The First Consultation
In the August TLC issue, this column asked, “What is the mind?” One of the main points was the distinction between the mind and the intelligence. Now we begin to examine how psychiatrists can utilize the answer to that question during the first meeting or consultation with a new patient. This article focuses on suggestions for a new kind of psychiatric evaluation, which includes spirituality.
If you were to take 30 seconds to watch your mind and observe its activities, you would have no problem watching the stream of thoughts. You are capable of observing your mind. But, who is it inside of you who says, “My mind is driving me crazy.” The “you” that can watch the mind is the “Intelligence.” Deeper levels, such as the soul or spirit, are also capable of watching the mind (and intelligence). If you can watch your mind, you “are not” your mind.
The average person's mind churns out 5,000 random thoughts a day, 35,000 per week, and 1.8 million per year. A person who lives 80 years will have churned out approximately 125 million random thoughts. The faster the speed of the mind, the more stress and mental suffering an individual faces.
The mind's main activities are: comparing, contrasting, judging, separating, and being vigilant. The intelligence is more “who we are,” closer to our deepest, true nature. The intelligence has the job of wisdom, discrimination, and problem solving. When we are centered in our intelligence, we feel connected to ourselves, Nature, others, and God. When the mind has too much control, we feel separate, isolated, anxious, and depressed.
The mind is in control of most of us. It is as if the mind wraps itself around the intelligence. The mind can be trained, so that it becomes the servant of the intelligence, and the soul, spirit, or atma. My job is to help my patients turn their mind into the servant of their intelligence. If we don't accomplish that, we are slaves of the mind. For millennia, spiritual seekers and prophets have developed various techniques to help weaken the grip of the mind, and to empower the intelligence.
One model of the human being views us as having 5 layers, like rings of an onion or sphere. The soul is at the center. The layers surrounding the soul are: the bliss layer, the intelligence, the mind, the energy body, and the physical body. The soul is like the sun, and all the other layers are like clouds that block the light of the sun. There is nothing wrong with any of these layers, but we can choose to identify ourselves with one layer or another.
Most of us identify ourselves with the outer 3 layers — physical body, energy body, and the mind. To become more peaceful and connected, you want to empower the intelligence, and engage in practices to weaken the grip of the mind. I believe that psychiatrists, the medical experts of the mind, need to assist people with this task.
At times, all the layers peel away, and we experience ourselves as pure spirit. The person having a genuine mystical experience is experiencing himself as spirit, experiencing himself as being one with all beings, nature, and God/Goddess. Psychiatrists need to be educated about the mind, intelligence, the soul, spirituality, and consciousness. None of these words and concepts are easy to define, but the task of understanding them is essential.
Spiritual Beliefs in America
In 1987 the National Opinion Research Center of the University of Chicago found that 67 percent of Americans have experienced extrasensory perception, 42 percent have had contact with the dead, 29 percent have had visions. Polls in the late 1980's showed that: 43 percent of us have had an unusual spiritual experience; 15 percent of us have had a near-death experience . . . and 23 percent of us believe in reincarnation. According to a 1976 Gallup poll, 94 percent of us believe in God, 90% of us pray.
One survey reported that 33% of Americans have had a life-changing or mystical religious experience, during which their identification with the mind, body, and intelligence fell away. A mystical experience is one in which we are fully identified as being spirit, and the impact of the mind is zero.
A recent study reports that 60% of Americans believe in angels. A 2001 Gallup Poll showed that: 54% of Americans believe in psychic power or spiritual healing or the power of the mind to heal the body. 28% of us now believe it is possible to communicate with the dead.
Whenever a patient shares with me an unusual or spiritual experience, they are usually sharing something private, and immensely meaningful to them. It is highly unlikely they will share these important experiences with a doctor if they sense that it is not going to feel safe to talk about.
What I've shared so far is not the standard kind of issues you would share with a psychiatrist. Psychiatrists trained over the last 20 years spend almost all their time prescribing medications, and then referring their patient to a counselor of some sort'——“it that is required.” Research done since 1975 has shown that the combination of medication and counseling is better than medication alone.
New Job Assignment
How a psychiatrist gathers information, takes a history, makes an initial connection, and begins to make a diagnosis will set the stage for success or failure.
Here are some recommendations to psychiatrists for the first meeting:
1. Take a complete history that involves every aspect of a person's life.
2. Understand that sometimes we work with biological mental illness, such as schizophrenia and bipolar illness, and sometimes we are dealing with emotional pain that we should be slow to label. It is my experience that nearly all the major mental illnesses require strong medication.
If the person is psychotic, treat with medication. If a person is sad, upset, depressed, anxious, or stressed out, medicate only if the degree of suffering is at an emergency level. Otherwise, slow down, get to know the whole person, which includes understanding how his or her symptom fits into his entire life, and what role his family is playing (for better or worse).
Understand that “feeling depressed” can have a dozen causes. Feeling depressed, in-and-of-itself, is not justification for diagnosing clinical depression.
3. Take a history that includes physical problems or symptoms from head to toe. Psychiatrists, who all went to medical school, treat from the neck up. They will evaluate the thyroid gland, which is in the neck. Not all emotional problems originate in the brain.
If you have adrenal exhaustion, you are probably depressed (and exhausted). If you have chronic digestive problems, most likely you don't break down and absorb the food you consume at a 100% level. Maybe you don't have the right balance of amino acids in your body for your brain to build all your neurotransmitters.
4. Seek to understand the basic personality makeup of the individual. All of us have a personality. All of us have strengths and weaknesses. As part of personality assessment, determine if this person is mainly an optimist or a pessimist. If she is an optimist, your job as a doctor is much easier. Chances of success are much greater.
