Integrative Psychiatry

[MCB2014]

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I'm looking into options for residency applications next year, and as the thread title probably suggests, I am seeking programs with residents and mentors who are open and even encouraging to integrative psychiatry. Aside from UCI, which currently has several residents also interested in this, it's really not clear to me where else I would find MDs with a similar interest. Guesses are: anywhere on the West Coast, Arizona, New Mexico, Colorado, but since the program websites don't list current resident career goals, it's hard to say for sure.

Any input regarding where I might find what I am looking for would be greatly appreciated!

 

[OldPsychDoc]

Is that what the kids are calling it these days...?

 

[notdeadyet]

I'm looking into options for residency applications next year, and as the thread title probably suggests, I am seeking programs with residents and mentors who are open and even encouraging to integrative psychiatry.

"Integrative psychiatry" is a pretty nebulous animal. I'd be careful about being very specific with your goals and desires when you start evaluating programs. Do you mean mind/body connection? Psychosocial preventative care? Complementary/Alternative Medicine? Or do you mean integrative psychiatry as in integrative care?

Any input regarding where I might find what I am looking for would be greatly appreciated!

Look for liberal-leaning academic programs. As a big generalization, larger programs tend to have more diversity among faculty interest. If you have an actual interest in mind, make it as specific as possible and query individual programs. At mine, if you made it to the interview stage, we'd try to find a faculty member with interests along those lines and see if any residents had similar interests.

 

[MCB2014]

"Integrative psychiatry" is a pretty nebulous animal. I'd be careful about being very specific with your goals and desires when you start evaluating programs. Do you mean mind/body connection? Psychosocial preventative care? Complementary/Alternative Medicine? Or do you mean integrative psychiatry as in integrative care?

Look for liberal-leaning academic programs. As a big generalization, larger programs tend to have more diversity among faculty interest. If you have an actual interest in mind, make it as specific as possible and query individual programs. At mine, if you made it to the interview stage, we'd try to find a faculty member with interests along those lines and see if any residents had similar interests.

Ah, I didn't realize the term was ambiguous. I guess that explains why I don't often see it explicitly mentioned in the residency curricula. My interests would be of the mind/body CAM sort.

 

[nitemagi]

I'd try to narrow your interests even more, as to what you want. Hypnosis? Acupuncture/TCM? Homeopathy? Herbalism? Energy work?

Understand that for the bread/butter of what you'll be brought in residency, these are at best 2nd/3rd line treatments, if on the algorithm at all. You may find centers that are researching AN intervention.

I would recommend taking a harder look at psychotherapy as a mind/body intervention, including uses of hypnosis. My experience is that it's better to learn the mainstream in training, and augment on your own with that which you're interested in.

 

[heyjack70]

everyone knows integrative psych is just an excuse to prescribe marijuana as a mood stabilizer

 

[happygilmore]

everyone knows integrative psych is just an excuse to prescribe marijuana as a mood stabilizer

Sounds awesome.

 

[MCB2014]

everyone knows integrative psych is just an excuse to prescribe marijuana as a mood stabilizer

Right, 'herbalism' 😉

 

[MCB2014]

I'd try to narrow your interests even more, as to what you want. Hypnosis? Acupuncture/TCM? Homeopathy? Herbalism? Energy work?

Understand that for the bread/butter of what you'll be brought in residency, these are at best 2nd/3rd line treatments, if on the algorithm at all. You may find centers that are researching AN intervention.

I would recommend taking a harder look at psychotherapy as a mind/body intervention, including uses of hypnosis. My experience is that it's better to learn the mainstream in training, and augment on your own with that which you're interested in.

Yea, I figured…non-allopathic modalities are best learned where they are known, and that's not in an allopathic academic institution. That being said, surrounding myself with co-residents with similar interests is preferable. In terms of mainstream approaches, I will be looking for places with a strong and diverse interest in psychotherapy.

 

[MacDonaldTriad]

Looking for this in academic psychiatry is a little like looking for anorexics at a fat farm.

 

[michaelrack]

Looking for this in academic psychiatry is a little like looking for anorexics at a fat farm.

I wouldn't be too surprised to find an anorexic trying to enroll in a fat farm

 

[MacDonaldTriad]

I wouldn't be too surprised to find an anorexic trying to enroll in a fat farm

True, but if the fat farm took their business, an anorexic would not be well accepted among their peers.

 

[notdeadyet]

Looking for this in academic psychiatry is a little like looking for anorexics at a fat farm.

Disagree with this. At my program, there are more than a few folks interested in CAM psychiatry.

Lots of CAM is not evidence based and not widely accepted in psychiatry. Some CAM is understudied but seems to have positive results. When it starts to get studied and those positive results are better validated, it ceases to be seen as CAM.

Lots of examples of this. Mindfulness was very much CAM, but now it seems to be widely taught. This is why I suggest looking at open-minded institutions. They are out there.

 

[Ceke2002]

I wouldn't be too surprised to find an anorexic trying to enroll in a fat farm

Er *sheepishly raises hand* What? Applying for the Biggest Loser at a BMI of 14.5 seemed like a perfectly logical thing to do at the time.

