James Greenblatt is an innovator and longtime authority in the fields of integrative medicine and functional psychiatry, focusing on nutrition and other natural modes of treatment for people in distress—including teens with eating disorders and children and adults diagnosed with ADHD. 

He’s the author of eight books, most recently on antidepressant withdrawal, and the founder of the website PsychiatryRedefined.org—where he works to educate his colleagues/professionals on the science and practice of functional, integrative, and metabolic psychiatry.

Greenblatt serves as Chief Medical Officer and Vice President of Medical Services at Walden Behavioral Care, which is based in Massachusetts. He teaches at the Tufts University School of Medicine and the Dartmouth College School of Medicine.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Amy Biancolli: Dr. Greenblatt, welcome. Glad to have you here today.

James Greenblatt: Thank you, Amy. It’s good to be with you.

Biancolli: I have a lot of questions today, because you’ve done so much interesting work. But for a start, for our listeners, could you define functional medicine and integrative psychiatry? And how do those approaches differ from conventional psychiatry? What do people need to know going into this conversation about what you do and how it differs?

Greenblatt: Good start. We can have three buckets here. Conventional psychiatry, we’re all quite aware of, is pretty much a symptomatic-based polypharmacy treatment model. We have one tool and it’s a medicine for a symptom. The second, third and fourth medicine, I think we’re all aware of that, and the limitations of that. We throw in psychotherapy, but the model is medications. 

Integrative medicine, which has gained steam over the last 30 years, includes the terms like mindfulness and yoga and lifestyle and exercise, and diet. All these terms that the consumers had to push forward and finally have been embraced by our medical establishment—and that’s great news. We have mindfulness trainings at Harvard and Stanford, and we have lifestyle fellowships for doctors, but in my 30 years of practice that hasn’t been enough to make a dent in—I believe—the tragedy of our current treatment model in psychiatry. That’s where the term functional medicine comes in. 

Functional medicine looks at the root cause. It looks at that connection between genetic vulnerability and environmental stresses or deficiencies or toxins, and it’s based on objective testing. We look for nutritional deficiencies, we look at the gut, we look at genes. So if we add our traditional model, if we add an integrative model with a functional model, I believe, in my experience, it’s a recipe for dramatically improved outcomes.

Biancolli: You used a term just now, the root cause. So, could you describe a little bit what you do to determine that? Because, of course, what’s missing from psychiatric diagnosis and treatment is the test. In the mainstream narrative, everybody is always comparing psychiatric disorders with, say, someone with diabetes, but with diabetes you get a blood test to determine that you need insulin. Is there something specific in your modalities, in what you do, that, again, differs from the original approach? How do you determine that root cause that you’re talking about?

Greenblatt: This is both the exciting part and the challenging part, because the work-up that we would do on a patient in a functional psychiatry approach might look at 250 biomarkers. And the list is very long, but we could just take B12 deficiency [as an example]. How many psychiatrists are routinely looking at B12 deficiency? And we know it contributes to depression, anxiety. We’ve seen it contribute to psychosis and a whole host of other mental health problems. 

We could do Vitamin D deficiency. Some of the most common tests that we look at is actually celiac disease. As a root cause, I could tell you over the years, as a child and adolescent psychiatrist, how many kids have walked into the office with everything from anxiety to anorexia nervosa—and that when celiac disease was diagnosed and treated, the nutritional deficiencies repleted, those psychiatric symptoms disappeared.

So it’s not one test. We start all of our trainings with teaching psychiatrists: We have a neck. What happens in the body affects our brain.

Biancolli: The interesting thing to me, too, is that you’re talking about genetic causes or the idea of something being an inheritable tendency, an inheritable predisposition to some nutritional deficiency. Again, how is that different from the biomedical model, which says that “chemical imbalance” that you have—there is a genetic cause for that, and you could inherit depression from your parents, your grandparents?
Of course, I’m sure you’re aware that Mad in America trains a very critical lens on that view, that biomedical so-called “chemical imbalance” view that’s regarded as inheritable. And once again, I’m just really curious to hear: What is the difference? That’s one thing that, in general, really interests me about your work—those differences between what you do and what usual psychiatric practice does.

