Dr. Nishi Bhopal On Integrative Psychiatry

Dr. Nishi Bhopal On Integrative Psychiatry

OYM Nishi | Integrative Psychiatry

 

Treating psychiatric disorders do not just stop with prescriptions. They extend far beyond that. What better way to treat something that affects our entire health and wellbeing than holistic care? In this episode, Timothy J. Hayes, Psy.D. sits down with Dr. Nishi Bhopal—triple board certified in psychiatry, sleep medicine, and integrative holistic medicine—to talk about integrative psychiatry. She shares the things she found about helping patients with their mental health issues and how she is bringing her experiences with yoga and meditation into clinical practice. Dr. Bhopal then breaks down some of the misconceptions surrounding integrative medicine and its difference from the traditional medical model and allopathic medicine. Ultimately, integrative medicine helps people maintain that sense of balance so they can function optimally in all aspects of their life. Tune into this conversation to learn more about how this is achieved.

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Dr. Nishi Bhopal On Integrative Psychiatry

Dr. Nishi Bhopal is triple board certified in Psychiatry, Sleep Medicine, and Integrative Holistic Medicine. She graduated from the University College Cork School of Medicine, completed her Psychiatric Residency at Henry Ford Health System, and the fellowship in Sleep Medicine at Harvard Medical School. She also received training through the Maharishi Ayurveda Association of America and the Integrative Psychiatry Institute.

Nishi, thank you for being here. Thank you for visiting with us. Welcome.

Thank you for having me. It’s a pleasure to be here.

I like to ask people how they got started in their particular line of work and what it is that drives their passion. How would you respond to that?

I’m an Integrative Psychiatrist and I also specialize in sleep medicine. When I was in medical school, I didn’t intend to become a psychiatrist. I thought I was going to be a pediatrician. I took this circuitous route. I thought I was going to go into Peds. When I was in my medical school rotations, I became fascinated with physiology, then I thought I was going to go into internal medicine. I started my residency training in internal medicine. While I was doing my rotations, I found myself talking to all my patients about what was going on in their lives, how they were feeling, what was happening in their relationships and did they enjoy work? All of these things that you don’t have time to delve into in a fifteen-minute clinic appointment in the internal medicine setting.

I came to this realization that maybe I picked the wrong specialty, and I ended up transferring into psychiatry after my intern year in internal medicine. When I was in my psychiatry residency, I was seeing many patients with sleep issues either insomnia or oversleeping. I felt like I didn’t have a good foundation in how to help them. Part of the reason I was interested in sleep as well is because of some of my own issues with sleep, fatigue, and learning how to manage that with yoga, meditation, diet, nutrition, and all of these other holistic modalities. It became this convergence of my clinical work with my own personal experiences. That led me to pursue integrative psychiatry, sleep medicine, bringing in elements of Ayurveda, yoga, and all of these other things. That’s how I practice now.

Do you work out of a clinic or private practice? What’s your setting?

I work with a group practice but now I’m focusing more on my private practice. My private practice is based in the Bay Area. I’m in California and it’s called IntraBalance Integrative Psychiatry. I focus a lot on holistic approaches to mental health, integrative approaches, bringing in conventional psychiatry, using medications and things when appropriate. I’m looking at other ways to help people achieve optimal health and optimal mental health, helping people wean off sleep aids, and draw upon their internal resources to feel better mentally and also to optimize their sleep. I’m doing this in my private practice setting.

How do people find you normally? Do you get referrals from insurance or is it word of mouth? What happens?

Since this is an integrative practice, it’s an out-of-network practice. We don’t take insurance. The reason for that is because in the insurance system, you’re limited by time so you don’t have the opportunity to go in-depth into ways that are going to heal people, looking under the hood and looking at the causes of their symptoms. I do a two-hour intake with most of my patients. Sometimes, it goes over two hours and then my follow-ups are usually 1 to 1.5-hours. It’s not possible to do that in an insurance-based system. Most of my referrals come from word of mouth. I work with a lot of therapists in the community. They’ll send me patients. I also get patients from primary care doctors in the community. A lot of people also find me on Psychology Today or through Google. There is a number of different channels that people find me through.

