Hyla Cass M.D.
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 Hyla Cass, M.D., author of St. John’s Wort: Nature’s Blues Buster, Kava: Nature’s Answer to Stress, Anxiety, and Insomnia, All About St. John’s Wort and All About Herbs is an assistant clinical professor of psychiatry, UCLA School of Medicine. She has integrated nutritional medicine with psychiatry in her clinical practice. A noted public speaker, consultant and educator in complementary medicine and psychiatry, she is also a frequent commentator in newspapers, magazines, radio and television, contributor to numerous books and journals and consultant to the supplement industry.
When I was asked how I became involved in practicing complementary medicine and psychiatry, I realized that there was no one moment of enlightenment or one turning point. Rather it has been a process, beginning with my earliest family life. My father was a general practitioner who practiced out of our home in Toronto. From an early age I recall following him around on his medical rounds at the hospital and going along on house calls. A caring and conscientious GP in an old-fashioned practice, I saw him use integrated medicine long before that term was coined. Available and responsive, he ministered to his patients with care and skill. He would talk about what he was doing, assuming I understood, never talking down to me. Looking back now, I realize I learned a great deal as the doctor’s apprentice about the spirit and art of medicine, and even about the “how to.”
Moving forward many years, I studied medicine at the University of Toronto, then interned at the Los Angeles County-USC School of Medicine, where I was struck by the serious class divisions in the medical care system. In Canada, health coverage is universal and there isn’t such a disparity in terms of quality of care and in the respect given to patients. Both my experience with my father and my medical school training had already given me a more humane and holistic view of medical care in contrast to the prevalent mechanized, impersonal system.
My interest in a more relational, holistic approach, coupled with an appreciation for the mind-body connection, led me into a psychiatric residency. There I eventually found that the standard “couch and Prozac” combination of psychoanalytic and pharmacological treatments went only so far. When I spent time as a volunteer at the Pain Control Unit at UCLA, I experienced a more open approach to patients. In contrast to the impersonal psychoanalytic stance of my training, these therapists were warmer, more personally involved and interactive with their clients. Inspired, I soon incorporated interactive techniques such as guided imagery, voice dialogue, and later EMDR (eye movement dissociation and reprocessing). Not only did these work more quickly than the older methods but clearly could affect the body in many ways, in alleviating physical symptoms or bolstering the immune system.
This attention to the mind-body connection and partnership in the healing process led me to explore the influences of nutrition and lifestyle on health. The other side of the issue was emerging: how imbalance in the body can affect the mind. The brain, after all, is an organ, affected by its internal environment. I went on to discover how many typical psychiatric complaints—anxiety, depression, PMS, even schizophrenia—are frequently due to biochemical imbalances. These can range from low blood sugar to viral and fungal infections, hormonal imbalances, allergies, toxic overload or deficiencies of specific nutrients. We are able to diagnose these conditions with the appropriate laboratory tests and correct the imbalances with natural substances. Compared to drug therapy, these treatments offer safer, more user-friendly solutions with far fewer and less harmful side effects. In addition, psychotherapy can be much more effective once the brain is functioning properly and able to absorb new information.
In this move toward “integral” or holistic psychiatry, I found myself treating a variety of medical conditions, from chronic fatigue syndrome to irritable bowel syndrome. Patients don’t walk into our offices as disembodied heads, nor are our bodies divisible, separable into specialized compartments for the convenience of cardiologists, allergists, endocrinologists or gastroenterologists. Here is a typical story:
Grace, a 60-year-old college teacher, was referred to me because of anxiety, depression and insomnia, with no obvious psychological explanation for these except maybe for the stress of her physical illness. On an array of medications with their attendant side effects, she was already being treated by various specialists for heart palpitations, food allergies and inflammatory bowel disease. The likeliest common cause seemed to be a magnesium deficiency. After a short time on a trial of high daily doses of this inexpensive and ubiquitous mineral, Grace was able to stop her various medications. Encouraged by this result, she trusted me enough to eliminate some foods to which she was allergic, which helped her even more. We integral physicians see cases like these all day long, with simple solutions to what appear to be complex conditions and where a good part of the problem soon stems from the prescribed medications.
We are then left with the following questions: Why had Grace’s internist been unaware of her mineral deficiency or even of its possibility? Why prescribe drugs first? This approach is like turning off the smoke alarm without looking for the fire. More pointedly, why is the prevailing standard of medical practice so symptom- and drug-oriented, especially when it so clearly fails to serve the patient? One answer is all too clear. Through sales representatives, medical journal ads, research articles and conventions, the pharmaceutical industry is the main source of education for physicians in practice. There is no counterbalance to this, due to their lack of exposure to more natural treatments, which most doctors dismiss as “unscientific.” Of course the science is there, but largely overlooked. Fortunately this is changing as more doctors are encouraged by the results they observe in their patients who are incorporating alternative care. Physicians, and even medical schools, are showing an increasing interest in integrative medicine, which takes the best of both worlds.
Another crucial factor that demands an integrated approach to apparently psychological conditions is the increasing incidence of “environmental illness.” These patients complain of such seemingly unrelated symptoms as chronic fatigue, depression and joint pains, and others, while their doctors insist that “there is nothing physically wrong.” Yet not only is there something physically wrong with these misunderstood people but there is something wrong with the increasingly toxic environment in which we all live. We are not able to metabolize many of the chemicals that contaminate our water, air and food. Such exposure compromises our immune systems and creates a variety of symptoms not able or easy to diagnose or treat. Doctors need to recognize these disorders and treat their metabolic causes with specific detoxification programs which include nutritional supplements. Prevention clearly demands that we reign in the runaway industrial abuses to our environment before it’s too late.
In the emerging future, with all the variables affecting our health and well being, from diet and lifestyle to toxic exposure, we each need to take greater responsibility for our own health. Rather than taking our body (or mind) to the doctor as we would take our car to the mechanic, we need to become participants in a working partnership in which the physician becomes a resource. Our common goal must be the healing of ourselves—body, mind, and spirit—of our systems of health care, of our communities and ultimately, of the planet we all share.
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