Welcome back to the Healing Pain Podcast with Dr. David Tomasi, PhD

We’re talking about Integrative Health Programs for mental wellbeing. Joining us is Dr. David Tomasi. He’s a psychotherapist, researcher and philosopher, as well the author of the bestselling book called Medical Philosophy and the co-author of a paper called Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry, which was published in 2019 in the Journal of Global Advances in Health and Medicine. It was also the most read research item from the University of Vermont. He’s a member of several National and International Academy of Sciences.

Dr. Tomasi works in the Inpatient Psychiatry Unit at UVM Medical Center, teaches at the University of Vermont and the Community College of Vermont. We’ll discuss how the combination of psychotherapy, nutrition and exercise together can help patients in an inpatient psychiatric facility. This is an important topic because approximately 50% of those with chronic pain also struggle with anxiety and depression, about 10% also struggled with PTSD and this episode, as well as podcasts in general, really dives into how we can integrate strategies, integrate different types of therapies and approaches to help people living with chronic pain. Let’s begin and let’s meet Dr. David Tomasi.

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Developing Exercise & Nutrition Programs For Mental Wellbeing with David Tomasi, PhD

David, welcome to the Healing Pain Podcast. It’s great to have you here.  

Joe, thanks for having me. 

I was trying to think before we set this podcast up. How did I come onto your work? I know I found one of your papers but as I started reading through your bio and your different degrees and some of the great research you’re doing, I think what you’re doing is pivotal not only in the fields of Psychotherapy, but also it starts to have these overlaps into different areas of exercise, nutrition and mindfulness in so many of the different things that we talk about that have to do not only with chronic pain but many of the chronic conditions that we see. Give us a little bit about your background. You’re a psychotherapist, how did you get involved in more of this? You have an integrated flavor to a lot of the things that you’re doing. How did that come about? 

My background was a combination of neuroscience and psychology at first. My first degree was in Visual and Performing Arts. I enter the field of Psychology through art therapy. That was my first interest. I wanted to expand on what you could call the nature basis of our profession. That nature–nurture debates. I wanted to know how the brain works in particular the neurotransmitters and emotional concrete response to things. I’ve always been exercising. It was also a passion of mine. I practiced martial arts for several years. I was trying to combine these two passions of my life, the neuroscience background and the exercise science. The ultimate goal was to help people in general. As a psychotherapist in an inpatient psychiatry, I have the opportunity to witness the benefits of the more holistic approach to medicine, the mind–body connection, you could say. That’s my background. I also teach in the University of Vermont in the Integrative Health Program. 

You’re teaching as well as doing clinical research at University of Vermont? 

That’s correct, yes. My clinical hat is that University of Vermont Medical Center, the Inpatient Psychiatry unit and I teach for this Integrative Health Program, which is a shared program by the Lerner College of Medicine hosted in a College of Nursing and Health Sciences. 

It’s an interesting program. Tell us about the aim of that program before we talk about your paper. 

The University of Vermont has always been one of the very interesting places nationwide for what used to be called Complementary and Alternative Medicine. However, due to this strong emphasis on evidence–based science here at UVM, our program attempts to bridge the gap between some, I would say lack of scientific knowledge in certain areas of Complementary Medicine. We try to provide more evidence–based clinical background as well as evidence–based clinical remedies, controlled trials and the fact that UVM has been such a fertile ground for this type of research and a very strong emphasis on science makes this program quite interesting. We have different areas of specialization, including health coaching, integrative healthcare. We have students from all different backgrounds, especially from Medicine and Nursing, but also from Architecture, from Computer Science and Human Development Family Studies. It’s a hybrid, fertile ground for a self-discovery and scientific enterprise. 

I appreciate that because oftentimes, Complementary Alternative Medicine is thrown around a lot like it’s evidenced–based and there is some evidence but there are certain techniques, therapies that have just been studied more deeply with RCTs, systematic reviews and some of that. We’re still learning about them and I think it’s interesting to learn about those. I came across a paper of yours in the papers called Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry. It was in the May 2019 Journal of Global Advances in Health and Medicine. What I loved about your paper is that you’re using one of the primary modalities in the paper is exercise. Tell us what the aim of that paper was and give us some context about the participants in that study. 

