Hi again! I want to wrap up the (honestly all-too-)brief comparison I am doing between the biomedical model of psychiatry and that of Chinese medicine. Truthfully, my “comparison” is not super in-depth (I want to say so much more than I can in even 2 blog posts)– and I am clearly biased toward Chinese medicine, given my profession. Moreover, I can confidently call myself an expert in Chinese medicine, whereas I’m not trained in Western psychiatry (despite an avid personal fascination with it). Therefore, while I wanted to make it clear in my last blog post I believe there are many aspects of Western psychiatry that can be very beneficial, I still may not have done the mental health field due justice in outlining potential therapeutic benefits. Anyway, I don’t want this comparison to be an argument for one form of treatment against another: this is about diagnostic models and lenses for approaching treatment decisions which may include varying modalities.

                A good place to start is with the concept I mentioned at the end of the last blog, pattern differentiation, or ‘bian zheng’ 辨证 (“bee-en j-uhng”). There is a Chinese saying you may have heard if you are familiar with acupuncture, even if you have not studied Chinese medicine in-depth, that goes, “One pattern, many diseases. One disease, many patterns.” Originally, this saying was not referring to Western disease at all. A Chinese disease in many cases may refer to a Western symptom—i.e. dizziness, abdominal discomfort, insomnia, somnolence—although there are certain Chinese diseases which, when translated, roughly share a common Western disease name— depression, for instance. One major difference between depression as a Chinese disease and as a Western disease is the diagnostic criteria.

                So in Western psychiatry, for example, to be diagnosed with ‘major depressive disorder’ or clinical depression, according to the DSM-5 (most recent edition, published in 2013) a patient must meet 5 or more of the following symptoms within a 2-week period, these symptoms must be a change from patient’s previous subjective experience, and at least one symptom must be either depressed mood or loss of sensation/pleasure:

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
  4. Insomnia or hypersomnia nearly every day.
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

                Honestly, it’s been a few years since I last looked at this list. Looking at it now, at the end of my 3-year Masters degree, all I can think is, “….holy $h!*, so many of those are totally different symptoms that could have so many different pathomechanisms—how can just having a collection of THESE symptoms lead to ONE diagnosis, and such a small range of similar pharmacological therapies?” Truthfully, the answer is that Western psychiatry does not have a great lens for understanding the development and cause of depression—which is what the study cited in my last post sheds a little light on.

                Did you notice how so many of the qualifying symptoms are related to an individual’s energy? One is directly related to food intake, appetite, and digestion (weight loss or gain), while others are often indirectly related to this (depressed mood, sleep pathologies, psychomotor changes, fatigue, poor focus/concentration, indecisiveness). And this is just how my Chinese medicine brain works now—I can’t help but crawl all over these symptoms individually and collectively, and see how there could be so many potential root causes of this person’s depression! All of these individual symptoms are areas of questioning and observation that Chinese medicine practitioners gather more information about (eating habits, appetite, quality and quantity of sleep, subjective sense of energy). Upon looking at this list of symptoms, I cannot help but start to ask questions about what initial non-invasive steps an individual could take to experiment with how lifestyle factors affect their mood and energy.

                People sometimes become uncomfortable when epigenetic (AKA lifestyle) factors are implicated in disease, which is becoming more commonplace as the study of epigenetics (how genes are turned on and off based on interaction with one’s environment) grows. Pointing the finger at lifestyle factors as opposed to genetic factors may make people feel as though they are being blamed for their condition. However this could not be further from the truth! I would like to quote my friend, the poet and photographer Clare Welsh, who responded thoroughly to my last blog post with some of her thoughts as someone going back to school to study psychology:

“There are certain universal mental illnesses: schizophrenia exists in every culture. However, there is research that suggests that this is actually an adaptive disorder the brain develops to protect itself, or even protect against certain cancers, much like the condition of sickle cell anemia was developed by people in warmer climates to protect against the condition of malaria. Taking this view of schizophrenia helps combat stigma. The brain isn’t messed up. The brain is doing what it does in all of us: trying to survive.”

Shifting focus from genetic to epigenetic factors allows for individuals to be empowered by their own sheer ability to change their lives. Many diseases– not just mental-emotional, but musculoskeletal and visceral as well– develop due to the body initially adapting to protect itself against harmful stimuli. Understanding changes in physiology from this perspective allows for patients to connect with the idea that our bodies are NOT static, and chronic conditions CAN change.
Of course, there are many aspects of our society dictating parts of our day-to-day lives which we are unable to change. Unfortunately, we see over and over in clinic that this often leads to the development of disease, primarily as a result of emotional constraint or repression. In TCM, this is understood to be one of the primary causes of depression.

