"When you've seen one kid with autism, you've seen one kid with autism," Dr. Bergina Isbell (Dr. Bergina for short) reminds us, encapsulating the essence of her approach to mental health care—deeply personal, individualized, and innovative.

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As the CMO at Led Life Psychiatry in Maryland, Dr. Bergina harnesses the use of Ketamine-Assisted Psychotherapy (KAP) for individuals facing depression and anxiety, including those on the autism spectrum. And as a TEDx speaker, she champions the cause of restorative justice within psychiatry—all of this while finding time for ballroom dancing  and raising a family.

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In this episode of Psychiatry Tomorrow, we uncover:

• Considerations for treating neurodiverse individuals with ketamine or esketamine, transforming skepticism into trust as a conerstone of her therapeutic practice.

• Embracing flexibility and joy in professional practice: Learn from Dr. Bergina's transition to locum tenens and her "dancing in the rain" philosophy for balancing family needs with career, highlighting the importance of flexible work models and finding personal joy to enhance work-life balance.

• Empathy and advocacy that stem from personal experience, guiding families and individuals with special needs through life's challenges.

• The transformative power of restorative justice in mental health, offering a path to healing through the science of forgiveness.

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Let’s dive in:

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A personal Journey where work meets life meets work

Dr. Bergina’s journey into autism advocacy and her approach to work-life balance began with an urgent call from her son's school nurse. Dr. Isbell was with a patient but needed to tend to her son… an hour’s drive from her work.

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"I felt like I was doing a disservice as a mom and definitely doing my patients a disservice," she recalls. This realization prompted both her and her husband to reevaluate their careers. She shifted to locum tenens work, then ultimately started their own practice, which allowed for greater flexibility and the ability to respond to their children's needs more effectively.

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She got licensed in multiple states and utilized telehealth to meet patients where they’re most comfortable, giving her more flexibility, and reducing the need for physical presence in the clinic.

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Ketamine therapy: A transformative approach

Dr. Bergina's venture into ketamine treatments was sparked by a patient's inquiry about ketamine's effectiveness for pain and mood disorders, challenging her preconceived notions. "At first I didn’t want to touch it with a 10 foot pole… But after seeing patients rapidly remit from suicidal ideation I thought, this is like a wonder drug. It helps with everything: depression, anxiety, PTSD, pain, and substance use.” This realization spurred the integration of ketamine therapy into her practice, offering new hope to patients with or without autism experiencing co-occurring conditions like depression and anxiety.

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Tailoring the clinical environment

Recognizing the unique sensory needs of individuals on the autism spectrum, Dr. Bergina meticulously designs her clinic to be a sensory haven. From rooms themed after natural environments to custom scents that mimic the flora of the the Big Island of Hawaii, every detail is crafted to create a calming, immersive experience. "Every room in this facility has a theme that's based on a different area of the big island," she explains, ensuring each patient's experience is as comfortable and effective as possible.

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Sensory inventory: Customizing the experience

Before undergoing ketamine treatments, autistic patients undergo a sensory inventory, a process to assess their sensory perferences. This inventory includes preferences for tactile sensations, auditory inputs, and visual stimuli. "We have someone who curated scents for us. He researched the flora and fauna of the island of the different areas and created an essential oil blend that's unique to each room,"

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Whether you prefer forest or ocean, Dr. Bergina’s clinic provides a theme based on each patient’s unique preferences.Other aids include weighted blankets, fidget tools, adjusting lighting and sound. White or brown noise machines to provide a consistent and soothing background sound, masking the unpredictable noises of a clinical environment. For patients needing further auditory adjustments, headphones are available, allowing for individualized control over their sound environment to ensure maximum comfort. This personalized approach ensures a calming experience, complementing the amplified sensory perceptions often experienced during therapy.

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Autism advocacy beyond the clinic

Dr. Bergina’s work grew organically from not just medical expertise, but lived experience. She explains, “We started getting asked by family friends. They knew I was a psychiatrist, but they also knew I had one child on the spectrum. We just had so many people saying, “Hey, could you be an advocate with us for an IEP meeting?” Or, can you explain to us how you go about getting a 504? So we started out kind of doing it on a volunteer basis. And then we started noticing in our practice, more and more people were getting referred to us to see them as patients.”

