EPISODE 439

Bringing Harmony to the ‘Family’ Within Our Minds - Dr. Richard Schwartz, Founder of Internal Family Systems Institute

12-13-2023

Subscribe

Download

Transcript

Shiv Gaglani: Hi, I'm Shiv Gaglani, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

 

The notion of a person having multiple personalities is most often associated with mental illness, but today's guest, Dr. Richard Schwartz, contends it is actually the nature of the mind to be subdivided. Dr. Schwartz is the creator of Internal Family Systems, an evidence-based therapeutic model that depathologizes the multi-part personality. He is currently on the faculty at Harvard Medical School and has published five books, including No Bad Parts, Healing Trauma, and Restoring Wholeness with the Internal Family Systems Model

 

I missed him at the talk he gave at the Psychedelic Science conference in June because it was standing room only, but I'm excited that we were able to get him on the Raise the Line podcast so we can share some of what makes him and the IFS system so innovative in the field of psychiatry. 

 

So, Dick, thanks for taking the time to be with us today. 

 

Dr. Richard Schwartz: Yeah, I'm glad to be with you, Shiv, and thanks for inviting me. 

 

Shiv: We always like to ask our guests, in their own words, to describe what got them first

interested in healthcare, and in your case, then psychology.

 

Dr. Schwartz: Well, I come from a highly medicalized family. My father was a prominent endocrinologist and researcher, physician, helped to create Rush Presbyterian St. Luke's Hospital in Chicago. I'm the oldest of six boys, and I was supposed to be a physician. I was spared that fate because I had kind of ADD, so I wasn't a great student and I didn't get the grades to do that. Three of my brothers are physicians, actually. So, yeah, so I was indoctrinated into that world pretty well, and also came out of the family feeling pretty worthless because I couldn't be like them and so part of the reason I think I wound up working so hard to create this is to prove to my brothers and my father that I had some value. So, IFS is really the product of all of that. 

 

I got to see what the life of a physician was. I think back in those days, it wasn't quite as bad as it is now in terms of how hard physicians have to work -- and not just physicians, but all healthcare professionals -- and how much stress they're under. But I did see, and I don't know that it's changed all that much, what the ordeal of medical school was like -- which you know firsthand now -- and how much it was a kind of initiation by fire. You know, my father would talk about how it was really designed to test people to see if they can take it, which I don't know that it's changed all that much. 

 

Shiv: Yeah, there are a lot of like barriers, I think, to becoming a clinician that are just put up there straight for supply-demand reasons. More people have generally wanted to get into these programs than there are spaces available so if you put up a national test like the MCAT or USMLE, that helps weed people out. But then to some extent it's kind of like, how bad do you want it? Do you really need organic chemistry to be a good clinician? Most clinicians don't think that's the case. 

 

Thank you for being candid about your own family dynamics growing up, because certainly that's something I've talked about on the podcast, and it's important for us to be real with each other and vulnerable. Part of my decision to go back to med school is I'm sort of the black sheep in the family. My mom's a physical therapist, my dad's a doctor, my sister's a dentist, and brother-in-law's a dentist, and I was a tech entrepreneur. And so that used to be maybe 30% of why I went to med school in the first place. Now it's 5%, but it's still there. 

 

So, maybe before we go into IFS, which is going to be the meat of the conversation, can you talk to us a bit about college and your career trajectory? Like, what are some of the milestones that were leading to you being very well known now, having standing room only speaking gigs at important conferences? 

 

Dr. Schwartz: So, like I said, I wasn't a great student and I went to a small liberal arts college from which you graduate with no real marketable skills whatsoever. But during college, my father would get me a job on the psych unit at Rush. Actually, back then it was Presbyterian St. Luke's Hospital. I thought something's wrong with this picture, the way it was a very psychoanalytic unit for teenage kids, basically. I'd be close to these kids and then I would see how, because I'd be working weekends, I'd see how their families would scapegoat them and attack them during the weekends in the day room. Then I would hear about their sessions where the families weren't mentioned and it was all about their pathology and I thought, there's something wrong with this and maybe there's a better way to do it. 

