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Freud & Fashion

...BECAUSE IT'S STYLISH TO TALK ABOUT MENTAL HEALTH, ESPECIALLY HOW WE MAINTAIN OUR OWN.

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freudandfashion

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.

Psychiatrytherapy

Therapy Pet-Friendly Guide

written by freudandfashion
Therapy Pet-Friendly Guide

I learned about the concept of service dogs early on since my dear aunt has a guide dog (which I featured in one of my blog posts here).  In my practice, I am often asked about the process of making a beloved pet an emotional support animal (ESA) or a psychiatric service animal (PSA), so I thought it might be helpful to share info for those who are interested.  And as a side note, it wasn’t until I wrote this post that I realized the differences in nomenclature, for “therapy dog” (a dog trained to provide comfort to people in hospitals, nursing homes, and other institutions where their services are needed) certification has its own set of guidelines that you can refer to here.  Therefore, for the sake of this post, I will limit my discussion to PSA and ESA.

Psychiatric Service Animal (PSA):

  •  The 2010 Americans with Disabilities Act (ADA) regulations define “service animals” as dogs that are individually trained to do work or perform tasks for people with disabilities.
    • a dog trained to perform tasks that benefit a person with psychiatric disabilities = a “psychiatric service animal”
      • examples: calming a person with PTSD during an anxiety attack, reminding individuals to take medications
    • Miniature horses may also be included under this definition, however, there are four assessment factors that facilities may use to determine whether or not miniature horses are permitted
  • How do you get your dog to qualify as a service animal?
    • In my research, I was surprised to find that registration for a service dog is not required, nor are special vests, tags, or harnesses required to be worn (though many utilize these as a way of identifying them).
    • Almost anyone can train a service animal.  In order to be protected under federal and state law (I know this to be true in California, but please check with your respective states), the only requirement is that the dog must be individually trained to benefit the person with the disability (Bronk v. Ineichen).  Otherwise, if the owner fails to demonstrate their dog’s ability to perform the trained task, it is considered a crime of misrepresentation.

Emotional Support Animal (ESA):

  • An ESA is any type of animal (not just limited to dogs) that can provide comfort to a person with a psychiatric disability.  Training to perform a specific task is not required [1].
  • ESAs are not protected the same way that service animals are protected when it comes to access to public places (restaurants, buildings, etc).
  • Will your ESA be allowed to stay in your home even if your housing complex has a “No Pets” policy?
    • The answer is generally yes, however, the details are a bit more complex so I suggest checking out the answer to this question here starting on page 5.
  • What is required for your pet to qualify as an ESA?
    • As mentioned above, the animal must provide comfort as therapeutic benefit for a verifiable disability.
    • For situations pertaining to housing or travel, a note from a physician, therapist, or other qualified medical professional should indicate the animal’s provided benefit for the person’s disability.

Helpful Resources:

I like to print out information for my patients, so I bookmarked the following link from Disability Rights California (still quite useful even if you live in a different state) as it provides simplified, yet comprehensive information on the topic:  Psychiatric Service and Emotional Support Animals.

For physicians, mental health clinicians, and other qualified medical professionals, the link above also includes useful sample letters to use as a guide when writing notes for your patients.

 

Notes:

  1. See Majors v. Housing Authority of the County of Dekalb (5th Cir. 1981); Housing Authority of the City of New London v. Tarrant, (Conn. Super. Ct. Jan. 14, 1997); Whittier Terrace v. Hampshire (Mass. App. Ct. 1989); Durkee v. Staszak (N.Y.App.Div. 1996); Crossroads Apartments v. LeBoo (City Court of Rochester, N.Y. 1991)

 

 

February 26, 2015 9 comments
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Lifestyle

Casual Fridays

written by freudandfashion
Casual Fridays

{Scripps College, Claremont, CA}

To lighten up the mood, I decided to create a series that highlights a bit more about my lifestyle as a busy physician, in addition to specific interests related to fitness, fashion, food, and travel. When I first started my blog during residency, my original goal was to create a lifestyle blog, however, my schedule at the time consisted mostly of work and studying, so my nerdy lifestyle wasn’t too exciting!  Over the years my blog has evolved to focus on inspiring, creating, and maintaining a lifestyle geared towards the promotion of mental health.  I believe that providing a forum to share information on activities and items that we use to enhance such a lifestyle can be beneficial. 

