Positive Psychiatry - with Rakesh Jain, MD

How Positive Psychiatry Can Prevent Burnout And Restore Purpose - Perspectives from A Residency Program Director

• Rakesh Jain, MD

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Our special guest today is Shailesh 'Bobby' Jain, MD, MPH, professor of psychiatry and residency and fellowship program director at Texas Tech University School of Medicine - Permian Basin. 

What if the goal of psychiatric training wasn’t just fewer symptoms, but fuller lives? We sit down with Dr. Bobby Jain—program director and full professor—to examine how positive psychiatry reframes care for patients and preserves purpose for clinicians. The disease model gave us rigor and a shared language, yet it cannot teach identity after depression, relational repair after trauma, or meaning after remission. That’s where strengths, values, and purposeful routines step in—not as extras, but as essential parts of recovery.

We dig into the tension residents feel: becoming expert problem-spotters while growing blind to what’s strong. Bobby names the hidden curriculum—sleep loss, moral injury, relentless evaluation—and explains why wellness is a professional competency, not a perk. He shows how a few evidence-based questions in the first interview shift outcomes: What helped you survive? Who gives you strength? What matters most now? These prompts surface adaptive data, boost engagement, and anchor plans in what patients value. We connect the dots to neuroscience and behavior: neuroplasticity, reward pathways, inflammation, and social connection all support strengths-based care.

Then we reimagine supervision. Instead of only risk and paperwork, we build reflective space: Why did this case land so hard? What value was challenged? What did I learn about myself? That practice reduces depersonalization and grows clinical wisdom. Finally, we sketch a training redesign where positive psychiatry is woven into inpatient, outpatient, psychotherapy, and consults. Residents graduate fluent in diagnosis and well-being, and success metrics expand to include resilience, curiosity, and professional longevity.

If you’re a clinician, educator, or trainee hungry for care that heals beyond remission, this conversation offers practical tools and a hopeful roadmap. 

www.JainUplift.com

Rakesh Jain, MD, MPH:

Well, hello, friends and colleagues, and welcome to another episode of Positive Psychiatry with Rakesh Jain. This is your host, Rakesh, and today we have a very special podcast because we have a guest, and the guest is Dr. Bobby Jan. And in a minute, he will introduce himself to us. But there's a very specific reason that I've invited Bobby to this podcast, is because, in addition to being a full-time psychiatrist, a practicing psychiatrist, and a full professor of psychiatry at his medical school, he has also, for well over a decade, been involved in the training and teaching of residents and fellows and medical students. So he is a very influential figure. And I wanted to have a deeper conversation with him to understand how positive psychiatry influences his work and how he teaches it to his residents. What are the shortcomings of modern-day psychiatry? And how can we start incorporating positive psychiatry in today's curriculum? As you can imagine, that's a pretty exciting opportunity for us to learn about positive psychiatry from a person who is very much boots on the ground as an educator and as a clinician. Having said that, Bobby, welcome to the podcast.

Shailesh 'Bobby' Jain, MD, MPH:

Well, thank you for inviting me into this space. What I appreciate about positive psychiatry and about your work specifically is that it gives us permission to ask better questions, not just the louder ones. I want to say up front that this is not a critique born out of cynicism. It's born out of love for psychiatry and concern where our current training model is falling short. The disease-oriented model has given us a rigor, credibility, and treatments that serve lives. But the question I'm increasingly asked is, is it enough for the world our residents are inheriting? I don't think so. And positive psychiatry gives us a way to evolve without abandoning science.

Rakesh Jain, MD, MPH:

I agree. Now you trained in the 90s and 2000s, right? Is that about the time you trained in psychiatry with your residency and fellowship? Yes, that's correct. And maybe you can share with our listeners how much information on positive psychiatry you received in your training?

Shailesh 'Bobby' Jain, MD, MPH:

Almost non-existent. The term was not even known by at that time. I think this one came in the second decade of this century, the term pastor psychiatry, but during our training in the late 90s and early 2000s, this was not a term that we were familiar with.

Rakesh Jain, MD, MPH:

Yeah, and I'm about eight years older than you. And I must say, I also was never ever exposed to this concept. So, with that said, when did we start training psychiatrists to only look at what's broken? What's your thinking on that issue?

Shailesh 'Bobby' Jain, MD, MPH:

Well, when I observe residents early in training, I noticed something very striking. They are bright, curious, compassionate people, but within months they become extraordinarily skilled at one thing that is identifying what is wrong. That skill is absolutely essential, as you would imagine, but it slowly crowds out something equally important, noticing what is right. Strengths, coping strategies, values, relationships, these don't disappear. They just stop being visible in our formal assessments. They are adaptive data.

Rakesh Jain, MD, MPH:

Yeah, and when we train residents to ignore strengths, we're not being neutral, we're actually distorting the clinical picture. You said some things that are so important, I wanted to underscore them. You said, let me see, let me see if I can turn to my memory, which is that clinicians, residents, after a few months get experts in identifying what's wrong, but forget about what is strong in our patients, right?

