We hear a lot about “mind over body” but so much about “body over mind,” but that is exactly the sense that you would get from the approach Dr. Phyllis J. Heffner is taking in her pursuit for a holistic model of child psychiatry. Taking the principles of integrative and functional medicine into her psychiatric practice, Dr. Phyllis explores the causative link between psychiatric symptoms and their physiological underpinnings. In her practice, she uses a variety of alternative treatment modalities depending on what works for a specific patient. This has made her trailblazer in a new, emerging field of integrative and functional child psychiatry, a path that few others in both physiological and psychiatric medicine have ventured before. Listen in as she shares some of her knowledge on the show with Dr. Timothy J. Hayes.
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Body Over Mind: Applying Integrative And Functional Medicine In Holistic Child Psychiatry With Dr. Phyllis J. Heffner
Phyllis J. Heffner MD practices Functional and Integrative Psychiatry for children, adolescent and adults in Columbia, Maryland. She attended medical school at the Pennsylvania State University College of Medicine, Hershey Medical Center graduating in 1986. She was a General Psychiatry resident at UNC-Chapel Hill and completed a trial at Adolescent Psychiatry Fellowship at the University of Maryland in Baltimore. She practiced Conventional Child and Adolescent Psychiatry for 24 years after developing chronic abdominal pain and an autoimmune disease which conventional medicine could not treat. She discovered Functional and Integrative Medicine and has since integrated these modalities into her psychiatric practice. She completed requirements to be an Institute of Functional Medicine certified practitioner in April of 2018.
Phyllis, thank you for joining us. Welcome.
I was hoping you could tell us a bit about what got you started in the work you’re doing and what drives your passion for this work?
It started with my own health. I became ill probably back in 2010 and went to all the conventional medical treatments and doctors because I was at that point a conventional child psychiatrist. They couldn’t help me so I started looking at other places. I first started looking at diet and nutrition because some of my initial symptoms had to do with digestive issues. It helped a bit but not enough. I kept pressing further and got further into other types of alternative, integrative, then eventually functional medicine trainings, and started doing better. I got to the point where I was not having nearly the same problems and I was able to start doing yoga, Pilates and things like that again. Unfortunately, I got sick again and did not realize what it was until many years later when I went to another training and figured out that I had mold illness, which plays a big role into where I am in my practice now.
I started realizing that I was not helping people a whole lot with the conventional psychiatry model of evaluation and medication, which is what we were mainly doing and wanted to try to find another way to help people. I started using the things I was learning for myself and started applying it to my patients because I started realizing that many psychiatric symptoms are not just a psychiatric behavioral issue, but often the cause is something deeper. Either physiological, biochemical, nutritional or something else. I started using those techniques. After I had enough training and opened my practice in 2015, I found out probably in 2016 when I went to a different training on environmental health that the symptoms I had been experiencing since at least 2014 were mold-related. I started realizing that depression, anxiety, OCD, all kinds of psychiatric symptoms can be from mold. Later I started going into the Lyme realm and figuring out that Lyme was playing a big role in my patients, as well as their digestives issues, their hormonal issues, biochemical issues and all other kinds of things. I kept spreading out further and into what I was looking at to try to understand those underlying causes for people’s psychiatric symptoms. That led me to where I am now.
On your website, which is HolisticChildPsychiatry.com and on the IFM website, it talks about you as an Integrative Child Psychiatrist. How would you say that’s different? How can you educate us about how that’s different from the average child psychiatrist?
I have changed it a bit since that time. I call it functional and integrative, and I work with children as well as adolescents, adults and older adults. I’ve spread things out a whole lot more. Big difference is that I’m using various types of strategies, treatments, techniques that are not at all considered conventional. A regular psychiatrist never thinks about using nutrition or never looks at using labs to figure out if there’s any medical or physiological reason behind someone’s symptoms. They immediately go to medication for a specific symptom. Many of my patients say, “We were shocked the doctor never did any testing.” I also use a lot of other strategies. For instance, in my office I have hyperbaric oxygen. I use sauna, something called frequency-specific microcurrent, neurofeedback, photobiomodulation or on the med, which is pulse electromagnetic frequencies, advanced nutrient therapy. I’m using a lot of different techniques that general medicine doesn’t even usually acknowledge. If they do like for hyperbaric, it is for limited purposes and not for issues related to inflammation or the other things that I use it for.
