Integrative Pediatrics: A New Path for Autism, ADHD, and Chronic Illness

Introduction and Guest Background 0:00

Typically, the person that is most affected is the one who's kind of really trying to break free in some ways from this kind of intergenerational pattern, and it's not easy. I recently, you know, spoke to Dr. Adele LaFran, and she, you know, she says one of the first things she does with families is also then to dump this whole, like, parent shaming. Like, parents feeling shame about, like, oh, it's all the mom's fault or it's all the parents' fault. that's actually not what this is about either.

So she's like, that's the first thing she tries to bet to bet is that this is not even what we're talking about. But we're looking at everything that's in play that caused, you know, the kid, the adult, whatever, to have this type of mental health expression. This is Doctor Talks. Real talk from real doctors on the issues that matter to you most. Hello and welcome to the Two Curious MDs podcast. You're here today with me, Dr. Surya and Dr. Alia Ahmed and today we're both interviewing Dr. Leila Contractor.

Welcome Leila. Leila is a double board certified integrative child adolescent and adult psychiatrist with a practice in Irvine, California. She specializes in trauma, learning challenges, ADHD, autism, and post-injury recovery in athletes. She's also known for her work with ketamine and other psychedelics and her focus on holistic treatments and cutting edge psychiatry to maximize wellness. Some key aspects that we're going to go over today is your integrative approach using a holistic collaborative care model.

You work closely with therapists and other practitioners to address the root cause of challenges. You specialize in trauma, learning challenges, ADHD, autism, and post-injury recovery in athletes. And as we've gotten to know you, we know that you emphasize listening to your patients and validating their concerns, drawing on your ancestral influences on your approach. And we're really going to get to that as well. Welcome, Leila, to the Two Curious MDs podcast. Thanks for having me, guys. I just love hearing your background.

It really speaks volumes about who you are as a person. And I'm curious to know about the layering, the richness of your experience and how you've kind of come together from this traditional way of psychiatry to this integrative and even the psychedelic healing aspects of the type of care that you provide. What inspired you to this? evolution in your clinical path. I think like many people, my own personal journey really brought about this transformation. And so I had been working for Kaiser for a number of years, which is super helpful as far as seeing the sheer volume of patients that I was seeing and what I kept seeing time and again.

So I had come there with some pretty significant training in working with people who are suicidal and trauma. And so as soon as I got there, I started getting all these patients, you know, for who had experienced terrible traumas in their life. But, you know, I kept telling the staff like medicine does not our medication, like the dirty secret in psychiatry is medication. really doesn't treat trauma. Like you truly need therapy, as in traditional medications. I'm not talking about ketamine and psychedelics, of course.

So that started kind of this process of trying to get more support, more help. for patients and then as things went along, I had a pretty, you know, I had a patient burden that was, I mean, you know, people had experienced significant traumas and then I got physically really ill and couldn't work for over two and a half years and nobody could really figure out what was going on with me. They could see that, you know, I was having clearly some pretty significant neurological problems. I met some great doctors.

I met some awful doctors along my journey. And one day I posted on Physician Mommy Group on Facebook, like everything, all my labs, all my imaging.

From Conventional Psychiatry to Integrative Healing 4:17

And quietly, I was getting direct messages from integrative medicine doctors. They're like, look, you're probably not going to find your answers through a traditional meta set. I met some amazing people who just really, you know, led me then to Dr. Kelly McCann, who's here locally. And I begrudgingly went. I went there, I met her after waiting months to see her, and I thought it was crap. I thought it was crap. I thought this was like way too expensive. And then I kept getting progressively worse to the point where I actually couldn't, I couldn't really get out of bed.

And I had three young kids. And one day one of these women said, I don't know how much worse this could get. Why don't you just try the herbal thing that she's recommending? Like, what do you have to lose? And I'm like, she's right. And so I tried it and it worked. It actually halted the progression of the process that was going on. And so that had my attention. And that's how I got into getting interested into integrative medicine. And I kind of slowly started finding my way back to health. And it was in that process then I started becoming curious for my own patients.

Like how could my own patients be helped? And so I went and did a year long fellowship in integrative psychiatry. And so that started my interest to finding other ways because what I kept seeing time and again, and again, I feel like I have a balance. There's definitely a place for traditional medications where people need help and support, and yet it truly doesn't often address kind of the root of what's going on, what made somebody unwell. in the first place. And I often also started seeing that being unwell isn't necessarily an illness.

It can be your body screaming that something drastically has to change or something needs to be different. So that's how I started like that path, and then I felt like I couldn't practice in the way I wanted to at Kaiser, and so I started my own private practice with the hopes of offering these type of healing modalities to my own patients. It's quite a journey to go from the work that you did and were doing at the time, the recognition of that idea of trauma, the trauma-informed process, right, and addressing that, which is often not discussed in, you know, in conventional treatments, like to the source of a condition, and then your own journey, which sounded like you had to really take time out and investigate and, you know, become really much more aware.

And, you know, even presenting this out of frustration on Facebook, I can't even imagine what that process must have felt like to kind of really dispel this out there. And receiving the answers that sometimes we need to have when we think out of the box, right, when you have to step out of the usual mindset and I know we met at the integrative medicine psychiatry conference and I was really impressed by Your voice your journey you've described yourself in your in your work as a good girl to a wild woman healer And I'm very curious about that.

I think you said that But what is what does that transformation mean to you? going from this usual way of doing things to this really out of the box, really stepping out of the zone and that transformation. How do you take that as you engage with it in your practice now for yourself as well as for your patients? I mean, to be fair, so my family is from India, and so I was always, and I had been, you know, pursuing yoga, and my uncle was a homeopath in London, and I was aware of Ayurvedic medicine, so I was always open to other modalities of treatment.

I'd been trained in Reiki, and so I've had I always look to other cultures and modalities for healing because I don't think, you know, any one field of medicine has, you know, a monopoly per se in healing. But what I really came to see is, like, especially when we look at antidepressants, you know, there's a curious phenomenon in training that we would see is that there are these women in domestic violence shelters, right? Really, obviously, very unsafe situations. they would come there kind of motivated to leave highly depressed and anxious as anybody would be fleeing a situation like that.

