functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
hours a night. Alternately listless and agitated,
Theresa’s been unable to concentrate at work.
She leaves her office late—feeling guilty for what
she hasn’t done and anxious that she will have to
make up for it the next day. While she used to
go dancing with friends in the evenings, now she
tells them she’s tired. At home, she watches TV
and eats frozen dinners. Sometimes she measures
her wine in bottles, not glasses. She is feeling
increasingly hopeless. Theresa is clearly clinically
depressed and her internist and psychotherapist
have already urged her to take antidepressants.
But she doesn’t want to. She has come to me to
find ‚a better way.‛
Theresa already knows I view depression
differently than her doctor and therapist do--
‚Depression is not a disease,‛ as I explained to
her on the phone when she called to make an
appointment. ‚It’s a wake up call, potentially the
start of a journey that can help us become whole
and happy, a journey that can change and
transform our lives.‛ Before any patients visit my
office or pay me a fee, I make sure to speak on
the phone with them, let them know who I am,
what my perspective is, how I work, and make
sure they want to participate in what I have to
offer. I also usually suggest that before the first
appointment, they read something I’ve written
about my practice, get to know a little more about
the meditative, eclectic, active and engaged
‚Unstuck‛ approach I will offer. This kind of
conversation feels respectful, clears up
misunderstandings and helps ensure that our future
time together will be used well.
The congruence, the fit between what I’m offering
and what my patient is hoping for, will be the
springboard for all our work. It will provide the
shared vision on which we can draw in the
difficult and challenging times that may come in
any therapy. Finally, commitment to an integrative
approach – and the urgency that may fuel that
commitment - help provide the energy which
sustains us in meeting the challenges of our work
together.
I begin, as any therapist would, by asking Theresa
what happened a month ago right before her
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depression. She says that she has just ended
another relationship and reminds me that at almost
40, she still doesn’t have a man who loves her
or a child. I listen carefully as Theresa describes
the inhibition and despondency that shadowed her
childhood--the recent break up with her boyfriend
has plunged her into the same kind of hopeless
darkness she remembers from that time. A
thousand miles away, she tells me, her mother’s
arthritis has slowed her to irritated immobility and
her father’s sight and vigor are fading. Theresa
feels she should be with them, but doesn’t want
to, and she feels guilty about that. ‚I carry my
whole organization on my back, too‛ she says
ruefully, ‚women’s rights for everybody except this
woman.‛
As I take in what Theresa is telling me, I
encourage her to see herself as a student and
adventurer, an active participant in our work
together. Indeed, she is the one primarily
responsible, with my guidance, for helping herself.
‚Self-care,‛ I often tell clients, ‚is the true
primary care.‛ From our first session, I convey to
her my belief that she has within her the
resources for her own healing. Indeed, I begin to
help her recognize what she is already doing that
is helpful to her. In Theresa’s case, the morning
yoga she still sometimes does gives her energy;
and phone calls or visits with her best friend,
Barbara, dispel, at least for a while, her
deepening loneliness. I write these activities down
on a prescription pad, as another physician might
an antidepressant drug—crafting ‚a Prescription for
Self-Care‛ at the end of the first session.
I also teach Theresa (and virtually all of my
patients), a simple, meditation technique called
‚Soft Belly,‛ involving slow deep breathing in
through the nose, out through the mouth, with the
belly soft and relaxed. I encourage Theresa to
close her eyes as she breathes in order to
remove distracting stimuli. I suggest that she say
to herself, ‚soft‛ as she breathes in through her
nose and ‚belly‛ as she breathes out through her
mouth. If thoughts come, I say, let them come,
and let them go.
2012