Author

freudandfashion

I'm a newly graduated psychiatrist who believes it's stylish to talk about mental health. Welcome to my diary, Freud & Fashion, created in 2010 to document my life as a psychiatrist-in-training and share knowledge and psychotherapy pearls that I learned along the way.

Personal

Residency Memories

written by freudandfashion

{Voodoo Doughnut, Eugene, Oregon}

I enjoy taking a stroll down memory lane every once in awhile to reminisce about the past. While trying to find a photo for my next blog post, I came across pictures of fun times in Oregon during residency training. In effort not to embarrass my fellow colleagues (think trashy theme party, dancing to “Baby Got Back,” and movie nights with some of the most grotesque films ever made, to name a few examples), I limited the photos to the least embarrassing (not surprisingly, many photos were eliminated), pictures mostly of myself, or with the obtained consent from my residency friends (if identifiable in the photos). I may constantly mention the hardships of the journey through medical school and residency, but my three years spent in Oregon brought about many friendships, fun experiences, and memorable moments that I’ll treasure forever.

{Residency Retreat at Black Butte, Oregon}

{Wine Tasting in the beautiful Willamette Valley, Oregon}

{My 1st time golfing}

{Good thing I didn’t get graded on my Pictionary skills because I clearly would’ve failed}

{Oregon Medical Association conference in Bend, Oregon}

{My 1st time snowshoeing, Bend, Oregon}

{My Princess-themed party that my awesome co-residents threw for me before graduation}

April 2, 2015 6 comments

Psychiatry

Brain Injury Awareness

written by freudandfashion

{With my mentor after my sports concussion talk in San Diego last year}

I find that the more passionate I am about a certain subject, the harder it is for me to write about the topic in my blog (mostly because there’s so much I’d like to convey in a brief post). Today is the last day of Brain Injury Awareness Month and the theme for this year’s campaign is Not Alone. I’ve worked with several patients whose lives and their family’s lives are dramatically changed as a result of the injury. From mild concussion to post-concussion syndrome to traumatic encephalopathy — to be honest, I don’t believe there’s anything about brain injury that can be characterized as “mild” mostly because the injury can potentially lead to longterm, permanent damage and impact their lives forever.

My goal in treatment has been to improve their quality of life and restore daily functioning to as close to normal as possible. Unfortunately, restoration of baseline functioning is not possible for some. At that point, the focus shifts to recovery, acceptance, and how to move forward and cope with the sometimes debilitating symptoms. And acceptance doesn’t only need to be acknowledged by those injured, but also their families. One of the hardest, yet most rewarding parts of my job has been to help my patients find motivation within themselves to keep pushing forward and find a sense of purpose in their lives. And it’s crushing to see family members feel helpless as they watch their loved one struggle to overcome the physical and emotional barriers. However, recovery is possible and I work with several patients who find hope and are motivated to look for work, seek support from loved ones, and find ways to make their lives as enjoyable as possible.

The theme Not Alone refers to the estimated 12 million Americans who live with the impact of traumatic brain injury and the 5.3 million who live with resultant disabilities. These numbers don’t even account for the number of people who do not seek treatment. There are many misconceptions about when to seek help (which I plan to discuss in a future post), in addition to social pressures to underreport (especially in sports). Many often feel ashamed of their injury, but hopefully with increased awareness, the general public will recognize its prevalence and take part in providing support and understanding to those effected.

For more information on brain injury, please visit the Brain Injury Association of America website.

March 31, 2015 6 comments

Personal

Drift Away

written by freudandfashion

{San Diego, CA}

My whole week was a bit of a blur. I sometimes wish that I could take a vacation for a few months and have no responsibilities whatsoever. Where would I go? I have no idea. What would I do? No clue. Come to think about it, having no responsibilities for an extended period of time might be depressing. After all, my entire life has been devoted to my career, which is a huge part of my identity. Without my work, I’d lose my sense of purpose especially since being a physician makes up a large percentage of who I am. Perhaps that’s why retiring can be so hard (I have several retirees who present with depression). With that in mind, I suppose the better alternative to an extended vacation would be to continue working, but at a comfortable pace with firm limits and boundaries in place. It sounds so simple. After all, I know my limits and the workload I can handle before getting overwhelmed…but it’s my job to reinforce it. I guess reinforcing it is sometimes harder than the job itself.

