Understanding Integrative Psychiatry With Dr. Lila Massoumi

 

Integrative medicine has more to it than simply integrating non-medication treatments with medication treatments or conventional care. How does it really differ from conventional medicine? Timothy J. Hayes interviews Dr. Lila Massoumi, the Chair of the American Psychiatric Association Caucus on Complementary and Integrative Psychiatry and the author of the first-ever chapter on Complementary & Integrative Treatments for the American Psychiatric Association Publishing Textbook of Psychiatry. Dr. Massoumi educates us further about her unique field in psychiatry by explaining how integrative psychiatry differs from other forms of psychiatry such as conventional and integrated psychiatry. She also goes through a few of its tenets they subscribe to.

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Understanding Integrative Psychiatry With Dr. Lila Massoumi

My guest is Dr. Lila Massoumi. Dr. Massoumi is an integrative psychiatrist with a private practice with three physician assistants in the Metro Detroit area of Michigan. She is the Chair of the American Psychiatric Association Caucus on Complementary and Integrative Psychiatry. She is a Clinical Associate Professor of Psychiatry at Michigan State University. She’s the contributing author to the textbook, Complementary & Integrative Treatments in Psychiatric Practice. She is the author of the first-ever chapter on Complementary & Integrative Treatments for the American Psychiatric Association Publishing Textbook of Psychiatry. In addition to her commitment to patients, Dr. Massoumi’s mission is to change the way psychiatry is practiced in the United States.

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Thanks for joining us.

Thanks for having me.

Tell us a little bit about yourself.

I’m an integrative medicine psychiatrist with a private practice in the metro Detroit area. I am the Chair of the American Psychiatric Association Caucus on Integrative Medicine and Psychiatry. I’m a clinical associate professor at Michigan State University. I’ve authored a few textbook chapters, including the first-ever chapter on Natural Treatments for Psychiatry for the textbook of psychiatry for the American Psychiatric Association.

What is integrative medicine and psychiatry?

It is a conventional psychiatrist or integrative medicine psychiatrist who combines conventional medical care, which in psychiatry tends to be medications and either doing psychotherapy or referring to a therapist with non-medication or non-mainstream treatments. Those can include supplements such as herbals, electromagnetic treatments, the use of electricity and magnetism to affect biological change, and an emphasis on lifestyle factors like diet, exercise, meditation and other mind-body practices.

How is integrative medicine different than conventional medicine?

The definition of conventional medicine, if you were to look this up on Medline, which is the bibliographic database maintained by the National Library of Medicine, is those medical interventions taught extensively at US medical schools that meet the requirements of the generally accepted standard of care. They tend to be a lot of evidence for conventional medical treatment. A lot of the studies are done by drug companies that have a lot of money to do large studies. I’d say a lot of the conventional medical interventions, i.e. medications we know about physicians because the pharmaceutical industry also has a lot of money for marketing to come to our offices, to teach us about their product. To teach us about what studies were done on their product, as opposed to either generic medications or supplements where there’s no big money to support coming to our office and buying us lunch and teaching us about it.

Some other differences between conventional medicine and integrative medicine would be to understand an industry, you have to understand how it’s funded and physicians are reimbursed via volume. The quicker we can see a patient, we’re still marking it on our super bill as a high complexity case that we’ve done quite a few procedures or review of systems. If we can get the patient in and out, we make a lot more money than if we spend a lot of time with patients. In integrative medicine, we forfeit that benefit and we spend a lot more time with our patients. Many of us, not including myself, do not take insurance for that reason because we want to have sufficient time to spend with the patient to get to know them well and to go deeply into what might be going on medically and psychologically.

That might be the reason when some of your readers are looking for an integrative medicine doctor and many of them don’t accept insurance. That would be because we want to give you quality care and we don’t want you to come in and out. Integrative medicine has more to it than simply integrating non-medication treatments with medication treatments or conventional care. There are various values and tenets that we subscribe to, which I’m going to go through a few of them. I’ve written some textbook chapters, so I might send a more didactic conversation and I apologize. For example, when it comes to the definition of health, in conventional medicine, health is defined as the absence of disease. In integrative medicine, health is defined as the attainment of optimal health. How do we help you be the most energetic and vibrant psychologically and physically that you possibly can be?

Integrative medicine has more to it than simply integrating non-medication treatments with medication treatments or conventional care. Click To Tweet

When it comes to nutrition, conventional medicine is looking at the recommended dietary intake or RDI. That is the bare minimum of the nutrient required to avoid deficiency. In conventional medicine, when they looked at your lab work, they would want your vitamin B12 level to be above 200 nanograms per milliliter, or whatever the unit of conversion is. In contrast, in integrative medicine, we’re interested in your nutritional status being high enough that it reflects what the studies show are most likely to allow you to prevent chronic illnesses. In America, the normal B12 level is above 200. That’s enough to avoid peripheral neuropathy and overt signs of dementia. In Japan, a normal vitamin B12 level is 500. In integrative medicine, a lot of us would like your vitamin B12 level to be closer to 1,000 because that’s the level that’s been shown to minimize your chances of developing Alzheimer’s and other forms of dementia.