                In Chinese medicine, we consider the 7 emotional factors influencing disease to be joy, worry, grief, sadness, anger, fear, and fright (fright differentiated from fear in that fright is more acute and sudden—to be startled rather than to be chronically afraid of something). Chinese Acupuncture and Moxibustion states,

“These are normal emotional responses of the body to external stimuli, and do not normally cause disease. Severe, continuous or abruptly occurring emotional stimuli, however, which surpass the regulative adaptability of the organism, will affect the physiological function of the human body, especially when there is a preexisting oversensitivity to them […] The seven emotional factors […] directly affect the zang-fu organs, qi and blood. For this reason, they are considered to be the main causative factors of endogenous diseases” (page 268).

In all cases, each patient presentation must be evaluated individually to determine the best treatment plan. After a clinician has interviewed the patient, reviewed their medical history, and performed observational and palpatory investigation, the patient’s pattern can be determined. In part, the reason why this diagnostic method works so excellently in clinical practice is that it allows for changes in the treatment plan based on how the patient presents in that moment and what they have experienced since last treatment.

               I have a ton more I would like to write about this, but I think this is a good place to stop for now. I have not even begun to discuss the consideration of the Shen, which is 100% essential in TCM psychiatry. There may be a 2-part discussion of the Shen coming up in the not-too-distant future. Meanwhile, I gladly welcome any questions related to this post or the previous post. You can e-mail me at our clinic e-mail or shoot me a message on our clinic FB page. I would love to hear your thoughts. Thanks again for reading!

Megan



                Hello again everyone! Megan here with a little announcement… On Saturday, I “preliminarily” passed my Acupuncture with Points Location board exam… which means I have completed everything I need for New York State licensure!! Now just waiting for my scores to be confirmed by NCCAOM, at which point I can have them sent to NYS and become licensed. The past few days have felt sort of surreal. I look forward to going back to Pittsburgh this weekend to see my mom, brother, and grandma, and to celebrate my brother’s birthday. This is all to say: I am extremely excited to soon be able to open my availability to new acupuncture and Chinese medicine patients! We should know by the beginning of August, but I should have multiple days and times available during the last two weeks of August. Our Facebook and Instagram will be updated with my new hours as soon as I can confirm these. Words cannot convey my excitement! Can I please just show you my new, ever-so-slightly premature business card (LOOK I KNOW IT’S PREMATURE BUT I’M NOT GIVING IT OUT YET BB-BUT LOOK AT IT GUYS I LOVE IT)…!!!



                Hi everyone! This is Megan, and I want to share some very new research with you, as well as discuss a little bit about the treatment of mental-emotional disorders in Chinese medicine. Apparently I’ve got quite a bit to say (bear with me please, I have a lot of feeeelings about this), so for your sake I am going to split this into two posts over the next couple of days. Please feel free to reach out with any questions or comments!

                The treatment of mental-emotional disorders, or of the Shen (‘spirit’), was perhaps the first ability of Chinese medicine which captured my attention. I had been disillusioned for years by the current Western psychiatric model. This was largely due to 1) a sort of disconnect I felt (feel) between the fact that patients must receive a medical diagnosis in order to receive insurance coverage and that patients so often experience a deep, personal identification with their diagnoses and 2) the seemingly apparent prevalence of mental illness- or shall we say, mental disharmony- in the everyday person, despite a societal stigma against these conditions.
                Often we become uncomfortable or resistant when faced with problematic truths about ourselves, and as a result of that, there is a tendency to demonize and marginalize others in an attempt to distance oneself from culturally taboo behavior. To quote one of my personal heroes, Dr. Gabor Mate, “Which addiction is greater: the addiction to oil or to consumerism, [or to drugs]? Which causes the greater harm? And yet we judge the drug addict because we actually see that they are just like us, and we don’t like that, so we say, ‘You’re different than us. You’re worse than we are.'”           