March 28, 2015 6 comments

Psychiatry

Teaching Influence

written by freudandfashion

{Malibu, CA}

Current thought: I’m glad I turned out to be a decent psychiatrist.

I remember being an eager medical student during an internal medicine rotation and asking a consulting psychiatrist the reason he diagnosed two of my elderly patients with schizophrenia. I anxiously awaited his response (Note: I highlight the word elderly because diagnosing schizophrenia at such a late onset in life is rare) and he gave me the most nonchalant, dismissive response: “because they’re having hallucinations.” He got up and walked away before I could ask him any more questions. Well, Mr. Psychiatrist, if I knew what I know now, I would’ve told you back then that you were a horrible doctor because you did not even talk to my patient nor put any thought into your diagnosis, nor care that giving a frail 70-year old woman excessive doses of antipsychotic medication might actually make her worse (excessive doses of antipsychotics may increase risk of confusion, oversedation, and pneumonia in the elderly population).

The accumulation of my experiences working with various attending physicians (aka supervising physicians) have shaped the way that I practice psychiatry today. One of the first lectures I attended during my psychiatry residency was about the emphasis of humanism in mental health, which was a concept that was markedly different than what I observed during internship (I had made the decision to switch to a different residency program after internship). I remember feeling ashamed during the lecture because I recalled how I used to write orders for “B-52’s” (the nickname for a cocktail of medications given by injection for acute agitation; a chemical restraint) so frequently and unhesitatingly during internship. Needless to say, that lecture set the tone and confirmed that I made the right decision to change training programs. My whole perspective and approach to psychiatry changed by working with the most caring and compassionate psychiatrists, therapists, and nurses. I obviously recall interacting with a few terrible psychiatrists, which actually turned out to be a useful learning experience: I learned how NOT to practice psychiatry. So, if you are interested in pursuing a career in the mental health field, I hope that you train with amazing supervisors, remain open-minded (psychiatry is not so clear cut as reading the DSM 5, our diagnostic manual), maintain empathy, and remember that each individual/client/patient has a story.

The greatest compliment that I’ve received from several of my patients is also a sad reality about the spectrum of practitioners in my field: “You’re not like any psychiatrist I’ve met before. You actually try to get to know me.”

March 25, 2015 36 comments

Psychiatry

Antidepressant Awareness

written by freudandfashion

I have a love/hate relationship with antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Basically, I love them when they actually help my patients, but hate the intolerable withdrawal that may occur when taking patients off of them. If you’ve ever contemplated abrupt discontinuation of an antidepressant, consult your doctor before stopping them altogether, particularly if you’ve taken them for at least six weeks.

In my practice, I never hesitate to prescribe antidepressants when indicated, however, I always warn my patients of potential withdrawal effects that may occur if the medication was to be discontinued in the future. Informed consent and patient education should be given before a physician prescribes any new medication. Over the course of my training and practice in psychiatry, my observations of the negative impact of weaning off antidepressants shocked me, mostly because I never learned about the phenomena in textbooks the way that I learned about other withdrawal syndromes (such as alcohol, opioid, methamphetamine, etc). From flu-like symptoms to acute somatic pain symptoms — I witnessed a full range of issues (see below for a more extensive list). The unfortunate thing is that patients often internalize the symptoms and believe there’s something wrong with them, though typically the only factor that changed since the last visit was lowering the antidepressant dose.

A telling statement was hearing a patient say that getting off an antidepressant was worse than getting off heroin. Antidepressant discontinuation is no joke. And the unfortunate thing is that many people aren’t aware of the negative withdrawal effects that may occur from lowering the dose or discontinuing the antidepressant. I was fortunate to have an amazing mentor during residency training, who taught me that “slower is better” when it came to lowering the dose of antidepressants. A literature search for any research articles regarding weaning off antidepressants yields little results, therefore, guidance on how to take patients off of them is minimal.

I am NOT writing this post to bash antidepressants especially since they have improved the quality of life of many. However, I AM writing this post to raise awareness because I see this issue OFTEN. And if this information encourages one person to advocate for him/herself and the symptoms they experience, then mission accomplished!