The whole project started due to the very hard work that my colleagues and I, especially Sheri Gates and Emily Reyns, had been performing on the new patient psychiatry unit, they are both psychotherapists just like myself. The idea for exercise and from a constant conversation we have had over the years, Inpatient Psychiatry is to provide more of a holistic approach to the already delivered technologies of intervention, which are psychotherapy and pharmacological interventions. We won a grant in 2017, which allowed us to remodel that previously existent exercise room on Shepardson 6, the more acute unit and build from scratch, a brand-new gym on Shepardson 3, which is a union in which we deal mostly with depression, mood disorders, bipolar, borderline personality disorder, etc.  

We were aiming at offering a more omni-comprehensive background to our patients. The idea was to complement pharmacological intervention and classical behavioristic approach, so Cognitive Behavioral Therapy, Dialectical Behavior Therapy, two forms of therapy that are usually considered integrative health. We already practice our therapy, dance/movement therapies, yoga, mindfulness, meditation, Tai Chi. We wanted to focus on physical exercise as a strenuous exercise because the research there is pretty strong in terms of the modulating effects. Serotonin, dopamine, endorphins, GABA receptors due to strenuous exercises. Thanks to the grant in this brand-new research we present at each year. We were able to do just that. 

This is an inpatient psychiatric part of it. Is it a psychiatric hospital or is it just a part of a hospital that has an inpatient psychiatric floor to it? 

It’s part of the University of Vermont Medical Center, which is a hospital with all different specialties. We have two units within the Department of Psychiatry within the University of Vermont Medical Center, which is the hospital–affiliated. We own the University of Vermont. 

You took a place in the hospital that was maybe underutilized and you created a gym atmosphere to support your study? 

That is correct. Unfortunately, nationwide the inpatient‘s psychiatric facilities, whether inpatient psychiatric hospital or clinics that also offer any type of physical exercise are limited. It’s unfortunate because aside from I would say incredible results from our research, there are plenty of meta-analysis and RCT out there that were in the previous years linked positive benefits from any type of physical activities. It’s surprising that only few facilities do offer that. We are at the forefront of this separate research here at UVM. 

You mentioned CBT before and CBT has wonderful research for treating depression. If you look at a lot of the studies maybe debated by some people, but exercise is potentially a better intervention at times for certain people for depression. It’s interesting that you as a psychotherapist is turning towards that and I think as a physical therapist, it’s interesting. These are some of the things that we’ve been preaching for a long time. Tell us about the exercise intervention specifically in your study. What did that consist of? 

We’ve been also very lucky to work in collaboration with the Integrative Health Department and our Director of Education, Dr. Carol Westerville. She’s a physical therapist herself, a doctor and a physical therapist. She’s very sensitive and in a positive way to any type of research that will involve exercising in this regard. We follow closely the recommendation on the American College of Sports Medicine, in order to provide a type of exercise sessions that will work both on anabolic catabolic fractures as well as heartbeats, stretching, warm–up session, modulated exercise because due to the restriction of any business that psychiatric unit.  

We cannot do weightlifting for instance. We have several bikes standing. We have both a rower and water rowers. They also provide a seen aesthetic atmosphere with mimicking the sound and the movement of the water itself. We have yoga mats, we have gymnastic balls, we have elliptical, and we have quite a bit of equipment. We were also utilizing the help of the Department of Exercise and Movement Science at University of Vermont to target individualized plans for patients that might otherwise be limited in their range of motions, for instance. This is for two main reasons. The first one is to provide an intervention that will work right in the moment. For people that might only be able to exercise let’s say 30 minutes, three times a week in between psychotherapy session, that’s something we can implement right away on the event of what’s been happening.  