 

Then when I got out, I heard about family therapy, which was an incipient movement at the time and was a kind of rebellion against the excesses of psychoanalysis. So, I became very passionate about that. In the early days of family therapy, I was a kind of rising star. I co-wrote the textbook that everybody used and thought that was going to be my career until it turned out that family therapy didn't do the whole job. 

 

Shiv: Very interesting origins. So, when did you have that realization that ultimately led to the birth of IFS? And for our audience -- hopefully most of them have heard of it, but for those who haven't -- could you give us your elevator pitch to healthcare professionals about it and how it works? 

 

Dr. Schwartz: Yeah. So, you know, to prove family therapy was the be all and end all, I did an outcome study. I was working in a research place in Chicago and tried to do it with bulimia as a symptom. I had about thirty bulimic patients that I organized their families with and tried to reorganize the families just the way the book said to and these kids, you know, didn't realize they'd been cured by my interventions and they kept binging and purging. So, I began asking why, and they started talking this language of ‘parts.’ They would say when something bad happens, it triggers this critic who's calling me all kinds of names inside and then that brings up a part that makes me feel totally worthless and alone and empty and that's so dreadful that the binge comes in to get me away from that. But then the critic comes back about the fact that I binged, and that goes right to the heart of that part that feels so alone and empty and worthless. 

 

So, they were in this vicious cycle all the time, and that felt intriguing to me at the time, because I hadn't studied intrapsychic process deliberately because I was a family therapist. So, I really had to learn from my clients what was happening in there. Family therapy is all about systems and systems thinking, and I could hear how these parts were operating as a kind of inner system so I became intrigued. 

 

Long story short, it took a while, but I learned that none of these ‘parts’ -- what other systems might call sub-personalities that we're born with -- are what they seem like; that they are good, but they get forced out of their naturally valuable states into extreme roles that can be very damaging. They get frozen in time during traumas and they live as if you're still five years old and they still have to protect you in the way they did back then. They also carry what I'm going to call burdens, which are extreme beliefs and emotions that came into your system during the trauma, and then sort of graft onto these parts like a virus and drive the way they operate. 

 

It took me a number of years to get clear about any of that, and I was amazed because I had assumed that they were what they seemed and that the critic was some kind of internalized parental voice and the binge was an out-of-control impulse. But just getting curious and having clients listen to these parts, or speak for them, I learned that that wasn't the case. That even the most extreme ones...if you were to ask, what are you afraid would happen if you didn't make her feel like shit all the time or you didn't take her off into a binge, they would talk about other parts that they were protecting or that they were trying to get the client away from, and that they really thought they needed to do that because they really thought she was still five years old and they were doing the role that they got into back then. 

 

As I got all that, I really started helping clients stop fighting with their parts or trying to get rid of them and instead start listening to them. As I was trying to have them dialogue -- let's say, I'm trying to have you talk to your critic, and I'm a family therapist, so I'm trying to have you listen to it, but suddenly you're furious with the critic -- it reminded me of family sessions where I'm having two people talk to each other, and then a third-party jumps in and everything goes south. 

 

So, I might say to you, “Could you ask the one who hates the critic to give us a little space to finish this conversation?” And most people could do that pretty readily and when they did, they would shift and it was like this other person came out who suddenly was curious about the critic and even had some compassion for it and was calm relative to it and confident relative to it. When I had you in that state, the critic would relax and tell its secret history of how it got forced into his role and talk about the parts it protected. 

 

So, as I did that over and over with all kinds of extreme parts, it dawned on me that maybe there aren't any bad ones, which it turns out forty years later is the case. But that person who would pop out when other parts would open space, turns out is in everybody, can't be damaged, and knows how to heal. And that's the big discovery of IFS -- what I call the Self, with a capital S, is there -- and the job often is just opening enough space for it to pop out and start relating to the parts or relating to other people in the room. 

 

Shiv: Wow, that is an incredible ‘aha’ moment, for sure and something very relatable. I mean, even on this podcast, we've had a lot of people in the psychedelic space talking about this,

and psychedelics clearly are one mechanism to help people understand that they have different selves. One of the people we had on the podcast a year and a half ago is Jim Fadiman, who wrote the book Symphony of Selves, which very much references and is based on a lot of your work, too.