Greenblatt: Sure. The lens that the Mad in America and Bob Whitaker have been focused on is helping everyone understand the limitations of such a simple model. So’ our model is not [that] depression is genetic. Our model is [that] for individual A, the genetics has to do with their metabolism of a nutrient called folates. We look at a gene that metabolizes folate. For the next person, the genetics is how they absorb Vitamin B12. The next person happens to be the autoimmune disorder, celiac disease. 

So there’s powerful genetics, and we can’t deny that, but our traditional approach is just depressed: antidepressant. If you’re sad, we’ll give you an anti-sad pill, and Mad in America has exposed the profound limitations around that model. We just expanded a deeper dive into why, what’s going on, and it’s different for everyone suffering the same illness. There are certainly similarities, and that’s part of our teaching, but the core concept in functional medicine is biochemical individuality. Everyone is different, and we have to appreciate that—and look for it with objective tests. 

Biancolli: Is this part of the whole-body approach? Instead of taking a close look at one piece of a person’s biology or mind or emotions, or social setting, or history, or genetic history, family history—instead of just looking at one piece of that, looking at the whole picture? Is that part of it?

Greenblatt: That’s it, Amy. Pretty much, if we can do a better job of taking three-generation family histories, looking at all the parts of what makes us human—from relationships to our diet—absolutely, we would have better outcomes for our kids and adults with mental illness.

Biancolli: Just hearing you say that, it just seems so obvious. Whenever I have a conversation like this with somebody or I read an article making a similar argument—from a human standpoint it just seems really obvious, or it should be.

Greenblatt: It’s so obvious that for me, sometimes, that is both the [source of] optimism and the excitement, but also the anger and rage. Some of this information has been embedded in our research for 30 years, and our medical community and our therapeutic community have just ignored it. Or, what’s happening now, which is even more frustrating, we’re acknowledging it and not doing anything about it. 

Like sleep—sleep and adolescents. We know sleep increases risk for depression and suicide, and we know kids aren’t sleeping enough, and we know the mechanisms of what happens in terms of all these inflammatory markers. So we know all this stuff, and everybody admits it, but we’re not integrated into how we’re treating these kids in our emergency rooms after the second suicide attempt. But the information and science is there.

Biancolli: How did you come to this different take on psychiatry? If you could tell us a little bit about your backstory. From what I’ve read, you started out 35 years ago or so in a conventional child psychiatry practice. Is that right?

Greenblatt: Yes, it goes back a little further, because I walked into medical school thinking I was going to cure the world with brown rice and kale. I originally was interested in nutrition and mental health. Nine years later, medical school in child psychiatry, I came out as a child psychiatrist. The model in psycho-pharm and psycho-therapy, and quickly in private practice I realized that the meds were Band-Aids. Sometimes they helped, sometimes they didn’t, and I really got back to my roots. I’ve been studying and teaching other doctors this functional medicine model, which, as you said, is obvious and not that complicated.

Biancolli: I’m just curious about your a-ha moment. Did you believe in psychiatric drugs as treatment for disease at some point, and then was there one case, one instance—or was it just a wave of kids that you saw, and you just looked at them and thought, “This isn’t working”? What was your turning point, your epiphany, if there was one?

Greenblatt: It really wasn’t an epiphany, because I still prescribe medications—and this is what I think has been hard and polarizing for communities that clearly have tried to criticize or improve our psychiatric model. I’m desperate for that improvement, but there is a role for psychiatric medications—if you’ve ever seen someone who is psychotic or manic, or watching an ADHD child who can’t function, and then functions well. So there is a role for medicine, and I still believe that, but it’s certainly over-prescribed, over-used, and no one is looking for the root cause. 

So there were patients that I would see where they never have to take a medication, or my job was just helping them get off medications. There are other patients I’ve seen over the years, where medications have truly been life-saving. It just really is helping clinicians understand that difference, and our traditional model is really just focused on that one direction.

Biancolli: This was one of my questions – that you’re not anti-medicine. From your perspective, it depends on the circumstances and the individual patient?