With that whole wide range of things, and I’m sure you didn’t even give us an exhaustive list of different treatments or techniques you have. How do you decide which to use for what person and when?
It depends on the person and both their symptoms, what I find in the testing, as well as their history. I do exhaustive evaluation. It includes usually at least 2.5 hours of an initial evaluation. I order a lot of testing that can include conventional testing, blood testing and things like that, but I use a lot of specialty labs to look for do they have something called mycotoxins, which are toxins from mold? Do they have Lyme or another vector borne illness? Do they have gut issues? There’s stool testing or something called a breath test looking for small intestinal bacterial overgrowth or hormonal testing. I do a lot of testing, and then I try to pick the treatment modalities that seem to be the most appropriate for what I’m finding. I work with my patients. I give them options. I told them, “These are the various things that make sense. What do you feel the most comfortable with?” They have to feel comfortable with it as well or it’s not going to be beneficial for them, or they’re not going to follow through with it. My view is always that there’s never only one way you can treat someone. There are lots of ways and we have to find what works and fits in best with a specific person.
That’s right in line with what I’ve been telling people for decades in therapy that you have to have two things at a minimum for a therapy to be successful. Someone that knows what he or she is doing and someone with whom you are comfortable. You can have the best therapist in the world, but if you’re not comfortable with her, you won’t go to her long enough that she can help you or tell her the things she needs to know to help you. While having the best friend in your life and be up until 3:00 or 4:00 in the morning and several nights a week talking about everything that’s bothered you might be helpful from time to time, but that person doesn’t have the professional distance and training to do for you what a good therapist can. Is there a way at a pre-screening level to help people understand that they would be far better served finding somebody who’s into functional and integrative medicine than going to their traditional doctor?
There certainly are various ways. I have the website that tries to explain some of the differences. I also offer potential patients a free telephone call beforehand so that they can get an idea about what I do. We can talk about whether it makes sense for them. They can get a feeling of whether I am someone that they feel comfortable working with because that’s a critical part. You have to have a good match between what I do and what the person wants and is looking for. I offer those free calls. People can also be looking at other websites. Institute for Functional Medicine, IFM has some information although they aren’t focused on a whole lot of mental health. They do some. I went that route mainly because it gave me the bigger picture of the whole body and how everything works together.
As much research as someone can get about what the differences are. Unfortunately, a lot of the people that come to me have been through the traditional psychiatry many times and seen many different people and gotten put on lots of different medications. They’re coming to me as a last chance because they’re not getting help. I wish people would have an idea ahead of time. I do get some people that come to me because they view themselves as either holistic, wanting a different way, not wanting medicine or wanting to get off of medicine. Occasionally, I get people early on, but a lot of times it’s not that way.
Is part of that driven by the insurance reimbursement? Does insurance reimburse people for the kinds of things you do?Many psychiatric symptoms are not behavioral issues. Often the cause is physiological, biochemical, nutritional or something else. Click To Tweet
Insurance reimbursement plays a big role. A big question I get a lot of times is, “Do you accept insurance?” I’m not a participant in insurance programs mainly because they do not reimburse for the 2.5 hours for a psychiatric initial evaluation. They’ll pay the same price that they would pay someone that does 45 minutes. I can’t afford to do that. I couldn’t stay in practice. They don’t reimburse for a lot of the non-conventional treatments. They would pay for an office visit, usually their ideas of what an office visit should run is based on a 10 to 15-minute appointment. I can’t do that work in that time. I have patients that I do give them a detailed receipt that has ICD-10 codes and CPT codes that insurances require. Some of them get some reimbursement. It’s nowhere near what it costs and not what they would be paying a conventional psychiatrist. It plays a big role.
I don’t know about how you address that with people, but the way I address it with people is that to think in terms of the total picture in line with the functional or integrative medicine. If my option is to see a conventional psychiatrist and pay my copay, and get given a medication that then I pay for the medication, and keep taking it for months or years with limited success. Sometimes quite a few negative effects built up over time from taking those medications as is mapped out in books like Whitaker’s book on the epidemic and mental health or I can commit a chunk of money and my own efforts, and get a shift in my life experience on health then I’m free to live a healthier life moving forward rather than getting stuck in what most people experience. It’s mapped out in the book, Anatomy of an Epidemic by Whitaker.
