Positive Psychiatry - with Rakesh Jain, MD
Positive Psychiatry with Rakesh Jain, MD explores the science and practice of fostering mental wellness, resilience, and flourishing through the lens of psychiatry. Join me as I discuss articles and opinions from expert clinicians, researchers, and thought leaders as they discuss emerging strategies to enhance well-being, purpose, and strengths—not just reduce symptoms. From gratitude and optimism to meaning and connection, this podcast brings evidence-based insights into the heart of mental healthcare.
I am additionally a proud member of the Steering Committee of Psych Congress. This year's annual meeting is September 17-21 in San Diego, California.
Positive Psychiatry - with Rakesh Jain, MD
Positive Psychiatry Masterclass: How A Med Check Appointment Can Be UpLifted
What if the most powerful tool in your exam room isn’t a prescription, but a better question?
We sit down with Professor Shailesh “Bobby” Jain, MD, MPH to reimagine everyday psychiatry through a positive lens—one that treats flourishing as a legitimate clinical outcome alongside symptom relief. Rather than racing through checklists, we explore how starting with “What does a good life look like to you?” shifts the room, clarifies values, and turns treatment into a collaboration.
Bobby lays out a practical playbook for clinicians and curious listeners: identify strengths like perseverance, curiosity, humor, and compassion as data, not decoration; approach resilience as capacity for recovery, not a demand to “be tough”; and bring meaning and purpose into the plan because they modulate reward circuits, buffer stress, and predict long-term health. We dig into trainable positive emotions—gratitude, awe, humor, kindness—and how brief, intentional practices broaden attention, increase cognitive flexibility, and help the brain rehearse safety without denying pain.
Relationships take center stage as core treatment, not an afterthought. We map belonging, ask who helps you feel seen, and treat connection-building with the same seriousness as dose changes. Hope reappears as an honest engine—belief that steps exist—while self-compassion helps separate identity from illness and quiets the body’s threat systems. We also look at why this approach protects clinicians from burnout: it restores meaning in the work, deepens rapport, and expands what success looks like for patients and providers alike.
If you’ve ever felt that a visit focused only on symptoms leaves healing on the table, this conversation offers clear questions, concrete steps, and a refreshing North Star.
www.JainUplift.com
Well, hello dear friends, and welcome back to the podcast Positive Psychiatry with Rakesh Jan. This is your host, Rakesh, and today's conversation is going to feel a little different because we're not going to be racing through headlines. We're not even debating diagnoses or medication algorithms. Instead, we're slowing things down intentionally because sometimes the most powerful intervention in positive psychiatry isn't a prescription or a protocol. It is a question or questions. Now to help us with that, we have a special guest with us, Shelish Jan MD MPH. He goes by Bobby, and he's a full professor of psychiatry at Texas Tech University School of Medicine in Permian Basin. And he also happens to be the residency program director and has been so for several years at the Department of Psychiatry at that medical school. He has wide interests in a lot of topics, and we're going to have a lovely conversation about positive psychiatry, not as philosophy, but as a practical clinical framework. Specifically, we're going to explore the kind of questions a mental health professional like a psychiatrist or a nurse practitioner or a physician assistant may ask when the goal isn't symptom reduction, but in fact it is human flourishing. So let me start out with something foundational. But first of all, Bobby, can I welcome you to the podcast? Thank you. It's a pleasure to be here today. Wonderful, Bobby. So we're going to leverage your expertise here. So let's start with the very first question I have in mind, which is when you use the phrase positive psychiatry, what does that actually mean in the exam room, in the consultation room? How is it different from what most people experience in mental health care?
Shailesh 'Bobby' Jain, MD, MPH:Well, that goes that question goes right into the heart of this entire conversation. In reality, posture psychiatry is deeply grounded in suffering. It simply refuses to let suffering be that story we tell. If you know, traditional psychiatry, as we at it has evolved over the last century, has been extraordinarily successful in identifying pathology. We are very good at naming disorders, categorizing symptoms, applying evidence-based treatments to reduce stress. That work is essential, and positive psychiatry does not replace it. What positive psychiatry adds is a second equally rigorous question, which is what allows human beings to function well, adapt well, and live meaningful lives even when illness is present. In the exam room, that means I'm not only tracking symptoms, side effects, and risk, I'm also tracking well-being, which is a psychological, social, emotional, and existential well-being as legitimate clinical outcomes. Now, past this psychiatry is based on the understanding that mental health is not a zero-sum game where the absence of depression automatically equals happiness. Those are different neural systems. So if we only treat what's broken, we leave enormous healing potential untouched.
