Dr. Jessica Eastman, a naturopathic doctor and psychedelic-assisted therapist, shares her integrative approach to trauma recovery and mental health. She emphasizes the significance of preparation and integration in psychedelic therapy, highlighting that healing occurs during the integration of insights gained.
Dr. Eastman discusses the need for emotional readiness and a curious mindset, addressing the risks of poorly guided experiences. Advocating for a holistic, patient-centered approach, she stresses the importance of foundational health and patient autonomy. She also announces her upcoming online trauma recovery program and offers resources for ongoing support and education.
[0:01] All right welcome dr jessica eastman a fellow ccnm colleague and so we recently connected over um yeah well i guess like topics around psychedelics and mental health and uh some cult psychology and spiritual bypassing and um but i think what we want to talk about today is like mental health and maybe some psychedelics and trauma and because that’s a big part of what you do and what your practice is in BC.
[0:34] And yeah, maybe you could introduce yourself and tell me a little and tell the audience a little bit about your practice. Yeah, for sure. Yeah. So I am a naturopathic doctor licensed in British Columbia. I’ve been practicing there for almost 10 years.
[0:49] And I also am a psychedelic assisted therapist and as I call it, a trauma recovery coach. Um, so I kind of mashed together, uh, integrative psychiatry and, um, integrative mental health work with trauma-informed primary care and, uh, some psychedelic, um, assisted therapy, like prep and integration work. I don’t do the actual medicine sessions because it’s not in my scope of practice, um, but. I could do that if I was like working
[1:19] under another like field trip or a numinous or something like that. But I get a ton of value in doing like harm reduction discussion and prep and integration. And I have a little niche of people who come to see me when they’ve gone to do psychedelic assisted therapy, usually with an underground therapist who wasn’t super well trained and they had a bad experience.
[1:38] And then they are looking for somebody to like help them sort that out. Also because a lot of psychiatrists and psychotherapists and psychologists and medical doctors don’t have a whole lot of training or understanding about psychedelics and so these people sometimes come to me they’re like in inpatient psych and their psychiatrist is saying like you’ve broken your brain and there’s nothing we can do to help you and then they call me kind of like as a last-ditch effort to be like hey is my brain really broken and I get to say like no it isn’t actually we can heal this and we can work through this so that’s a really fun little niche that um is is developing there’s like more and more need for that um and then i do some trauma recovery coaching specifically both in my practice and separately um so i get to kind of weave a whole lot of mental stuff together that’s really cool that’s really really really interesting i know bc has a more expanded scope than ontario when it comes to um like i think i Dr.
[2:37] Ray St. Arnall about ketamine therapy and like that’s in scope or like legal for therapeutic use. But yeah, how did you get into the and what maybe you can describe some really interested kind of like what the prep would be like in a in a responsibly administered sort of psychedelic session, like what kind of prep is usually involved and what’s the integration like afterwards if someone’s really going about it in like a.
[3:04] Yeah, totally. Yeah, safe way. Yeah, so the prep work is actually done from, you know, anywhere from one to multiple, like three or four, you know, up to like six months worth of sessions before you do the actual medicine sessions.
[3:25] And what’s involved in prep work is really variable from person to person. The kind of universal things that are involved in prep work is having a discussion with the client or the patient about what they are expecting. And a big part of the prep work is helping them to get clear on what their goals are and helping to work away from a bunch of expectations and toward like intentions and an opening to the possibility of whatever the medicine is going to take you into. Um as a lot of people go into these sessions understandably like hoping that they’re gonna you know be a cure-all because they’ve been struggling with you know depression or PTSD or OCD or whatever it is for a long time and um, psychedelic medicine is a unpredictable in certain ways and so it doesn’t it’s not linear in the way that like when you give this dose of a of an ssri we generally have this response and when we increase the dose we have an increased response and so psychedelics are a more unpredictable, world they kind of um work often by teaching you how to surrender and and exposing you to, feelings and or stuff that you want to work through or that you maybe need to work through.
[4:47] But going in the most likely things that are going to create a bad time or a bad trip is if you go in with a whole bunch of expectations or you go in with the expectation that you’re going to be able to control the experience. And so like a classic example is like people who come And they say, OK, I want to go into this session to heal my relationship with my father. And that sets you up for a challenging session, potentially, because there’s a whole bunch of expectations built into that concept. And so what we often work that into is something more open ended is like I my intention for this session is to be curious and to understand more about my relationship with my father because we don’t put expectations on like healing or outcome necessarily because a the medicine doesn’t do that for you. It illuminates things and helps you to do that work on your own and be surrendering or being able to like relinquish control to the experience is a big part of how the medicine works and how it helps you to allow for neuroplastic change and perspective updating.
[6:01] So, yeah, that’s a big part of kind of like universal prep work with anybody who’s doing it well. And then there are some other things that some people need more support in than others. Like some of the things that I personally would, you know, like more or less require would say like this is a prerequisite to being able to do this work is… Decent amount of experience and tools in being able to manage uncomfortable emotion and knowing that you understand like how to know where your edge is in terms of like I can handle this and this is where my overwhelmed edge is and when I need to ask for help and then also having the skill set of being able to ask for help when you need it because like I said sometimes these sessions are unpredictable and sometimes they’re very chill and gentle and like lovely and warm and you you know feel love for the whole time and other times they like you know open doors to old emotions
[6:51] or memories or stuff that like can be a flood of discomfort. And it’s important that people are not going to be super dysregulated after and not then know how to handle that or get the support that they need.
[7:06] So that’s a component of it. And so, you know, if people come with years of psychotherapy experience, then they’re probably full up on all of those tools. And if they’ve never done any of that work before, then we do some of that work first. Yeah, that’s really useful. It’s like, what are your intentions that are kind of reasonable? And then, yeah, maybe looking at, because one of the things it does, it kind of drops defenses. And sometimes those defenses are there for very important reasons that once they’re gone, you know, what do you, you know, how might you respond or, you know, how might you find stability?
[7:50] Yeah. Like, you know, if there’s some things that have been compartmentalized for good reason and now they’re blasting open or you’re in touch with them or, you know. Yeah. Yeah, exactly. Exactly. And I think that’s probably the most misunderstood part of psychedelic-assisted therapy and all that kind of work is that people think that the medicine is the thing that heals them or is that the thing that fixes their brain, so to speak. And it’s actually like it reveals a bunch of stuff to you and it puts your brain into a particularly like flexible and malleable state where you have the potential to have neuroplastic change and build new neural
[8:34] connections in the like, you know, a few days and weeks right after your session. So you are more changeable in that period, but the change comes from you and the work that you do a little bit during the session, but in large part after in the integration work where you’re being exposed to or choosing to expose yourself to the feelings that it illuminated and the memories and the awarenesses and the connections and then how you process and integrate all of that into the rest of your life. That’s where the change and the growth and the healing really happens. Yeah, in that integration period of like, kind of, yeah, it’s like this, like this kind of like ego dissolution. It’s like your ego dissolves and you’re this raw kind of.
[9:20] Bare soul but that’s not how we operate through the world like we we need to kind of reconstruct the ego the persona to like be able to work your job and be in relationship and parent your kids and like all that stuff right like you can’t just be connected to the trees um or like in a dissociated state so it’s like how do we kind of repair and and like carve new pathways around well traumas or metabolize and reintegrate the traumas that may have been yeah yeah exposed yeah yeah exactly what do you find like when people are so i know you’re not administering the medicine but like what is because a few patients have asked me like especially with treatment resistant depression that’s often like a category where these medicines are really like looked at and studied um a lot of people who have had kind of lifelong depression lots of treatment not really a lot of resolution uh maybe some trauma they’re like maybe i should do an ayahuasca retreat or what do you know about you know psilocybin assisted psychotherapy and like what do you find when someone’s been in years and years of psychotherapy and maybe they’ve got some they’ve built some skills they’ve learned some things about themselves but what what are you seeing with people when they do psychedelic assisted therapy like is it like what kind of changes or what, you know.
[10:42] What’s that like? Because it is framed like a miracle a lot of the time. Yeah, totally. And sometimes it is. Like, sometimes people’s experiences of that are like, this is actually a miracle. And so it does, like, that rhetoric exists for a reason.
[10:55] It’s just, it doesn’t happen every single time. It doesn’t happen in every patient. It’s also really about where you are at in your journey and, like, if the medicine was chosen correctly in alignment with where you’re at. And so, yeah, there’s a lot of parts. But excuse me, I think that.
[11:13] So, a big thing that often people take away from psychedelic experiences is new perspectives, looking at the same things they’ve been talking about or working through or feeling for, you know, months, years, decades, but they get to look at them from a new lens.
[11:34] So it allows you to see things from different angles that also often allows you to develop or unlock compassion for yourself in the past or for the other people in the story in a way that allows you to, as you said, like metabolize the trauma a little bit.
[11:50] Feel, process, and release is the language that I use a lot of the time. Um and as you said earlier it it really also as some medicines more than others but there’s a lot of like dialing down of the amygdala activity during while you’re under the influence of the medicine this is especially true for mdma um but true in you know ketamine psilocybin etc and the amygdala is responsible for our fear response and therefore our protection responses and that is the thing that is often preventing us from being able to really look at and feel the emotions or feel the memory or whatever um and that is there for a reason as you said but also when we dial down how intense the amygdala is active uh is activated in that moment sometimes we can often we can have the memory or feel the feelings without the associated fear and intensity of like a need to protect and so you’re able to just feel.
[12:50] It as opposed to it being buffered by your nervous system saying like it’s too dangerous for you to feel this and so there’s often container too of safety so it’s like yeah it’s appropriate to have that like reduced defense like yeah yeah yeah for sure if if the psychedelic assisted therapy is done well and you’ve got a safe container with a therapist that you trust and it’s yeah so uh it often so it gives people often new perspectives it also gives them an opportunity to have a big release of feelings like i’ve heard many people talk about how this is my experience also like it helped you it helped me and and many others to feel the feelings separate from the story that your brain is telling it for the first time ever just like a thing we work so hard at in psychotherapy to try and like allow for and validate and make space for the feeling without your brain pulling you into like but that shouldn’t have happened or I shouldn’t have done that or if it was different and so to be able to just feel the raw feeling and feel the sad or the anger or the fear, maybe not even connected to a story, but that has been kind of stored in your body. And to be able to release that…
[13:58] And being able to experience that and then know that your brain is capable of
[14:02] that often translates into you being able to retain that ability in your sober life. And then kind of on that same track, another common experience is like being able to feel love or feel cared for or feel cared for others or feel connected to others in a way that people haven’t been. And because that protection that keeps you, you know, from not being drowned by your feelings also prevents you from being able to connect with other people fully, connects you from being or prevents you from being able to feel the love and the vulnerability and all that stuff. And so letting down those defenses also lets that in. And that can be a really powerful experience for people to be like, oh, I am capable of feeling love. This is what it feels like. Now I want to look for that in my regular life. Now I want to strive for that or create a safer container in my regular life so that I can feel that more regularly. Yeah, that’s cool. Yeah, that’s a great way of saying it. Like this, like you feel you release the emotion separate from the story. It’s just the raw experience of the emotion without the like fear of experiencing it, you know. Like, yeah, it’s kind of like this grief dumping that you get.
[15:11] Yes. you clean out your house and you put it all in in donation bins and you’re just yeah you know.
[15:17] Yes yeah yeah exactly yeah that’s beautiful yeah I know too like research has shown it increases like the personality metric of openness to experience like permanently yeah kind of this yeah which is kind of connected to like intelligence creativity but also connection like there’s less inhibition and and store you’re less trapped in the story and those like well-worn paths yep you know yeah which then very linearly um connects to an increase in empathy which then allows you to have more compassion for yourself for others to be able to connect more to people that like understand other people’s struggles you’re like less, intolerant this is that’s the um the facet of psychedelics that people reference when they say like if you know if like all the world leaders took psychedelics the world would be a way happier place because it like helps you to see things from other people’s perspectives and helps you to remember or realize maybe for the first time that we’re all just humans out here like struggling and doing our best and having feelings and loved and being hurt and all of that and like we’re all if we if you can.
[16:29] Remember or remain connected into the fact that like there’s more similarities than there are differences then suddenly a lot of the like world problems feel silly oh we’re all just out here hurting and loving and trying to take care of ourselves and each other yeah like that raw human emotion like when you feel it you recognize it in others and maybe our stories like there’s an infinite amount of stories so maybe that keeps us separate yeah it’s like well i’m different from you because of this particular detail even though maybe it’s kind of the same, which kind of keeps us siloed but if we when you really understand sadness or happiness or joy in your body and you.
[17:10] Can recognize it in others like oh this is just yeah that’s one of the elements of self-compassion is the common humanity idea of like this is just this is something that all humans feel no matter how rich or privileged you know we have these emotions that run through us yeah yeah and that’s like that’s a big part of what is not talked about in our regular society because it’s not productive or it’s not encouraged or it’s like weak or whatever but it’s it’s a big part of it and i think that that contributes to us all feeling like we are alone in these experiences if we all felt more capable more comfortable more confident more safe to be able to say like oh i’m a person and i’m having these feelings then we would all probably feel less alone in that experience yeah and if you say that to somebody who is comfortable or can provide a container for their own feelings they can provide a container for yours like a lot of the time empathy like moments of empathy can be missed when somebody like doesn’t really want to feel it because empathy is ultimately kind of feeling or letting in another’s experience so if I don’t really want to feel that because I’m uncomfortable with it I may invalidate you or dismiss you or you know yes and yeah create like a chasm between us which isn’t helpful yeah yeah totally yeah what happens when okay so now like the negative like what when you when you see people who are worried that their brain is broken or maybe.
[18:39] They had kind of an irresponsible journey or somebody that wasn’t trained like.
[18:43] What kind of things like what are the risks that you’ve seen.
[18:47] Yeah, so there’s a few different facets there. The biggest risk, I think, is the emotional-mental dysregulation piece, and that’s often what the, like, my brain is broken piece is, right?
[19:02] And that, I think, comes from a combination of things that in the patients that I’ve worked with that have been through that experience, it’s often that they were not in a safe or regulated or grounded or nourished state to begin the treatment. And so like the patients that I’m thinking of were like, they had been burnt out for decades and they were like, you know, had recently gotten over like really significant illness and were feeling fairly dysregulated in their day to day. And then a poorly trained or untrained therapist, in quotations, says like, oh, yeah, well, this will solve all your problems. And so they encourage the patient to come in before they’re ready, before they’re like physiologically ready, before they’re mentally ready, and then also sets them up with a whole bunch of unrealistic expectations. Sessions and that then puts their nervous systems and their physical bodies in a position to be very depleted, to be very dysregulated.
[20:07] Like these experiences are taxing. I think that’s a thing to recall. And especially the longer sessions, like ketamine is a shorter session. It usually is like two hours in entirety, but it’s a draining experience for your body.
[20:21] Psilocybin is like six hours ayahuasca is like eight or ten or twelve depending on where you’re doing it and how long you’re doing it for and so these are not it’s like you’re like, running a marathon that whole time. And so if you think about, is this patient fit and ready and has the capacity to like go and do a really hard, laborious task for 12 straight hours, that kind of gives you some idea of like, is the foundation laid for this to go well or not? And then I think the other big mental emotional risk is that, like we’ve talked about already, often psychedelics can open doors to big feelings or big memories or like realizations about traumatic pasts that you’ve had like traumatic experiences that you’ve had in your past and I think that there’s a handful of well-intentioned underground therapists who haven’t been properly trained in trauma or in what happens when people get really dysregulated or their sense of identity gets really disconnected or threatened.
[21:31] And then those people have the really scary experience of being hit with all of this awareness that they didn’t know about, like memories of stuff that happened or connections about like, oh, I’ve been avoiding thinking about this because it was too scary and now I’m being faced with thinking about it.
[21:51] Paired with a therapist who doesn’t know how to meet them there and hold space for them or how to carry that back into their regular life.
[21:58] So then they feel this compounding like, I’m really overwhelmed. I don’t know how to handle this. And I’m alone in that experience. And then the nervous system understandably responds with like big fear responses in those moments. So then you are flooded with all of the hormones that try to keep you safe. And you’re just like on a crazy high alert and you end up in a like perpetual state of hypervigilance. Um so that that’s like a common outcome you know you’re not sleeping and then that’s all compounded that you’re not sleeping you’re not eating your hormones are dysregulated and then everything just kind of snowballs um and i think so that’s like um yeah i’ve worked with a handful of people who’ve been in that position it just takes time for us to help them return to and like rebuild safety in their body and then also understand the patterns that they were living in before they did the session that maybe perpetuate or contributed to this that they didn’t even realize. And so it’s like a process of healing from the experience itself, but then also like rebuilding new patterns because we don’t necessarily even want to go back to what they were like before we want a healthier version of that.
[23:08] And I think I would be remiss to not mention also like some of these, some people have more risks than others for these things to trigger like other things. Psychological disorders. And so certainly a properly trained psychedelic assisted therapy program is going to really assess like your medical history, your psychological history, your family medical history. Not all of these things are safe to take depending on the medications you’re taking. And so there’s definitely some risks there.
[23:38] And then there are some physical capacity risks like you have to have controlled blood pressure. You could be on medication or you have regular blood pressure, but if you have uncontrolled hypertension, all of these medications temporarily increase your blood pressure like they would if you were doing strenuous exercise and so that needs to be a thing that we are cautious of so there’s some like purely medical side um precautions that need to be taken as well to make sure we’re not hurting you in any way or interacting with medications you’re on or putting you at risk for you know bipolar mania or anything like that yeah that makes sense yeah it’s like an underlying predisposition or like you know risk factors or family histories even um and then yeah this kind of like physical stability and how you know what are the structures that are in place in your life like yes it’s like you know all of a sudden you’re you discover like my job is intolerable my life is intolerable my relationship but I have nowhere now to go no safe place to land like how do I cope with my daily life as I figure out how to transition or like all of these things you know yes exactly yeah yeah and then you mentioned too yeah I know we talked about kind of like, maybe traumatic experiences that people don’t really remember and sometimes people have the experience of like.
