I recently heard the podcast of a famous psychiatrist who is bringing "Positive Psychiatry" to new light. Kudos to him. In simple terms, Positive psychiatry is the idea of patient well-being included while treating a patient in psychiatry. His opinions and future is accounted for in his treatment. BTW currently its is not. Not in practice at least. Psychiatrists themselves often state that psychiatry is mostly pharmacology (medicines) oriented to treat symptoms and they do not think beyond that. Positive psychiatry brings to light a clear gap and wishes to address it. Surveys have found that what patients want from psychiatry and what clinicians believe patients need are different.
Dr. Dilip V Jeste defines Positive psychiatry as the science and practice of psychiatry that seeks to understand and promote wellbeing through assessments and interventions involving positive psychosocial characteristics in people who suffer from or at high risk of developing mental or physical disorders.
Positive psychiatry states that professionals must seek to address patient desires in life and not look only at functionality. Research has found that when a person experiences a positive affect, he tends to have lower inflammations too. So in autism, their gut health, their limbs movement etc find meaning here.
Psychiatrists now have a choice. Go the “only medicine route” or embrace more and help the patient with positive psychiatry in mind and have a chance to engage longer. When I was discussing this with my father, he stated that when a family doctor entered Indian homes in the 1980s; the patient felt instant relief as he knew his entire well being will be taken care with a more personal touch as well. These family doctors usually knew the dynamics of the families they worked with and were able to provide more holistic solutions.
Though it is not in the DSM, “Wellness Deficit Disorder”, is a growing term. Gallup survey has shown that well being has decreased in all states in USA. Wellness is a human trait to flourish. Happiness, resilience, enthusiasm, a will to live against all odds, courage to move on, acceptance. For all these, patients now go more towards therapeutic environments and Holistic healers. Did psychiatry miss an opportunity here ?
Medications in autism, sometimes make the child lethargic and sleepy. It is often given to reduce hyperactivity and help him be more available to learn skills. Though children learn through this, the journey back to being themselves, tapering down etc needs a psychiatrist who is able to see long term, prioritise wellness, hand hold families and believe in a good Quality of Life for the family. I work with psychiatrists who believe in these !
Psychiatrists refer patients to psychologists stating, that a more holistic development be prioritized when treating autism and not be stuck on Behavior or Speech alone. Perceived wellness is the ability to experience positivity in life. You will now slowly see hospitals introduce this new term. "Well being Therapy"-WBT. It can be combined with Cognitive Behaviour Therapy too. WBT targets curiosity, engagement- the will to do, gratitude and much more. There are 30 day programs which help build enthusiasm costing lakhs!!! I do these too! But there are ways we can ensure that autism experiences positive well being from day 1.
As Indians, our households always hold many practises which infuse well being. Make children a part of them and prioritise culture. Be a part of it. Be it eating home cooked meals together, visiting a temple seeking for courage, langar at a Gurudwara, packing charity boxes during Diwali, Yoga, pujas, meditations, talking to extended family members, festivals, socialising is a large part of well-being. Prioritising it is natural in the Indian culture and very much practised in villages. Lets continue to practise well being methods well known to us and spread awareness.
Psychiatry is suppose to aim to enhance human potential and not reduce symptom alone.
A child until 6 years of age at least is not prescribed medication in autism - most of the time. So psychiatrists felt there was no role when they are very young! If Well-being had been taken more seriously and included, they too would have a role! They can champion parents towards better Quality of Life and emotional regulation in child and families by becoming their guides. One wonders if therapists are sufficiently trained in well-being areas as we often see them using only behavioural approaches across all disabilities. Autism needs a lifestyle through parents and society which helps them get better. First it needs people to believe in them and know the path to their well being.
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