The second reason, which is even more important is to provide from a holistic standpoint, the tools that patient might need upon discharge. Unfortunately, especially in mental health, one of the risks is you do a wonderful job while you’re in a union, a supervised environment but then life happens and upon discharge, there are only few people that can follow up also due to restrictions in economic terms, and financial issues that a patient might encounter. A lot of our exercises were free–body exercises so that the patient does not have to necessarily pay for a gym membership. That’s the type of work we’ve been doing here. 

That’s great because they can take it home and hopefully that exercise program will carry over and they continue to do it at home or wherever they wind up going to next. I’m just curious, how long does the average patient stay in this inpatient facility? 

That’s one of the hardest questions just because of the nature of our job. I would speak on Shepardson 3, which is more of a mood disorder, behavioral disorder, depression. I would say the average length of stay is about two to three weeks due to more neurologically based presentations. We should take neurologically based with grain of salt because the research and the genetic background, it’s very unique. Patients struggling for instance with schizophrenia, then the length of stay is longer in many cases. It also has to do with some clinical and legal aspect related to medications, admission rates, as well as status. 

How long was your study? 

We’ve been doing the study for twelve months. We started a study right after we completed the gym. The grant that led to the extra study was that in 2017. By the time we built the gym, we created the structure and quantitative analysis over the following twelve months we collected data. 

The American College of Sports Medicine Guidelines for exercise for normal, healthy individuals, it’s quite full in terms of the number of minutes and intensity people have to participate in on a weekly basis. Were all of your patients in this study able to meet those guidelines? Are you modifying the exercise based on their feedback? 

I would say both. Shepardson 3, the fact that the biggest diagnosis in terms of the statistical prevalence will be depression. Patients were more apt to just being involved in exercise and we’re closely following those guidelines. On Shepardson 6, just because of the nature of the cognitive struggle, that some patients might have, they were not as able to perform as well in a sense of closing following the guidelines. What was interesting is that we were very successful because for other forms of therapy, including DBT and CBT, patient in the past have declined group attendance. Here at UVM, it’s not mandatory. We are very patient center facilities. Patient’s rights always come first. We don’t have any actual leverage to speak, convince patients to attend groups but exercise opened the gates for a more holistic approach.  

Even if they were doing exercise for let’s say only ten minutes, then they’ll still spend the rest of the session dialing with us and discovering other types of two of them. They may have used to nurture self-esteem and by default then coming to the next session and attend the session for 30 minutes while exercises. It was a win-win situation. The fact that we were customizing the exercises meant that we used the guidelines for the American College of Sports Medicine as a safety guideline, which is the parameters that we want to utilize to make sure that everybody’s safe from what the physiological and psychological perspective. Within those primary, we’re pretty free to move around the needs of every patient. 

In addition to exercise, you also utilize nutrition education. Talk to me about how that was a part of the study and how that informed their care and their outcomes. 

We were lucky because each of us psychotherapist beside a clinical psychology background that we all share have a different and very targeted background. For instance, in the case of our research, Sheri Gates, my colleague, her background is in Counseling. Reyns also has a background in a Dance Movement Therapy and Nutrition so we were working on the two main pillars of exercise. One of the concerns that a lot of patients had was more on a programmatically perspective, “Why would I exercise? I like food so much and I don’t know what the point is to lose weight and gain weight again, I feel like it’s a waste of time.”  

We were targeting a nutrition education similar to what will happen in a health coaching session. We were empowering patients to make more informed choices and beyond what the classical approach on calorie counts or balancing proteins and carbs. We’re working on empowering patient to be more in control of their health and that was one aspect. The other aspect was that other patients, especially those struggling with depression, were missing the main purpose of, “Why would I need to get better? My life feels empty. My life feels a struggle.” Nutrition is at the bottom of my interests. They don’t care about my own body. Emily Reyns was instrumental in this time because we use a different, not just a different, cognitive or philosophical background but different neural mechanisms in the brain to target that element.  

