2_2 Nikhita Singhal: Overcoming Adversity, Demystifying Eating Disorders, and Building Holistic Models of Care

[00:00:00] Raad Seraj: Welcome to Minority Trip Report. MTR is a podcast spotlighting stories of personal transformation and underrepresented leaders in mental health, psychedelics and consciousness. I'm your host, Raad Seraj. If you're learning from or enjoying Minority Trip Report, please subscribe to MTR on YouTube at Minority Trip Report and follow us on Instagram at Minority Trip.

[00:00:18] Raad Seraj: Thank you and enjoy the episode.

[00:00:20] Today my guest is Nikhita Singhal. Nikita is a fourth year psychiatry resident at the University of Toronto, who completed her undergraduate degree and medical training at McMaster University. She's passionate about engaging advocacy work, empowering individuals with lived experience, and contributing to medical education.

[00:00:35] Nikhita hopes to combine her clinical interests in addictions, eating disorders, and psychedelic assisted therapy to work with underserved and marginalized youth. 

[00:00:42] Nikhita, welcome.

[00:00:43] Nikhita Singhal: Thanks so much for having me. 

[00:00:45] Raad Seraj: This is very exciting to, to have this conversation with you, not only because I think you're a very inspiring individual and I've read a number of interviews now about your work and what you're hoping to do.

[00:00:58] Raad Seraj: I think it's super inspiring and really courageous. But not only that, I think your lived experience itself can shed a lot of light in into what feels like to me as somebody who's never experienced it, the hidden world of eating disorders and what the experience itself is like. And so I think it's gonna be really helpful for our audience and even for me to understand and maybe then assist others around us who may be experiencing these struggles that we don't know about.

[00:01:28] Raad Seraj: And I think the flip side of that, Compulsive behaviors or addictions and things like that are also, generally quite mysterious. I don't think we understand enough about them, so never mind, how to treat them effectively in a wholesome way.

[00:01:41] Raad Seraj: So I'm really excited about this conversation. Before we get into the work that you're doing now, I'd love to know a little bit about your most formative memories and feel free to start wherever. I often find it's really helpful to understand the setting, setting in which somebody grew up, their relationship with their parents, how their parents, came to be. A lot of my guests are immigrants, so their parents' experiences are quite formative and influential because from from our parents' experiences, do we gain sort of the value set that we further live our life by. All to say, let's start, when you are much younger, what were your first formative memories like? 

[00:02:20] Nikhita Singhal: That's an interesting question. I think up until probably a couple years ago, I would've said, I just genuinely don't really remember anything. Probably pre age 10 or so. And it was more like, my parents would tell me things that happened or I knew things happened, but it wasn't really like I remembered it.

[00:02:40] Nikhita Singhal: It was just like having a story told to me. Recently though, as, and as I've gone through a lot of this like my own personal journey I have started to have little bits and pieces, but I guess one of the places I generally start or can point things back to would be when I was around seven years old.

[00:02:59] Nikhita Singhal: That was when, first I guess my parents noticed something was off or wrong and at the time I guess I could go even back a little bit further. So my parents are divorced. They divorced when I was probably two, so I don't really remember much from that time at all. But. We were actually, they're, they're both Canadian.

[00:03:22] Nikhita Singhal: So my mom came to Canada she was born in Fiji, but came when she was quite young and my dad was born in India, but then came, he was actually out east in in f Fredericton, new Brunswick. So they both grew up in Canada and they were living in Canada. And it was just happened to be that my dad was working in San Diego the time when I was born.

[00:03:45] Nikhita Singhal: So again, I really had no idea about any of this until much later, like probably in my teen years. But it was quite an a, I guess a interesting divorce. It was basically my dad has bipolar disorder and. At that time, he was going through his own struggles and he actually, I think, was in the manic episode and then afterwards in a depression.

[00:04:11] Nikhita Singhal: And so the, all of this was going on at the time. I was like an oblivious toddler. But that was basically what happened around the time of the divorce. My mom ended up coming back with me back to Toronto and I lived with her, with my grandparents, so her mom and dad. And my dad. I think he came back to Canada as well.

[00:04:31] Nikhita Singhal: He stayed back with his parents out east and he did get help. And at, when I was younger, I would see him. He traveled a lot for work as well, so I'd see him probably, Once every few months initially. And then we had this routine of like once a week. And that was the drill, I didn't know any differently.

[00:04:49] Nikhita Singhal: It was just, I look with my mom, I see my dad once a week, we hang out and we would always do fun things like go to the movies. And yeah, that was basically me around age seven. My grandfather, so my mom's dad had passed away recently. My mom ended up getting remarried. But it's like looking back, these are some of the things that different treatment providers I saw said, oh maybe that's what was going on.

[00:05:14] Nikhita Singhal: That was what precipitated all of this. At the end of the day I still don't really know, but I started. Acting differently. It wasn't, it was different things. Like I was like tapping things. I was like hitting myself. I did decide I just didn't really want to eat much anymore, and I was never like much of an eater and I wasn't like I guess I was on the smaller side as a kid.

[00:05:39] Nikhita Singhal: So then when I stopped eating and then I wasn't like, sticking on the growth curve and I was falling and then my pedia, my doctor sent me to a pediatrician who sent me to sick kids, just for an initial assessment. And back then, I guess this was like 20 years ago it wasn't as common for kids that young to be diagnosed with eating disorders.

[00:05:58] Nikhita Singhal: So anyway, went to sick kids for that initial assessment and they decided right then and there to admit me to the hospital. And that was where all of this kicked off. I was very stubborn and they sat down and played food in front of me. And I think back all the time what if I had just eaten whatever it was, like macaroni and cheese.

[00:06:18] Nikhita Singhal: I was like, what if I just ate it? What would've happened? But I refused. And so that was like my first time being admitted to the hospital. It was five weeks. It was pretty, like a pretty terrifying experience. Just because again, most of the people there, they were teenagers. There was a lot of, very ill people, a lot of feeding tubes.

[00:06:39] Nikhita Singhal: There were people in like restraints at times and it was just not Yeah I think, and again, maybe this is why a lot of it, I don't really remember might've blocked it out. But ever since then, it was I was in the treatment system and I don't know that it was about food initially, or it was, I was just really anxious and I had obsessed with compulsive disorder and I also had this behavior around not wanting to eat.

