On Maslow and Medicine

For the January, 2008 newsletter, I had a great idea for an article. It was to be called “Synopsis of Simple Truths.” I was all excited about sharing and compiling the wonderful ideas and concepts I had learned over the years since I began using orthomolecular and energy medicine in my psychiatric practice. These simple truths had given me the power to heal beyond my wildest hopes or dreams, and had helped me to be the holistic psychiatrist that I am today.

However, I realized as I sat down to the task, that such an article could be considered similar to Martin Luther’s 95 Theses–blaspheming against the church of the almighty medical establishment–and I could be considered as much a heretic of mainstream medical fundamentalism as Martin Luther during the Reformation. And since the Maryland Board is not pleased with me right now for suing them for their unconstitutional persecution of alternative medicine, I decided that now would not be the ideal time to unveil any simple truths. So, moving on.

Of course, being as I was stuck in my writing because of society’s state of medical affairs (which places our nation in the enviable position of spending the most money per capita for health care, yet placing us among the ranks of other third world countries in actually achieving health), I focused my thoughts on those factors that have not only interfered with my newsletter, but have interfered with progress in medicine as a whole.

In particular, I thought of the evolution of medicine within society, and the challenges physicians face during transitional periods in medicine. The movement from psychoanalysis to psychopharmacology was a such a shift in the 1950’s. Today’s shift from psychopharmacology to complementary and alternative medicine poses many of the same challenges for physicians, patients, and society. Change is difficult and often does not happen in a coordinated and smooth fashion. Sometimes physicians, such as I, are taught information and given tools which are accepted as self-evident by one part of society, e.g., among patients and cutting-edge academicians, but rejected by those who are slower to embrace change, e.g., certain government establishments. When these situations arise, the physician is left with conflicting responses to their progressive approach: acceptance on the one hand and rejection on the other. A choice must be made at this juncture: whether to continue the journey of self-actualization or to accept the status quo.

Which brings us to some ideas that Abraham Maslow (1908-1970), a leader in humanistic psychology, taught in self-actualization theory:

Maslow’s Self-Actualizing characteristics

* keen sense of reality – aware of real situations – objective judgment, rather than subjective
* see problems in terms of challenges and situations requiring solutions, rather than see problems as personal complaints or excuses
* need for privacy and comfortable being alone
* reliant on own experiences and judgment – independent – not reliant on culture and environment to form opinions and views
* not susceptible to social pressures – non-conformist
* democratic, fair and non-discriminating – embracing and enjoying all cultures, races and individual styles
* socially compassionate – possessing humanity
* accepting others as they are and not trying to change people
* comfortable with oneself – despite any unconventional tendencies
* a few close intimate friends rather than many surface relationships
* sense of humor directed at oneself or the human condition, rather than at the expense of others
* spontaneous and natural – true to oneself, rather than being how others want
* excited and interested in everything, even ordinary things
* creative, inventive and original
* seek peak experiences that leave a lasting impression

According to Maslow’s famous “Hierarchy of Needs,” a person’s highest need falls under the category called “Self-Actualization.” Here, the person is no longer a pawn of greed, status, or reputation, but has an inner drive of wholesome principles that govern the person in his or her life course. Maslow’s Self-Actualizing characteristics include, among others, “reliant on own experiences and judgment — independent — not reliant on culture and environment to form opinions and views,” “comfortable with oneself — despite any unconventional tendencies,” “true to oneself, rather than being how others want,” and finally, “creative, inventive and original.” After reading this list of Self-Actualizing characteristics, one could say that Maslow was either referring to a group of outlaws, or he might have been referring to those pioneers over the course of history that had transformed our society for good.

Needless to say, being “creative, inventive, and original” is not a quality of the highest priority in the medical field. Neither would being “reliant on own experiences and judgment — independent — not reliant on culture and environment to form opinions and views” be rewarded with any stars on the physician’s forehead. In fact, I would say that these characteristics are considered flaws of the highest sort in a physician of the 21st century — punishable by law through imprisonment, revocation of licenses, fines, and all those other acts that have replaced being burned at the stake. Perhaps for the unfortunate physician, self-actualization is an expensive luxury. For to do so, one would need to be flanked by several respected attorneys.