Attached to nutrition and food intake, you also have an emotional response. You have a pleasure center mechanism and you have a hippocampus structure that better playing a role. It was a psychoeducation session prior to the beginning of every exercise so the patient will start a day with a nutrition education session. They will exercise, after exercise, they’ll have the time to relax, take a shower and then they will have lunch. They will have this holistic, well–informed presentation on the way they can think and the way they can feel about their body. Plus, the other thing to be said is that the research is pretty straight forward in regards to the importance of the gastrointestinal tract on neurotransmission itself. Gut health is mental health after all. 

That’s great to hear you say that because there were a lot of mental health practitioners that haven’t yet ventured into that realm of gut health and nutrition. They’ve heard about it. It’s talked about in the media a lot. We talk about on this podcast all the time but it’s great to hear a psychotherapist start to look at that as far as how can we help someone from a holistic perspective. You talked about exercise, nutrition, a little bit about some of the more catchwords in psychotherapy, CBT and DBT. It sounds like the program you created with regards to psychotherapy, you’re a psychotherapist, there is always that element there but it sounds more of a motivational interview perspective to help patients make change and to accept where they are. 

That’s where we have at least aiming at. The way our inpatient’s psychiatry unit structure is we have an inpatient psychiatry unit multidisciplinary treatment team that makes those changes happening on a daily basis. The four main professional figures are psychotherapist or psychologists, psychiatrists and nurse, and then social worker meet every day for the morning clinical round. We need to plan for the day. We have this ability to deliver customized care that is based on this mutual understanding of the clinical strength each of us brings to the table during clinical rounds.  

We are also supported by mental health tech, lesson nurse assistants, secretaries and everybody’s playing a major role in the delivery care. In terms of the clinical schedule, we are lucky because we are very flexible. To give you an example, an average day you might have a morning clinical rounds that have shared with the patients. We have this open dialogue model, this patient-centered on. That patient is taking part in whatever clinical decision making is shared during the clinical morning rounds. That’s part of motivational interviewing and empowering health coaching. We have the central part of the day so we have three sessions, one around 10:00 AM, 11:15 and 1:45 that are psychotherapy based. 

You may find CBT, DBT, may might have self-esteem, grief and anger, boundaries, self-image, addiction and recovery, substance abuse. These types of groups are very cognitively based. Each day starts with a morning checking and evening checking in which we set a base for the day. Every other element, there is pretty much exercise, Tai Chi or yoga. We spend a lot of time working with our bodies and that’s something that provides a good rhythm. Part of being a patient in inpatient psychiatry is having a civil routine that also helps frame the day. Having a sense of duty every day, something that’s waiting for you, something that has to be done that moderates patients, “I need to do this.” The team creates a sense of familiar environment as well.  

It’s a great structure. It sounds similar to many of the interdisciplinary or multidisciplinary pain clinics that the US used to have more of them. We still have some but not as many as we need. Let’s go back to your study, have we gone through some of the details about it? Tell us what some of the outcomes were and how you first, what did you use to measure the outcomes and what were the results?  

There is that they were very exciting too. To be fair, we were expecting positive results in general just because again, there’s a big body of evidence out there on generally speaking, the positive benefits from exercise to any type of exercise for depression. What was surprising is that we were between 93% and 95% positive results across the spectrum. Both units, mood disorder, neurologically–based disorders, personality disorders, schizophrenia, schizo–phase, so the vast majority of patients in the 90th percentile benefited from exercise. Saying that there were some differences between all the type of exercise they were doing, but in general there was a very high percentage. We were also lucky because it was a very controlled environment, so we were able to follow patients closely. There weren’t senior size performing the past on an outpatient setting, but it’s hard to monitor the benefit of something else happening their lives on a daily basis because you don’t have the chance to observe patients.  