Are you finding that the term, integrative psychiatrist, is gaining traction that people have a sense of what you mean when you say that?

I feel like it’s still a new and nebulous term. A lot of people don’t quite understand what that is yet. Even in the field of psychiatry and mental health itself, I don’t think there’s a great understanding of what integrative psychiatry or integrative medicine even is. In conventional medicine, there’s this bias that integrative medicine doesn’t work, it’s not evidence-based, it’s some snake oil selling or something like that. I’m in California, so there’s a lot of awareness of holistic medicine and integrative medicine out here. In general, it’s not fully been accepted into mainstream society yet. A lot of people don’t quite yet understand what it is.

How would you differentiate between the traditional medical model, the allopathic medicine, and what you’re practicing as an integrative psychiatrist? How would you describe that to people?

Integrative medicine or integrative psychiatry does not reject conventional medicine. That’s a misnomer that a lot of people often believe. Integrative medicine blends the best of conventional medicine with integrative and holistic modalities. For example, it could be looking at a fully integrative approach for anxiety. It could look like using medications when appropriate, using other conventional modalities like psychotherapy, but also looking at nutrition, yoga, meditation, breathing practices, or other practices from Eastern medicine as well. I’ve done some basic training in Ayurveda. I bring those practices into my clinical work in addition to the conventional approach. Integrative medicine doesn’t reject conventional medicine nor does it blindly accept holistic practices without question. It’s about offering the best tools to our patients in a personalized way that is going to help them achieve optimal healing.

OYM Nishi | Integrative Psychiatry
Integrative Psychiatry: Integrative medicine doesn’t reject conventional medicine, nor does it blindly accept holistic practices without question. It’s about offering the best tools to our patients in a personalized way that is going to help them achieve optimal healing.

 

In the traditional sense, if I refer somebody for an evaluation by a psychiatrist, generally speaking, if they’re lucky, they’ll get a 45 to 60-minute intake, and then they’ll get a medication prescribed almost predictably like lockstep that’s what happens. In very few cases, do I refer somebody for an evaluation, they don’t come back with a script or multiple scripts. The follow-ups are 3 or 6 months ad infinitum. It keeps going. What does a pattern of treatment or course of treatment look like in your realm?

When a patient comes to me, I’ll do a two-hour intake with them, and sometimes it might go beyond that timeframe. Essentially, what we do is we go through many things that are involved in a conventional psychiatric evaluation. We’re looking at their medical history, psychiatric history, medications that they’re taking, family history, but it will also take a deeper dive into lifestyle aspects that might be contributing to their symptoms. I focus on sleep. I do a lot of sleep assessments, circadian rhythm assessments, sometimes we’ll do some functional testing or nutritional testing to see if there are other root causes for their symptoms. We’ll also look deeper at trauma or complex traumas that the patient might have experienced.

There are many people, especially the allopathic psychiatrists that I refer people to, who don’t even ask about trauma. It’s like they’re allergic to the T-word. You’ve made it official that every integrative psychiatrist or medical doctor I’ve looked at is opening to and focusing on the impacts of trauma.

That is one core aspect of integrative psychiatry that differentiates it from conventional psychiatry. At its core, it is a trauma-informed approach.

Dr. Lila Massoumi talks about her model that some children are rocks and some are laptops. I said, “What?” She said, “With rock, you can throw it against the wall, drop it in a snowbank, splash it in a river, and it still functions as a rock. If you do that to a laptop, it’s not going to work so well.” A lot of people live in a household that most people looking in from the outside would not label as an abusive environment or a traumatic environment. Yet for a child whose emotional needs don’t fit what’s available in that household, they can download a lot of energies that are baggage later in life. That’s what we call trauma.