Rakesh Jain, MD, MPH:That is really deep, Bobby. That is really deep. And I think it speaks to the whole issue that nowhere in the DSM V, you know, I read the DSM V closely, Bobby, does it ever talk about human flourishing? It doesn't talk about positive psychiatry. It only talks about clusters of symptoms, right? And the challenge, of course, is that's not what patients are wanting. So there's a recent study I've reviewed that showed that clinicians' top priority is reduction of symptoms of the patient's psychiatric disorder. I think, Bobby, you would agree with me that has been our traditional training. But for based on what you're saying is, that's not enough. And what positive psychiatry adds is a second, equally rigorous question. What allows human beings to function well, adapt well, live meaningful lives, even when an illness is present? I hear you exactly. And I think you're saying there is no conflict between absorbing the principles of traditional psychiatry and updating our game by including all these skills and principles from positive psychiatry. So let's maybe start our conversation on a slightly different topic. Really, I would like for you to perhaps imagine someone walking into your office for the very first time. What kinds of questions help establish that broader frame?
Shailesh 'Bobby' Jain, MD, MPH:If I were interviewing a person from the lens and look at the person from the lenses of positive psychiatry, I would be starting with the person, not the problem. What I mean by that is when someone comes in for the first time, they often brace for interrogation. They expect a checklist of symptoms, a rapid diagnostic level, and maybe a prescription. That's the experience most people have had. So I intentionally disrupt their expectations. I'll often begin with something like Before we talk about what's been difficult, I want to understand who you are. What does a good life look like to you? That question immediately changes the emotional temperature of the room. It tells the patient that the values matter, that their definition of wellness matters, and that this process is collaborative. I'll follow up with the question: When you're at your best, how are you thinking, feeling, and living? What's remarkable is that even patients who feel completely hopeless can sometimes access a memory or image of themselves that feels more alive. Sometimes it's from years ago, sometimes it's fleeting, but it exists. Those descriptions become a North Star. They help us define what we are moving, that what we are moving for toward, not just what we are moving away from.
Rakesh Jain, MD, MPH:I think you just made a very important point that the North Star for today's mental health professional cannot simply be reduction or even full elimination of symptoms. So, Bobby, I grew up in an era where remission was the gold standard. I think what you are telling us is while remission is a very worthy gold standard, the true North Star is a combination of symptom reduction, but also appreciating the strengths of the individual and moving them towards true flourishing. I get it. So strengths aren't something that most patients expect to be asked about. As you said, you want to disrupt their thinking. How do you introduce that conversation?
Shailesh 'Bobby' Jain, MD, MPH:Well, I introduce it directly within and with intention, because strengths are not optional, they are clinically relevant variables. I'll say something like, you've been dealing with it a lot. What personal strengths have helped you to get through difficult periods in your life? Sometimes patients hesitate because a culture doesn't train people to name their strengths. So I normalize that discomfort. I might add, this isn't bragging. This is information that helps me understand how your mind and nervous system work. Strengths like perseverance, perseverance, humor, curiosity, creativity, spirituality, or compassion aren't just personality traits. They influence how stress hormones are regulated, how quickly people recover from setbacks, and how likely they are to engage in treatment. When patients reconnect with their strengths, sometimes subtle but powerful happens. Their entity expands. They stop seeing themselves solely as a diagnosis and start seeing themselves as a whole human being navigating difficulty.
Rakesh Jain, MD, MPH:You are really talking about disrupting a clinical interview, aren't you? Because classically, the only thing that happens is a quick review of symptoms, and that's all there is to it. What you're saying is you're trying to engage a patient into a deeper exploration of their strengths. What are some of the weaknesses in the positive psychiatry symptom complex and how to move patients in that direction? Now, Bobby, you're also a child and adolescent psychiatrist in addition to an adult psychiatrist. Do you think positive psychiatry may equally apply to all three age groups rather than just adult patients?