[25:04] I know with some ayahuasca stories, I’ve heard people have talked about, like, I was kind of in my childhood watching it like a movie.
[25:12] That could be amazingly therapeutic, but, and we’ll probably talk about this when we talk about trauma, but not, it’s not always that. There’s a time and a place to kind of revisit memories, you know, and maybe don’t want to revisit memories at all. And so there’s a lot. Yeah, there’s a lot there for.
[25:33] Yeah and that’s a good example like I would say like if a person came to me and they said okay I want to do psychedelic assisted therapy but I want to make sure I don’t revisit any memories from this one time in my childhood I would say like okay you’re not ready yet like this is maybe not the right tool for you at least right now because we can’t control what happens in that experience just like we can’t control what happens in life and so a lot of the the work is like making sure like you said you’ve got support systems and mechanisms in place to help you manage whatever comes up yeah it’s like okay like yeah we don’t know what will happen but we can’t necessarily yeah like you said have an expectation of what will happen but also have kind of a boundary of what i don’t want to experience it doesn’t exactly work like that yeah and and And there’s like, there’s a lot of variability with dosing and with medicine. And so it’s, I know people talk about ego dissolution and psychedelics a lot. And that, you have to like work hard to get to the ego dissolution place. And so I would say most psychedelic experiences don’t involve like true ego dissolution. And so you do retain some, you like, you know who you are, you know where you are, You have some connection to like, you know.
[26:54] And everybody’s got a different experience and the medicines are all different, but there are definitely a lot of opportunities in there for you to be like, I’m not sure I want to go there. And so you do have some influence, but we can’t guarantee it.
[27:05] And also there is some…
[27:08] It’s worth discussing, like, the things that you explicitly don’t want to look at are, you know, it’s like, don’t think about white elephants. Like, that’s where your brain is going to take you a lot of the time, probably for good reason, because there’s stuff there that’s worth looking at and then metabolizing and moving through.
[27:25] Yeah, if you’re consciously, like, suppressing. Yes. Like, a closet overflowing, but, like, I know it’s there. I know I got to deal with that. Yeah. That’s exactly the analogy that I use. Yeah. It’s almost like, though, I think the gravitation towards psychedelics is kind of like the person’s like, okay, I kind of do want to open that closet. Like, I’m ready. I’m scared, but I’m ready. You know, otherwise I, you know, probably don’t want to take ayahuasca, you know? Yes. Agreed. Yeah. And most people, very rarely does somebody come to me and say like, I want to do this, but I don’t want to look at any of this stuff. Yeah, it’s very much like, okay, I don’t know how to look at that stuff, but I know that there’s probably something in there for me. And so I’m ready to explore whatever that is. Hire like a closet organizer.
[28:17] Yeah, exactly. You still watch. No, no, don’t throw that away. Okay, actually, fine. you can yeah and that’s that’s the that’s the analogy for trauma recovery that i use all the time is like hey you’ve got a closet in your basement that you’ve been shoving stuff into, no judgment but like that’s your that’s been your coping mechanism you’re like i can’t deal with this right now it’s going in the closet you know and that’s been happening for you know five ten twenty thirty years and now you the closet is so full that you have to spend all day leaning on the closet to keep the door closed and so you’re living your life with like one hand and maybe one leg so because you’re just like using a lot of your energy to keep the door closed and so the the process is like okay we open the door we let six things tumble out we close it again and then you and I together work through and learn how to deal with the six things that tumbled out you know and for each one you’re like Marie Kondo-ing your brain sort of you’re like picking each thing up and holding it to the light and saying like, okay, is this mine? Do I want to keep it?
[29:21] If not, do I want to get rid of it? Do I want to give it back to the person that it came from? Do I want to burn it? And then also you have the question of, well, is there a hole that is left behind by that belief or that paradigm? And what do I want to replace it with? And just like go through that process slowly over time until one day you can open that closet and look in and walk in and like it’s all organized and there’s a bin and every now and then you’re like, okay, I’m going to take down this childhood relationship with my father bin and like figure out what’s in there, you know, but it’s it’s, more organized, you have more say over when it happens and how it happens.
[29:57] And that’s where people start to gain the experience of being in control of
[30:03] their emotions and of their life. It’s like it doesn’t make the past go away, but it teaches us how to work with it in a way that feels like we get to be in charge. Yeah, that’s an amazing analogy, actually, because, you know, like I can picture the person kind of like one arm and a leg leaning on the closet, And then the other arm is your job and your kids and your daily life. Why am I so exhausted? Why am I sober? Why am I so overwhelmed? Exactly. And then when you sit down with someone like you, like a therapist, a naturopath, and you’re like, okay, now with my free hand, though, I’m going to sort the six pieces that we let out. So now, so this kind of describes the type of context to enter into trauma work with, where it’s like, can you use that hand or are you using it to like keep things afloat in your life, right? Like, can you take, is there a container that you can, yeah, you have, you know, therapists and support to help, but your free limbs are kind of engaged now in like doing this work. But eventually, you don’t have to be pressing on the closet because stuff kind of stays in there so you can walk away and now you have your full capacity to, you know, enjoy and engage with your life. But in the meantime, yeah, there is kind of this.
[31:21] Like not checking out from life but like you’re you’re there’s time and energy that needs to be kind of uh allotted to tend to it yep yeah you’re not able to be fully present in your life because you’re spending a decent chunk of your energy either keeping that door closed or dealing with the mess that happens every time you step away from the door oh yeah it is a thing that i say often in the early days of trauma recovery work is like this is unfortunately and through no fault of your own your next full-time job you know and now you have to figure out how to balance your actual full-time job and your responsibilities as a parent or a partner or of whatever and also doing this work and that determines the pace of recovery a lot of the time because we can’t always do all of that and so that’s where a support person or multiple support people therapist coach naturopathic doctor come in that’s also where medication and supplements and optimal diet and nutrition come in to help like give you the most capacity that you have potential
[32:27] for in that moment so that you can put more effort into that.
[32:30] If you want to but this is also why i don’t have any judgment or anything but like respect and compassion for people that don’t want to do this work because it’s really hard sometimes and it takes energy and capacity and not everybody like it’s a privilege to be able to do this work if you are drowning in like you know food insecurity or paying your bills or keeping a roof over your head or being a single parent that might not be the right chapter in your life for you to be able to do this because more important stuff is taking your attention and your effort and your capacity. Yeah. Like if that free hand is like keeping you alive, essentially. Yes. Yeah. Then yeah, you need it. It’s not the appropriate time right now. And it’s interesting because as we’re talking, like I think of many psychotherapy clients often don’t.
[33:24] With who are kind of neurodivergent and they’re like they come in they’re like I’m burnt out and I’m just.
[33:30] Kind of in this um treadmill with work like.
[33:33] I’m I’m behind I’m overwhelmed you know and so when we do kind of just like almost like solution focused stuff and we help like build skills and manage the day-to-day overwhelm you know systems stuff like that that’s often when now we go down and it’s like okay actually no it’s my father it’s my mother it’s my you know traumatic past or it’s uh my core beliefs there’s like it goes deeper it’s like once we’ve kind of addressed that initial layer that was sucking all the energy now there’s room to address.
[34:10] The contents of the closet um yeah but yeah when you’re managing things with one hand again like it’s a great analogy because it there’s a lot of compassion it’s like well no wonder you’re overwhelmed and it’s so hard for you to like have your inbox like at zero and not be kind of flooded all the time and like not have not be behind in all these deadlines because you only have one hand to manage everything yeah yeah exactly and then what’s the integration like so after someone’s doing psychedelic therapy like you know how many sessions is it usually i know that can obviously vary but super variable yeah so in the literature like in the research that we have currently usually it’s and you have an integration session that day or the next day right after the medicine session and then one or two weeks later and then kind of ongoing with your own therapist.
[35:04] Um and so there’s a there’s a various various things that happen in an integration session like and it also it depends a lot on how new you were to the experience like in early days for people have never done psychedelics before often a lot of the integration is just talking with somebody and sharing your experience to be like well that was a crazy experience like I’ve never had an experience like that before um the the to be able to like be validated and seen with somebody that also has been there and understands what it feels like to be in that um The terminology that we use in the literature and in the academic world is a non-ordinary state of consciousness, NOSC, which can be also accessed via breathwork and some forms of meditation and that kind of stuff. But it is an altered state and it is a wild experience. And so it’s difficult to talk about if you haven’t experienced it before.
[36:00] So that’s often a little bit of what happens. And then there is sharing about the revelations or the awareness that you have, you know, come to realize or come to experience. Or sometimes you take the medicine and like nothing really happens. And then you are like, at least in your perception.
[36:19] And so then you are processing and metabolizing the feelings of like frustration and disappointment and curiosity and like did something in my brain change but even though I didn’t feel the medicine and all of those things people that have been doing this work for a while talk about how like the integration session is like six to twelve months long so it’s it’s kind of like laughable to say like oh yeah it’s one to three sessions because what actually happens in the integration happens over time as you you know you’ve adopted a new perspective about yourself or the world or belief or whatever and now you have to go through slowly the experience of living your life through this new lens and be like oh wait well how does this change the way I handle conflict with my partner how does this change the way I handle uh feeling underappreciated in my job how does this handle you know like and and it’s it’s that same kind of like Marie Kondo effect of like well I I have to pick up every piece of my life and figure out, well, how does this change that? And that takes time.
[37:22] And the cool thing about all of the work that I do is like it doesn’t require you don’t have to sit down and do that consciously. Like you don’t have to journal about every single part of your life in this new belief system. A lot of it happens in the background, like in the default mode network controlled stuff that just is like happening as you’re living your life. Yeah. As long as you’re committed to curiosity and like paying attention to what is changing and noticing what’s happening in your body and in your mind, you’ll be able to see the changes that happen over time.
[37:53] That’s really cool. Yeah. Yeah. Like it’s, it takes a while to like kind of encounter the moments that you’re maybe watching for or like, you know, okay, the next conflict with my partner, what changed and to kind of be aware of how these changes happen. Yeah, like it’s and like making meaning of the experience can take time to write like what does it mean? How does that weave into my narrative? Yeah yeah exactly yeah yeah and like maybe you have a you know a perspective of like oh i um i am worthy of love you know or i am deserving of being cared for and so then you have this new belief but now you have to go through each part of your life to be like well how would that change all of the ways in which i interact with this life and how can i ask for more and so then you have like okay well you have a sit-down conversation with your partner and be like Actually, these are the things that I would like to be receiving from you in order to feel more cared for. And then you go through that many-step process with your partner to update the systems and the ways you’re caring for each other. It’s a big ripple effect, and it takes time. I think I’ve told this story before, but I remember my own experience where after an experience with a medicine, I was walking in the forest, actually, and I passed somebody. And I saw this kind of like.
[39:18] Judgmental or kind of contemptuous expression on the person’s face. And I remember distinctly feeling like, oh, they made an expression on their face. And it was this first time, like really embodying this feeling of, oh, people’s crap doesn’t always have to do with me, you know, or my, but how does that then, how do I act that out in my life now? Like, how do I bring that awareness to, you know, I mean, that’s a clear interaction. I don’t know that person they’re just walking by what did I do like there’s you know so cognitively I know that it doesn’t have anything to do with me even if that little schema is running yeah but when somebody is unhappy with me or I am in a conflict with someone how can I bring that into the you know how do I how do I work with that or what replaces that schema or you know how does it become modified because sometimes it is about me sometimes I did screw up you know so yeah yeah so What’s the more balanced thought, I guess, in CBT language? And so that can take a lot of time. Yeah, for sure.
[40:23] It is a process. And I think that it is a gift to be able to give yourself time to process all of that.
[40:31] And it’s a recognition of that the medicine isn’t doing the work, you are doing the work. The medicine just kind of like showed you a door that you didn’t know existed. You get to choose if you want to continue to keep that door open or walk through that door in your your waking regular life it’s so cool yeah it’s a really fascinating, area like I’ve always been kind of interested in it because of the.
[40:58] The kind of pivotal way that it can really like accelerate like it’s, It’s very hard to, like, build those different neural pathways when you’re stuck in this same groove and you just, you know, like, you know, often there’s a lot of intellectualizing and a lot of like the cognitive changes that can be really, really sticky. But there’s something about embodying the feelings and just seeing that as a truth that kind of hits you that can be really powerful. Yeah. Yeah. For sure. Like you said, seeing another possibility or another perspective and really seeing it, not just like, oh, yeah, I can use my imagination and kind of see how, yeah, like I know it on a level that’s deeper than just, like, I wish I knew this. I wish I believed this, but I don’t know. It’s hard for me, you know? Totally. And for that reason, the primary modalities that are used in psychedelic therapy and psychedelic integration are generally somatic work and like internal family systems parts work and like mindfulness and where those three all overlap, which is like polyvagal theory and all of that stuff.
[42:09] Because it’s not really about the cognitive understanding. It’s about the somatic felt sense of like, oh, I know that I’m deserving of being respected or cared for, but I feel it now. And being able to feel that is the thing that’s going to enable you to like enact a boundary, you know, or ask for more or decide that you want to make a different choice. It’s not the cognitive knowing that drives behavior a lot of the time.
[42:35] Much as we want it to. Yeah. And I think that’s a good approach to trauma work, too, for most people. I know that CBT-informed trauma therapy is the gold standard because it’s easy to study it. Yeah, exactly. but mostly when you talk to people they’re like uh you know the real movement that i experienced was ifs internal system somatic therapy where i really like you know emdr like where i really was able to kind of locate these parts in my body and metabolize them because a lot of it’s not verbal and not cognitive and not a conscious decision you know yeah exactly and also the like analytical conscious brain often gets in the way and so there’s that’s like a thing i’ve seen in cbt many times both as a patient and um like when i was the patient i mean and in in my patients now who’ve come to me from cbt is like the talking about the trauma or about the patterns or about the belief systems like reinforce them or keep you stuck in those patterns and.
[43:42] There’s like no way to talk your way into something you’ve never felt before. You have to experience your way into something you’ve never felt before. And that’s just not a framework that CBT holds. So it’s a useful set of tools. And I don’t think it is an all-encompassing trauma treatment because it doesn’t really get anything like below the head, so to speak.
[44:06] Yeah, that’s a good way of describing it. Like you know write out your beliefs why do you believe this is there another way of thinking about this that’s a good skill sometimes it’s the first layer like to introduce therapy like oh wow my thoughts like awareness of self-talk is really useful challenging self-talk but yeah it’s a lot of um people who’ve experienced trauma are caught up in ruminate ruminative cycles you know so it’s like all in the head um yeah i guess that brings us to like how can an nd support someone who’s experienced trauma because yeah yeah so there’s a few layers to that the place where i always start is an assessment and a shoring up or a stabilization of the foundations of health so like what what nds are you know functionally good at across the board because Like, are you sleeping? Are you eating enough of the right nutrients at the right times? Is your blood sugar regulated? Are your stress levels even remotely manageable, sustainable?
[45:14] Do you have the ability to move your body? Do you have a support system? Those are the like five foundations of health from my perspective and also they are like the you know the bottom of your maslow’s hierarchy in terms of health like we can’t do higher order healing whether it’s like regulating your reproductive hormones or healing your trauma if you’re not sleeping or eating enough or if your blood sugar is super dysregulated or if you can’t leave your house or can’t move your body in any way um.
[45:45] And it’s a common thing that also comes up with medication because psych meds are notorious for being mediocre in their efficacy. And I think a decent amount of that is because they’re not going to do very
[46:00] much if you’re not sleeping and eating. And that’s such a brutal catch-22 because mental health stuff, especially when you are in the throes of PTSD or complex PTSD, make it really hard for you to sleep and eat. And then people are like, take these drugs, and the drugs aren’t working, or you’re doing your CBT, and you just feel worse and worse because you’re taking the meds and you’re going to therapy, but you still don’t feel good. Yeah. Or you feel like your functioning is even decreasing even further. And so I always start with sleep and nutrition, and that’s different for every person. Sometimes it’s like we run labs and we make sure you’ve got adequate vitamin D and iron and B12s, common deficiencies that are going to contribute to mental health and your ability to be regulated in any regard. Sometimes it looks like, you know, sleep hygiene and sometimes it looks like medication to help you sleep better. Because if you are so, so sleep deprived and your sleep is so interrupted, we’re not going to be able to do any of the trauma work. You’re not going to be able, you have no chance at regulating if you’re getting three hours of interrupted sleep at night. So we start at the bottom, and we work there.
[47:10] Sometimes that’s, there’s like a lot of education involved there because often people come to me and then they are like, okay, I’m drowning in trauma or I’m stuck in complex PTSD. Like, how do I get out of this? And I’m like talking about sleeping and what you’re eating for breakfast. And it’s important for me as the practitioner to make sure that they understand why that stuff is important and how it’s going to help them to feel better.
[47:33] And I love starting there for, in addition to that, like it is the prerequisite to everything else we want to do. I love starting there for two reasons. One is that so often when we start there, a lot of the symptoms that people are struggling with correct themselves on their own because the body has the innate capacity to heal when we give it the building blocks that it needs and we remove the obstacles in the way. And so I think it’s a very useful way for us to get out of the trap of like a supplement for every symptom or a drug for every symptom. It’s like, well, when you sleep and eat and give the body its basic building blocks, you know, half your symptoms are going to get better. And then the other half, okay, those are what we build a treatment plan for. And the other thing that I think is really important about that step of the trauma recovery work is that most people who have been drowning in trauma and struggling for long enough to come and see me have lost a lot of faith in their body and a lot of trust. And a lot of trust is broken between their body and their ability to interpret what their body needs. And I think rebuilding that trust or maybe building it for the first time that like your body is sending you messages and you can learn to interpret them in a way that allows you to take care of yourself and get to a place of happy, healthy well-being.