We'd start on antidepressants and you'd start seeing the motivation to leave these dangerous situations. You know, psychiatrically they were less depressed and yet I couldn't help but wonder like, was this a real, were we doing these women a service? by actually containing the trauma, containing their mood symptoms, only to have them return to a very, what we would know would be a very unsafe environment and untenable, not just for them, but for their children. And so this is what started me to even see with my own patients There's a phrase that doctors, so after I did the year-long training with integrative psychiatry, I then did Dr.

Gabor-Mattei's year-long training in compassion inquiry, which is his type of psychotherapy. And I've really come to see that I think in medicine, we go where we really try to help people with their suffering and their pain and minimizing it. And I've come to see that that's not always helpful. It's not that we want people to suffer. But there is a gift or there can be a gift in helping people walk through their suffering and finding meaning in that. Because what I saw with what was happening with these women, this is not what I wanted my antidepressants to do.

I wanted it to empower them and help them to move. And oftentimes it does. I'm giving kind of a more general picture, but sometimes we have to be able to hold our patients and you guys do this so well right through this kind of trial by fire, ring of fire, whatever you want to call it, to be able to come out on the other side much more empowered and much more being able to find their voice. And that isn't always the easiest way through it. And it isn't for everybody. I think there is something to say that sometimes it isn't the right place or the time to be able to move through this.

Like I don't think I could have gone through what I went through while I was, you know, pregnant with my kids or even honestly while I was in med school. This, you know, taking two and a half years off during medical school wouldn't have really worked that well. Yeah, I find that there's a moment of timing that I've started to realize is the body somehow carries it until, you know, carries the trauma until a time where it's actually safe enough or circumstances push us to the wall enough to kind of break it down.

And I typically see this as like people are like, oh no, I had a happy childhood. Everything was fine. I struggled to get my career on the way and now everything is fine. Why is it now happening? Right? There's something happening underlying in our psyche that says, okay, you can handle this now.

Trauma, Validation, and Family Systems 11:46

There's some sort of inner knowing, right? Do you think that's something you see? Yeah, definitely. And I think, you know, I'm talking about women, but I, in my practice, I started seeing this with men too. And again, somewhere in their four, you know, again, in their forties, typically coming from, can typically not always come from a background that was, could have been very traumatic, but they had a lot of resilience and they were holding it all together. And all of a sudden, and I call it the bottom fault, like the bottom, tends to fall out and they're not functioning and they can't work and they can't and it's like you can't your body just can't hold this anymore.

Yeah yeah and to recognize that as a portal like you said it's a ring of fire it's an opening and how do you you know how do you frame this for your patients I know you've moved now from symptom management to a deeper soul level healing so how do you even address this aspect? Though it depends on people's circumstances. So, you know, ethically speaking, I really need to assess where people are at, right? So if you have, you know, a family and people to support and, you know, I have people coming in, so I have a lot of people coming in saying they want to work with psychedelics.

I think ethically, I often have to assess what is appropriate. So somebody who may come in, again, family, they have all these employees under them, other financial commitments. And you can see that the bottom has fallen out for them. That may not be an appropriate time. to do psychedelics. And so for people like that, I will still use conventional treatment, but while supporting them and normalizing really the process that they're going through, I have a lot of relationships with various therapists.

So connecting them with the right therapist, just make sure that the therapist is helping them support. If they don't want to have a therapist, then it's something that I work with them And so in a case like that, I will start them in antidepressants. I can't let them have the bottom fall out, them sell off their company, move to Mexico. That's just like not an option. Those are some of the patients that I have. And once they're in a place where there's much more stability, an insight into what's going on, okay, then that's the time to bring in.

And that's the beauty of ketamine. And that my patients can still be on an antidepressant and access those type of medicines. But I also actually get a lot of young adults. who are financially resourced. And in those cases, I would have to say, you know, I still connect them with therapists if they don't already have one, or they work with me. And in those cases, you know, I help them walk through that. And then we do psychedelic work. But I'm having an interesting rash of young adults, too, who I think are really have an inner knowing that medication is not the way to go, that medication is actually gonna cover up what's coming out for them and needs to come out for them.

And I find this really interesting. I have some who are be like, man, you really need to get on something. Like you are not able to function. They're like, Nope. Like they want to work through this. They want to work through what has been coming up for them. And I actually think that's you're able to do that. And if you're in a place to do that, that's actually in the long run, the way out. Yeah. I love how this is reframing for us that psychedelics don't just need to be for the treatment resistant cohort, right?

Like that's what we're seeing the research being done on is treatment resistant. You've burned out on every medication, but now I'm hearing from you that maybe there is a place if somebody is supported, has the right story around it, has the right construct around it. And it won't be too destabilizing that you don't have to try the medications, maybe do the psychedelic healing. And now we're seeing that there are young adults who really are feeling like they don't want to go on conventional medications.

a space here for them. Yeah, and so I came from a background of, I mean, I worked at a clinic with Dr. David Brunt with suicidal adolescents. Dr. Brunt has done a lot of the pioneering research in suicidality in teens. And what I saw repeatedly is what we call in psychiatry treatment resistant depression. And again, I wanna preface this with I have another colleague, Dr. Lisa Pan, who's doing phenomenal psychogenomic work and people are truly treatment resistant. Like people are not making enough serotonin.

People have really significant deficits in their ability to produce neurotransmitters that we need to even just survive. So I'm not talking about those people. I'm talking about what I see are like the 95 plus percent rest that we are labeling as treatment resistant depression. It is not. It is trauma. Like these people, like every story, and that's what the gift that Kaiser gave me is just seeing like all these people failing one, two, three, however many psychiatric medications, it's because our meds are not meant to treat trauma.