In our case, it was very controlled, as controlled trials as you can get. Also, we wanted to emphasize the qualitative analysis. Beyond the numbers that were very exciting for us, we wanted to create a survey, a questionnaire that focuses on pain perception and mood perception. Granted one of the big questions we had is how reliable are surveys that are qualitative structure in comparison to for instance, collecting vitals, which we did anyway and we are planning to expand this research. I will mention that. How reliable is this quality of analysis? The big answer is if you had very strong data and you have pretty good vitals, but then those data, those numbers do not reflect in the way a person feels then you miss the point. It’s great for the research but for us researchers, we wanted to make sure that the patient felt the difference.  

You serve as not only target, the general wellbeing pre, post–exercise but also their mood, their sense of self, their favorite exercise and whether they will envision in the near future, continue exercise or making some life changes and that was exciting. The narrative part, as much as the numbers were great, it was even better because the patient will be able to work in a pragmatical way. We do that in CBT. We target distortion, we do motivational interviewing, but if the patients were able to utilize their own proprioceptive apparatus and no susceptive apparatus for the perception of pain and lack thereof was fantastic. 

I appreciate that because it’s so often we look at studies and there’s “statistical significance” and people get excited about that but the qualitative part brings the patient’s story and it’s like, “Well here’s the stat of how someone got better and here is how they responded. Here’s what they said about the quality of their life and how their life changed based on this study.” There are few studies that weave those two together. I liked that you included that in your study. From the perspective of professionals who might be reading your study, we could take psychotherapists first which includes psychologists, social workers, all different kinds of counselors, marriage and behavioral therapists, how does it influence their work and potentially their clinical work going forward? 

I would hope that besides what is becoming somewhat of a commonplace to throw the term mind, body medicine everywhere. People pay attention to what that means because those two are not two separate fields. There is something to be said from a more theoretical, philosophical standpoint. One of the reason that I personally decided to join my team and started working on this research was a sense of duty, a sense of expectations so to speak, that I had when I was discussing existential question with my patients and that was related to the nature–nurture debate, to the mind body debate or a mind brain debate. There is no time here to do a philosophical discussion. Those topics are very complex. In practice, one of the things to keep in mind is that regardless of the philosophical, religious or ethnic–cultural background patient may have, it is a fair assumption that at least we could say that there is such thing as a mind. You can call it a psyche. You can call it a soul depending on your background and something matter based like a body and brain. This assumption is healthy in a sense they provide a framework upon which any type of psychotherapeutic intervention.  

The fact that by we’re treating your thoughts, you can have an impact on the way your brain works. That’s one of the greatest things about psychotherapy but then the brain, we should think about embodied cognition that we think through our bodies. The brain is a fundamental element and I’m a little biased because I love my neuroscience research. The truth is that we think with our body and philosophy aside, the research is pretty strong. I would hope that my colleagues, whether they are focused more on pharmacologic intervention or talk therapy, they will understand that those things should not become separated. When you throw the patient, you throw the mind and the body and what the mind does not want to accept right away and that will be the case for instance of a typology of behavior that might be obsessive, compulsive or traumatized in general. Then you may reach that inner core of their mind or soul through their body. That‘s the type of change I hope my colleagues will implement more and more. 

Does that mean you hope that there is less sitting in traditional psychology and so maybe some more moving, which can be tough for a psychologist? It’s not just tough for a psychologist to change their practices. It’s tough for any practitioner to change their practice patterns and habits. 

That is absolutely correct. There is something that should be said about the long–term research structure that we have implemented. This exercise or study was focused on that status quo to ameliorate, to improve the situation in a business psychiatric unit and by way of testing it out in our hospital possibly, share our results nationwide so other facilities could do the same. In the long run, our next research will involve a more holistic approach to virtual reality and olfactory bulb stimulation and ensure what we are trying to do. Originally, we were probably starting about a month or so. I’m not going to have, we will work on this concrete structure and neurological systems that will otherwise be and utilized for patient, for instance, have had major physical injuries and are therefore not in a position for any type of exercise. We will use this same neurological structure as if they were moving for real. Similar to what’s happening in neurological response, when you think about, it’s like tasting lemon and you start to salivate, automatically response and the logical level, that’s where we are going to test again.  