Possible Antidepressant Withdrawal Symptoms:

insomnia
agitation
worsened anxiety
resumption of depressive symptoms
headache, “brain zaps”
stomach upset
flu-like symptoms
increased pain
tiredness
nightmares
dizziness
suicidal thoughts

March 20, 2015 21 comments

Lifestyle Personal

Finding Balance

written by freudandfashion

{McDowell Sonoran Preserve, Scottsdale, AZ}

During my stay in Arizona, I was fortunate to reunite with friends from my residency training program and was especially excited to spend time with one of my closest friends from medical school. One of the subjects we talked about most was the struggle to obtain or achieve work/life balance. Balance and avoidance of burnout is essential for overall emotional and physical health. Burnout has been shown to be more prevalent in medical students, residents, and early career physicians compared to the general U.S. population.

My life is much more balanced than it has ever been, and I believe the biggest barrier towards accomplishing this in the past was the perceived lack of time as an undergrad, medical student, and psychiatry resident. I emphasize the word perceived because I truly believed that sacrificing my personal life for the sake of my future career was well worth the burnout. Well, by choosing to become a physician, yes, an immense degree of sacrifice is required. If I failed at any point in the process, would I have been upset? Hell yes! And I actually did almost fail because I put so much pressure on myself to do well that my anxiety sky-rocketed and impacted my test-taking abilities. Therefore, my scores were in no way reflective of the amount of time I spent studying, which really sucked (no need for a more formal term for my emotion; “sucked” pretty much sums it up). At that point, I broke down, cried, and told my parents that I wanted to quit medical school. And it wasn’t until then that I realized they didn’t care which profession I chose — they just wanted me to be happy. What a huge relief! All this time I thought I’d dishonor my traditional Asian family if I didn’t become a physician. Suddenly, at that moment, the weight and pressure to please my family lifted. I felt liberated. However, the remaining pressure I possessed was the pressure I placed on myself because I didn’t know of any other way to approach life while working towards my medical degree.

Looking back, if I had the opportunity to offer my past medical school self any advice, I’d tell her the following:

To sacrifice a few hours of studying a week in order to instead go out and do something enjoyable to enhance personal growth and interests.
To be less self-critical. Little does she know that she’ll be just fine if she doesn’t graduate from the most prestigious, academic medical school or get accepted into the most renowned residency program.
Just try your best and don’t beat yourself up in the process. After all, one of the top 5 things people regret most on their deathbed is “I wish I hadn’t worked so hard.” I definitely know that I’d never say I regret not working or studying more. Simple activities, such as enjoying nature and going on hikes, are far more memorable in my mind compared to the insomnia I experienced trying to squeeze in last-minute studying for a histology exam.

March 17, 2015 7 comments

Lifestyle Personal

Thankful Thursdays – Time Off

written by freudandfashion

{Fairfield, California}

Time off from work couldn’t have arrived at a better time. It has been awhile since I wrote my last “Thankful Thursdays” post (see previous ones here and here), so I think it’s appropriate to write one given my current state of mind (which is more relaxed and centered). My vacation started off with a quick, last minute trip to visit my family in northern California, which is usually my preferred travel destination each time I get the urge to feel more rooted and have the need to reset. During a stroll with my sister, I realized the grassy hilltops are gorgeous landscapes that I’ve taken for granted ever since my family first moved to the area when I was in junior high. For some reason, the lush hills appeared immaculate and majestic this time around. I enjoyed reuniting with family visiting from the Philippines, tasting my mom’s traditional filipino dishes, and playing card games with my cousins and siblings. I truly savored my brief stay.

Currently, I am sitting in a hotel lobby located in the flourishing city of Scottsdale, Arizona. I stare outside at the backdrop of pristine mountains, pale blue skies streaked with thinly layered clouds, and adobe fountains and fixtures at the forefront. Everything seems extremely tangible – from the texture of the furniture to the warmth of the sun hitting my face. While attending a conference, I am also aware of the numerous psychiatry and neurology residents here preparing to take their board exams tomorrow, as they lay out by the pool with heads buried in flashcards and exam prep books.

“I remember being in your same position two years ago,” I said to one of the girls who studied while lounging on the chair next to me. All I could remember from that day two years ago was memorizing the diagnostic criteria for various psychiatric diagnoses, the treatment for alcohol and drug withdrawal, etc. I never would have imagined noticing the simplistic, yet characteristic details of the locale like I am able to observe now. Fortunately, I passed the horrific test, yet I reflect on the past and a part of me wishes I was more mindful of the details from that experience. However, as the saying goes, “better late than never.”