They don't. And these are the young adults that I'm talking about. It's not that they're, again, even treatment resistant. They're just, our meds don't treat trauma. Our conventional medications don't. They can help contain trauma. They can kind of help calm things down. And certainly, we all could use that at different points in time. And I certainly access psychiatric meds for those reasons. But really, I've come to see that treatment resistant depression, we see it's all, it is all trauma. And by the time you get to your third antidepressant, you're abutting at like 13%. That's actually worse than placebo.

True. You mentioned that the STAR-D trial, I mean, that definitely demonstrates that. I want to interject here because you said something earlier, which I thought was very important. You talked about gobramate, and you're talking about trauma. And trauma isn't what happened to you, it is what happened after, right? What was not provided, the resourcing, the support. around that active trauma and in adolescence and young adults, most of trauma occurs really early in life. And then we see the filtration of that effect later in adulthood, which to me surprised me when in my own practice, like as a pediatrician, I'm like, oh my God, all these things were happening.

at that time that this child was being seen. And we're now seeing the effect of that in adult. But back to this idea of trauma and the work of Garbamate as you described in your training as the compassionate inquiry, providing that place of safety in your care. How do you first, how do you get to that in that compassionate inquiry lens? in your practice to really help facilitate that root cause? What is that approach that you provide in the interactions you have with your young adults or these challenging, complex patients who have come to you now after being trying so many things?

Yeah, so I think, you know, I'm going to step back just a little bit. We often think of trauma as like this one big event, like one big terrible thing. that happened. And what I saw at Kaiser and what I'm actually really seeing here in my private practice is really what is more like a death by a thousand cuts. And it's really probably more pervasive than we think is like this real trauma of neglect. And it's often unintentional. We have, you know, parents who are doing their best. You know, parents are often struggling with their own trauma and the way that they see things.

And so, I mean, I've worked in some pretty, you know, places that have a lot of economic and housing instability. You know, I was in Pittsburgh. I worked in places with, you know, government subsidized housing. Same thing in Philadelphia. Actually, same thing. I worked in East LA. South Central kind of Compton catchment area at Kaiser. And I would have to tell you, the type of neglect that I see amongst the wealthy is probably the worst I've ever seen. And I only say this because it can be just as impactful, if not worse, than the big thing that happens, the big horrible thing that happens.

And it's often missed. And again, it's subtle, especially in people who are financially resource. You're like, What could you have possibly wanted? You had nannies. You had roof over your head. You went to the best schools possible. What was there? But it's almost worse because it can be covered up. And I think that's what I'm seeing more and more. It's not the big egregious stuff. And it can be, too. It can be. that as well. So the most important thing I feel I can offer patients is just being seen.

And that sounds very simple or silly or almost, you know, too good to be true. But that's what people need to be validated and seen for what they've been through. Because this is the message that they're getting, right? Even to themselves. I do it to myself. I felt like my story couldn't compare to anything I'd heard time and again from all my patients and the horrific things that they had to endure. But really, people being seen and having their story validated, which is what's amazing about the narrative work that both of you do.

is so important and can't be, I can't emphasize it enough. So the first thing is really listening, spending that time. So my evals tend to be 90 minutes and then even as we keep going, you know, remembering what people have to say about what they've had to go, showing the discrepancy really between what they feel is nothing and yet how is it impacting their ability to function. So one of the first things you can do is just really validate and listen to people's stories as simple as it sounds. And I think that in so many ways is kind of the most effective tool.

Yeah, we call it the radical listening aspect is kind of really just being present in that space. And we've talked about this in narrative medicine at that third space between the patient and the provider or the healer. And there's that third space, which is also just as valuable because you're unfolding, the patient is kind of revealing. And then there's this understanding of that. processing that's happening while that's happening, right? While somebody's revealing their story and you're attentive to it, you can attend to even the language, the tone, the pause between the words.

And that itself is so revealing and opens up again that that third space, which is such a little, like you're talking about relational healing here, right? You're talking about healing through relationship, but also how that attachment that they didn't receive when they were younger. And I, you know, I have to recognize that, you know, as pediatricians, you know, we've seen kids going through all of this. And now as we're practicing with adults, I've had like a real shakeup in my worldview. as to exactly how pervasive and prevalent this is amongst adults, and it's not addressed.

These are some of the patterns that people only realize when it comes out when they have their own kids, for example, and they're trying to reach back into their own attachment, and they're like, wait a second, and it re-triggers. So really just becoming aware that these things can be dormant until they get triggered by circumstances in our lives and just come all the way out and

Spiritual Crisis and Cultural Context 24:18

we don't have language for it. We don't have stability and sometimes patients and you know, they come and they're so afraid of revealing that. They're so kind of ashamed, guilty. There's a story about what kind of child they were. You were attention seeking, you were this, you were that. And I'd even had patients like you said, that higher resourced socioeconomic strata where child protective services actually went into the house. But because of the power differential that existed, they were not able to do anything.

You know, so I absolutely want to label that and also just recognize that social media is playing into that. You're absolutely right. Like when, when you have a well-resourced kind of child adolescent growing into a young adult in a very, you know, kind of in a situation like that, they can be made to feel like the scapegoat. Like there's something wrong with them because they're not fitting into that matrix and what's wrong with you. You know, so there's so many multiple layers that we can uncover in this third space.

and really having the patience and allowing that to come through. So I'm just, I wanted to add that in there. Yeah, no, and that actually is a dynamic that is, I see time and time and time again that exactly we're seeing that many of my patients are the scapegoat because they're the ones challenging kind of the family structure in some ways by calling out what wasn't there for them. And this is where mental health is actually, no, she's got that color. She's by, you know, she's always been like, you know, or this is just like, what could you possibly want?

Like you had everything, I gave you everything, like, and they are scapegoated and they are made to feel like, and I think this is where Phil Wolfson's work really, I mean, we talk about using it just for adolescents, where the adolescent is the messenger for the family system, but frankly, I see this, you can be talking about young adults, you can be talking about adults. Typically, the person that is most affected is the one who's kind of really trying to break free in some ways from this kind of intergenerational pattern, and it's not easy.

