Philosophy and Focus of Treatment

I follow an evidence-based practice, but also recognize the inadequacy of the current scientific research model to explain complicated mind-brain phenomena. Generalizability of findings from ideal study populations to the individual is also quite limited and not always apparent. I stay up-to-date with findings in molecular biology, neuroscience and advanced neuroimaging that may one day revolutionize psychiatry but that day is probably far in the future. Although I have strong opinions, informed by empirical evidence and clinical experience, about what currently works and what doesn’t, when it comes to theoretical orientation and treatment formulation, I follow scientific model agnosticism. That is to say, I do not confine myself to any one model or particular way of looking at things and I use what works, (which is usually multiple perspectives), with a given patient. Given how much there is yet to discover about the staggeringly complex workings of mind-brain, the last great frontier in science, I think this is the only honest posture to adopt.

Therefore, I use psychoanalytic thinking, CBT, DBT, mindfulness, motivational interviewing, mentalization, attachment theory, epigenetic and biological models, where appropriate, as tools to inform my understanding and treatment of different patients and to meet them where they are. Most importantly, I focus on the patient as an equal and active partner in their treatment. I conceptualize psychiatric treatment as a collaboration involving a process of two people thinking and changing what either alone cannot think or change. Thus, I focus on an alliance that establishes an interaction of mutual involvement rather than mere observation or authoritarian hierarchy.

Overall, I have found medications can be, but are not always a first line choice for the individual. Psychotherapy seems to have gone from being the rule to being relegated to the backburner as drugs occupy an increasingly pivotal role in patient care. I endeavor to find a middle road of plain old therapy, in addition to biological, and holistic treatment methods to help my patients find balance and meaning in their lives and satisfaction in their relationships. I believe the answer to patients’ complex problems lies in a combination of these two models rather than an “either-or” approach.

Additionally, I think of individuals as complex ecosystems made up of various sub systems (mental, emotional, social, spiritual and physical and environmental) that are diverse, interconnected and interdependent. An imbalance in one of these subsystems can affect all other sub systems and reduce over all wellbeing. An antidepressant alone for example cannot hope to cure a person suffering a spiritual crisis or overwhelming loss or someone who is depressed because they have poor physical health, poor stress management skills and a poor diet. Consequently I make sure I address the whole person in context.

In my thinking about patients, I follow the dictum: “all perception is co-creation.” We create the environment we perceive to suit our own dogmas, emotions, and aesthetics. Every nervous system perceives a different universe made up out of some common signals coming to all of us, and most defects of communication, and consequent behavioral and relational problems are caused by the fact that we think everyone is living in the same 'world' as us. When we find out they are not we think they're either 'crazy' or 'evil' or 'mad' or 'bad.'

We live in a world where we are all continually negotiating on behalf of our stories, yearning to be understood. When we realize that each individual is looking through the point of view of their own subjectivity or “reality tunnel” it is much easier to understand where other people are coming from. Then, the ones who do not have the same beliefs, desires, wishes, and motivations as us do not seem ignorant, deliberately perverse, lying or hypnotized by some mad ideology. They just have a different perception than ours and every perception might tell us something interesting about our world, if we are willing to listen and be accepting. It is now a medical truism that one must deal not just with the disease but with the individual that has it and his whole 'world.' This position now known as "the mentalizing stance" is the cornerstone of any healthy interaction between human beings. It is the starting point and orienting guideline of my approach in practice. Thus, I am committed to the idea that each individual is unique and deserves a distinctive treatment plan that maximizes the opportunity for a successful outcome. I find it a privilege to be let into the inner lives of my patients.

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