Our view on nutrition tends to be a little bit pickier than in conventional medicine, as far as the treatment approach in conventional medicine. A synonym for conventional medicine is allopathic medicine. That term comes from the homeopaths. Allo means other. The idea in conventional medicine is that you are treating disease with other or opposing forces. When you have a fever, we give you Tylenol to oppose that fever and bring the fever down. The treatment approach in conventional medicine is fighting off the disease using an opposing force. In integrative medicine, we have a profound respect for the body’s ability to heal itself. We attempt to provide nutrients and care that supports the body’s ability to heal itself. Similarly, another tenet where we differ is the view of the body. In conventional medicine, the body is divided into disparate systems. For example, you might have the gastroenterological system, the neurological system, the endocrinological system or endocrine.

In contrast, in integrative medicine, we believe that all the different body systems are intricately linked, which we know they are. Studies are beginning to show that the distinction between a brain, chemical, i.e. neurotransmitter and inflammatory cytokine or the chemicals released by our white blood cells to fight off infection. A hormone or the chemicals released by our organs is much grayer than previously thought. In other words, there’s an overlap between the functions of those three different kinds of chemicals. What I normally explain to my patients is that, where conventional medicine shines is when it comes to an acute illness or an acute trauma. God forbid, you get into a car accident and you are hemorrhaging. That is a time that you do want to be on the surgeon’s table and you do not want to be on the acupuncture table or the massage table. In contrast, with chronic illnesses, it tends to affect a bunch of different body systems and they all tend to contribute to your chronic illness. For chronic illnesses, whether it’s fibromyalgia, migraines, diabetes or mental illness, integrative medicine is superior because we’re considering how everything is contributing to the illness that you’re coming in for.

I love the idea that we’re looking at optimal health rather than keeping out of the disease state. You’ve talked a bit about how integrative medicine differs from conventional medicine. How might integrative psychiatry look different than conventional psychiatry? What does that process look like if someone comes to see you?

I’ll walk you through on what it looks like when a patient comes to see me using an example of an integrative medicine psychiatrist. The standard of care in psychiatry is that a psychiatric evaluation is between 30 to 45 minutes. That’s the way you could also make the most money, seeing patients for a shorter period of time. At the end of the psychiatric evaluation, you’re prescribed your medications or you’re referred to a counselor or the psychiatrist feels they can do the counseling themselves. In my practice, I spend 90 minutes with the patient. I start the session asking the patient what brings them in to see me, what problems they want for me to address, what their preferences are, what drew them to me to begin with, so that I know if they’re anti-medication or pro or what they’re looking for.

What I do, and this may or may not be different than the conventional medicine psychiatrist, I proceed with what’s called a psychiatric review of systems. That’s when I ask the patient questions about every psychiatric disorder I can think of, minus the very rare zebras. For example, a patient might come to me for depression, but I’m still going to assess them for ADHD. We might find out by the end that the patient has significant symptoms of ADD and they’ve been fighting it their whole lives. They haven’t been able to perform at the level that would be expected for their IQ. It is this battle that they’ve unknowingly been waging that’s resulted in the worthlessness and hopelessness that have caused their depression. It’s important to understand all the comorbidities or all the other illnesses that patients might be suffering from, even if they don’t know that they’re suffering from it to fully address everything that’s affecting them.

After the psychiatric review of systems, I’m skipping some sections, then ask about past medical history or what medical problems the patient has. I might focus on those things that I think I could help with. For example, female cycle irregularities or mood swings if they pertain to female cycles. Thyroid, sleep apnea, chronic pain, autoimmune disorders, and inflammation. We know that if you’re in an inflamed state, that you’re 3 to 5 times more likely to relapse psychiatrically, even if you’re stable on your psychiatric medications. If you’re in an inflamed state, an anti-inflammatory could have psychiatric benefits. It’s not a huge benefit. It’s not like taking aspirin is going to cure depression per se. I’ll ask about medical problems that I think that I can help with. Another thing that I do that other psychiatrists may or may not do is assess for trauma and quite a bit of detail. I ask about overt trauma, whether the patient has any history of having been abused sexually, physically or verbally. I also ask about more subtle forms of trauma. There’s a misconception that if you haven’t been sexually or physically abused, that you haven’t undergone trauma. It is a lot more subtle than that. It has to do with how sensitive the patient was, whatever was going on exceeded their ability to cope and made them shut down instead of becoming more resilient.