Shailesh 'Bobby' Jain, MD, MPH:

That's correct.

Rakesh Jain, MD, MPH:

So what does the DSM teach us well? As you said, we don't want to reject it at all. We want to embrace it. So what does the DSM teach us well and what it simply cannot teach us?

Shailesh 'Bobby' Jain, MD, MPH:

Well said, the DSM is one of the most powerful tools psychiatry has ever created. It allows us to speak a shared language, it supports research, billing, communication, and whatnot, but is never meant to teach someone how to live well or help someone build meaning after illness. Residents quickly learn how to diagnose depression, they are far less often taught how to help someone reconstruct identity after depression. Pastor psychiatry steps into that gap. It says diagnosis is necessary but not sufficient. Healing does not end when symptoms remit. That's often where the real work begins.

Rakesh Jain, MD, MPH:

That's when the real work begins. Life can't just be about controlling symptoms, it has to be filled with meaning and purpose. That's what I hear you say, right, Bobby? That's correct. So it sounds like residents are burning out while learning to treat burnout, which is kind of a really interesting concept. Would you mind expanding on that?

Shailesh 'Bobby' Jain, MD, MPH:

I'm glad you brought up this topic. This is one of the hardest truths in academic psychiatry. We teach residents how to recognize burnout, depression, anxiety while placing them in systems that quietly generate those same conditions. Long hours, chronic sleep deprivation, moral injury, constant evaluation. The unspoken curriculum becomes push through, don't complain, endure. Pastor psychiatry allows us to say something radically different. Your wellness is not a luxury, it's a professional competency. If we don't train residents to cultivate well-being, we are setting them up for long-term erosion.

Rakesh Jain, MD, MPH:

Yeah, so unless we start our trainees on the right foot, they could be residents, they could be NP students, they could be PA students, social workers, therapists. Not only are we cheating our patients, sounds like we're cheating our trainees from appreciating wellness could be a way to prevent clinician burnout.

Shailesh 'Bobby' Jain, MD, MPH:

What are your thoughts on that? I think we are missing out and empowering them with a tool that will help them the rest of their professional life. And they suffer without it.

Rakesh Jain, MD, MPH:

So positive psychiatry is not just a one-way street, right? It is a two-way street. It helps the patients, but it certainly helps the clinician. Is that fair to say? That's very fair to say. Can you talk about professional burnout that you're seeing in your trainees, in your colleagues, etc.?

Shailesh 'Bobby' Jain, MD, MPH:

Well, symptom reduction.

Rakesh Jain, MD, MPH:

Okay.

Shailesh 'Bobby' Jain, MD, MPH:

Well, a number of symptoms are evident to me while I am as a program director. One is depersonalizing the patient. The patient becomes a number or an age or a just an unfamiliar adjective that that is very difficult to communicate or to approach to. The second thing I think is is work becomes a chore. It becomes a dreaded thing every Monday morning, and we look forward to Saturday morning. I think the moment we start looking at work as a chore, there is something wrong.

Rakesh Jain, MD, MPH:

So you're describing the classic symptoms of burnout in us clinicians. This isn't a problem just for our patients. This is a problem for us too. I get it. Thank you. And I believe what you're saying is if we were to adopt positive psychiatry into our own thinking, we could do a lot of good for everybody involved.

Shailesh 'Bobby' Jain, MD, MPH:

I agree. The fact that if clinicians are not being good to themselves or kind to themselves and taking care of themselves, it's very unlikely that we will be able to take care of our patients.

Rakesh Jain, MD, MPH:

Wow, that's a profound statement you made, Bobby. In fact, so profound, I'm going to underscore it and just repeat your words. Unless we are adopting positive psychiatry as a tool in our work with patients, we are being unkind to them and to ourselves. I got it. Now, why don't we move on to another topic where you have discussed this with me before? That symptom reduction alone is a shockingly low bar for us clinicians to set.

Shailesh 'Bobby' Jain, MD, MPH:

Would you speak more to that, please? Yes, uh, if you're honest, symptom reduction is the floor, not the ceiling. Patients don't come to us asking for fewer symptoms, they come asking for their lives back. When residents are trained only to reduce symptoms, they may miss deeper questions. Many questions such as what does this person care about? What gives meaning to their lives? What would thriving look like, not just surviving? You know, Pastor Sakati reframes success as a presence of well-being, not merely the absence of illness. That reframing fundamentally changes how residents listen and how patients experience care. Wow.

Rakesh Jain, MD, MPH:

Another set of profound learnings from you. So what are residents really asking for, even if they're not saying it with their own lips?

Shailesh 'Bobby' Jain, MD, MPH:

It's very difficult to say that and to judge what the residents are really looking for. In my opinion, the residents are often looking for technical questions, medications, algorithms, diagnostic nuances. But beneath those questions are existential ones. How do I do this work without becoming hardened? How do I witness suffering and still believe in hope? How do I grow instead of burnout? Positive psychiatry, I think, legitimizes these questions as part of professional identity formation. It definitely tells residents becoming a psychiatrist is not about acquiring knowledge, it's also becoming a certain kind of human.