[00:07:04] Nikhita Singhal: And then it definitely did do an, like a full-blown eating disorder. I was very fixated on then, they wanted me to gain weight and I was not it became about always about food weight and that, that first time actually my parents, my mom and my stepdad, they. Ended up pulling me out, I guess they call it against medical advice because they just didn't really understand why they kept pushing.

[00:07:32] Nikhita Singhal: They wanted me to be on like the normal BMI, even though I had never been an average weight. And so it but they had to agree to, put me in the outpatient treatment. And they actually, I'm thinking back now, and I know at the time I was just mad at everyone. I was mad at the treatment.

[00:07:48] Nikhita Singhal: I was mad at my parents for doing this to me. Like it was all very self-centered as a kid. But I can see now, like my parents, like my mom I know they threatened to call children's aid wanted to take me outta the hospital. So yeah, it was a bit of a whirlwind at that time. But, sorry, I know I rambled on a lot.

[00:08:07] Nikhita Singhal: That's Where this all started, if that gives a bit of a picture. 

[00:08:10] Raad Seraj: No, thank you for sharing that. I can imagine how traumatic that might have been, not only in the sense of being disoriented in that space, but to see other kids and young teenagers being treated in that way.

[00:08:27] Raad Seraj: What sounds like to me was violent even if the intention was there to help them I often feel like how can it be that was helpful... 

[00:08:36] Nikhita Singhal: and I, yeah, I know, like looking back, I can see people are, doing the best with what they have at the time. And that's what was reinforced in treatment.

[00:08:47] Nikhita Singhal: It was, like the force feeding. And it's very, even now, like 20 years later, unfortunately, I don't think much has changed in that emphasis is really on, weight restoring. And I just remember like other times, like I, when I had been admitted and come out again, like even the people working there know it's not working.

[00:09:06] Nikhita Singhal: Like I know one of the nurses told me it was like a revolving door and it just, I guess there was like a lack of any other way to do things. Yeah. 

[00:09:16] Raad Seraj: I feel like you have to do something, even if that's something is ineffective or wrong it's something, so I guess the immediate question in, in, in sort of the experience that you described is, When you say you didn't want to eat, how does that feel in your body?

[00:09:31] Raad Seraj: Because I imagine, most of us think that, hey, when you're hungry, the only thing you wanna do is eat to eat something because your body's craving food. Describe to me what it is.. Is it because you don't feel hungry or the idea of eating or putting something in your mouth, to chew is revolting? What exactly is it like? 

[00:09:50] Nikhita Singhal: And this is where, it's probably different. I can only really speak to my experience with it, but I honestly cannot remember liking food ever. And maybe it came from that starting place where it was like food was punishment. It was like, oh, you're moving, like you're extra. Okay, we're gonna give you like extra food. And so all I can remember is like hating food. And it was this thing that was forced on me. And I don't know.

[00:10:16] Nikhita Singhal: Like I, for me, and this is another thing I guess is not too uncommon with eating disorders, is that those hunger cues are disrupted. And at least growing up I was maintained, I was force fed by, my parents as part of the family-based treatment approach. And so I wasn't ever really allowed, to be having what I would want to have, which was as little as possible.

[00:10:38] Nikhita Singhal: But no, it was never like, I want to have that, but no, I shouldn't. It was this, I just, if I could have my weight growing up, it was like I would just not have wanted to eat at all. And then, When it became my own responsibility, like once you phase out of the pediatric system, it's suddenly on you.

[00:10:57] Nikhita Singhal: It's okay, if you want treatment, then you go in as an adult and if you can't adhere to, whatever the rules are of the program, then you're out. Because there's so many people who need those beds. And so it, what ended up happening was, again, I went out on my own. I managed to I would have a meal plan for myself, so I'd be like, okay, I'm going to make sure that I eat this many calories per day.

[00:11:19] Nikhita Singhal: And it was okay, like I wanna make sure I don't fall into that zone where I'll get flagged or something. Going through university, going through medical training, there was always like strings attached and I never wanted it to be like evident to other people that I was sick.

[00:11:34] Nikhita Singhal: And then it was when I got to residency, That was no longer, it was kinda Okay. Wow. Somehow they let me all the way through. I've caught in here and I didn't really mean to, I started having less and I was losing more weight. And I think that's maybe when I started to feel like my body was just exhausted.

[00:11:56] Nikhita Singhal: And it was really hard for me to admit that to myself or acknowledge that because it was like, look, I'm still going to work every day. I'm still doing all of these things. But that was maybe when I realized maybe it was things like I was hungry. But I just, even at that point, like the idea of eating was so terrifying to me.

[00:12:15] Nikhita Singhal: Like I had to like, weigh everything. Like to the gra I was like, looking back at that now I felt so stuck. Like it was just so terrifying. And. That's shifted a lot. Like I, it's just, I a bit remarkable to me thinking about where I was at that point. I still, food is not something I enjoy.

[00:12:37] Nikhita Singhal: It's something I make myself eat, but I'm actually able to do that. Whereas that was unthinkable before. 

[00:12:44] Raad Seraj: So how many, from the age of seven to when you were out on your own, how many years were that? Was that? Yeah, so 

[00:12:53] Nikhita Singhal: I guess like when I was like 17, about turned 18 was when I went off to like undergrad.

[00:12:59] Nikhita Singhal: When I went to university at that point it was still, I had to like, keep up some degree of I would go to, I would go to therapy and I would see a doctor and it was all, but it was for other people. It wasn't for myself. And it was really only, I think probably. Around 2019, like when I started residency, when it really shifted and I started to realize okay, this is a problem.

[00:13:24] Nikhita Singhal: It's not, I always was like, the treatment was the problem. Like I was just so mad. I was like, that is the issue that me having an eating disorder not a problem. But that really changed. Yeah. Kind of 20 19, 20 20. 

[00:13:35] Raad Seraj: So it sounds like a lot of the reluctance, admitting to yourself that you're sick is hard in itself. I think most of us when it comes to mental health, we don't want to admit that we need help. That goes without saying. But I think eating disorders are a lot more complex, I imagine. But it also sounds like there's an element of that is clearly not going to help me. I don't want that. That is not what I want.

[00:13:56] Raad Seraj: And I don't wanna even admit that is something helpful because it doesn't look right, it doesn't feel right. I can see people who are experiencing this treatment, so to speak, goes against what they are as a person. It violates their sense of self. It's like force feeding and things like that.

