Positive Psychiatry - with Rakesh Jain, MD
Positive Psychiatry with Rakesh Jain, MD explores the science and practice of fostering mental wellness, resilience, and flourishing through the lens of psychiatry. Join me as I discuss articles and opinions from expert clinicians, researchers, and thought leaders as they discuss emerging strategies to enhance well-being, purpose, and strengths—not just reduce symptoms. From gratitude and optimism to meaning and connection, this podcast brings evidence-based insights into the heart of mental healthcare.
I am additionally a proud member of the Steering Committee of Psych Congress. This year's annual meeting is September 17-21 in San Diego, California.
Positive Psychiatry - with Rakesh Jain, MD
Beyond Symptoms: The Promise of Positive Psychiatry
Psychiatry finds itself at a crossroads. For decades, we've focused on symptom reduction—targeting depression, anxiety, and other mental health challenges with medications and traditional therapies. But something crucial has been missing from this equation.
In this inaugural episode of Positive Psychiatry with Rakesh Jain, I reveal what patients truly want from mental health treatment—and it might surprise you. Drawing from groundbreaking research by Zimmerman and colleagues at Brown University, I share how patients rank their priorities differently than clinicians expect. While symptom reduction matters, patients place even greater importance on regaining life satisfaction, finding meaning, and recapturing joy.
As a psychiatrist with over three decades of experience, I've witnessed firsthand both the triumphs and limitations of traditional approaches. That's why I introduce the concept of positive psychiatry—not as a replacement for conventional methods, but as their essential complement. I explain how psychiatric disorders don't just cause negative symptoms; they actively erase positive psychological traits like optimism, resilience, enthusiasm, and happiness (the "HERO" traits).
The science behind positive psychiatry is compelling. Brain imaging studies show optimistic people have larger gray matter volumes in key regions and different activation patterns in emotional regulation centers. Even more fascinating? Positive emotions can actually lower inflammation markers in the body. This isn't just feel-good psychology—it's neurobiologically sound medicine.
I also introduce evidence-based interventions that work, including Well-Being Therapy and the Wild 5 Wellness Program, which has demonstrated remarkable results in just 30 days: 51% increases in enthusiasm, 63% improvements in resilience, and 43% reductions in depressive symptoms.
Join me on this journey to expand our definition of successful treatment beyond symptom elimination toward cultivating true wellness. Subscribe to future episodes as we explore practical strategies to help patients—and ourselves—build lives filled with meaning, joy, and resilience.
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www.JainUplift.com
Well, hello, dear friends, welcome to this podcast Positive Psychiatry with Rakesh Jain. Hello everyone, and welcome to this inaugural episode, and you might be wondering who I am, so let me briefly introduce myself, and then I will perhaps give you a bit of an understanding of why I think this podcast may be of some benefit to you, whether you are a mental health professional or otherwise, a clinician or otherwise, just someone profoundly interested in optimizing mental health. So my name is Rakesh Jain and I am a psychiatrist. I'm a clinical professor of psychiatry at my medical school. I'm also in practice and this is my I was counting this back I think my 31st year in psychiatry, and let me tell you I have learned a great deal about what I've done right, which is substantial, but also what I have not done right over the last 31 some years, which, I hate to admit, is also fairly substantial. So I'm very much looking forward to having deeper discussions about positive psychiatry with you, and my hope, of course, is by doing so we elevate the very cause of mental health care, never, ever rejecting the concept of traditional psychiatry. It is a lifesaver for thousands, millions of people. It really is. My own family has benefited a significant amount from the offerings from traditional psychiatry, but the missing piece has been a lack of focus on positive psychiatry. So here we go, and perhaps the question we could ask ourselves is, instead of just asking ourselves, how do we reduce depression, perhaps if we asked ourselves, how do we reduce depression, but how do we also build happiness, optimism, resilience, enthusiasm. That, my dear friends, is the promise of positive psychiatry, and I'm very thrilled to be exploring that concept with you, not just today, but on a regular basis. I will offer you podcasts so that you can perhaps be as tuned into what's happening in the world of positive psychiatry. So my essential goal is to reimagine mental health treatment, not just from symptom relief but from a flourishing life.