 

I'm curious...you had this aha moment working with patients with bulimia, who had the different parts that were causing them to do these different behaviors, the binging and the purging. What are the DSM-5 indications that maybe you think are most effectively addressed through IFS?

 

Dr. Schwartz: Well, we work with most every diagnosis, and for me, the DSM is really just a fairly accurate description of clusters of ‘protectors’ that people have, which is a very deep pathologizing. I don't know if I talked about ‘protectors’ and ‘exiles’ yet, but when I was trying to map out the territory of these parts, it became clear there was a distinction between parts that other systems might call inner children, who, before they're hurt, are these wonderful, playful, lively, loving, creative parts of us, but they're also the most sensitive part, so they're the ones who get hurt the most. After they get hurt, now they carry the burden of worthlessness or of terror or of emotional pain, and they can overwhelm us with those feelings because they just sit in all that. So, we almost naturally try to lock them away in inner basements, and then these other parts have to become protectors to protect them so they don't get triggered and overwhelm us or keep us away from them. 

 

Some of them are what we call managers. They're trying to manage our life so the exiles don't get triggered, and others -- if an exile does get triggered -- go into a kind of impulsive, reactive place to try and take us out away from all the pain or the shame or the terror.

 

If you gave me a DSM category, I could give you the common protectors that it's actually describing. Again, that's a very de-pathologized way of understanding it, because then you help the client just start to get to know the part that makes them an addict or the part that goes into a sudden rage out of the blue or all those things that wind up labeled personality disorders, or addicts, or whatever the diagnosis is. 

 

Shiv: Yeah, that makes sense. So, for example, just today we had a lecture on PTSD, which is the first DSM category for MDMA therapy that hopefully will get approved in the next couple of months or so. Maybe we could use that as an example of people who experience severe trauma enough that they're having these recurrent intrusive thoughts, flashbacks. Was that a particular part that's been damaged, so-called? Or like, how have you worked with a PTSD patient? 

 

Dr. Schwartz: It's not damaged so much as exiled. 

 

Shiv: Exiled. Sorry. 

 

Dr. Schwartz: So, the flashbacks and all of that generally come from these parts we've tried to lock up, because we don't want to feel any of that anymore, or see those scenes anymore. So those would be the exiles that are still stuck maybe in the combat scene, or in a scene when you were molested as a child, or something like that. We tend to try our best, and everybody around us, because this is a rugged individualist culture that tells us to just move on, don't look back, just let it go. 

 

A lot of psychiatry tells people to do that and in the process of doing that, we're locking away the parts that were most hurt and carry the memories and everything else from the traumas. And so as we then try to move on in our life, they're trying to let us know ‘we're in here, deal with us,’ and they're giving you the flashbacks and all the emotions and they're interfering in your life, because they don't want to be left behind.

 

We've actually done a considerable amount of very successful research with IFS and PTSD, and one big study just completed at Cambridge Health Alliance. Simply getting PTSD patients, first to go to the parts that are trying to protect them and manage these exiles -- which often they're doing in extreme ways -- and honor them for their attempts to protect, help them see they don't have to do it quite that way and get permission from them to then open the door to these exiles and start getting these parts that are giving you the flashbacks and so on, out of where they're stuck in the past and help them unload all the memories and everything that they're still carrying, so they can live with you. Because the other downside to exiling all these parts is most people think they're just moving away from the memory, sensations, and emotions, not realizing they're locking away their essence. They're locking away their most precious parts, because these are the ones who hurt the most, but they're also the ones that give us all the joy in our life, or give us creativity, lots of ideas, and playfulness. As we continue to stay away from them, our life becomes more and more limited so just bringing them back and healing them allows us to be much more complete and integrated. That would be a different way to understand PTSD. 

 

Shiv: This is super interesting. I mean, the way you're describing it, it makes sense why you were speaking at Psychedelic Science conference because obviously those people who've done psychedelics know that there's often that understanding and that patience that emerges...like MDMA will lead to being more patient, less defensive, coming to terms and accepting your different parts fully.