I don’t view that the conventional psychiatry model of medication sometimes for life is anything other than at most a band-aid, many times causing more problems than it is helping with. I view that in treating what is going on and helping the whole person is an investment in health. People can get to the point where they don’t need ongoing treatment especially if they take it as making lifestyle changes, rather than this is a short-term treatment. It can make a huge difference in a person’s life. Unfortunately, a lot of times people are impatient and want the quick fix. The type of thing that I do doesn’t usually come with a quick fix that usually does take work. That’s the other thing that I would like to see a difference in people’s whole life philosophy. We don’t try to do what’s easiest and fastest, but what makes the biggest difference in the long run.
The issue is that while it might take some work and not be in a “quick fix,” my experience has been the people I’ve known who’ve gone to a functional and/or integrative psychiatrist or medical doctor have ended up getting results and disengaging from that continual treatment far sooner than the people that go to a traditional allopathic psychiatrist. I remember one patient, this is a lot of years ago, she came to see me and she was depressed that she couldn’t make it through the first session without breaking down in tears. She had to cry and tell me her story. I stopped and asked her if she ever thought that she was depressed. She said yes and I said, “Have you ever thought about getting treatment for?” She says, “I am.” I said, “You are good. What’s happening?” She said, “I’m taking this medication.” I said, “How much are you taking? How long you’ve been taking it?” She said, “Seven years.”
I’ve had patients on antidepressants for 20, 25 years. I work very much with them many times to try to get them off of medicine. I have one patient who had been on several different antidepressants, probably 12, 15 years. Unfortunately, she developed one of the long-term side effects of antidepressants, which is tardive dysphoria, meaning un-apathy, no mood, no interest in things, no motivation. I worked with her for a while and we were making progress. I found out that she had thyroid issues and I found some other things. Finally, she decided she wanted to try something different. We did neurofeedback and her mood improved tremendously. We got her off of two antidepressants. At this point, she’s on no medication at all. We did about 30 neurofeedback treatments. The first twenty we made a little progress. The last ten made a huge difference. She is enjoying life. She’s having some activities that she’s doing even in these COVID days. To me, that’s been a big success because someone that was on medication and she kept trying to come off of medicine then going back on because the apathy and lack of motivation were worse without it. At this point, she’s not on anything. She’s coming in every three months to check her thyroid and some of the other things that we found.
Dr. Peter Breggin has a wonderful book about withdrawal from psychotropic medications, and as Whitaker points out in his book. It’s the thing that taking people off those medications after they’ve been on them for a good long time and doing it in some, “I’m going to cut it in half and cut it in half again” or cold turkey. It ends up producing such a shock in the system that they get flooded with negative symptoms. They give up and go back on the medication. If you’re going to do that, it’s important to be working with a doctor and/or following along with Peter Breggin’s book on how to do that. The primary thing in that book is that you shouldn’t be doing it according to somebody’s schedule about if you’ve been on this dose for this long and you have this height and weight. You should be doing it based on what’s happening with you day to day, moment to moment as you try and do that. You should be working with a professional like you and getting monitored through that process. If that happens, good results can be the end result.
I’ve helped people get off of number of medications including benzodiazepines, which are also difficult to get off of. Sometimes I go to compounded medications. A lot of the people think of ridiculously small reductions over long periods of time for someone to be able to successfully do it. I have one woman who she was only on a tiny dose of Klonopin. The doctors she saw before said, “This is nothing. You can stop it.” No, she couldn’t do that. Too many negative effects. We went down something like 0.075 milligrams, because she was only on 0.5 milligram, but we went to 0.075 milligrams every 2 to 4, sometimes even 8 weeks depending on how she was feeling. She’s off of them at this point.