[00:14:11] Raad Seraj: This sounds very intrusive and as I guess so to be soft about it. 

[00:14:16] Nikhita Singhal: Yeah. And this is where I struggle with it because I don't wanna just, bash that treatment. I think. As much, it gets hard for me to say. So I think there are people out there that it does maybe help and that, they say often, if it's somebody, like a younger person and it's like very early in the trajectory of them becoming ill, that it can be helpful for them to have, their parents take over and just do the feeding for them and then they come back into it.

[00:14:43] Nikhita Singhal: But I think, again, everyone is so different and I really taking like a one size fits all approach just in general, whether it's, usually where there's anything is where it starts to go wrong. And yeah. Often when people who are not in like the eating disorder treatment world hear about it, they're like, oh my God.

[00:15:00] Nikhita Singhal: What is that? It's, it seems very, yeah, like you said, intrusive and not, doesn't seem to make a lot of sense, but that's, the prevailing. Philosophy in, in that field. 

[00:15:09] Raad Seraj: What was your relationship like with your parents at that time and who did you consider to be close to you at that time?

[00:15:16] Raad Seraj: Friends, family, siblings.

[00:15:19] Nikhita Singhal: So I guess this was part of the story, like when I was growing up and when I was in the, the outpatient treatment I withdrew, like I wasn't allowed, I guess I, I was never any good at them, but I really liked like sports and I liked playing tennis and swimming and part of it was always, restricting the amount of activity because, and it was, seeing, oh, like you're burning more calories, you have to eat more.

[00:15:42] Nikhita Singhal: And so I, and it was also really Things were okay up until, they started to get better. When I started high school. My parents eased back a bit and but then I think I got to like grade 11 or grade 10. And then I suddenly got into this other outpatient program and it was like, again, very very much controlled and they made me like gain weight again.

[00:16:05] Nikhita Singhal: And I ended up, withdrawing again from my friends. I just, I didn't feel like I could I was just so ashamed. And it's not, it wasn't just like a appearance, like it just felt physically, like it was very, again, this is where I think there's that interplay, at least for me, between the obsessive compulsive disorder and the eating disorder.

[00:16:24] Nikhita Singhal: I just felt so uncomfortable in my own skin. I couldn't be around other people. And then, With my parents. My mom was always, the one I lived with my mom and my stepdad, so she was always the one who was more kinda in charge of the food. And so I took out a lot of the anger on her too. My dad, I'd see him once a week.

[00:16:43] Nikhita Singhal: He started to then get more involved in the treatment that's, that repeat round, like in, in high school. And ultimately though I think my relationship with him always stayed a little bit closer because for some reason, I always blamed my mom. A lot more. And anyway, it got to the point, actually, like in grade 12, I, they I had had it and I ended up, my mom and I will tell her like I was asked to leave versus, I left.

[00:17:11] Nikhita Singhal: And then I ended up moving in with my dad and that was the first time I'd ever really lived with him. And. At that point. It was nice because he gave me more freedom to do what I wanted and what I wanted was to not eat. And so I lost weight again, and then I ended up being hospitalized again.

[00:17:29] Nikhita Singhal: And that was like a, one of the worst ones because I went straight from this, like inpatient to day hospital, and they had by that point said, look, you're treatment resistant so we're just gonna make you gain a ton of weight because we know, again, this was the thought behind it was, you're gonna lose it anyway, so we're just gonna get you up as high as we can.

[00:17:48] Nikhita Singhal: And like basically hammer you with the treatment. And to me it was like, okay, if the same thing isn't working, don't just keep doing it and doing it more intensely, let's try something else. But yeah, so that, that was a, one of the worst experiences I had. And at that point, like it ended up being like, I only, looking back, I didn't really.

[00:18:10] Nikhita Singhal: I wish I had run away from home. I blamed myself for not running away. I was for some reason I was like, I really wanted to finish high school and like graduate. And so that was the, the punishment was, okay, you won't be allowed to go back to school if you don't do this program.

[00:18:25] Nikhita Singhal: And yeah so that, I had a very poor relationship with my parents at that point. And then it only really started to heal once I left home. And yeah, by the time I had gotten to residency it's it was a lot better. And I trusted that they couldn't do anything to me anymore.

[00:18:43] Nikhita Singhal: They couldn't force me into treatment. They I was an adult, so yeah, we were a lot closer and I, I had friends at school and I just had a lot more of my life back. 

[00:18:53] Raad Seraj: It's it's tricky, right? Because at that age, and I remember being a teenager, it's all about finding your own way.

[00:18:57] Raad Seraj: Even if you're wrong, you're not gonna admit you're wrong, right? Because you are still at the center of the universe in some ways. So in some ways a lot of your story is like what every one of us experiences being a stubborn, snotty nosed teenager, right? On the other hand, you had this other thing that you were trying to figure out and.

[00:19:15] Raad Seraj: So at what point when you said you, it started to heal when you came back after being away for a few years or doing your own thing for a few years, how do you think your parents or your dad in particular look at that period of time at now? Looking back at that particular time, I'm, we're, sounds like you're all, you're both wiser and you've learned a lot from it.

[00:19:37] Raad Seraj: Grown a lot from it and accepted a lot from it. How do you look back at that time now? You and your dad? 

[00:19:42] Nikhita Singhal: And this is the part where I guess it, it gets more complicated again because they did step back and I think at the time though, they were still very worried and because, I was. There was always that worry for them that, they would rather I was at like a healthy or normal or more normal way, but they saw that, I was doing all the things I wanted to do.

[00:20:07] Nikhita Singhal: I was, able to travel, able to be in school. And so it was I guess this uneasy it's good, let's wait and see, let's watch. But I think they were still very worried. And so that was, I was okay, they've seen the air of their ways, look, I'm doing my own thing.

[00:20:22] Nikhita Singhal: And that was why it was especially tough, I think when it happened again, but as an adult that they forced me into treatment. But yeah, I think now they've really seen that is not help, a helpful approach. And I think, they've had their own journeys and they've really come to accept that At the end of the day, they've done everything they can to help me and none of this is their fault.

[00:20:46] Nikhita Singhal: And yeah. Whatever happens to me now at this point, it's it's my responsibility. 

[00:20:50] Raad Seraj: A lot of it also comes back to, I think eating disorders are not understood well. A lot of it, at least from the layman like me, it comes down to maybe why wouldn't the person eat?