 

How did you get involved in that work? Have you done much work with IFS and psychedelic therapy in combination, or other therapeutic modalities, or even pharmacological modalities? 

 

Dr. Schwartz: I have, mainly ketamine because it's legal. But I've run a series of about five different retreats with ketamine and IFS with my co-leader, Sunny Strasberg, who was also at that meeting. I'm amazed at the combination, actually. I think you mentioned you've had Michael and Annie Mithoefer on your show. They are well-trained IFS therapists, and I don't know if they mentioned it, but Michael called me excitedly once early on in the research with MDMA saying that he was finding that when people took particularly higher dose MDMA, they would spontaneously start doing IFS without any coaching from the facilitator. They would just start seeing their parts, and they would start relating to them from what I call Self and he kept track of how often that happened. He was finding about 80% of the time, they were spontaneously doing IFS. 

 

It was validating to me, because it seemed like maybe I had just stumbled onto a way of healing that we all know how to do once we get all these protectors out of the way, which is what MDMA seems to do. It seems to put to sleep a lot of these parts that are trying to manage us, so you access a whole lot of Self. Your heart's very, very open, and that's a big invitation for all these exiles to come in and get some attention, and so that got me very interested. 

 

Then about, I think, four years ago, Phil Wolfson contacted me because he was getting interested in IFS and invited me to be part of one of his retreats with ketamine and introduce IFS to his staff and the group there. I thought, “Oh, okay, it's interesting and the Mithoefers had good luck with MDMA, but we do pretty well without psychedelics. But we do get stuck sometimes so I went ahead and did it and I was just amazed at how much it accelerated the work to have the medicine. Again, it just really gave people this tremendous access to this Self, and then that was an invitation for these exiles. We could do in one, like, twenty-minute session what otherwise it might take ten sessions to do, and that's held up. That has just been amazing to me. So, our later retreats have been by invitation because we want to bring this to leaders, so we're inviting leaders in various fields to come, and yeah, it's just been amazing. 

 

Shiv: Wow, that's awesome and it's obviously very appealing to take something that would normally take ten sessions and be able to replicate it through some pharmacotherapy and IFS in one session. Obviously, we are in a culture that wants instant gratification, that wants magic weight loss pill like Ozempic. There's big business in that.

 

I'm on the psychiatry clerkship right now. Just for our audience to be clear, the reason I think this is so valuable, this combination, is that there are a lot of people who give up too early before they see progress. It takes an SSRI like four to six weeks to even kick in. Or, if someone has, PTSD and they're waiting for the SSRI to kick in but they also are doing cognitive behavioral therapy, they're getting exposure to the things that are causing them trauma and they may not do the full course. So, if you're able to get them faster results, they may stick with it longer and become maybe a lifelong student of it. So, I think that's a really important realization or discovery you guys have made. 

 

Where do you see it going? Once MDMA is approved by the FDA or psilocybin shortly after, are you going to continue experimenting with IFS in combination with psychedelics or other modalities?

 

Dr. Schwartz: Yeah, I hope to. That's the plan. I love the intimacy of these groups. The last one we did was about twenty-seven people, and the groups would get so close. And, you know, as people are being so vulnerable and helping each other, it creates this big Self of the group, just like I'm talking about internal. So, it's wonderful just to be in that energy as a facilitator. I love doing it. We now have a really talented what we call ‘self-led team’ that we do it with and again, I'm trying to bring this to leadership, so it's part of my project to try and bring IFS to larger systems rather than just in psychotherapy. 

 

All of that combined makes me very motivated to keep doing it. I'm very fond of ketamine. It's been really good for me also. I don't have nearly the experience with MDMA or psilocybin either, but I'm very open to seeing what can happen. 

 

Shiv: Yeah, very interesting. So, when you see your work kind of progressing over the next, say, five, ten years, maybe you can talk us through how popularly accepted is IFS now? Do you have any sense of how many therapists are practicing it, how many patients have gone through it? And I know it's been popularized by some really well-known figures like Tim Ferriss, I believe, that you've spoken to and maybe even done a session with him live, I believe.