Rakesh Jain, MD, MPH:

So, how can positive psychiatry change perhaps even the very first interview with a patient?

Shailesh 'Bobby' Jain, MD, MPH:

Well, I think one of the most immediate and powerful changes happens in the intake interview. Alongside symptom checklists, we teach residents to ask what has helped you survive so far? Who or what gives you strength? What matters most to you even now? Patients often respond emotionally, not because the questions are complicated, but because they are rarely asked. The interview becomes not just diagnostic but also relational. And residents learn early that healing begins with recognition of humanity.

Rakesh Jain, MD, MPH:

Recognition of humanity. I think that's one of the most beautiful and attractive things about positive psychiatry as far as I am concerned, Bobby. So it sounds to me that strength-based interviewing does not mean that it's soft or unscientific, correct?

Shailesh 'Bobby' Jain, MD, MPH:

I think you're right. I think there's a myth that strengths-based approaches lack of rigor. In reality, positive psychiatry is grounded in neuroscience, biology, and behavior science. We are talking about neuroplasticity, stress physiology, rewards pathways, inflammation, social connection, and whatnot. The strengths are not abstractions, they are biologically initiated capacities. This is not about ignoring illness. It's about understanding how wellness buffers illness and sustains recovery. The science supports this. The clinical outcomes demand it.

Rakesh Jain, MD, MPH:

Demanded, that's a strong word, but I very much like how you said it, which is the science supports this approach of positive psychiatry and clinical outcomes demanded. Things are not going well with our patients, Bobby. I like what you said. So in your task as a residency program director, you also supervise. So let's do this. Let's together do a reimagination of supervision from case management to meaning making.

Shailesh 'Bobby' Jain, MD, MPH:

Supervision is an integral part of any residency program. Supervision often becomes procedural, it becomes risk, documentation, compliance, necessary but incomplete. However, positive psychiatry invites us to expand supervision into a reflective space. A space where residents can ask, why did this case affect me so deeply? What effects were challenged? What did I learn about myself? When a technique's model reflection, humility, curiosity, residents learn that wisdom. Not just efficiency, it is the goal.

Rakesh Jain, MD, MPH:

Boy, I wish I had had this when I was training back in the 80s and 90s, Bobby. But it's never too late, is it? I mean, just because I'm an old dog doesn't mean I can't learn new tricks, right? I think it's never too late to incorporate these characteristics into a training program. So, Bobby, let me ask you this. If I could redesign a residency training program today, what might you say positive psychiatry could help us?

Shailesh 'Bobby' Jain, MD, MPH:

Hmm. If we were designing residency today without historical inertia, positive psychiatry would not be an elective. It would be woven into every rotation, be it inpatient, outpatient, psychotherapy, consultation, leadership. Residents would graduate fluent in teaching illness and cultivating well-being.

Rakesh Jain, MD, MPH:

So we could measure success not just by board scores, which is what we do now, but also by their understanding of resilience, curiosity, and professional longevity without burnout, right? That's correct. Say more about that. I because you've been a program director for so long. Say more on what has worked and how this kind of new thinking may potentially influence your role as a program director and your resident's educational experience.

Shailesh 'Bobby' Jain, MD, MPH:

I think the psychiatrist we are training now will practice into the future that is more complex, more fragmented, and more stressed than ever. Technical excellence will always matter, but the psychiatrist the world needs now must also embody hope, adaptability, and wisdom. Pastor psychiatry doesn't replace traditional training, it completes it. I think. And I truly believe it represents the next necessary evolution of our field.

Rakesh Jain, MD, MPH:

That's beautiful. You've given us a lot to think about, Bobby. You really have. And the fact that you are training clinicians, you are the one molding them. So perhaps in closing, if you have any few comments, we would really appreciate hearing them.

Shailesh 'Bobby' Jain, MD, MPH:

I think conversations like this signal the psychiatrist is ready to grow, not just technically, but philosophically and humanistically.

Rakesh Jain, MD, MPH:

Well said. And I'm so very grateful you appeared on this podcast. And I'm sure our listeners appreciate what you had to share with us, too. And all I can do besides thanking you is be grateful that people like you are appreciating that positive psychiatry was something we completely missed out on when we were coming up in our training. It wasn't because psychiatry was mean, it's just that our vision was small. And look, the very last sentence you said is one I'm going to repeat. Positive psychiatry gives us a language, a science, and a vision for that growth. And growth is what we're all about. So, dear listeners, thank you so much for being with Dr. Bobby Jan, who's a full professor of psychiatry at Texas Tech University School of Medicine in Permian Basin. He also is the residency and fellowship programs in psychiatry there. And he was here as a true leader in both clinical practice and in medical education to tell us how positive psychiatry is impacting him positively, no pun intended, and how he intends to infuse these learnings into his trainees. With that, we thank you for your presence and your kind attention. And here's wishing more positive psychiatry in your own clinical practice. Goodbye.

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Rakesh Jain, MD

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