Integrative Psychiatry

  • An approach using all elements of mind, metabolism and body
  • Food as medicine
  • Medicine only where needed
  • Psychological approaches as part of the picture

Our brains are part of our bodies and embedded in our metabolic forest. The idea that simply working on the brain and neglecting the rest of our metabolisms and bodies is really rather silly. In recent years I have finally begun to bring together all the elements of my professional and personal lives into an integrated picture.

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I started out in medicine as a GP, then moved to adult psychiatry and finally children and adolescents. Along the way I took in family therapy, realising that, even there in psychiatry, looking at a part of the system made no sense: children and adults are embedded in a family system (or forest) as well. Perhaps this was an early glimmer of what I would come to realise later.

Personally, I have always been a firm food lover and enthusiast, and in 1999 as part of that I founded the Italian Wine Club with my close friend Andrew Scoones. In the mid-noughties I started to have symptoms of heart disease, something that runs in my family. I have had many procedures and much angst around this disease process. But it finally made me realise that simply popping drugs (and even doing a bit of exercise) was not enough.

Statins made me feel dreadful and I was also just getting worse. I turned to my colleague Lisa Steel, Naturopath and Nutritionist, and together we have found me another way to be. One that involved dietary, lifestyle and metabolic change. Over ten stents (I have lost count) and one cardiac bypass later I am still here, swimming, exercising, working as hard as ever and feeling much better. It is an ongoing project. For more about Lisa’s work please see

It made complete sense to start to apply this with my patients. People coming with, for example, depressions sometimes do need tablets and CBT, or individual psychotherapies. Sometimes they need family work. But sometimes they need to look at their metabolic setup and change their gut, endocrine and immune system functioning. This then impacts on their ability to synthesise neurotransmitters, and brain functioning generally. Conventional medicine is getting there, but slowly. I now regularly meet, work and talk with another nutritionally-based colleague, Lucinda Miller.  Lucinda shares my interest and feelings about the importance of food and nutrition as an approach to full health and has been working in this area for many years.  She, too, helps to inform my thinking and approach to a scientific basis for addressing mental health and metabolic difficulties.  This is not speculative stuff.  More about her work can be found on

In my view practitioners like Lisa and Lucinda are ten to fifteen years ahead of the game in their approach to individualised medicine. In our practice in the last ten years I have seen, time and again, changes in diet along with some (often temporary) dietary supplementation with what are called nutraceuticals (as opposed to pharmaceuticals) make a real difference. When I first wrote this site the gut microbiome had not been heard of in the wider public arena – now it is becoming mainstream but perhaps still less so in psychiatry though it is getting there.  Unfortunately the Medical Insurance Industry is largely not yet on board (see back page).

It is not always easy, but it works for those who can do it. It is not for everyone, but it becomes apparent quite soon who will and who will not benefit. I can now integrate my skills in all the areas of medicine I know about, as well as bring my love of good food and eating into my practice. This way I am more integrated and so, I hope, are my patients. If you know that eating a particular food makes you feel weird, or even better, you can regard that as medicine. There is little difference.  That said, I wholeheartedly agree with the statement that food is not medicine: food is food and you have to enjoy it.  In fact there are studies to show that if you do not enjoy it, you will absorb it less well and it will not nourish you as well.  So there you have it.

Increasingly, I adopt a twin-track approach using some conventional drugs where they are not harmful, and moving over to dietary and similar approaches for the longer term. This is not easy because the approaches sometimes conflict. This is where having the dual view is invaluable and I will work with other practitioners in joint sessions and increasingly debate matters in front of the patient, if appropriate. For those of you who are interested, this is allied to a systemic approach pioneered by a Norwegian family therapist, Tom Andersen, in the late 1980s.

I enjoy my work more using this thinking and I feel more honest and healthy in my practice. I hope you would too – that, after, all is the aim of coming to see someone to help, isn’t it?