[48:53] That’s a really important part of, important part of healing and of trauma recovery. And so if we help people to see, like, I don’t give supplements or medications in a lot of cases on visit one, because people are so quick to attribute improvement to those things. But if all we did was we helped you to eat breakfast and go to sleep a little bit earlier, and then you feel, you know, a 50% reduction in your anxiety, which I hear all the time. Yeah people are like oh damn like okay this is real and when I take care of my body it actually does feel better and you start to like build your we get to start to build a blueprint for people of like what are their baseline needs this is the thing that you want to do every day for the rest of your life to take care of yourself so we’re empowering them it’s the you know teach a person to fish thing like I want them to not need me anymore and this is part of how we do that to be able to help them to understand, okay, what does my sleep and my diet and my supplements and my social support and my movement need to look like in order to set me up to be able to do that stuff? And how do we make that sustainable for people? I love that. That’s where we start. Yeah. Yeah. It’s like, yeah. I know we said before we recorded, I’m like, let’s talk about mental health and what NDs do because it is my focus. But you lose yourself in the weeds as you’re talking about the specifics and the extra things and the cool new therapies or the angles.
[50:21] And what is really beautiful about natural health medicine this is like the topic of a new sub stack i’m working on but like the but we’re really the biopsychosocial yeah you know um that model like you know because, And a lot of people will kind of get that biopsychosocial from various practitioners, but an ND is really true. Like, that’s what holistic means, ultimately.
[50:48] And, yeah, like, so many, like, in my psychotherapy practice, a lot of people who, like, there’s probably a blood sugar dysregulation here. And all the talk therapy in the world or somatic work is not going to fix that, you know? It might help you understand you need to eat. Yeah, yeah, yeah. Yeah. But a lot of the time with that, like being tired and needing to regulate your blood sugar, like you were saying, there’s sometimes a disconnect in that biofeedback of really even understanding what those signals mean or what those cues mean. Especially if that hasn’t been built in when you were a baby like the inner child kind of needs that safety and that reconnection with like talking about like ifs like the different parts and how do we take care of ourselves recognize what it feels like to be tired it’s time to go to bed even if you might also be kind of wired or um procrastinating when it comes to sleep like revenge bedtime procrastination or yeah you know you’re so um hungry that you don’t really feel hungry anymore. You just feel anxious and almost nauseous. You don’t really think that food would help, but then you develop this relationship with yourself where it’s like, oh, actually, that’s when I should eat, you know? So there’s a lot of these pieces of like, how do we learn how to take care of ourselves?
[52:08] Yeah, so it’s all of that. And it’s all of that through a trauma-informed lens, which means that we’re approaching all of this without judgment. And we’re building a plan to help those pieces get accessible for the patient at whatever pace works for them. The understanding that a lot of people will come to this point like they know that they’re not eating well and they know that they’re not sleeping well and if this you know like if all they needed to do was to have somebody tell them to do it better they would have done it already right so there are there are things that are blocking them from being able to make those changes and so that’s why i really like having to getting to wear multiple hats under one license because I you know my my coaching clients are also my patients and so we can like jump back and forth for me to say like okay like let’s maybe do a coaching session here where we talk about the parts of you that are resistant to taking care of yourself or to explore why it doesn’t feel safe or even accessible to listen to the signals that your body is giving you.
[53:19] And then we can jump back in to the naturopathic work and be like okay now that it feels a little bit safer for us to even talk about what you’re eating or to be able to even give any attention into how you’re making food for yourself because it no longer is like going to trigger a full disordered eating flare or whatever okay now we can talk about yes you need 30 grams of protein at breakfast and you need to have that before caffeine and you know all of those things so it’s like a back and forth of that um and then also compounded by an awareness of how many people come here for this work with a history of being really mistreated or dismissed by other medical professionals like the medical trauma layer it’s really common in women especially and in mental health um patients and in like you know people in bigger bodies or people that aren’t straight or that aren’t monogamous or that aren’t you know like that don’t fit the standard you know, white straight norm basically skinny you know all of those things yeah and so it’s like building a therapeutic relationship and a relationship with themselves to be able to make those changes.
[54:28] To make them accessible and to make them sustainable and like yes you and I could talk forever about like the herbs and the supplements and I’ll give you my 10 cents on on psych meds because I think that’s a really cool layer but so much of it is the foundational piece, but just really like taking our time in the foundations to be able to make it feel possible for people. Yeah, that’s a great point, right? Because there’s sort of the…
[54:56] I’m very resistant to the idea of protocols, even though it’s, but sometimes these courses or packages, they can be accessible to people, right? When you do your own research and go to Chachi PT and here’s, but there’s a lot to the art of like, okay, yeah, sleep, breakfast, but how does that look like? Like what does that look like for the particular person right and how much time do we need to just spend on psychoeducation and like letting them like kind of helping match the symptoms to that or letting someone talk and you know express what they already know about their sleep or what their obstacles are what their difficulty is or um yeah like looking at yeah like the ifs like there’s a lot of um stuff that comes out around lifestyle changes around like the the inner rebel and then the inner critic and their dance. And sometimes people will describe, like, I know I need to exercise. I really want to exercise. I have so many values that are connected to getting stronger, longevity, but I just can’t do it. And then we often discover that there’s a rebel that’s trying to stand up to the critic who is like.
[56:12] Yes, you have these values, but the critic is also kind of shaming you. Why aren’t you living up to your values? What’s wrong with you? And then there’s a rebel that’s like, no, I don’t want to live this way. I don’t want to live under your rule. And so looking at that, you might not see any change on the surface. You might not be lifting a weight for many months as we kind of tease that apart and understand it. You know yeah another one I see often there in that realm is people that have all those values but are really resistant to doing the work because they didn’t get cared for in the way that they deserve to as a kid and so there’s a lot of resistance to being like I’ve been caring for myself my whole life I it’s like not fair that I have to do even more to get myself out of this hole that got dug for me by trauma that I experienced as a kid. So there’s like a lot of grief work often to be able to sit with like how shitty and unfair it is. Like, yeah, that sucks. And it’s okay that you really don’t want to do this work right now, you know, and how can we make space for that and allow you to feel and metabolize and process those feelings of like, Like, yeah, this, it’s not fair that you have to do all of this work on top of all the work you’ve been doing already
[57:27] to, you know, to get yourself here. That you’re still, yeah, you’re still having to do this. Like, you’ve been adulting since you were five.
[57:36] And, yeah, I can see, like, there’s a, you know, without kind of really understanding or unpacking that layer, sitting in front of someone who even compassionately or, you know.
[57:51] Benevolently is like, okay, like, let’s eat protein at breakfast. It’s like, here’s another thing I’m doing wrong. Here’s another thing I have to do. Like, feeling that.
[58:00] Burden of like okay so I’m already I’ve already been feeding myself cooking for myself planning my own meals my whole life but now you’re telling me that I have to fix it even more there’s something that I wasn’t like yeah totally yeah exactly yeah and so like my stance on that is like there are no such things there’s no such thing as a non-compliant patient only a practitioner who is missing a piece that’s education or compassion or the trauma layer or the resistance or whatever But yeah, it’s all of that. Yeah. For patients listening, you can come back if you haven’t done anything. Yeah. A lot of the time people will say like, I’ve been wanting to come back. I haven’t been feeling better, but I’m just worried because I didn’t do the thing you said. But that’s an amazing opportunity because especially when we’re getting to know somebody, you can say like, okay, like sleep, let’s work on getting to bed 30 minutes earlier. Let’s come back. And then we often don’t know what the obstacles are until we try. Yep. So that’s a good opportunity to come back and be like, hey, look, I didn’t do it. And we can work together to understand why, you know. Yeah. Yeah. And that’s the thing that I now like build into my patient communication, especially after our first visit. I’m saying, okay, here’s what we’re going to do in the second visit. We’re going to check in on all these things that I’ve suggested for you. And if they’re going well, this is what we’ll do. And if you didn’t, none of them, this is what we’ll do. And so that they can know like there is space here. It is safe here. I’m not going to be like chastising them.
[59:29] And that’s part of a trauma-informed practice is to like really be very transparent with your patients and with your clients about what’s happening so that they are not going to be scared or not going to be surprised or not going to be blindsided, because trauma is like ultimately about, having your agency removed yeah so if you give people back their agency it’s a big part of the healing process yeah and i’m glad that you brought up the medical trauma piece because i think that’s huge right like i remember talking to a friend about this and she was like i just can’t take a like i can’t take a supplement or an herb that’s recommended there’s something about just.
[1:00:10] Like having you be like we should try like melissa the herb that just feels like i don’t want to just take advice when it’s given to me like there’s an immediate kind of um defense that comes up like i need to maintain my own agency so i can’t you know i’m so used to just being told what’s good for me or what’s going to happen and and i thought that was really interesting and very self-aware of her and you know we don’t always have that kind of like, awareness of when it’s happening but yeah that’s yeah like yeah but if you have yeah if you’ve got a patient that comes back and they say like okay well I didn’t do any of the stuff that you said like you can either approach that from like okay well what now or you can get curious like hey let’s explore why that felt inaccessible for you and let’s get let’s spend time like working through that so that we can figure out how to make it accessible for you yeah yeah the nice thing too about natural medicine is there’s so many herbs, supplements, angles, ways to approach something that, And something, I’m not an expert on this, but something that’s always been interesting to me is when someone kind of has an intuitive sense around an herb or supplement, like one person was like, I had a dream about this herb last night for some reason, like Hawthorne or, you know, and that’s great. Let’s go with that.
[1:01:33] Um but sometimes people like i just don’t want to take iron i don’t know why like i know it’s good for me i know and so to be able to trust that and allow that can also really help build someone’s self-trust and agency and then the therapeutic relationship okay don’t let’s not take iron let’s go somewhere else with this um as opposed to like yeah fighting or doubling down like there’s a million other ways to yeah maybe get iron or maybe there’s something else that needs to happen first and our body is so complicated that it isn’t so linear like low iron take iron you know yeah um yeah yeah totally the number one rule in my practice is no forcing like i am not going to force you to do anything i don’t want you to force yourself to do anything even if it’s a thing i’ve told you you should be doing because if if you have to force it it’s a it’s a cue to us that there’s resistance there that we should get curious about and at the very least if you’re able to force it, it’s not going to bring about sustainable change.
[1:02:34] Because most of my patients come to me with a background of trauma and either come to me directly for trauma work or for the physical manifestations of trauma. I think the no forcing rule is a very foreign concept for a lot of them because they’ve had to force themselves to do things for a long time. And also that rhetoric is really reinforced by society. Be like, oh, you’ve got a headache, take an Advil, go back to work. Oh, you’re tired? Have caffeine. Go back to work. Oh, you have your period? Suck it up. You know, like forcing is like a part of our life because of capitalism and the patriarchy and all of that stuff. And so if we can start to.
[1:03:11] And what it does is it really reinforces that you shouldn’t be listening to
[1:03:16] the messages your body is sending you. And then over time, that just dilutes your ability to even interpret them at all. So if we can really work back into a flow and a reciprocal, safe relationship with your body and its messages, and maybe it’s no iron right now, and maybe three months from now, they’ll be ready to take iron, but willingly. And and I would much rather us wait three months and then work into a plan that feels accessible to them because we’re building these plans for life and so like three months on the scale of doing being able to take care of yourself for the rest of your life is a drop in the bucket yeah but the alternative is that I like you know force you or you force yourself to do this thing in spite of what your body is saying in this moment that’s going to fracture our therapeutic relationship, likely, it’s also going to further break the trust between you and your body, and it’s not going to help you get better long term.
[1:04:10] Yeah. And a lot of this is like a patience and an immense amount of trust in the inner wisdom of the person’s nervous system. And that doesn’t always mean that their dreams are right or their intuitive sense is, you know, like, yes, that’s exactly what you need. But it’s coming from somewhere. and to honor that and to work with that and to meet the patient where they’re at I think is really the the key yeah yeah like I think you know you really want to like honor someone’s intuition and like how they’re building that trust with themselves and their gut instinct and um you know it’s not I know better or this is the way because you’re yeah um I love that yeah Yeah.
[1:04:59] And I’m also thinking, you know, how sad it would be if someone, because it takes a lot to finally reach out, right? Like many patients will say like, I’m thinking about this for eight months, a year, multiple years, like I’ve been following you, listening to your podcast. And now I’m finally booking an appointment and you know how sad it would be if there’s a rupture that you know yep, where the person’s like okay like I I need to be at a certain level of like readiness or I need to like.
[1:05:31] Take this on wholesale if I am going to get this kind of help, as opposed to being met where I’m at. Yeah. Wherever that is. Yeah. Yeah, I agree. Yeah. Yeah. You said you had something to say about psychiatric medication. Oh, that’s like that. Yeah. Yeah. Okay. This is my own personal little soapbox. So in British Columbia, natural medical doctors have a pretty broad prescribing scope. And so we prescribe most of the things that a GP can prescribe or an NP, like a primary care provider, because we are primary care providers here. We can’t prescribe anything scheduled. So like no opiates, no benzos, that kind of stuff. But all the psych meds are in our prescribing scope. And not that many of our colleagues out here are trained in them. So not that many people use them. But SSRIs are a common drug that lots of people use, especially GPs.
[1:06:25] And I think they are a really, really useful drug and potentially life-saving
[1:06:31] in a lot of cases, and they are often not well understood. And so then they are misprescribed or misused in a way that perpetuates the stereotype of them. And so I think, so the way that I use SSRIs and the way that I think they are best served or best serving the patient is to use them to support the expansion of the patient’s window of tolerance like it’s like you know you are leaning your whole body against that closet and you’ve only got one arm and an ssri like gives you a longer reach no or it gives you a second arm and it like doesn’t um it doesn’t so i think a common error that people make is prescribing too high yeah and it results in just like a numbing out like a disconnection from the feelings and for some people that is what they want because they have no skill set or understanding of like why feeling their feelings is important or how that can be productive or valuable for them.
[1:07:31] And it’s not a criticism of GPs. They aren’t properly trained in a lot of ways as well. And so they just have their patients coming back saying, I’m drowning in my anxiety, and they don’t know what else to do but to increase the dose.
[1:07:45] But I think the best and most effective dose is the lowest dose that you can get that gives you more capacity, that makes you feel like you’ve got a little bit.
[1:07:57] More room to handle what life throws at you that doesn’t numb you out that doesn’t disconnect you from your feelings and also doesn’t you know give you bad or uncomfortable side effects yeah um but with my patients um like escitalopram or lexapro is a is the most common one of the most common SSRIs that we use now and the research as done by the drug companies suggests that the starting dose is 10 milligrams. And I start a lot of my patients, most of my patients, I would say at two and a half milligrams. It’s like a literal 25% of the starting dose of what’s recommended. And most of my patients see benefit, you know, and we get up to like five milligrams or seven and a half milligrams and some they’re at 10 and that’s great. And I’m not at all opposed to people taking a higher dose when they need it. But I have a lot of patients that have a history of being on SSRIs and they came off of them because they didn’t like how disconnected they felt because they started at 10 or, you know, an equivalent starting dose of another drug. And, you know, it’s just, you know, the analogy I always make here is like, you know, it would be about equivalent of somebody saying like, oh, I’ve got a really brutal headache. And somebody say like, oh, take ibuprofen 20 milligrams. Like the minimum effective dose of ibuprofen is 200 milligrams in most people. And so if you don’t, if you’re not familiar with that, you’d take 20 milligrams of ibuprofen, you’d be like, oh, that drug is stupid. It doesn’t work.
[1:09:24] And it was actually just not the right dose. And the same thing is true in a lot of drugs, but especially in SSRIs, which have just such a really bad rap. Yeah. Because I think they’re often dosed too high. Yeah, I agree. Like, yeah, I think I’m really happy that you mentioned that because I think a lot of the way that studies are designed, you want to see an outcome, you want to see an effect. You don’t want to do a really, really long study because that’s very expensive. And you’re also going to get like a placebo response in the placebo group that’s pretty robust, especially with subjective symptoms like mental health. You know, you’re not measuring blood pressure. You’re not looking at like an MRI. not like you’re just how are you feeling are you eating like so yeah but what i i totally agree like i think um what i see very often it’s interesting that it’s usually like i see this so much with zoloft or sertraline for ocd which can be extremely crippling for a lot of people that’s not a good word but like destabilizing for a lot of people like caught up in like rumination and unable to function and just really trapped in those sort of thought loops.
[1:10:37] And very often, like, okay, I’m trying Zoloft, you know, first, I think it’s 25. And they’re like, and that’s great. That works really well. And then their GP is very often like, okay, so you’re tolerating it. Okay, so we’re going to 50.
[1:10:53] And then they don’t feel as great. And the benefit isn’t really there. And we often have a conversation where I’m like, let’s just stay at 25. But maybe even better to start even lower and just see what’s the minimum effective dose because there’s yeah you know often a trade-off like the more the higher the dose the more the side effects you know yeah yeah exactly yeah and i think um i end up starting with lexapro often because it’s a tablet so you can cut it in half but my patients uh who prefer serotonin will just get it compounded and then we do drop dosing to figure out whatever less than 25 milligrams is a good place for them to start. I think it’s a common misconception that the.
