessary that at least once in your life you doubt, as far as possible, all things.”
– Rene Descartes, 17th century French philosopher; proponent of mind-body dualism theory.
Imagine the excitement that physicists are now having in mapping the dark matter and discovering new information that dark matter provides the scaffolding for our material universe and finding that Einstein’s theoretical assumptions (including about his famous theory of relativity) are proving to be incorrect! Here’s a BBC article about this new discovery.
In this article, one of the authors of this new research, Dr. Niall Jeffrey, UCL physics and astronomy, told the BBC:
“If this disparity is true then maybe Einstein was wrong. You might think that this is a bad thing, that maybe physics is broken, but to a physicist it is extremely exciting. It means that we can find out something new about the way the Universe really is.”
On the other hand, if we believe too fervently in any concept, we are at risk of being dogmatic, fanatic practitioners of a “faith system” a.k.a. religion. Yes, I would say that a dogmatic practice of medicine is akin to kneeling at the altar of the religion of (pseudo) science.
However, if one remains curious and is guided by observation and subjective (and/or intuitive) experience, we remain open to the truths unfolding as they are. This alone can maintain our enthusiasm and interest in whatever field we are in. Yes, I did say, “subjective experience.” Because, there is no true objective evaluation. Our subjectivity always plays a role. Quantum physicists call this the observer effect.
To be aware of our subjectivity (the observer effect caused by the act of our observation), is to be a conscious observer of life and its mysteries.
An example here…
As I am reading these articles and the description of the dark matter and how it provides the scaffolding for the material universe, I am reminded of Ayurveda’s theory about the origin of the universe.
Ayurveda posits that there was a big bang. After which, the five great cosmic elements (known as Pancha-Maha-Bhuta. “Pancha” – Five; “Maha” – Great; “Bhuta” – cosmic element) were created. The first one being “Ether” or loosely translated as “space.” This Ether is the most basic and most subtle form of matter and cannot be perceived with the 5 senses. But its existence was “felt” or “observed” by the ancient seers of India who wrote down their subjective observations in these ancient texts. Ether then became the “Tabula Rasa” or the empty canvas on which all of creation materializes.
As I read the articles about the Dark Matter, I cannot help but wonder if the ancient Indian seers were in fact calling Dark Matter as “Ether.” This is my subjective experience deepening the understanding of new material I am learning and also coming up with more questions which may be answered by more observations and experiments in the future!
To be ignorant of the “observer effect” is to have blind faith (no pun intended) in concepts such as the “gold standard” of modern medical research, a.k.a. “double blind randomized controlled studies.” Such studies routinely show many drugs to be highly effective for their treated indications but post-market surveillance studies seem to invariable fall short of such expectations and add to the problems of side effects not originally found.
A classic example is that of antacids – one of the most commonly prescribed medications in the US. Double-blind RCT’s clearly showed that antacids successfully reduce acid production in the stomach and that this was the answer for acid reflux. But only post market studies showed the long list of problems associated with them – rebound acid reflux, mineral malabsorption, h.pylori infection, kidney stones and even cancer.
It is this combination of objective and subjective experiences that paved my path towards Integrative Psychiatry.
In Oct 2013, I attended my very first integrative medicine conference (ABIHM); and for the first time in over 13 years of medical education (5.5 years of undergrad education + 3 years of post-graduate education in India, followed by 4 years of residency in US + 1 year of fellowship! Yes, it did take me that long), I learned many concepts related to holistic and integrative medicine.
I still recall the dueling emotions I felt then – exhilaration that I could be a real healer vs the anger that I wasted 13 years in medical education and now, I literally had to start all over again!!! Anxiety as to whether I could do it…and so on.
What kept me going was this:
All this new information simply seemed “just right” to me. It came with a “knowing” that this is the way forward. It was a very personal, intuitive experience at that time. It felt like a whisper from my soul.
BTW, I see this in many people who come to work with me. A couple clients come to mind who decided to stop taking their psych meds, despite pressure, even threats from their previous providers. They just “knew” that this path was not working for them, that there is something better for them, that the way they are feeling on their meds is not how it should be. Or the intuition that guides us in regards to a relationship or a job offer, etc. Of course, this “knowing” or intuition can be enhanced with meditation and self-awareness.
As I pursued education in Ayurveda, I learned that equal importance is given to both subjective and objective experience. For eg: measuring a patient’s blood sugar is an objective experience. On the other hand, I have now learned to rely on my sense of smell to reliably identify (skin and digit) fungal infections in my clients and gut dysbiosis (by the smell of a patient’s breath). This subjective knowing of a fungal dysbiosis is objectively proven by lab tests or by a positive response to recommended treatment.
When I was still new in my transition to integrative psychiatry, I began to apply this new knowledge in a limited way to my clinical practice and saw radical results.
It then became increasingly difficult to stick to the old paradigms that was expected of me within the system I was working in. The internal conflict I began to feel was too much to bear and I had no choice but to make a clean switch to Integrative and holistic psychiatry.
Thus Trinergy was birthed.
The radical transformation I have witnessed in countless patients since 2016, affirms that I need to continue on this path.
Yet, it is not time to rest on this bed!
In the beginning phase of my transition, I began to focus on healing the gut-brain axis and this worked. As I learned more from my patients and kept my eyes, ears and mind open; I began to see trauma (from loving yet misguided parenting, all the way to severe physical/sexual trauma). Now, I have become a trauma informed, a trauma conscious clinician. This has beautifully integrated into the gut-brain axis paradigm as well. As the long term effects of trauma are in fact mediated by stress induced inflammation of the gut lining.
And, this is how it has come full circle for me. But the journey continues with eager curiosity on my part to learn objectively and subjectively from new patients and new experiences!
Viva La Vita Curiosa!!! (Long live curious life!!!)