Expert Profile - Aruna Tummala
Dr. Aruna Tummala
MD, Integrative Psychiatrist
Board certified in Integrative and Holistic Medicine
Founder of the Trinergy Center for Integrative Psychiatry
Board member for the American Association on Intellectual and Developmental Disabilities Wisconsin Chapter (AIDD)
Dr. Aruna Tummala’s Bio:
Aruna Tummala, MD, is a board-certified adult and geriatric psychiatrist and founder of Trinergy Center for Integrative Psychiatry in New Berlin, WI. Dr. Tummala is also board certified in Integrative and Holistic Medicine (by Academy of Integrative Health & Medicine: AIHM.org) and is pursuing further education in both Functional Medicine and Ayurveda, the oldest medical system in the world.
Inspired by the realization that conventional psychiatry has become a linear, medication-dependent, symptoms-based model with little to offer the millions of people struggling with mental illness, Dr. Tummala turned to Integrative Psychiatry, fully embracing its patient-centered, collaborative care approach. Unlike conventional psychiatry, Integrative Psychiatry attempts to find the root cause of a person’s problems and work towards achieving overall mental health and balance.
At Trinergy Center for Integrative Psychiatry, Dr. Tummala has developed a unique method to treat mental health problems with tremendous benefit to her patients. She embraces an innovative, mind-body-spirit approach that combines the science of modern medicine with the wisdom of ancient medicine to address the root causes of physiological symptoms.
Rather than just addressing the symptoms of mental health issues, Dr. Tummala uses a broad scope of intervention, including diet, exercise, meditation, yoga, nutritional supplements, chiropractic care, Ayurvedic herbs, psychotherapy and careful use of psychiatric medicines. She recognizes that reducing the reliance on psychiatric medicines, reduces the severity and occurrence of side effects, while empowering her patients.
Dr. Tummala has authored and presented on the topics of mental health, Ayurveda and integrative approaches to mental wellbeing; to academic audiences both in the United States and abroad. Dr. Tummala was a resident psychiatrist for the Medical College of Wisconsin Affiliated Hospitals, and then a Fellow in Geriatric Psychiatry for the same organization.
She received her MD in Psychiatry in 2003 from the Deemed University, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. She was recognized for excellence and was the recipient of three awards during her undergraduate medical education at the Vijayanagar Institute of Medical Sciences in Bellary, India.
Dr. Tummala is a Board Member At Large for AAIDD organization (American Association on Intellectual and Developmental Disabilities Wisconsin Chapter).
What life events or challenges that you’ve experienced (could be minor, could be major) – whether you’ve experienced them directly or via someone close to you, have had any type of impact on your desire to pursue a career in psychotherapy?
Truth be told, I fell in love with psychiatry because the mind seemed so fascinating! When I first learnt about symptoms like hallucinations, it was simply fascinating to me that our powerful minds can make us see, hear, feel things that are not real!
It is likely that my lack of self-awareness in my younger years, obscured the reality that I needed this field of science as much as a fish needs water.
Being a psychiatrist helped me personally in many ways. After the birth of my first child, I experienced intrusive images of harming my baby which caused me a lot of anxiety. The prior knowledge that this heightened anxiety was an evolutionary mechanism to ensure survival of the newborn and prior knowledge of certain therapy techniques helped to curb this anxiety in the bud.
There is a period in my life that reinforced my desire to practice not just psychiatry but integrative and holistic psychiatry…
After my fellowship training in Geriatric Psychiatry, I began work as an inpatient psychiatrist (hospitalist) for a local psychiatric facility. I had my second child in the first year of my career with this company. My family was growing, I was settling down in my career, life was becoming predictable and “normal.”
Except I became interested in nutrition and mental health. This interest was likely fueled by my desire to provide the best nutrition and nourishment to my babies. (Especially during my second pregnancy and working full time in the hospital, I realized I did not want to eat in the cafeteria. Because, the food was not organic, and it was mainly processed and re-purposed food. When I paid attention to the food that was served to the patients in the hospital, I realized again, it was highly processed meals put together in the kitchens. It was not “made from scratch” meals.). This interest made me research about nutritional psychiatry. One of the first landmark studies was the Vienna study that looked at the effect of Omega 3 fish oil supplementation in patients at high risk for psychosis. This study found that Omega 3 supplementation for just 3 months significantly reduced the risk of conversion to psychosis at the end of 12 months and this benefit held true even after 5 years.
I began to recommend fish oil to all my patients with psychosis. This prompted one of my colleagues to complain to the Medical Director of my hospital that I was getting a kickback from supplement companies. I was not. I was asked about it by my superiors and when I denied it, the matter was let go.
My interest in nutritional psychiatry took me to the field of integrative psychiatry and organizations like ABIHM (American Board of Integrative and Holistic Medicine), IFM (Institute for Functional Medicine) etc. I was blown away by the information presented to me when I attended their conferences. For the first time as a psychiatrist, I was exhilarated to learn that we can reverse many mental health issues by healing the body first. I learnt of the role of inflammation, the microbiome, methylation genes, gut-brain connection, and so much more. I decided to get formal education in these fields. So, I pursued and received my diploma in integrative and holistic medicine in 2014, pursued education in Ayurveda. But it is only after I began to attend IFM conferences in 2015, that I was able to organize all this information and I finally found an operationalized manner to implement these new ways of thinking, evaluating and treating patients under my care.
Each time, I would come back from the conferences with renewed enthusiasm and vision of changing how psychiatry was practiced especially in the hospital settings. I was learning new information about the dangers of long-term use of many psychiatric medications, that we were over-prescribing them especially to vulnerable populations like children. All this new information was finding its way into my practice.
