Chair’s Column May 2012

Emerging approaches in psychiatric assessment

J. Lake

Every human being is unique at the level of social, cultural, psychological, biological, and
possibly also “energetic” functioning. By extension, in every individual the complex causes
or meanings of symptoms are uniquely determined. The diversity and complexity of factors
that contribute to mental illness often make it difficult to accurately assess the underlying
causes of symptoms and to identify treatments that most effectively address them. A future
more integrative psychiatry will include an eclectic and sophisticated array of individualized
assessment and treatment approaches capable of addressing symptoms of mental illness at
disparate biological, informational and “energetic” levels of body-brain-mind. Although
quantitative electroencephalography (QEEG) analysis has become an important research tool
in psychiatry this technique is not yet widely employed in conventional psychiatric assessment.
Thus, for purposes of this discussion, QEEG is regarded as a non-conventional approach.
Emerging evidence suggests that ultra-weak biophotons may provide useful indicators of illness.
Serologic and urinary assays used in functional medicine are increasingly used in clinical
settings. Assessment approaches that purport to detect subtle forms of energy not described by
Western science are also now widely used by alternative medical practitioners to evaluate mental
health problems. These include pulse diagnosis in Chinese medicine, Ayurveda, and Tibetan
medicine, and analysis of the vascular autonomic signal (VAS). Some approaches will be
scientifically validated by future research findings while others will be refuted. The increasing
use of novel assessment approaches in Western psychiatry will permit more comprehensive
and cost-effective treatment planning because accurately characterizing the underlying causes
of symptoms will point to the most appropriate and effective biomedical or non-conventional
treatment. In this article I briefly review approaches used to assess psychiatric disorders that are
not currently used in conventional Western psychiatry.

Non-conventional assessment in context

Chinese medicine, Ayurveda and other non-Western systems of medicine rest on assumptions
that are fundamentally at odds with the philosophical position of Western biomedicine which
argues that the causes of illness are reducible to identifiable physical or biological factors. In
contrast, Asian healing traditions assume that complex non-linear energy-information processes
play important roles in illness causation and that human intention has direct as well as non-local
effects on health and illness. This model argues that health and illness are manifestations of
complex dynamic interactions between psychological, physical, biological, social, energetic and
spiritual factors at multiple hierarchic levels of organization in space and time (Bell 2002). In
contrast, biomedical psychiatry posits that discrete “causes” of symptoms are biological
processes manifesting as depressed mood, anxiety of varying degrees of severity, impaired
cognitive functioning, etc. Indirect “causes” of symptoms include acute or chronic social,
cultural or psychological stresses that lead to changes in specific biological (including
neurobiological and endocrinological) systems which ultimately manifest as symptoms.
Integrative medicine starts from classical neurophysiology and extends the conventional
explanatory model to include putative causes of symptoms that are “energetic”
or “informational” processes affecting the body-brain-mind at various “levels” in a dynamic web-
like hierarchy of structure and function that includes the neuro-endocrine system, the immune
system, highly organized bio-magnetic fields generated by the brain and heart, and possibly also
non-classical energy-information processes including large-scale coherent quantum fields or
other “subtle” energetic or informational phenomena associated with human consciousness. In
this broad context the goals of integrative mental health care include accurately characterizing
the causes of symptoms and constructing treatment strategies that effectively address those
causes.

The benefits of integrating non-conventional approaches in psychiatric assessment include:
Clarification of the psychiatric differential diagnosis when conventional assessment methods have failed to identify the causes of a symptom or disorder, or when the patient’s medical or psychiatric history is vague or complex.
Combining conventional assessment methods with non-conventional biological assessment approaches based on current medical theory, including quantitative electroencephalography (QEEG) and urinary or serologic studies of neurotransmitter metabolites, immunologic or endocrinological factors, may result in increased specificity and accuracy when ruling out postulated biological causes or markers of mental illness.
Combining conventional assessment methods with emerging approaches currently outside of biomedicine will clarify the role of putative “energetic” causes of mental illness.