I recently, you know, spoke to Dr. Adele LaFran, and she, you know, she says one of the first things she does with families is also then to dump this whole like parent shaming, like parents feeling shame about like, oh, it's all the mom's fault, or it's all the parents fault. That's actually not what this is about either. So she's like, that's the first thing she tries to put to bed is that this is not even what we're talking about. But we're looking at everything that's in play that caused, you know, you're the kid, the adult, whatever to have this type of mental health expression.

Yeah, I really understand diagnosis, right? I just want to put in a word. Even diagnosis can be a way of weaponizing mental health. And we're kind of getting in the midst of that and saying, I see what's happening here, all the different ways that we could get into this space and do the wrong thing. but let's talk about what it takes to do the right thing. And we're asking this child, young adult, adolescent to really, one, be the scapegoat, feel everything, be impacted by the story that they're broken, And now, as providers, we're kind of like, well, let's heal you enough so you can understand that there's nothing wrong with you, that you actually are kind of the carrier of all the dysfunction that's been under wraps, nobody's talked about, nobody wants to address, has just taken us as normal.

And that is a really difficult job. I have to say, you know, thank you for bringing in Adelle LaFrance because, you know, emotionally focused therapy, it needs compassion. It needs so many skills that you have to bring to the fore. And it also seems like you don't have one modality. You've reached out to really facilitate a deeper kind of understanding of all these different modalities, emotional. you know, healing approach, the narrative approach, the compassionate inquiry approach, and the conventional approach as needed, trauma-based somatic approach.

This fascinates me how that opens up the view of psychiatry in general, right? Because the view of conventional psychiatry right now still remains based on DSM-5 criteria, right? Everything is labeled and categorized And symptoms are considered diseases, which I find very funny because every most psychiatric illnesses are based on a symptomology. It's not like, you know, it's based on you have ADHD, you are labeled as such. And that's the stamp that gets placed in the chart. And that's what, you know, that home, everything is geared toward that way of.

seeing the lens of that patient. And it's ironic that we're talking about this and we've been in the conventional space and now seeing that where do you take this way of thinking to the bigger venues, right? We're not treating patients, we're treating symptoms that are a manifestation of something else. So where do you take that? How do you take this forward? What do you feel is impactful for our audience to know, to recognize, to appreciate? That's a big question. And I used to ask this. I think, I mean, to your point, like is you know, is somebody who is like, you know, I'm gonna go back to the domestic violence survivor.

Is depression really an abnormal response to what that individual, like, is the... Something that I see a lot is the depression I see in adolescents is a lot of, you know, what Dr. Monte talks about is misattunement. You see these kids, and again, well-meaning parents, but really not being able to kind of reflect back to the kid in a way that that kid needs. And that is really hard if your primary caregivers are not able to kind of meet your needs on an emotional level. And I'm not just talking, I think when people hear that, they think, oh, like overindulging, that's not it.

You can kind of have a parent who comes from a really authoritative background That's not good or bad. That can be actually really helpful for certain kids. And studies show that, that actually some kids need that. But you'd have a kid who just really needs to be seen and held and validated. And if the parent doesn't have that skill set for numerous reasons, I see that causing depression. Is that really pathologic or is that just like the kid's nervous system is not getting kind of what it needs?

But I think, you know, psychiatry actually means healing of the soul. And I think that's part that's really lost. With psychiatry, and I think healing of the soul doesn't mean just providing medications, which is really what psychiatry has been relegated to. In the past, actually, if we look at psychoanalysis, not that I necessarily psychoanalyze, but only psychiatrists were able to do it. It then became expanded to other therapists, which kind of But really it's whatever it takes and it may not be just medicine and it usually isn't just medication.

It really isn't. And I think that's why psychiatry has to be open to like all the different things. I use actually one of the biggest referrals I use of being, you know, a child and adult psychiatrist is referring to OT. We have plenty of science on the cerebellum. You know, cerebellum holds 70% of our neurons in our brain. I won't go down that path. I kind of talk a lot about it. But that is one of the most impactful things I can provide for parents whose kids have ADHD and autism. There are other things that we really need to look at, even at a neuroscientific level, like what can we do to support that?

What can we do to support the emotional elements? And then with trauma, really Some of the most impactful, what are the most impactful things we can do? The most impactful thing I can do is make sure that this family system is as healthy as it can be to support this kid. So, so much, I mean, and you guys are pediatricians, so I'm like preaching the choir, but really the majority of the work I do is with the parents. And this is why I even started seeing adults again, is because the more trauma work I did, the more I realized it's the parents who need kind of the support and the help.

And oftentimes the parents are doing things in the most well-intentioned way, but the parents are grieving over kind of what's happening with their kid and feeling out of control, or especially in the case of I mean, I still remember this case where the mom, every time she came in, was crying. The girl had had horrific abuse, which the mom really, truly didn't seem to know about. She had really trusted these caregivers. And finally, one day I asked, I was like, can you tell your daughter what, like, so the daughter kept feeling she couldn't share this, like, painful information, and she wasn't.

And so I asked the mom, can you tell her what's behind your tears? And she's like, I'm so angry that the people that I trusted to care for my kids did this. And you could see this is what the girl needed to hear. It's not that her mom couldn't handle it. It was that the mom was so horribly traumatized herself that she had put this poor kid in harm's way. But that's what's like helps people heal. It's not my medication. It's not even me. I mean, at the most I might see my patients twice a month. Like, I'm not doing anything special, but what can I do to create an environment that continues to help with the healing and perpetuate the healing?

I mean, I think this is what we're all doing, right? Helping our patients have an environment where the healing continues for them. And I think this is where, unfortunately, psychiatrists just being relegated as just dispensing pills is sending a very kind of dangerous message, is pathologizing our patients, right? identifying them as the patient and the one who's well, and even the overly reductionistic idea of biological psychiatry. I totally believe in the biology and the neuroscience of psychiatry, and that is not the only thing that's going on for people.