[00:21:02] Raad Seraj: It just boggles people's minds like, you're hungry, you eat. Yeah. Why wouldn't you eat? I think it's a fundamental misunderstanding under appreciation of the complexity and experiential nature of it. What do you think most people misunderstand or don't consider when they think of eating disorders?

[00:21:19] Nikhita Singhal: It's not about, it's not about food and it's not about weight. Like I think that is like fundamentally it's just as with, I think, and this is why I do think that disorder similar in a lot of ways to other substance use disorders or other, compulsive behaviors like you've mentioned where the not eating or for some people, who have say binge eating disorder or the over, whatever it is, it's a coping mechanism that somewhere along the way, when I was a kid for some whatever reason, to me it was like, not eating made me feel safe.

[00:21:54] Nikhita Singhal: It was dealing with something. And so in, instead of, trying to just correct that behavior, it doesn't get at the underlying issue. So it's sure you can make someone gain weight and send them back out again and until you deal with or find another way to. Deal with whatever it was that was helping you deal with.

[00:22:13] Nikhita Singhal: You're not, going to really be able to heal. And so again, like I can't speak for everyone. I just, I know for me that it was never about the food, it was not about weight. It was something, and I still not entirely sure what it is. All I do know is that now I was able to eventually recognize that with a lot of help to that it wasn't serving me anymore.

[00:22:39] Nikhita Singhal: Maybe it was at some, and I think the other part maybe that I guess I'll jump to is that I think it's common especially with in, in youth that they like to. Frame the eating disorder demonize it almost. Treat it as like this external monster that has taken over your child to help parents, because it, it's really frustrating.

[00:23:00] Nikhita Singhal: Yeah. Never times like you hear and not understanding and, I was generally a pretty like, quiet like non intrusive child, when they were trying to force me to eat, like I, I was like throwing dishware and screaming and had security called on me. Like it was not me. So I can understand, sometimes that might help parents to not be angry at their child. And at the same time for me it's it was very difficult. Even now, like I think I'm not angry at the part of me that. Had the eating disorder or that behavior, because I think it was protecting me from something and it was helping me, and it was just learning to now say like it's okay.

[00:23:39] Nikhita Singhal: I can find other ways to deal with this. Thank you for what you did. And then letting that go. 

[00:23:46] Raad Seraj: Stepping into putting the conventional psychiatrist hat on because you are in your fourth year, you're soon going to be practicing. How does conventional psychiatry see things like eating disorders?

[00:24:00] Raad Seraj: What is the definition? And from that, what are the range of treatments that are applied or available? Sounds like you've experienced a quite a few different types of treatments, whether effective or not. What are the sort of, what are the under, what is the un underlying premise behind these treatments?

[00:24:17] Raad Seraj: What do they think is going on? 

[00:24:19] Nikhita Singhal: Yeah, and I'll preface this by saying that unfortunately in psychiatry training and medical training, we do not get very much training at all in eating disorders. I think that's starting to shift, but really, it's if you choose to go do electives in it or seek out more of that that exposure yourself, that's where most people would get it from.

[00:24:40] Nikhita Singhal: It's in like even now, if. Somebody with an eating disorder is trying to seek help. There are many psychiatrists, because you know of the lack of training. They just think, sorry, I don't feel comfortable treating immune disorders, which is really challenging and frustrating.

[00:24:55] Nikhita Singhal: It's, it's just, I think that Why do you think that is? Is 

[00:24:58] Raad Seraj: it the medical, is it because there's not enough cases that have been studied? Is it because it's prevalent in what I imagine maybe more prevalent in women? Or is it not enough data? What is it? What is the discomfort behind not wanting to treat?

[00:25:14] Nikhita Singhal: And I can totally like, understand I think part of it is that complexity, the medical complexity piece. Because if somebody is, Really in a, in an unstable place medically it's a whole lot more added, liability for someone to be trying to help them. And y when you don't know if their heart's gonna stop beating in the middle of the night it's a very scary place to be in as a treatment provider.

[00:25:37] Nikhita Singhal: And I think as well, like the lack of actual training, I think the lack of understanding of, or lack of, real treatments out there. When it comes to eating disorders, there's the typical classification that we have, there's anorexia nervosa, which is where people are generally restricting, and then bulimia nervosa where people binging, purge, and, Often in psychiatry, we approach things from when it comes to treatment, thinking about biological treatment, so medications and, there aren't really any medications to treat, say anorexia interval.

[00:26:08] Nikhita Singhal: So there's medications that people may be on to treat comorbid conditions, whether it's depression, anxiety but at the end of the day, like then we think shifting biological, we think about psychological treatments, therapies, there's especially in youth, family based treatment is or the Mosley method.

[00:26:27] Nikhita Singhal: It's where, the, they have parents take over. But again, that doesn't work for everyone. Not everyone has the standard, family structure around them to support them. And so we are at a loss and I think part of. And maybe this is more broadly in psychiatry. The issue is that we really silo things.

[00:26:46] Nikhita Singhal: So even, somebody trying to get treatment for, say, a substance use disorder who has an eating disorder, may be rejected from a program because of their eating disorder, because of the added like medical complexity. Somebody with depression or anxiety may not be able to participate in a program cause the, or may not be able to participate in a trauma program because of, so we have all of these silos when ultimately, with many of these, they, the reason there's so much comorbidity is because there's that underlying issue, whatever it may be.

[00:27:16] Nikhita Singhal: And our whole diagnostic system, like the DSM, is based on clusters of symptoms, not underlying, pathophysiology. It's like saying to someone, oh, Like instead of depression, you have pain. That doesn't really tell us anything but we treat it as though, everyone with, eating disorder is going to have the same reason and should be treated the same way.

[00:27:37] Nikhita Singhal: And I think that's where, again, this, I think this is where psychedelics really helpful. They help us get to those underlying issues and help empower people then to, be able to have a greater understanding of that and then move towards healing. 

[00:27:53] Raad Seraj: Beautifully said, and it's a great segue because from what you shared with me previously is that breakthrough did come eventually with plant medicine and particularly with ayahuasca.

[00:28:05] Raad Seraj: And I think what's really beautiful about what you described before is you experiencing ayahuasca and going through the medicine, but with your dad, And both of you decided to go together and Sanjay was on the podcast previously and he described that the before, during, and after.

