A Visit to Flatland: A “New” Perspective on Broadening Psychiatric Practice

A colleague and I recently attended a continuing education meeting at which various sessions were dedicated to the increasing evidence of the association of inflammation not only to physical ailments, but also to mental health issues such as depression and some forms of dementia. 

The speakers were very interesting and the research they cited, compelling. It was a good day, and we would be garnering continuing education hours towards our certification. The final session, though, had us looking at each other with wonderment. Besides the information on selecting pharmaceutical agents, this last presentation addressed extending and broadening treatment to the whole patient. 

The speakers recommended adding exercise, paying attention to nutrition, adding the practice of mindfulness, and particularly singling out rumination as a potent maintainer of depression. 

We felt like we had entered the story, Flatland, which was written in 1884 by Edwin Abbott Abbott. Flatland is the story of a two-dimensional creature, A Square (who is actually a square), one of the inhabitants of Flatland, a world consisting of a just a single plane. 

In the story, a creature visits A Square from one of the higher dimensions. This creature is a sphere, but since Flatland has only two dimensions, it appears as a circle that can change its diameter continuously at will. The Sphere visits Flatland once every millennium, when he is allowed to try to convince Flatlanders of the existence of the third dimension. Ultimately, in order to convince A Square of the reality of the three-dimensional world called Spaceland, the Sphere is forced to pull him out of Flatland and allow him to experience Spaceland’s full three-dimensional effects. 

And here we were listening to esteemed psychiatrists recommending expanding the practice of psychiatry beyond prescribing medications. As clinical nurse specialists in a state where we do not have prescriptive authority, we have never lost sight of our nursing roots and the adjunctive therapies that go into treatment. 

For the past 25+ years, I have regularly “prescribed” exercise for patients with depression and anxiety—not having a real prescription pad, I use the little sticky notes we used to get from pharmaceutical vendors. Along with exercise, we focus on nutrition as well as “sleep hygiene”, a term for a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness. 

I have also focused therapy efforts on reversing the social isolation that so often accompanies depression by insisting the patient indulge in one – only one to start – activity she used to enjoy. Sometimes getting someone to follow through on this takes a while. For one patient, who was never very social to start with, this meant volunteering a few hours at the local SPCA playing with the cats to help socialize them for adoption. While doing so, she started to talk with some of the other volunteers; the experience took her out of herself and her ruminations about her life. 

The final presentation of the day was affirming and the research underpinning the broadened modalities like exercise, mindfulness ,and diet added to our current practice. It turns out that when all you have is a hammer, everything looks like a nail, but when you have a whole toolbox of techniques, the approach can be customized for each patient. 

Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.