Yeah. Thank you for describing that. That's so beautifully put as we try to hold the both end, right? We've all trained in Western science, in just the categorization, the diagnosis, and the medication. That's been really well done. And here we are going, well, there's all this other stuff. And it feels kind of nebulous. And the more we can kind of define it, bring it down itself to a science. I think what you're talking about is connection. We're talking about relational healing. We're talking about treating that as a system, a family, as a system that moves together.

And I love working like that as a pediatrician, because I think as pediatric hospitalists, we would see that in every room we walked in. There was kind of this complex that you see happening. And you can kind of say, well, actually, the identified patient is not the one sitting in the bed. It's actually the one that, you know, is crying in the corner or really seems to have a lot of anger come up and can't seem to handle it. And how do we deal with that? And, and I know time and time again, we go through situations in the healthcare system where that's exactly what's happening is there's the story that the audio and the video of the story are not matching up.

And as physicians sometimes we're kind of like, well, what's the gap there? You're looking at a movie and the mouths are moving, but the wrong sounds are coming up. I love this. Let's switch a little bit about thinking about spiritual emergence or spiritual crisis. Because I think that's one of the things that really, when we're in the healthcare system and it's happening, it's really hard to get that kind of perspective on it, that holistic perspective. So how do you describe that? Let's say I'm a resident, I'm training in psychiatry, and I'm like, I've been trained to do, you know, do the HAL doll, do this, do the restraints, and this is how I do it.

How can I do it differently? And what can I learn about this process that my patient is going through that may help everybody in that system recognize what's happening? So I think, you know, everything starts, I mean, again, as people practice narrative medicine, it starts with the story, like, what is the story of what's going on? And why is the, you know, spiritual emergency or emergence? What are the conditions that has now brought this to light? And do we know what age group it mostly happens in?

What's the gender? Like, what do we know from just the science of it? Like, who does this happen to and what is spiritual emergence or spiritual crisis?

Ancestry, Epigenetics, and South Asian Trauma 38:08

Though I would have to tell you, I'm actually not, I mean, be honest, I'm not familiar with what the research shows. I can tell you clinically, like doing this for 20 years, it can really happen at any age. So, I mean, I see adolescents and again, I call it the bottom falling out, but it's really a place of deep emotional crisis where the person tends to question almost everything where the reality of how much they've had to carry really comes to light for them. And it can, you know, in the West, we term it as like, she's having like a mental breakdown, right?

That would be, but truly, I think there comes a point where the body can't carry this. you know, the body, the soul might cannot carry this anymore. I think Western, you know, medicine and culture has really compartmentalized, you know, and separated the mind and the body. But if you look at other traditions like, you know, the Shipibo tradition in Peru, they believe that trauma affects the mind, body, and the soul. And the way they see it is that oftentimes in these like spiritual crises or spiritual emergencies the soul becomes so distraught that it leaves the body and so much of shipibo healing is around creating the conditions for the soul to come back home and so what so again the first thing that I do is I want to know the story what is the story what has happened what's occurred and often as much information as we can get from other family members, partners, and sometimes it's available and sometimes it isn't.

Sometimes we see this happening in very, you know, even in teens, you know, it comes to a point where they realize that their family system is either not working for them or you see this often in parentified teens, right? The teens who've had to actually be the parent for everybody. And then I mentioned the people are, you know, what I see more classically for women is around the time of perimenopause. There can be a real shift medically, like because, you know, the actual physically what's going on but it's also looking at midlife, like we call it a midlife crisis, but this is kind of where we're at with it.

And so I don't think it actually, there is more prevalence as far as, I think it's just more recognized, I think as women, you know, women tend to access mental health more, and actually that's problematic. because it really men need this just as much and there's just so much more stigma and shame that they actually have. There's so many more barriers for them to access. I don't think there's a particular time and for some people it comes much later in life depending on they may have something that they have a kid who is now challenging the status quo, challenging the culture and it now all of their perfectly constructed, you know, schema of their life is now falling apart.

and they're having to look at the choices they made that has now led to whatever the big event might be, whether it's a kid who's, you know, homosexual, a kid who's divorcing, a kid who's decided to leave their church. follow a different faith. I mean, there can be many things that shake this up or choose a career path that they really didn't see for their kid. But there can be so many different things that bring along the spiritual emergency, which I really just see as kind of, it's a reckoning point.

Thank you for walking us through that term, as well as the application and examples of how that shows up at different points in people's lives. And I'm also very, very curious about the intersectionality that we have, that we share at this moment. You talked about your Indian heritage past, and I'm very curious about that. you know, because we talk about transgenerational experiences showing up through, you know, our DNA that then manifests sometimes as that break, that nervous breakdown that can happen generations later, right?

Where is that trauma? And just being some South Asia, all three of us here today, the identity of ourselves, but in the context of mystical, you know, practices Right indigenous practices. We have our own I know I have our own faith that talks about Your spiritual connection to your body, you know Wash your hands and you know, clean your hands with hand hygiene. So you before you pray know it's about Washing your hands and spending time and blessing the water and taking that in and then doing that, you know, and then making intention as you stand up before you meditate or pray, you know, these things.

And if you do this three, five times or whatever times a day, your body will feel good, you'll feel grounded, you know, but really you're supposed to do it because it's a requirement. You can see the language around this belief of, you know, and I see this so much in patients as well, where we're asking about that, your spiritual practice, you know, what is it that you believe and how does that come into your life or does it or not? And tell us more about yourself in this context of who you are with the transgenerational experiences that you may have and bringing the aspect of spirituality forward in your practice.

Yes, so my family is from India, so in India they would call us Parsis. So my religious faith is I'm Zoroastrian. Zoroastrianism was the largest faith around the time of Jesus' birth. It probably came around the same time as Judaism, possibly earlier. has contributed to the beliefs of actually heaven and hell, good and evil, a judgment day, a final resurrection. So many scholars who study world religions will study interactionism because a lot of those concepts which now seem like, oh, there's nothing new or kind of quite new for the time.