[00:28:24] Raad Seraj: From his perspective. I'd love to know how did you come to a place where you thought, okay, I'm gonna go do this with my dad. Cause both of you found out about psychedelics. I think he found out about it first through Robin Car-Hart Harris, who is obviously a celebrated pioneer in this space. And then you got to find out about it.

[00:28:44] Raad Seraj: But I think you would only be open to it, I imagine if you had accepted that there's something that you needed to do about this, that you have to try something else. So maybe describe to us what that period of your life was like. How did you and Sanjay decide that, okay, we wanna do this together.

[00:29:02] Raad Seraj: What was the intention behind it? And then we'll talk about the during and the after. 

[00:29:07] Nikhita Singhal: Yeah, so even thinking back to that time, so that was again like 2019, I set off to go start my residency and I was actually, I guess through undergrad medical school, I had lived with roommates, but I came back on weekends a lot.

[00:29:25] Nikhita Singhal: And so this was, my first time, like I moved downtown. I had my own condo, no roommates. And I was really like more on my own than I had ever been before. And it wasn't really intentional, but it was also like I was no longer having to put on this performance. I didn't have to like, stay at a certain weight to pass as being healthy or normal.

[00:29:49] Nikhita Singhal: And so it just, over the course of that beginning of residency, I was having an amazing time. I loved what I was doing and I was just losing weight and. It, I, it got to the point, I think it was by around like January, February, and like I was just randomly having panic attacks, like on the ttc, like on the subway.

[00:30:11] Nikhita Singhal: And I never had panic attacks before. I didn't know what was going on. I I would just wake up and I was like I just don't want to keep going. I wasn't actively wanting to end my life. It was just, I was so tired. And to me, like stopping school or taking a break or saying like anything, like to other people to signal that I was not okay.

[00:30:32] Nikhita Singhal: Was not an option. It was just, I just have to wake up, keep going, go to sleep, hope I don't wake up. Oh, I woke up again and I was just in this like really dark place and all of this so my dad had I think, introduced me to psychedelic the year before when he had first heard about it. And so I'd had a couple of M d m a assisted psychotherapy experiences.

[00:30:55] Nikhita Singhal: And that was really like life changing for me. Like it was the first time I was able, I remember the first session I had I was able to look in a mirror and not hate myself and not just how I look, but just not hate myself as a person and that, so that, that was really powerful. But it still wasn't enough to stop this like trajectory.

[00:31:17] Nikhita Singhal: I was still, going down. And so by, it was, I think it was February we had planned, and actually my mom was really involved by this point too, and she was like new to all of this as well. And I so it was actually, the three of us. And then we had some amazing, very supportive people who made this happen for us that we were able to go and do like a five day.

[00:31:42] Nikhita Singhal: Like of ayahuasca ceremony, I didn't make it like all five days. I think I only did three nights, but it was just this last last ditch effort. And I went into it like, I don't know, I had nothing else to lose at this point. I didn't know what to expect. But what ended up happening was during it I, the first night, I actually nothing happened to me really.

[00:32:06] Nikhita Singhal: I was sitting there for six to eight hours. My dad was the time like having his, dragon experience. And then my mom was having her own thing and like throwing up and they're all, puking. And I was just like lying there is something wrong? Like it didn't work. And then, I think it was like afterwards we all went back, like back to our rooms to sleep and then something just hit me.

[00:32:25] Nikhita Singhal: It was like much later, but then I was like, oh my God. What is happening? And it was really like terrifying and awful. And I remember like during it, I was like, oh my God, what am I do? I'm never doing this ever again. What was I thinking? And and then I like went into this period where I was like laughing hysterically and I was like, I love Iowa.

[00:32:48] Nikhita Singhal: And they were ha they were like, and then I don't know what happened, but somehow I don't know. And the nights are blurry together, but it's like one of those nights that had happened. And then the following day I just, I had seen myself like in the middle of this storm. Like I was just like there all alone in the middle of this Crazy, like clouds and lightning.

[00:33:10] Nikhita Singhal: And I just saw, I was like, you need help. And I don't know, I like, I finally just got it that what does it matter? If you're not, if you're dead, like it, it, isn't it better to, take a step back, take a week off work or something like and just try to help yourself a little bit.

[00:33:29] Nikhita Singhal: And so I ended up I was I was just, I guess in this place, so I was like, okay, so maybe I do need help, but there is like, where do I go? I'm not going into back into another inpatient treatment program. I just, that doesn't work for me. We ended up, and again, like I am incredibly fortunate, like my dad and my mom and all these people, like made this happen that I was able to get transferred to this like acute eating disorder facility, like this facility in Denver.

[00:33:59] Nikhita Singhal: Basically, like we flew out there. And I, I was very scared to go there because I was like, I don't want this to be another experience. Where it's going to be like, it's gonna be on my terms. They're not gonna force me to eat whatever their foods are. Like, I will make myself gain weight with like I have very restricted things I was going to eat.

[00:34:19] Nikhita Singhal: I was like, I'll have protein powder and that's it, but like I'll have as much of it as I need to. And I ended up getting there. And this was right at the time of Covid too, so I think it was probably one of the last flights where they were like letting people like, go out of Canada. And my parents had initially planned to, come and like.

[00:34:37] Nikhita Singhal: Bring me into the hospital. They weren't allowed in. So I went in that first night there, like they took my blood sugar level and it was like low. And I was like all I have eaten probably for the past 24 hours is like a banana on the plane. So it's understandable that it's low. So okay, if we're gonna have dinner or something now I'll have that.

[00:34:55] Nikhita Singhal: They wanted me to drink a cup of juice. And again, this is where my stubbornness like, and also I just, I was like, I'm not drinking juice. Sh to me like sugar was very scary and I had already had this like banana. I was like, no, I'm not having juice. Like gimme anything else. They wouldn't, we got into this, and I think it's, again, it's like I can see how a lot of times, it's people are frustrated treating people with eating disorders because it's like, why the hell can you not drink this juice like your blood sugar is?

[00:35:27] Nikhita Singhal: But to me it was just so terrifying. So then, I decided, like I was there for the night. I was like hooked up to all these monitors. I was like, this is awful. I wanna leave. So the next day I called my parents who were like staying in a hotel, like they next door. I was like, okay, I'm done. I wanna go home.

[00:35:42] Nikhita Singhal: They were like, okay, you've been there one day. Give it a chance. I was totally done with it. And again I don't think it was intentional like the staff working there, but it was just very, it did not feel good. It felt, again, very you're being forced, you're being controlled. And to me that was like the scariest thing in the world.

