by Barbara Steinberg, Site Moderator, Integrative Practitioner
After attending Wesleyan University, Jonah Hershowitz's graduate studies included training at San Diego's Pacific College of Oriental Medicine, a six-month clinical internship at Chengdu University of TCM in Sichuan, China, and two years of practice at Five Branches Institute in Santa Cruz, where he received his Master's in Traditional Chinese Medicine (MTCM).
From 2002-2005, Jonah practiced in Centro Shen clinic and Ascalese hospital, and taught Thai massage in Naples, Italy. Since 2005, Jonah has lived in San Francisco, practicing in the city at San Francisco Acupuncture Group, and at Providence House in Oakland. He is the owner of Roots and Blossoms Medicine.
On a sunny Monday afternoon, I had the pleasure of speaking with him, and immediately felt his caring, devotion, and commitment to how integrative medicine can help patients with mental illness. Each case required a different approach. In his opinion, the practitioner's role included helping patients to learn to perceive their feelings differently, so they can re-learn emotional reactions to trauma or low self-esteem, among other issues. The goal was to enable patients to walk up the road to health themselves.
Jonah left a soul-imprint on me. I hope our conversation will allow you, the members of our community, to feel his goodness and respond with your own ideas and experiences in our discussion.
Please allow me to introduce Jonah Hershowitz. The following is a transcript of our conversation:
"I treat patients with musculoskeletal pain, anxiety-depression disorders, insomnia, allergies, HIV, sometimes co-treating with a psychotherapist. I try to understand what other kind of help they might need. What I do involves less about their story than their body and their physical and emotional experience, differently than either talking therapy or pharmaceutical medications," Jonah said.
"I try to affect emotions through a patient's physical state, because the body can influence the mind, which in turn affects the organs, including the heart and brain. Acupuncture does something to the body which changes the way people feel in their minds, which includes the subjective nature of each person's condition. Asking patients to pay attention to how their bodies feel when they feel emotional despair can give them a tool to help regulate their feelings. I also use lifestyle recommendations, as well as herbal medicines and certain nutritional supplements, nudging patients with numerous tools to feel healthy and secure in their bodies and minds."
I asked him about the role unresolved circumstances played in depression-anxiety disorders.
He responded, "At that point we're getting into more philosophical questions about the doctor's role. If something can be done to resolve the traumatic situation, okay. If nothing can be done, what is that person's most healthy outlook and approach? My philosophy allows for anxiety and sadness to be a normal process of real-life trauma, but when it’s dysfunctional, it goes on too long and inhibits someone’s life, it needs to be addressed. If someone's heart constantly carries the pain of loss, there are physical and psychotherapeutic ways to help address the effects of trauma.
"We don't realize we can choose how much energy we're going to spend on something we can't control. We don't have to remain or lapse into a maladaptive response that will make us deeply unhappy. The resolution to trauma and loss needs also to be internal. If the situation can't be changed, we must choose our mental strategy.
"We can empower patients by helping them gain control. When acupuncture is used to treat a knot in the stomach or a tight diaphragm, it alleviates the physical symptoms caused by mental trauma. Then patients realize they have control over some aspect of their trauma.
"We've lost the heart of integrative medicine if we don't value the strengths of how individual approaches apply themselves in different ways. Patients have to be given enough time to see what the situation is, and what methods have been tried. The goal is not to get rid of pharmacology, or to move everyone to a natural regimen. My goal is to give everyone I see the most benefit with the least risk, at the least cost.
"You have to ask, 'What's the cost of the treatment?' If the cost includes undesired effects, that's something to address. Take Zoloft, for example. If someone is taking Zoloft, but doesn't feel like themselves or can't live with the side effects, we want to find alternatives. I don't have an ideological bias about which method or result is best for a patient: it’s up to them.
"Integrative practitioners in mental health should be aware of the cultural nature of disease diagnosis. I question the exportation of a singular model of mental health onto the world, to touch on a recently hot topic. Even if we can define diagnoses according to specific neurochemical patterns, which I also applaud, we still must account for the sociological and personal manifestations of each condition, and recognize the malleable nature of mental illness. I don't believe that most mental disorders are general across time and cultures, though certain aspects of them certainly are.
"Our perception of how we feel affects, and is the result of, for example, dopamine and serotonin levels, but I don't want to place myself on one side of a false mind-body argument. I'm glad medications are taking more responsive directions, such as the partial dopamine agonist Abilify (aripriprozol), as opposed to the more digital SSRI’s. But whatever therapy is applied, chemical, psychological, or physical, the individual has to learn how to be at peace with how they feel.
"Let's say we determine someone has a predisposition to anxiety. How are they as an individual affected by that? What are their triggers? How are their symptoms a reflection of what's expected of an anxious person, or an anxiety disorder? Is it a universal disorder throughout cultures, throughout time? Or is also a specific condition that conforms to cultural expectations?
"For example, in the United States, if people have a headache, it’s unlikely to trigger a panic attack. However, chest pain could bring one on. In Asia, it’s precisely the opposite. It's not that the Western understanding of how to define mental illness is irrelevant. If you have low uptake of serotonin, you will have corresponding mental symptoms. But in New York City, those symptoms won't have the same social effects as they would in rural Vietnam.
"If we empower people, they will learn that they have more control over their brain chemistry than they realized, through those triggers and cures that are physical, mental, and social. When someone feels loved, it changes their brain chemistry. When someone experiences the death of love, a big piece of their identity has been taken away. When they find new love, their brain chemistry changes again. We can look at it both chemically and socially. Norepinephrine, or coffee and soda, can’t be surrogates for missing love.
"We can teach patients how to re-learn how they feel. Ask them, 'How do you want to respond to this?' When patients see problems differently, they can learn to cope and refocus their perceptions and assumptions. We do have a lot of room to affect people's lives using physical treatments like acupuncture, which helps relax physical tension associated with mental stress. When they can do that without the needles or medicines, we have affected our patients' own power to change how they feel. The heart of my integrative philosophy isn’t the integration of medical modalities, but that of the patient, and what choices are best for them, as individuals, in terms of what medical options they have and at what risk for what benefit.