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 psychiatry?

I was an “A” student until 5^th grade and then began struggling. I went to 2 middle schools. When I went to high school, I put my energy into dancing and theater. When I was about to graduate, I was told by my school counselor that I was “too stupid to go to college and if I ever went, I should only go part time because I would never make it”. I was lucky to find a passion for dance and became a professional ballet dancer. Realizing I could not dance forever, I began to think about my next step in life. When I was 27, I realized I had 4 learning disorders. That knowledge allowed me to develop compensatory mechanisms to overcome them in grad school. I applied to medical school but was turned down at age 32. I went to talk to the Dean of Admissions to see what I could do in order to apply the next year. I told him my story and admitted my undergrad grades were poor (2.6) but when I discovered my learning disorders, I went to grad school and earned a 4.0 GPA. The medical school class was filled. The Dean left the room. I sat confused not knowing what was happening. He came back in and stated that someone had just decided not to take a spot in the class. He told me they had not received my Grad grades and because I was persistent, he offered me the spot in the class. In medical school. I was like a sponge absorbing the information and constantly reminding myself of the privilege I had been given. My Dean asked if I would set up an impaired student program after he had tried to intervene with a student and did not get the results he hoped for. I was totally surprised when I received the Chancellor’s Award for most outstanding student at graduation. I had no idea of the impact I had made in volunteering to do things while there. It just seemed fun for me. I hated my psychiatry rotations. It was at Charity hospital and we only came in contact with schizophrenics who were unmedicated and one time was I chased down a hall by a psychotic patient who was screaming he wanted to kill me. I was going into surgery but became unexpectantly pregnant. We had been married for 15 years and did not think we could get pregnant. I ended up in a psychiatry residency by default. However, many of my mentors were analysts and I was a teacher. I was told my approach with patients was wrong. I had almost given up when I met a child psychiatrist, Judy Roheim, who encouraged me to leave New Orleans and go interview at Yale or Harvard. I looked at her with astonishment. “Me, interview at Harvard!” Anyway, all the child residencies were filled. She told me to get the hell out of dodge and go interview for anything-just get out. She saw something in me that I did not see in myself. I was lucky to have met her. I approached my incredibly supportive husband who said to go for it. I went to interview for an addiction fellowship. While at McLean.  I was offered a double residency in child and addiction psychiatry. Again, I wondered what they were seeing in me that I did not see in myself. After conferring with my husband, I accepted. My experience with mentors while there was extraordinary. One of my favorite supervisors was Dr. Onesti. During my supervisions with him, I would always go in apologizing for teaching during therapy. The 3^rd time I met with him, he stopped me at the door and said “the next time you apologize for having a gift for child psychiatry, do not come back in my office”. I asked what he meant. He stated that good mentors help you to recognize your flaws, guide you on how to improve them but applaud your assets. They help you to find your sense of purpose. He said my previous mentors felt inadequate with their inability to teach and projected their inadequacies on me. That was mind blowing to me. I said “I love you Dr. Onesti” and he smiled. At that moment I realized what being a great mentor meant and I have never forgotten the path he put me on and encouraged me to take, especially since I was not quite comfortable with using all the medications I was learning about. After that experience. I felt I was really at home. I continued to have incredible mentors while there, each finding my special gifts. Another mentor really helped me to understand that I have an ability to connect with people and see their attributes. Dr. Wolf called me a “relationship therapist” who had the ability to find hope in individuals and families that I encountered.

It is amazing how experiences cause us to reflect on our lives. I realized I got all of my gifts my from my father. My dad never finished high school and served in the Navy during WWII. I grew up in a 900 square foot house with 5 brothers, my mom and my dad. I remember seeing holes in the bottom of my dad’s shoes with newspapers in it. He always gave more of himself than expected and gave to his children the love of a father he never knew. His dad was an alcoholic and was never there for him and his brothers. However, he was not bitter about this. He always counted his blessings and found joy in life. He was a great dancer (another thing I inherited from him). Music brought him joy and laughter- but his relationship with his children was the most important thing in his life. So much so that when he realized he was drinking too much, he never drank again. That relationship with children continued even after we all left home. He and my mom volunteered in the Lion’s organization and raised more money for the eye foundation and the crippled children camps than any other Lion’s organization in the state. His ability to grow psychologically and spiritually was amazing to watch. Even though my dad was from the south, he was able to understand that what his culture taught him was not always based on reality. He learned to love children of every race and religion. I still have memories of him kneeling down next to a child in a wheel chair. Children would light up when he came by because he made each and every one of them feel special. He always told me that when he looked into the eyes of a child, he felt connection and that this work really gave him a sense of purpose.

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?

I realized that my father served as a mentor to me and that the mentors I met during training were able to solidify my identity and passion beyond what my father had given me. I also knew that just prescribing medications (which psychiatry began to emphasize) did not allow me to use the skills I had when relating to patients. Nor did these medications allow a patient to find within themselves happiness and the stigma mental illness carried or side effects medications caused, often was a reason to stop medications. Mental health was not seen as a medical disease. Medications are necessary for stabilization and, many do have to stay on them, but traditional medications were insufficient in helping someone to find spirituality and never addressed underlying reasons for a disease. I began searching for other ways to understand the neurobiology of mental health. I realized simple things like low vitamin D3 levels or an MTFHR T/C or T/T gene profiles or inflammation, if unaddressed, can lead to things like a refractory depression and the false idea that medications are necessary. I sought other ways to help my patients. I first engaged in mindfulness work and the neurobiology behind this approach. I also began taking courses in mindfulness from a Harvard psychologist who was also a Buddhist minister. This was the first time I began to find the inner peace that I had experienced when dancing.