Greenblatt: Absolutely. I’ve been treating eating disorders on an in-patient level of care, where they are all malnourished. So, I get to talk about nutrition, and malnutrition, and prescribe supplements like zinc and fatty acids. 

But in the traditional psychiatric community, I’ve admitted patients who are suicidal, manic, psychotic, and those patients can benefit from medications. Where I differ with my colleagues is they usually over-medicated, medicated too long, and the side effects are just ignored. So yes, I believe there is a place for psychiatric medications—used judiciously,  short-term, as we look at the root cause of the functional medicine model. 

Biancolli: As a psychiatrist you question psychiatry but still use the drugs, as you were saying, for some patients who get short-term benefits: Since you’re focused in most of your work on finding those root causes—not just the biological factors but all the causes—how is it different when you’re prescribing drugs that people don’t really understand when they do work, why they work? And the science is so unclear? 

Greenblatt: The important question is it has to be discussed, and I think that I’m 100%—no, we’ll say 90%—in agreement with the Mad in America narrative, the incredible writing and the articulate stories and questioning our current model. What has been frustrating for some of us in the functional integrative sphere is that on Mad in America, the narrative hasn’t offered solutions—and that’s what our focus has been on. How can we help these individuals who are emotionally, physically, psychologically, spiritually tormented due to their mental illness? 

My job as a child psychiatrist and adult psychiatrist—as a human being—is to offer the tools. One, first do no harm, and two, anything to be a benefit. So I’m looking to support a patient and a family, and I think the tools of integrative and functional medicine just offer a tremendous scientific-backed ability to look at it. Whether it’s Vitamin D [levels] in our minority populations that are very low, or celiac disease, or long-COVID—whatever the process is, we are investigating that, and we are going to treat it. 

In the interim, if I need a medication for a week or two or a month to support that patient’s journey towards health, then I believe there are some medicines that could be of benefit.

Biancolli: So, correct me if this is the wrong metaphor or analogy, but it’s like putting a cast on someone with a broken limb for some weeks or months so they can move forward and go through PT, eventually, if they’ve had an injury—or is that too strained an analogy?

Greenblatt: No, that makes sense. Let me give you two examples. One is a 12-year-old girl who’s been refusing to eat, has been in the medical hospital, the children’s hospital here, locally, being fed by an NG [nasogastric] tube. And gets to our eating disorder facility not eating and starts to get malnourished. And I give this child—and I probably could give you a thousand examples over 20 years—a tiny dose of a known medication. We’re talking about 1.25 mg of Zyprexa, [the brand name of] Olanzapine, an antipsychotic. 

And I’ve seen hundreds, if not thousands, of kids lose their rigidity and their delusions that are preventing them from eating—and they start eating. And we taper that medication, sometimes in weeks, sometimes in a month. That Olanzapine was lifesaving, and anorexia nervosa is the most lethal illness in all of psychiatry. So we have to do something. 

The other example I always use was a series of articles in The New York Times a number of years ago on mental illness in West Africa. So, at the time, if you were delusional you would get chained to a tree. Your family would bring you a mat and they would put shackles on your leg, and they would bring you food. [One] story talked about a visiting nurse giving this woman an injection of Haldol, long-acting Haldol injection, and I think it was a 19-year-old girl. It cured her delusions. She was unshackled from her tree, she went home to her family and got a monthly injection of Haldol. So, how can anybody say that that is an evil, dangerous medication?

Now, in our in-patient facilities, absolutely, our antipsychotics are over-used—and they cause side effects and diabetes, and weight gain, and it is poorly monitored. It is a disaster.

Biancolli: Are we talking about harm reduction in two senses? I haven’t asked you much so far about your work with Psychiatry Redefined, but it really intrigued me when I went to your website and saw your efforts to educate your colleagues, because you’re trying to get them to adjust their practices—and I wondered whether you have a harm-reduction mindset, actually, about the practice of psychiatry, getting people to adjust their thinking a little bit, change their practices a little bit, and whether or not that’s actually an equivalent of what you’re describing right now in terms of prescribing small doses of psychiatric drugs for patients who need it in some moment of crisis. Are you just trying to make things a little better? Is that the case?