                OK, so I’m gonna try to sum this up quickly: A study by the University of Liverpool published just earlier this month (July 2019) has found that many psychiatric diagnoses in the biomedical model of health are “scientifically meaningless.” Researchers at the university analyzed five chapters of the latest edition of the DSM (Diagnostic and Statistical Manual), the standard text used to diagnose Western psychiatric disease. The chapters examined were ‘depressive disorders,’ ‘bipolar disorder’. ‘schizophrenia’, ‘anxiety disorders’, and ‘trauma-related disorders.’

                THE MAIN FINDINGS OF THIS STUDY:

  • Psychiatric diagnoses have different decision-making requirements.
  • There is excessive overlap in symptoms between diagnoses.
  • The role of trauma and adverse events is almost entirely absent from any diagnosis.
    • Sidebar: consider the fact that PTSD is the first (and possibly only) diagnosis which acknowledges trauma as a main contributing factor, and it did not exist as a diagnosis until the ‘80s when soldiers returned from Vietnam. We know today that trauma nearly always plays a significant role in mental illness; we know this because of contemporary, published research. And yet clinical practice does not reflect the research.
  • And finally, the diagnoses themselves do not provide information about patients as individuals or what treatment they may require.

                Here is a link to the research article– which unfortunately is closed source- and here is a link to a nice summary of the research with some choice quotes.

                First of all, I strongly believe speaking to a trained counselor- whether that be a psychiatrist or social worker- can provide enormous benefit to an individual’s mental well-being by equipping patients with methods to improve their quality of life and allowing space to process intense emotions. Realistically, every single human being could benefit from professional therapy (assuming that each person was paired with someone they felt comfortable confiding in). Additionally, some people do need treatment with pharmaceuticals in order to maintain a reasonable quality of life.

               Also, it should be noted that many professionals in mental health fields today are already intimately aware of the shortcomings of diagnosing via the DSM, and remain excellent healers despite this. But we must ask ourselves: what use is a diagnostic model unsupported by real life, pragmatic evidence?
               As a Chinese medicine practitioner, I do not take the place of any of these specialists; “alternative” medicine practitioners should be educated in Western biomedical diagnostics to know when to refer out to other healthcare providers and collaborate in care with said providers. Holistic, traditional, patient-centered medical models can and do work alongside Western, biomedical models in other parts of the world. Why? Maybe because integration of multiple perspectives and techniques is ideal when treating complicated diseases…

                Tomorrow I will be posting part 2 of this topic, which will be discussing the Traditional Chinese Medicine (TCM) psychiatric perspective and treatment of the Shen, or ‘spirit.’ I will also discuss the fundamental theoretical model of pattern diagnosis, which is absolutely central to determining treatment strategy! Thank you for tuning in!!

Megan

Dr. Kam wrote an article that was accepted by Ithaca & Cortland’s “What’s HOT” magazine for their July edition. Here’s what the article says:

The hottest thing in medicine right now is alternative & holistic care. On May 1st, Dr. Kamran Mirshahi and Megan Bell Mirshahi moved to Ithaca and opened up their health clinic in the South Hill Business Campus, which is located at 950 Danby Rd, Suite 103B, Ithaca , NY, 14850. 

Dr. Kam is a Canadian chiropractor who used to be an athletic therapist. He is passionate about treating athletes and families in the Ithaca community. He also teaches anatomy and neuroscience part-time at Ithaca College. Megan will be joining Ithaca Health and Wellness to provide acupuncture services and chinese herbal medicines.

Their goal? To serve and educate the community on preventative and holistic health care. “We are conservative caregivers and do not encourage surgery and medications, unless it is absolutely necessary. People have been brainwashed and misinformed about pills and surgery and it’s time to break the corporate pharmaceutical wheel.  Drugs and surgery are the MOST invasive interventions and have been reflexively used and often abused.” By targeting the root of the problem and addressing the entire human body, Kam & Meg believe that holistic preventative care is the healthcare of the future.

You don’t change your oil or brush your teeth once in order to maintain longevity, so you cant be treated once and expect to hold the results forever. The human body is under constant repetitive stress all day every day and can’t be fixed in a single visit. It often takes a long time to develop dysfunctions, so it will likely take multiple treatments to reinforce, re-integrate and prevent further harm. Invest in your health now and save a lot in the long term.

Dr. Kam and Meg are eager to help and can be contacted at (607) 218-2639 or at ithacahealthandwellness@gmail.com. You can also visit their website at ithacahealthandwellness.com to learn more or schedule an appointment online.

Hi all! Meg here. I wanted to talk a little bit about the experience Kamran and I had yesterday with the wonderful staff of Southern Tier AIDS Program in Ithaca.