The question I tend to ask to elicit trauma is, “Did you grow up feeling like your parents understood you, appreciated you and supported you? What makes you unique? Did you grow up feeling misunderstood and are alone at times?” If the answer is the second one, to any extent, I ask them to expand on that. That’s usually where the trauma lies. If the patient is blowing me off because they know their parents were well-intentioned and loved them, there couldn’t be any trauma. They were supported and loved and they’re not even giving much thought to the question I asked. I’ll go a little deeper and I’ll say, “Could you please give me three words or phrases that would accurately describe your mother or your father as you remember her growing up as a child or adolescent? It’s not as your mother is now or how you perceive her now. How would you have described her when you were little to your childhood friends in describing your mom?” That’s where I might elicit something like loving, caring, overly controlling, something like that.

That word, over-controlling, that’s where the meat is. That’s where a trauma may have come from. If there is a history of trauma, what do I do? I believe that in the modern-day age, with as little therapy as psychiatrists are taught, we’re given maybe one semester or one class per semester, that it is presumptuous for a psychiatrist to believe that they can do therapy. If you were trained prior to the Prozac era, then the majority of your training was based on therapy. After the Prozac era, the majority of our training is biologically based. To think that one class per semester is as much counseling training as someone that’s got a CID or an LPC was eight hours a day for 2 to 4 years, they did nothing but learn to counseling. I don’t think you can compare those two things.

If I do have a patient with a history of trauma, I tend to refer out. I don’t do counseling myself. I find it too difficult to be an expert on everything. I did try starting psychoanalytic training. There was no way I could be an expert in business, in medicine, in integrative medicine and counseling. It was impossible. I tend to refer out. I’ll give them the referrals at the end of the session, either to a therapist that I know that specializes in trauma or I might refer them to Psychology Today, which is a popular magazine. They have a very good website with a tab. It says to find a therapist and you can limit it by your insurance, by your diagnoses, by gender. You see a headshot and a personal statement so you can see if you feel intuitively drawn to them. If a patient has no idea how to go about finding if this therapist good or not, one of the ways I encourage them to find a therapist that specializes in trauma is to look for a therapist that feels comfortable treating what’s called Dissociative Identity Disorder. It is the modern-day term for Multiple Personality Disorder. It is not common, but dissociation or the tendency to compartmentalize and tune out is quite common in anyone with a history of trauma.

 

A lot of the research on trauma that has been in the past few decades tends to be relatively newer information, unless the therapist is keeping up with the latest trauma research. I’m concerned that they won’t have the skills necessary to treat trauma fully. I tell my patients, “When you try to limit your search of therapists, try to look for someone that says they’re comfortable with DID or Dissociative Identity Disorder. If they are, I promise you, they have a ton of skills in their tool belt.” At the end of my assessment with the patient, which takes about an hour, I provide them some education. I teach them what their diagnoses are and what their symptoms that qualify them for that diagnosis. I also tell them what diagnoses their symptoms suggest. I’m not sure they fully have it, but they have traits of it. These are things we want to keep in the back of our minds so that if such and such medication doesn’t work, and we’re trying to figure out what would be a good fit, we might want to consider these other rule-out diagnoses.

On the topic of diagnosing, I also want to make a point that one of the arguments against the field of psychiatry, things that psychiatry is maligned for is the fact that we diagnose patients at all. How can you diagnose people? People are not diagnoses. The reason we do that is I want to help. In order to help, I need to choose the right medication or the right supplement. In order to choose the right medication or the right supplement, I need to know what I’m treating. All of the research studies on meds and supplements were based on a given diagnosis. If you have bipolar disorder and I’m giving you an antidepressant for people who don’t have mood swings, I can make you worse. Diagnosis is important as far as it guides prescribing. That is why for diagnosing, I do believe psychiatrists are superior many times to therapists because we have to get the diagnosis right. That’s assuming the psychiatrist has spent enough time with the patient. If psychiatrists only spent twenty minutes doing psych eval and the therapist has known the patient for years, the therapist is going to know a lot more than the psychiatrist.

A therapist doesn’t necessarily have to get the diagnosis exactly correct. If all the therapist does is help the patient with their childhood trauma, the therapist is helping the client significantly. It doesn’t matter what the diagnosis is. Helping the trauma is going to help the diagnosis. That’s is my little spiel on psychiatry diagnosing, who diagnoses, and who’s I think is better at therapy. Other things I might educate the patient on besides their diagnoses is I believe that everyone on this planet has an amount of stress that they can take above which they will develop a mental illness. What makes all of us on this planet different is how much stress we can tolerate. For some people, their cat getting sick is enough stress to develop a mood disorder or a psychiatric symptom. Some people would need to be a prisoner of war with parts of their limbs chopped off daily for a few decades before they developed a psychiatric symptom. We all have a breaking point.

