Psychotherapy At The Crossroads

Psychotherapy At The Crossroads

A New Vision of Integrative Mental Health

By Andrew Weil

January/February 2012

Epidemic depression is occurring at a time when the field of mental health appears very robust. There are more mental health professionals treating more people than ever before in history: psychiatrists, clinical psychologists, licensed social workers, counselors, and therapists of all kinds. We have a powerful “therapeutic arsenal” of drugs to make us happier, calmer, and saner. When I leaf through the pharmaceutical ads that take up so much space in psychiatric journals, I get the feeling that we should all be in great emotional health. Depression and anxiety should be as fully conquered as smallpox and polio. But more of us than ever are discontented and not experiencing optimum emotional well-being. What is wrong with this picture? Why is the vast enterprise of professional mental health unable to help us feel better?

I want you to consider the possibility that the basic assumptions of mainstream psychiatric medicine are obsolete and no longer serve us well. Those assumptions constitute the biomedical model of mental health and dominate the whole field.

In 1977, the journal Science published a provocative article titled “The Need for a New Medical Model: A Challenge for Biomedicine.” I consider it a landmark in medical philosophy and the intellectual foundation of today’s integrative medicine. The author, George L. Engel, M.D., was a professor of psychiatry at the University of Rochester (New York) School of Medicine. Determined to overcome the…

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Tuesday, March 13, 2012 5:43:01 PM | posted by Laura
Thank you for this article. In my work as a Consciousness-Based Practitioner I see that we can go even further than what is mentioned in this article to help patients. Shifts in Consciousness are what help people heal most quickly. From here we are more in touch with Higher Self and get out of thinking mind, which holds us in patterns of illness and disease. Thoughts are what keeps us or makes us sick -- our thoughts and lack of ability to see our connection with Universal Consciousness.

Saturday, February 25, 2012 1:32:14 PM | posted by IntPsych
Re: David Widelock's question above -

You raise a difficult point and one that I struggle with almost daily with patients. As an integrative psychiatrist working on a hospital unit and in outpatient practice, I find that the more severe the depression, the more relief an antidepressant may provide, to at least temporarily make other treatments feasible (ie someone with crippling depression probably won't be able to exercise, shop for healthy food, make rapid gains in therapy, etc.) Someone plagued by suicidal urges may find an antidepressant turns down their frequency.

I often dissuade patients with mild or moderate mild depression who are demanding an antidepressant as "the solution", and will recommend other options that I consider more health-promoting and less risky. This is always a collaborative, extensive, and both evidence and intuitively-informed decision between me and a patient, and is a work in progress each time.

Dr Weil has co-written an excellent article on what a true informed consent for an antidepressant might look at which I've found helpful in my practice (see Weil, Shannon and Kaplan 2011)

Sunday, January 29, 2012 10:57:00 PM | posted by David Widelock
"...evidence accumulates that, in most cases, SSRIs work no better than placebos to boost mood."

"The new integrative model of mental health ... takes into account correlations between imbalances in neurotransmitters and mood disorders. ..Integrative treatment plans for depression, particularly for severe depression, may well include medication..."

Which is it?