On Teachers and Students

In school, we understand that good teachers are invaluable for facilitating understanding. Students who truly want to learn will go to great lengths to learn from these teachers. For wisdom is priceless and more valuable than knowledge, and good teachers are a well of wisdom.

In life, we have good teachers that are invaluable for facilitating understanding. Students who truly want to learn will go to great lengths to learn from the best teachers. For wisdom is priceless and more valuable than knowledge, and good teachers are a well of wisdom.

The mystery of Life’s Teachers is that these teachers are both invisible and visible, seemingly haphazard yet simultaneously precise and calculated. One does not go up to a good teacher in life, tap the teacher on the shoulder, and request to be enrolled. Life’s Teachers come to you and in the fog of your forgetfulness, and you fail to recognize their presence.

I learn from one of life’s best teachers: mental illness. My patients and I are students who learn from this teacher day in and day out. I believe that to be a student of this teacher, you must be among the elite.

But even among the elite, there are those who will succeed in learning and those who will not. The lessons that this teacher teaches are beyond difficult, they make the challenges of Olympians look like child’s play–for there is no greater fear than losing one’s self, and no greater challenge than finding one’s Self–for the self of the body and the Self of the soul are not the same. It is the difference between being lost and being found.

Being a successful student of life requires something both insubstantial and substantial. It’s hard to say when a person enters life’s classroom whether he or she would be able to master the challenges or not. With mental illness as one’s teacher, the price is even more demanding. Will one have to pay with an arm or a leg? Will one need to surrender one’s job or one’s honor? What will be required to win wisdom from mental illness?

Over the years, I have come to see how patients and doctors succeed or fail in their lessons. I am moved by the magnificence of my patients as they master lesson after lesson, gathering wisdom as they learn and not knowing how truly breathtakingly brave they are. Mental illness asks that students master the following basics of life’s lessons:

1. Understanding that one’s Self is more than physical matter. The mind is understood as something like a radio, a receiver and translator, but not the whole Being. Sometimes this radio stops working or receives the wrong messages, but it does not mean that the essence of one’s Self has changed or disappeared. To value and even love one’s life as a state of being beyond physical matter is an opportunity given to each student of mental illness.

2. Humility. Mental illness and the stigma associated with such an experience allow for an opportunity to grow in humility. The acceptance of humility not as a mantle that one takes on and off, but rather as an essential quality of self is the greatest and hardest of lessons to master. Humility is an essential quality to development and growth. For before one reaches out for greater wisdom, there is an awareness of one’s own ignorance. Before the awareness of one’s own ignorance, there is humility.

3. Fortitude. Disappointment, suffering, and loss allow for the practice of courage and strength to gather oneself up from the ashes and to rebuild a life shattered by illness. Fortitude is a quality in every one of my successful patients who overcome their illness and maintain wellness. They overcome through sheer persistence and dogged work. They do not give up.

4. Compassion. It is natural to be self-absorbed and judgmental of others. Without being challenged, there is no motivation to change from this state of being. Under the intense challenges given to all who suffer from mental illness, there is the opportunity to find relief through forgetting self, connecting with others, and developing tolerance. To have mental illness, even in these modern times, is like having leprosy in times of old. The shame and stigma associated with having this condition still prevails throughout society, even among the professionals who treat this condition. When one is a pariah within society, one can finally and clearly see how necessary compassion is, how compassion may be lacking, and how one can be more compassionate towards others.

There is more to life than our birth and death. There is also the before-we-were-born and the after-we-die. Take a moment to consider mental illness as an invitation and a means toward rapid growth and enlightenment that has eternal value and infinite worth. Mental illness can be transformed by our will for growth into a blessing. It is not an accident or punishment, but an opportunity.

I want to honor all those who have bravely shouldered the challenges of mental illness. In my practice, my patients are also my teachers. Through my patients I am taught great lessons on each one of the qualities listed above. The patients who have taught me the most are sometimes the ones who have suffered the longest. I have seen them during their most difficult trials, and I have watched them get up and move forward with their lives, quietly and unassumingly. Their humility and perseverance remind me of poignant music that stirs the heart and makes me want to weep, but I don’t know why.