 

So, yeah, I would love to know where is it now, and then where do you see it in the next five or ten years? 

 

Dr. Schwartz: This is our fortieth anniversary, and I labored in relative obscurity until I'd say the last eight years or so and for some reason, it just has taken off in a way that's almost out of my control. We now have like 20,000 people on a waiting list for our trainings. I hear about it everywhere, you know, you see my books in airports. So, that's all been very gratifying and a bit overwhelming. But it's along the lines of what I'm saying. I think this approach can have a big impact on the culture. That's my goal now, is I'm shooting higher. I really want to. Our culture and the world really needs a different paradigm that can lead more toward self-led relating. I talked about burdens, but there are also what we call legacy burdens, which come down through the generations from a trauma that was not at all related to you. You see the Middle East now, and there are legacy burdens driving both sides and there's very little Self to be found. 

 

So, I'm aiming big, you know? I want to have an impact at that level and it may not happen in my lifetime, but I know this model has that potential. 

 

Shiv: I'm really glad you mentioned intergenerational systems and trauma. Our Osmosis board member Mitch’s wife is Rachel Yehuda, who maybe you know or work with. 

 

Dr. Schwartz: Yeah, I've met Rachel, yes. Yeah, she's great. I respect her work. 

 

Shiv: Absolutely. She's at Mount Sinai and did a lot of that seminal research showing that epigenetic markers of trauma were passed on from Holocaust survivors to their grandchildren who never directly experienced that terrible atrocity. And so it’s very interesting to know how IFS could be used to maybe heal intergenerational trauma as well in conjunction with this. 

 

One of the reasons we've been so focused on psychedelics, but also mental health in general

at Osmosis, is many of our audience have burned out or suffered moral injury during COVID from all the things they saw and have experienced. We recently had Josh Gordon, the head of NIMH, on the podcast to discuss some of this as well. I'd love to hear your take on provider burnout and moral injury. What are the things we could be doing to better support them? I'm sure you've done IFS for providers and would love to hear any take on maybe patterns that have emerged from doing IFS with this group of people.

 

Dr. Schwartz: As I watch my brothers struggle sometimes and a lot of other extended family, I'm pretty intimately connected to this issue of burnout and it's just getting worse. The healthcare system is deteriorating in a lot of ways. During COVID, it was really bad. So, you know, many healthcare professionals come into it because they have these big hearts, they have what we call big caretaker parts, big caretaker managers that want to help and also don't let them take care of themselves that well. 

 

We worked, for example, with nurses in particular who have that in spades. If you can help them go to the caretaking part and let it know that it doesn't have to dominate the way it does, and that they can try to balance their life in other ways, and that there is this Self in there who can lead and can be the one interacting with patients, and that they also don't have to take in all the pain...a lot of people in healthcare, and this is true of therapists too, feel like empathy means taking in all the pain of your patients and carrying it and that'll burn you out very quickly, too. So, we're helping people learn the difference between empathy and compassion. 

 

Tania Singer is a brain researcher who has shown they show up in different places in the brain, actually. In compassion...like when I'm with a client, I'm not feeling their feelings. I get some sense of what they're feeling, but mainly I'm just feeling a lot of caring for them. So, helping healthcare professionals lead from compassion rather than empathy also prevents burnout. I can go on and on. I know we don't have a lot of time, but there are these common parts that draw people to the field that if they feel like have to dominate you, will burn you out and so all of that on top of how hard it's become to be a healthcare professional means that there's just lots of turnover now.

 

Shiv: Yeah. I'm really glad you mentioned the difference between compassion and empathy. Just today before we started the podcast, I mentioned I was talking to a resident who's fairly burned out from all the stressors that it takes and I think one of the biggest stressors I'm realizing being back in med school now is just you want to do so much for your patients,

but just systemically you can't. It's not set up for that. There's not enough social workers, there's not enough psychologists. Frankly, a lot of the patients are stuck in the hospital because we're just waiting to find a bed for them at a facility or they'll just go back to their families. 