In my case, without meaning to be offensive to anyone, I had been unobtrusively learning the principles and practices of orthomolecular and energy medicine, integrating them into a coherent treatment system, and then developing ways to heal using basic principles learned in these fields as taught through textbooks, conferences, mentors, and authors long dead–but still useful. I was, in all modesty, “creative, inventive, and original.” As a result, I became quite good at helping patients recover from mental illness without needing to prescribe medications, and became capable of helping patients get off medications with much greater ease. In this natural progression of my understanding about healing, I found myself in the ironic predicament of being vilified by the Maryland Board of Physicians as an apostate and adored by my patients as a savior.

The process of self-actualization which lead to a conflict between my higher principles and the Maryland Board’s expectations of me as a physician would not have occurred had I been allowed to practice as a holistic psychiatrist undisturbed. However, it did become a conflict for me when the Maryland Board sought to impose the opinions of unqualified peer reviewers and nonexistent guidelines on my practice. Of the three peer reviewers asked to review me, only one admitted that there was no standard to judge by and gave me a positive review. Two others considered themselves qualified to judge my work in orthomolecular psychiatry and energy medicine without having any clinical experience or training in either field. Not only did these two peer reviewers lack the training and the ability to heal patients without medications, they lacked the ability to even imagine that it could be possible. In short, I was being measured by psychiatrists who had failed to demonstrate during the course of their career any interest or aptitude in alternative approaches to mental health care. Given their level of ignorance, it was no surprise that these two peer reviewers concluded that the appropriate “standard of care” would be to use the same prescription medications and dosages that the patient would have received had she gone to a traditional, allopathic psychiatrist who knew nothing about alternative interventions.

However, after all that I had learned above and beyond my medical training, I came to think of their “standard of care” as being substandard care. Substandard care defines mental illness as a chronic, incurable condition. The standard of care that had evolved in my practice allowed individuals to heal from mental illness without depending on prescription medications to achieve a natural state of wellness. The Maryland Board would not tolerate such independence of mind, and I would not tolerate substandard care for my patients. Therefore, I was forced to protect my right to heal holistically through the court system.

For the Board, the mere fact that I had attempted to heal holistically was interpreted as an act of negligence, for according to them, I had neglected to worship sufficiently the very heart of medicine and Big Pharma business–prescription medications. By the old paradigms of medical practice, a physician is judged by the appropriate use of prescription medications. In addition, the paradigm presumes that mental illness cannot be appropriately treated without relying on prescription medications. But what if science has outmoded these paradigms and the reality standing before them is a new kind of creature: a physician who does away with illness without using prescription medications? What to do with such an anomaly! Do physicians stop being physicians if they choose to heal without relying on prescription medications? Can one assume that mental illness only responds to drugs, and punish a physician for practicing orthomolecular psychiatry before any evidence of harm? And what is to be done when a physician continues to heal people right and left without needing prescription medications? Should they be reprimanded for forgetting to add that central ingredient–prescription medications–when obviously it is no longer quite so central?

These questions lie at the heart of the debate between the Board and I in court.

In the long scheme of things, I rest assured that progress will prevail as surely as the knowledge of the world being round eventually got around. The sun now spins in the center of the solar system rather than the earth. And the time will come when a physician will no longer need to justify in court the practice of healing people without relying on drugs.

However, for now, as a holistic physician, I must choose between the status quo (level 4) and fulfill my need for acceptance, or self-actualization (level 5) and risk losing my license. It is precisely at such crossroads that opportunities exist to show true character. As Maslow once noted, self-actualizers “seek peak experiences that leave a lasting impression.” The opportunities for leaving a lasting impression is inherent to the role of a psychiatrist. However, as a holistic physician, the opportunities to leave a lasting impression during these pivotal times in medicine include transforming society’s basic paradigms on health and healing and being champions for our patients who rely on our integrity and courage.