[00:35:59] Nikhita Singhal: And and I decided I was going to leave. So I tried to grab my passport, my coat, my things, and they called security. They. Ended up certifying me actually, and I did not know the law in Colorado, here in Ontario when you certify someone, it's initially like a 72 hour hold 

[00:36:18] Raad Seraj: what do you mean by certify for the first?

[00:36:19] Raad Seraj: What does that mean? 

[00:36:21] Nikhita Singhal: Oh, so sorry. Yeah. So basically when you feel someone is a danger to themselves or a danger to others, or unable to care for themselves and they need psychiatric assessments here in Ontario we call it like a form one. You put somebody on a form and basically you involuntarily can detain them until they're assessed.

[00:36:39] Nikhita Singhal: And so that's like for 72 hours. And so that's the same in Denver. But the difference is that after that 72 hour period in Ontario, if you decide, okay, this person is a danger to themselves or others can't care for themselves, you can put them on another form which allows you to hospitalize them for two weeks, the initial form, and then, you can extend that.

[00:36:58] Nikhita Singhal: There's different pass that can go from there. But in, in Colorado Little that I know the initial form of 72 hours, the next one is three months. Oh, wow. So I ended up being certified in Denver for three months. And this is something, I don't think any, and like I've never talked to any of my co-residents about it, because for me it's still something very, when I'm on call in the psych emerge, we're certifying people and every time I'm just, I think back to what it was like to have that happen and that like feeling when it's, you suddenly realize like you literally cannot walk out of. And 

[00:37:33] Raad Seraj: do you need a guardian to help? I guess at that point you're not a guardian because you are legally an adult, only an institution can certify. Am I right? 

[00:37:43] Nikhita Singhal: Yeah. Yeah. So it's, you're in a, like a psychiatric facility and you have the right to challenge it. And so I did.

[00:37:51] Nikhita Singhal: I I went through this hearing, but it was not it was not re it was basically they said this person does not want to eat. They're not capable of making their own decisions. And anyway, I, so I ended up there, my parents were so scared, I think because I, and I can see why they were very scared, like looking at how I was from a medical perspective.

[00:38:10] Nikhita Singhal: But I was so angry for them because they, they agreed to keep me there for three months. And again, when we think about users, often some of the things we learn are they. It comes from this, feeling of a lack of control or, and so the treatment being to like overly control someone and restrict them further, it just did not make sense to me.

[00:38:32] Nikhita Singhal: But anyway, I ended up at the end of towards the end of the three months, they wanted to extend it for another period of several months. But my parents by that point saw that I it was not. Helpful in any way. It was more damaging than anything else. And so I did end up coming back. My program was so in my residency program was so incredibly supportive through all this.

[00:38:55] Nikhita Singhal: Like I didn't tell them what was going on exactly, but they knew I was like on a medical leave. And so I, I was fortunate and then I was able to when I came back to Toronto, it was around June. It was all still during Covid, so everything was very weird. Anyway, so it helped a bit that, I wasn't having to go into work every day and see there was a quite a period when I came back where I was just done.

[00:39:18] Nikhita Singhal: Because they had made me gain weight again, I felt so uncomfortable and I just, I couldn't really see myself continuing to live. But eventually, like I was able to move past it. I got back, started up in my program again and I did end up like losing weight again. And but I was able to keep going.

[00:39:43] Nikhita Singhal: That was like all through, I guess 2020 by like towards the end of 2021. I was in a, not like my weight started sliding again. And this was where I think it was really tough for me to admit as well because I was so against, okay. That treatment did not help me. But I also wasn't able to do it on my own.

[00:40:03] Nikhita Singhal: But in that interim, like from when I came out of Denver, I had other ias experience. I had done more M D M A assisted therapy. I had done psilocybin assisted psychotherapy. I did there was five M O D M T ketamine. And I was again very lucky that my dad and my mom had And that we had supports around us to get me all that.

[00:40:25] Nikhita Singhal: I don't know what ultimately did flip, I think it was accumulation of all of this, but and then I was able to actually get like internal family systems or if f s therapy and together, like all of something shifted. And then by, I guess it would've been like a year and a half ago now, like the end or very beginning of 2022, like last year, I started to just be able to gain weight on my own.

[00:40:54] Nikhita Singhal: Like I, and I'm at this weird place now where again, like I look back and before it was just like literally if you had put something in front of me, if I couldn't weigh it or add the calories, like I would just vastly overestimate the calories in it. I would not eat anything unless I knew like exactly what was in it.

[00:41:12] Nikhita Singhal: And now it's still, I still have a lot of. Odd I'll still only eat limited types of foods, but like I was able to finally make myself eat the amount that I needed to gain weight. And as uncomfortable as, I still feel like it's not by any means that I'm totally better.

[00:41:31] Nikhita Singhal: There's times where I'm like actually angry. I'm like, why? I wish I had it back. I was like, cuz it felt so safe to be that way, even if it meant that I could die. But I'm still, I'm in this place now where it's I am lucky that I am still alive and I think I'm gonna find eventually like that place where I can be comfortable and happy.

[00:41:52] Nikhita Singhal: But yeah, it's been, sorry that was a long No, that's kinda, 

[00:41:55] Nikhita Singhal: no, that's super. Thank you so much. I'm really grateful that you've shared this crazy journey so far. All the learnings and transformations that come from it. I'm curious. You said a few times that the eating disorder for you at least stem from the need for control.

[00:42:15] Nikhita Singhal: And when I think when I hear control, it's the need for certainty and certainty. For what reason? Certainty. To feel safe or to know what's going on to where you are, your surroundings and what is coming, after, and things like that. I'm speculating, of course I don't know. But from that perspective, meaning the need for certainty.

[00:42:37] Nikhita Singhal: The need for control, and having gone through a range of experiences with psychedelics, with therapy, what shifted in terms of the need for control? You think even looking at the food and being able to judge differently or to see it differently, what do you think shifted?

[00:42:56] Nikhita Singhal: I'm still trying to. Figure that out. I think what it came to was just this realization, and I, it sounds so, it sounds ridiculous when I say it because it's like why couldn't you just realize that earlier? But it was just so inconsequential so insignificant. It's if I right now were to go and eat a strawberry, who cares if it's 20 calories or five calories or at the end of the day I think it, it just something in my head it switched and it was like, you, like it was buried before.