Integrative medicine or integrative psychiatry does not reject conventional medicine. Click To Tweet

That’s an important distinction to make as well. Everyone responds to situations differently. You could have two different kinds in the same household and they could have a completely different experience of what it was like to grow up in that family. It can affect them deeply in different ways as they get older. Oftentimes when we talk about trauma, people think of overt abuse. I’ll ask my patients about trauma and they’ll say, “I had a very happy childhood.” If you start digging deeper and then you might realize there were issues with misattunement with their parents that created deep-seated feelings of shame, internal confusion or low self-esteem and all of these kinds of things that carry over into adulthood that may have not been very obvious until you start peeling back those layers.

For many, referring to somebody who’s a functional or an integrative practitioner is better because they’ll start looking at that and helping the individual assess things that oftentimes the individual didn’t realize, “This was a problem in my life. This might be driving my anxiety, obsession, depression or sleep problem.” You have a two-hour session and then what does a course of treatment look like in your practice?

The course of treatment is individual. In the conventional model, you might have someone get placed on medication and then they’ll follow up with their doctor every few months. The medication dose will be tweaked or adjusted. In the integrative model that I follow, patients will come and see me again sometimes after 1 or 2 weeks or 1 month, depending on what they need. In those follow-up sessions, we’ll keep digging deeper into three core aspects. We’ll look at lifestyle. As I mentioned, I focus a lot on sleep and circadian rhythm management. We’re trying to optimize their sleep because if you’re not sleeping well, it’s going to affect every other aspect of your health, life, and functioning. That’s one aspect.

Then we’ll start digging deep into beliefs, mindset, trauma, ideas of meaning and purpose where that might be lacking in a person’s life, and how those might be contributing to their current symptoms. We start digging into those things as well. The third aspect is the biological piece. Are there nutritional deficiencies? Is there a microbiome dysfunction? Are there supplements that we need to add in or specific dietary and changes that we need to make? Do they have gluten sensitivity? Those are the three core pillars that we look at as we dive into treatment.

The goal is to get the person to a place where they’re functioning optimally and they don’t need to see me anymore. I tell all of my patients, I want them to graduate from treatment. I don’t want them to be seeing me for many years. I want them to get to a point where they feel empowered to take their health into their own hands and to know exactly what to do when things might slide back a little bit. Sometimes, they’ll come back and see me for follow-ups for a tune-up, but the idea is that they should be able to go out into the world on their own and not be dependent on treatment.

If your caseload or population is anything like mine, when you start asking people about questions like purpose, meaning and life goals, there are quite a few who’ve never even explored those issues. It begins with, “What do you mean by my sense of purpose or my life goals?” That’s one of the things I love about Dr. Mark Hyman‘s approach. I heard him in an interview once say, “It’s not rocket science. What it takes to live a healthy life for a human being are these 5, 6, 7 or 8 categories. They don’t get limited to good clean water, good nutrition, and sleep. It’s all of this sense of purpose in life, a connection in the community and a sense of love.” When that happens, are there particular tools or resources you use to help people tease that out or point them in different directions?

There are a few things that I do. One is starting the dialogue and opening up that conversation. As you said, a lot of people haven’t even thought of this stuff before. They haven’t had the time to think about it, the opportunity or the venue in which they can discuss these things. One of the questions I ask people is, “If you were financially free, what would you do with your time?” Sometimes simply asking that question gets people’s minds open, gets their imagination going, and starts thinking, “Let me take a step back and look at that.” Sometimes, you’ll get some interesting answers. That’s one way that I start up the conversation.

Another is asking them, “What used to light you up before you were ten years old? What could you lose yourself in? What did you love to do when you were a kid?” That also can open up people’s minds and their imaginations to exploring this. Sometimes I will use tools like the Strengthsfinder Assessment. I work in the Bay Area, so I see a lot of people who work in tech or corporate environments and they feel like they’re a cog in the wheel. They get stuck and end up in roles that aren’t the best fit for them, for their temperament or their style. Some of these tools like Strengthsfinder or even the MBTI, the Myers-Briggs Assessment, can give people some insight into what makes them tick and how they operate. That’s often a great launching pad to have these conversations and to explore further.