It’s amazing. I have gratitude for finding things like the functional medicine. Back in 2015, Dr. Mark Hyman did an interview with Krista Tippett. That’s available on her website, OnBeing.org. If you go there and search for functional medicine, two medical doctors and a woman philanthropist, both of whom had their own health issues and came out of it with non-traditional approaches started their own clinics. Dr. Mark Hyman has a clinic in Ohio. Dr. Goodman, the psychiatrist was the other person there, but that’s a great way to start listening to an hour interview like that. It is a great way to help people get introduced to, flesh out a bit more about what’s the difference. Each of those people had a story like you did where they were going to their colleagues in the traditional allopathic medicine and coming up with nothing to be of use. Out of desperation, they went searching outside the normal realm and fortunately, found some good things to help themselves and turned it into helping others.
It’s common in not only functional medicine but any integrative medicine that the doctor themselves or a family member or close friend have had an illness that wasn’t helped by conventional methods. That’s what got them into it. I know when I got first sick, the doctors that I was going to couldn’t find anything. They wanted to send me to pain management to put injections into my abdomen so that I didn’t have pain. I said, “No way. That pain means there’s something wrong here.” We’ll completely miss it until it’s a terrible problem if we ignore it.
Some would call it a tragedy that one we’re taught with a limited set of tools. Every problem seems to be requiring the tools we have. While it’s useful to try the tools you have in your toolkit when they don’t work, it’s also useful to expand and look to other areas.
I’ll tell my patients, “I don’t know enough about that. I have to do some research.” I don’t mind saying I don’t know something, but I’m also going to then try to find something else. It’s why I have so many different tools. A lot of times if I go to some of the programs that try to teach doctors how to open a practice, they talk about narrowing things down and getting your niche. To me, that restricts how much I can help someone.
I have the same issue with having been practicing therapy for many years that I will continue to go to new treatments or techniques or thought models, and only keep those that work for me on my own personal issues. Also, they already fit in with whatever I’m already doing. It broadens what options I have to offer my patients. What’s an area of your practice we haven’t even touched on yet? What’s one of your favorite areas to work with?
One of my favorite ones is something called frequency-specific microcurrent. It uses low micro amperage type electricity. The machines are run by nine-volt batteries. There’s no shocking. There’s nothing like that involved. People occasionally feel a bit of a tingle. Some people feel nothing, other people get relaxed and fall asleep during it. The frequencies are on two different channels. One channel is what organ or tissue you’re trying to work with. I can do it with all the areas in the brain. I can do it with muscles. I can do it with joints. I can do it with spinal cord. I have double-sided laminates of five sides of all different kinds of frequencies. The second set of frequencies is the conditions or what we’re trying to have happen.
For instance, if I have someone that has issues with conducted tissue disorder called Ehlers-Danlos. It’s an issue where they have too much mobility and the connective tissue is not at its normal strength. There’s a condition 124, which is repair, torn and broken. You can do that to reduce their hypermotility and their pain. It’s not a permanent thing because the condition is genetic, but it can last for a period of days to a week or so, giving them some relief. I have protocols for depression and anxiety, and post-traumatic stress. If someone is working with me in other ways to help their body get in what some called a stable state so it continues, meaning good nutrition, good sleep, things that help their body do well. It can make a huge improvement in mood issues. It can make a big difference in memory things, attentional problems, in addition to all kinds of physical conditions. It is super flexible and beneficial for many people but nothing works for everyone.There's never one way you can treat someone. You have to find what works best with a specific person. Click To Tweet
Let me ask you with that frequency-specific microcurrent. Not everybody can come out to Maryland to see you. If people in their area want to find somebody who works with that thing, is there a name for that device or for that protocol, that training you have?
There are several different companies that make the devices, the overall arching organization that teaches professionals and also as a way of getting the general public in touch with professionals is FrequencySpecific.com. The person that has developed this whole series of treatments is Carolyn McMakin, she’s a chiropractor. They have a listing on there of practitioners that you can try to find someone in your area. There’s not a tremendous number of them. There’s maybe 2,000 or 3,000 people in the world that does it. It’s not that known. She has trainings several times a year. More and more practitioners are getting to know about it partly because some of the bigger names in functional medicine are starting to do it. They’re letting people know about this practice.