We had the wonderful opportunity to work with this company called OVR Technology here in Burlington, Vermont, Olfactory Virtual Reality. It’s a combination between the olfactory bulb simulation and our sense of smell is one of the most powerful senses because it almost completely bypasses the style of modus and goes straight to the cortical area. It has a strong motivational component to it combined with virtual reality, so in practical, we’ll have this virtual exercise session. It will stimulate very similar cortical areas as if you are exercising for real. You can ambulate around the natural environment, you can interact with the plants, trees and the flowers and those marshmallows.  

The brain will start to get used to this 360 type of movement. You set the standard neurological safe response and with that said, once your brain is able to see, to feel that there is something more out there then the whole body will respond. It’s like explain to someone who does not know how to read alphabet, how beautiful is to read a book, if you haven’t experienced it, it’s hard for you to guess it. For our patients who might be otherwise not able to exercise right away because of limited range of motion due to physical injury or because depression keeps that in bed all day. The second part of our research will provide us with more cognitive leverage to achieve just that. 

In essence, you’re setting up a safe context for them to start to develop an engagement of potentially moving later on whether it’s weeks or months or potentially even years down the line for them. 

We have a pretty solid evidence that at least from the neurological standpoint, those cortical circuits are the ones are responsible for our emotional response and they are also involved the immuno-neuro response but the teaching by example, that’s what it is. Since we have the neuroscience that we have a pretty good theoretical framework upon which to base our intervention, then I would hope that we as practitioners will also move more with our patients. Maybe they will change the structure of our clinics too. Our office will become more I would say, customer friendly. I don’t like the term customer for my patients, but you know what I mean. 

As I was reading your study, I’m like, “What?” I worked in a hospital for the first three years of my career. The hospital had an inpatient psychiatric floor, which I would occasionally go to help certain patients and to be honest with you, it was a dark place. There was not a lot of lighting. There was a bed, probably like if I remember correctly, blue color on the walls and there weren’t a lot of lights, the windows are small. There are bars on the windows. I can go down the list of different things, but when I read your study in the hospital itself, you start to create more of a nurturing, healing environment and contacts for patients to recover in. That’s what‘s interesting to me. I don’t know how many papers are out there like yours, but then you start to look at, “What is our healthcare system like and what do we need to, deconstruct and rebuild that can help people?” 

That’s a very good observation. In our study, the exercise itself and the fitness equipment we purchased, we made a lot of changes to the environment. We have ceiling tiles, we have posters, we have nature images everywhere, we have a healing garden downstairs and the patient can access this garden twice a day, we have a big veranda overlooking Mount Mansfield, a beautiful view here in Vermont. It’s beautiful in the summer and we have the falling season. It’s great, especially during those change of season that might affect seasonal affective disorder as well as the depression. Again, there’s something to be said about the expectation they start with therapy. Unfortunately, as much as I would say that here in the US, more and more holistic approaches are utilized in medicine and psychotherapy and everywhere. There is still some suspicious attitude towards that, some of which is justified. Unfortunately, especially we are complementary alternative medicine, some of the claims are not evidence–based and we should be careful about that.  

It’s a fight for science that we should fight every day. Sometimes the general attitude is that all those approaches are nice, embellishing the therapy that are now making major changes, even exercise. If you’re suicidal, you need to take an anti-depressant and do psychotherapy, if you have time, you can also do exercise. We have to change that mindset. Granted the opposite extreme can also be a risk, for instance, thinking that if you have a mental health disorder, you could pack your bags and we’ll try ashram in India. You’ll find your soul and all your problems will be solved. They’ll be fantastic if it was a case, maybe a little expensive to travel to a place, maybe not as expensive of our current healthcare system in the US but it’s unfortunately not the case. Mental disorders are real disorders, as well as the other medical problem. We should try to combine the two poles without any extreme views on it, but the body is the host of our brain, leads for the mind believers.  

