Russell Razzaque on Psychiatry and Mindfulness
On the future of mental health
Posted February 27, 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 Russell Razzaque
EM: You are a trained psychiatrist with an abiding interest in mindfulness. What are the connections between the two?
RR: Mindfulness and the traditional way psychiatry is practiced are really more divergent than anything else. Psychiatry is about removing emotional pain, whereas mindfulness teaches us the value of being present with our pain.
It was through the practice of mindfulness that I started to learn this new perspective and started to relate to my own pain differently. Instead of running away from it, I was taught to welcome it; to befriend it and thus convert it into a source for my own emotional and spiritual growth.
As I conducted my own development this way, I realized that there must be a different way to do psychiatry too. That's when I really started to think about different approaches. Approaches that, while they may involve taking action - even using medication - to help people with the worst aspects of emotional pain, had the ultimate aim of helping people be with their pain as much as possible (& so rely on other treatments less).
This was the way, I realized, that long term healing could be brought about, instead of consigning so many people to the label of "chronic.” A whole new world of possibilities thus opened up, in which psychiatry could become more than just an exercise in pain removal (though it's never really removal because it always comes back), but more fundamentally a way in which people can experience and thus grow through their pain.
In order to do this, however, it would mean the psychiatrist being more able to sit with their own pain first, and so the first challenge was in teaching mindfulness to mental health professionals. From this desire the College of Mindfulness Clinicians was born and now we run retreats every year for health professionals, with excellent attendance and even better results. I published a paper on the outcomes (in terms of improved empathy, therapeutic relationships, and reduction in burn out) last year.
EM: You have an interest in innovative forms of more mindful mental health care. Can you tell us some your thoughts on that and provide us with some examples?
RR: It was the realization that we need a more mindful form of mental healthcare that started me on my journey in the research and academic world. My first port of call was Acceptance and Commitment Therapy. This has some excellent mindfulness based techniques for use in 1:1 therapy and I learnt and did some research around some of these and found they had great effect. The problem, however, was that it didn't have an effect on the wider treatment system. It was a form of therapy, rather than a more widely encompassing model for providing care that addressed the system and the doctor, the nurse and all other members of the team working together.
Then I came across Open Dialogue and it blew my mind. It is a whole system approach to care that resonates strongly with mindfulness. It is about organizing the entire care pathway around a whole social network - rather than just an individual - and the role of the clinician is to sit with them and be present with the what is happening. It puts the service user and their family or network in the driving seat so that they can find their own strength and meaning through the journey, while the clinician facilitates the creation of a safe space to enable that to happen. I have helped organize the first training around this in the UK and set up a few pilot teams across the country that will be engaging in a nationwide research project around it.
EM: You’ve written a book called Breaking Down is Waking Up: The Connection Between Mental Illness and Spiritual Awakening. What were your intentions with that book?
RR: I wanted to write a book that showed people who were suffering with mental health difficulties that there was another way of looking at things. So many people find a spiritual perspective on life as a result of their mental health difficulties, only for that to be ignored, or worse, pathologized by professionals and so I wanted to speak up and say that, in fact, there really can be something profoundly spiritual coming through in the midst of a breakdown.
And it isn't a case of a spiritual experience being mistaken for a psychiatric condition, as sometimes, both can occur at the same time - in fact, in one form or another, they always do. And this happens because I believe emotions take us to the edge of our egoic sense of self, and strong emotions sometimes break us out of that ego shell altogether. And that is both frightening and liberating at the same time. As well as all the pain, great wisdom can be accrued through such experiences too. I thought it was important, as a professional, to write a book about this so others could realize that their intuition around this was valid. And since I wrote it so many people have thanked me for confirming to them what they had always suspected. I'm really glad about the way it's turned out.
EM: What are your thoughts on the current, dominant paradigm of “diagnosing and treating mental disorders” and the use of so-called “psychiatric medication” to “treat mental disorders” in children, teens and adults?
RR: I don't think that the current paradigm has no place or validity. For some people - seeing their experience in those terms and accepting treatment in traditional medical ways is what they want and how they feel comfortable. But if we insist that this is the only way things must be understood and the only way we can help people then we are really going to end up harming a great many people whose own creativity, background and life experience mean that they can understand their issues in a very different way.
Whether that’s a response to earlier stresses and traumas, or more esoteric ways of understanding these things, I believe that it is the duty of the professionals to give people the freedom to find their own way to understanding what's really happening for them. After all, unlike physical health, mental health does not have any objective measures or reliable biological markers, so no scientific/medical person can come in and pretend they know better than the sufferer. It’s really the person having the experience who is the expert and so the clinician's role should be to help them express what they (and their loved ones) really believe deep down inside is going on, and then find their own pathway to healing through that.
This way the experience becomes one of empowerment, rather than one that fosters a dependence on an "expert." For this reason I only like to use medication as a last resort and if the client really wants it. Therefore, I'd be very wary of such things in young children. I don't practice child psychiatry so I'm not best placed to comment but in general it's not something I'd feel good about.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
RR: I guess that depends on so many things. What is the nature and degree of that distress, for a start? In general such things tend to be connected to relationships in the person's life and so talking with people close to you - maybe or maybe not those concerned too - would be the first thing. Much mental distress comes about as a result of things being locked up in the inner world and it is often, I believe, through the ability to be heard that people can heal. Finding a way to have such dialogue - whether with outside help or not - would be the first thing.
In the longer term practices such as mindfulness help build up a resilience to life's vicissitudes, so that the waves that come our way end up knocking us about less. I'd recommend that for anyone and there is good evidence that it reduces relapse in a variety of areas.
On the whole it would be about finding ways to acknowledge and sense the pain - as much as one can reasonably do (obviously such things can never be forced) - while also seeking to find connection through the process, both with one's self and others.
Russell Razzaque is a psychiatrist based in London and also a mindfulness teacher. He is engaged in research into more mindful ways of providing mental healthcare and is currently leading a national transformation project around Open Dialogue in the UK. He is also a writer and his latest book exploring spirituality and mental health is entitled Breaking Down is Waking Up. For more information on his projects and research go to: www.russellrazzaque.com and to learn about his work in Open Dialogue join him in the 2016 UK conference on it on April 25th. Tickets can be booked at: www.nhsopendialogue.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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