Sometimes I’ll have the patient say, “Dr. Massoumi, I’m going through a divorce. I’m not depressed.” I say, “What’s happened is the divorce has created an amount of stress that your body and mind can no longer take and now you are exhibiting symptoms. You’re already not able to sleep. Your appetite is changed. You’re having a difficult time getting out of bed. It is still depression, even though we know what the stressor was.” Assuming we have time, I educate the patient about the difference between conventional and integrative medicine and explain to them, “I understand that your primary care physician has already done lab work on you and told you everything is fine. I want you to understand that I might look at that same blood work, even though the lab itself says that you are healthy, you’re not going to have a serious issue in the next 1 to 2 months. I might say that your blood work has not been optimized. I want you in a position of health to be in the top 15% of the population psychologically and physically.” I did this a lot more at the beginning of my career, but it’s a nice thing to teach on. I explain to patients my analogy of being born a rock versus a computer.

This is where I’m trying to normalize the fact that they have a mental illness and not have them see their mental illness is a bad thing and see how it could potentially be a strength or that it’s a symptom of the fact that they have a strength. What I say is some people are born like rocks. A rock is hardy. A rock can be thrown into the lake, into the snow, taken inside the next day and still be intact. A rock did not have to have perfect parenting. The rock could have been kicked around a little bit, thrown around, afterwards it is still intact. It can still do its job as a paperweight, as a doorstop, as decoration, as a weapon. It is still intact and functional. Some people are born like computers. They feel their emotions very deeply and they think deeply about things. They are affected by the emotions of the people around them. The computer needs to be maintained between 40 and 90 degrees Fahrenheit. It needs to have parenting that it’s a good fit for that particular computer.

You cannot throw the computer into the lake or the snow overnight and take it out the next day and expect it to work. Its wires will be crossed, it will be completely broken and it won’t be able to do anything. The point of treatment, whether medication or therapy, usually therapy, you get the wires fixed. When you fix those wires, the computer can send people to the moon and do more even than the rock. The same thing that made you a computer and may have made you more vulnerable to this mental illness is the same thing that’s potentially making you exceptional. If you overcome this, you are going to be able to do more than maybe someone who hasn’t been through what you’ve been through. That’s my rock and computer analogy.

Finally, we go to treatment planning. I order lab work. In my practice, I stick with lab work that your insurance will cover. I have various reasons for that. Then we talk about medications or supplements. I want to be clear on something. If supplements were as effective as medication every single time, it would be malpractice for us psychiatrists to be prescribing medications. The reality is, the effect size, the degree of benefit or the degree of improvement that you get from a medication far exceeds the effect size that you get from a supplement. There are some workarounds. You can combine different supplements that each helps you 5% or 10% and then you combine them all and then you get a 40% improvement. Whether we rely on a medication or supplement, it is going to depend on how bad your symptoms are. If I’m treating depression, if ten is the happiest your mood could be and one is the most depressed, what number is your average mood these days? A normal mood that I’m shooting for is 7 or 8.

If a patient says their mood is a six, that is mild depression. We can talk about supplements. If it is a five, which is moderate depression, four is severe or you’re having thoughts of suicide. I’d rather give you a medication that will make you feel better in three days than talking about vitamin D and vitamin B 12 repletion and hoping you feel better in a couple of months by 30%. I do have patients that are opposed to medications. In those situations, I explore it with them. If they were put on a previous antidepressant and it made them more depressed, they think psychiatry is a bunch of hogwash or psychiatric medications are hogwash, I explain to them why the antidepressant made them more depressed. Mood swings or mood disorder is on a mood swing spectrum that’s not either depression or bipolar. It is a spectrum.

Everyone is on this spectrum. If you’ve got more depressed on an antidepressant, you’re probably on the mood swing spectrum. We have medications for people in the middle of the spectrum. Demystify the psychiatric medication. They might have a trauma history where the very parents that they were supposed to rely on, they couldn’t. You can’t rely on people. You can’t rely on authority. How can you trust the medication? You have to trust the doctor. Whereas the supplement, they can do their research, they can go to the drug store or the health food store. They can buy it themselves and they are in control. I want them to be aware of what’s influencing their decisions when we’re talking about something so serious is how we’re going to treat their psychiatric illness.

Despite those things, if the patient still absolutely does not want psychiatric medication, I will start with supplements. I do have supplements that were probably about everything. Usually, there is a little bit of improvement from that. The patient usually develops trust from that, “I do feel better. What else you got? What else can make me feel better?” Eventually, they trust me enough that they’re willing to try this one time before you see me and tell me what happens. We can break them in. I’ve already mentioned that besides recommending medications and supplements, I’m probably going to refer them to a therapist if needed. I might refer them to an integrative medicine physician. To be honest with you, those of us in integrative medicine speak a different language than doctors in conventional medicine. It’s easier for me to work with other doctors that are also integrative medicine because we’re aligned.