Greenblatt: No. I think I’m going for the home run. The Psychiatry Redefined website has no medication trainings. It is 100% focused on an integrative and functional model. Again, I don’t know how many people have seen a 9-year-old hearing voices and seeing things, and unable to function, but I’m confident that rather than [using] multiple antipsychotics, that we can find the cause. And we’ve seen it. I’ve seen undetectable nutrient levels and serious gut problems that we know can create psychosis. No, Psychiatry Redefined is focused on a completely new model, looking for the home run, looking for the root cause—and if we can’t find it, we do understand. There are some [cases], certainly in my hospital work, that medicine is used, but Psychiatry Redefined is really only focused on this functional model.

Being in the real traditional world of psychiatry, it’s the only way I’m going to embrace my colleagues. I certainly think there is a lot we can just throw away and start over. It’s just not going to happen. So, absolutely, for my traditional work at the in-patient hospital for serious mental illness, there is a concept of harm reduction early on in treatment. But what keeps me going in this field is, as we train more doctors, they send us cases of complete remission of major psychiatric illness—and that doesn’t happen with the medication model, which is just symptomatic-based Band-Aid. 

Biancolli: You truly are talking about healing people—not just, “Okay, we’re going to write this prescription, and you’re going to be on it the rest of your life, because there is no cure for whatever diagnosis you have.” You’re saying, “Yes, we can heal from these things.” Can you give an example of that?

Greenblatt: Stanford now has a clinic called Metabolic Psychiatry, where they are looking at ketogenic diet, dramatically changing the neurochemistry of the body. With ketones fueling the brain, we’ve seen—and there are case studies—the reversal of psychosis, binge-eating disorder, depression, and helping people taper off medicines.

So there is very good research, actually, around the globe on ketogenic diet and looking at insulin resistance. We’ve seen infections, strep infections or tick-borne disease like Lyme, cause neuropsychiatric symptoms. Some of the most dramatic cases I worked with is something that’s ignored by the integrative and traditional community—is looking at a simple marker like cholesterol. And there is dramatic, 30-plus-year research understanding the role of very low cholesterol with suicide risk and depression. Very low cholesterol is considered under 130 total cholesterol.

So we’ve had kids admitted to an in-patient psychiatric unit for multiple suicide attempts. Usually, the low-cholesterol kids are violent. Aggressive attempts. And total cholesterols of 119. So, the brain doesn’t work well. By treating this, we believe, as a genetic, physiological difference unrelated to dietary intake, we’ve been able to stop these chronic depression and suicidal thoughts. 

Again, I mentioned hundreds of biomarkers that we can train our doctors to look at to determine the root cause. 

Biancolli: You’re saying there is actually a lot of science that shows the dangers of having very, very low cholesterol, but people aren’t aware of that. This is, again, something that Mad in America grapples with—that the science shows, for instance, the harms and deficiencies of say, SSRIs, all the side effects, the suicidality and all of that associated with SSRIs and other psychiatric drugs. But then most people aren’t aware of that—because there’s what science says, what research says, and then there’s what the mainstream narrative says. And I realize you’re more concerned with altering, expanding, adjusting the narrative for your colleagues, but how do you change the wider narrative? Is it possible?

Greenblatt: Absolutely. I mean, the last book we wrote is the textbook on antidepressant withdrawal, and all of our presentations are on suicidal ideation on SSRIs. What I have found working with our patients with eating disorders: When the SSRI suicide risk came out, the Black Box warning, I was practicing adolescent psychiatry in a hospital, and I never saw a suicidal ideation—it didn’t make sense to me. And then, 20 years ago, I shifted to this eating disorder in-patient program, and I started seeing a lot of kids started on an SSRI—intense suicidal ideation. So I started understanding the connection between malnutrition and this side effect. Why do some individuals get the suicidal ideation, and some individuals don’t? To me, that is one of the most profound questions. Why do some individuals have horrible withdrawal, and some don’t? 