You’re saying there are parts of Europe that may be a little bit further along in terms of providing integrative healthcare to people who need it. 

There is something to underline in terms of the differences. They’re two very different systems. Granted you could say that EBS evidence–based medicine in Europe is the same in the United States. We share research, we share the meta-analysis and we share training. There are some important differences. One big difference is due to the historical, anthropological framework. It was different. I want to give you a story. For example, the way medicine started in the West is pretty much a product of the age of enlightenment, I would say. The 1700s, 1800s on, there is a strong emphasis on the scientific method, the positivistic attitude, the fact that we need to test our claims, that we cannot rely on anything that’s either philosophical, spiritual, we need to test our claims and it’s a fantastic thing. 

That’s the thing that allowed to discover vaccination and led to the discovery of antibiotics. It’s a fantastic thing. One of the differences is that in Europe, this type of medicine was a natural evolution from millennia–old tradition. It was a gentle progression so to speak with setbacks and that’s how science progresses. In the US, there was some cut–off, some interruption between the traditional Native American holistic tradition and the European evidence-based that came from countries like the UK, Germany, Italy. We need to rediscover those roots that were uprooted in this part of the world. To combine traditional forms of healing with solid science is what it’s needed at this point.  

That’s one of the differences between Europe and the US. For instance in the US, you can find clinics that will offer a traditional Chinese medicine but one of my field of expertise is traditional European medicine. It’s possibly unknown here in the United States. It doesn’t mean you have traditional European medicine in the first place. Many times when it mentioned it is labeled, people might look at me, “Is this some conspiracy theory with pseudo-scientific claims makes with Shamanism?” Which is absolutely not true, but that tells about the separation between everything that led up to the fantastic discovery of European and the traditional remedies.  

The universal healthcare and readily free education in Europe, which allows for a more direct approach to give us for example the training of a physician is the same, speaking between Europe and the United States. The way physicians are perceived in Europe, it’s still part of the tradition. Traditionally speaking, there was a difference between physician and surgeons and that’s part of what the name of the degree is in the UK and the Commonwealth countries. You get a Bachelor’s in surgery and medical bachelor. The physician is the person who does research and it’s on a higher standard. Being in surgery used to center to the person who was hands–on, operate on the patient. Then to be claimed to have a full Doctorate that you need to get a PhD in your field. That’s one of the differences between European states and our thing is the way mental health is perceived.  

We mentioned Germany, we mentioned the United Kingdom, in Italy for instance, there are no psychiatric facilities by law. There are no psychiatric hospitals, no inpatient units since 1976. That was due to the implementation of this law called Legge Basaglia, that attempted to understand mental health disorder as holistic disorders not only about just a person but society as a whole. Since the patient could get sick, society could get sick as well. We need to be together in order to achieve more balanced outcomes. From that background, in Scandinavia but especially in Finland, this open dialogue model was developed that allows patients to not just be informed but take part in the clinical decision making. That is where I like to some extent reinforce some European flavor to the US. 

That’s an interesting perspective because then if what you’re saying is the case, then society has a role and responsibility in helping and taking care of people versus at times the United States we have very much health is your responsibility. It’s not, your health is your responsibility and I don’t necessarily have an influence or responsibility for your health. 

I like to think of it as throwing a stone in the lake. It might be the stone, but then the reverberating effect of the waves will affect the surrounding environment. We should bring them away from the blame game, “I’m guilty. I’m responsible.” We are on this together as cheesy as this may sound. That is the truth. Your environment will affect who you are and you will play a role that will affect your environment. 

How does your research help inform what’s happening in today’s opioid crisis? 

That’s our hope that this research and some other research will change the way we look at things. The opioid crisis especially in the Northeast of the United States and unfortunately here Vermont, we’re playing a big prize is to some extent, a combination of societal mistakes, system mistakes as well as lack of personal responsibility. At least lack of personal knowledge, lack of empowerment and we are guilty in that sense. The medical system, for instance, played a major role in the way opioids were prescribed starting in the mid-‘90s and for the right reason. Nobody likes to see their patients suffering. My colleagues in the past and currently dealing with the opioid crisis, deep in minds seem to be the moral, the ethical thing to do so to prevent pain. Unfortunately, like with every other shortcut and from a quadrant intervention is to some extent a shortcut, then you have to pay the price.  