OYM Nishi | Integrative Psychiatry
Integrative Psychiatry: When people are under stress, they’re going to go to these extremes. You’ll see them completely withdraw, start to numb out with substances, make decisions impulsively, or hideaway under their blanket.

 

To clarify for people, some people call the Myers-Briggs a test but it’s a questionnaire. When someone fills it out, it doesn’t tell them right or wrong, good or bad, it gives a description based on their own report about how they like to interact with the world. I have found that to be very useful for individuals and couples. There are adaptations of that, the DISC Profile, and things that people have adapted for work settings that have become popular. What I like about referring to someone like you is that’s not going to be out there as a data point. It’s going to get integrated into your picture of the person.

What can happen all too often in my experience is that people glom onto one thing like the Myers-Briggs typology indicator and either use it as a weapon against themselves or their partner or think that because of that, it rules out certain professions that they might have a passion for. What I’m hearing you say is that you use that in combination with all of the other things you get from your assessment and your ongoing work with people to help them integrate that information and to make better decisions.

It’s important to not get attached to the outcome. It’s not defining the person’s identity, but these things are tools to help people understand themselves a little bit better and understand how they make decisions, what’s depleting to them or what gives them energy, and how they follow through on goals. Goal setting is another thing that I work with patients. I’ll see a lot of people who experienced a lot of shame or they’re hard on themselves because they feel like they can never follow through on things. These assessments can help us understand how they operate and leverage their strengths is what we’re working on.

One of the things that were useful to me personally, and then working with others with the Myers-Briggs was the fundamental assumptions in that work. Number one, everybody has access to both sides of all four dimensions. It lets us describe ourselves according to four different dimensions. Everybody has access to both sides of every dimension. If I test out as a feeling person, I can also develop the thinking aspect of things. If I test out as an introverted person, I can develop the skills of an extrovert, etc.

The second thing is that “almost everybody” is going to have a natural tendency towards one side or the other on all four dimensions. The last piece that’s critically important, especially in a society like ours, is that the more stress I’m under in any given situation, the further I’m going to move toward the extreme of my natural tendency, and those of us who work with people know extremes are not useful. It doesn’t matter how good it is in that moderate range or high-level skill range, if I go to an extreme in it, it gets to be dysfunctional. Those key pieces to help people understand like, “When things are going along and I’m humming along at a low to moderate stress level, I can do this. If I get into a situation that I interpreted as a high-stress level, I need some different coping skills. I’ve got to be monitoring my responses and pull it in or go for the tools that Dr. Bhopal might have taught me about getting some balance back in my life.”

That’s why I named my practice IntraBalance, to help people access those internal resources so they can find balance. As you said, when people are under stress, they’re going to go to these extremes. You’ll see them completely withdraw, start to numb out with substances, make decisions impulsively, or hideaway under their blanket.

You enable them to make a decision to save their life.

The goal of integrative medicine or integrative psychiatry is to help people maintain that sense of balance so that they can be functional and function optimally in all aspects of their life. Not only with their physical health but also in their relationships at work and with their families. When they go out into these extremes, my goal is to teach patients what to do to bring themselves back into balance so that they don’t have to rely on taking a Xanax, calling me for a crisis appointment, or something like that. They have all the resources and the tools that they need to keep them in a state of balance.

Integrative medicine aims to help people maintain that sense of balance so they can function optimally in all aspects of their life. Click To Tweet

It resonates for me that many people have everything they need and they don’t know what they haven’t been taught and how to access it, but it’s right in there. One of the keys in work for me and a lot of the things that work is helping people understand that their emotions are energy and they’re good sources of information. They’re not something to run away from or drugged out. That is a relatively unique perspective in our culture. I’m hoping that in your practice, you do the same as helping people in IntraBalance, become aware of their emotions and learn to use them more productively.