So, if we stop focusing on the med and start looking at the individual, the individual’s biochemistry, we can answer some of those questions. I clearly want to change the traditional narrative of informed consent around many of these medications, but I believe some of them can be used safely. I’m less of a fan of some of the SSRIs than some of the other medications in these unique situations.

Biancolli: So you’re saying some people might have a genetic predisposition for withdrawal or side effects, and the informed consent would mean being told you might have this reaction? 

Greenblatt: I’m not sure it’s genetic as much as—I could predict those individuals that are going to have severe withdrawal by looking at these biomarkers. These are the individuals that have profound nutritional or metabolic problems. So we can predict who’s going to have withdrawal problems, and that’s why I wrote the book. 

We treat severe B12 deficiency, genetic variants of folate. If we treat all that first and then begin a slow taper of these medications, they often don’t have these withdrawal symptoms.

Biancolli: So, you’re saying whatever the root cause—the root cause in the sense of nutritional deficiency, or something else that’s going on—you’re not saying there’s necessarily a genetic cause for it. It’s just that people are responding a certain way to a drug. It can be largely related to these nutritional deficiencies. Is that correct?

Greenblatt: Yes. I mean, know these medications disturb serotonin metabolism. We know from animal studies, people end up having lower levels of serotonin over time. So a very major disruption in neurophysiology—and then you pull that medicine away, things wreak havoc, and horrific stories about antidepressant withdrawal. But let’s just take that celiac patient with malabsorption of nutrients like zinc and tryptophan and folate, and vitamin D. They didn’t know they had celiac. They could never stop their antidepressant without severe symptoms.

If we treat the celiac, if we replete those nutrients, they can safely taper off the medications without withdrawal.

Biancolli: So that’s the first approach: looking at it and saying why, or doing the test that you’re describing. And saying, “Do you have these deficiencies, do you have these causes that can be addressed?” before prescribing anything else. 

Greenblatt: Yes. I find it silly, but lots of people—antipsychiatry people or even psychiatrists—everyone had this theory, OK, taper five percent a week or 20%. Everyone has these programs, and none of it makes any medical sense. So someone walks into my office who’s tried to taper and has had withdrawal, and brain zaps, and dysfunctional, I would tell them do not taper your medicine for three months. Let’s do these tests, let’s replete the nutrients, as you described, before we begin to taper.

Biancolli: Okay. So, even the super-gradual tapers that a lot of people use—they’ll be very, very careful and cautious and it might even take them a couple of years. You’re saying, instead of doing that, take that person and figure out what else is going on.

Greenblatt: If you’ve been on SSRIs or benzos for many, many years, it is still slow, but we can dramatically minimize these withdrawal symptoms. The counting-the-beads and the suffering that people go through is not necessary.

Biancolli: There are so many people who don’t have access to the care that you’re describing. What can be done? Do you have a sense of wanting to change the system entirely, so that access to alternate therapies and modalities and approaches would be easier for people?
So many people wind up on antidepressants after a 10- or 15-minute meeting with a GP, and it’s easier for the GP to just write out a script. It’s more efficient from everybody’s standpoint. So, how do you correct that? How do you reach people who are suffering, and how are they going to even know that they might have something else going on that makes them predisposed to withdrawal?

Greenblatt: Well, that’s why we’re talking. And it’s going to take communities like Mad in America, like Psychiatry Redefined, and many others. So I don’t have the answer. I think for me and Psychiatry Redefined, I thought education would be a path. I used to give some of these presentations. I started in 1990, and I didn’t have as much research. It was usually clinical experience or people in my field, but now, in 2023, we have the research—so nobody can argue with some of the low cholesterol data, or the Vitamin D data. So it’s a little easier with our colleagues now, but it’s going to take the articulate thinking and writing of communities like Mad in America and our traditional community in mental health to make those changes.

I am optimistic. I tend to be optimistic. I think some of the younger psychiatrists and psych nurse-practitioners, they are asking for this information. Why? Because their patients are asking for it. Just like the health and fitness movement 40 years ago, it was the consumer that started pushing that—and now, there are wellness plans. I believe now the consumer is a little frustrated. The patient, if you will, with this polypharmacy guinea-pig approach. They are looking for alternatives. They are coming in to the prescriber and saying, “Is there anything else you can do besides the medicine?” So, there is a movement of people looking. We know the supplement industry and the health industry is booming. It’s a little disjointed, and we need our medical colleagues to jump in and lead it.

