Anna Yusim on Humanistic Psychiatry
on the future of mental health
Posted February 15, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Anna Yusim
How might a basic agreement with the current, dominant paradigm of “diagnosing and treating mental disorders” and the application of traditional psychiatric procedures marry with humanistic values and a spiritual orientation? Meet Anna Yusim.
EM: Readers may not know how a psychiatrist is trained or what a “traditional” psychiatrist does. Can you provide a little background on that?
AY: If you would like to become a psychiatrist, first you go to college (4 years), then medical school (4 more years), and then a psychiatry residency (yet 4 more years). And there go twelve years of your life! It had better be worth it. Rest assured: it is. Once you finally reach the proverbial light at the end of the educational tunnel, you are equipped with the knowledge and skills to help people in a most profound and meaningful way.
For myself, being a psychiatrist gives me a privileged glimpse into people’s inner worlds. I become the bearer of secrets revealed to nobody else, that which remains when the ticking clock of daily life pauses for breath between seconds. This work comes with a huge responsibility, at times forcing me to stand at the precipice of life and death with a suicidal patient. Knowledge and training can certainly prepare one to better heal others, but the true work of healing comes not from the mind, but from the heart and soul. In a room with my patient, we are two souls connected in a mission of growth, healing and transformation. This is not purely cerebral work—this is deeply intuitive work of the soul. For me, my work is much more than a profession; it is a calling.
EM: What does the residency training of a psychiatrist entail?
AY: During residency, you see people dealing with every kind of psychiatric issues, from the homeless 60-year old woman who has had schizophrenia for the past 40 years to the 21-year old college athlete plagued by depression and anxiety after his girlfriend breaks up with him. In treating these patients, you learn about all the different treatment modalities available to your patients, which includes both medication and therapy. You learn about possible medical causes of psychiatric illness, such as low B12 levels contributing to depression or trouble with concentration, or thyroid abnormalities leading to fatigue, weight gain and anxiety. You also learn about lesser known psychiatric treatments like brain stimulation (ECT, TMS or ECS), light therapy for seasonal affective disorder (i.e., when people get depressed in the winter), ketamine therapy for treatment-resistant depression, and sometimes even brain surgery for very serious psychiatric illnesses, such as severe obsessive compulsive disorder. You also learn about the importance of a having a balanced diet, restful sleep, regular exercise, a healthy social support system, and a sense of purpose/meaning in your life. All of these are crucial for sustained mental and physical health and well-being.
The Western medical model is based on the gold standard of science: a double-blind, placebo-controlled medical trial. These trials evaluate the effectiveness of a certain type of therapy (like cognitive behavioral therapy) or medication (like Prozac) for a given condition (like depression). Once several such trials have been completed, the results of all the data are pooled into a "meta-analysis" to reach the conclusion of whether a given intervention is indeed effective. Based on these conclusions, standard treatment protocols and recommendations are then created for all doctors to follow. When the state of the science changes (such as when a new drug is found to be more effective for treating depression than Prozac) the treatment recommendations change according. With science being the currency of truth in the Western world, everything we learn in residency is grounded in solid scientific evidence and the latest advances in science and medicine.
EM: You see yourself as a “humanistic psychiatrist” or "spiritual psychiatrist." Can you explain what you mean?
AY: Relative to my colleagues in the field of psychiatry, I work with my patients in a unique and unusual way. In my own life and in my work with over 1,000 patients in my private practice in New York City, I learned something very important about the healing process: a complete healing frequently requires a spiritual outcome as well as a clinical outcome. I seek much more than bringing my patients "into remission" and temporarily alleviating their pain and suffering. What I seek is a complete healing for each and every one of my patients. While I learned a great deal about the healing process through my training at Stanford University, Yale Medical School and the NYU Psychiatry Training Program, this important lesson was never taught in medical school or residency.
In addition to being a psychiatrist, I am also a deeply spiritual person and incorporate principles of spirituality into my psychiatric practice. Seeing oneself as connected to something greater than oneself, a loving energy that always has our back, is a very powerful tool for healing, guidance and transformation. It is the tool that has helped me to change my life and a tool I employ to help my patients change theirs. In this way, I stand at the interface of two often contradictory worlds: the world of science and the world of spirit. Some of my patients are atheists and/or have no interest in spiritual principles, which I certainly respect. Others find these principles a source of guidance and a new way of seeing the world; the principles resonate with them. This work with patients is not meant to evangelize or preach a specific religious or spiritual philosophy. In contrast, it appeals to the spirit within all of us, the divine soul that is our birthright and our greatest source of guidance once we know how to access it. In my work with patients, I have found that integrating the Western medical approach with a spiritual approach is important for complete healing.
EM: Can you describe what you mean by appealing to people's souls and engaging patients on a spiritual level as a psychiatrist?
