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 Empty desert has been
replaced by condominiums, golf courses, mansions, and manicured lawns.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.
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