5. Identify the patient's sense of purpose, passion, and meaning in life.
If s/he has no passion or purpose, one of the most important things a psychiatrist can do is start the process of finding purpose.
If life is like a horse drawn carriage, the horse is your sense of purpose, and the carriage is the rest of your life.
If purpose is strong, the horse will pull your life ahead, and you just need to go with the flow.
If you feel no sense of purpose, your life is a carriage with no horse. In that situation, it takes enormous effort to get moving, or to get anything done.
It is also nearly impossible to be happy on a prolonged basis if you have no purpose.
6. Take a spiritual history. Here are 24 questions that most psychiatrists are afraid to ask:
1. In what religion were you raised?
2. What religion are you now?
3. Do you believe in God or a Higher Power/Intelligence?
4. Is God an important part of your life?
5. Is S/He nearby or far away?
6. Is there life after death? What is it?
7. Do you pray or meditate? If so, how often?
8. What do you call God?
9. Have you had any experiences in life that you couldn't explain? Have you ever known things that you simply had no way of knowing?
10. Do you go to church, synagogue or some other organized religion? If so, how often do you attend?
11. Is God a man or a woman? Or both? Or neither?
12. Does God listen to you?
13. Are you and God on good terms?
14. Does He or She scare you? How do you feel about God?
15. Do you deserve God's love?
16. Is God critical, watching every move you make, and looking for mistakes?
17. Is your idea of God “Infinite Intelligence?”
18. Have you ever had a mystical or spiritual experience?
19. If so, how has that experience affected your life?
20. Do you believe there is a heaven or a hell? If so, where do you believe you'll be going?
21. Do you have any particular spiritual practices?
22. If you met God, what would you ask for?
23. Do you believe in miracles? If so, do you deserve a miracle?
24. What is your purpose or passion?
So far, I've talked about God and purpose, and I still haven't used the word “Paxil.” I haven't written a new anti-depressant order in at least 5 years.
With a holistic (body, mind, intelligence, spirit) approach, along with a doctor bag full of strategic techniques (meditation, guided imagery, breath work, trauma release work) . . . and nutritional approaches — I have not needed to resort to medications.
Up until 1998, when I left hospital psychiatric work, I was working with people with much more severe mental problems than I now deal with.
I've treated hundreds of people who have attempted suicide, and in those situations, a psychiatrist has to jump in quickly and do whatever is necessary.
A psychiatric emergency is just as real and dangerous as a surgical or medical emergency. I now work more with the walking wounded, and far less medication is required or appropriate than when treating psychiatric emergencies.
The fact that I prefer not to prescribe meds, especially anti-depressants, does not mean I am opposed to them. We just need to be more careful about how and when we use them.
Before a psychiatrist plunges into treatment, he will be most successful when he has the most complete picture possible, which means embracing spirituality, and also knowing how to differentiate a miracle from madness, and the mystic from the schizophrenic.
While evaluating a person's symptoms in this comprehensive way, there are several key attitudes for a psychiatrist to maintain:
1. Be open to the unexpected. Create a safe space in which “anything” can be said. Be ready to hear things you have never before encountered.
2. The reason your new patient thinks she is there (depression, hives, insomnia, or any other symptom) is the tip of the iceberg.
His or her symptom is what lit the fire that brought her to your office. You're about to embark on a healing journey together . . . if patient and psychiatrist allow and want that.
3. Be okay with saying, “I don't know,” words that doctors are afraid to say. Doctors have taken on the burden of thinking they have to know everything, have a good answer for every question, and always be ready to “Do something now!”
Doctors feel obligated to write a prescription for nearly every patient visit, because . . . he is supposed to do something. Healing is about “being” and “doing.” The first consultation is mainly about being and connecting .
4. Remember that you are always dealing with another person, and not merely his or her diagnosis.
5. Unless the diagnosis is quite obvious, take your time, get to know the whole person, and be slow to diagnose and label.
When a psychiatrist meets a patient for the first time in this way, open to hearing anything, the healing process begins. At the end of the first session, the most important thing is that my patient walks out the door with a sense of hope.
Hope alone will help the process of transformation begin, long before either of us knows where the healing journey will take us. In the next issue, we'll explore the “how-to” part of spiritualized psychiatric psychotherapy.
David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com.
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Fear Getting in Your Way?
Is fear getting in your way? You, like many, may be harboring vital plans you haven't yet accomplished.
These could range from gathering courage to ask your boss, mate, or friends for better treatment – to changing course with a different profession, new location or extensive business promotion. Months and years go by. You're still stuck –yearning for change — but too scared to move forward.
Finding the guts to go for it is a real challenge.
Here's the tip. First, ask yourself why you want this change. Make a list of all the reasons this is important for you. Imagine what life would be like – how happy you'd feel — with this change in place. Once you've determined this aspiration reflects your deepest truth, make another list of support you'll need. Be precise about the emotional, financial and/or physical back up required. Plan carefully how to get it.
Next, make friends with your fear. It's not going away. Feel how it feels. Ask what it needs. If it's freezing or numbing you, seek professional help to restore feeling.
Stay away from caffeine, sugar and alcohol as they can increase anxiety. Recheck your support list for mistakes or additions.
Remember, if you wait until there's no fear, you'll be waiting forever. Fear is a normal part of living full out. Finally, take a breath, feel your fear and do what you're now really ready to do. ©
Penelope Young Andrade, LCSW www.penelopetalk.com Call: 858-481-5752 fax: 858-484-8374 email: firstname.lastname@example.org
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