About Kelly Brogan

KELLY BROGAN, MD, is a holistic psychiatrist, author of the New York Times Bestselling book, A Mind of Your Own, Own Your Self, the children’s book, A Time For Rain, and co-editor of the landmark textbook Integrative Therapies for Depression.

"Our Beliefs are our Destiny."

-Mahatma Gandhi

From Brain-Based Medicine to Heart-Based Healing

I’ve always been confident.

Somehow, I feel like I may have been born this way. It didn’t come from my upbringing, from years of therapy, or from new-age soul work. I am comfortable with being wrong, with not knowing, but have always felt in touch with an inner reservoir of competence to get me through any challenge.

I brought this confidence to my clinical work as a holistic practitioner and have felt powerfully optimistic about my ability to help patients -  as the first stop, the last stop, or somewhere on the path. With an enormous tool kit, I have wanted to believe that I could help whomever was sitting across from me in my office.

At one point, this attitude earned me a one year waiting list for a consultation.

Now, becoming a patient in my practice is something between a Harvard application and an Okcupid.com profile assessment.

What’s changed?

In my work with Dr. Nicholas Gonzalez, I learned about the alchemy of the healing dyad. He said:

As someone who spent my entire adult life as a self-identified faithless individual, he helped me to understand that I did have faith back in my atheist days. It was in the religion of medicine. I believed that science could bring truths. Clear, present, incontrovertible truths. I believed that doctors delivered these truths. And I believed in the power of the intellect to commandeer the recklessness of nature.

Then, six years ago, my belief shifted.

It became more of a visceral sense of knowing as I watched my own body heal through nutrition, supplementation, exercise, meditation, and more purposeful living. I began to clear the cobwebs from my mind and peel them from my eyes. I woke up to the truth about information and how it is trafficked and manipulated in our society.

Through my mentorship with him, I came into better touch with my own intuition because I was learning through a trusting relationship and a heart-connection. In this space, I was able to let my frenzied brain and all of the 1000s of catalogued studies in my mental Rolodex, go. I let it all go and I listened harder for the truth. My truth. And he helped me do that. He modeled it for me, and I witnessed its effects on his patients.

He taught me that I am not meant to help everyone and anyone. He taught me that fear can destroy the most effective protocol and that faith can heal with no protocol at all.

You have to engage the medicine that is right for you. And you have to be aligned with it.

I get that now.

I want to help the patients who want to be helped. Who truly want to be guided back to themselves. Because some people need to be sick and want to be sick even when this isn’t conscious. Others harbor so much fear that I could never wrest their attention from the conventional model’s rhetoric. Still others suspect there is something to holistic medicine but aren’t ready to take the plunge, and so they fight it, while engaging it.

Now, I do a preliminary assessment to establish how willing a given patient is to shed their fear. And how much faith they bring to the healing process, to the unpredictability and complexity of their journey, and to their intuition. Faith as an active belief in the body's self-healing potential is, as Dr. Gonzalez said, the most important ingredient for healing.

Sickness as Part of Health

Symptoms and illness don't have to be scary.

Dr. Gonzalez and holistic pediatrician, Dr. Larry Palevsky speak about the vital importance of childhood illnesses, for example, to the priming of the adult immune system. An immune system in adulthood that can now be disabled by a tick bite or a bout of Mono. If we look to illness as a precursor to progress, as suffering for growth, it becomes less of something we want to beat into submission.

I own my faith now. I believe that life is an unfolding. I believe that if I live connected to a feeling of lightness and if I seek joy and focus on the wonder, I will be protected. And if I become ill or if tragedy befalls me, then I accept it and look for the lesson in it, letting curiosity and non-judgment lead my understanding. I embrace the Maybe principle.

Mind Control

You may have rolled your eyes at The Secret, or corny phrases like The Law of Attraction, and also, somewhere inside you, acknowledged that there must be some truth to it. The truth may be as simple as this:

I make this point to my patients with a simple example.

If you are walking down a dark alleyway, alone, and hear rapid footsteps coming up behind you, what’s going to happen? An entire fight or flight cascade complete with racing heart, sweating, shortness of breath, and paralyzing fear, unleashes. You see, feel, think danger. If you then hear your friend’s voice from those footsteps, what happens? All of this dissipates and you may even laugh. What has changed? Your perception. You told your body that it is safe. And your body reflected that.

I recently read Mutant Message Down Under, the story (fact or fiction) of an American doctor who spends three months (somewhat involuntarily) in the bush with Australian aboriginals. In one particularly powerful scene, a tribesman suffers a compound fracture of his leg.

After a ritual that involves chanting and the application of a clotted blood salve, the man walks on his leg the next day and even the wound heals completely within five.

I thought – what if we believed in the body’s spontaneous healing potential? We know the body can heal itself, but what if we have been interfering with it for so many decades – with Tylenol, antibiotics, steroids, and the like, that we have shifted expectations for just how rapidly and completely it can do so?

What if we were raised in a culture that believed more in the vital power of the body to heal, even spontaneously, rather than in one that believes we need man-made chemicals to outsmart it?

A contemporary example of this was carried out at Harvard Medical School where 12 patients with fractures were randomized to treatment as usual with xray studies over 12 weeks. One group was guided in healing hypnosis and the other wasn't. The hypnotized group healed 2.5 weeks faster, according to a blinded radiologist, than the non-hypnotized group.