One of my mentors, Neil Nathan, is involved with this and mentions it in his book, Toxic. There’s a number of others. It’s another way of getting to know people. It’s just going to different websites that talk about these things. FrequencySpecific.com does give a lot of information both about the protocols itself. There are different types of machines. When I have patients, I usually have them come to the office first and do at least a few sessions. Some patients have decided to purchase small portable units for themselves and do it at home because it makes it more convenient. I don’t usually recommend that as the first line. I usually recommend having at least a few sessions that we can figure out what works for them and what they need.
Is there another area that we’ve either briefly touched on or haven’t mentioned yet that you want to talk about in your practice?
I do a lot of different individual treatments. An area that I find to be a major issue for a lot of people has to do with what some people will call either chronic inflammatory response syndrome, mold illness, mycotoxin illness or other types of chronic infections. They often go together. Many of my patients might have issues with mold and have Lyme disease, or have mold and digestive problems. All kinds of imbalances in the bacteria in their digestive system, because mold can affect the immune system. It can affect the endocrine or hormonal system. It can affect the nervous system. It can cause certain kinds of cancers as well. Where it comes in with psychiatry is that it is often the cause of depression, anxiety and other mental health symptoms.
People often don’t realize that there’s an issue with mold. It might be in their home and it hides well. That’s where mine was. Our home was inundated with mold issues. It can be in a school. I had a lot of patients that the schools are not always that good a shape. I’ve had patients from schools that had a few professionals that got it at their offices. You don’t always know it’s there. People can go for years and the mold toxins can stay in the body sometimes 10, 15 or more years. You don’t always know where it comes from either. I always ask about environmental toxins which includes mold in my evaluation. If I get any sense at all and even sometimes if I don’t. If I have, for instance, a child with PANS and PANDAS, I will always check for mold because that’s one of the things that can cause PANS. PANS is Pediatric Acute-onset Neuropsychiatric Symptom, which looks like an abrupt onset of obsessive-compulsive disorder, rages, anxiety and all kinds of other symptoms caused by an infection, a toxin, mold or something like that. I see a lot of it. Any of the things that that can cause chronic inflammation is one of the things I have to look at. Mold plays a role with that too.
What treatments are required for people once you find out they’ve got a mold problem or this chronic inflammation response due to mold?
There are a number of different things. One of the things is to help them detox or get the mold out of their system. It’s not necessarily an infection. Although some people can get mold that gets into their body and starts growing. It can be in their sinuses. It can be in their digestive systems. It can be in their respiratory systems. If that’s the case, we do need to use antifungals to get rid of the mold that’s growing in the body. For the majority of people, that’s not necessarily the case, but we’ll use either prescription or non-prescription, what are called binders. They are specific substances that the mold toxins cling to. It’s not like it’s a Velcro where they’re a tight binding, but it’s more like a static cling. If we don’t use binders, the mold toxins recirculate in the body over and over again and don’t leave.
By using the binders, it helps remove the toxins through the digestive system so they get out of the body. I also use other strategies. I use something called liposomal glutathione, which is a supplement that our body makes it, it gets used up in its attempt to try to fight the mold. I will always recommend saunas because sauna uses sweat as another way of getting mold out of the system. I’ll try to improve the immune system. There are certain supplements that I use that help the immune system get more balanced and be able to work better because often when someone has an issue with mold, they tend to get reactivated viruses. We’re all carrying these viruses in our body that we’ve had for years. If we have a good immune system, they keep them quiet and in check because mold affects the immune system. These viruses can start getting active again and can start causing other problems. Trying to treat the viruses doesn’t do it. If it’s a mold issue, you have to get the immune system working better too. I’ll recommend things like frequency-specific microcurrent to help with getting their detox systems better, get their immune systems working better. There are some protocols that help trying to remove some of the mold out of the various tissues. I’ll recommend hyperbaric oxygen to help get more oxygen into the brain so the brain’s working better and to reduce inflammation. I’ll recommend sometimes supplements to help the liver work better or to get the kidneys working better as ways of other detoxing.
There are all kinds of issues that have to do with nutrition because unfortunately many people are not eating in a healthy way. That negatively affects how well they do. A lot of foods carry mold. Grains are a terrible source of mold. The people that know that best are people in the agricultural field because they they’ve studied mold more than medical doctors have because of how it affects livestock. There are lots of different aspects to mold treatment. It’s all individualized, at least the way I do it because not every person’s body works the same. You have to do what is working for that person. If it’s not working, that means we have to find a different way.