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As for Integrative Psychiatry, my Psych is a residency supervisor (far as I know) and practices Integrative Psychiatry (my current treatment plan is a combo of medication, various modalities of psychotherapy, yoga, mindfulness, yoga and fish oil), so there are definitely places out there. It depends on where you live and what's available. Good luck with your search.

 

[michaelrack]

Er *sheepishly raises hand* What? Applying for the Biggest Loser at a BMI of 14.5 seemed like a perfectly logical thing to do at the time.

~~~~~~

Anorexics aren't logical in the area of food/weight and perceive themselves as being heavier than they are/fat. I was joking, and doubt that an anorexic would really try to enroll in a fat farm.

 

[Ceke2002]

Anorexics aren't logical in the area of food/weight and perceive themselves as being heavier than they are/fat. I was joking, and doubt that an anorexic would really try to enroll in a fat farm.

Yeah, I got that. I knew you were joking I just thought it ironic that I'd pretty much done the exact same thing you were joking about. My thought processes did go pretty wonky (let's just call that an understatement) when I was at the lower end of the weight scale. I'm a healthy BMI of around 18-19 now, so I can look back and laugh at the ridiculousness of it all. Your post just reminded me of one those 'did my brain just completely fall out of my skull' moments. 🙂

And on that note, bowing out of the thread and returning it to the topic at hand.

Integrative Psychiatry FTW

 

[MDchouette]

I know someone with an interest in integrative psychiatry who did her training at Yale and is now on faculty at University of Arizona. So, I'm assuming Arizona would be a place to start. UCLA also has an integrative medicine fellowship (for internists) but it might be worth asking whether you could spend some time in that clinic while you're a psych resident.

You should consider doing the fellowship at the Arizona Center for Integrative Medicine after residency. It is costly but well-regarded.

 

[rkaz]

I agree. There is a good amount of mind-body research going on at University of Arizona, even in the psychiatry department. There is also an elective rotation in integrative medicine open to both medical students and residents. You can also participate in this elective as a visiting resident (even if you are not based at the U of A).

The other program I found that had an integrative medicine elective open to residents was Ohio State.

 

[nitemagi]

Research is a different matter than clinical training. UCLA has the Cousins Center for psychoneuroimmunology. Michael Irwin would be an excellent advisor to anyone interested in research in this area.

 

[masterofmonkeys]

UA. I'm wanting to do the elective next year (we'll see what happens though). But honestly, there is so much out there with CAM, not to mention so many different philosophies and disciplines, that I do think it's something that you will need to really do some training with after residency (workshops, distance courses, and possibly the UA fellowship) in order to feel really comfortable. Part of why CAM is so easily demonized is because it includes everything from homeopathy (crap) to Ayurveda/Yoga (increasingly robust evidence) to acupuncture (needles and/or pressure on the skin are good, location doesn't seem to matter, no one knows why).

Part of what makes CAM hard is that even within a system that has some evidence-base and evidence of efficacy, you still have to separate the wheat from the chaff and THEN you have to get to know the substances pretty well in order to understand their risks and benefits. As an example, Ashwaganda has some fantastic properties, but you need to be careful of source due to heavy metal contamination and pregnant women really shouldn't go anywhere near it. And, at the end of the day you're still playing in a relatively uncharted world.

I have a real philosphical problem with the attitude of 'once we have the evidence it isn't CAM anymore', as it's basically a form of intellectual colonialism. But that's a rant for a different time and place.

But all the same, I think there's a real need out there for physicians who are friendly to Allopathic medicine as well as integrative medicine however.

 

[notdeadyet]

I have a real philosphical problem with the attitude of 'once we have the evidence it isn't CAM anymore', as it's basically a form of intellectual colonialism.

Interesting. I don't see it so much as intellectual colonialism as intellectual corporatization. Going to the workshops, groups, and the like tends to result in cultural "skinning." Docs tend to take things they find intellectually/clinically/ethically palatable piecemeal and ignore the rest. This gets incorporated (word used deliberately) into their practice while the rest does not. This is why mindfulness as we use it is quite different from the meditation practices it comes from. Same with "medical acupuncture" as opposed to the offerings someone will get from an Oriental Medicine practice. As soon as it's been adapted to be compatible with the allopathic medical model, it becomes viewed as less alternative. This has happened with mindfulness. It's starting to happen with Ayurveda.

It's not limited to medicine either. It happens with the public too. There has been the corporatization of yoga in a big way (anything offered at 24 hour fitness...). It's not colonialization to me because the original purists still exist and are available to those interested. You have to look to find it and it's not as well marketed, but it's almost always out there.

I think the CAM stuff is great, when approached properly. I've noticed some people view it with much more lax standards than their "native" modalities, which I think is a disservice. I also think we need to have comfort in a cultural humility which allows us to accept methods that just don't fit the medical model if it works for patients, but people seem to get scared with this. Acupuncture for psych ailments is a great example. Just because something doesn't fit our medical model or is something we are not qualified to do ourselves doesn't make it "bad."