Shailesh 'Bobby' Jain, MD, MPH:I would say so. I think that part is applicable to all age groups, all genders, all racial origins, and ethnic origins to everybody. It is, I think, just being part being human.
Rakesh Jain, MD, MPH:Got it. And I think that humanity needs to be appreciated. I think you're right. Even the most psychotic patient I've ever met has some drive towards wellness, right?
Shailesh 'Bobby' Jain, MD, MPH:That's correct.
Rakesh Jain, MD, MPH:Yeah, and I think we ought to appreciate that no human being comes to see a mental health professional just for one set of difficulties, but a large number of difficulties. I think you've given us a lot of tips on how to engage with patients, but perhaps you could talk a little bit about what personality, traits, and strengths we clinicians can develop inside us in order to optimally introduce the concept of positive psychiatry to a patient.
Shailesh 'Bobby' Jain, MD, MPH:I think you're talking about resilience. That's a critical distinction. Resilience should never be used as a weapon against suffering. I frame resilience not as toughness, but as capacity for recovery. I'll ask, can you tell me about a time in your life when things were very hard and you still made it through? This question does not minimize pain, it honors it. It acknowledges that survival itself is evidence of adaptive capacity. I also ask, when things feel overwhelming now, what helps you stabilize even briefly? Even small answers matter. Calling a friend, taking a shower, sitting outside. These are not trivial behaviors. They are signs of a nervous system that still knows how to seek safety. Resilience is not about never falling apart, it's about learning how to come back together.
Rakesh Jain, MD, MPH:Beautifully said. Beautifully said. So perhaps the one thing you're suggesting, at least to my ears, is think about resilience as being a very important protective factor for both the patient and the clinician, right, Bobby? I mean, this is not just for one person. And I think I'm going to just repeat what you said, asking patients when things feel overwhelming now, what helps you stabilize even briefly? Because I think what that does is allows even the psychopharmacologist in us to offer our patients some practical tips and suggestions. I really liked your conversation about resilience. That feels good to me. But can we move into another topic, which is look, even positive psychiatry needs its own North Star? And I wonder if meaning, purpose, and existential health aren't important things. So does meaning feel like a core pillar of positive psychiatry? And how do you explore it clinically?
Shailesh 'Bobby' Jain, MD, MPH:That's a great question. I think meaning is central because it organizes the entire human experience. I'll ask, what gives your life a sense of meaning or purpose? Who or what makes life worth living even when things are hard? These questions are not philosophical detours. They are biologically relevant. Meaning modulates reward circuits, buffers stress, and predicts long-term health outcomes. For some people, meaning comes from relationships. For others, from service, creativity, faith, learning, or responsibility. There's no right answer, only their answer. What's striking, I think, is how rarely patients are asked before questions in medical setting. How many people tell me no one has ever asked me this before? And in that moment, something shifts. Clinical encounter becomes human again.
Rakesh Jain, MD, MPH:Such a wonderful thing you have shared with us. You know, I have been a patient on more than a few occasions in my life, as probably most other people have. And most of us have dealt with some very competent clinicians. But I think it's rare for me to have a combination of both a competent clinician and someone who treats me like a human, with drives and passions, and fears and hopes and aspirations. I really like what you said that for some people, meaning comes from relationships. For others, it could come from service, creativity. There is no one right answer. And perhaps what you're saying is, how can we find out what the right answer is if we don't talk to our patients? So I agree with you. What's striking to me also is how rarely patients are asked these questions in medical settings, as well as in psychiatric settings. And can I be the first one to frankly admit on this podcast, until recently, I also was very driven by checklists. I wasn't driven by patients' needs. And I really appreciate that that clinical encounter can feel human again when we move into that area. So let's talk about positive emotions. We know that is a deficit, right? You've heard and you read some of my writings, Bobby, on wellness deficit disorder. Well, the evidence is psychiatric illnesses take away your wellness. But the question I'm going to ask you is if positive emotions are important, are they a trainable skill? And how do positive emotions fit into psychiatric treatment?