In the modern-day age, with as little therapy as psychiatrists are taught, it is presumptuous for them to believe that they can do therapy. Click To Tweet

I may make a primary care physician referral, then I asked the patient what questions, concerns or comments they have for me. I provide them a tight handout of my recommendations so that everything is clear and I tell them, “Follow the handout.” On this handout, if I do recommend supplements, it will be the brand of supplement I recommend. Where to buy it, what the price is and what the instructions are. I do not sell supplements at my practice. I believe that is a conflict of interest. I may, at the end, recommend some electromagnetic treatments and that’s a whole other topic. Your readers might be more familiar with ECT, Electroconvulsive Therapy, also known as, shock therapy. That is extremely helpful, but an extreme form of electromagnetic therapy. That’s not what I’m talking about when I say that. There are various other treatments. There’s something called cranial electrotherapy stimulation or CES, which has been shown helpful for PTSD, anxiety, and insomnia. There’s something called neurofeedback, which can be helpful for ADD and cases of traumatic brain injury. There’s lightbox Therapy or using a bright light for treating not only the seasonal affective depression but also depression of any kind. It has a 70% success rate. It’s very hard to comply with to sit in front of a lightbox for one hour every morning. That can be difficult.

In general, the United States is behind Europe when it comes to electromagnetic treatments. That has to do with the influence of the pharmaceutical industry on our FDA and difficulty in getting an FDA stamp of approval in the form of an FDA indication for electromagnetic treatments. The caveat that I would make as an aside for your reader to know and try to figure out which provider they want to see themselves or refer their loved one to. In my practice, I do subscribe to a physician extender model. I get about 5 to 10 new patient inquiries per day. Each psychiatric evaluation takes 90 minutes. There is no way on the planet that I could see the number of people that are calling my practice. What I do is train physician assistants or nurse practitioners.

These are masters level healthcare providers that have gone through an expedited or brief medical school. Four years or eight years are combined and collapsed into two years. I spend several months training them ad nauseam with an hour lecture daily with two months of shadowing me, followed by weekly supervision once they’re off on their own, seeing their patients. Patients that see me, see my physician assistants whom I have trained to be extenders of myself. If the PA or the patient feels they’re not getting better quickly enough, within 6 to 8 months, the patient is then elevated or escalated to see me so that I can stabilize them. That would be what it’s like with seeing an integrative medicine psychiatrist being myself at my practice.

That’s a wonderful review. I know people are going to want to tap into this and look at it. Is that all right with you if I attach this outline or some form of it?

I can give you another form of it. Some of it has my notes that might not be appropriate for viewing.

There is good stuff there that I’d like them to have access to that. It makes me wonder how did you get into this?

I got into psychiatry when I was in Spain in my junior year of high school. The summer after my junior year, I was homesick. I was reading the book, The Road Less Traveled, which is a bestselling book from the past. People might not have heard of it. It was written by a psychiatrist, M. Scott Peck, MD. What this book emphasized was that love is putting someone else’s spiritual growth ahead of your own happiness. I even get chills thinking about that phrase. That resonated with me. I’d always felt different from other people. I was self-analytical. I was a very analytical person. I was a high self-monitor. I was always analyzing myself. I was always analyzing other people. I came from a long line of doctors on both sides of my family and I already knew I loved science and helping people. I already knew I wanted to be a physician. Suddenly, the fact that I felt so different and overly self-aware at my young age, uncomfortably acutely self-aware, combined with my love of medicine. I was also a spiritual and had been for a long time. That book conglomerated all of my interest into one thing. I decided at age seventeen that I wanted to be a psychiatrist.

As far as integrative medicine, that was a little bit more arduous a path. It came about more through a healer’s crisis. I was in medical school and I was faced with hypocrisy that I wasn’t expecting. I came from a family that had always emphasized good health and medical school. I described the difference between conventional medicine and integrative medicine. I kept being trained on how to treat disease, but there was no mention of the optimization of health. The hypocrisy I’d see is, for example, I’d be shadowing a primary care physician who himself was morbidly obese. He would be criticizing his overweight patient for failing to lose weight. That seemed hypocritical. My Biochemistry teacher was also obese and he’s the one that taught us nutrition. We had to take a hiatus from our Biochem class because he had a heart attack in his 50s.