Yesterday, we received training in the use of naloxone (aka “Narcan”) to prevent opioid death from overdose. Deep appreciation and gratitude goes out to the folks working at S.T.A.P. for everything they do to help those who are hurting. They will provide free training to any individual or business on how to prevent death by opioid overdose. In addition to providing free training, they give you a rescue kit for free, which you may restock with them at no charge.

I hope we never have to use our kits, but I am so, so glad we now know how. We feel very strongly about advocating for the addict population.

Instead of demonizing people with addictions, try showing loving-kindness to those living with tremendous amounts of emotional and physical pain. Instead of asking “Why?!” from your perspective, understand that there are often so many reasons why, which we are lucky to not experience, or even understand, ourselves. **If you do not understand, you are lucky.** People learn coping mechanisms (healthy, or not) as the result of exposure to repeated stress and trauma. It begins as an adaptation initially, which helps… Until it doesn’t. Try to understand and imagine someone else’s perspective and life.

Did you know that now they make Narcan as a nasal spray? And it is actually twice the dose of typical IV Narcan…. plus you don’t have to stab a friend or stranger! Always a bonus…. (I like stabbing with acupuncture needles, NOT hypodermic 😖😵).

Many types of free clinics offer this training for free, as well as resources for addicts to receive clean needles and sharps containers to prevent the spread of deadly contagious disease. These are already people who are sick and hurting– preventing more illness is paramount. Please show compassion and seek this training. Kamran and I are stoked to be volunteering our services this September at the 21st AIDS Ride for Life (and I am already thinking about fundraising for next year’s ride so I can get on my bike and participate).

AND STILL, MORE AWESOME NEWS…. I am thrilled to announce that I have finally been approved by New York state to begin working! I will be working with Coleen and Tim Foley at the wonderful Ithaca Community Acupuncture within the next couple weeks. I absolutely love their clinic and their mission. It is a truly unique clinic environment which lends itself to DEEP relaxation not often found in other settings. Their sliding scale fees make the necessary frequency of acupuncture treatments (especially early on) affordable for those who are paying out of pocket!!! Community acupuncture empowers people to not have their healthcare choices dictated by what their insurance company will or will not cover.

Ithaca Community Acupuncture also provides $5 “drop-in” appointments to receive auricular (ear) acupuncture to help treating smoking cessation! Yeah, you read that right… Five bucks. Moreover, acupuncture is a proven-effective alternative for opioid use, and regular treatment can assist in curbing the discomfort of the withdrawal process. If you have questions about this, please feel free to send a message to me on our Facebook or Instagram!

If you made it this far, thanks for reading my first official blog post! I’m so excited to share more with all of you!!

Megan

On Saturday June 15th, Dr. Kam and Meg volunteered their services at the Gorges Ithaca Half Marathon. Setting up their booth in the middle of the Ithaca commons, Dr. Kam and Meg had a really enjoyable time donating their time and services. Dr. Kam treated over 30 athletes and Meg helped organize and coordinate all the athletes seeking care. Follow them to their next race at the Ithaca Beer Co. where they will be doing the same kind of thing for the Mudder Earth Race on June 23rd. The following weekend they will be at Cayuga Lake Triathlon and Reggae Fest!

A BIG thank you to memory vault photo & goat factory media entertainment for these beautiful photos.

  • Are chiros real docs? – Yes. That’s what we are recognized as by the state. We have very similar scientific and educational backgrounds, but we’re treating completely differently.
  • Why aren’t you an MD? Chiropractors have completely different standard of care. We find the ROOT of pain, and don’t just treat the Symptoms.
  • Why aren’t chiros allowed to prescribe medication? We believe in conservative care that is not invasive or addictive. People need to wake up and see the damage that Big-Pharma has done to our communities. With skyrocketing rates of prescription medication and opioids, individuals are doing much more harm than good for their health. Medications such as tylenol and ibuprofen have also been reflexively used and often abused. There is a more holistic and natural answer to pain and dysfunction and that is “alternative health-care” (which should be THE primary health care because it is preventative & preventative medicine should be emphasized a lot more)
  • There is certainly a time and a place for medical interventions such as surgery and medications. And that’s when someone has neglected their health and well-being for much too long – to the point where lifestyle changes and preventative medicine cannot do enough to reverse the years and years of damage done from poor diet, lack of exercise, and lack of preventative care.