[1:11:32] Instructions that are determined in a study are exactly how you’re supposed to do it in in your clinical community practice and having you know interacted with researchers that are running these studies like they are out there saying like no no this is not what this is to determine safety and efficacy this is not to determine best practices yeah and I think that’s a thing that’s often overlooked and like we could talk about how like you only have five minutes with the patient and so you don’t have time to think about like what’s the best practice you’re just trying to do the best that you can in a really limited amount of time in the conventional system at least so I understand the contributing factors but I think there’s a lot of art to prescribing yeah and I think it’s worth it to talk about it because these drugs I have so many patients that it took them like five plus years to get comfortable with taking this drug because there’s so much negative rhetoric around taking SSRIs or taking any medication for your mental health stuff. And so many of these patients are like, oh my God, I have a life now. I wish I started taking this drug five years ago. Yeah. It’s a good point too, to point out how that might perpetuate a stigma.
[1:12:47] Also, it’s held up as like, this is the first line treatment. If you have depression or anxiety, then you get one of these medications and that’s kind of it. Yeah. Versus the, and that is kind of how it’s studied, right? It’s like, we just want to see what’s the effect on like the GAD score for your anxiety, you know, like, is there going to be an effect? And you’d probably have to prescribe pretty high to see something change. But I love that you talk about the window of tolerance. It’s like, we don’t want to numb your feelings. We just want to create a bit of softness around and expand. And for listening, window of tolerance is sort of like.
[1:13:23] You know, where you’re regulated and connected to yourself and above the window you’re hyper aroused and below you’re in a dissociative state or under aroused.
[1:13:33] And like the work is kind of done within that window. So if you can kind of soften the edges and like open it up a little bit, then work is done inside of that, whether it’s like lifestyle stuff or therapy. Be but that also implies that there’s like other things that you’re going to receive, in terms of treatment not just the substance you know yeah and like a one of the there are kind of a few main questions that i use to help people decide if starting medication is the right choice for them and like we already said earlier like it’s it’s almost never the place that i start like we start with all the foundational stuff but one of the big questions is do you feel like you have the capacity to add more things into your life in terms of supplements or therapy or practices or meditation or exercise or whatever in order to continue to work on improving your mental health right now and um or do you not have capacity for that right now and in which case sometimes medication is the right answer because it very quickly gives you more capacity like it expands your window of tolerance which like allows you to.
[1:14:39] Takes the intensity down off of the like high highs and the low lows. That’s what the drug does. And then expanding your window of tolerance gives you more capacity to handle feelings and stress and tasks without getting super dysregulated. And then another question that I use to help people make this decision is like, do you have, based on how you’re feeling right now, do you feel like you could hang out here for another like two or three months while we build these practices and like get you to eat regularly and get you to take your meds and or take your supplements and do your workouts and do your journaling and go to therapy? Or do you feel like, no, I need to feel better yesterday or else something bad is going to happen? Then, okay, that also helps us to decide what is the first treatment. And like you said, if I’m prescribing a medication, that’s by no means the only thing I’m doing. It’s just the beginning or like a step in giving us more capacity to be able to implement all the other things. And for some people, it’s this is a drug they want to be on for the rest of their lives. And for some people, it’s more capacity temporarily so they can learn how to do all this other.
[1:15:43] Tools and like ways of managing their mental health so that they don’t need the drug down the road and like i’ve got no attachment to one one outcome or the other it’s just how can we help you to feel better and get to the place you want to be yeah so it’s like yeah true holistic kind of biopsychosocial prescribing of like yeah do you need to do you need immediate relief and And, you know, I mean, our style of medicine is quite active, you know, so if that and that’s not always accessible for people like, you know, we’re asking you to, okay, like, add some things and take some things and that’s adding more to your plate. So, you know, if you’re already squeezed, then it may not be possible to add more things. Those are great questions. Yeah.
[1:16:30] And then a low dose is easier to wean off of. Yeah. Yeah.
[1:16:36] Yeah. And it’s also like the slower we build, even if we end up working up to 10 milligrams, if we do it slowly, then we’re also in the process giving you more opportunity to get to know what your body is saying and to feel the changes and to as opposed to just like barreling through and like placing you in this new mindset of like, oh, I’m not drowning in depression anymore. Like, well, actually, let’s give you the opportunity to be present in that process so that you can really understand what it feels like as you start to feel lighter or feel things less intensely or feel more capacity, which is a part of, you know, like learning how to.
[1:17:14] Like, the process of healing, especially in trauma, mental health, nervous system recovery stuff, is learning to have a relationship with your nervous system. And you can’t have a healthier relationship with anything if you don’t speak its language. Yeah. And this is the part like we have and learning language takes time. Yeah. And and and it also takes exposure. And so if we build that up more slowly, then we have a greater capacity for exposure to the signals that your body is giving you that you can then learn to interpret and that strengthens your ability to speak to and engage with your nervous system and with your body in a healing, sustainable way.
[1:17:51] Yeah that’s a great point right when you’re like kind of titrating up very slowly you can like watch the change like what do i feel as opposed to oh my gosh i’m at 25 milligrams this is like maybe too high for me yeah and it’s like too big of a jump and yeah are there oh go ahead yeah go ahead like you said like some people are in such an acute state that they like that’s not the time where we learn the language like that’s the time where we get immediate relief and so we we don’t have to do it slowly we can do the slow on the other end as we taper down as well so it’s just it’s really it’s about meeting the patient where they’re on as opposed to just like applying a protocol to every patient universally yeah it’s like if someone’s screaming at you in a language you don’t speak you’re like i’m not gonna get my like book out i don’t know yes yeah like do i need to get off the road am i like stepping on something you know yeah yeah Yeah.
[1:18:48] So like I need to calm down or have like a more regulated state to be able to like start to interpret and learn the vocabulary and hear the syllables.
[1:18:59] I was going to ask, though, if there are other, so for people who are very against medication or for us Ontario practitioners that don’t have prescribing and can’t kind of titrate doses, do you use other stuff that works in the serotonin pathway? Like have you find that that’s effective or yeah yeah I it works a little bit differently than medication but for a lot of people it’s the right choice for for various reasons um,
[1:19:25] I use a combination of supplemental nutrients and botanical medicine. Lots of magnesium and higher dose EPA omega-3s and St. John’s Word in really high doses, but like concentrated doses.
[1:19:42] Saffron, ashwagandha, theanine, inositol. There’s lots of nutrients and a handful of plants. Um hawthorne is a nice one for like the the panic palpitations that people feel so yeah there’s there’s a combination of things that i will use for sure and lots of my patients don’t want to be on meds or can’t be on meds or you know were and had a bad time and so there’s like many many tools that we can use and a lot of it is also about getting really curious about so like once we’ve established the foundations what are the underlying drivers that are contributing to the anxiety or the depression and like in some people yes it is just like pure you know neurotransmitter biochemical imbalance we think but there are a lot of people for whom it’s like you know a histamine thing or a reproductive hormones thing or a menopause thing or a gut health microbiome thing or an inflammatory thing and so it’s also really a lot about like what getting curious about what or the root causes that we can influence from a more broad perspective.
[1:20:52] And that just generally also tends to work better, more sustainably, and gets us away from just like symptomatic management and like the, you know, they call in school, they call it green allopathy, like prescribing a supplement for a symptom, which is like sometimes the trap that GPs or MDs can fall into as well. Yeah. So, yeah, it’s so easy to kind of Yeah, I get wrapped up into like, I just want to help. I just want someone to feel better. And you, um, the fixing part or the performance part wants to kind of like, you know, um, yeah, one of my most popular, like I made this YouTube video, I don’t even know, 10 years ago, I don’t know about, uh, about, uh, amino acids. I don’t even know. It’s not even a good video, but it’s so popular compared to my other YouTube. And it’s just very interesting because like I always think I’m like what is so attractive about the idea but I think I mean this idea of like you’re right my medication stigmatized so people looking for kind of an alternative based on that neurotransmitter idea but also this I just want relief I just want to feel better you know so I did a follow-up video saying like yeah they can be helpful, but I, you know, kind of like a pyramid. I mean, you know, by the time that we’re working on neurotransmitters.
[1:22:16] Maybe we find that’s not really the thing that’s out of balance, you know, but I like that. I like the frame that you created of like, well, you know, when do we start with foundations and when do we start kind of at the top of the pyramid to provide relief? You know yeah exactly yeah yeah which is like functionally it’s are your symptoms the thing that is impairing you from being able to sleep or eat or take care of yourself yeah okay well then we treat your symptoms first so that we can then down the road or three weeks or it’s free you know a month from now start working on the foundations but it’s it’s the same thing we were saying before like if you just shout louder at somebody that they need to sleep more and eat more and that It doesn’t address the reason why they’re struggling to do so. Right. Yeah. Yeah. We talk a lot about like vicious cycles, right? So where do you address it? And where do like chicken and egg kind of cycles? Like where do you start with the chicken or the egg? And sometimes it doesn’t matter. It’s just about patient preference and what, you know, they intuitively feel because, you know, if you take a neurotransmitter to help with sleep and then you sleep better, well, then now you’re sleeping better. And then that’s addressing the underlying thing or if you’re able to work on sleep then might regulate your neurotransmitters so it’s kind of just about where it makes sense to start and yeah yeah i love that collaborative aspect i think um.
[1:23:39] It can feel a little bit foreign for a lot of people that has a practitioner that’s like, you know, woody, like kind of turning it over to you and not just telling you what to do. I think a lot of people are like, oh, my gosh, wait, I have to make the decision. I don’t know what I need to do. You’re the doctor.
[1:23:53] Yeah. Yeah. And I ask my patient that question all the time. Like, hey, here are some options.
[1:23:58] Which path do you think feels the most accessible or the most aligned with you? And, yeah, often people are caught off guard. And so, like, sometimes I will walk them through, like, here are my thoughts. Like, here are the pros and cons. Here’s how I would make that decision but I think it’s actually really important for us to.
[1:24:14] Give the power back to the patient like a lot of the values that I operate from in my practice is that to like minimize the power differential as much as possible like I’m not the boss I also don’t know what’s best for your body more than you do yeah and so but but the the world, and the medical system and especially if you’re a woman especially if you’ve got any mental health challenges has just told you over and over and over that like you have to outsource everything to somebody smarter than you or with more letters after your name or with more power than you and like that is part of the problem yeah totally yeah i just had this conversation with a friend it’s a little bit of a non-sequitur but we were talking about societal pressure to like for women to have children and i’m like you know it’s like if somebody’s like don’t you have kids and it’s like okay let’s like unpack this for a second like I would have to be the one to be pregnant to deliver a baby to care for a baby so you know you’re you’re telling somebody you need to take iron but you’re not the one going to buy the iron taking the iron swallowing iron maybe feeling nauseous from the iron so it’s all well and good to give someone advice but to actually have the burden of having to follow through and do it and be in the body.
[1:25:32] Is, yeah, that’s, you know, that’s something else. So, yeah, to be able to, like… Allow someone to embody their health experience again.
[1:25:42] And information is so accessible that I think maybe that is helpful for the power differential a little bit too. Like a lot of patients are coming in with a lot of, like kind of a massive confusa of information that, you know. As long as we are receiving it with grace and being like, yeah, bring me your questions. I would love to, you know, like dispel your Reddit myths or show you the data on why I think this is true but conversely if we’re if we’re receiving that as an attack or a threat to our ego or you know like you know shut up about your doctor google like that’s just going to perpetuate the problem but yeah yeah yeah but i that’s one of my favorite things to do is like yeah bring me all the nonsense you find out on tiktok and we’ll parse it apart here’s the evidence that i know here’s the evidence that disproves that here’s the question mark or the gray area that like maybe that’s true but here are the risks here’s how you make that choice because i i think it’s you know our jobs are evolving as the world around us evolves and i think part of you know like, docere is the root, you know, Latin word for doctor, which means teacher. And I think that’s a big part of our job is to give people the opportunity to learn how to take care of themselves in the world that we are living in in 2025, which now means how do you interpret.
[1:27:00] Media and social media and all of the nonsense that’s out there? And how do you figure out what’s right for you? Yeah, exactly. Like the common, I’m sure you get questions. I get question all the time and the answer is always it depends because there’s a reason that the intakes are an hour and a half like we got to sit with everything and go through it and but another thing i really love is the the broad spectrum of of being an nd is that i don’t feel beholden to any or in love with any particular therapy of course i have my biases like we all do but, I’m okay with killing off darlings like you know I’m there’s I don’t want to make myself sound amazing I’m sure there’s lots of resistance that my parents have encountered sometimes but um you know like because we there’s a big toolbox yeah like okay supplement like one person came in um a few people actually have been like it’s not good to take vitamin d and so I kind of went down a rabbit hole and unpacked it and came in and out of the cave. And I think my point that I’m sitting at now is that maybe we should probably take vitamin D in the winter because we don’t make it. But, you know, our bodies are complicated and the thing like there really isn’t an answer. Like even the best study with the best outcome is not going to be 100% effective.
[1:28:25] You know, whatever it is, even exercise, even all the things that we know are amazing, like exercise, like the you know um there’s tons and tons of nuance and uh so much individuality and everyone’s different so it’s nice to kind of be a little bit you know like on our toes like a little bit um flexible with how you know yeah it’s that like open-minded um like personality trait that we it earlier i think there’s a make somebody a really good physician because i think the analogy i are the example i always use here is like the doctors in the early 1900s were making fun of and laughing at the guy who suggested that we start washing our hands between autopsies and deliveries because he they were like yeah you right yeah right there’s like imaginary invisible little poisonous dudes in the air you know and it turns out germ theory is real yeah we didn’t have the right tools to study at back then. And so those guys that thought he was.
[1:29:28] Making stuff up, didn’t have any evidence for germ theory. And, like, it’s hard to fault them for that. And I think it’s really worthwhile for us to remember that, like, we are not by any means at the pinnacle of our understanding of the body or science or of medicine. Like, we know way more than we did five years ago and, you know, a ton more than we did 100 years ago, but we do not know everything.
[1:29:51] And it is really complicated. And I think it’s really important to, as a care provider to not get trapped in the like belief that we have all the answers because it’s it’s an ego trap it’s going to result in you know like making an unsafe space for your patients but also.
[1:30:12] Closing like prematurely closing your mind to what the possible solutions are, yeah i love yeah and the that story with saml weiss saml weiss yeah yeah yeah wasn’t he um He had his license removed. Yeah. That’s for being like, oh, you know, maybe we shouldn’t deliver babies after we handle cadavers without washing our hands in between. And they were like, you’re a quack. Yeah.
[1:30:40] Yeah, totally. Yeah. A lot of humility in that, you know. It’s funny, though, like you hear that story of when you’re like, oh, yeah, we would never. They were idiots back then. But then, you know, you can really humble yourself by thinking like, well, what are we doing now that we’re going to be disgusted by in like 50 years or 100 years, you know? Yeah. So tread kind of carefully, you know? Yeah. Yeah. Yeah. Absolutely. Yeah. Live with that uncertainty a little bit, I think. Yeah, I think you’re right. I think, you know, kind of flexibility, open-mindedness, humility, curiosity is important to be a practitioner and give the power back to patients because there has been an era in medicine where people have been disempowered and there’s like authoritarian structures in medicine. It’s like a very authoritarian system that I think is being dismantled. Like my GP feels very different. I know like the new generation of doctors feels a bit different. Agreed. Yeah. All of my peers that are like our age that are MDs are very different than the doctors that I grew up knowing. So, yeah, it is changing.
[1:31:47] And patients are different, too. Like people are encountering like a doctor who’s like, you know, not really working with them. And they’re pushing back or looking for a different practitioner, kind of not just accepting that answer. So, yeah, really encouraging and good. Yeah, agreed. I don’t think we’re mistaken about that in 100 years. They’re like, no, no, the authoritarian systems were right. Yeah, we’ll see, but I don’t think we’re mistaken about that. Yeah, I think we’re good. Yeah, I think it’s important for people to be empowered. I think that’s universally a good thing. I agree. Yeah. Any last thoughts, Jessica? Anything you’re offering? Anything you want people to know?
[1:32:30] Yeah, my private practice is in Vancouver, BC. I can see patients anywhere in British Columbia. So I do lots of virtual work as well as in-person work.
[1:32:39] I do have a little bit of private trauma recovery coaching, like separate from my medical practice for people that are outside of BC, if that’s of interest to you, if you’ve got specific like psychedelic integration stuff that you want to talk to me about um and hopefully by the end of this year i’ll have a trauma recovery um online program it’s like with my guidance um but again like more available for people at like a lower cost than seeing me in person and also not restricted to british columbia um but yeah i’m on instagram and the internet dr jess eastman that’s pretty Yeah, I think there’s a huge place for programs like psychoeducation programs and teaching people skills and having some guidance and can drop the burden of cost down a lot. Yeah. I’m glad you’re offering that. Yeah. Even for practitioners to take to learn, you know. Yeah, totally. It’s for everybody. But yeah, it feels important.
[1:33:35] Like I, you know, Vancouver is an expensive city and our work is expensive. And so I am very aware that the cost of seeing you or I is not accessible to everybody. And I hate that. And I also have to pay my bills. And but it’s important to me to make an offering that makes it more accessible to more people.
[1:33:57] Yeah. Amazing. OK, so people I’ll have links for people to find you and yeah, hopefully they can join in. And thank you so much for talking with me. Yeah, thank you. It was really lovely.
I, like most of my colleagues became a naturopathic doctor because of my own extremely disempowering experiences with the healthcare system.
In my late teens and early 20s I was suffering from what I now know were a series of metabolic and hormonal issues and I, like almost all of my patients and colleagues experienced confusion, gaslighting, frustration and a complete lack of answers for what I was dealing with. I tell my story more in depth in other places, but I was told to “stop eating so much”. I was told everything was normal in bloodwork (or simply not called back). I was weighed incessantly. I was chastised for doing my own research (I had to–no one would tell me anything). I was interrupted, cut off and dismissed.