[00:43:36] Nikhita Singhal: It was like safe and predictable. It was like, okay, even if I feel awful and exhausted and tired it was just at least it was like this routine was what I knew and it was, In that way it was very safe. And I think I just became fed up with not having the energy anymore to do things that I loved to do.

[00:43:56] Nikhita Singhal: And I really loved to travel and I love to walk around and, it was even things like at the hospital when I'm at work I was like taking the stairs. Cause one the elevators are forever like getting broken and stuck. But I got to the point where I was like so exhausted. I was like, I just had to take the elevator.

[00:44:14] Nikhita Singhal: And that for me was like, what am I doing? Like I, there's other things more important and I guess I'm not sure where the control really shifted, but it was being able to have, I think that openness and again, I think that is due in large part to the psychedelic assisted therapy and all of that work.

[00:44:34] Nikhita Singhal: But before it was like, even though I realized that there were things that were more important I just wasn't able to change my behavior. It was too rigid, too stuck.

[00:44:43] Raad Seraj: So what it sounds like, at least to me is it's not like you didn't see what was on the other side before you saw it, but because you felt trapped in it, it further debilitated you I can't escape my own circumstances, even I don't, I know I would be happier on the other side.

[00:45:00] Raad Seraj: And I can imagine that sort of like almost spirals and makes it worse because now you're like, okay, you're subject and the very thing you want control, you are actually giving up control. It's a, it's, yeah it's sounds really like a infinite loop and what may have happened, just going off, what you've said is that you were able to see the other side still, but feel secure enough in taking the leap and go if I don't, I need to try something and you let yourself do it.

[00:45:30] Raad Seraj: Is that right? Is that fair? Yeah. Yeah. That's amazing. How do you, when did you first decide that something had shifted and you were doing things different? Like, when did you give yourself the credit to go you know what? I took a leap and it was worth it, and I did something and it's, I'm not there yet, but I'm doing something different.

[00:45:48] Raad Seraj: I can feel something change.

[00:45:50] Raad Seraj: It probably would've been around, yeah, like January or February of last year. And again it's, this sounds weird, but it didn't feel good and it still doesn't feel good because in many ways I was always able to, when I had to, gain weight or it was always, I was blaming, like somebody else was forcing me to do it.

[00:46:12] Raad Seraj: So now it's I can't be mad at, I'm doing this to myself. And so every time it's I really, it. It's, it would be feel a lot more comfortable and safe to go back to how things were, but something is stopping me from doing that. 

[00:46:28] Raad Seraj: And I often find like it's not important to know what the answer is.

[00:46:31] Raad Seraj: Sometimes maybe knowing that it worked or something's changed and you are actually, you can be yourself is enough because, whether you come back, come from a perspective of science and psychiatry or experience. Ultimately just having a sense that you are no longer a psychic prisoner of your own mind can be really powerful.

[00:46:53] Raad Seraj: I wanna pull out a quote from an interview did that I think is it really speaks to what may be your approach or motivation for becoming a psychiatrist and the work you hope to be doing and. The quote is, recognizing patients as the experts in their own experience and appreciating the vast wealth of insight they bring to the table is crucial.

[00:47:15] Raad Seraj: My hope is that we can bridge the gap between us and them in the healthcare system. We are all human beings who may fall ill ourselves at some point, and this is not a weakness or flaw on our part. In what ways do you think conventional psychiatry is ill-equipped or has been ill-equipped because psychiatry and on some levels I find even with psychology and understandings of the mind, it feels super outdated.

[00:47:44] Raad Seraj: And I understand nothing can exist in a vacuum, but in what ways do you feel like conventional psychiatry is ill, ill-equipped to handle things like eating disorders, but on the other hand, having gone through experience knowing about psych psychedelics, all the other sort of alternative treatments, What gives you hope?

[00:48:04] Nikhita Singhal: I think this is where we are in a really exciting and promising time because, in the past, even a few years ago I would've been terrified to say anything or acknowledged, having a psychiatric illness myself and in a way that could be, seen or picked up by in my professional spheres.

[00:48:27] Nikhita Singhal: And I think it, it's exciting to see that within, within our department, across the board, really, like in, in medicine. And now increasingly in psychiatry, there are groups being built, advisory groups of people with lived experience of mental illness themselves or their families.

[00:48:45] Nikhita Singhal: And it's not just this token, we have this like people are actually listening and I think. Increasingly recognizing that in many ways, like what we're doing now isn't working. Let's ask people who are on the receiving end of the care what would be helpful to them.

[00:49:02] Nikhita Singhal: And I am really heartened to see that. And I think that it's not just clinically, I think even in research more and more people are being consulted as, having expertise that's different. People go through training, whether it's become a psychologist, psychiatrist, they get a degree.

[00:49:17] Nikhita Singhal: And you do, it's a lot of time, it's a lot of, studying and knowledge that people gain. And that is very different than the experiential knowledge of somebody with an illness. And so I think we need to be able to bring all of that together in order to provide that individualized care that people need.

[00:49:37] Nikhita Singhal: It's not just about, what does the research show us or what do generally studies show us because. Everyone is different. And so that does give me hope that more and more there is this shift towards that. And again, I've touched on this, but another of the ways in which with psychiatry that I we struggle is because again, our whole diagnostic classification system is based on clusters of symptoms, not underlying the roots of it.

[00:50:04] Nikhita Singhal: And so as we start to more and more understand, trauma, especially how that is so intrinsically linked, not just to psychiatric illnesses, to, to physical illnesses and more and more that's being highlighted, there's the adverse childhood experiences or like the ACEs and there's more light being shed on how that can lead to health problems for people.

[00:50:27] Nikhita Singhal: And so again, as we start to embrace different. Types of therapy and really appreciating. I think there's a role for, biological and understanding things from the neurons and the disorders, like actually structurally in the brain. And also taking into account like the social factors in someone's life and cultural and psychological and all of that coming together.

[00:50:50] Nikhita Singhal: It makes us a lot better equipped to treat people no matter what illness or box category they fall into. It's just treating a person and, seeing, whether it's an usual or whether it's an addiction. Those are, maybe coping strategies they've come to, to develop not in themselves the problem. Yeah. Does that make sense? 

[00:51:14] Raad Seraj: That makes total sense. Do you think there's an there's increasing attention on. At least let's say compulsive behaviors or eating disorders in particular because of things like technology addiction. There's a lot of research that is talking about, what is the implications for me of media and it's influence on, let's say young women and their sort of image of themselves, low self-esteem, which can, as I understand, lead to things like eating disorders or any, anorexia and so on.

