Mental Health through an Integrated Lens
Seeing people as layered beings
Anyone who has stepped into a meeting with a doctor can attest to a degree of heightened anxiety and wariness. What tests need to be run? What will be the results? How will my family and friends react? What does this mean for my life? It's that last question which eventually seeps into the conscious eye and becomes dominant. Whether the diagnosis is allergies, a broken bone or cancer, the "I" of our personal stories inevitably comes back to center.
Faced with uncertainty, we desire to make sense of what has become our new reality, and reach out to the mechanism whereby meaning is created, our relationships. While this may mean friends or family, as it should, there is also the professional class to turn to. Those who, with the reduction in religious institutional power, have become a secular priesthood to hear our travails, and absolve us of our concerns. As with their religious forebears, therapists also come with assumptions about the nature of humanity, the role that discomfort plays in our lives, and how change is best sought.
These assumptions, rarely carefully articulated, and particularly related to the relationship between mind and body (if indeed the two are even separate), inform the therapeutic interventions. Despite the prevalence of a so-called ‘medical model’ concerning mental pathologies, very few mental health professionals have any education concerning medicine, despite how medical issues may contribute to or even largely define the mental/emotional difficulty currently being experienced.
One perspectival lens to approach mental health care is that of an integrated one, where the multiplicity of a person’s life is taken into considerations as having variable influences. Rather than disorder-first thinking, the question of care becomes one of functionality.
Integrated Systems Care
Integrated care is not a new concept, and it’s put into practice in many different ways. The following exploration is just one perspective on it, largely focused on the underlying theoretical structure. Another word commonly used is that of “holistic” and for some, this may immediately set off concerns of delving into airy, unrealistic, woo-woo scenarios. I very much acknowledge the concern. That won’t be happening here.
Consider the shift in how drug and alcohol addiction has been treated over the last few decades. Initially thought to be fully understood as a moral failing, science has brought us a broader understanding of the genetic and biological variables, leading to greater acceptance and a lessening of shame. Think also of the prevalence of psychotropic drugs. While debates exist (and should exist) about their proper usage, there is no doubt that for a great many people, these drugs are the difference between a functional life and one of debilitating emotional/cognitive difficulties.
I was recently at a seminar concerning stress-resiliency. There it was noted caffeine has a half-life of 5-6 hours and any amount still in the system can disrupt the body's ability to go into and stay in deep sleep, the only part of sleeping that is rejuvenating (Preston, 2016). An example was given of a patient who came in for treatment following twenty years of dealing with depression and treatment through various drugs, without a positive outcome. A questionnaire was given concerning caffeine intake, where it was found the man was drinking the equivalent of 13 cups of coffee a day and had been doing so for decades. Over the course of nearly three months, the caffeine was slowly lowered and the result was a near complete removal of depression as sleep became normalized.
Other examples abound, all of them having to do with the intimate connection between body and mind. In my own therapeutic practice, the role of the body often takes center-stage in my questions, where issues of food intake, sleep habits, and physical activity are all considered from a functional perspective. Let me be clear. None of this is to mean that changes to one or all of the above is a “cure” for pathological behavior. The silly memes of curing depression by going for a run are simplistically absurd, but unfortunately are sometimes exactly what people are told.
Bringing focus to physiology is simply a recognition that we are bodies interacting within the world, not minds interacting with bodies. Ignoring the role of the body is like blaming the driver for the car not going when it’s out of gas.
I will add a third component, relationship. In Daniel Siegel's work Interpersonal Neurobiology: "Our mental lives are profoundly relational. The interactions we have with each other shape our mental world" (Siegel, 2012, 04-02). Consider that without the relational connection of the doctor and patient, any solution would not be found. We talk of ‘bed-side manner’ and yet I would say we don’t talk about it enough. Whether a person follows through with intervention strategies, and how a person considers the potential to exist for changing their behavior, is bound to how they relate to the person giving the advice.
Information flows within, between and through the body and mind, but it manifests in the world through relationship dynamics.
Without a theoretical foundation allowing for the integration of body and mind (and relationship), the profoundly unhelpful distancing between the medical and psychological fields will continue. This is not a situation where simplistic declarations of "mind over matter" will suffice. We are not disparate parts, but integrated wholes.
