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
Schizophrenia: Using the Lens of 'What's Strong, Not What's Wrong'
Shifting our perspective on schizophrenia means recognizing that people aren't defined by their diagnosis. This fundamental truth forms the foundation of positive psychiatry—a complementary approach that acknowledges the serious nature of schizophrenia while focusing on strengths, resilience, and possibilities for a meaningful life.
Traditional psychiatry views patients through a deficits-based lens, treating them as collections of symptoms to be fixed. This creates a missed opportunity to foster purpose, resilience, and joy. Positive psychiatry doesn't ignore pathology but enhances treatment by asking deeper questions: What are this person's strengths? How can we support recovery through meaning-making? How do we improve their social connection and resilience, even during psychosis?
The approach operates on the HERO framework—Happiness, Enthusiasm, Resilience, and Optimism. These pillars support positive human experience and exist in everyone, including those with schizophrenia. Practical applications include strategic medication selection that preserves cognitive function, character strength identification, peer support utilization, and positive psychology interventions like gratitude practices and savoring exercises. Research shows these approaches improve emotional regulation, quality of life, and social connection even when positive symptoms persist.
Cognitive remediation becomes particularly important since cognitive difficulties are core symptoms of schizophrenia that can limit a person's ability to benefit from positive interventions. Physical exercise, proper nutrition, and sleep hygiene—all aspects of positive psychiatry—address areas where people with schizophrenia often struggle.
The neuroscience of recovery connects directly with dopamine systems implicated in schizophrenia, highlighting why this approach makes biological sense. By shifting our lens from "what's wrong" to "what's strong," we acknowledge patients as complete human beings who happen to have a disorder, rather than being defined by it.
Ask yourself daily: What can I do to help patients thrive, not just survive? That's the heart of positive psychiatry.
www.JainUplift.com
Well, hello, dear friends, and welcome to another episode of Positive Psychiatry with Rakesh Jain. This is, of course, rakesh, and I'm delighted to have you, and today I wanted to have a deep conversation with you on the topic of reframing schizophrenia through a positive lens. Now I know what you might be thinking Schizophrenia is a serious, disabling condition. What's positive about it? And I can understand why you would feel that way. Schizophrenia is indeed what I said serious and disabling. But to frame it in our minds as clinicians only from the viewpoint of traditional psychiatry is not to fully respect the disorder or the patients who suffer from it. So, one more time, delighted you are with me and, as you know already from our previous conversations, I'm a complete believer in traditional psychiatry. Heck, I'm a card-carrying member of the psychiatry profession. But I will be the first to tell you that to not appreciate the foundations of positive psychiatry harms everybody, harms our patients, harms us, leads to burnout and, of course, it harms society. So today we are going to challenge ourselves to see, even with a disorder like schizophrenia, can we reframe, can we explore the disorder applying the lens of positive psychiatry, focusing on a person's strengths and wellness and resilience and hope, because every human being, no matter how ill they are, have those, and that can transform the care and the outcomes in the lives of those patients who live with schizophrenia. So come on, folks, let's do this, let's dive right into it Now.
Speaker 1:Not every listener to this podcast probably is as intimately familiar with schizophrenia as we prescribers are. So let me just spend perhaps less than a minute reminding people that schizophrenia is indeed a neurodevelopmental disorder. It's a major disorder. It affects our ability to have the right perception, the right thinking. It comes with challenging emotions. It has hallucinations, delusions, disorganized thinking. You and I know these people, either in our families or we see them on the streets. Sadly, they also have negative symptoms, which some other time we will talk much more about it, and of course, they have what's also called general psychopathology. So when you summarize it, schizophrenia is a pretty vast disorder.
Speaker 1:But hear me when I say this, dear friends, I say this, dear friends schizophrenia is not the sum total of a person's identity. It's a condition they live with, not who they are. See, that is positive psychiatry. On the other hand, traditional psychiatry I don't fault it, but it is indeed a deficits-based lens view of human beings that we are a collection of symptoms to be fixed. But that's a missed opportunity, folks. The opportunity to foster purpose and resilience, and even joy in these patients is lost. So in these patients is lost. So enters positive psychiatry in this conversation.