Biancolli: In this interview, you’ve emphasized the science, the science, the science—looking at these biomarkers and everything. The DSM [Diagnostic and Statistical Manual] is basically a construct. So, can that change? Does the DSM serve a potentially helpful purpose in some circumstances? And what would you, how would you—if you had total power over the DSM, how would you change it? Or would you get rid of it? As a psychiatrist, what would you do?

Greenblatt: I’d probably change my mind every two minutes, but my first thought is it’s completely useless, right? It’s a list of symptoms that are somewhat meaningless. That’s my gut thought: It ‘s really derailed us from looking at etiology and underlying cause. In my world, I have 10, if not 20, unique causes for that individual suffering with a checklist of major depressive disorder.

So I’d like to throw it out the window, but there is some role in being able to communicate to colleagues, do research, and maybe help a patient understand, “You are struggling with major depressive disorder.” But the truth is it’s been a useless concept of just symptoms—and that’s not what functional medicine is. We’re looking at underlying cause.

Biancolli: In your vision of psychiatry redefined, what are your hopes in terms of how practice changes? What’s been the response from your colleagues, and how does that feed into how you feel about your mission to redefine psychiatry?

Greenblatt: I would say 30 years ago, I was tiptoeing around. People would come to me as the vitamin doctor, and then I ended up working with eating disorders, where it was easy to think and talk and give grand rounds on nutritional deficiencies for our eating disorder patients. But in the past five years, as the research has exploded from the gut microbiome to Vitamin D, nobody can argue with the science. So there is not a lot of push-back, it’s just laziness in learning a new model. And it’s also trying to break some of the hold on a traditional psycho-pharm model.

But when you think about it, it’s common sense. We’re not looking to disrupt the infrastructure. We’re just looking to enhance the model. You said, what’s the fantasy? The fantasy is every child or adolescent coming to a physician with psychiatric problems, whether it’s your PCP or the child psychiatrist, they get a battery of tests. We’re going to rule out celiac disease. We’re going to rule out PANDAS [pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections]. We’re going to rule out an infection that could be causing your OCD. I mean, it’s tragic that people wait five or 10 years before someone remembers you had a tick bite, and all your symptoms started after the tick bite.

Biancolli: We’re so used to thinking about a physical symptom or a physical deficit as being in a box. Like it’s separate and distinct from what we’re going through mentally or emotionally. Is part of it the challenge of thinking in that more integrative, holistic approach where you literally integrate the pieces of ourselves, and how we think about ourselves, and how our own conception of what it means to function? 

Greenblatt: I think so. Certainly, for optimal brain health, I think what has helped is the research on the gut microbiome. We’re all obsessed with our gut and bowels. Over the course of 10 years, the research has exploded. So now people can appreciate that what’s happening in your gut can affect brain function. We have that science. So then, maybe we can appreciate, what’s happening in your liver, and your kidney, and your thyroid: Those all could also affect brain function and depression. Iron deficiency, anemia in adolescence, might cause depression. The list is endless, but I think it is a mindset. It is thinking holistically, and remembering we have a neck.

I don’t want to oversimplify the model. I just want to bring up one point—that this functional model, looking at nutritional deficiency in particular, it just optimizes someone’s brain health, if you will. It doesn’t dismiss [something] which is just so powerful and overwhelming in our field, [which] is trauma. It doesn’t dismiss the emotional abuse that is just rampant in our kids and adults. I believe the nutritional optimization just enables people to participate better in psychotherapy, in their healing journey, if they have suffered from trauma, or tragedies, or losses. 

So it is not that same, single-minded biological approach that our psycho-pharm model has disrupted, it’s just an adjunct. We still do a careful history. We still understand who we’re talking about, their relationships, their connections, and their life, and their story. And maybe medication is needed, maybe it isn’t. Oftentimes, if we can get the kids young enough, it’s not needed.