I tell them, “You should write about your life,” but I know that their lives are indescribable, because there are no words to capture their valor, their private victories. It would be like trying to capture the beauty and fragrance of a rose . . . blossoming on the top of a snow capped mountain in the Himalayas.

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.

Heroes and Heroines: Patients that Make the Work Worthwhile

Sometimes, people ask me whether being a psychiatrist is a depressing job. On a tough day, I would say that it is. On those days, I would envy the baggers in the grocery store–how nice to have the task of putting groceries in a bag for someone! I’m sure that bagging groceries would also have its frustrations, but sometimes when I look at the baggers, I would yearn for the sheer simplicity of their work.

Consider for a moment what is required of a psychiatrist on a routine day: to fix minds and heal broken emotions, to save lives and salvage joy. Now that I am practicing as a holistic psychiatrist, I add to my list of patients those whose medications don’t work for them, or who want to get better using orthomolecular approaches–work that brings me fulfillment and joy, but also additional demands. Yes, on a tough day, it’s easy to see why all I want to do after work is curl up in a chair and read People Magazine. It’s a nice distraction.

However, just as a mother wouldn’t quit after years of struggling with crying, tantrums, vomit, or sleepless nights, a psychiatrist doesn’t just quit because the going gets tough. Patients are like children. As we serve, guide, and nurture them, we find ourselves learning, growing, and benefiting twice as much in return.

One of the most wonderful aspects of my work with patients is that I get to learn from them and admire them. Like crocuses raising their blossoms through snow, I see my patients bearing great challenges with a beautiful spirit of courage, faith, and humility. It’s one thing to be the doctor and tell the patient what to do, it’s quite another to be the one to do it and have to live with the consequences. Especially during the long journey of lowering psychiatric medications, the amount of faith and courage it takes for a patient to do so is beyond what most people can comprehend. For, consider this: what can be more devastating than losing one’s mind or emotions, and what kind of courage does it require for someone to voluntarily put his or her mental health at risk for the sake of freedom? The stakes are extremely high and the level of trust and faith a patient demonstrates must be equal to the task.

Many years ago, I had a six-year-old boy with bipolar disorder whose mother brought him in faithfully to see me once a week and sometimes twice a week. She was a single mother who had to struggle against the negativity of an unsupportive ex-husband. Through much of her son’s life, his illness caused him to treat her with disdain. In addition, the cost of treatment must have been a very heavy burden for her, for she worked in a grocery store. Despite times when she felt inadequate at facing the task of raising her son, her love and perseverance resulted in her son doing very well on nutritional supplements. Her perseverance through the treatment process allowed him to have a life free from psychotropic medications.

More recently, a man in his late fifties who worked part-time bagging groceries began his journey in coming off an antipsychotic medication. During his medication withdrawal, he would sometimes say, “I just need to work harder. I am doing all that I can.” His attitude touched me. There was something about his humility that was truly remarkable and admirable. Not once during his treatment did he complain about the over three hours of travel from his home to my office, nor the cost for the nutritional supplements that he was required to take. He was a go-getter, finding ways to facilitate his own healing process through reading, exercise, service, and prayer.

Another woman began her journey with a chronic history of severe depression, anxiety, and mood swings. Even a breeze during a walk could put her in bed for days due to her severe allergies. Over a period of years, we worked together to help her reduce her medications and stabilize her mood. Finally she was able to come off all medications completely and feel well. However, one day she encountered a problem that necessitated an earlier appointment date. By the time the date of her appointment arrived, however, she said that she was “feeling better by the minute” and had stabilized. This was a pattern that I had noticed about her: when faced with a challenge, her response was to do all that she could to help herself overcome the problem, using the tools that she had learned over the years. In this situation, she identified repressed childhood trauma as a root cause, understood its effects on her perspective on life, and used her energy medicine techniques to eliminate the problem. What amazing resourcefulness.

Life is not easy for my patients. They hobble into treatment on mental crutches, scarred by stigma and barred from abundance. As I begin to work with them, they become the heroes and heroines of my world. For these individuals, and many more that I can name, the power that moves me to help them is not from duty, pity, guilt, or fear. It is simply love that they deserve and have earned for who they are. They look to me to guide them out of their hell, and I look to them to lift me with the fire of their spirit. Then, when I am able to share in their triumphs along their journey to freedom, the joy we feel lights up the room–and that makes my work worthwhile.