Speaker 1:And positive psychiatry does not ignore pathology. In fact it complements it. It complements it by totally focused on the challenging pathology of the patient, but it goes beyond it. We as positive psychiatry practitioners do ask ourselves what are this person's strengths? Can we support their recovery through meaning making? How do we improve their social connection, purpose, their cognition, even their resilience? How do we do that, even in the context of psychosis? We do have to unpack these questions, my dear friends, and we should be reminded that positive psychiatry is truly an integration of science and character, strength, understanding and, I think, the hero traits. We've had a discussion on them before, but those who might not have listened to the podcast, hero stands for happiness, enthusiasm, resilience and optimism. These, in my opinion, are the four important pillars supporting human positive experience. These exist even in the most ill of our patients, even in those who have schizophrenia. It absolutely exists and the clinician and the family member who recognizes that the positive aspects of the person are important often develops a tight bond with the patient, which of course leads to a number of advantages. So how do we go about doing this right? I mean, that's all talk, you might say, but how does one go about doing it? So let's spend a few minutes perhaps, chatting about it. One of them is to perhaps have in mind is strengths-based evaluation, and interventions, and psychosocial tools will complement any of the psychopharmacology we offer our patients. Would you do me a favor and hold that thought just for a second, because I want to.
Speaker 1:For a second transition into talking about psychopharmacology medications for the treatment of schizophrenia. There is no doubt in my mind, and most likely in your mind either, that medications are essential, they are valuable, they genuinely help our patients, our friends, our family members who have this dreaded disorder called schizophrenia. But the selection of medications we offer our patients is incredibly valuable, because very many of our treatment options often worsen a patient's wellness. They do. They often make a patient excessively lethargic or unable to concentrate or unable to focus. They feel challenged by that and that may help some of their I guess their schizophrenia core symptoms. But to harm someone's wellness symptoms, but to harm someone's wellness, it's both a bad strategy in the short run and definitively in the long run, that's not a winning strategy.
Speaker 1:So to those of you who are psychopharmacologists listening to me, I urge you, as you make your decisions, you really want to balance three things in your mind. The first, of course, is efficacy. Our medications have to work and they have to work the best we can possibly make them do their work right. We do have to have the best tolerability Weight gain, for example, apathy, prolactin elevation, all those things, yes, but what about that third pillar? What about choosing a psychopharmacological agent, a medication that either spares the cognitive dysfunction our patient's cognitive dysfunction but potentially even improves it? What if that's a possibility? And the truth is it is very much a possibility. Now we have emerging treatments where we see that the cognitive impact that they produce on our patients is minimized. Some actually show improvement, and that ought to be really important for those of us who are profound believers in the importance of positive psychiatry. I promise you, in time, as I grow into the maturity of this podcast, I will take on individual medication classes and we will have a deep conversation.
Speaker 1:So today is more an introduction, really about how do we go about thinking about positive psychiatry, even in the face of you know, category five, hurricane that schizophrenia is. So there are a few suggestions I would really like to offer you. First one I would love for you to consider is the importance of character strengths. Look, every single human being and there are no exceptions to this rule, folks, and that's a good position to take there are no exceptions to the rule that we all are innately born and innately possess individual strengths. And to work with the patient and their support system to identify that particular individual's individual strengths is really important. It could be things like kindness, it could be things like curiosity, it could be spirituality, it could be whatever. It doesn't matter. And positive psychiatry asks us to amplify these, to remind the individual you are so much more than this disorder. Dear patient, dear fellow human being, I want to empower your identity beyond illness. Here's the second thing I would recommend.