There was a morbidly obese patient in the hospital and we were rounding, which means a bunch of medical students and attending physician go room to room, seeing different doctors. You go in the hallway and you talk about the case as an educational experience. People were talking negatively about the obese patients, blaming him for his condition. Having been myself bullied for 2.5 years of my youth, I am turned off by groups of people getting together to criticize someone in a weakened state. All those things together, I was put off and I wasn’t sure I wanted to continue medical school. I took time off and did a lot of reading and ended up writing a book proposal and sending it to an agent. During that time, I discovered what used to be called the American Holistic Medical Association, AHMA. Suddenly, I found out there was this professional group of doctors that all felt the same way that I did.

We all viewed health as attaining optimal health, not simply the absence of disease. We thought love was part of the equation. We felt that the relationship between the doctor and the patient should be one of partnership and mentorship and not a paternalistic, authoritarian view that, “I say and you do what I say.” I got a letter back from the agent that I submitted my book proposal to saying that very few people are going to trust a book authored by a twenty-something-year-old with no credentials with that. If I was able to get my medical degree, my book would sell far more. Finding that AHMA and getting that very nice handwritten note from the agent who all they had to do was send back my safes but instead gave me a very thoughtful response, I did decide to return to medical school. I went through medical school with closeted interest in integrative medicine. That’s how I got into it.

 

This group you found used to be called the AHMA. Has it changed names? Does it still exist?

It may still exist, but it’s gone through some permutations with integrative medicine being more mainstream. They’ve begun to be not just an organization for physicians, but also an organization for chiropractors, naturopaths, and everyone interested in the integrative medicine movement, any providers. It’s not the organization it was when I was first looking at it. It used to be the only source of looking for other integrative medicine providers. There are a lot more other sources at this point that I’m happy to share with you a little list of the resources for that.

What makes you so passionate about this? Your passion is obvious.

A couple of things, and this is where I out myself a little. It’s one thing to talk about science and the research you’ve done. It’s another thing to talk about, personal experience and personal spiritual beliefs. I believe that I was reincarnated to do what I’m doing. I believe that’s my purpose on Earth. I’m here to spread the word on integrative medicine and psychiatry to help other people that might have had their traumas that are having a difficult time navigating it. I do have a personal history of trauma. I was not sexually abused. I was not physically abused. I had very well-intentioned, very loving parents to this day who would give up their limb or life in a millisecond if they knew it would save the limb or life of their children.

Despite their being well-intentioned and loving me that intensely, the fit between the way they were and my genetic temperament was not necessarily a good fit. I was a deep child. I was sensitive at age seven. I was wondering, what are we on this planet for? What is the meaning of life? My parents are more occupied with day-to-day living. They would look at me confused and not sure how to answer that. I had my challenges that I had to go through. If I can help anyone go through less suffering than I had to go through, and find help in an easier way than I did where I had to be in the field knowing as much as I know to even figure out where to begin to get help, then I feel happy about that.

The idea that you can use your life experience as a guide and a motivator to help other people, even when those life experiences weren’t as fabulous and exciting. Greg Moore has put together the idea of heart virtue where he said, “You can figure out what your life purpose is by looking at the worst things that happened to you in your life and find the one that when you think about it, it makes your blood boil. Decide to commit a significant amount of your time, intelligence, money and energy to make sure that a certain number of people have helped to recover from that. If it happens to them, they don’t have to go through that and you can turn your pain into your life’s purpose.” It sounds like a big part of what you’ve done here, which has benefited you and everybody you come in contact with. I think it’s fabulous. How might somebody go about finding an integrative medicine psychiatrist?

You can search for me on the internet, but I would like to educate your readers on terminology. If you don’t know the right terms to use, you’re not going to be able to find what you want. If there’s a bunch of different terms thrown at you, it’s going to get very confusing. I want to talk a little bit about terminology first. The first thing, integrative psychiatry versus integrated psychiatry. The term is integrative medicine. Integrative medicine in psychiatry as in the past few years has been shortened to be called integrative psychiatry. This is different than integrated psychiatry. That is a term coined by the American Psychiatric Association and has to do with psychiatric care being provided at the primary care physician’s office or the primary care physician and the mental health provider collaborating very closely. That’s a different thing, so don’t get confused.

Also, integrative medicine used to be called Complementary and Alternative Medicine or CAM. If you see those terms, complementary medicine, alternative medicine, integrative, they all mean the same thing. Integrative medicine, in case you want to know, a lot of conventional medical doctors may not know what that means. It is, however, a term defined in Medline, the bibliographic database of peer-reviewed scientific journal articles maintained by the National Library of Medicine. This is the database that doctors, dentists and veterinarians use when they want to research something and see what studies were done or what case reports have been made. Medline has all these definitions and terms that you can punch in. Integrative medicine is indeed a medical subject heading within Medline.

