As part of Mental Health Awareness week, GP, lifestyle medicine physician, yoga teacher and very good friend of Yogamatters, Dr Chang chats with Dr Charlotte Marriott, a Consultant NHS Psychiatrist and a Certified Lifestyle Medicine Physician.
Charlotte is also a retired yoga teacher but continues to enjoy her personal practice and yoga’s benefits for mind, body, soul and spirit. She likes to inspire and empower her patients (and everyone else!) to make small changes to their lifestyles to improve their physical and mental health and well-being.
Charlotte and Dr Chang graduated in the same year from UCL medical school almost twenty years ago, so it was an extra special pleasure for her to catch up with her and talk about her work and yoga.
Tell us about how you got into Psychiatry…
I always had an inkling that Psychiatry would be where I would be heading. At medical school, I found Neuroscience fascinating – learning about emotion and behaviour, learning and memory and how the brain works.
And people’s stories have always interested me. In Psychiatry, you have time to find out about patients, their life stories, and the inner workings of their minds and experiences; it’s a very holistic speciality. We help people with a whole range of things they need in their life; we work in a very multidisciplinary way.
You are known as The Lifestyle Psychiatrist. What made you move in this direction?
I have always had an interest in health and maintaining health. In medical training, there is such a focus on illness and disease but not necessarily on helping people improve their health. I often felt like we would do a ‘sticking plaster method’ – patch people up and send them on but not really help with the whole range of whatever else was going on for them. I came across Lifestyle Medicine in 2018, and it just made so much sense to me – reducing the burden of chronic disease, morbidity and comorbidity, polypharmacy, helping people lead healthier lives, and even reversing chronic diseases like Diabetes through lifestyle.
Lifestyle Psychiatry is a growing speciality – it’s a term coined by Douglas Noordsy – he brought together all the evidence about how lifestyle can improve mental health. The pillars of Lifestyle Medicine are nutrition, physical activity, sleep, substance reduction, positive psychology and stress reduction. The research is vast and ever-growing. Particularly with researchers like Brendon Stubbs and Simon Rosenbaum, who do a lot of research into physical activity, and in Australia with Prof Felice Jacka and her work on the SMILES trial looking at nutritional Psychiatry. I wanted to incorporate this into my NHS work, train and educate other clinicians, and have conversations with our patients about what they eat, how they sleep, what movement they do, and take an even more holistic view for mental health.
What’s the reception like from colleagues and other psychiatrists to the Lifestyle Psychiatry approach?
I’ve had good feedback and reception from colleagues. People are fascinated – if you present the evidence, people are interested, and you can’t argue with the science.
Some of the scepticism I’ve had is around the idea that we all know we need to eat better and move more, so what’s the big news here? But the point is that knowing it isn’t enough, you need to actually do it. Understanding behaviour change, evaluating someone’s confidence to change, their motivation to change etc., to help them identify what is possible for them is an integral part of helping a patient make those changes.
How about the reception from patients?
I sort of weave it into our regular consultations. Part of why I’m so keen on it in what I do in early intervention psychosis is because my patients with Schizophrenia, for example, have a reduced life expectancy – they die 15-20 years younger than the general population. A lot of that is to do with cardiometabolic syndrome, and then we contribute to that risk with the medications we prescribe, and so to mitigate that lifestyle medicine has a role to play.
Tell us about your yoga journey and what your practice looks like now…
I went to my first yoga class at the University student union on a Monday lunchtime. I couldn’t do any of it (!), but the feeling I had after the class was amazing. I felt so relaxed, and so I kept going back.
Over the years, my practice has waxed and waned; there’ve been times when I’ve been very dedicated and times when life gets in the way. After I had my second baby, I picked it up again in earnest. I got strong again, fitter than I’d ever been before but also calm, more able to manage the day-to-day stressors of being a working mum, and more able to be present for my family. I also really enjoyed the meditative aspect and stillness of practice, finding that peace and clarity of mind, and that’s what I really loved about it.
I taught for a few years but stopped just before the pandemic. I was exhausted doing too many things. One of the drawbacks of teaching a group class was that the spiritual element was missing for me – it felt more like a group exercise class. I enjoyed one to one more. But I was doing too many things and knew something had to give.
What does your practice look like now?
I’m practising in a much less rigid way. I’m less attached to it, how well I do poses, whether I can do a pose or not. I’m much more interested in the benefits it has for me mentally and emotionally than how my practice looks. I think it helped not having a teacher during Covid because no one was looking at my practice, so it was much less about trying to achieve and more about how it made me feel. It’s much more free form these days; yesterday, I did Primary Series standing postures and then Savasana. I still like the Ashtanga method; the sequence makes sense to me. Doing that sequence, I’m very quickly in a meditative state. I’ll do a bit of yin and restorative, and sometimes I’ll just do child’s pose for ten minutes.