Speaker 1:As clinicians, our goals often are symptom-focused. We should continue doing so. We want our patients to stop feeling anxious or sad or tired. But have we really asked what patients really want? And throughout my podcast I'm going to make sure that I'm deeply grounded in the scientific literature, and one of the most impressive studies I have seen on this issue is one from Zimmerman and colleagues from Brown University, and in this particular study, patients were asked what do they wish they derived from their treatment with a health care provider. Of course, the same question was asked of mental healthcare providers and they thought the number one thing that patients wanted reduced were their symptoms of psychiatric disease disorder. But that was not the case with what patients wanted. They certainly did want that, but that was the fourth most important thing that they wanted. You might be wondering now what are the top three things that they wanted? So, at number three, they wanted to regain interest and pleasure in doing things. They wanted that even more so than just the mere reduction of their symptoms reduction of their symptoms and, of course, what they really wanted was feeling satisfied with their life, ability to enjoy life and feeling that life is meaningful. So there is a disconnect between how we clinicians perceive our patients' interests and what patients want. Therein lies the reason why the birth of positive psychiatry, which occurred not all that long ago, is in fact very, very important.
Speaker 1:So what is the definition of positive psychiatry, you might be wondering? Is it in fact a rejection of what traditional psychiatry is? And not one bit. It isn't. I'm a dyed-in-the-wool traditional mental health care provider and I wish to continue being. I do want to expand what I offer my patients, my clients and Dilip Jeste MD, a psychiatrist from University of California in San Diego in 2013 was the president of the American Psychiatric Association, and in his presidential address and in his writings, which he published in the Journal of Clinical Psychiatry in 2015, this is what he defined positive psychiatry.
Speaker 1:As he said, and I quote, positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being, through assessment and interventions involving positive psychosocial characteristics, in people who suffer from, or are high risk of developing, mental or physical disorders. Isn't that a pretty spectacular definition of what positive psychiatry is? I hope you will note it is not at all a rejection of what we do already, which is using DSM to diagnose our patients, to offer them treatments, psychotherapies to reduce their symptoms, and pharmacotherapy reduce their symptoms. That's all fantastic. We help our patients improve functionality, which is great, but something really important is missing. If we think about our patients and their desires, what they're really missing is wellness. They are saying that in survey after survey, and we really ought to be listening to our patients.
Speaker 1:Oh, I should also perhaps remind you that positive psychiatry is not just positive psychology. Positive psychology is profoundly important, but positive psychiatry is something that all prescribers and non-prescribers can embrace, and there is a profound neurobiological benefit patients derive when their positive psychological traits are improved. So, for example, take optimism. Let's just use that as an example. Well, brain imaging studies have shown that optimistic people have larger gray matter volumes in key areas of their brain like the thalamus, the parahippocampal gyrus, and get this. They also show lower amygdala activation in response to negative stimuli and higher activation in a part of the brain that's really important in the regulation of both negative moods and positive moods, that being the anterior cingulate cortex. Isn't that fascinating All of these psychological traits that we can really help our patients enhance. Heck, we can even enhance them in ourselves. We clinicians need as much positive psychological traits as we can have. They, in fact, are both alterable quickly We'll be discussing that in this and future podcasts but, quite fascinatingly, positive emotions can lower inflammation and studies have shown that people with high positive affect have lower levels of pro-inflammatory markers like IL-6 and C-reactive protein. That's right, dear friends. In some ways, awe and joy and wonder are anti-inflammatory.