This is when I was put under the microscope. Things were changing rapidly at the hospital. There was change in leadership at many levels. The new leaders (including the new medical director) were keen on profits, even at the expense of quality. All of a sudden, we (as attending physicians) could not say “no” to more and more extra work. When I started working at this hospital, I was told that a patient load of 8 per day is full time work. This included 3 new patient assessments. By 2015, there was no upper limit. If there was a bed available, then we had to take more and more patients onto our case load even though we felt overwhelmed, burnt out and protested that we were putting patients at risk. My colleagues in the adult inpatient unit, we all felt overwhelmed, burnt out and resentful.
Especially, when we were on call for the weekend (only physician was on call from Friday 4 pm to Monday 8 am), the stress, burnout, resentment, was just building up. To practice integrative psychiatry which involves more thorough evaluation and counseling of diet/lifestyle intervention was more labor intensive on my part. On the one hand, I could not unlearn this new information and go back to simply evaluating patients based on the atheoretical DSM IV model and prescribe a slew of psychopharm meds. On the other hand, providing the in-depth evaluations and treatments was causing my work-life balance to suffer, and causing me a great deal of stress.
I became vocal about both these issues. Advocating for my needs and rights as a physician, and also advocating for my patients and their needs/rights. I was also (probably a bit overzealous) zealous about implementing integrative psychiatry principles and would talk to my colleagues, my superiors, the admin about this new approach to mental health. I learnt the hard way that my vocal protest was not welcome. I was looking to reform the system, but it backfired.
All in all, I became persona-non-grata. I remember that I felt confident to practice Functional Medicine specifically in fall 2015. By March 2016, I felt so persecuted by my superiors and the admin; I was experiencing stress at very high levels. It felt like all my actions were scrutinized. I was forced to explain myself over and over again. I was constantly on the “witness stand.” Looking back, I could have been diagnosed with acute stress disorder or adjustment disorder with anxiety. I was miserable at home and at work. I was highly irritable. My family took the brunt of it, sadly. My work suffered. I was not able to complete my notes on time, for which I was dinged again. It was a vicious cycle!
I also recognize now that this time period of persecution caused me post traumatic stress for at least 2 years after I quit my job. In addition to feelings of stress and burn out, I was also having severe acid reflux. I recall that one night, I thought I was having a heart attack. Barely 40 and having a heart attack!
The last straw was a false accusation that I discharged a patient without prescription medication and the community psychiatrist she was discharged to was irate about this and had complained to the hospital medical board about my “negligence.”
From my perspective, I know I did excellent work. I had suspected the client to have had methylation gene polymorphisms and consequent nutritional deficiencies contributing to her mental health issues. Blood tests confirmed my suspicions and therefore, addressing the methylation polymorphism and nutritional deficiency was the key to her recovery (not medication, which would have just contributed to side effects).
Unbeknownst to the hospital’s medical board, the community psychiatrist is a particularly good friend of mine. I reached out to him directly to clarify the work I had done. Imagine my surprise when this friend of mine had no idea about what I was talking about. He had not yet seen the patient in question in outpatient setting. He certainly had not complained about me. He heard my story and quietly pointed out it was time for me to leave this hospital. He planted the seed in my mind that if I was so passionate about my work, I should start my own practice.
So, the very next day, I handed my resignation and finally started my Integrative psychiatry clinic in September 2016. At first, it was a lot of theory but little practical experience. I am ever so grateful to the original handful of patients who came to me, trusted me and my care. Gradually, I was able to implement theory into practice and began to see amazing stories of recovery and healing in my patients. Now, 5 years and over 700 patients later, we have a successful model of mental wellness. Which can be replicated in a wide variety of patients.
How did those events impact you emotionally/morally? How, if at all did those events impact the way you view how our current system teaches us to treat patients with mental health challenges?
As described above, I was struggling emotionally at that time and for a couple of years afterwards. The rejection I felt from mainstream colleagues was hard to digest.
I understand the motivation behind this rejection of what I represented. Many of my colleagues were in their late forties and early 50’s. I was younger in comparison. I was 35 or younger when I became exposed to and interested in integrative psychiatry. I was not yet steeped in dogma. For my older colleagues, it was about giving up what they believed in for so many years. That would be hard for them.
The reason the admin was so against me was purely ego driven. Our current system completely dehumanizes our patients. This is very evident in the revolving door, fast paced, short-stay world of inpatient psychiatry. The focus here is to “stabilize” patients when they are inpatient and quickly discharge them to their outpatient providers. As part of this stabilization, sometimes rapid med changes are made which contributes the neuronal perturbation and further chemical imbalance. But this phenomenon is not even recognized in mainstream psychiatry just as psychiatric drug withdrawal syndromes are also not recognized. There is no time (or money) to understand the pathos of the person in front of us. Mainstream psychiatry’s cookie-cutter approach treats the disease, not the patient.
When and why did you decide to actually focus on practicing Integrative Psychotherapy, specifically, and how was your decision shaped by the experiences above?
What methods or practices do you utilize to help individuals get/feel better?
I practice a combination of Ayurveda and functional medicine. This involves mainly healing the gut brain axis through diet/lifestyle intervention; herbal/nutritional supplements, detoxification through Ayurvedic modalities (massage, sauna, Shirodhara), and trauma informed psychotherapy (I find trauma is the most common psychological root cause).
How did people react when you share this Integrative/Holistic approach with them – whether it be patients or other doctors?
The awareness is very much increasing amongst the lay public. Unfortunately, my experience is that other doctors in mainstream medicine are very resistant to integrative medicine in general.
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