 

Michael Mithoefer talks about this...how he was an emergency medicine physician

first and then went back to do psychiatry because he realized that he was just treating the symptoms of social determinants that were happening in these patients' lives and if we can go upstream, we may be able to actually nip it in the bud and help fix it. So, I think that's what IFS

has the potential for doing for a lot of people and families. 

 

Dr. Schwartz: Yeah, I mean, we train a lot of physicians now, and they both learn how to be present like that in Self -- which is fairly effortless...it's very different than the parts of you that are really so eager to help and get so frustrated when you can't -- and also to not focus so exclusively on the symptom. At least in some cases, medicine is designed to kill the messenger rather than listen to the message. 

 

We actually did a nice outcome study with rheumatoid arthritis that's published in the journal Rheumatologywith a control group and everything. We found that by simply having patients focus on their pain and get curious about it and ask some questions, they would learn about the parts that were giving them the pain or exacerbating their pain to try and get hurt because they can't get hurt otherwise. This was actually at Brigham and Women's in Boston and it was Irish Catholic mothers who had these massive caretaking parts that never let them take care of themselves and the parts that were furious with that were giving them the pain. 

 

As we listened and tried to work it out between those two sets of parts, their arthritis

got much better to the point where in some cases, it totally went away. So, that is another way that physicians can help people listen inside and is more rewarding than just giving them medicine. 

 

Shiv: Absolutely. Yeah. I've just literally been meeting patients with conversion disorder and somatic symptom disorders. Clearly not everyone has to have a DSM-5 diagnosable disorder to have back pain that comes from grief, as many people in Chinese culture develop. So, I'm glad you mentioned that and it's also why people should care about this beyond, say, the field of psychiatry or psychology. 

 

I want to be respectful of your time, so I only had a couple other quick questions. 

 

Dr. Schwartz: Go ahead. I'm OK. 

 

Shiv: OK. The first is, you have a waiting list of 20,000 people looking to learn and train. I'm curious, how do we scale this out more? I'm sure you do in-person, but also online. Why can't we get more trained quickly? Or even just individual caregivers training in this because , ultimately, we're getting more healthcare at home. The scope of practice has to increase because there certainly aren't enough psychiatrists or psychologists out there to be able to do this kind of work. 

 

Dr. Schwartz: As you may guess, that's a question in my head all the time. The problem we're facing is that now we have seventy trainers, and we can't come close to meet the demand. We're running trainings all over the place, but the trainings are pretty labor-intensive because it's a pretty delicate endeavor to take people inside to these very vulnerable places and we want to make sure the therapists are very well-trained and so our trainers need to be really well-trained. 

 

It takes several years to become a trainer. We've been cranking out trainers and trainings as fast as we can, but it's really hard to scale because of those constraints. Also, we have a three-to-one ratio between students of the trainings and we call program assistants who are trained in IFS and help the students because the trainings are very experiential. People learn it by doing it actually, and doing it with each other. So, that's the big constraint and so we're playing with, are there ways to bring this directly to the public that could be safe? 

 

Again, coming from a medical family ‘first, do no harm’ is in the back of my head all the time so I want to make sure it's safe. 

 

Shiv: Very interesting. The tech entrepreneur side of me would love to hear more about that at some point, because I know there's several well-known academics who've taken their large body of work, in your case, forty plus years, and been able to make it more democratized. There's a Stanford clinician who has an app called Reverie, which has brought self-hypnosis to the masses, hopefully in a very safe way. I'm not sure. I used it once, but I haven't really stuck with that or been as informed. Or Sam Harris, which is bringing more Buddhist philosophy among other things, and mindful based stress reduction. So yeah, I could totally see an app or something coming together if you don't already have that. 

 

Dr. Schwartz: We don't. I was approached recently by a guy who wants to use AI, and actually demonstrated it. This was for training therapists, but I could see how it could be used for the public too, where I'm the therapist and I'm asking questions, and the AI is responding as a client would. And then there's an AI supervisor over here. I was pretty impressed, actually. 