There are subcategories within integrative medicine that may not be categorized in Medline and are used in the vernacular or it’s an idiom, but it may not have made its way to Medline yet. One of those terms is functional medicine. It is a subset of integrative medicine. It’s not that all integrative medicine providers are functional medicine providers. I am not a functional medicine provider. A functional medicine provider is an integrative medicine provider that has been trained by the Institute of Functional Medicine. This is one of several professional organizations that train physicians to become integrative medicine providers. You could do a Google search for a functional medicine psychiatrist to see what comes up. That would be a way to find an integrative medicine psychiatrist. Other things I already talked about that allopathic is a synonym for conventional medicine, and that allopathy was coined by homeopaths. That falls under integrative medicine. Homeopath, being a homeopath, that doesn’t mean you do everything else.

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Homeopathy is a kind of energy medicine where you believe like treats like. You believe that the body’s fever serves a purpose to fight off the illness. You might give the patient a substance that induces a fever, but you don’t give it at the dose that could induce a fever. You give it at a diluted dose to the point that conventional medicine would say, “There’s nothing in there.” It’s more energetic than it is an actual thinking in terms of a substance. To answer your question about how to go about finding an integrative medicine psychiatrist, you can look up the word integrative, functional, or complementary alternative medicine. There are ways to find integrative psychiatrists.

There is a directory that I used to maintain but I’m talking on Journey’s Dream founder, Mitzi, to talk to her about giving my list of 300 psychiatrists to your organization. That will be one way, potentially. As far as finding functional medicine providers, there is the Institute of Functional Medicine or IFM. There is the organization I used to belong to, the American Holistic Medical Association or AHMA. The last one and this is not as intuitive, it’s called the American Academy of Anti-Aging Medicine or A4M. That’s another organization that is integrative that if you look at their provider directory, you might be able to find an integrative psychiatrist. There are a few other ways, but those I’d say are the top ways that I’d recommend at this point.

Two things I want to get to on your list of suggested questions. One of them is how do people contact you?

The easiest way is to go on my website, which is DrLMassoumi.com. However, if you can’t remember that, if you do a Google search for Michigan Integrative Psychiatrist, as of February 2020, I’m one of the top results to come up. You could do that. My reminder to your readers is if you do contact my practice, there is a most likely chance that you’ll be seeing one of my physician assistants. If you are not satisfied, which 99.9% of the time people are, you have always the option to be escalated to see me.

What separates you from other integrative medicine psychiatrists?

I don’t know to what extent that separates me from another psychiatrist, but I will say I don’t feel like I’ve met someone who’s like me in the following ways or all these ways combined. I’m going through them. I identify as having a personal history of childhood trauma. I also do have a history of being bullied for 2.5 years and I’m still not completely over it, I’ll be honest. That’s the reason I’m nervous doing this video because I’m like, “How am I going to look? How are my fifth-grade peers going to perceive me?” When I was in medical school when I took my leave of absence, I suffered from depression and I was misdiagnosed with a bunch of different things. I also have some traits of ADD. I was diagnosed as bipolar because I speak loudly and quickly or at least that time I did. I was placed on a whole host of different medications. I will say the bulk of the medications that I prescribed, I have taken. Every family of meds that I prescribed, I have been on.

I know what the textbooks say about the medications and I know what I experienced. I also did experience seeing providers that let me down. I don’t think I ever found anyone that met my needs until I was well more advanced in my professional career. I had experienced being invalidated, taking my first dose of Zoloft, feeling better within twenty minutes. I was being told that was a placebo response and my experience being invalidated even though my mood was immediately better. I’ve since learned that people on the bipolar spectrum will notice a benefit immediately. People with traits of bulimia might notice a benefit immediately. I’ve learned that when my patient says something, I listen to them. I believe they are experience. If I have three patients that all experienced the same thing, I don’t care if the studies or the textbook are saying that what my patients are saying is incorrect. It’s got to be true or the universe wouldn’t have brought it to me.

I have a personal history of having been a patient. I also identify as having some traits of Asperger’s. Anything related to my field is fascinating to me. Psychiatry, psychology, animal behavior, sociology, or anthropology, if it’s related somehow to the mind and behavior and understanding people and the way societies are, I am fascinated. If it is outside of that realm, I can’t make myself pay attention to it. I am oblivious and I could look uneducated if I have to talk about something other than my field. Along the lines of identifying with some traits of Asperger’s, I identify with just about every diagnosis in the DSM. I’ve never met a psychiatrist say, “I think I have everything,” but I do believe that at one time in my life I’ve gone through every diagnosis. The only two exceptions are schizophrenia, yet on both sides of my family, there is heavy schizophrenia.

I have a lot of experience firsthand interacting with schizophrenia. I used to chair the inpatient unit of a hospital and there was a lot of schizophrenia on the unit. Even though I haven’t experienced it as a patient, I’ve experienced it closely as a family member of. The other illness I can’t identify with is a substance abuse addiction. For that, I refer out, but everything else I understand what it feels like to have gone through it. When I ask questions of my patients, I am not asking the questions according to the textbook and checking off boxes. I know how it feels when you describe to me what you’re going through. I’m like, “That’s when I felt this way. That’s what this is.” That makes me a little bit different. “This could be the Asperger’s, this could be because in Myers-Brigg, I’m an IFP,” whatever the case, I tend to be honest.