Photo by Marlon Santos

March 12, 2015 6 comments

Personal

Weekend Reflection

written by freudandfashion

{Ventura Pier, CA}

In order to take charge of my life after a stressful week, I made the decision to temporarily cut back on certain responsibilities. In the past, I rarely said “no” to projects or other opportunities, however, as I mentioned in my last post, I’ve been extremely overwhelmed and need some time to regroup. Though it’s difficult, especially if you’re someone who people rely on (especially if you’re the caregiver type), setting boundaries with people and activities is a healthy way to cope and manage your life. I’ve never met anyone who devotes a huge percentage of their energies on work and everyone else BUT themselves without getting burned out. However, if you have mastered the art of life balance, please message me. I’d love to know your secret.

Hope you’re having a wonderful weekend filled with relaxation and self-care!

March 8, 2015 19 comments

Personal therapy

Numb

written by freudandfashion

I honestly didn’t want to write a blogpost today. The main reason being that I’m not in a peppy mood, but why should blogging only be about happy thoughts when reality is that human beings experience a full range of emotions?

My current emotion = numb. I participated in a suicide debriefing at work today, which is a meeting where we review a recent suicide, process grief, and provide support for staff members involved. I have been open about my feelings surrounding patient loss (here, here, and here), and experiencing this sort of numbness is somewhat new to me. The intellectual part of me feels inclined to look up research articles to find meaning behind this numbness, however the emotional side of me lacks motivation to perform the work. We may sometimes experience a mixture of confusing, unfamiliar emotions, which may contrast from what one might perceive to be normal or expected. But that leads to criticism for feeling a certain way. How nice would it be to have freedom to be yourself and feel a certain emotion without being judged?

Yesterday, one of my newer patients wanted me to tell her where her anxiety is coming from and I replied, “I’m actually not sure, but perhaps you have an idea what might be triggering it?” My patients often expect me to identify the reason behind a specific emotion, but I find it difficult to formulate my thoughts without the patient’s own input. If I switched roles right now and sat in the patient chair and the psychiatrist asked me where I think my numbness is coming from, I’d say “I feel too overwhelmed and there’s no room for extra stress in my life.” (Then, the light bulb goes off in my head). I have too much going on in my mind and don’t have the reserve to tolerate more emotions at this current moment. Hence, feeling numb. Now that I think about it, feeling numb isn’t much different from the hours I spent watching House of Cards last night (Note: it’s out of character for me to watch that much tv on a regular basis). Either way, I am trying to avoid some unsettling feeling that I’m not quite ready to process. However, I’m bracing myself because I know the time to process the difficult emotions will eventually come. Until then, I still have two more seasons to watch.

March 5, 2015 20 comments

Personal Psychiatry

Casual Fridays – Join the Cause

written by freudandfashion

I started blogging during psychiatry residency training a few years ago not only because I needed a creative outlet, but also because I felt lonely and isolated living in a new town without an established support system. I initially coped by laying on the couch watching excessive amounts of television, but then the idea to start a blog popped up in my mind. Since I rarely shared my feelings with colleagues and supervisors, imagine how embarrassed I felt when my medical director told me that he read my blog! He said that he learned far more about me within minutes of reading a few blog posts compared to the last few months since I joined their program. Since I never felt comfortable enough to verbalize my thoughts nor struggles, I realized that my writing provided a necessary outlet of expression. Over time (through my training and participating in both group and individual psychotherapy), I let down my guard, however, it’s still a significant work-in-progress (ask the members in my current group therapy cohort). However, my experience allows me to empathize with my patients, especially when they describe the difficulties of discussing their issues with others.

The purpose of my blog has been to create an openness to discuss mental health, so I was excited when I came across the conscious clothing line, Wear Your Label, which shares a congruent mission: to create conversations around mental health and ultimately end the stigma. Each garment creates a sense of connection and empowerment by emphasizing positive messages in each piece. For example, their “Stuggle vs. Strength” tee (worn in photo) highlights the co-existence of both strength and struggle, for, the “most valiant strength develops through times of struggle.”

Many organizations, advocates, social media forums, etc, are rising with the same goals in mind of providing support, education, and resources to prioritize mental health. However, each one of us can contribute to this goal simply by opening up about our own individual struggles. That way, none of us ever have to feel alone.

February 27, 2015 6 comments

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