Speaker 1:How about peer support utilization to a far greater degree than we currently do? And why does that matter? Because see, peer supports, if you ever worked with them, really encourage our patients who might be struggling with both understanding of the disorder and hope for the future. And what are they offering hope about and hope for the future? And what are they offering hope about. I've listened to enough peer advisors and workers to know it's beyond. Your voices will go down or your thoughts will come back under control they often talk about you will come back into society, you will be happy one day, you'll be respected one day, you will live independently one day. So do you see, this model of peer supports and a recovery model offers human beings who are suffering from schizophrenia possibilities, and possibilities is the lifeblood of positive psychiatry. They also often talk about resilience. They teach individuals about how do you deal with tough situations happening in your life and, of course, they bring credibility to the game. So recovery is not just about cure, my dear friends. It's about the reclaiming of life. And peer support is, I think, a foundational principle of positive psychiatry for our patients and for our practice.
Speaker 1:But we should not shy away, not shy away from, in fact, offering proactive, positive psychology interventions to our patients. Well, just because they have a diagnosis of schizophrenia, is there any reason that they might not appreciate gratitude? Well, you might say, but some of my patients are so ill, so psychotic, that they literally are unable to understand any rational, logical thought. And I would say you're completely right. This isn't the right time to talk about positive psychiatry with them. But you know what that particular patient as they're recovering, if, in addition to giving them medications, we offer them things like gratitude, journaling or perhaps even savoring exercises. Asking them what do you enjoy? Do you like going out for a walk? What about going out on the walk is so joyful for you. What do you look at? Oh, you look at flowers. Yeah, what about flowers do you like so much? Oh, it's the color, it's the smell. Okay, so, dear John, dear patient, next time you're out, just savor it, enjoy it even more. That's a gift for us.
Speaker 1:Now you might say, rakesh, you're a psychiatrist, you should just be talking about which medications to use. But I ask you, is this not medication itself? Is teaching patients, even with schizophrenia as a diagnosis, strength spotting in themselves, mindfulness practices, savoring practices, gratitude practices? Why is that inappropriate? In fact, it's not. There have been studies. Dilip Cheste has in fact published studies in yes, you got it in patients who carry a diagnosis of chronic schizophrenia, and he revealed that, even if positive symptoms are persisting, even in that particular situation, there is no reason for you and I, as clinicians, to feel that we can't help our patients, none whatsoever.
Speaker 1:So please do know that positive psychiatry shows great promise. They improve, obviously, emotional regulation, quality of life, social connection and meaning from life and, as you can absolutely perhaps imagine this scenario that you are offering your patient the very best pharmacological treatments but on top of that, you're giving their life meaning and purpose and showing them, despite the difficulties, they're not a diminished human being. Remember what I said before they don't have the disorder, the disorder doesn't have them, they just are full human beings. That's how I see you, dear patient. Sure, you've got a disorder. That's really important and we must take care of it, but you're so much more than that.
Speaker 1:Let me offer you a couple of other thoughts in this brief message, brief podcast that I wanted to share with you, and I want to focus on cognitive remediation and functional gains, and perhaps the reason why I've talked so much about cognition is because it's rather difficult for any human being, whether they have, I don't know, no disorder or schizophrenia or bipolar disorder, to fully benefit from the great beautiful rewards and awards that positive psychiatry can bring you if cognitive difficulties are challenging, and cognitive difficulties are sadly one of the core set of symptoms of schizophrenia. So there might be a time and a place to offer positive psychiatry interventions, but there's also time and a place to hold back. But once you do have a patient who's more stable, please do consider the profound importance of cognitive remediation. Please do remember that cognitive remediation is a royal road to success, especially when it's offered in the context of coaching. And you got it positive reinforcement. What's the evidence show us Well, this can boost memory, it can improve attention and, of course, it can improve functioning, certainly with you know, activities of daily living, but also functioning, that people with high levels of positive psychological traits engage in, such as laughter, such as connection, such as joining groups such as you get the picture, don't you? So you and I come in not as people who quote, unquote, prescribe positive psychiatry interventions, but we also come in as coaches. We do. I know the degree behind my name says MD, but you know what? An MD is a bigger degree than a prescriber. An MD is also a coach. It's also a cheerleader, right? So positive reinforcement matters. So our own level of positive mental health does infect our patients.