One of my favorite tools that I use in my practice is a simple tool but it’s an emotional vocabulary list. It’s a list of different feelings and emotions because most of us are not taught how to identify our emotions. We know that we don’t feel good, but a lot of us have difficulty articulating what it is that we’re feeling exactly. One of the things I do is I use this tool and people start journaling on what they’re feeling. They’ll refer back to the tool and pinpoint exactly what emotion they’re experiencing. I love how you said it’s information because that is simply all it is. It’s not that these emotions are good, bad or we’re trying to achieve any particular type of emotion. All of these things are information that we can use to then achieve our treatment plan.

I’ve worked with a number of people who had the experience growing up that they were told to shut it off or dry it up or, “I’m going to give you one minute. If you don’t stop crying, I’ll give you something to cry about.” The teaching has been, “This is a bad thing. This is something I need to run away from, something I can’t handle, and this is something my parent can’t handle in me.” The more I have those emotions and I get the signal from the environment or my parent, whether it’s true or not for the parent, the child interprets it as, “My parent can’t handle this. The more I formed the belief there’s something damaged in me. There’s something wrong with me.” For a lot of my patients, that’s a primary piece of self-education.

That self-education is incredibly important, and coupling that with self-compassion is incredibly powerful. Helping people understand that you can experience the emotion without it being overwhelming. You don’t need to be scared of it. That’s a powerful piece. Bringing in that mindful awareness and that nonjudgmental awareness of their emotions is incredibly important. The breathwork, regulating your nervous system with the breath, and using whatever tools work for that person. I’ll have a lot of patients tell me they feel more anxious when they do breathwork. If that’s the case, “Let’s try something else. Let’s try progressive muscle relaxation, some yoga poses or tai chi,” whatever works for that individual. That’s also the crux of integrative medicine or integrative psychiatry. It’s finding what works for that individual. It’s a personalized approach.

I’ve run into several people where they say, “People tell me to take a deep breath and it doesn’t work.” I’ll ask them, “Show me what is your deep breath looks like?” They’ll go, “I don’t feel any better.” I say, “Try this breath. Try where you pull it in, hold it for 2 or 3 counts, and resist the exhale. The exhale is 4 to 8 times longer than the inhale.” In that extended exhale, my body gets this irrefutable signal. This is not life and death. I don’t have to go to fight or flight, and people notice that parasympathetic response kicking in.For some people, that doesn’t work well. We have to add things like the acupressure techniques of EFT tapping, yoga poses or the jumping jacks, to get up and get some vigorous exercising. Most people can find benefit unless their system has been completely hijacked because of trauma or chemical imbalances in nutrients and hormones. How do you know when somebody is ready to fly without you and not have any more sessions? What assessment goals do you have for yourself working with someone?

I’d like to share the story of one of my patients who is at that point. This is a person who is in her 40s and she’s been in the psychiatric system since her 20s and was diagnosed with Bipolar 1 Disorder with psychosis. She had been on heavy-duty anti-psychotics and mood stabilizers for several decades. She’d come to me because she was tired of taking medications, feeling like a zombie, numbed out, and not being able to access her emotions under these layers of heavy doses of her meds. I’ve been working with her for a few years now, and we uncovered that her symptoms were primarily related to several traumas that had never been addressed.

These manic episodes were more dissociative trauma-related. What we did in our work together was, one, I had her start working with a trauma therapist for a specific trauma protocol called EMDR. She started doing that. We also started looking at nutrition and bringing in principles of Ayurveda, circadian rhythm management, which is important for people who have manic, depressive episodes, or changes in their sleep patterns. That’s powerful to regulate their circadian rhythm. We also started working on nutrition, supplements, and gut healing. Over the course of the past couple of years, she has completely tapered off the medication. She has not had any dissociative episodes, no mania, no depressive episodes. She feels more alive than she has felt in decades.

She’s working again. She started her own company and feels amazing. She has been so touched by this experience of healing that now she is training to become a holistic healer. She’s at a point now where she’s not only stable but thriving and healthy. She is functioning at her best in every aspect of her life, in her family life, her work life, relationships, and friendships. We’re at the point now where we’re looking at terminating treatment and following up as needed. That is the goal. When people are feeling better and they’re functioning their best in every aspect of their life, that is often the time that we can start to wean down on treatment.