And so, I did what most of my colleagues do–I got educated. I went to school. First for biomedical sciences and then, when that degree left me with more knowledge gaps than answers (and no one who would indulge, let alone answer, my questions), I became a naturopathic doctor.
Throughout my 8 years as a practicing ND, I have encountered thousands of similar stories of disempowerment and confusion and frustration. We patients are trained to see our doctors when we feel depressed, fatigued, or debilitated by PMS, menstrual pain, headaches, and mood issues. Most of us don’t care what answer we get–fine, if it’s a medication I need, I’ll take it! But if we experience lack of benefit from the solutions and a lack of answers, then what? I’ve heard this story over and over.
And so, like many of my colleagues I use the privilege of my education to help me navigate the system. I ice a sore foot for 2 days and then get an x-ray (picking a non-busy time to visit the ER). I take the orthopaedic surgeon’s advice with a grain of salt and implement my own strategies for bone healing. I ask for the bloodwork I need (and know my doctor will agree that I need) and pay for the rest out of pocket. I know my doctor’s training and I understand her point of view and I don’t get frustrated when diet and nutrition or lifestyle are never mentioned. I don’t get upset if my doctor doesn’t have an explanation for symptoms that I now know are related to functioning and not disease, and that it is disease which she is trained to diagnose and prescribe for.
And thankfully, my experience with the healthcare system has been quite limited as I’m able to treat most things I experience at home and practice prevention.
My good friend, who is a naturopath as well, and who has given me permission to share her story, had the same experience up until this summer. She too used the healthcare system quite judiciously and limitedly until a series of stressors and traumas landed her in in-patient psychiatric care (i.e.: a psychiatric hospital) for a psychotic episode–her first.
…And until she started experiencing debilitating gastroesophageal symptoms that were beyond what one might consider “normal.”
And in both cases she sought help from the medical system. She told me recently that her experience was quite different from the ones she’d had in her 20s when her long-standing parasite was misdiagnosed as IBS and she was repeatedly dismissed by doctors. She told me “I’ve been having great experiences with the healthcare system. It’s not like it was before. My doctors have listened to me. They’ve been helpful. Yes, they’ve recommended drugs but when I tell them that I don’t want to take the medications because I know what they do and how they work and don’t think I need them, they respect that. They treat me like I’m a real person. They’re all our age, too. The procedures are more state-of-the-art. The facilities are pleasant. Something has changed in healthcare.”
I know that my friend’s experience might be different from yours. I’m not saying her experience is universal. In fact, if I reflect on my interactions with the fracture clinic in St. Joe’s hospital in Toronto, I had a fairly good experience as well (except for long wait times and booking errors). Sometimes medical trauma can blind us to reality–sometimes we aren’t willing to re-evaluate our assumptions until someone points out a piece of reality that is hard to deny. I actually haven’t had a direct negative experience with healthcare in years– and yet I had chalked that up to the fact I rarely need to use it.
But my friend had had two quite intense experiences and came away from them feeling positive about the care she received. I wondered what was different. Here are my thoughts.
Medical care has evolved. It is inevitable that this happens. Sometimes we might have just had a bad doctor, or someone who was having a bad day or maybe was triggered by our experience. I sometimes think not knowing how to help triggers doctors—I think this might have been the case with the doc who told me to eat less. She might have felt helpless and incompetent at not being able to help me and projected those feelings onto me as a “difficult patient”.
Ultimately health professionals got into their field to “help people”. If you’re not helping people you might feel triggered. But then, if you’re a competent professional, and I believe most are, you look for new ways to help. You open your mind to other practitioners, like NDs. You might not understand why or how what they do works, but “whatever works.”
Healthcare is constantly evolving, and so is the way we communicate its advancements. My friend’s experience highlights how much has changed—not just in medical technology and treatment approaches, but also in how healthcare professionals engage with patients. As understanding deepens and patient-centered care becomes the norm, it’s crucial to share these stories in ways that foster trust and transparency.
Doctors are increasingly open to new studies on nutrition. They recognize treatment gaps in their care and in medical knowledge and guidelines. Nutrition and alternative practices are entering mainstream and are dismissed as “woo woo” less and less, particularly by doctors who embrace science and research.
With the evolving landscape of medical care, doctors and health professionals are adapting to new perspectives and approaches to help their patients effectively. Acknowledging that some past encounters might have been influenced by various factors, professionals are increasingly open to alternative practices and unconventional methods. They are embracing the significance of research and scientific advancements, often exploring innovative solutions such as the MAS Test to bridge treatment gaps and enhance patient care. By incorporating cutting-edge tools like the MAS Test, doctors are demonstrating a commitment to understanding diverse approaches, ensuring they provide comprehensive and personalized healthcare solutions to their patients. This openness to holistic methods and ongoing research not only enriches medical knowledge but also fosters a more inclusive and effective healthcare system for everyone.
I always say, when picking a doctor pick one that listens, that is curious and that is humble. I strive to be these things, although it’s not easy. Practicing medicine is as much an art as it is a science–we need to be able to not only admit but carry with us the absolute truth that we do not know everything. It is literally impossible to know everything. The body and nature will constantly present us with mysteries on a daily basis, but the gift of being a clinician is that we are constantly learning.
“I don’t know, but I will try to find out” should be every doctor’s mantra (along with Do No Harm).
In a busy and overloaded system we need to help healthcare workers help us. This means being informed. My friend is highly informed and educated in healthcare. I believe her healthcare providers could sense this. She was respectful in denying medications and wasn’t pushed (because she had informed reasons that the healthcare practitioners ultimately agreed with, “no, you shouldn’t go on a PPI long-term, that’s right” “yes, anti-psychotics do have a lot of side effects, and taking them is a personal choice”).
A significant element of my medical trauma was the feeling of disempowerment. I was completely in someone else’s hands and they were not communicating with or educating me. I was left feeling lost and hopeless. Empowerment is everything. It allows you to communicate and make decisions and weigh options. You know what healthcare can offer you and what it can’t.
Of course we can’t always be empowered, especially when we’re very sick and when we’re suffering. In this case, having advocates in your corner are essential. Perhaps it’s having an ND who can help you navigate the system, think clearly and help you weigh your options.
I also recognize that it is hard to be empowered in emergencies. Fortunately, modern medicine handles emergencies exceptionally well. Still, in this case, having an advocate: friend, practitioner or family member, is an incredible asset.
Physicians are burned out. Patients are burned out. I believe this is because of responsibility. Neither the medical system nor the individual can possibly be solely responsible for your health. I believe that responsibility is better when shared. We need help. We can’t do things alone: we need someone’s 8+ years of education, diagnostic testing, clinical experience and compassion. We also need our own sense of empowerment so that doctor’s don’t succumb to the immense pressure of having to fix everyone and everything.
My sister in law is an ER nurse and once remarked (when asked if the ER was busy and chaotic) “people need to learn self-care”. She didn’t mean self-care as in bubble baths. She meant: learning how to manage a fever at home, when a cut needs stitches or how to determine if a sore ankle is a sprain, strain or break. A lot of people were coming in with colds—self-limiting, non-serious infections that could easily be treated at home. This was burning her out. Of course, she meant, go to the ER if you’re not sure. But, there are many non-grey areas in which we can feel empowered to manage self-limiting, non-serious health conditions as long as we know how to identify them or who to go to for answers.
Education is power. In a past life (before becoming an ND and while studying to become one) I was a teacher. I am still a teacher and in fact the Latin root of the word doctor, docere, means “to teach.” Healthcare is teaching. No doctor should say “just take this and call me in the morning” and no patient should accept this as an answer. We have the right to ask, “what will this pill do? When can I stop taking it? How does it work?” This is called Informed consent: the right to know the risks and benefits of every single treatment you’re taking and the right to respectfully refuse any treatment on any grounds.
You have the right to a second opinion. You have the right to say, “Can I think about this? I’d like to read more about it.” You have every right. You have the right to bring a hard question to your doctor, like “do I really need this statin? A study in Nature found that the optimal cholesterol level for reduced all-cause mortality is around 5.2 mmol/L, which is much higher than mine. Do I really need to be on something that lowers my cholesterol?”
If we can’t speak to our doctors, we turn to Google. Being a good researcher is a skill. This is what I was trained to do at naturopathic medical school and in undergrad. How can you tell if a study is a good study? Does the conclusion match the results? What does this piece of research mean for me and my body? Your doctor should be able to look at you and answer your questions to your satisfaction. This is basic respect.
You deserve to access the results of your blood tests and be walked through the results, even if everything is “normal”. Even a normal test result tells a story. We deserve transparency.
I was once told in a business training for healthcare practitioners (NDs, actually) that “people don’t want all the information. They don’t want to know how something works. They just want you to tell them what to do.”
Now, I sincerely disagree with this. In my experience, patients listen vividly when I walk them through bloodwork, explain what I think is happening to them and try to describe my thought process for the recommendations I’m making. I’m sure a lot of what I say is overwhelming–and then I try to put it differently, and open the conversation up to questions to ensure I’m being understood. Again, doctor as teacher, is a mantra we should all live by. There are few things more interesting than learning how our bodies work. In my experience, patients want to know!
When our bodies occur as a mystery, we are bound to live in fear. We are bound to feel coerced and pressured into taking things that our intuition is telling us to wait on, or seek a second opinion for. When we are scared to ask our doctors questions or take up their time, we end up having to deal with our concerns on our own. When we are dismissed we end up confused and doubting ourselves. We end up disconnected from our bodies. We are anxious. We catastrophise. We give away our power to strangers.
Empowerment is everything. It helps us connect to our bodies. It strengthens our intuition. We know where to go or who to go to for answers (or at least a second or third, opinion). We can move ahead with decisions. (i.e.: “I’m going to take this for 8 weeks and if I don’t like the side effects, I will tell my doctor that I want to wean off or ask for another solution”). We are aware of the effects and side effects of medications. We are aware of our options. We know if something isn’t right for us. We can make food and life style choices in an informed and empowered way. We can feel in our bodies who is trustworthy. We can trust ourselves and our bodies.
When patients are empowered, I believe doctors experience less burnout. The responsibility is shared evenly among patients, friends, family and a circle of care of helpers. No one faces the entirety of the weight of their health alone. No one should.
Empowerment and health don’t mean that you’ll be completely free of disease, or that your body will never get sick, or that you will be pain and suffering free. We all get sick. However, empowerment can help you notice something is off. Increased awareness helps you advocate for yourself to get the care you need in a timely fashion. It helps you take necessary steps, even if you’re afraid. You might be less afraid when you have more information. You might have more hope when you know all your options.
Empowerment in healthcare is everything. And here’s the thing: your doctor wants you to be empowered. Empowered patients are fun to work with. They ask good questions. They are respectful. They are open. They give us practitioners an opportunity to learn. My friend experienced this. I’m sure she was a joy of a patient to work with because she was knowledgeable, alert and present. She maintained her own power. She asked questions when she was unsure. She knew what questions to ask. She knew where to go for answers on her own time. She knew which information was relevant for her practitioners to know. She knew how to ask for time and space before making a decision. She knew how to maintain her sense of autonomy. Most of all, empowerment gives us the strength to find a new practitioner if the therapeutic relationship we’re in isn’t respectful or supportive.
I believe we get into the helping professions to help–to heal, to learn and to alleviate suffering. We all swore an oath to “do no harm”.
What do you think? How has health empowerment helped you navigate your own healthcare?
It’s mulberry season, which means while walking through my neighbourhood I can snack, picking food right off the trees growing behind fences or on people’s front lawns whenever I walk by a berry-stained sidewalk.
There’s something therapeutic about entering into the flow state of berry-eating from a tree (or a bush? they’re massive bushes. The act of eating becomes a ritual. It demands presence and attention. It becomes like a game, the objective is looking for rich colour, ripeness, size, and strategizing how to access the delicious, prized morsel you’ve laid your eyes on, then savouring the experience of having attained it, before beginning the process again.
It’s impossible to binge-eat this way.
I remember at my friend’s cottage last September it was blueberry season and we spent the weekend casually hanging out in the middle of blueberry patches. I would find an abundant bush, settle down in the midst of it and graze. I must have eaten 5 cups of blueberries each day and yet it took me the entire day to do it.
What better way to spend a day?
The best part of it was: I met my food.
I was listening to Paul Saladino of the Fundamental Health Podcast interview Daniel Vitalis from the Rewilding Podcast. The subject came up about foraging, and hunting and meeting your food.
“Some people have never seen a bass,” Daniel Vitalis commented.
“Maybe not in the wild, maybe not in a zoo. They don’t know how big it is, what colour it is, what kind of lakes it lives in, what it looks like.
“And, more importantly, even if someone fishes for bass or knows what they look like, if they eat bass in a restaurant or from a frozen filet they’ve bought at the grocery store, they most likely haven’t met that bass.
“There’s a massive disconnect in our society between us and the food we eat.”
In almost every other culture we would have shared an intimate relationship with food.
When I was eating blueberries I took the time to settle down in a patch of bushes and linger. The act of eating was immersed in a ritualistic past-time. I was connecting with the specific plant whose food I was borrowing. I was visiting her home–her environment.
When you fish for bass, or hunt a deer, you enter that animal’s setting. You meet it alive. You witness it living. You witness it dying.
The animal’s fate intertwines with yours.
Your survival and his become like a seesaw. Yesterday it was your turn. Today it’s mine.
I suppose the fish filet’s fate is also intertwined with yours: he may have been destined to end up in the freezer section of the local Costco, but somehow… it seems radically different, largely impersonal. Colder.
This is why we obsess over food sometimes: where was the bass made? Was it caught or farmed? Is it organic? Where was it processed? Eating animals is wrong—I’m going to go vegan. And so on.
I believe that this neurosis becomes our remedy for disconnect, for the disembodiment we experience. Eating becomes an intellectual task. We need to read labels, visit websites, and do research, rather than just experiencing our food first in its living form, before engaging in the eating of it.
Hunter gatherers don’t read labels. They don’t diet.
The Hadza from Tanzania don’t have food rules, restrictions ,or even mental, nutritional concepts about food. That’s a Western thing.
The Hadza, like many other cultures more connected to their food sources, simply possess the raw biological desire to eat whatever and however much they like that they can get, whenever they can get it. They are guided by taste and hunger.
Their lives revolve around hunting and gathering food. They simply immerse themselves in their food environments and eat.
We are also immersed in a food environment: the packaged, fried, doctored foodstuffs packed into grocery stores, fast food restaurants, gas stations, and convenience stores. These foods connect with our hunger cues and communicate with our tastebuds but offer none of the impact of “real” food on our physiology. They don’t nourish us.
They don’t connect us to the natural world. They don’t encourage ritualistic eating. What happened to that wheat sheaf or corn blade for it to become refined flour or hydrogenated oil? Could I participate in the making of it? Or do I lack the chemicals and technology to process this food to make these potato chips, bread, or cookies?
Our food environment encourages our disconnect and this encourages our neurosis around food and nutrition. In order to thrive in this environment we need to think about food. We need to read labels and make choices and abstain from certain foods, and make an effort to change our environment so that it becomes one more conducive to human nourishment.
We need to refuse foods served to us at events, or buy separate groceries, and make separate meals for our partners or children.
We create a food “island” for ourselves, in the midst of our community.
And this becomes impossible.
You are only as healthy as the group and environment you find yourself in.
So what can we do? Perhaps we can start with community. Where do the healthy people shop? Where do you feel most connected to your food? Is it in your garden? Is it visiting a farm? Hunting or buying meat from a hunter, or a farm? Can you meet your meat before you buy it? Can you develop a relationship with those who grow or process your food?
A hunting trip offers a deep connection to food, land, and tradition. It’s an opportunity to step into nature, understanding the balance that sustains both wildlife and people. For many, harvesting meat firsthand is the most ethical way to eat—knowing exactly where it came from, how it was taken, and the effort required to bring it home. A well-planned trip isn’t just about the hunt; it’s about immersing in the landscape, respecting the process, and ensuring nothing goes to waste.
Perhaps it means more at-home food preparation. Visiting more farmer’s markets. Talking with the people selling you your eggs. Perhaps it means developing a connection with a local farm where you source your food. Perhaps it means you pick your apples in season, or you grow your own herbs. Maybe you bake bread with your children, or can your own tomatoes.
Maybe you develop your own food and eating rituals and you practice them as a family or as a community.
Maybe you ask some questions about your food–what does this bass look like? How did this cow live?
Food has always been so central to human culture.
When we connect with the rituals of picking, hunting, growing, processing, and consuming our food, we learn what it is to be truly human.
I talk about contrast showers for boosting immunity, lowering inflammation, mood, pain and weight loss.
Hello everyone, my name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and today I’m going to talk about hot and cold contrast showers. As naturopathic doctors, one of our modalities is hydrotherapy. Hydrotherapy comes from naturopathic medicine’s roots, using hot and cold water to make changes to circulation, hormonal functioning and immune functioning. I’m going to talk about some of the science behind hot and cold contrast showers.
This is something I recommend to my patients to increase their immune activation, decrease autoimmunity, improve mood and hormonal functioning, as well as increase circulation and there’s some evidence that it might help with weight loss as well.
So, firstly, things like exercise and hot and cold therapies induce a little bit of stress. There’s two kinds of stress: distress, which is sort of that chronic, cortisol-fuelled stress that a lot of people come in with, in a state of burnout that’s causing things like inflammation, and mental-emotional illness, and autoimmune issues, and dysbiosis, and then there’s something called eustress, which is more like exercise, cold therapy: short, small bursts of stress that actually up-regulate proteins and genes in our body to combat stress. These genes are involved in DNA repair, increase antioxidant synthesis, and the antioxidants that our body makes are far more powerful than the ones that you’re going to get from food or supplements.