[00:51:47] Raad Seraj: Do you feel like there's an increasing amount of, appreciation or attention on something like eating disorders? And if so, how do we understand eating disorders differently now than let's say 10 years ago? What is the emerging sort of understanding of frameworks? 

[00:52:02] Nikhita Singhal: Yeah, I think for sure that awareness out there, that, the media can contribute and I think this is where, again, we can run into difficulties because it's multifactorial it, there's always multiple things going on.

[00:52:15] Nikhita Singhal: It's not necessarily that somebody will see a model on TV and then think, I want to look like that. And developing e store, there's all of these, underlying predisposing factors and potential triggers. And so I worry, That we over can oversimplify things at times. I think it's really important that there is, I think there is more a tension on it, especially, coming out of Covid there was a real spike especially among young people and it really highlighted some of especially I think eating disorders were in, in the news a lot more.

[00:52:45] Nikhita Singhal: I worry that sometimes the way that it's portrayed as, there is this link and of course I think it can contribute, social media and people filtering themselves and changing themselves can definitely maybe influence someone. And I think it also can make it a little bit tougher at times.

[00:53:04] Nikhita Singhal: Because then it almost frames it as, it's more of this like a choice, it's oh vanity, or they want to look like this. Whereas at the end of the day it's not just about wanting to look thin or attractive, at least I know for me, when I was like sick, very sick, like I knew it was not attractive, but it was not about the way I looked to anyone else.

[00:53:27] Nikhita Singhal: It was just, I was so terrified to be any different. So yeah I think in some way good to get more attention. Good to get more focus on trying to treat things and we have to be careful about or generalizing or or st if you had to bring it 

[00:53:44] Nikhita Singhal: all together and say, what things could be done better, what would that be?

[00:53:49] Nikhita Singhal: And I'm asking, and as you described your experience and coming back to the notion of control and security, go, frequently talks about every person having this fundamental need for both authenticity and attachment or security. A and maybe part of the challenge is that, Most medical conditions, or at least from congressional medicine, psychiatry and whatever, you're, they're, it is meant to look at only the symptoms in a very compartmentalized sense.

[00:54:21] Nikhita Singhal: Instead of looking at holistically, how does one thing affect a whole web of stuff? Are there, is there a different way of looking at eating something like eating disorders, whether, as an eating disorder or as an umbrella, under an umbrella of other things that is fundamental to the human need that could help alleviate suffering?

[00:54:41] Nikhita Singhal: I think, and again, this is like a broad term that gets used a lot. I think though it really comes back to trauma also, as Dr. Ma says, trauma is not what happened to you. It's not about necessarily the thing it's about. How the individual person responds. And I think that's where, again, not just eating disorders all kinds of things that people struggle with.

[00:55:08] Nikhita Singhal: If we could shift in an idea where, to more of a system where we really try to understand people's stories and what their pain is and how they are coping with it. And then helping them, find another way or really to look underneath though. And to dig down to what's underlying it.

[00:55:32] Nikhita Singhal: And again, not necessarily a specific event or but it's the emotions that are there. And then using that as the way to guide how we treat people. I think. That could really help. And I think it gives me a lot of hope because right now there are, unfortunately, there are many people with eating disorders who feel so stuck and lost and hopeless because like you said, you're like stuck in this prison of your own mind.

[00:55:58] Nikhita Singhal: And just knowing that it's possible, whether it's through psychedelic assisted therapy or other approaches that we're going to try and explore more, that there is the possibility that some of that could relax a bit and you could find a different way. It gives me a lot of hope and I hope that it gives others hope too.

[00:56:19] Raad Seraj: It's such an inspiring story, Nikhita and I really appreciate, again, you taking us through like the crazy journey you've had so far. And I'm sure the work doesn't end for any of us really. The work continues and maybe that's where both like the beauty and the the.

[00:56:35] Raad Seraj: The ongoing cycle of suffering and liberation is in life. I think I, this is going to, this is such an inspir inspiring sort of story in, in every sense of the word be, not only in terms of like how the things that you've gone through, but how you look at it back now and then I assu, I can imagine how much healing it's taken for you to get to this point, not just for yourself, but for your relationships with your parents and so on.

[00:57:03] Raad Seraj: Imagine that you were speaking directly to people or an individual who let's say, hasn't gone through what you've gone through so far, or they're struggling with whatever condition. What would you say to them to help them?

[00:57:21] Nikhita Singhal: I don't wanna come at this from too, I guess much of a self-centered perspective. I know what maybe I would've wanted to hear. And so I, I hope that this will help people just knowing that it's okay, that you want to give up or that you don't see any way to keep going. And it's okay to be tired and it's okay.

[00:57:49] Nikhita Singhal: It's just, it's okay. You don't need to constantly, keep fighting and struggling. And at the same time, there is hope and you don't need to try these new roots. And you don't, nobody needs to force you to do those things. However, there are alternatives out there and, I never would've imagined being in the place I am now, even a couple of years ago.

[00:58:17] Nikhita Singhal: And I am, as much as it's been challenging and it's still difficult, I am very grateful that that I was able to explore some of these alternative therapies. And yeah at the end of the day it's up to you and you can choose and there is hope if you feel that you have the capacity to keep going and moving towards it.

[00:58:41] Raad Seraj: Amazing. Nikki, thank you so much. What's really amazing is that you are now on the inside, someone with lived experience, who is fighting to make the thing better. I always feel that ultimately if you center everything on the human experience, There is always reason for hope and you are certainly there and I'm rooting for you.

[00:59:01] Raad Seraj: I'm very excited for you and the future ahead. Thank you so much for sharing your life and journey. 

[00:59:06] Nikhita Singhal: Thank you for the incredibly kind words and for having me here. I honestly, it's a true honor and a privilege. 

[00:59:14] This podcast was brought to life with the help of Carolyn Tripp on art and design. Thanks so much for listening to Minority Trip Report. If you're learning from or enjoying the podcast, please subscribe to MTR on YouTube at Minority Trip Report and follow us on Instagram at Minority Trip. It's a zero cost way to support us and help us spread the word.

[00:59:30] Please also sign up with your email for new episode announcements, events, as well as our forthcoming newsletter. I'm your host, rod Sarraj. See you next time.