AY: Our soul is the blueprint we bring into this world of how we are meant to grow, change, evolve, transform and meaningfully contribute to humankind over the course of our lives. It is what some call our "divine essence," that which connects us to something greater than ourselves and, at the same time, to the deepest part of who we are and to each other. Once we learn to hear our soul's whispers and uncover its deepest longings, it will guide us to a life of meaning and fulfillment. Physician and humanist Albert Schweitzer writes, "No one can give a definition of the soul. But we know what it feels like. The soul is the sense of something higher than ourselves, something that stirs in us thoughts, hopes, and aspirations which go out to the world of goodness, truth and beauty. The soul is a burning desire to breathe in this world of light and never to lose it -- to remain children of light.”
In my initial evaluations with patients, I am looking for their souls to emerge. I want to understand why they have come to see me at this point in their lives, on this very day, under these very circumstances. I seek to genuinely understand what is troubling my patients on the most basic existential and human level. I want to know their deepest desires and greatest fears, what makes them laugh, what makes them cry, what bores them to tears, and what keeps them awake at night. I want to know what they would be doing with their lives if nothing stood in their way and the world was their oyster. Usually, the world is their oyster; they just don't know it yet.
EM: You talk about connecting to something greater than yourself and being open to spiritual guidance. What exactly does this mean? How do you apply this principle as a psychiatrist?
AY: Albert Einstein said, "The most important decision we make is whether we believe we live in a friendly or hostile universe." Becoming open to spiritual guidance in a friendly universe is a powerful catalyst for growth, healing and transformation. One form such guidance can take is through synchronicity, a term coined by Carl Jung to describe the occurrence of two significant but seemingly unconnected events that are particularly meaningful to the individual experiencing them. Synchronicity may present itself as a meaningful coincidence, a feeling of déjà vu, a powerful dream, a strong intuition, a gut feeling, an instinct or impulse, or even unexpected thought, among many other possibilities. The presence of numerous positive synchronicities in close temporal proximity to each other may be the Universe's way of signaling to you that you are moving in the right direction in your life. In contrast, when there is a series of negative synchronicities -- when something repeatedly fails, often for nonsensical reasons, despite your willful and concerted efforts, or a number of negative things happen to you, one after the other, the guidance from the Universe may be, "Change course! You're going the wrong way!"
EM: What are your thoughts about psychiatric medications? How do psychiatric medications fit in with soul work and spirituality?
AY: A disconnection from one's soul may present in many ways: anxiety, depression, obsessions, excessive worrying, suicidal thoughts, self-harm behaviors, psychosis, mania, addictions, and phobias, among many other presentations I may see in my medical office. Traditional medical and psychiatric practice may attribute the above symptoms or illness to chemical imbalances in the brain that need to be fixed with medications. A deficit in serotonin leads to depression. Prozac increases serotonin and so cures depression. It's as easy as that. Or is it? In many cases, although medications can treat the symptoms resulting from a disconnection from one soul, they rarely treat the underlying etiology, which is the disconnection itself. Only by looking inside oneself and aligning with the deepest part of yourself can you address the root cause of the problem instead of the effect.
In my medical practice, only about half of the patients I treat are on medication, which is a relatively low percentage for a psychiatrist. For certain patients, however, medications are a lifeline without which they feel they could not survive. Soul work is hard to do, even impossible, if you are so depressed that you cannot get out of bed, or so sleep-deprived from insomnia that you can barely function, or so anxious that you cannot leave the house, or in an opiate withdrawal so painful that you don't know if you will even survive the day. Engaging in soul work is necessary for complete healing, but it is predicated on first being able to function in this world. When clinically indicated, psychiatric medications can sometimes be the very tools that allow one to emerge from the darkness.
EM: What kinds of patient come to see you? Can you describe your work with patients?
AY: Often times, a patient will come to me in a time of great darkness in their life. Something precious has been lost, whether it be a loved one, a job or even one's health. Perhaps one day they awaken with a new realization that they have been living their life all wrong up to this point. Others may have been silently suffering with a set of symptoms -- insomnia, fatigue, anxiety, deep sadness -- and one day the pain and suffering just becomes too much to bear. As I sit with my patients, seeking to decipher their inner code -- what makes them tick, what brings them joy, what causes them pain -- I feel more connected to my soul's purpose than I do at any other time in my life. It is deeply fulfilling to watch my patients gather the courage to make real and lasting changes in their lives, to release the self-destructive tendencies and choose to live more fully and completely, to heal, grow, transform and align themselves with the deepest part of themselves.
With the societal stigma that still exists around seeking out psychiatric services, when somebody walks through the door of my office for the first time, I know that they are carrying many layers of pain and suffering that must be uncovered and understood. Studies have found that the average person will struggle with a given symptom for at least six to ten years before seeking mental health treatment. This is six to ten years of potentially unnecessary suffering. So when a patient does finally walk through my door, it is a huge opportunity and a big responsibility. In my work with patients, I try to steer my patients away from medical nomenclature and complicated diagnoses that can dehumanize and alienate. Instead, I get their souls on the table, as that is where the true work of healing begins. No matter what a patient's presenting symptoms, they are human beings with a soul that needs to be engaged deeply in a treatment if the desired outcome is complete healing.
EM: How can patients learn more about you and your work?
AY: I have a full-time private practice in psychiatry in New York City. I am also making a film and writing a book on the intersection of psychiatry and spirituality. For more information, please visit my website, www.annayusim.com.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
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