So, by upregulating these genes, we can protect ourselves from cancer, neurodegenerative disease, and other chronic diseases. It’s really powerful stuff, this is called a “Hormetic” response, hormesis, where small stressors mount bigger responses by the body than is needed to deal with those stressors and overall we’re better off; there’s this net beneficial effect. This is one of the proposed mechanisms for some of the antioxidants or flavonoids in green leafy vegetables. It’s not that they provide us with antioxidants, it’s that they encourage our body to make antioxidants due to the small, toxic load that they present to us. And so there’s some evidence that getting short bursts, or longer bursts of cold, very cold, will increase a hormone called norepinephrine. Norepinephrine is involved in depression and mood. Norepinephrine is a catecholamine and it increases the sympathetic nervous system, which is that fight or flight nervous system. When boosted in small amounts, it can actually elevate mood and so a lot of anti-depressant medications also induce, or inhibit the reuptake of norepinephrine. So these are called SNRIs and they include things like Venlafaxine and Cymbalta. So there’s some evidence that norepinephrine increases 2-3 times after only 20 seconds of immersion in cold water. There’s a connection between norepinephrine lowering pain and inflammation and increasing metabolism and there’s some anecdotal evidence and one study, at least, was done to show that cold immersion therapy actually decreased symptoms of depression.
There’s also these things called hot and cold shock proteins, heat shock proteins and cold shock proteins. So, for example, one is called RBM3, which is a cold shock protein, and these proteins can actually help increase longevity and they can actually help decrease incidences of neurodegenerative diseases and neurodegeneration, so something like Alzeimer’s disease or Parkinson’s disease, which can help us with health longevity, so staying healthier into our later years.
We know that inflammation is one of the drivers of the aging process. Probably the primary driver of the aging process, and one of the main factors in chronic, debilitating disease, and, especially in my focus, mental health, there’s more and more researching coming out that inflammation, low levels of inflammation in the brain, is the main cause of mental health conditions, such as depression, and anxiety, bipolar disorder, OCD, ADHD. There’s these low levels of inflammation that contribute to the symptoms of low mood and by increasing norepinephrine, through small bursts of cold and increasing those cold shock proteins, we’re actually able to combat these mental health conditions. Norepinephrine decreases inflammation by decreasing a cytokine called TNF-a that is known to increase inflammation in the body and in the brain. TNF-a can cross the blood brain barrier and it can inhibit serotonin synthesis and it can actually also increase neuro-inflammation, causing symptoms of mental health disorders.
There’s some studies that cryotherapy, for rheumatoid arthritis actually decreased pain significantly. And there’s also some studies that being in cold water, that cold shock, can actually increase the immune system activation. It’s good to increase our immune system activation if our immune cells are behaving properly. If our immune cells are attacking ourselves, then we want to decrease the immune response. But having higher levels of lymphocytes, especially cytotoxic T lympthocytes that are involved in killing cancer cells, is a very positive thing and that’s been shown to increase in people that underwent cryotherapy, or really acute, short exposure to intense cold.
There’s also an ability to lose weight when exposed to cold, over the long term. There’s a man called Ray Cronise who lost over 80 lbs by just habitually exposing himself to mildly cold temperatures. And one of the mechanisms for this weight loss is through non-shivering thermogenesis, in which the cells in the mitochondria uncouple proteins that make energy and they dedicate all the stored energy in fat to making heat. Kind of like cutting your bike chain. So instead of biking, you’re not moving forward, but you’re generating energy and you’re generating heat. And so our body will do this when it’s slightly cold that it can increase heat. Our body is always striving to maintain constant temperature, between 1 or 2 degrees. This process is regulated by norepinephrine, which rises acutely as soon as we’re exposed to just a few seconds of cold. This can be 40-50 degree water. And then I already mentioned that short, cold exposure can increase the production of antioxidants. Our mitochondria are constantly creating reactive oxygen species and reactive nitrogen species. This is just a product of normal cell metabolism. These become toxic, though and damage DNA if our body doesn’t also produce anti-oxidants to clear out those reactive oxygen species and reactive nitrogen species. The cold induces a little bit of a stress that increases our metabolism that increases the reactive oxygen and nitrogen species in our mitochondria and therefore our body is incited to up-regulate the enzymes that create those powerful anti-oxidants that I talked about that are far more powerful than the ones that you can get from food: vegetables, fruits, vitamin C supplement. A couple of these enzymes are glutathione reductase and superoxide dismutase, which are very powerful to our cells.
There’s some evidence that hot and cold therapy can increase muscle mass, can increase muscular strength and aerobic endurance. So this is great for athletes post-workout to lower inflammation and improve muscle regensis. And then, it can also increase something called mitochondrial biogenesis, which is the production, or the replication of more mitochondria in the tissues, especially the muscle tissue. So our body will increase the mitochondria content, the mitochondrial mass, in muscle tissue under certain conditions. These conditions are mainly fasting, exercise, and hot and cold shock.
So, what I’ll recommend to my patients, somebody who’s suffering from low immunity, so they’re getting frequent colds and flus, or maybe autoimmunity, or maybe just general inflammation and pain, brain fog sluggishness adrenal fatigue, that kind of sluggish lethargy from depression. So it’s more the sluggish depression, I’ll recommend hot and cold showers.
So what you do is, in your shower, either during your shower, during your regular cleaning routine, or after your shower is done, and you’ve already washed your hair and everything, you’re going to turn the water on to a reasonably hot temperature, so not so hot that it’s scalding, and you’re going to leave that hot water on for 30 seconds to 1 minute. When that’s done, you’re going to turn the shower to as cold as you can tolerate. So with my patients I often coach them to start with a lukewarm temperature before going whole hog and doing cold. And this is just to coax the body into that stress response that we want, that short, quick stress response that’s going to do all those good things: up-regulate anti-oxidant production, increase norepinephrine, decrease inflammation, increase mitochondria synthesis, burn fat. So you’re going to try and make it as cold as possible, for 20 to 30 seconds, and then you’re going to cycle back and forth at least 5 to 10 times, always end on cold, and then, when you’re done, towel off and keep warm.
There’s some evidence that doing this before bed can actually increase REM sleep and help you sleep more soundly without waking up in the middle of the night. We all know that a good sound sleep is going to set the tone for the next day and your energy for the next day. And then there’s also some evidence that doing this in the morning can increase your energy and alertness throughout the day, so it’s almost like this same practice at different times of day impacts our circadian rhythms differently and can give us more of what we want: either more profound sleep or more daytime energy.
So, that was hot and cold showers, my name is Dr. Talia Marcheggiani and you can check out my website at taliand.com or contact me at connect@taliand.com . A lot of this research came from Dr. Rhonda Patrick at foundmyfitness.com .
The Therapeutic Order is a tool that helps guide naturopathic treatment approaches. I explain how naturopathic doctors’ healing philosophy might differ from the conventional medical model.
Hi, guys, I’m Dr. Talia Marcheggiani and I’m recording to you guys from my clinic in Bloor West Village and today I’m going to talk about some myths about naturopathic medicine, especially regarding our relationship with conventional medicine and medications and, in order to talk to you about that, I want to talk to you about something called the Therapeutic Order. So the therapeutic order is from our traditional roots in the formation of the profession of naturopathic medicine. This is one of our philosophical ideas about how to treat somebody that comes in our door and how people should be treated in terms of the medicine that we practice. And this is a 7-step process, or a hierarchy, of what our treatment goals are for seeing somebody. And the reason that I’m relating the Therapeutic Order to medications is because one of the steps in this hierarchy of the Therapeutic Order is pharmaceutical medication. And so I feel that, in naturopathic medicine, most of us, and certainly in our philosophy, in regards to medication, it’s not that we don’t agree with medication or surgery or conventional treatments, it’s our agreement about when they’re implemented and it’s also about our efforts to treat patients before the need for surgery or medications arises. And so, the Therapeutic Order is a system of interventions and we go from lower-force interventions to higher force interventions and the first step in the Therapeutic Order is to remove obstacles to health.
In modern healthcare, both naturopathic and conventional medicine strive for the same goal—restoring and maintaining a patient’s well-being. Naturopathic doctors emphasize prevention and addressing the root causes of illness before resorting to pharmaceuticals or surgical interventions. This approach aligns with the Therapeutic Order, ensuring that treatment starts with the least invasive methods first. However, when necessary, medications play a crucial role in managing conditions that require immediate intervention. The key lies in knowing when to integrate pharmaceutical solutions within a broader health plan rather than relying on them as the first line of defense.
So, anytime someone walks into my office, and is displaying certain symptoms, I’m always looking for, what are the obstacles that their body is facing when it’s trying to achieve its optimal state of health and wellness. Our bodies have evolved over 300 billion years, from whatever our common ancestor was, that first created life, we’re this result of a lineage of survivors, if we’re here on the planet today. And so our bodies have evolved amazing mechanisms to preserve our health and well-being to ensure that our genes are carried on to future generations. So when somebody is coming in in the initial stages of disease, and so this may manifest for you as just this subclinical feeling of “imbalance”, for lack of a better word, there’s often an obstacle in the way. And a big obstacle that often presents itself in my patients’ lives is stress. That’s one that’s huge and that’s the reason that I talk about it so often. Another is toxic burden from our environment. Things like pesticides, plastics, smog pollutants in our air, in our water, in our food, that can also cause an obstacle to health or just give our bodies some extra things it has to deal with that divert it from its job of making us feel and look our best. And another thing, of course, is diet that’s inadequate, that’s not providing us the nutrients that we need or a diet that’s providing us with anti-nutrients, so it’s preventing us from absorbing the vitamins, the minerals and the macronutrients that we need to function optimally.
And some naturopathic doctors will focus on the energetic aspect, the spiritual aspect. So, is the person in front of them pursuing a meaningful life, do they feel satisfied with their work, are they satisfied with their relationships. So, anytime one of these major pillars of our health is lacking that can also present an obstacle to us feeling our best. And oftentimes the obstacle is a mental-emotional one, even if the symptoms that are manifesting are physical.
So, another video that explains this is my wheel of balance video in talking about stress and when I work with mental health, a stage to mental health promotion is emotional wellness, which is why I use that term so often, rather than focusing on eradicating or eliminating or managing symptoms of mental “illness”—and I prefer to say mental health conditions, rather than mental illness—how can we improve our emotional wellness, how can we improve our mental wellness, as opposed to focusing on disease.
Most naturopathic doctors will focus on this level, this will be inherent in our philosophy we’re always going to be looking for what the obstacles are that are in the way of our patients’ achieving symptom-free lives or a life of low or no symptoms, and a life of abundant wellness and energy, and healthy weight management and healthy mood and all of the things that indicate robust health. This will always be inherent in our philosophy.
The second step in the Therapeutic Order is to stimulate the Vis, so this is the “vis medicatrix naturae”, which is Latin for the healing power of nature, which may seem a little bit woo woo to some people, but you can think of the Vis as metabolism or homeostasis, and this is the idea that our body is primed for optimal health, and our body is always striving to maintain balance. And there’s this idea in naturopathic philosophy that sometimes this inherent energetic mechanism that causes life and all living beings, that sometimes it needs to be stimulated and oftentimes the therapies to do this are more in the energetic realm. So things like homeopathy and acupuncture and hydrotherapy as well, so using water and various temperatures to increase metabolism, hormonal balance, homeostatic balance and blood flow, so those are all scientific terms for what I think the Vis attempts to describe.
So, I tend also to use diet in this realm and herbs. I believe that herbs, and there’s some research for this, some evidence that herbs are modulating, that herbs, as opposed to drugs, kind of seek where things are lacking and they balance our hormonal milieu, our hormonal landscape, more than a medication, which is man-made and an example of this is that some people supplementing with straight vitamin A experienced some negative outcomes in large studies that were done. But if you eat foods that are high in vitamin A, those negative symptoms from vitamin A supplementation seem to balance themselves out and that’s because there are some nutrients present in vitamin and nutrient-rich foods that we haven’t discovered yet and that seem to act synergistically with other chemicals, natural chemicals, that are present in those foods. And so, by taking nature into our bodies through forest bathing, so physically being in nature, or through the consumption of plants and natural substances, I believe that we receive some of those messages from nature. And I can get into this in future videos. I find that herbs have intelligence behind them. And that’s not necessarily woo-woo or pseudoscientific, there’s some research for sure that show that herbs modulate through their anti-inflammatory effects, their anti-oxidant effects, and their hormone-balancing effects, in ways that pharmaceuticals don’t do to the same extent.
So, these two stages, when patients are coming in and we’re focusing our treatment, we’re removing obstacles and stimulating the body’s capacity to heal and you can think about this. If you break a bone, we’re definitely going to remove the obstacle, which is whatever broke the bone in the first place, and then we’re going to promote the body’s ability to heal. It’s not conventional medicine that heals the bone, we simply align the bone so that it can fuse together. It’s the body that heals it. So, we’d be promoting the healing of that tissue with some of the nutrients that the body needs. So this can be applied no matter how serious the medical condition, but definitely it will always be implicit in our treatment plans and how we look at the body. And sometimes that’s enough, if somebody is just coming in with a general feeling of imbalance or, you know, someone who’s coming in with a good state of health, without a loss of apparent symptoms that just wants to manage their health in general, then we’ll kind of stop there, but we might teach you some ways to detoxify, to encourage a healthy diet, and the healthy consumption of health-promoting foods and we’ll let you sort of maintain that on your own.
But what often happens is that people are coming in, because we’ve been taught in our culture in North America and Canada, especially, to come in and seek medical care when we’re feeling ill, a lot of the time people will come in with some kind of issue, so some specific symptoms, and oftentimes these symptoms are apparent or located within one organ system. And so the third step in the Therapeutic Order is to strengthen weakened systems. So this might be somebody who’s coming in a liver issue and this may be a diagnosed issue, or based on their symptoms, we’re noticing some impairment in the liver in general. And so we take treatment a step further and we start to focus on actually repairing the tissues that are present in the liver and so we’ll be using some, perhaps, liver detoxification, some more intense diets, so diets that are geared more to therapeutics, and using some herbs and nutrients to clean out the liver.
We can also use some of our energetics, at this stage, acupuncture, homeopathy, hydrotherapy, self-care practices, and we’ll definitely be removing obstacles to cure, so high-sugar diets, or overconsumption of alcohol, or a high toxic burden. We’ll be looking at those things as well, but we’re also taking it a step further and specifically focusing on the liver in this case.
At this stage of treatment, acupuncture therapy becomes a powerful tool to complement the healing process. By targeting specific points in the body, acupuncture helps to balance energy flow, reduce inflammation, and promote the body’s natural healing abilities. This approach is particularly beneficial for those dealing with chronic conditions or weakened systems, as it provides a holistic method to address underlying issues.
And this is something that I see most of in my practice, is people coming in with hormonal imbalance, with a mental health condition, with digestive issues, skin issues, hair falling out, and so we’re ordering labs, we’re targeting specific organ systems, and we’re, maybe not necessarily putting these symptoms into a diagnostic category, that would be diagnosed by a conventional doctor, so sometimes these are still subclinical, but there’s definitely symptoms present, people are suffering and they’re noticing a change and they’re probably have already sought help with their medical doctor and maybe were told everything was fine, or maybe they received a diagnosis.
The 4th stage in the Therapeutic Order is to correct structural integrity. So, if our posture, if our alignment is off, then our health is not going to work properly, there’s not going to be proper nerve conduction, there won’t be proper circulation, there won’t be proper functioning of our organ systems. If our rib cage is collapsed, we won’t be breathing properly and we won’t be oxygenating our tissues. If our pelvis is out of alignment we won’t experience proper digestion and digestive regulation. And I often refer out for this stage, I might refer to an osteopath or a chiropractor, or a physiotherapist or massage therapist. I might so some acupuncture myself, but typically for structural correction, I’ll refer to another practitioner and I myself see a massage therapist, chiropractor, osteopath and do quite a bit of hydrotherapy and work on aligning my body through yoga and things like that because of its importance and just general health maintenance.
Correcting structural integrity is essential not only for pain management but also for ensuring the body’s systems function optimally. A professional physiotherapist plays a vital role in this process, offering tailored exercises and manual therapies to improve posture, mobility, and strength. They assess the alignment of your body and identify any areas of restriction or dysfunction. Through targeted treatments, physiotherapists work to restore balance and proper alignment, helping to prevent issues from becoming chronic or leading to further complications. By focusing on the body’s structural health, physiotherapists ensure that everything from nerve conduction to organ function is supported.
While this is the 4th stage in the Therapeutic Order, I often recommend that it be implemented as some kind of healthcare strategy that focuses on structural integrity be implemented early on or as a maintenance, especially because we’re so sedentary and we spend so much time in front of our computers and often engage in repetitive exercise. Working on structural integrity management is so important.
The 5th stage in the Therapeutic Order is the use of natural substances to restore and regenerate. And so this is a little bit like symptom management, if you can imagine that. The objective of naturopathic medicine is not necessarily to fix a specific disease, which is often confusing, because we have a very disease-focused healthcare system, not necessarily a health-focused one. And so we’re sort of indoctrinated into this view that if you don’t have a diagnosis that you’re healthy, or that health is the absence of symptoms, which is certainly not the philosophy of the world health organization who believes that health is a mixture of our mental and spiritual and emotional and physical wellbeing and not simply the absence of disease, however we do have a sickcare system rather than a healthcare system, and so we’re educated not to go to the emergency room or your family doctor unless you feel like it’s serious enough to warrant a diagnosis and, if it’s not, then you’re often sent home and told everything’s fine. And patients will always come in having told me that their labs are fine. And they are, they’re fine in the framework of not requiring a diagnosis, or pointing to necessary pathology, but they’re certainly not fine in the sense that not things that we can improve on and that are not giving us warning signals of what could come in the future.