Two systems of care for integrating medical and psychological practices are "Functional Medicine" and "Neurocounseling." As noted above where it concerns the use of the term “holistic,” I’m aware that terms can hide a great deal of absurd unscientific interventions. Seeing people from an integrated lens doesn’t mean anything goes, it just means single-variable cause-effect relationships are rarely the solution.
Functional Medicine
A fuller description by Dr. Will Cole can be found here, with two of the principles provided:
Functional Medicine views us all as being different; genetically and biochemically unique. This personalized health care treats the individual, not the disease.
Health is not just the absence of disease, but a state of immense vitality.
As with any theory, the way it is utilized in practice can vary in degrees of legitimacy. When moving from a restrictive theory of practice, sometimes the next step is to flail about in the new freedom found. There is much discussion and debate ongoing, but important progress is still being made. Treating people as whole persons, not just repositories of particular diseases can help humanize medical experiences. Looking at a good life as not necessarily being absent of suffering, but how it provides the space for change and energetic movement, can help people expand how they express themselves.
From an Acceptance and Commitment Therapy (ACT) view, which is the theory I largely operate from, the central question is one of functionality. What is the purpose of the behavior identified as a problem?
“Conceptualizing clinical cases from a functional standpoint (i.e., looking for patterns of behavior across time and context, including the interpersonal relationship and intrapersonal experience) sets the stage for detecting problematic behavior and intervening in rapid and effective ways, particularly as behavior change is linked to meaningful life outcomes. Behavior tied to its function can be quickly targeted for modification.” (Robyn D. Walser)
We are all attempting to deal with the perceived adversities in our life, both immediate and what we see coming in our futures. Behavior exists in that space of attempting to address those concerns. As such, no matter what it is, there’s always a functional question to explore, and that exploration gets us out of the vagueness that so often exists in counseling, and to more concrete changes to implement.
Neurocounseling
"...bridges the disciplines of counseling and functional medicine by combining physiology, the brain, neurosteroids and behaviors to create a synergy that is more effective than their individual parts" (Russell-Chapin). Benefits include:
Integration of neurocounseling provides additional insight into the physiological basis of interpersonal and therapeutic relationships.
Neurocounseling offers clients a fuller opportunity for personal wellness and intrinsic locus of control through the practice of emotional and physiological self-regulation.
Under the umbrella of neurocounseling, therapists can join with medical doctors, pharmacists and dietitians to treat the whole person. Depression and suicidal ideation can possibly be connected to thyroid problems. Exercise and the types of food eaten help control the types and amounts of neurochemicals being released in the nervous system, leading to variations in mood and thought. Sometimes simply knowing the structure and function of the brain can lead to a greater appreciation for one's struggles with emotions and particular experiences. Biofeedback and mindfulness practices can help with a variety of emotional difficulties and empower people to accept, monitor and regulate their inner lives.
I was at a training where the presenter, during a break from discussing attachment, responded to my question regarding understanding the brain better, that “Brains have nothing to do with therapy.” Suffice to say I was done with the training at that point, though I feel it important to note that the opposite is also not true, where psychology is reduced only to the brain.
Physiology is not just a “brain thing,” it’s every system that is integrated together, where, perhaps, the world as we live in it, and the devices we use, are further extensions of how we relate to ourselves and one another, with unforeseen and not always healthy results. Considering this relational extension is to acknowledge that just as our brains are embodied, so our bodies are embedded in broader systems.
Where to Go From Here
Therapy is first and foremost about meeting the client where they are at. By bridging the gap between the mind and body, by drawing attention to the relationships within and through which we live, therapy can be a system of care that helps hold the whole person while moving forward with greater understanding and acceptance.
Resources:
Preston, John D. February 2016. The Habits of Stress-Resilient People. Institute for Brain Potential.
Russell-Chapin, Lori A. Neurocounseling and functional medicine: How understanding neurosteroids complements our counseling strategies. Counseling Today. January 2016, Volume 58/Number 7.
Siegel, Daniel J. (2012-04-26). The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are (p. 15). Guilford Publications. Kindle Edition.
Siegel, Daniel J. (2012-04-02). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind (Norton Series on Interpersonal Neurobiology) . Norton. Kindle Edition.
Walser, Robyn D.. The Heart of ACT: Developing a Flexible, Process-Based, and Client-Centered Practice Using Acceptance and Commitment Therapy (p. 35). New Harbinger Publications. Kindle Edition.