When I know what I’m talking about, if I don’t know about something, if I’m unsure, I tell you. I feel like that helps my patients know whether and to what extent to listen to what I’m saying. If you’re asking me about using Ketamine Troches as a way to get off of your Lexapro, I’ve used Ketamine intranasally, but I haven’t used it as a sublingual. I’m going to tell you when I’m happy to go on this journey with you, but I’m also happy to refer you to people that I know are using Ketamine in this manner. This might be shared with a lot of my other integrative medicine peers. I am spiritually-minded and I believe that everything I’ve gone through is for the purpose of helping my patients, whether it is a psychological problem or it is a medical problem.

 

Recurrent sinusitis, allergies, irritable bowel syndrome, acne, recurrent yeast infections, whatever it is, if I’ve been through it and I found a natural way to overcome it through my own healer’s journey, then I’m sharing that with my patients. I feel strongly that there’s a reason I go through what I go through. Another thing, and this is where I become woo-woo, is I’m identifying as what’s called claircognizance. That means I’m intuitive in certain ways. The way that I seem to be intuitive, my life experience is showing me is when I’m presented with a periodical of a bunch of different journal article study findings, for some reason of the 50 that are listed there, two will jump off the page to me. I find it interesting and pertinent and it resonates with me as being true.

I implement it in my practice. It turns out that it’s true and then years later, there’s all these other studies coming out, validating the initial studies that I already had felt are true. I don’t know how I do it, but it seems to be happening. The other thing is when I go to a medical conference and I listen to a whole bunch of different speakers present their research findings, I can tell who’s telling me the truth. Who is smart and humble and I can rely on what they’re telling me and who’s maybe more narcissistically defended and is pumping up their results to look good or to not look stupid? Listening to the experts that I have considered, “I’m going to trust this expert,” always seems to work out for me. I think the claircognizance helps.

The last thing is I don’t get reimbursed for the work that I do as a Chair of the American Psychiatric Association Group on Integrative Medicine. I do a lot of work. There’s no pay whatsoever, but there is a perk. The perk is by bringing in the researchers of herbals to the APA to present their findings to conventional-minded psychiatrists. I get to know the researchers and get to know the inside scoop of what the pros and the cons are of the various herbal formulations and the different herbal brands. I have some insight knowledge that I think if I wasn’t the chair, I wouldn’t have. That’s part of what patients are getting when they come to my practice that is getting some inside knowledge about a particular herb, which is the patented form that you have to stick with.

When you responded to my request for the interview and sent me a little information about yourself, I got excited about the possibility of sharing the knowledge of who you are and what you have to offer with the readers. You’ve over-delivered. This was fabulous. I look forward to our continued connection. I’ll send you a little bit about me because you barely know anything about me. Is there anything that is in this exhaustive list of things that we haven’t mentioned that pops into your head that you want to say to our readers?

I would hope that anyone reading this who’s going through or has gone through anything and/or who feels ashamed or feels it’s difficult to get help, I want to give you hope that you can do this. You are amazing. Help is out there and you are going to be a better person for what you’ve had gone through.

If I could find a way to improve on that, I would. You are a blessing. Thank you so much for being here. I look forward to doing a shorter version soon, so we can offer new things that you’ve learned and continued exposure to you to our readers. Thank you so much.

It is my pleasure. Thank you.

Blessings.

Blessings to you as well.

Important Links:

• Dr. Lila Massoumi
• American Psychiatric Association Caucus on Complementary and Integrative Psychiatry
• Complementary & Integrative Treatments in Psychiatric Practice
• American Psychiatric Association Publishing Textbook of Psychiatry
• Medline
• Psychology Today
• The Road Less Traveled
• Institute of Functional Medicine
• American Academy of Anti-Aging Medicine
• DrLMassoumi.com

About Dr. Lila Massoumi

Dr. Massoumi is an Integrative Psychiatrist with a private practice (with three physician assistants) in the Metro Detroit area of Michigan.

She is the chair of the American Psychiatric Association Caucus on Complementary & Integrative Psychiatry,

She is Clinical Associate Professor of Psychiatry at Michigan State University, contributing author to the textbook, Complementary & Integrative Treatments in Psychiatric Practice,

And she is the author of the first-ever chapter on Complementary and Integrative Treatments for the American American Psychiatric Association Textbook of Psychiatry, 7th ed.

In addition to her commitment to patients, Dr. Massoumi’s mission is to change the way Psychiatry is practiced in the United States.

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