We often focus on disease prevention and healing the body rather than focusing on the symptoms or the pathology. We’re looking for the underlying cause. However, sometimes we get far enough along that we do need to manage symptoms, otherwise people aren’t going to notice benefit. And, so, further along the disease process, further along the naturopathic order we need to reach. To manage the diseases. These are a little bit higher-force interventions, rather than sort of encouraging tissue repair, like we were doing in the 3rd stage of the Therapeutic Order, now we’re focusing more on managing symptoms, managing inflammation through herbs that are going to calm it down quickly, and detoxify quickly, and we’re going to manage headaches with herbs, that are just generally anti-inflammatory. So we’re going to be looking at symptom-management. And so a lot of the time we’ll do that in conjunction with the other 4 stages of the Therapeutic Order, but this time there is a heavy focus on keeping symptoms under control for better quality of life and to move the needle further.
And the 6th step of the Therapeutic Order is similar to the 5th, except we’re using pharmacological devices and so it’s not that we’re against pharmacology and medications in naturopathic medicine, at all, we simply want to encourage patients to come and see us before things get to the point where you require medications and I certainly believe and I think even many conventional practitioners agree with me on this, that medications are probably too widely prescribed or over-prescribed. And this may be that there are no other solutions and, as a clinician, you want to help the person sitting in front of you and aren’t really sure how to go about that. So somebody comes in to your office who has depression and you’re going to reach for the selective-serotonin reuptake inhibitor, the SSRI, the Prozac or Cipralex, you’re not going to tend to risk using herbs or focusing on diet or digestion or those kind of things, you’re going to use this “proven method” and you’re going to implement that right away, whereas my philosophy would be to, depending on how serious the case is, to implement other interventions and make sure that our terrain is being treated, that we’ve removed some obstacles to cure, we’ve encouraged spiritual and life-meaning pursuits and we’re stimulating the body’s own healing mechanisms and anti-inflammatory mechanisms, and that maybe we’re directly targeting the brain with some nutrients and some vitamins and that we’re making sure structural integrity is there, and that we’re even using some herbs to manage depression because we know that St. John’s Wort works very similarly to an anti-depressant in terms of its efficacy. And then, if those things are not working or not having enough of an impact, then we might talk about an SSRI, depending on how severe the case is.
And I say this not to create a stigma around medication use at all. Every single body is different and everybody’s going to need a different treatment concoction and it’s never going to be just one treatment or very rarely will it just be one panacea, no matter how much we wish that there were, it’s going to be a few things that we need to implement to help manage our own health, so that’s when we’ll reach for the pharmaceuticals, when the natural treatments are not having enough of an impact, or the disease process has progressed far enough.
And then the last is the use of high-force interventions, so surgery, radiation and chemotherapy. When you’re diagnosed with cancer, then it’s definitely appropriate to do radiation and chemo or to excise the tumour, or if there’s joint degeneration to the extent that it can’t further be repaired, and you can’t sort of prevent it any longer, because you’ve reached the point where the cartilage in your joint is damaged, then a joint replacement is appropriate. It’s not that we’re against these things either, it’s that we believe in trying as hard as we can to prevent them from being necessary. But when appropriate, they’re definitely a gift that we have in our culture and the time that we live in that we can use these kinds of things to improve our quality of life and to get us back on track in terms of our health. And so very rarely will I see somebody who requires this stage of intervention, even naturopaths that work with cancer, their focus is not to treat cancer with natural therapies but to support the whole patient and to improve the outcomes of the high-force interventions, often an obstacle to healing from cancer is that patients aren’t able to finish their course of chemo due to the side effects, and so a lot of the natural therapies can help boost the efficacy of the medication and reduce the side effects and make patients feel better, so that they’re able to complete their treatment and then have better outcomes. So, at these two, the last two stages, where we’re using medications and high-force interventions, natural medicine is working to support the terrain and to support the body, through the therapies, through the side effects and to also encourage the therapies to work better.
And just to recap, the stages of the Therapeutic Order are first, number one, remove the obstacles to health, number two, stimulate the Vis Medicatrix Naturae, or stimulate homeostasis, improve our body’s self-healing mechanisms through applying nutrients, or looking at energetics, or using herbs to balance our systems and promote proper hormone balance. And the third is to strengthen weakened organ systems, focusing on one organ that may be the culprit in causing symptoms in particular, and really using nutrients that target that organ and the tissues that that organ has. Number four is to correct structural integrity, creating proper alignment and healing the musculoskeletal system through things like chiropractic medicine, osteopathy, massage therapy, even hydrotherapy and acupuncture, doing exercise like yoga as well fits under there. And number five is to use natural substances to restore and regenerate, so this is using natural substances to work directly with symptoms, to promote healing, but in patients that are further along the road to pathology and maybe already have a diagnosis of some health condition. And number six is to use pharmaco-substances to halt progressive pathology, so these are palliating, they’re stopping disease, they’re treating somebody who is either not responding enough or whose disease has progressed far enough that natural therapies are no longer strong enough. And then the seventh stage of the Therapeutic Order is to use high-force invasive modalities, such as surgery, radiation and chemotherapy and, again, these are removing the disease. Often that stage is usually life or death situations, we’re working to remove what’s causing a danger to our body and to our ability to survive. And so naturopathic medicine cover this whole spectrum. We have therapies that cover the whole spectrum of these stages and we’re working to treat the whole person not focusing on the disease or the symptoms, but looking at the person in front of us, and taking into account their lifestyle their preferences, their unique individuality and genetic expression and individual expression. My name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and I work at Bloor West Wellness in Bloor West Village in Toronto. Take care.
In this video I give an education talk to a group of seniors at the Bernard Betel Centre about naturopathic medicine. I discuss our philosophy, education, what kinds of conditions we treat and answer some questions along the way.
“I was born with an imbalance in my brain,” my patient explains to me, “The medication corrects it—Since I started taking Cipralex, I wake up feeling like a normal person again.”
It is estimated that about 10% of adults in North America are taking a medication to help them cope with anxiety and depression. Many people swear by these substances, others claim that they worsen depression, cause uncomfortable side effects and fail to treat the root cause of symptoms, numbing us to the experience and cause of our emotional pain and physical symptoms. The reality is, however, that prescriptions for these medications is increasing.
What are anti-depressants?
Most anti-depressant medication falls into the pharmaceutical category of SSRI, or Selective-Serotonin Re-uptake Inhibitors, like Prozac or Cipralex. These medications prevent the body from mopping up the “happy hormone”, serotonin, in the brain, making its feel-good effects last longer. The result is thought to be more serotonin in the brain and, therefore, increased feelings of happiness and euphoria. Other drugs work on preventing the re-uptake of other neurotransmitters, brain chemicals dopamine and norepinephrine, which also cause feelings of happiness, pleasure and reward, and give us energy.
The Monoamine Theory of Depression:
The leading theory of depression for decades, the Monoamine Theory, states that in people who suffer from depression, there is an imbalance in serotonin production and signalling in the brain—a “serotonin deficiency”—which SSRI medication corrects. Because this is how anti-depressant medication works, this has taken over as the prevailing theory of depression. However, there has never been a published study that proves that people who suffer from depression or anxiety have issues with brain serotonin production or metabolism. It almost seems that pharmaceutical companies have “reasoned backwards” creating a theory in order to support anti-depressant use.
As patients, we want to believe that the medicine our doctors give us is just that, medicine—something that treats the root cause of disease and makes us healthier, rather than covering up our symptoms while the underlying problem continues to worsen. However, most medications don’t work that way. While Advil may alleviate a headache, we intuitively know that our headache was not caused by an Advil deficiency. Likewise, alcohol may calm down those plagued by social anxiety, but we know that alcohol isn’t a cure for social anxiety; it is a drug that can temporarily help symptoms and relying on it will only cause further health problems down the line. We know that for most health conditions, while a drug may help temporarily, something else is going on inside our bodies that warrants attention.
While the percentage of people who are medicated for depression has increased in recent years, the rate of disability from mental health conditions is steadily on the rise. This is perplexing, especially if these drugs are doing what they’re “supposed to”, which is curing a brain chemical imbalance. Shouldn’t medicating patients with depression result in a cure, or at least a declining rate of disability for mental health concerns? Clearly, something else is going on.
Harnessing the Placebo Effect:
Many patients report the fact that anti-depressant medications saved their lives, radically turning around serious and debilitating symptoms. I’ve heard quite a few stories from individuals who couldn’t get out of bed until they found the right SSRI for their body.
The data shows that SSRI medication has the ability to reduce depressive symptoms by 30% in individuals, a modest reduction at best, but still significant. But, do these medications work as well as the studies claim? A glance at the entire body of research casts doubt on the efficacy of anti-depressant medication:
Firstly, there is a large body of unpublished negative studies. This means that studies that show there is no difference in anti-depressant medication and placebo is left out of the body of literature, favouring a bias for positive publications, publications that find anti-depressants work. Medical research draws conclusions by producing studies over and over again. When the results of several studies are combined, doctors and researchers are able to draw conclusions about whether a medication works or not. When only positive research is published, without negative research to balance it out, it casts medications in a favourable light that they may not necessarily deserve. This is an unfortunate phenomenon in medical science as a whole, and often skews the evidence in favour of drugs that may not be as effective as we hope.
Secondly, the gold standard for evidence, the Randomized Control Trial (RCT) may have design flaws due to the nature of the medications being tested. In RCTs, patients are randomized into two groups. One group is given placebo and the other the active drug that is being tested. The subjects and the people evaluating them are both blinded—neither knows which group is given the drug and which is given the placebo. This reduces the possibility of bias in reporting and observing the effects of the medication. The idea is because an inert pill, or “placebo” may be able to exert the effects of a drug, providing about 30% benefit, according to some sources. However, when patients who are in the active group experience side effects of the medication: gastric symptoms, nausea, headaches, altered sleep and appetite, they quickly become alert to the that fact that they are in the medication group, leaving room for the placebo effect to occur. This is termed the “Active Placebo Effect”. When SSRIs are compared with active placebos—placebos that don’t act as medicine but produce the same side effects—we found their effects rapidly diminished, perhaps because the placebo effect was not taking effect anymore.
What about the people who SSRIs help?
To cast doubt on the efficacy of anti-depressants does not in any way invalidate those who have felt the medications helped them. Every body is different and I believe that it is not for us to say how someone should or shouldn’t be reacting to a medication or therapy. The mysteries of our bodies are vast and there is only so much that we’re aware of in the world of medicine and health. Furthermore, the placebo effect, while often being used to dismiss therapies (“oh, it’s probably just a placebo effect”) should really be viewed as an amazing miracle of medicine and evidence of how powerful our bodies and minds are. The placebo effect shows us that, according to our beliefs, we have the power to heal ourselves. We believe that we’re getting treatment, we believe the treatment will help us, and the very nature of those beliefs heals our physical bodies.
This does not mean that the people who were suffering before taking the medication were “faking it” or should have been able to just snap out of it—that’s not how the placebo effect works. The placebo effect is based on changing our beliefs, which, as you may know, is not something we can simply will ourselves to do. However, the fact that our beliefs hold this kind of healing power, I find, frankly, is amazing. The placebo effect shows us evidence of an almost magical ability of the mind-body connection to heal ourselves, without side effects, and I believe it is something that we should harness and celebrate.
What’s the problem, then?
While anti-depressants may be harnessing the placebo effect to help individuals heal, there are downsides to them as well.
Firstly, SSRI medications have a long list of side effects, from weight gain and fatigue to sexual dysfunction and vitamin deficiencies, being on these medications over the long-term can be unpleasant for some and seriously affect quality of life for others.
Secondly, anti-depressant medications are notoriously difficult to get off of. I have assisted many patients in getting off their medication, with the help of their medical team, but it’s never easy and must always be done slowly and responsibly. Getting off medication involves a slow wean over months with support of natural therapies, psychotherapy and lifestyle changes. Because these drugs force the brain to adapt, causing a very real chemical imbalance, oftentimes the withdrawal effects are so intolerable that patients are not able to come off.
Most patients who decide to try anti-depressant medications are not aware how difficult it will be to stop taking the medication, if they should eventually choose to do so. This is unfortunate, as I believe that full informed consent should be applied to patients so that they may make appropriate decisions about their health—patients should be made aware that they are expected to stay on the medication for life and that weaning will be very difficult and, in some cases, not possible.
Finally, there is a growing body of evidence showing that patients who do not receive medication, but other forms of help such as diet and lifestyle changes, psychotherapy and stress management, do better, have higher rates of remission and less relapse than those who are medicated. As we see with the studies that show that more medication is correlated with more disability from mental health concerns, it is possible that medicating depression is only worsening the problem for most people.
So, what causes anxiety and depression?
Scientists and clinicians are not sure what the cause of depression is. However, the Cytokine Theory of Depression and the Gut-Brain Connection are two areas that are gaining increasing interest from researchers. These theories state that depression may be a cause of inflammation in the body that affects the brain, and that imbalances in gut health, especially with gut bacteria may offset mental health, respectively. Naturopathic doctors also notice a clinical correlation between burnout or “adrenal fatigue” and mental health symptoms.
Healing the mind and body, however, starts with creating a therapeutic relationship with a professional that you trust. After that, I find that healing the gut, correcting inflammation and nutrient deficiencies while addressing harmful core beliefs and stress can have wonderful results for healing depression and anxiety.
Depression is a symptom:
Psychiatry would have us believe that depression and anxiety are conditions that we are born with. Conventional medicine states that perhaps we have a familiar tendency to develop these conditions, perhaps we’ve had them since childhood, but, and in this case it is clear, depression and anxiety are not things that you heal from; they are things you simply manage.
I disagree. I don’t believe that depression and anxiety stand on their own as diseases, but symptoms of a deeper imbalance. Like any symptom, I believe mental health concerns are trying to tell us something. Our bodies have no other way of communicating with us other than through the symptoms they produce: lack of motivation, sore muscles, bloating and diarrhea, headache, joint pain, brain fog, fatigue and so on. As naturopathic doctors, we are trained to listen, not just to our patients, but the messages their bodies are signalling to us through symptoms.
This means that, when I start seeing a patient with depression, whether they are on medication or not, we develop a full work-up, asking in-depth questions about sleep, diet, exercise, digestion, mental status, mood, energy, reproductive health and so on. I connect these symptoms together to find out what is going on beyond what may be immediately visible.
Depression and anxiety often have a root cause. The cause may be stress, childhood trauma, leaky gut, adrenal fatigue, inflammation or even medication and drug use itself. Through uncovering the root of the issue, we are able to treat it, helping the body restore itself to balance and health.
My philosophy of healing is that, sometimes, illness can be a gift, especially if it encourages us to delve deep into our lives and values and make the necessary changes for healing ourselves. Sometimes depression and mental health challenges can be the beginning of a grand and fulfilling journey where we learn to connect more deeply to our bodies, discover our life purpose and a greater sense of happiness and life satisfaction.
People seek out naturopathic doctors for expert advice. This immediately positions us as experts in the context of the therapeutic relationship, establishing a power imbalance right from the first encounter. If left unchecked, this power imbalance will result in the knowledge and experience of the practitioner being preferred to the knowledge, experience, skills and values of the people who seek naturopathic care.
The implicit expectation of the therapeutic relationship is that it’s up to the doctor to figure out what is “wrong” with the body patients inhabit and make expert recommendations to correct this wrong-ness. After that, it’s up to the patients to follow the recommendations in order to heal. If there is a failure to follow recommendations, it is the patient who has failed to “comply” with treatment. This “failure” results in breakdown of communication, loss of personal agency on the part of the patient, and frustration for both parties.
When speaking of previous experience with naturopathic medicine, patients often express frustration at unrealistic, expensive and time-consuming treatment plans that don’t honour their values and lifestyles. Oftentimes patients express fear at prescriptions that they had no part in creating, blaming them for adverse reactions, or negative turns in health outcomes. It’s common that, rather than address these issues with the practitioner, patients take for granted that the treatment plan offered is the only one available and, for a variety of reasons, choose to discontinue care.
One of the elements of Narrative Therapy—a style of psychotherapy founded by Australian Michael White—I most resonate with is the idea of the “therapeutic posture”. In narrative therapy, the therapist or practitioner assumes a de-centred, but influential posture in the visit. This can be roughly translated as reducing practitioner expertise to that of a guide or facilitator, while keeping the agency, decision-making, expertise and wisdom of the patient as the dominant source for informing clinical decisions. The de-centred clinician guides the patient through questioning, helping to reframe his or her identity by flushing out his or her ideas and values through open-ended questions. However, the interests of the doctor are set aside in the visit.
From the place of de-centred facilitation, no part of the history is assumed without first asking questions, and outcomes are not pursued without requesting patient input. De-centring eschews advice-giving, praise, judgement and applying a normalizing or pathologizing gaze to the patient’s concerns. De-centring the naturopathic practitioner puts the patient’s experiences above professional training, knowledge or expertise. We are often told in naturopathic medical school that patients are the experts on their own bodies. A de-centred therapeutic gaze acknowledges this and uses it to optimize the clinical encounter.
I personally find that in psychotherapy, the applicability of de-centring posture seems feasible—patients expect that the therapist will simply act as a mirror rather than doling out advice. However, in clinical practice, privileging the skills, knowledge and expertise of the patient over those of the doctor seems trickier—after all, people come for answers. At the end of naturopathic clinical encounters, I always find myself reaching for a prescription pad and quickly laying out out my recommendations.