Shailesh 'Bobby' Jain, MD, MPH:This is a great question. I think, in a sh in short, I think I would say yes. Positive emotions are often misunderstood as rewards that come after this recovery. In reality, they are tools that help drive recovery. I ask, what brings you moments of joy, calm, gratitude? When was the last time you felt even a brief sense of peace? Positive emotions broaden attention, increase cognitive flexibility, and help the brain practice safety. Even brief moments matter. We treat positive emotions as skills to cultivate, not moves to wait for. Gratitude, awe, humor, kindness, these all be intentionally practiced, even in small doses. It doesn't invalidate suffering, it expands capacity.
Rakesh Jain, MD, MPH:I one more time appreciate your expansion on this topic because what I'm already predicting is some clinician colleagues will say, Hey, you guys sound like this is an opera show. That you're asking me to stop being a psychiatric mental health professional, a prescriber, and you're asking me to embrace new age pop psychology. And that's not at all what we are saying. What we are saying is positive emotions, if we train our patients and how to incorporate them into their lives, what might end up happening is not only do they have improvement in positive psychiatric symptoms, they might in fact have improvement in the psychiatric symptoms. Right, Bobby? That's what I am hearing you say. And you're saying, let's actually broaden the scope of what patients do. I'm just recounting what you shared. Gratitude, awe, humor, kindness. I just saw a study, Bobby, that you might find very interesting. Awe by visiting a museum and looking at paintings measurably improves mental health, not while you are in the museum, but even later. And I must underscore what you said at the very end of your comments that positive psychiatry does not invalidate suffering, it expands capacity. That is beautiful. Now you said something about relationships and belonging. You said that's a very important component of, you know, patience, entire mental health and mental well-being. How central are relationships in your assessment?
Shailesh 'Bobby' Jain, MD, MPH:I think they are absolutely central. I asked, who are the most important people in your life? Do you feel seen, valued, and understood? Human beings are wired for connection. Chronic loneliness is not just painful, it is physiologically toxic. Pastor psychiatry treats social connection as core treatment. Not an optional add on. Strengthening relationships is a is as clinically meaningful as adjusting medications.
Rakesh Jain, MD, MPH:My goodness, that's a shot across the bow in many ways. Never, ever in my 30, what is it now, 38 years of training, and I feel I've been trained pretty well in psychopharmacology, have I ever been taught about what you just said that strengthening relationships is as clinically meaningful as adjusting medications? I'm certainly hoping our listeners are really absorbing what you have to share, that if you really want to be a great psychopharmacologist in some ways, it would be wise for all of us to absorb the basic principles of positive psychiatry and bring that into our clinical interview. Now, hope. Hope is very important, is it not, Bobby, for patients? Well, for all human beings, but patients in particular who feel so hopeless as part of the disorder. So hope can feel quite fragile. How do you approach that issue in your practice?
Shailesh 'Bobby' Jain, MD, MPH:Well, I would say hope must be handled gently. I asked when you think about the future, what worries you the most? And then is there anything, anything at all that you still feel hopeful about? Hope is not blind optimism. It's a belief that change is possible and that steps exist. Often hope returns before symptoms improve. It's not the destination, it's the engine.
Rakesh Jain, MD, MPH:It's not the destination, but it is the engine. How well said. So we must think about ways to offer hope in a gentle, honest way. I'm hearing you loud and clear. Maybe we can now turn our attention to talking about self-compassion and identity. What role does self-compassion play in the healing in your exam room?
Shailesh 'Bobby' Jain, MD, MPH:Well, as a psychiatrist, I would say it has a profound role. I ask, how do you talk to yourself when you struggle? Would you speak that way to someone you care about? Self-criticism activates threat systems. Self-compassion activates safety and affiliation systems. Positive psychiatry helps patients disentangle identity from illness. You're not your symptoms, you are a human being experiencing them.
Rakesh Jain, MD, MPH:So that in a nutshell is the best definition I think I've ever heard of self-compassion. So self-compassion does not appear to be denial. Self-compassion appears to be really a re-identification of the illness and how we formulate it. So, as you said, if patients were to appreciate, they're not their symptoms, that they are a human being experiencing them, it is not their identity. It's the illness's identity, but not their identity in itself. And you said it so beautifully. Self-criticisms activate threat systems like the HBAxis, the inflammatory system, the autonomic nervous system, and of course, self-compassion deactivates these systems and in fact activates the safety systems that we have in our bodies. So there is power to this line of questions that I would say is a direct benefit, a direct gift from the world of positive psychiatry. Could you talk a little bit if patients listening to you and I took one thing from this conversation? What would you want that to be?