Speaker 1:Let me digress for a moment because I want to reflect on the last 30 some years of my work and being with supervisors who have taught me so much about schizophrenia. I will tell you this guys, the ones who had the greatest lasting impact on me, weren't just good psychopharmacologists. They respected and liked their patients. They saw them as human beings who happened to have schizophrenia. They did not say I've got a 22-year-old schizophrenic that I'm about to see, as if schizophrenia is the identity that describes the person. So please keep that in mind.
Speaker 1:To be an effective clinician when it comes to this disorder, one really has to reconceptualize. One really has to use the binocular vision, two separate lenses. The lens one is of traditional psychiatry which, as I've said, I think multiple times before, I wholeheartedly embrace. But I really am wanting to be even better at the full-on embrace of positive psychiatry. So meaning in life is important to everybody. A positive psychiatry practitioner will indeed be talking about meaning. Tell me, what do you like doing? What does life mean to you? Where do you want your life to be? Let's talk about it, because to me you are a person of great importance and unless I focus on it, dear patient, I'll never be the best clinician for you.
Speaker 1:Now, positive psychiatry isn't based just in positive psychology. It's in fact based in neuroscience. And briefly, in the next couple of minutes I really would like to talk about. What's the home base? What is the neuroscience of recovery? How does positive psychiatry and neuroscience even connect? And here we go. So much of positive psychiatry relies on dopamine and, as we know now, schizophrenia is a disorder with significant dopaminergic dysregulation. Now you see, don't you, why I chose today to specifically talk about schizophrenia? Because you know, when the going gets tough, the tough get going. So if I'm someone who is saying positive psychiatry is important, well, the rubber meets the road.
Speaker 1:When I meet a patient and I in fact look at them and examine them from the perspective of wholeness, just because a person has illness, their personhood is not diminished. That is a foundational principle of positive psychiatry. It's quite likely, just like me, you have not been exposed to that type of re-examination of our disorders. If you're like me, you are immediately trained to look for symptoms of a disorder and its severity and what interventions to choose and then walk away. That's not adequate If our goal is vocational re-entry of the patient or social functioning re-entry of our patients into society, emotional stability and, of course, to make our psychopharmacological treatments work better. And as I start winding down my conversation on this topic, I do want to remind you, positive psychiatry very much believes in physical exercise, wholeheartedly believes in the importance of appropriate diet and embraces the importance of sleep hygiene. These are three things that our poor patients who are afflicted with schizophrenia are not good at. So if you are intervening with any of those three and of course my hope is all of the three, guess what? You automatically are practicing the fine art of positive psychiatry, and I couldn't be prouder of you Because you know what folks Positive psychiatry means helping patients feel more alive and that you know to a clinician is by far the best thing that can happen to any human being with this challenge. So let's do this.
Speaker 1:Let's wind down our conversation with a few closing reflections. Schizophrenia is indeed a deeply challenging condition. There's zero doubt about that. I am urging you to please consider positive psychiatry as a good friend, along with traditional psychiatry, as we shift our lens from what's wrong to what's strong. So thank you everyone for listening to me. I appreciate your curiosity and I really appreciate your commitment to your personal growth and your commitment to converting what we talk about and what we discuss into clinical items. So keep asking yourself this profoundly important question. Try this one for size, will you Ask yourself today, tomorrow, day after tomorrow, when you're in clinic, what can I do to help patients thrive, not just survive? Because that is the heart of positive psychiatry. All right, dear friends, until next time, please stay curious. Keep the hope alive, because there's all the right, multiple right reasons to do so. This is Rakesh, and thank you for being part of this podcast on positive psychiatry. Goodbye for now.