Speaker 1:The question we should perhaps pose to ourselves is this Should we, as prescribing clinicians, only focus on medications here's the right dose to take, here's the side effects to avoid and bid our patients goodbye, or should we embrace positive psychiatry and its elements in order to enhance our patients' genuine well-being over a prolonged period of time? Okay, now I will shift our attention for a second to a concept that I and Dr Sandra Jan gave birth to perhaps 15 years ago, which is tongue-in-cheek, a disorder we diagnosed America with, and we've published that in both journal articles as well as a book, and that is the concept of wellness deficit disorder. Oh sure, nothing like that exists in DSM-5-TR. I am quite aware of that. But before you reject what I just said completely out of hand, think about it. Isn't wellness a essential, a crucial, a necessary human trait to flourish? And if it is diminished, then why don't we adopt the concept of wellness deficit disorder? It makes sense to me, does it not? Well, I didn't want it just to make sense to me. I wanted to show if the evidence in fact supports that America is suffering from a wellness deficit disorder and our patients perhaps even more so. So guess what? Yes, there's a Gallup survey from 2017 that showed that well-being decreased in all 50 states. In America, depression, daily worry and loss of interest has risen dramatically, and that was 2017. Can you imagine post-COVID and now where we are with our wellness. We are, dear colleagues, in fact facing a hidden epidemic. It is fair enough to call it a wellness deficit disorder. So here's a take-home message for us Psychiatric disorders don't just cause negative symptoms, they also erase positive traits.
Speaker 1:They also erase positive traits such as happiness, resilience, enthusiasm, etc. So I and Dr Sandra Jain in fact conducted a survey, a nationwide survey, in fact. We invited international individuals to be part of it too, and this is what we did. We created a particular scale to measure these wellness traits happiness, enthusiasm, resilience and optimism. You're welcome to think of them as the hero H-E-R-O wellness traits. We'll be talking about that a great deal in this podcast series, but we looked at where Americans are if they didn't have a psychiatric disorder and, generally speaking, we're not where we need to be. But here's the really bad news. The bad news is, if a psychiatric disorder was present, each one of these wellness traits were further decreased as a result.
Speaker 1:I do believe that I'm on the right track in saying that, yes, wellness deficit disorder is a real entity. You and I should be aware of it and, as clinicians who embrace traditional psychiatry, we should expand our thinking and think about positive psychiatry as a good friend to you and I and our patients. All right, let me transition now to talking about what? About antidepressants and positive psychiatry, and not just antidepressants, but a whole host of medications we use in the world of psychiatry to help our patients. How do medications fit into this conversation? So interestingly, antidepressants can both help, but in some people it can in fact hurt their positive psychiatry traits.
Speaker 1:So there is evidence for mixed findings. Some people genuinely, after improving with the help of their medications, see a reduction in their negative symptoms. They see improvement in their resilience, and that's wonderful. Improvement in their resilience, and that's wonderful. We want that. But I am here to alert you of something you perhaps are already noticing in your patients, which is about oh about a quarter of them in fact feel a reduction in their perceived wellness, in their perceived ability to experience positive emotions, and in a large number of patients we do improve their symptoms, but we don't improve their inner mental health. And this is where your and my adoption of positive psychiatry as a guiding force along with traditional psychiatry goes well above and beyond psychopharmacology in improving our patients' lives.
Speaker 1:Now perhaps we should turn our attention for a few minutes to talking about interventions that do work. Do we have such studies? And even though I was never taught this in my residency or in my two fellowships, the truth is yes, we do in fact have interventions, and I will be describing two of them to you in some detail right now. So the first one is Well-Being Therapy, wbt. This is developed by Dr Fava, who is at University of Buffalo School of Medicine and also has a home based in Italy. So WBT is very much a prescribable form of treatment that can be used along with psychopharmacology, and the goal here is to really enhance the psychological well-being of our patients. And absolutely psychiatrists, psych NPs, psych PAs and other prescribing clinicians, like primary care clinicians and whatever else, absolutely should know that to offer just pharmacotherapy or traditional psychotherapy like CBT is really not sufficient and WBT's goal is to develop really these beautiful traits like curiosity, engagement, gratitude oh gosh, gratitude. This will be a theme you will hear in this podcast series again and again, and again, because gratitude of course, enhancement of it is a gift that never stops giving. So this well-being therapy has now been studied in patients with cyclothymic disorder, generalized anxiety disorder, heck. It can even be combined with traditional CBT to improve patient outcomes, reduce comorbidities and enhance resilience.