My ancestors came from Iran 1,300 years ago and were facing religious persecution because they were the religion in Iran prior to Islam. And so my ancestors left Iran and came to India for religious asylum. And so in India, they call us Parsis, which just means Persian. I bring this up as now there's probably about 300,000 of us worldwide, maybe a little more. UNESCO has called us a tribe, not even a religion, and it's pretty much a dwindling faith. I bring that up because these things are important as far as, you know, I bring a lot of my own history, especially when I work with Jewish families.

or Armenian families, right? Other families that have experienced genocide because there is, I mean, this is now scientifically been proving, epigenetics. So the idea that certain genes under certain circumstances actually get turned on and then are passed down The research with Holocaust survivors bears the status of Holocaust survivors. So their children have actually much higher rates of PTSD despite the fact that they actually never experienced the Holocaust. And I'd have to say that bears out even in grandchildren when you see it can manifest as like panic disorders.

and anxiety, but this generalized anxiety when your very culture being has been threatened for millennia, centuries. And that's important to know because that informs my practice. So, you know, I do ask, I see a lot of, I have a lot of patients who go to a Jewish school and it's very important to understand these things because that is the kind of underlay for what their presentation is coming up as. So my own religious faith apparently had psychedelics. So we had something that was called Homa, Hindus had Soma, which was also a psychedelic thing.

So I actually see this very much part and parcel of like continuing kind of this heritage of mine which very much kind of informs how I practice. I think we know that prayer, belief in God, belief in spirituality doesn't even have to be in God, right? Having a spiritual practice is actually very protective. and very meaningful and gives people purpose. And again, it doesn't necessarily have to be that you believe in God. I mean, there's plenty of, you know, atheists, Buddhists who have that, but it's really an anchor, can be really an anchor for people.

But understanding people's histories are really important and in psychedelic practices or shamanic practices, your ancestors are very much a part of the work that's done and they're very much present with you. There is less of a separation of who's living here And who's like, let's say in the spirit world or in heaven or whatever you would want to call it. And oftentimes your ancestors are there to help and support you during these times. Sorry, there's a very, I feel like that's very confident.

There's like a lot I have to cover, but. These are really important psychiatric considerations. And again, with my Armenian families, with my Jewish families, and it doesn't even have to be that your ancestors went through a Holocaust. Every group of people, you know, I'm very sensitive to, you know, my Muslim patients who come because there's so much ostracization, especially after 9-11. that they have faced, which has caused them to feel isolated or that they have to explain themselves or feel like they, you know, unfortunately, like they feel that they have to be the ones that say, look, all Muslims are out like this.

That's a very heavy burden for anybody to carry. And so these things are just really important for us to understand, especially because we live in the third largest country in the world that truly has every culture and every religious faith under it. And these things are really important. Oh, I love how you was like absolutely late at that. It's like a big question. It is a big question. And I want to bring it up because it is something again, not in conventional medicine, but in the integrative way of thinking.

And I call it a way of thinking because it's a way of kind of pulling in and bringing together something to make it more holistically seen. and using all these different modalities that are available, both with the respect of the Eastern indigenous practices that have been practiced for centuries. And why not bring that in to even to the conventional space? Because that's what's real. That's what people are, you know, experiencing and have experienced transgenerationally. I just wanted to call out the aspect that we're all three Asian, from the South Asian continent, and with a different story of conflict, of relational distress and crisis, and now coming to America, which is the other.

Well, the 20th century in South Asia has really been about fracturing, right? Like a fracturing of the great continent, subcontinent of India into three pieces. And now we're seeing how these traumas of fracturing, like historical fracturing, post-colonial borders drawn between, for example, India, Pakistan, and Bangladesh, are still simmering under the subculture, right, the culture. And it's erupting, you know, and these are stories that because of the way, you know, I mean, they're both nuclear powers.

And, you know, it's strange that we speak the same language in Indian Pakistan. It's just a different script. We share similar cultural narratives and roots and history and practices and all of that. and beliefs and ideas. Yeah. And there's been such a great, you know, synchronization of a lot of between Hindu and Muslim culture, for example, right, over the course of time. And yet here we are, you know, separated by a border with the story. And now we are at the brink of that trauma that's been unprocessed, being activated in ways that are just making us more divided.

And I want to point this out, and this is not brought up enough, you know, partition, you know, which was the separate, really what I feel artificial separation of India and Pakistan is one of the unwritten genocides. Over one million people were murdered. in a very short period of time. And nobody talks enough about that and how traumatic it was and how many people have been displaced because of that. And then the betrayal of neighbors turning against neighbors. And this is really important because I don't care what part of South Asia you're from, everybody was affected by it.

My grandfather was very much a part of the Quit India movement. And I don't think this is what he had envisioned. My great uncle was Gandhi's physician and like, but everybody like has a story and now we're left with this and a world that doesn't seem to understand how awful. It wasn't, it feels like no, I feel like nobody, nobody's really one. Yeah. And if you're with this trauma, a trauma that's not even recognized by the rest of the world. I would even say not stories, right? These untold stories that are trapped in our bodies.

And I feel like, you know, one of the, for example, downstream consequences has been, for example, how we. treat this idea of arranged marriage, keeping the girls safe. Just how dangerous the world became in the post-partition world really established the mores that were passed on. Like, oh, don't marry outside of your small, safe community.

Personal Healing and Psychedelic Work 53:18

Don't risk too much because taking a risk after you've gone through something like that is something your neurobiology cannot do. So it leads to greater protectionism. And if it goes unrealized, it really can, as we've seen over two, three generations, determine just the stories that we tell about ourselves and what happened then. And there's all these untold stories of what really happened. I mean, in Bangladesh, we have genocide in 1971, you know, nine months worth, three million people. And if you look at the rate of how much, how many people were lost, it was actually higher than the Holocaust at some points.