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Oftentimes it's just a mom or a dad that are kind of frazzled and just want to be heard and be listened to and be told, “you know, you're a good enough mom. And it's okay. You'll make it through this”

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How do you balance self-disclosure with your personal experience and boundaries as a medical professional?

Dr. Bergina: “It's always a tricky issue. Often by the time people get to us, if it's specifically for autism, it's a small community here. So they already know that we do have children on the spectrum.

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We tend to just stick to the point. If they ask us a specific question, we answer that specific question. But to reiterate, it's kind of like when you've seen one kid with autism, you've seen one kid with autism, right?

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You've seen myself as a, as a parent of a child with autism. I'm just one parent of a child with autism. Your journey might be a little different from mine. So let's talk about how this you know, how can we talk about your journey? What's going to work for you and yours and the specific work that you're doing.”

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Embracing joy amidst chaos, navigating work-life balance, and “dancing in The rain”

Dr. Bergina reflects that work-life balance often feels more like a juggling act. But, as she reminded one of her autistic students who was sad that it was raining, ‘we can always dance in the rain!’ Beyond literally ballroom dancing for fun outside of work, Dr. Bergina’s philosophy serves as a metaphor for finding joy in challenging situations. For mental health clinicians, who often navigate the emotional and psychological complexities of their patients, adopting a similar mindset can be both a personal and professional strategy for resilience—reframing dreary challenges as playful opportunities.

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The transformative power of restorative justice

Speaking of opportunities, imagine a world where the deepest wounds could be healed not through punishment, but through understanding, forgiveness, and a shared journey towards healing. This is the essence of restorative justice that Dr. Bergina experienced as a prison psychiatrist.

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The essence of restorative justice

In her TEDx talk on the "Science of Forgiveness,” she delves into the intricacies of restorative justice, emphasizing its foundation on mutual understanding, forgiveness, and a concerted effort towards reconciliation. At it’s core, restorative justice is about the healing potential of establishing a dialogue between a person and those they have harmed. She recounts witnessing lifers in prison, "so many people that had done some heinous things," who deeply longed for the forgiveness of those they had harmed.

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The keys to restorative justice are two-fold:

1. The willingness of the offender to acknowledge their wrongdoing and seek forgiveness.
2. The structured facilitation of these encounters to ensure they contribute positively to the healing process.

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Restorative justice beyond the criminal justice system

We can broaden the scope of restorative justice to include not just the criminal justice system but also community disputes, educational settings, and even the environmental impacts of corporate actions. Her insights suggest that restorative justice can be a versatile tool for addressing a wide range of conflicts and harms, from the interpersonal to the global scale.

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You can apply it to more benign situations like neighborhood disputes or school squabbles; restorative justice is a versatile tool for reconciliation and community healing. The key is the genuine desire for reconciliation and healing on all sides, supported by a framework that encourages constructive dialogue and resolution.

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Implications for psychiatry and mental health practice

The topic raises questions for a reconsideration of practices such as involuntary commitments, urging a shift towards more empathetic, patient-centered approaches that prioritize the dignity and autonomy of individuals seeking mental health support. By valuing dialogue, understanding, and reconciliation over punitive measures, restorative justice aligns with a more compassionate and holistic approach to mental health care, emphasizing the dignity and worth of every individual involved.

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Seeking and implementing restorative justice

The journey to engage in restorative justice can begin with a simple search in one's community or through the guidance of a trusted therapist. She cautions, however, that not all situations or individuals may be ready for such a process, highlighting the importance of readiness and mutual willingness to engage in the restorative journey. This readiness is crucial, as "you both parties have to participate in a good faith effort," making it distinct from mediation where participation might be compelled without a genuine desire for resolution.

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Conclusion

Dr. Bergina’s career is as unique as each client she serves. Her work reminds us to stay flexible to changing needs - and that you can design your work and environment around those needs. Similarly, the ideal therapeutic environment starts with assessing each patient’s sensory needs and preferences. And when you can’t bend the environment, you can change your perspective:

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"It really doesn't matter if it's a rainy or cloudy day...you can have fun when the rain is here. You can have fun when the rain goes away," she states. Embrace life's unpredictability with grace, because sometimes, the key to balance is learning to dance in the rain.