The problem is not that painkillers are not working. They’re working too well and people rely directly so on the trained ones. There are experts in medicine, the doctors, and that’s how the opioid crisis started in the mid-‘90s. Nowadays, it became a much more complex issue and beside prescription drugs, this addictive personality that our society is being effective for the last twenty years. It’s something that we all in together and there’s something about exercise. First of all, it’s stimulating to exactly the same neurotransmitters that it will be otherwise, if not complete stimulated, at least modulated by antidepressant for instance. 

If you exercise, you’re still going to target serotonin, dopamine, b-endorphins and GABBA, so you’re going to do exactly the same thing. I want to make sure that people do not misinterpret that. Let’s get rid of all medications and exercise instead. It was two better different things and just as an example, you need to move away to do your problem. That’s not the one I’m implicating here, but you can teach your body or reteach your body how to secrete and modulate those neurochemical responses by way of controlling your body. In that sense, you will have a more balanced way to deal with your problems. I also want to mention that this should be something that will be very useful in this time of change. Beside abuse of prescription drugs, painkillers, opioids but also marijuana for instance, that is one of those substances that’s often discussed in the public sphere. 

Unfortunately, just because of our politicized environments, we merge the scientific, the legal and the moral or religious elements altogether and we had to make big distinctions. For instance, why a better is strong evidence of the benefits of cannabinoids for pain management for instance, from a hybrid, matching of physical pain and psychological pain as well, high tolerance for pain. In fibromyalgia for instance, there plenty of surmounting evidence, then we have to be extremely careful when we deal with neuroreceptors that are especially sensitive to cannabinoids. When we’re dealing with mental health disorders, we are also playing with the fire. While more and more research are needed to monitor the facts of any type of chemical intervention, whether it’s plant–based or artificial lab–based, that exercise has virtually no side effects if it’s done appropriately under supervision. 

It’s something we talk about all the time. We’ve been talking about it for probably several years. I want to thank everyone who follows along with that message and it is getting out there. It is changing but these are problems that have multiple levels to them. David, it was great talking with you. I look forward to reading about more of your research. Can you tell everyone how they can learn more about you and the things you’re up to? 

They can go on my website, DavidTomasi.eu. Google University of Vermont Integrative Health. That’s our department and there’s a whole list of research studies. The programs that we offer both for graduates and for continued education. If you want to be updated with my research, you can go and research gates or academia and you can find all the free downloadable, peer–reviewed papers there as well. 

I want to thank David for joining us once again on the podcast. You can find out more information by going to www.DavidTomasi.eu or go to University of Vermont and check out his page. I want to thank David once again. We’re talking about the intersection between mental health, nutrition and exercise. Make sure to share this out with your friends and family. We’ll see you again soon. 

Thank you, Joe. 

 Important links:

• Medical Philosophy 
• Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry 
• OVR Technology 
• University of Vermont Integrative Health 
• https://DavidTomasi.eu 
• https://Twitter.com/LagTomasi  
• https://Journals.SagePub.com/doi/10.1177/2164956119848657 
• https://www.Facebook.com/medicalphilosophy 

About Dr. David Tomasi, PhD

Psychotherapist, Researcher, and Philosopher Dr. David Låg Tomasi, is the author of the bestseller Medical Philosophy (Ibidem, 2016) and the co-author of Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry (Global Advances in Health and Medicine, 2019), the most read research item from the University of Vermont (Researchgate, 2019). A member of several national and international Academies of Sciences, Dr. Tomasi works in the Inpatient Psychiatry Unit at the UVM Medical Center, and teaches at the University of Vermont and the Community College of Vermont.

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