When and why did you decide to actually focus on practicing Integrative Psychiatry, specifically, and how was your decision shaped by the experiences above?

Before leaving my training at McLean and Mass General, Dr, Onesti nominated me to serve in some capacity as a resident with AACAP. I was put on the addiction committee and within a year I was recommended to head up the addictions committee and did so for 10 years. Then another one of my mentors at Harvard, who had been the editor for the Journal of Child and Adolescent Psychopharmacology, Charlie Popper, along with Wayne Batzer (who I had met on the addiction committee who was an outspoken critic of big pharm), and Scott Shannon (who was involved with the American Board of Integrative and Holistic Medicine), saw my interest and recruited me for the new CIM committee for AACAP. I felt a breath of fresh air and quickly took to this new approach. I set up the first Institute at AACAP on CIM. Scott told me about getting certified by the American Board of Integrative and Holistic Medicine and inspired me to take the board. After one year, I was made the co-chair of the committee. I discovered the neurobiology behind Transcendental Meditation and learned how to do this with Prudence Bruns, PhD (Prudence of the Beatles song “Dear Prudence”). Prudence introduced me to David Orme Johnson who was a researcher in TM. I then got interested in neurofeedback and have had the honor to work with the brilliant and modest scientist, Joel Lubar, PhD. He introduced me to LORETA neurofeedback and Bob Thatcher, who was the project manager at NIH who did cross correlations with QEEG and other neuroimaging. I got certified in neurofeedback and began helping Joel teach courses to physician and other clinicians on the subject. I then studied to get certified by the Institute of Functional Medicine and realized that this was really in line with the new Research Domain Criteria (RDoC) of the NIMH. Instead of following criteria in DSM, that had little basis for neurological, environmental and genetic correlations, RDoc was going to dismantle DSM disorders. This approach came about because psychiatry began to have access to neuroimaging of the brain and genetic research in the early 1990’s. Instead RDoC would look for symptoms that arose because of abnormal neurobiology and circuits that were influence by genetics and environment. This was the future of psychiatry. Integrative and, particularly Functional psychiatry, was more in line with this approach because it looks at why the disease arose and what interventions can prevent the disease, stop the progression of the disease or get to the pre-disease state. Education became a goal of mine to share this information with my colleagues and students. Charlie and I co-edited a 2-volume text in the Child and Adolescent Psychiatric Clinics of North America on Complementary and Alternative Medicine in Child and Adolescent Psychiatric Disorders. My Co-Chair on the CIM committee for the AACAP, Gene Arnold, and I began submitting more research-based symposiums on CIM at the AACAP conference. These symposiums have grown in popularity and recognition. We have had the support of the psychopharm committee, the military committee, the religion and spirituality committee, the Health Promotion and Prevention Committee, the Disaster and Trauma Issues Committee, and the Autism committee. Gene is another modest but brilliant scientist who I have had the honor to work with. I have written several chapters and articles with Joel and Gene. I now teach a Functional Psychiatry curriculum at Emory School of Medicine, continue my work with the CIM committee at AACAP and have a private practice.

My son is a pilot in the U.S. Air Force and his loss of friends to suicide was difficult to watch him deal with. I started volunteering to consult at the Invisible Wounds Clinic at Eglin Air Force base which has an Integrative Medicine approach. It was my son who introduced me to retired Brigadier Steve Salazar and Colonel Mary Lopez and the 360 VA program.  My son was looing for programs that were successful in preventing suicide and came across 360 VA. He told them about me and I have had the privileged to work with these incredible people. The program is the most comprehensive state of the art approach to helping soldiers care for themselves and others. It is about connection.

What methods or practices do you utilize to help individuals get/feel better?

I use traditional family and individual therapies and medications, if necessary, to stabilize with the goal of getting off medications once underlying problems are addressed. I use mindfulness, guided imagery,  address sedentary lifestyle with  exercise, address nutritional deficiencies, use supplements which are based on research that can improve certain conditions, genetic testing to looked at factors such as MTHFR, components of the folate and methylation cycles to identify deficiencies seen in depression, bipolar and autism, do stools to look at gut problems involving, such things as, inflammation, microbes, beta glucuronidase and infection, address saliva cortisol levels, etc. The list is endless. However, I never forget that I must connect with patients and inspire them as my mentors did with me.

How did people react when you share this Integrative/Holistic approach with them – whether it be patients or other doctors?

I think at first my fellow colleagues were skeptical but that skepticism is gradually decreasing. Patients really are seeking this approach out because it allows them to see mental illness as a medical disease. There will always be those who will raise an eyebrow but that is why I put so much emphasis in only using techniques that have good research. Change is difficult for many people. Some clinicians will feel they are being enlightened and those who question me, I think, are feeling a little threatened. However, this is family dynamics 101. I never get defensive. I only try to recognize the assets of those who may not want to jump on board. Everyone has played a role with good intentions and I have to remember that. I just continue to engage and answer questions. I often tell stories of patients who I treated in the past who may have continued on drugs with no further improvement and then I tell the stories of the people who I have helped to get off medication. This allows clinicians to see what I do as, perhaps, a way to lighten the load. Getting patients to change their ways is another thing. I use motivational techniques by DiClemente, I learned when doing addiction work to encourage change. We have to remember that change is slow but encouragement to do so is vital.