I am glad that you shared that story. I’m one of those people who’s been at this so long that I’ve had many experiences where people came to me with a diagnosis that the traditional psychiatric world would say, “This is a life sentence. This is a chronic progressive problem,” whether it’s bipolar disorder or several of the personality disorders. With all of those different things that you were mentioning, usually beginning with the trauma work and then building their skills in various tools, whether it’s the gut biome, nutrition, exercise and purpose in life, people end up going years without any symptoms of this supposedly terminal chronic progressive disorder. I do also know some people who no matter how hard they try are not been able to go off the medicine and still function. Medicine plays a role in those people’s lives.

Dr. Peter Breggin has written a book titled Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients, and Their Families. This is a book that anyone can read and it’s critical to do the withdrawal of those medicines carefully and sometimes excruciatingly slowly, depending upon the individual. One of the key things from that book with Dr. Breggin is, “There’s no schedule you can write up and say, ‘If you’re taking 200 milligrams of this drug, then you decreased by 25 milligrams for the first month.’” That might work for some people and it might also send somebody back into a rebound that’s completely debilitating.

There is no one-size-fits-all when it comes to tapering drugs. I’m also a sleep specialist. I see a lot of patients in my practice who have been taking benzodiazepines or Z-drugs like Ambien or Lunesta for years. These drugs were never designed to be taken for years on end. They were designed to be taken for two weeks at a time, situational stressors or taking it intermittently. I have patients who have been taking these things every single day for years. What happens is once you’re on these drugs, you need these drugs. If you’re taking something for sleep and you’re taking it every night, you’re going to need it every night to sleep.

I’ve had one patient, for example, who was on Klonopin for about ten years. We did a taper over eighteen months. We were going down by tiny doses and we were using liquid droppers. At one point, we had to use a compounding pharmacy to get these tiny doses. At the tail end, he was on 0.05 or 0.025 or something minuscule. Doing these slow tapers in conjunction with looking at all of the other pieces of the puzzle. That’s how I explain it to patients is that it’s like a jigsaw puzzle.

OYM Nishi | Integrative Psychiatry
Integrative Psychiatry: Our system is set up for acute management, but not for long-term healing. That’s where the integrative approach is important.

 

We want to make sure we’re looking at the nutrition piece, the microbiome piece, traumas, meaning and purpose at work, community, looking under the hood, and making sure there’s no sleep apnea, restless leg syndrome, fibroid dysfunction or other medical issues that could be contributing. If we look at all of these pieces while doing a very slow taper, the rates of success are incredibly high. Most of my patients who taper off of these benzos and sleep drugs, tell me they feel better than ever. They’re sleeping better than ever, less anxious, more able to function at work, concentration and cognition are much better. They feel great. They don’t want to go back to those drugs once they’re off of them.

Those drugs can serve a purpose if somebody is in a crisis. At the same time, my approach has been the shortest period of time, the smallest amount of medicine to get the desired effect. When you have somebody who’s going to help you with the skill-building and the IntraBalance approach that you’re providing all these various aspects of your life, then it’s a reasonable thing to do to build strengths in other areas and “I don’t need that medication” support. Dr. Breggin and Dr. Whitaker are the two of many who’s pointed out that the long-term effects of those medications are almost always negative, and they’re not intended, even the antidepressants aren’t intended for this long-term use that we’ve grown into in our culture.

The great irony is that oftentimes, the medications start to cause the symptoms that you were trying to treat in the first place.

Every time I’ve read the labels and warnings that come in with people, the most common one is either depression or insomnia. Every drug is ever written, the warning labels on for insomnia says, “It’s for short-term use only. One of the primary side effects is it causes insomnia if you use it for too long.” How does that make any sense? As you say, you’ve got people who come in and they’d been on Ambien every day for years.