Then there are the patients at UC Davis, undergoing spinal surgery who had 45% less blood loss when they practiced a brief pre-surgical visualization technique. Mind-set matters.

Placebo: Friend or Foe?

Once we shift our beliefs and our energetic focus, our reality begins to reflect these beliefs.

In medicine, the study of this phenomenon is called the Placebo Effect. Dismissed as a nuisance confounder in primary clinical research, it is a poorly understood but very powerful factor. So powerful that sometimes the only information that comes out of a sophisticated and expensive trial is clear support for the power of belief in symptom resolution.

In an effort to acknowledge the legitimacy of this phenomenon, the NEJM reports:

"Placebo effects rely on complex neurobiologic mechanisms involving neurotransmitters (e.g., endorphins, cannabinoids, and dopamine) and activation of specific, quantifiable, and relevant areas of the brain (e.g., prefrontal cortex, anterior insula, rostral anterior cingulate cortex, and amygdala in placebo analgesia)."

There's even data looking at outcomes of belief. In one of my favorite studies took 84 hotel attendants with cleaning responsibilities and told half of them that their daily work satisfied the Surgeon General’s recommendations for an active lifestyle as exercise. They told the other half nothing.

“As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.”

The brilliant Bruce Lipton, who has worked to awaken us to the reality of our beliefs as the most important factor in our health and wellness, and to decentralize the deterministic gene-based model, states:

“The placebo effect should be the subject of major, funded research efforts. If medical researchers could figure out how to leverage the placebo effect, they would hand doctors an efficient, energy-based, side-effect-free tool to treat disease.”

This principle is never more relevant than in Psychiatry.

With no objective tests for diagnosis or progress, psychiatry is the arena of opinion, belief, and subjectivity. Prospective patients are literally conditioned to believe in their broken brains that need chemical adjustments by Direct to Consumer advertising, legal only in this country and New Zealand. They form beliefs about what medications can do for them.

Placebo and Nocebo

In the literature, it is referred to as expectancy. Probably the most powerful demonstration of this was a study entitled The Role of Patient Expectancy in Placebo and Nocebo Effects in Antidepressant Trials . Two fluoxetine (generic Prozac) discontinuation studies including 673 diagnosed depressed outpatients were treated to in an open-label (they knew they were receiving fluoxetine)  trial over 12 weeks.

At the 12 week point, all patients were informed that they would be randomized to placebo or continued fluoxetine.

Impressively, participants continued on fluoxetine and those on placebo BOTH developed worsening depressive symptoms suggestive of two significant interpretations:

  1. The initial effect was attributable to placebo since all patients knewthey were receiving treatment (open label)
  2. The loss of benefit with the introduction of the possibilityof being randomized to placebo is the undoing of the placebo effect, or the nocebo effect.

This trial was the foundation for my clinical tenet of nonprogression with medication tapers if the patient is fearful. To engage a medication taper in my practice, there are several elements to best outcomes, but the most important one is mindset. I want patients to feel empowered by the changes that they experience through lifestyle modification, and then to approach the taper with enthusiasm about this next chapter in their journey.

There is also a rich body of literature implicating the role of belief in psychiatric symptoms relief that comes from the work of Irving Kirsch. In 1998, Dr. Irving Kirsch, an expert on the placebo effect, published a meta-analysis of 3,000 patients who were treated with antidepressants, psychotherapy, placebo, or no treatment and found that 25% of the therapeutic response was attributable to the drug's action.

This was followed up by a 2008 review, which invoked the Freedom of Information Act to obtain access to unpublished studies, finding that, when these were included, antidepressants outperformed placebo in only 20 of 46 trials (less than half!), and that the overall difference between drugs and placebos was 1.7 points on the 52 point Hamilton Scale.  This small increment is clinically insignificant, and likely accounted for my medication side effects strategically employed (sedation or activation). When active placebos were used (placebos with similar side effects to the active medication), the Cochrane database found that differences between drugs and placebos disappeared, giving credence to the assertion that inert placebos inflate perceived drug effects.

The finding of tremendous placebo effect was also echoed in two different meta-analysis by Khan et al who found a 10% difference between placebo and antidepressant efficacy.

What does this mean?

It means that what we believe can be so powerful that it directly shapes our experience. We have to reclaim our agency in order to reclaim our beliefs. We have to take back an inner sense of knowing, and to feel confident that our own intuition can guide us.

We need to go from believing this:

  • We are broken
  • Fear is an appropriate response to symptoms
  • We need chemicals to feel better
  • Science knows the definitive answer
  • The body is a collection of gears and levers

To believing this:

  • Prevention and disease remission are possible
  • Your health is under your control
  • Working with lifestyle medicine is an effective way to send the body a signal of safety and to engage vitalism - your body's natural desire for balance
  • Your journey is your journey for a reason

You have the choice to fear and stop living life like it is a minefield of infections, cancer, and random onset of predestined diseases that require urgent pharmaceutical attention. Choose to identify the beliefs that are keeping you sick. Change them. Heal.

“In fact, I am certain, there has never been a doctor anywhere, at any time, in any country, at any period in history who has ever healed anything. Each person’s healer is within.”

– Mutant Message Down Under

Featured Image Source: CHRIS JOELCAMPBELL