Shailesh 'Bobby' Jain, MD, MPH:I would say ask better questions. Questions that honor pain, but not possibility, but also possibility. Questions that explore meaning, strengths, and connection. Questions that remind patients and clinicians that healing is about more than symptom control. Now, positive psychiatry doesn't replace treatment, it completes it.
Rakesh Jain, MD, MPH:Well said, Bobby. Well said. In fact, you said it so well that that might be the concluding statement of our podcast. Positive psychiatry does not replace traditional treatments. That could be CBT, that could be DBT, that could be psychopharmacology, that could be TMS, could be ECT, whatever. It doesn't replace it. It, however, completes it, it augments it. And your questions were really, let's honor your pain, but let's also honor the possibility. I think that's a good example of hopefulness, is it not? You also said, let's explore meaning, strengths, and connection. My goodness, those are the pillars of positive psychology helping us in the world of positive psychiatry become better clinicians. Maybe the last question I have for you, Bobby, is you know, you are a very well-trained clinician. You know your psychopharmacology well. You train others in it. Why would you even want to quote unquote waste your time pulling in elements of positive psychiatry into your practice? I guess, in other words, what's in it for you?
Shailesh 'Bobby' Jain, MD, MPH:I think without having positive psychiatry, it becomes a very stale, repetitive interaction with patients pertaining only to medications. I think positive psychiatry helps connect on a human level. It is not only for the patients itself, but it's also for the clinician. Because I think that a clinician needs to grow and mature through the patients. And as the patients mature and understand their own thinking, it helps the clinicians also. I think it'll indirectly help prevent burnout in physicians.
Rakesh Jain, MD, MPH:Wow. Well said. Well said. So certainly positive psychiatry, every study I've ever reviewed shows that patients really like, really like it when their clinician treats them like a full human being, not just a collection of symptoms. But Bobby, what you said about, my goodness, it could also help prevent us from going stale, from having burnout. That'll be wonderful. Well, you are in a position to train other residents. What are your thoughts? Do you think your residents and NP students and PA students, do you think they would be willing to hear this important message regarding positive psychiatry as if, you know, why didn't you tell me this before? Or will it be like, no, this is just a little too much for me?
Shailesh 'Bobby' Jain, MD, MPH:I think that without positive psychiatry, learning will be incomplete. I think training them from the very early, from the early aspect of the training will be very, very helpful. I think not training them is not an option. I think that without that training, they'll be they'll be missing a very important ingredient of being a complete psychiatrist. Treating patients, as I said, it all not only helps the patient, it will help us grow better, being a better human being and being a better psychiatrist.
Rakesh Jain, MD, MPH:Gosh, well said, Bobby. No wonder you are a guest on this podcast. And I think I'll speak to you on behalf of all the audience members in this podcast, that we are grateful for not just your thoughts, but your willingness to keep changing, even though no one's forcing you to do it. And you have given us lots and lots of practical tips regarding positive psychiatry. And the last three or four minutes of what you said, I think captures the entire conversation well, which is we could get away with just doing traditional psychiatry, but why? It's not good for patients, it's not good for us, it's not good for outcomes. So why is it that we're avoiding embracing positive psychiatry in our practices? I think I have an answer. The answer is if you use someone like me as an example, I've never been exposed to it before. And what you're doing, Bobby, through, well, by being a host on this podcast, a guest on this podcast, and by also your willingness to train your students, I think you are moving yourself, your patients, your trainees onto higher ground. That's wonderful. Well, Bobby, I want to thank you very much for appearing on this podcast.
Shailesh 'Bobby' Jain, MD, MPH:Thank you, Rakesh. It was my pleasure to be here.
Rakesh Jain, MD, MPH:All right, and thank you, dear listeners, for being with us today. And we certainly hope you benefited as much from this conversation as quite definitely I did myself. Here's wishing you the very best, and we will talk to you down the road. Goodbye now.