I greatly appreciate your taking the time to share with us. Your website is HolisticChildPsychiatry.com. If you’re willing, I’d like to check back with you in six months to a year and see what you might have learned new that you could share with our audience. As you and I both know, this stuff is always changing usually for the better as people open up and are willing to explore and engage professionals like you.
I’m constantly going to conferences online because there are always more things to learn. My husband asked me a few years ago, “When will you stop going to many conferences?” My view is, “I can’t” There’s things that change, you can’t rest on what you know.
I appreciate your taking your time to share. I look forward to checking back with you. Thank you for being with us.
You’re welcome. Thank you.
About Phyllis J. Heffner, MD
As a Psychiatrist, I am trained and understand that Mental Health Challenges are related to Physical, Psychological and Social Factors. This fact is acknowledged in conventional as well as integrative Psychiatry, but often the conventional Psychiatrist focuses on the symptoms alone without searching for the underlying factors that have caused the symptom to occur. Subsequently, the conventional Psychiatrist’ initial Psychiatric Evaluation mainly stresses the current psychiatric symptoms and their development, along with a more superficial exploration of the person’s medical and social history. The major cause of mental illness is considered to be due to an imbalance in the neurotransmitters in the brain; as a result, the main treatment the Psychiatrist offers is psychiatric medication management. These medications can be helpful for some conditions, but often result in significant side effects or negative interactions with other medications or supplements. In addition, long term use of these medication have neither been studied to determine their safety or benefits. Unfortunately, it is all too common for a person to be started on medication and kept on it for months to years to the rest of their life, and if the initial medication is not helpful either another medication is added to or replaces the first one. When another form of talk or behavioral therapy is indicated, the person is usually referred to another therapist.I am a Maryland based Psychiatrist who specializes in holistic and integrative strategies to treat both mental and physical health conditions, I am double Board Certified in General Psychiatry and Child and Adolescent Psychiatry. I graduated from Franklin and Marshall College in Lancaster, PA in 1982, and Penn State/Hershey College of Medicine in 1986. My General Psychiatry Residency was at UNC-Chapel Hill. I continued my training with a Child and Adolescent Psychiatry Fellowship at the University of Maryland/Sheppard Pratt Hospital Joint Training Program. I am currently in the process of taking required courses for Certification in Functional Medicine, Integrative Pediatrics, and MAPS (Medical Academy for Pediatric Special Needs). I have over 24 years of experience in conventional psychiatry. I transitioned to integrative, functional medicine after developing a chronic autoimmune disease, and later Chronic Inflammatory Response Syndrome from mold exposure, that were not able to be adequately diagnosed or treated by conventional medicine. My goal is to pass on the knowledge I gained in helping to heal myself to my patients by applying integrative, holistic methods to Mental Health conditions.
Recent research has discovered that there is a strong relationship between inflammation and both physical and mental health symptoms. The primary physical factors that modify a person’s genetics and cause inflammation and dysfunction are: 1) allergens; 2) infections or imbalance of the microbes in the gut; 3) toxins; 4) diet and nutrition and 5) lifestyle and stress. Inflammation can result in digestive distress, asthma and allergies, heart problems, skin conditions, mental health symptoms (such as depression, anxiety, autism, and attention problems), cognitive impairments, autoimmune diseases, thyroid and adrenal problems, sex hormone imbalances, and many others. In addition, the microbes in the gut produce a large amount of neurotransmitters – including more serotonin and dopamine than in the brain! As a holistic and integrative Psychiatrist, the importance of evaluating the function of the brain, the body and the behavior, along with the Psychological, Social and Spiritual factors for each person, is critical in order to result in true health.
The integrative treatment plan is individualized based on this initial evaluation and can include nutritional and dietary modification, herbs and nutritional supplements, lifestyle changes, stress reduction/mind-body techniques, biofeedback, essential oils, biomedical treatment of physical health problems, psychiatric medication, detoxification treatments and other integrative methods. I always strive to reduce, and possibly even be able to eventually discontinue, the use of prescription medication as health is restored.
The goal is always to help the person improve their functioning to reach their highest potential so they can thrive and be happy!
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