There is an expected power imbalance in doctor-patient relationships that is taught and enforced by medical training. The physician or medical student, under the direction of his or her supervisor, asks questions and compiles a document of notes—the clinical chart. The patient often has little idea of what is being recorded, whether these notes are in their own words, or even if they are an accurate interpretation of what the patient has intended to convey—The Seinfeld episode where Elaine is deemed a “difficult patient” comes to mind when I think of the impact of medical records on people’s lives. After that we make an assessment and prescription by a process that, in many ways, remains invisible to the patient.
De-centred practice involves acknowledging the power differential between practitioner and patient and bringing it to the forefront of the therapeutic interaction.
The ways that this are done must be applied creatively and conscientiously, wherever a power imbalance can be detected. For me this starts with acknowledging payment—I really appreciate it when my patients openly tell me that they struggle to afford me. There may not be something I can do about this, but if I don’t know the reason for my patient falling off the radar or frequently cancelling when their appointment time draws near, there is certainly nothing I can do to address the issue of cost and finances. Rather than being a problem separate from our relationship, it becomes internal the the naturopathic consultation, which means that solutions can be reached by acts of collaboration, drawing on the strengths, knowledge and experience of both of us.
De-centred practice involves practicing non-judgement and removing assumptions about the impact of certain conditions. A patient may smoke, self-harm or engage in addictive behaviours that appear counterproductive to healing. It’s always useful to ask them how they feel about these practices—these behaviours may be hidden life-lines keeping patients afloat, or gateways to stories of very “healthy” behaviours. They may be clues to hidden strengths. By applying a judgemental, correctional gaze to behaviours, we can drive a wedge in the trust and rapport between doctor and patient, and the potential to uncover and draw on these strengths for healing will be lost.
De-centred practice involves avoiding labelling our patients. A patient may not present with “Generalized Anxiety Disorder”, but “nervousness” or “uneasiness”, “a pinball machine in my chest” or, one of my favourites, a “black smog feeling”. It’s important to be mindful about adding a new or different labels and the impact this can have on power and identity. We often describe physiological phenomena in ways that many people haven’t heard before: estrogen dominance, adrenal fatigue, leaky gut syndrome, chronic inflammation. In our professional experience, these labels can provide relief for people who have suffered for years without knowing what’s off. Learning that something pathological is indeed happening in the body, that this thing has a name, isn’t merely a figment of the imagination and, better still, has a treatment (by way of having a name), can provide immense relief. However, others may feel that they are being trapped in a diagnosis. We’re praised for landing a “correct” diagnosis in medical school, as if finding the right word to slap our patients with validates our professional aptitude. However, being aware of the extent to which labels help or hinder our patients capacities for healing is important for establishing trust.
To be safe, it can help to simply ask, “So, you’ve been told you have ‘Social Anxiety’. What do you think of this label? Has it helped to add meaning to your experience? Is there anything else you’d like to call this thing that’s been going on with you?”
Avoiding labelling also includes holding back from using the other labels we may be tempted to apply such as “non-compliant”, “resistant”, “difficult”, or to group patients with the same condition into categories of behaviour and identity.
It is important to attempt to bring transparency to all parts of the therapeutic encounter, such as history-taking, physical exams, labs, charting, assessment and prescribing, whenever possible. I’ve heard of practitioners reading back to people what they have written in the chart, to make sure their recordings are accurate, and letting patients read their charts over to proofread them before they are signed. The significance of a file existing in the world about someone that they have never seen or had input into the creation of can be quite impactful, especially for those who have a rich medical history. One practitioner asks “What’s it like to carry this chart around all your life?” to new patients who present with phonebook-sized medical charts. She may also ask, “Of all the things written in here about you, what would you most like me to know?” This de-emphasizes the importance of expert communication and puts the patient’s history back under their own control.
Enrolling patients in their own treatment plan is essential for compliance and positive clinical outcomes. I believe that the extent to which a treatment plan can match a patient’s values, abilities, lifestyle and personal preferences dictates the success of that plan. Most people have some ideas about healthy living and natural health that they have acquired through self-study, consuming media, trial-and-error on their own bodies or consulting other healthcare professionals. Many people who seek a naturopathic doctor are not doing so for the first time and, in the majority of cases, the naturopathic doctor is not the first professional the patient may have consulted. This is also certainly not the first time that the person has taken steps toward healing—learning about those first few, or many, steps is a great way to begin an empowering and informed conversation about the patients’ healing journey before they met you. If visiting a naturopathic doctor is viewed as one more step of furthering self-care and self-healing, then the possibilities for collaboration become clearer. Many people who see me have been trying their own self-prescriptions for years and now finally “need some support” to help guide further action. Why not mobilize the patient’s past experiences, steps and actions that they’ve already taken to heal themselves? Patients are a wealth of skills, knowledge, values, experiences and beliefs that contribute to their ability to heal. The vast majority have had to call on these skills in the past and have rich histories of using these skills in self-healing that can be drawn upon for treatment success.
De-centring ourselves, at least by a few degrees, from the position of expertise, knowledge and power in the therapeutic relationship, if essential for allowing our patients to heal. A mentor once wrote to me, “Trust is everything. People trust you and then they use that trust to heal themselves.”
By lowering our status as experts, we increase the possibility to build this trust—not just our patients’ trust in our abilities as practitioners, but patients’ trust in their own skills, knowledge and abilities as self-healing entities. I believe that de-centring practitioner power can lead to increased “compliance”, more engagement in the therapeutic treatment, more opportunities for collaboration, communication and transparency. It can decrease the amount of people that discontinue care. I also believe that this takes off the burden of control and power off of ourselves—we aren’t solely responsible for having the answers—decreasing physician burnout. Through de-centring, patients and doctors work together to come up with a solution that suits both, becoming willing partners in creating treatment plans, engaging each other in healing and thereby increasing the trust patients have in their own bodies and those bodies’ abilities to heal.
Today, I’m 30, working on my career as a self-employed health professional and a small business owner and living on my own. I’ve moved through a lot of states, emotions and life experiences this year, which has been appropriate for closing the chapter on my 20’s and moving into a new decade of life. I’ve experienced huge changes in the past year and significant personal growth thanks to the work I’ve been blessed to do and the people who have impacted me throughout the last 30 years. Here are 30 things this past year has taught me.
Take care of your gut and it will take care of you. It will also eliminate the need for painkillers, antidepressants, skincare products, creams, many cosmetic surgeries, shampoo and a myriad of supplements and products.
Trying too hard might not be the recipe for success. In Taoism, the art of wu wei, or separating action from effort might be key in moving forward with your goals and enjoying life; You’re not falling behind in life. Additionally, Facebook, the scale and your wallet are horrible measures to gauge how you’re doing in life. Find other measures.
If you have a chance to, start your own business. Building a business forces you to build independence, autonomy, self-confidence, healthy boundaries, a stronger ego, humility and character, presence, guts and strength, among other things. It asks you to define yourself, write your own life story, rewrite your own success story and create a thorough and authentic understanding of what “success” means to you. Creating your own career allows you to create your own schedule, philosophy for living and, essentially, your own life.
There is such as thing as being ready. You can push people to do what you want, but if they’re not ready, it’s best to send them on their way, wherever their “way” may be. Respecting readiness and lack thereof in others has helped me overcome a lot of psychological hurdles and avoid taking rejection personally. It’s helped me accept the fact that we’re all on our own paths and recognize my limitations as a healer and friend.
Letting go is one of the most important life skills for happiness. So is learning to say no.
The law of F$%3 Yes or No is a great rule to follow, especially if you’re ambivalent about an impending choice. Not a F— Yes? Then, no. Saying no might make you feel guilty, but when the choice is between feeling guilty and feeling resentment, choose guilt every time. Feeling guilty is the first sign that you’re taking care of yourself.
Patience is necessary. Be patient for your patients.
Things may come and things may go, including various stressors and health challenges, but I will probably always need to take B-vitamins, magnesium and fish oil daily.
Quick fixes work temporarily, but whatever was originally broken tends to break again. This goes for diets, exercise regimes, intense meditation practices, etc. Slow and steady may be less glamorous and dramatic, but it’s the only real way to change and the only way to heal.
When in doubt, read. The best teachers and some of the best friends are books. Through books we can access the deepest insights humanity has ever seen.
If the benefits don’t outweigh the sacrifice, you’ll never give up dairy, coffee, wine, sugar and bread for the long term. That’s probably perfectly ok. Let it go.
Patients trust you and then they heal themselves. You learn to trust yourself, and then your patients heal. Developing self-trust is the best continuing education endeavour you can do as a doctor.
Self-care is not selfish. In fact, it is the single most powerful tool you have for transforming the world.
Why would anyone want to anything other than a healer or an artist?
Getting rid of excess things can be far more healing than retail therapy. Tidying up can in fact be magical and life-changing.
It is probably impossible to be truly healthy without some form of mindfulness or meditation in this day and age.
As Virginia Woolf once wrote, every woman needs a Room of Own’s Own. Spending time alone, with yourself, in nature is when true happiness can manifest. Living alone is a wonderful skill most women should have—we tend to outlive the men in our lives, for one thing. And then we’re left with ourselves in the end anyways.
The inner self is like a garden. We can plant the seeds and nurture the soil, but we can’t force the garden to grow any faster. Nurture your garden of self-love, knowledge, intuition, business success, and have faith that you’ll have a beautiful, full garden come spring.
Be cheap when it comes to spending money on everything, except when it comes to food, travel and education. Splurge on those things, if you can.
Your body is amazing. Every day it spends thousands of units of energy on keeping you alive, active and healthy. Treat it well and, please, only say the nicest things to it. It can hear you.
If you’re in a job or life where you’re happy “making time go by quickly”, maybe you should think of making a change. There is only one February 23rd, 2016. Be grateful for time creeping by slowly. When you can, savour the seconds.
Do no harm is a complicated doctrine to truly follow. It helps to start with yourself.
Drink water. Tired? Sore? Poor digestion? Weight gain? Hungry? Feeling empty? Generally feeling off? Start with drinking water.
Do what you love and you’ll never have to work a day in your life. As long as what you love requires no board exams, marketing, emailing, faxing, charting, and paying exorbitant fees. But, since most careers have at least some of those things, it’s still probably still preferable to be doing something you love.
Not sure what to do? Pause, count to 7, breathe. As a good friend and colleague recently wrote to me, “I was doing some deep breathing yesterday and I felt so good.” Amen to that.
As it turns out, joining a group of women to paint, eat chocolate and drink wine every Wednesday for two months can be an effective form of “marketing”. Who knew?
“Everyone you meet is a teacher”, is a great way to look at online dating, friendships and patient experiences. Our relationships are the sharpest mirrors through which we can look at ourselves. Let’s use them and look closely.
Being in a state of curiosity is one of the most healing states to be in. When we look with curiosity, we are unable to feel judgment, anxiety, or obsess about control. Curiosity is the gateway to empathy and connection.
Aiming to be liked by everyone prevents us from feeling truly connected to the people around us. The more we show up as our flawed, messy, sometimes obnoxious selves, the fewer people might like us. However, the ones who stick around happen to love the hot, obnoxious mess they see. As your social circle tightens, it will also strengthen.
If everyone is faking it until they make it, then is everyone who’s “made” it really faking it? These are the things I wonder while I lie awake at night.
Happy Birthday to me and happy February 23rd, 2016 to all of you!
I’ve come to see my migraines as an internal measuring device for wellness, or rather, lack of wellness—kind of like a very painful meat thermometer. From time to time I get bouts of low energy compelling me to spend more time doing low-key activities. However, quick browses through Facebook show me busy colleagues achieving great things and I feel guilty about my relative inaction. A little voice pipes up. “Your body is telling you to rest”, it says. “But if you just started doing things, you’d probably feel more motivation”, voices another, its opponent, the devil on my shoulder. A war ensues and then a headache settles it all. I take it easy for a while, while I’m literally knocked out of commission, in the dark, on the couch with an icepack on my head.
L came to me for fertility, which is another litmus test for good health. When the body is struggling against some sort of imbalance or obstacle to wellness, it will not spend its resources readying eggs, ovulating and ripening uteruses. Our bodies protect us from the metabolic demands of having a pregnancy, which in our current stressed-out, unwell states we probably wouldn’t be able to handle, by simply not getting pregnant in the first place. And so, infertility is a nice entry-way to healing—patients are motivated to examine the effect of their lifestyles on their wellbeing.
The problem was, however, that L barely had time to make and attend her appointments. When she did manage to come in, she was in a rush. She’d often cancel follow-ups because she hadn’t followed through with the previous visit’s plan, even though it had been weeks before. She also reported working 50-hour weeks and staying up early into the morning to work on projects. I wondered, if she couldn’t even make an hour-long appointment with her naturopathic doctor, how would she manage growing and then giving birth to and then raising a brand new human? L simply might have not been ready to heal. Something in me fought to give her my professional assessment; in order to have the baby she wanted, she might have to give up, or significantly let up on, the demands of her job. However, how could I have made such a statement? I held my tongue and tried my best with the modalities at my disposal. We did acupuncture, CoQ10, PQQ and herbal remedies. We worked on sleep and did stress management with adaptogens. In a few months, despite the high demands of her lifestyle, L was pregnant. She still has trouble keeping her appointments with me. L’s body may now be functioning fine, but is it thriving?
Workplace wellness programs teach employees how to survive the 60+ hour workweeks in the office by doing yoga at lunch and eating healthier cafeteria food. They’re taught about stress management and, in the best of cases, given adaptogens and B-vitamins to help their bodies’ sails weather the stress-intensive storms of office life. It’s a great investment, these programs proclaim, because employees are happier, more efficient at their work and take less sick days. Workplace wellness programs keep their employees functional but, I wonder, can anyone really be well working that many hours a week?
When it comes to the health strategies we promote as a profession, how many of them are geared towards healing and how many of them are really just there to help us function?
At this stage in my career, I often have to gauge what my patients want. There are some people who come in ready to heal. They want to search for and address the real root cause of disease, no matter how elusive it may be. They are also willing to do what it takes to get better, even if it means a significant lifestyle shift. Sometimes these patients are at a point where things have gotten so bad that they have no other choice, however some of them simply intuit that the symptoms arising may be conveying a greater message; in order to be truly healthy, things might have to change. Most patients, however, come in looking to “feel better”—they simply want their symptoms to go away so they can get back to their daily lives, lives that might have made them sick in the first place. In our pharmaceutical-based Therapeutics and Prescribing exam, the goal of therapy in the oral cases was always to “restore functioning”, as if our patients were simply pieces of machinery; our parts are worn, maybe broken and we’ve gone decades without a decent oil change, but the factory declares we must get back to work as soon as possible and so we break out the duct tape. With this mindset, however, are we simply placating our bodies long enough to keep working until we eventually succumb to the next thing, a debilitating headache instead of mild fatigue, or something even worse? How long can we go suppressing symptoms or getting our bodies into decent enough shape before we realize that what we really need is some honest-to-goodness authentic healing?
Jiddu Krishnamurti, Hindu philosopher and teacher once said, “It is no measure of health to be well-adjusted to a profoundly sick society.” How much of our health marketing and wellness efforts are aimed at cleaning out the cogs in a jammed up machine so that they can go on turning smoothly again? The thought that real healing might mean dismantling the entire machine might be too radical for our society to handle. How can we address the problem of making a living if we acknowledge the fact that our lifestyle, or job, might be making us sick?
A therapist I work with (doctors need healing too!) once told me that mild to moderate depression is a sign that something in your life needs changing. “Look at the symptoms of depression,” She told me one afternoon in her office, “You lose the energy and motivation to keep going with your routine. You stop being social; all of your energy turns inwards. You focus your attention on your self and your life so that you can examine what about it is making you unhappy. Then you change it.” Then you change it, a scary thought. No wonder a tenth of the population opts for anti-depressant medication, which in some cases might be the medical equivalent of dusting oneself off and heading back to work. And, while they seem like more benign options, St. John’s Wort, B12 injections and 5HTP may not be that different.
A friend and I were talking about this very topic. He remarked that at a fitness retail store he worked at he’d often ask his female customers, “What will you be needing these yoga pants for today: form or function?” When I laughed at the shallowness of it all, he protested, “Well, some people are just going to use them to sit in coffee shops while others want to actually work out. What’s going to make your butt look great won’t necessarily be the best choice at the gym. I had to know their motivations.” Are most of our wellness efforts aimed at making our butts look great or are they filling a functional purpose?
I wonder if I should follow my friend’s lead and outright ask my patients, maybe on their intake forms, “Are you looking to truly heal today or do you just want to feel better and get back to work?”—form or function? Being candid with them, might help me decide when to schedule follow-up appointments. At any rate, it would definitely open up a conversation about expectations surrounding decent time-frames for seeing “results” and what true healing might look like for them. The trouble is, restoring functioning, if not easier, is more straight-forward. You make some tweaks to diet, correct some nutritional deficiencies and boost the adrenals or liver. It’s the medical equivalent of filling in potholes with cheap cement—it might not look pretty, but now you can drive on it. Healing, however, is more complex. It’s more convoluted, hard to define and get a firm grasp on. It is also highly individual. It might mean ripping up the entire road, plumbing and all, and building a new one or, even better, planting grass and flowers in the road’s place and nurturing that grass on a daily basis. Healing might be creating something entirely new, something that no one has ever heard of or seen before. Creating is scary. Creativity takes courage, and so does healing.
No matter what it might look like, I believe healing begins with a conversation and a willingness to look inwards, without judgement. Healing also requires an acceptance of what is, even if the individual doesn’t feel ready to take actions to heal just yet. Healing deserves us acknowledging that something is a band-aid solution. Healing definitely demands listening, especially to the body. Therefore, healing might begin in meditation. It might start with a mind-searing migraine that lands you on the couch and the thought, “What if, instead of reaching for the Advil, I just rested a little bit today?” Healing might just start there and it might never end. But, if it does, who knows where it might end up?
