Conventional Medicine and CAM Have Different Perspectives
Integrative mental health care offers a middle ground.
Posted Jun 14, 2019
In this post I describe the divergent perspectives of the dominant biomedical model of mental health care used in industrialized countries, and the increasing trend in the use of so-called complementary and alternative (CAM) approaches. I argue that integrative mental health care offers a ‘middle-ground’ approach based on each unique individual’s symptoms and preferences.
The divergent perspectives of Western medicine and CAM
In the U.S. and many other countries, the principle role of psychiatrists and family physicians is to prescribe and manage medications addressing a range of medical and mental health problems. The majority of non-pharmacologic modalities are regarded as complementary and alternative (CAM) therapies and are frequently dismissed by conventionally trained physicians before an objective appraisal of research evidence is undertaken.
Along the same lines, CAM practitioners may actively discourage their patients from using pharmaceuticals and other conventional treatments and to accept only those treatments recommended by them. The situation becomes more complicated in mental healthcare because the majority of non-medically trained clinicians, including psychologists, family therapists, and social workers, offer psychotherapy and advice on lifestyle while referring patients to psychiatrists for “medication management” consultations only when symptoms fail to respond to psychotherapy or lifestyle changes.
Limitations of conventional Western medicine and CAM
Systems of medicine including Western medicine (also called allopathic medicine), and complementary and alternative systems of medicine such as Chinese medicine, Ayurveda, homeopathy and others, have both advantages and limitations.
The Western medical model of mental health care is limited in its capacity to alleviate the root causes of suffering because its theoretical foundations and clinical methods address only some of the complex causes and meanings of mental illness. Incomplete understanding of mental illness has led to unsubstantiated hypotheses and a multiplicity of therapies that do not adequately explain or alleviate the root biological causes or social, psychological or spiritual meanings of symptoms.
Among psychiatrists, the dominant view is an extension of contemporary Western medicine, which equates mental health problems to functional abnormalities at the level of discrete neurotransmitters. According to the current biomedical dogma, successful “treatment” entails “correcting” a presumed neurochemical abnormality with the goal of restoring to normal a corresponding dysregulation in cognitive, emotional, or behavioral functioning.
While psychiatrists often use cognitive-behavioral approaches or “talk” therapies directed at changing maladaptive interpersonal dynamics, depth psychological approaches examining existential or spiritual themes are typically regarded as incidental to “more serious” psychotherapeutic or pharmacological treatments informed by the dominant Western medical paradigm.
Agreeing on a "most relevant” theory or a “most appropriate” treatment is even more problematic for psychologists for whom numerous theories of symptom formation have yielded disparate and frequently contradictory explanations of the underlying meanings of psychopathology.
Because of the multiplicity of theories and clinical practices that comprise psychology and psychiatry, there is no theory-neutral method for evaluating the relative merits and weaknesses of disparate treatments. Subsequently, consensus is lacking on the “most appropriate” or “best” conceptual framework or practical clinical methods when approaching a specific mental health problem.
In addressing this dilemma Wilber has systematically reviewed psychological theories of mind-body, and has proposed guidelines for the creation of an “integral psychology” that takes into account core psychological and spiritual features of many leading theories of mind-body (Wilber 2000). An important goal of Wilber’s work is the elaboration of a series of integrative psychotherapeutic strategies that are ideally suited for specific symptoms of mind-body, psychological or spiritual distress.
Like Western medicine, complementary and alternative medicine (CAM) also has advantages and benefits. Select CAM approaches such as acupuncture, yoga and meditation, biofeedback and select natural product supplements have been validated by research findings and found to be safe and efficacious. However, many CAM modalities have not been thoroughly examined in formal research studies, or have been examined and found to not work or to be unsafe.
The ambiguous position of many CAM approaches becomes complicated when one considers that millions of individuals self-treat using natural supplements or other CAM approaches with little or no reliable information about their effectiveness or safety, often in the absence of advice from a qualified CAM practitioner.
While select natural product supplements have been established as both beneficial and safe for a particular medical or mental health problem, and may have beneficial synergistic effects when combined with a particular medication, there is little or no evidence supporting safe effective combinations of the majority of natural products and medications.
Consequences of divergent perspectives
The divergent perspectives of health care providers reflect differences in training, financial interests, and values of conventionally trained physicians, psychotherapists, and CAM practitioners that may result in treatment delays, inappropriate or inadequate patient care, and poor outcomes.
Increasing numbers of individuals who seek care for a mental health problem consult with more than one conventionally trained or CAM practitioner and receive widely differing treatment advice. The differences in how practitioners think and practice has important practical consequences for patient care.
While patients are actively seeking information and advice from a range of providers, limited or no dialog takes place between physicians and other conventionally trained mental health providers and CAM practitioners. This becomes problematic when patients receive contradictory advice resulting in misdiagnoses, missed diagnoses, delays in starting potentially beneficial treatment, or treatment combinations that are potentially unsafe.
Many patients who do not benefit from a particular Western medical, CAM or psychotherapy approach eventually seek other kinds of treatment. The process of moving from a conventionally trained provider to a CAM practitioner is frequently based on limited or unreliable information about the efficacy or safety of different treatment approaches.
Integrative mental health care—a middle ground approach
Conventional mental health care emphasizes prescribing of psychotropic medications and psychotherapy and often excludes complementary and alternative (CAM) approaches. CAM practitioners are often reluctant to refer patients to physicians or other conventionally trained providers. The perspective of integrative medicine is that combining select Western medical and CAM treatments on a case-by-case basis offers more advantages compared to any particular Western medical or CAM treatment or any single system of medicine. Integrative medicine and integrative mental health care, provide individualized care plans that address each person’s unique symptoms taking into account personal preferences.