But the Zoloft, the 50 mg of Zoloft for that depressed adolescent, it’s just a Band-Aid that might or might not help. We know it has helped some people, and we know it causes side effects in some people, but it’s just that symptomatic potential Band-Aid—without looking at some of those nutritional deficiencies. If Zoloft did help, it would be very challenging to stop the medication. So the other problem is we’re teaching psychiatrists, and doctors, and nurse-practitioners how to prescribe medicines, but nobody is teaching them how to stop medicines.

I think our goal is just to educate—and now we have the science and the common sense, and we have consumers that are really not going to tolerate just the symptomatic-based model any longer.

Biancolli: Do you have a message of hope that you convey to patients, to families, to parents of kids with eating disorders or kids with ADHD? Do you have a message of hope that you convey to them when they come to you in distress? Or, do you have a message of hope for our listeners? What would you say?

Greenblatt: Yes. I think it comes in a couple of different forms. One: Clearly, my message is optimistic and hopeful. And I think framing this as biologically based—we’re going to test and look at you, the individual who is struggling—is helpful. Because once we take away the blame—if it’s a child or an adult, the self-blame, the guilt and the shame? That becomes devastating. 

So we frame it as a biologically based illness. It’s nobody’s fault. We’re going to look carefully, and then part of that hope is helping people just understand that the human body is based on its ability to change. Our cells turn over. Some cells turn over every three days, every seven days. With treatment, we can help you change—and I think that is the message of hope. Sometimes it takes extra nutritional support, sometimes it takes looking at some of these environmental factors. Some of it looks at the immune system. It’s at times complicated, but there is a model of healing. 

So it is clearly a model of hope, because we can use words like recovery and remission in this model. Our current psychiatric model, we don’t talk about recovery and remission.

Biancolli: Dr. Greenblatt, thank you so much. I so appreciate you taking the time to speak with me today.

Greenblatt: Thank you, Amy, and I appreciate all the work Mad in America has done over the years and is doing, and if we can work together with finding solutions, there is a lot more we can do

Biancolli: Our guest today has been author and functional psychiatrist James Greenblatt. For more on his books and his work with functional psychiatry, integrative medicine, and nutrition, see JamesGreenblattMD.com, and PsychiatryRedefined.org


MIA Reports are supported, in part, by a grant from The Thomas Jobe Fund.


  1. Very interesting interview, Amy. But I found myself wondering how Dr. Greenblatt feels about the roles of trauma, abuse, and adverse life circumstances as being more of the root causes of depression. If someone is being abused or has had a chaotic and painful childhood, I’m sure nutrition can play a role in healing, but I don’t think it will get someone over the finish line to a clear resolution and healing.

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    • Hi, Ann. He didn’t go into trauma at length but did touch on it, bringing it up as a significant difference between his and the biomedical approach:

      “I don’t want to oversimplify the model. I just want to bring up one point—that this functional model, looking at nutritional deficiency in particular, it just optimizes someone’s brain health, if you will. It doesn’t dismiss [something] which is just so powerful and overwhelming in our field, [which] is trauma. It doesn’t dismiss the emotional abuse that is just rampant in our kids and adults. I believe the nutritional optimization just enables people to participate better in psychotherapy, in their healing journey, if they have suffered from trauma, or tragedies, or losses.”

      He also spoke a bit about therapy, although we had to cut that for length.