But we don't talk about it. You know, it's just what is talked about, what is revealed, what is actually acknowledged. And I feel like that's what we're doing. When we talk about the soul retrieving work, like when our ancestors are here and they're asking to be acknowledged, you know, they are present in our bodies and our souls. And I feel like in psychedelic work, this is what's coming through. very powerfully. I almost feel like my heart is clutching right now because there's just this way of talking about it and being seen and heard that we can talk about outside of being, you know, the victim, you know, story.

Right. I remember when I went to Pakistan to study, I was so struck by the fact that I had grown up in Dubai within like a Bengali culture. And I was told a certain story about 1971. And, you know, it's called the disturbance. And then when I went to Pakistan, they were told a different story about it. And I was just like sitting there with these two, you know, competing stories about the same piece of history and realizing like, oh, the truth is somewhere there. And because we don't communicate about it, because we don't share language about it, and we've been told in a certain way, that's all we carry.

But when you meet people from other places and you share their stories, it's like it becomes really real. And we're all trying to make this real, you know, make our histories real, because they're real in our bodies. Yeah. I want to talk forever. I love this conversation because you're right. I mean, I can feel the healing of having this kind of dialogue among something that we've carried in our body. I was with my moment of stillness when I, on my death anniversary of my father, and I had this moment.

I just had to, I just sat there and I was so sad. I had not, and I had to, you know, write down, I had to grab a piece of paper and I just started to write. And I felt like there was a portal that opened right on his death anniversary at that same moment, you know, possibly because it was 12, 24 hours away from me and distance-wise he was in Pakistan and he died very prematurely. But it was this portal of tell my story, write down my story, my father's story. He was on a train. in the partition.

He was nine years old, migrating from India to Pakistan. Nine years old, and my father carried this story that was the cause of his death. And now I could see it. I could not even see it until I had to write it down in what he told me. about what happened and what he witnessed and the effect that it had all in his life of distrust, of anger, of rage, that showed up as diabetes, heart, you know, depression, and sadly, you know, a lot of other things. And so, but that revealing of that experience, however it was perceived or, you know, that existed, It shows up.

And as I'm talking about this, my heart is fluttering, fluttering because it's feeling lifted and heard and felt. And I want to just hold that heart and say, yeah, thank you for listening to this. And this is kind of what happens when we talk about having being seen, right, with patients as well as with ourselves. Our work is also with ourselves. And my question, I guess, is, you know, how do you do your own healing? What are the integrative practices that you provide and recommend to, for yourself as well as for your patients?

So for myself, I lean into my own faith. I've adopted other practices from other cultures. I do meditate. I smoke mapacho. So every morning I get up, I smoke mapacho. which is actually don't inhale it into your lungs, but it's an idea that you're communicating with God and the message, your messages, your prayers, your wishes are being taken up to Spirit or God or whatever. And then I do hape, which is another kind of sacred tobacco. And then I go work out. So I'll meditate with that. My story with psychedelics came because I actually developed what I realized in part of my journey on my own is I was like, the only thing left unturned I felt was like, I wonder if my antidepressant is making me sick.

So I abruptly stopped it and my symptoms improved. And so yeah, it's kind of like dark humor that a psychiatrist who I cannot take stimulants, I get such bad side effects. So I don't have a way to really treat my ADHD conventionally. And I can't. Now on multiple antidepressants, I've developed autoimmune reactions. Some look like lupus. It wasn't And this actually caused what people thought I had ALS. People thought I had MS. They thought I had Santa Gravis. I had none of that. And so what I was left with was all of the trauma I had been covering up, not intentionally.

And that was kind of my, you know, whatever you could call it, spiritual emergence. You know, I started studying integrative medicine, psychiatry. I did Gabor's course. And I became a Gabor Maté groupie, and I started following him at all these conferences. And I had actually met him during my course, and he was the first person who I'd say, I nailed my shit in 10 minutes. And I've been in and out of therapy like half my life, being someone who's in psychiatry and like, I was like, how did this guy figure it out?

So he was like, call me, read my book, call me. And anyways, by then I signed up for his course, but he was in San Diego talking about, and I didn't know anything about it. It was psychedelic assisted psychotherapy conference. And I went there and I couldn't believe the scientific evidence for this. So the first psychedelic I did was actually ayahuasca. I didn't research anything about it. I said, it sounds like from what Gabor said, it's going to work. I was like, I have nothing to lose. And so I know, right, out of all the ones to try first, So, so much of now my personal work revolves around working with ayahuasca, working with psilocybin, and leaning on these because, I mean, pretty much conventional medicines are now completely off the table for me.

But the that is how I know for my patients that doesn't mean that that's for that. So if somebody comes to me wanting to work with psychedelics, that's a whole thing. And then we open up, but I don't lead with that because I do believe it's calling. And if that's something that people want to do, but usually I really try to tap in on what are my, you know, everybody has strengths. There's a reason somebody has moved forward, is resilient enough to be standing there in my office or be in my office.

What are their strengths? And that is the way I work into what can be of resource to these people. whether they're a kid or an adult and so as far as involving those for my patients it's not necessarily something that I will prescribe per se but work working with them on what are they already doing because they're already doing something that's brought them this far. And again, encouraging practices, but I also find like in our space, everyone's quick to say like, Oh, everyone needs to meditate.

Have you ever tried to ask like a trauma survivor to meditate? No, they don't want to sit still. They don't want to be still. They don't want to be stuck with their thoughts because typically what that would mean is they have to also be there with their pain. And at that's, you know, one of the many difficulties with trauma is that the way most of us will survive it is by checking out in any way shape or form. And so I don't prescribe people to like meditate or do that, but really working on what are they already doing that's meaningful to them.

and that could be of a resource, and that could even be just sports. It could be hanging out with their friends. It could be hiking, whatever they're already doing, and then we kind of build on that. And then if they ask more questions about what else could I do, then we work on that. It's really within the framework of what works for them, their life, and what's already meaningful for them. I love that. I love how you're kind of calling the soul back into the body. Just like in the shipibo, you know, just what works for you, what calls to you, what does your soul love?