It’s no one’s fault. I don’t want the patient or the person to feel judged or blamed for being on these medications. It’s a product of our healthcare system. People will go and see their primary care physician, they have 5 or 10 minutes to talk to them, they’ll tell them about their sleep issues, they get put on the drug, and then it’s on their record. It gets renewed every month. Ten years later, they’re still on that medication because we don’t have a great system of healing. Our system is set up for acute management but not for long-term healing. That’s where the integrative approach is important.

I don’t want the patients to generate guilt or shame because, in my work, I understand those are not useful. I don’t want the doctors to get blamed and hammered because they’re only doing what they were trained to do. I had the privilege of interviewing Dr. Jodie Skillicorn and she wrote a book, Healing Depression Without Medication. She talked about how she got out of medical school and was excited to be a psychiatrist, and then she read Dr. Whitaker’s book and said, “Is there that much evidence that these medications long-term have all those negative effects?” It was only after she’d had the full psychiatric stamp of approval from the establishment that she got introduced to something that said, “There might be another way to look at this.”

As doctors who go through training, we’re not exposed to these other ways of healing and thinking about health. We’re taught how to reduce symptoms but we’re not taught how to optimize health and wellbeing. For me, it was through my own work with yoga and meditation, my own personal journey with that. I started to realize that, “There are other ways, there are other dimensions to health and healing that we’re not addressing in the conventional system.” That’s what got me interested in learning more about Ayurveda and holistic medicine. I was a skeptic before. I was like, “I’m a scientist. Those things don’t work. There’s no evidence for them.” It wasn’t until I had my own personal experiences with those healing modalities that I started to understand firsthand what they could do.

There is another psychiatrist we’ve interviewed on the show who was practicing for years as a psychiatrist. She had her own internal physical pain that conventional medicine was completely unable to identify or give her any relief for. She was telling her story that, at the point where they finally gave up, they couldn’t figure out what was causing it and they suggested that she let them inject nerve blockers or painkillers directly into her abdomen. That’s when she said, “This is not working.” That was her U-turn to go toward a more holistic alternative approach. When she started to things that worked for her, then she felt compelled to offer them to her clients and patients. Now, that’s her practice. It’s a functional integrative holistic approach. It’s nothing that she learned in her medical school training.

Self-education is incredibly important; coupling that with self-compassion is incredibly powerful. Click To Tweet

Another aspect that’s interesting is patients intuitively know that all of these things are connected. For example, I have a patient who has a lot of auto-immune issues. She’s got autoimmune thyroiditis, Hashimoto’s, fibromyalgia, overweight, fatigued, chronic depression, there’s a history of trauma, and she understands at a deep level that all of these things are interconnected, yet she’s seeing four different people. She’s seeing an endocrinologist and then a rheumatologist. She’s got her therapist and she’s got all of these different people in these different silos who don’t talk to each other on her treatment team. When I explained to her that in Ayurveda, which I see as the original functional medicine, in Ayurvedic medicine, it’s understood that all of these things are connected.

We looked at her symptoms under the umbrella of Ayurveda and looked at what the root cause might be in terms of a root imbalance. She burst into tears because it was validating for her to hear that because it’s something that she understood very deeply personal, but none of her doctors believed her. She asked her different doctors, “Could these things be connected? How might they be connected?” She’s been told, “They’re not. They’re separate conditions. You have to treat them as such.”

If the doctor has been trained to believe that and they’ve got what they consider to be the evidence, the facts, the scientific proof, it’s difficult to convince them otherwise. It was Dr. Phyllis Heffner that I was mentioning who’s a child psychiatrist that had that story about her own illness. I believe that Dr. Mark Hyman, a prominent name in functional medicine, has a similar story of being a physician, having his own physical problems, and running into brick wall after brick wall in conventional medicine. What they’re telling him is, “You’ve got to go home and take these meds and write it out because this is never going to get better.” He refused to accept that. That’s what turned him toward the more holistic alternative and eventually the functional medicine approach.