 

Shiv: I'll definitely be following up on that, because you preempted my next question on AI and how we can use it. We've had people talk about AI for clinical documentation, which is an obvious need and I think where a lot of the quick wins in healthcare will be over the next two, three years, if not the next couple months. But having AI therapists or therapist helpers is a possibility too, because I could imagine you could fine tune a model based on the most successful IFS therapists in terms of patient outcomes and patient ratings. Having an IFS AI that can help bring it to the masses...I'm sure that's being discussed with this person, maybe. 

 

Dr. Schwartz: It's being discussed. I still feel like when I'm with somebody, a lot of the success of the work has to do with my presence and what I call ‘self-energy’ that I'm conveying, that people palpably can feel. I don't know that we can train a computer to do that, but I'm open. I'm willing to explore it, because I really do want to bring it in an affordable way to many more people. So, that's got the appeal to me. 

 

Shiv: That's awesome. Well, I'm excited to see what comes of it. And again, very excited about maybe being part of that journey over the next couple of years. That's why I went back to Hopkins for med school. 

 

What advice would you give to me as a medical student -- or anyone listening to this, if they're in nursing school or early career PAs or whatever it may be -- about approaching their careers in healthcare? 

 

Dr. Schwartz: That's a big question. Just know that you've chosen to do something that's going to be really stressful, and that it can really help if you know how to take care of yourself emotionally. That you're going to need to do that or you will burn out, and that this is a system that can help with that.

 

Shiv: Yeah. That's, again, one of the main reasons, if not the main reason I invited you on, and I'm privileged that you joined us, because I want people who listen to this to explore these things for themselves, and then if it works for them, hopefully bring it to their patients, too. My last question for you is, is there anything else you wanted to share with our audience about you, IFS, mental health in general, before we let you go for the evening? 

 

Dr. Schwartz: Some of what I said earlier, which is this is an alternative paradigm for understanding all kinds of what are seen as mental illnesses, and that I think one of the things I'm proudest of is that there are many, many heavily diagnosed people who feel hugely relieved to know that they're not sick; that they're just, because of the traumas they suffered, they have these parts that do extreme things that are stuck in the past, but they can all be worked with, and that people work with them on an ongoing basis, on a daily basis. 

 

People teach IFS all over, but very few psychiatry departments yet. I'm on the staff at Harvard through Cambridge Health Alliance, and so we have a little outpost there, but as far as I know, it hasn't really taken root anywhere else, and so that's part of my goal also, is to just bring this different perspective on all these things that have been so medicalized. 

 

Shiv: Yeah, I couldn't agree more. Again, being on an inpatient unit at one of the best research hospitals at Hopkins, I've been shocked how few people actually know about, alternative approaches at this point, but one of the reasons I've come back to Hopkins is because they have a huge psychedelic research center, and I think that-- in combination with the real work, which is the therapy behind it, IFS, CBT, DBT, etc. -- will, I think, be the game changer. 

 

Dr. Schwartz: Yeah, I think that's the other thing I'll say, which I think is becoming more common knowledge: that the medicine is not necessarily the healing agent. The medicine opens a portal for a lot of healing, but to really heal, to really seize that opportunity, people need therapy. They need IFS or something similar to actually do a lot of the healing that this opens the door to. So, you know, I was disappointed with Michael Pollan's book because it's so focused on the medicine as the healing agent. 

 

Shiv: Yeah, Michael Mithoefer and Rick Doblin, Rachel Yehuda, will be the first also to agree with you and say that it's therapy first and foremost, and the psychedelics are just a portal, and there's a lot of other ways to get there, but psychedelics just happen to be faster and more replicable, it seems. 

 

Dr. Schwartz: Yeah, I totally agree with that. 

 

Shiv: Well, Rick, this has been a real privilege of mine and a pleasure to have you on. I'm a huge fan of your work and really appreciate you taking the time to share with our audience as well. 

 

Dr. Schwartz: Thank you, Shiv. I've really enjoyed it, and it'd be fun to further connect. 

 

Shiv: 100%. I'll definitely follow up on the AI and the app. So with that, I'd like to thank our audience for listening to today's show and remind them to do your part to raise the line and strengthen our healthcare system. We're all in this together. Take care.