Speaker 1:There's another program, and this is the one that I and Dr Sandra Jane have developed. It's called the Wild 5 Wellness Program. It can be paired with medications, can be done without medications, it can be used in individuals who either have a psychiatric problem or don't, or had one and want to make sure that they prevent it in the future. To make sure that they prevent it in the future, and even in 30 days, what we saw was a 51% increase in these positive traits, such as enthusiasm, 43% reduction in depressive symptoms, 63% in resilience. All of this in 30 days with a free program. No, you know no bells or whistles to it. It's traditional ancient wisdom that is just applied to, you know, whatever kind of situation, whether a patient is on medications or not on medications.
Speaker 1:You might be wondering what does WILD stand for? It's Wellness Interventions for Life's Demands, and who here amongst us doesn't have a demanding life Right? So this could be applied in any of us. And you might also be wondering why is it called five? Well, because these are the five traditional, well-studied interventions, such as exercise and meditation and sleep, hygiene and social connectivity enhancement and, of course, nutritional improvement. All right, there'll be so much more to talk about regarding the wildfire program and other things that we can do, practical things we can do without further taking time away from the very limited interactions we have with our patients.
Speaker 1:But the adoption of positive psychiatry almost as a flag to fight under just is beneficial not just to our patients. It of course is. Just is beneficial not just to our patients it of course is but to their family members and, very importantly, to you and I as healthcare providers. We are understandably at risk for burnout. We really are. I must tell you that I'm quite concerned about how many clinicians I meet all the way from their late 20s, which is just like two or three years into the psychiatric career, and perhaps even those who've been in psychiatry for 30 or 40 years. Yes, burnout is a big problem and I think part of the reason is that we continue seeing a mismatch between what we think is optimized mental health care delivery and what patients keep saying is optimized therapy. In fact, the last individual I met told me you know, every time I come to see psychiatry, all we talk about is pills, pills and pills. Now this gentleman has really benefited from psychopharmacology, so he's not rejecting the benefits of traditional psychiatry. He's, in fact, embracing it, as am I, but he is wanting more. He genuinely is, and what I think he's asking for and needs direction and help from you and I is enhancement of his positive psychiatry. That is what he genuinely asked me for, and I'm more than happy to have provided it to him.
Speaker 1:So, as mental health professionals and even as individuals interested in our own wellness, and even as individuals interested in our own wellness, I welcome you to this podcast series, positive Psychiatry with Rakesh Jain. It is indeed time to expand our goals. Let's not just aim to stop suffering. Let's build lives our own, our patients that are filled with meaning, joy and strength. Let's practice psychiatry that doesn't just treat illnesses but it instead cultivates wellness. Do you think I'm setting too lofty a goal here? I hope you agree with me when I say this. Not at all. This is essentially us returning back to our roots.
Speaker 1:Psychiatry never was just a symptom-eliminating specialty. It was a human potential-enhancing specialty. Well, friends, thank you so much for joining me. Rakesh Jain, thank you for allowing me to speak to you from my heart. I hope you found this episode hopefully enjoyable, perhaps even inspiring, of course. Please feel free to share it with your colleagues. You're also welcome to share it with your clients or anyone you think could benefit from this perspective on healing. All right, with that, I will sign off on this inaugural podcast of Positive Psychiatry with Rakesh Jain and I promise you this I will practice what I'm preaching and I also promise you that I'll continue to stay in touch with you over time. Goodbye for now, and I wish you the very best of well-being. Goodbye.