There’s a real feeling of helplessness that is built into the system. Patients feel helpless but so do doctors. In the conventional system, as doctors, we’re trained to use medications or few other modalities. When we run out of those, we’re stuck. This idea of helplessness is baked into the Western medical model. That’s what’s beautiful about functional medicine or integrative medicine, Ayurveda, and traditional Chinese medicine. It’s about empowerment, balance, and giving people the tools to bring themselves to that state of balance.

If we can create that mindset shift with our patients from the state of helplessness to empowerment, like with my patient that I told the story about who was diagnosed with bipolar disorder, who had had multiple hospitalizations, who was told she’s going to need to be on these meds forever, and she’s never going to be able to work. How helpless would you feel hearing that? Now, she’s in this state of feeling empowered. If we can do that for our doctors and healthcare providers at a system level in Western medicine, can you imagine how powerful that would be for our society?

That’s a big part of what Journey’s Dream is trying to promote, the idea that optimal health and wellbeing are possible and you could learn to expect that of yourself, physicians and health team if you want to term it that way. We’re closing in on a time when I have to get going here. I wanted to give you an opportunity to let people know how to contact you, whether or not you do any telehealth work for people that aren’t in the Bay Area, and what’s an aspect of your work that we haven’t even touched on yet that you would want to put out there?

People can find me on my website at IntraBalance.com. I do have a free holistic sleep guide that people can download at IntraBalance.com/SleepGuide. I do offer telehealth sessions for people in California. For people outside of California, I’m putting together a Holistic Sleep Program. That’s a step-by-step program that teaches people holistic ways and integrative ways to optimize their sleep quality. This will be available to anyone and that will be coming out in January of 2021. For more information on that, people can get my Sleep Guide, and they’ll get email updates about the program. Sleep is a huge part of the work that I do. We touched on that a little bit, but that’s what I’ll be focusing on in 2021.

Thank you for taking the time to be with us. I look forward to watching how this develops, you and your sleep soul sisters as they put together this program. If I’m right, Deepa and Aarti are with you on that project.

That’s the three of us.

Thank you. I appreciate you taking the time. It’s a pleasure to meet you.

Thank you for having me.

Dr. Nishi Bhopal is triple board certified in Psychiatry, Sleep Medicine, and Integrative Holistic Medicine. She graduated from the University College Cork School of Medicine, completed her Psychiatric Residency at Henry Ford Health System, and the fellowship in Sleep Medicine at Harvard Medical School. She also received training through the Maharishi Ayurveda Association of America and the Integrative Psychiatry Institute. Having grown up in an Indian family in Canada and lived in several different countries, Dr. Bhopal understands what it means to be multicultural and is attuned to the unique challenges faced by immigrants and ex-pats.

She’s also a meditator and brings her experiences with yoga and meditation into clinical practice, blending the best of ancient wisdom and modern medicine. She is the Founder of IntraBalance Integrative Psychiatry and Sleep in San Francisco, and is a founding member of the Same Here Psych Alliance, a global initiative to reduce the stigma around mental health. Her passion is making mental wellness and the science of sleep easy to understand and accessible to all. Her website is IntraBalance.com.

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About Dr. Nishi Bhopal

OYM Nishi | Integrative PsychiatryDr. Bhopal is triple board certified in Psychiatry, Sleep Medicine, and Integrative Holistic Medicine. She graduated from the University College Cork School of Medicine, completed her Psychiatric residency at Henry Ford Health System, and a fellowship in Sleep Medicine at Harvard Medical School. She has also received training through the Maharishi Ayurveda Association of America and the Integrative Psychiatry Institute.

Having grown up in an Indian family in Canada and lived in several different countries, Dr. Bhopal understands what it means to be multicultural and is attuned to the unique challenges faced by immigrants and ex-pats. She’s also a meditator and brings her experiences with yoga and meditation into clinical practice, blending the best of ancient wisdom and modern medicine.

Dr. Bhopal is the founder of IntraBalance Integrative Psychiatry & Sleep in San Francisco and is a founding member of the SameHere Psych Alliance, a global initiative to reduce the stigma around mental health. Her passion is making mental wellness and the science of sleep easy to understand and accessible to all.

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