It was 3 a.m. and the fluorescence of the hospital bed “nightlight” was not very flattering to either of us. Shawna had delivered her first daughter 34 hours ago and I was called, as a consulting psychiatrist, to evaluate her safety for discharge. Some collection of entities had vested the power in me to determine the “correctness” of her mind, mood, and behavior. More than passing judgment on a snapshot of her thought processes, I was also charged with protecting, indirectly, her newborn daughter. Guarded and prickly on approach, she eased into a staccato discussion of her beliefs around the pregnancy, particularly, that the baby was still inside her, growing into “the next Jesus”.
My conventional training had been in assessing the risks and benefits, based on the latest available data, of medication treatment in pregnancy and postpartum. I spent years learning how to conduct a proper informed consent based on an imperfect data set. Always stimulated by science, biochemistry, and the illusory opportunity for mastery that a biomedical approach represents, I was able to adeptly consider known mechanisms, common side effects, drug half-life, protein binding, and other variables in this equation amounting to "yes medicate" or "no medicate".
Once I moved into private practice and began to have to the opportunity to work with women longitudinally and to exist in their philosophical space, beholden to their preferences, I began to feel severely limited by the black & white version of treatment that my training had prepared me to offer. I began to learn about other evidence-based natural alternatives to treatment of mood and anxiety disorders in pregnancy and postpartum – light box therapy, vitamin D, b vitamins, essential fatty acids, SAMe, exercise, acupuncture. This knowledge expanded my toolbox, but still did not help me to offer patients what I was longing to provide – a path to healing, a way back home to themselves.
Functional medicine and my ongoing training in this enlightened field, endeavoring to expose root causes of chronic medical problems, has been the "aha" moment of my past 5 years. How do we attempt to understand escalating rates of autoimmunity, mood disorders, allergies, diabetes, asthma, arthritis, developmental delays, and autism. We can turn off the check engine light for a couple of figurative weeks, but eventually, we have to look under the hood, take out the tools, and get to work from the inside out. We have to ask, why, not just express passive concern and commit to maintaining a medication-buoyed new, and highly-suboptimal, normal.
I see women with debilitating anxiety, hyperarousal, insomnia, paranoia, suicidality, obsessions, intrusive rituals, and anorexia. I can offer them the option to take a medication, likely laced with unstudied artificial dyes and preservatives, with largely pharma-manipulated data for its efficacy and risks of short and long-term side effects, or we can work to uncover what is keeping their body in this state of sickness. Bodies want to heal. Toxic environments, diets, and stress get in the way and conspire with genetic vulnerabilities in an undercover operation called epigenetics. While it may feel like the sky is falling when we think about how bombarded we are, as a race, by the unintended consequences of our technological progress, I am here to argue that the sky only keeps getting bigger.
I have spent a decade in a world with which I felt fairly confident I had gained sufficient familiarity. It was like being ushered into a strange room with intricate and layered décor and being told to memorize every detail – this is life as you will know it. But I have followed a small crack in the wall out into a much bigger, airier room, and learned that that original room is not the world. The bigger room is not the world. The house isn’t, the town isn’t, the country, globe, and galaxy aren’t.
We must remember that our current knowledge needs to be contextualized by the arch of scientific inquiry, its contemporary influences both political and financial, the population’s access to information, and subsequent norms. In the end, we must default to the inherent complexity of human biology and the ecosystem we live in, and to remember that just when we think we have figured out the roof over our head, an even higher one might present itself.
In my personal and professional life, I have devoted myself to the precautionary principle and the tenets of an informed consent prior to intervention or exposure. I believe that these principals extend beyond psychopharmacology to the questionable evidence base in obstetric management (fetal monitoring, ultrasound, induction, epidural, surgery, episiotomy, cord clamping) that seeks to pathologize and marginalize natural and home birth. Evidence supporting the safety of a physiologic birth seems as unnecessary as evidence supporting the superiority of natural foods, but despite the availability of these large-scale studies, natural remains fringe.
Before conducting population-wide experiments which will serve to demonstrate the insidious effects long after unconsenting humans have been injured, hurt, and damaged, a practice that honors civil liberties and right to bodily integrity is one that serves to put the burden of proof on those seeking to deviate from what occurs in unadulterated life. It is not the responsibility of those exposed to demonstrate danger, it is the responsibility of pharmaceutical, commercial, and industrial companies to properly evaluate the long-term safety of such exposures, including an evaluation of the severe risks to a potentially genetically vulnerable minority. Only then can a governing body be in a position to sanction, condone, or even promote such chemicals.
From the processing of grains, creation of novel malignant fats, infusion of sugar into every imaginable source, our diet has been rendered devoid of essential elements that are critical to detoxification and immune balance. In the midst of this, we are exposed to long-term medications such as oral contraceptives, acid blockers, and statins that further deplete and disrupt micronutrients and burden our metabolic processes. We cook in PFOAs, drink from BPA, slather on DEA and SLS, and eat GMOs.
This veritable alphabet of unpronounceable lab creations serve to disrupt cellular metabolism and signaling, stimulate our endocrine and immune system, and integrate into our DNA in ways that we have yet to fully comprehend. If we are concerned about learning, post hoc, about the deleterious short- and long-term effects on a vulnerable population of novel chemicals introduced through personal care products and tainted foods, would we not be concerned about those same agents being injected into their tissue from the first day of birth, or even while in utero?
Do adjuvants and additives such as polysorbate, formaldehyde, triton-x 100, ethylene glycol, betapropiolactone, and known neurotoxins aluminum and mercury, let alone fetal and animal tissues with potential as-of-yet-undiscovered microbial entities not raise a flag? We are being assaulted by our own laboratory creations, and the vulnerable among us are crying out for help.
When I care for the women in my practice and the little ones in my home, I default to this principle: we must make an effort to unburden our bodies, and if we expose ourselves to a “modern” intervention, it should be because we have considered all of the known and unknown risks. This doesn’t mean I don’t prescribe. I believe that women should have the choice and I spend a lot of time, endless hours of reading primary source material, to better prepare me to consent them. We constantly revisit and reevaluate. They are in the drivers seat.
It continues to irk me when they come in from their OBs office entirely unconsented for their flu shot and Zofran. Remember, we, as a society, seem to be in our adolescence, full of exuberant hubris, driven to self-destruction by irrational emotion, behaving selfishly and irreverently. When we grow up, let’s hope that we don’t have too much to feel ashamed about.