      Report comment

  2. I, too, am wondering what Dr. Greenblatt views are surrounding trauma, abuse, and adverse life circumstances, especially in early childhood in particular, and throughout all of childhood in general. And though it’s rather refreshing to see a psychiatrist apply actual (allopathic) science to their psychiatric medical praxis (as opposed to the standard fare of scientism), the absence of any mention of environmental factors upon ones mental health is a glaring omission, yet, not a particularly mystifying one to me. For above all else, the institution of psychiatry must thoroughly affix the placement of the locus of mental health issues (symptoms) ‘entirely within’ the individual biological subject. The reasons for this ‘necessity’ are complex and varied, but are, effectively, irreconcilable. Here are a but a few of my thoughts surrounding:
    1. It’s impossible to adequately, either quantitatively or qualitatively, square the environmental/historical impacts upon ones mental health with that of any “scientific”/medical paradigm, beyond theoretical, or worse, SWAG frameworks.
    2. The collapse of any vigorous and dynamic praxis from the psychology and social work professions, from which, has, over the last 40 years, bunkered between being handmaids for psychiatry and life coaches for technocratic neoliberalism (i.e., helping their charge either fit into or otherwise thrive as uncritical subordinated subjects of human capital).
    3. As Johan Harri reported in his most recent book (Stolen Focus), the vast majority of zoos now drug their animals with psychotropic drugs. The reason they do is that the animals are ‘so far removed’ from both their natural and evolutionary habitats, that they are suffering from, what is called, “zoochosis” (animal psychosis) Kind of hard to not see the state of modern mental health as not having several similar overlaps, if not panopticon implications.
    4. “Providence” :The belief and historical dominion of those with power, now having long since evolved to credentialed experts, are deemed the only credible determinants to what is acceptable, normal, true, and righteous, ergo psychiatry and its proxy practitioners in particular, and the PMC in general. In today’s mental health world, the likes of Einstein, Edison, and legions of historical figures (geniuses) would likely be slapped with one “disorder” or another, and drugged in tow. Thus what passes for abnormal mental health is very often a nugget of genius trying to find a crack in world that desperately needs that articulation.

    I’ve scarcely scratched the surface of what troubles me here. That said, Dr. Greenblatt is a breath of fresh air…

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  3. Here is a doctor making some headway towards making psychiatric care more effective.

    But it’s hard to convey my frustration – based on how I was trained – in seeing these “experts” continue to ignore the very object of their chosen profession: The Psyche.

    It is quite clear to me that they won’t get much closer to a proper view of mental health until they bring Spirit into the picture. He even mentions “spiritual” at one point. But most people who talk about this have no real idea what they are talking about.

    There is material there to be studied. They pretend it doesn’t exist. And that self-enforced ignorance continues to cripple our attempts to understand even what we are trying to do.

    To actually heal the psyche is no small challenge. To not even know what the psyche is borders on professional malpractice. These people should at least have some idea, some ability to talk about the thing I call Spirit, and its creation, the mind.

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  4. For all his incredible, unfathomable and unprecedented brilliance, I believe that, for many years, at least, it may not have occurred to Carl Jung that his very presence with people so sensitized by long suffering to that presence may in very many cases have been all it took to bring about the transformations he so sought to offer those seeking his aid.

    While I believe hydration, nutrition, sleep, chronic illness and exhaustion and more are often deeply involved in the horrible emotional states in which many of us find ourselves, I also believe that coming into close contact with any greater teacher/healer may often suffice to prompt and empower and release folks to seek and to find the rest and the physical remedies they need.

    I believe James Greenblatt, like many other doctors, such as Howard Schubiner, for instance, and some of them (also, EVEN) psychiatrists, such as Loren Mosher, H. Stephen Moffic, Joanna Moncrieff is one such healer.

    Thanks to all concerned for yet one more most magnificent MIA podcast.

    “The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.”

    “When a log that has only just started to burn is placed next to one that is burning fiercely, and after a while, they have separated again, the first log will be burning with much greater intensity. After all, it is the same fire.”
    Eckhart Tolle – “The Power of Now.”

    “When two or more are gathered in my name…”

    Comfort and joy, peace, love and laughter, and lots of it.

    And more heartfelt and soulfelt thanks.


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  5. I’ve found that any psychiatrist who uses terms like integrative, functional or holistic doesn’t accept insurance and charges more than anyone without significant means can afford.

    Every aspect of psychiatry is blind to social and economic realities. If you were disabled by psychiatry, as I was, and do not have what they call “natural supports” (financial and otherwise) you subsist on a fixed income and accept the status of social outcast untill it’s over.

    People with a platform will bandy around terms like “fraud” and “class action” when speaking about what psychiatry has gotten away with, but the reality is that someone in my situation will suffer alone in poverty and will wind up in a facility where the abuse will start up where it left off.

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