Do you recommend yoga to patients? What’s been your experience with that?
I do recommend it to patients. About ten years ago, a patient was admitted to a psychiatric ward I was working on with an anxiety disorder. He was on a lot of medication and he was still super anxious and wanted more medication. I noticed he was hyperventilating a lot. I started to talk about how he could learn to breathe to help his anxiety and to begin with, he was so angry with me about this suggestion. I explained the physiology of breathing, and he eventually tried it. Within a couple of weeks, he was reducing his medication. That gave me the confidence to continue to talk to people about these things.
And a few years ago, another patient mentioned that he had started going to a meditation group, which he found helpful for his anxiety. So I said, ‘well if you like meditation, have you ever tried yoga?’ So I suggested some beginners videos online; three months later, he returned and said, ‘doc, that yoga that you recommended? I feel fantastic; I’ve stopped all my medication and want to be discharged; I feel great.’ So I’ve had a couple of real success stories.
You mentioned breathing for anxiety. Could you speak of the mechanisms by which yoga helps – what do you think it is?
I think it’s multi-faceted; part of it is just pausing during your day. It gives us a window of opportunity to have a bit of stillness in the mind. Stillness, quiet, breathing, and to stop thinking so much. To learn that we are separate from our thoughts and they are not us, we don’t always need to pay attention to them. This can be particularly helpful for people with anxiety disorders, where people get so caught up in their thoughts. Think of yogas-citta-vrtti-nirodaha, finding that quieting of your mind. I think it takes practice to get to that point.
I think breathing is fundamental to yoga practice. There’s so much research about the benefits of deep, slow breathing on our brain waves, our default mode network, how our brain is working, and our parasympathetic nervous system.
Is there anyone that yoga wouldn’t be suitable for?
We have to be mindful of trauma. I know that many yoga practices are not helpful for those who have experienced trauma. For example, some people don’t like to close their eyes; they find concentrating on their breath or turning their attention to their body can be triggering. So we need to be mindful of those things. I know some yoga is deliberately therapeutic, using very slow, cautious ways of getting people to get into their bodies again.
I don’t tell all my patients that they should go and do yoga. I get a sense of when it could be helpful for them or what aspects could benefit them. The breathing side of things is fundamental for people with anxiety disorder, so I tend to teach that to everyone with anxiety. But I don’t always call it yoga.
A big question, but what do you think are the most significant challenges for the mental health of the nation as a whole?
One big thing is disconnection. I think we’re all not connected to each other or the natural world around us. We’re not even connected to ourselves most of the time. I think that’s a massive problem with how we live in the 21st century. Everybody lives individually, going about their individual lives and being too busy.
I think technology has a lot of pros and cons and has a lot to answer for too. It’s so easy to use technology as escapism – play video games, watch TV, social media. All of that is disconnecting you further from your life and other people and I don’t think that’s very helpful.
I think there are big social issues – poverty, racism, sexism, drug abuse, trauma, adverse childhood experiences are a massive problem and have a huge impact on adult mental health. issues with education funding, poor quality housing and food where our biological needs are unmet. We are not living in tune with our biology as human beings; we’ve gone so far down the route of progress that we are now no longer in touch with our animal nature.
I see so many young people who are struggling, they are kind of lost in their lives – struggling to find meaning, purpose, just disaffected. Not necessarily depressed but suffering nonetheless. And Covid has had a huge impact on the nation’s mental health. Research shows that chronic loneliness is as bad for you as smoking fifteen cigarettes a day. We have come out of lockdowns and the ramifications are hitting home. People are struggling in so many ways which will obviously impact on mental health.
Do you turn to anything for your wellbeing apart from yoga?
Being outside in nature is fundamental for my health and wellbeing, and the research evidence says it is for all of us. We need nature for our survival and it’s a biological necessity for us to be in nature.
One of the other things I found helpful is a gratitude journal which I started as a kind of experiment for a week. But I started and was never able to stop – it makes you remember the lovely things that happened, even on a difficult day. You can still pick out a few nice things, and they are always the simple things, like the sun was shining or I had a really nice coffee. Small small things that bring you joy every day. And it helps you to notice them – the more you do it the more you look out for the little moments of joy.
Dr Charlotte’s Recommendations:
Books:
- One Simple Thing, Eddie Stern
- Breath, The New Science of a Lost Art, James Nestor
- The Inflamed Mind, Edward Bullmore
- Brain Changer, Felice Jacka
- The Psychobiotic Revolution, Anderson, Cryan and Dinan
- The Body Keeps the Score, Bessel van Der Kolk
- Losing Eden, Why Our Minds Need the Wild, Lucy Jones
Apps:
Podcasts:
- Feel Better Live More
- Huberman Lab
- The Ashtanga Dispatch
Find Charlotte:
Instagram: @thelifestylepsychiatrist
Website: www.thelifestylepsychiatrist.co.uk