And I want to hear a little bit about how you feel like ketamine is, you know, as a dissociative in this trauma work. How does it work? What's it doing for people? So, so the way I see, you know, all psychedelic work, but even, you know, including ketamine, yes, ketamine is not, it's, although we, you, it's found in mushrooms, right? Or, like, there's not a bloody mushroom that makes it. Yes. So it's not totally artificial, or, you know, made in the lab. But what I see psychedelics doing, and again, that has to be the right time and place, right?

There has to be some level of stability. that a client or a patient has, because our job is also not to destabilize an already fragile situation. So a lot of times when people come to me wanting to just take it out, again, we already talked about, first thing is assessment. What's the safety? What are their resources that are there? My approach is a little unconventional. I often will work with people for several months. to get them the type of stability that they need before working with it if that's the appropriate way to go.

And what I see psychedelics including ketamine do is really bring to the surface what it is that needs to be worked in. So I had, you know, a client who had an unfortunately severe, severe history of abuse, including physical abuse. And so often, you know, when he underwent this, what came up was like, you know, kept asking, am I dying? And I thought, oh, no, he's having some, you know, so he's having uncomfortable feelings. As you know, the psychedelics, you know, I think people are painting this as this panacea, but the work can be very uncomfortable.

So, right, it brings out kind of the trauma that needs to be dealt with and your body feels like can be dealt with and it has to be titrated. You know, we often talk about this window of tolerance and with trauma, and what Simeo is what you are also talking about, our window of tolerance, our ability to tolerate distress, shrinks. Because your body wants to make sure it's keeping you safe and it keeps it narrow and it keeps it guarded. So even with this psychedelic work, it's very important to titrate or start low, very slow, so you're not shocking the system.

You know, I think in the US, we have a very white-knuckled approach. Blast through it. And this isn't helpful. It actually can be counterproductive. And so it brings up the trauma, but it helps us metabolize it in a way that we weren't able to. Like, especially if you're younger and so in this patient's case, he thought he was going to die, right? When he was being abused, he thought he was going to die. And this is what was coming out. But this is a chance to change the narrative, to change the story, right?

So with this work and this particular client, like, you know, he asked for his hand to be held, right? Saying that you are safe. You are okay. It's not happening. But helping them stay with it, right? This is what helps people process. So it brings out the trauma. It helps us metabolize it. And on the other side is you know, growth, insight, empowerment, expansion. That's the idea, but it is not often comfortable and it isn't always appropriate. Like people have to have some sort of stability to be able to do it.

And that's one way that I use ketamine, right? To help people metabolize the trauma and be able to come out on the other side Recently, actually, an ayahuasca retreat that I went to, so my own abuse came up and, you know, they call ayahuasca she, but she was basically like, you were alone with this when this happened. Do not be alone again. Go get somebody. And so I did. And it's literally like the helper was there witnessing my pain. witnessing, I was crying, and yet I felt pretty good the next day.

And that's what needed to happen, right? Trauma keeps us frozen. It keeps us perpetually frozen in where the event happened, right? We get stuck with flashbacks. What we don't appreciate enough is our nervous system gets stuck as if the trauma is happening. And this is what we see in anxiety disorders or generalized anxiety. panic disorders. It is a nervous system that is stuck. Right? Literally, we loop. We play. We keep replaying. If we are somebody who is checked out, we continue to be checked out.

And Dr. Mate talks about this in his kind of unconventional look at ADHD. I'd have to tell you, like they say, 25% people who have PTSD would meet criteria for ADHD. I would tell you it's 100%. Not one of my patients does not meet criteria for ADHD. And so the work of psychedelics is really to get us, and it doesn't nine just psychedelics, therapy, un-stock from the trauma so we can move forward. Because what we know what trauma does is it actually keeps us developmentally stunted at the point of where the trauma occurred.

So this is like the really important work that psychedelics can really do for us. I think there's another approach with ketamine, which is another bigger conversation, but I also use it for rapid deescalation of suicidality. And in those cases, I think we're not waiting for stability. We are creating the stability for the patient around. But when there is suicidality involved and we need to rapidly deescalate that, ketamine is super helpful. And I think that needs to open up a bigger discussion of what are we doing with adolescents?

Like this, in my opinion, and it's, I know, very unconventional and seems this should be a first line. Is it really helpful to keep an adolescent on antidepressants or do I rapidly deescalate the depression, the suicidality, and get them into family and individual therapy so they can do the work? Because as you know, patients who are severely depressed, they're not really able to access therapy in a way that's meaningful or helpful to them. So I know there's a lot of information, but these are the two ways that I use, you know, ketamine, a kind of watchful, waitful approach when we really want to address trauma.

And then when there's really severe suicidality, we're not waiting. We need to jump in and get people better, faster, and then continue to resource them. and rally around them. Yeah, absolutely beautifully put. And thank you so much for holding it all and describing the complexity and clarifying all that is coming into the soul retrieval work of psychiatry, right? I love that. I'm going to just carry that with me. And how beautifully you've been able to bring in all the different threads and then apply it to the here and now.

that there's nuance, there's a lot to learn. We're still figuring it out, but there are clear signs that there is a way forward specifically for, you know, people who are in distress in this way. So thank you so much for just encapsulating all of that. I really appreciate this conversation. Thank you. Thank you for teaching us again to curious MDs where we ask those unasked questions. It's really about really poking at the bear, maybe just kind of understanding, really looking at things from different points of view.

I think it really brings audience so much richness to the answers that they're seeking and we're learning as we go too as physicians. And we need to keep that in the forefront because that learning mindset is really where neuroplasticity occurs. Thank you for being here, Leila. It's a beautiful conversation. I hope to have it again and again and again. Thank you. Thanks for having me. Thank you for tuning into Dr. Talks. We hope today's episode has enlightened and inspired you on your path to optimal health.

Each day is a new opportunity to make choices that empower your wellbeing. For more insights and strategies, subscribe to our podcast and visit our website, www.DrTalks.com. Stay connected, stay healthy, and join us next time on Doctor Talks, real talks from real doctors on the issues that matter to you most.