My first post of the “Casual Fridays” series is about shopping and methods I use to save time as a busy professional.  When I lived in southern California, I seriously lived across the street from a shopping mall, but when I moved to Oregon for residency training, the closest mall was over an hour away (this might seem frivolous, but not if you’re a so-cal girl)!  Therefore, online shopping became my best friend.  One important item I’ve been lagging to buy are a new pair of prescription lenses, basically because I’m often exhausted after work or don’t like the hassle of going to busy shopping centers on weekends, so I keep putting off going to the store.  When I came across Warby Parker, I felt relieved to find out they have a home try-on program, which meant not having to deal with LA traffic (definite bonus points).  Customers select 5 pairs of prescription eyeglasses from their website and they are mailed to you shortly after, then you attach the pre-paid shipping label to send them back after 5 days, all at no cost.  The whole process is simple and straight-forward, which I especially appreciate.  Since I tend to lose track of time and dates, I had to call their customer service number to confirm my return date and the representative on the line was helpful and friendly.  Below are the 5 styles I chose:

I have a tendency to go with simple monotone frames, so this time I’d like to be a bit more adventurous.  I’m considering the Finch design from their Spring 2015 Collection (worn in photo at the very top and below).  Before I commit and order them online, I’d love your opinion…Yay or Nay?

 

Photos by Marlon (Veils & Vows)

February 20, 2015 22 comments
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Personal

Pre-Med Flashbacks

written by freudandfashion
Pre-Med Flashbacks

{Fairfield, CA}

I see numerous posted pictures on social media of college students studying late at night, cramming for tests, and getting frustrated with material.  While viewing these images, I can’t help but get flashbacks of the times I was in the same position stressed and anxiety-ridden over upcoming exams.  Over the course of my experience in blogging and social media, I have met numerous amazing people, which includes students, fashionistas, clinicians, other professionals, mental health advocates, and people coping with mental illnesses.  I am always taken aback each time someone comments on my intelligence and fortitude because I never viewed myself as academically gifted nor standout in any way.  I studied A LOT, attended office hours (even though I was too scared to ask any questions), diligently highlighted and took notes during and after class, drew study diagrams, attended practically EVERY class (I could never get myself to entrust in blackboard), participated in several organizations and held positions (even though I was often too nervous to voice my opinion), and volunteered at hospitals as often as I could.  I knew my grades and MCAT (Medical College Admission Test) scores weren’t going to be enough to get accepted into medical school, so I filled my resume with numerous meaningful activities to prove I’d be a good candidate.

I guess the reason I’m writing this is because I’d hate to see anyone give up on their goals just because they’re not inherently the smartest, nor ranked at the top of their class, nor well-connected with professors and administration, or may be struggling with a difficult life event or an episode of mental illness.  I often advocate for my college patients who struggle with mental illness to take time off from school to focus on self-care rather than crushing themselves to points beyond instability.  If there’s anything that I have learned most from my mentors, my own experience, and also my patients’ experiences is that persistence and execution of your goals are key, and if it takes a bit longer to get there, then so be it. Persistence can mean anything from allowing yourself to regroup from illness, taking a break for experiential work to explore and solidify your goals, to putting yourself in roles that challenge you beyond your comfort zone.

So, while you anxiously await your exam scores, grad school acceptance letters, etc, I hope you entrust that the outcome (whether exciting or disappointing) will lead you a step in the right direction towards self-enhancement and achievement of your ultimate goal.

Photo by Marlon Santos

February 18, 2015 7 comments
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Psychiatry

Valentine’s Day Healing

written by freudandfashion
Valentine’s Day Healing

{Malibu, CA}

Oh, the chatter of couples reserving a spot at their favorite romantic restaurants, enamored significant others shopping for the ideal gift, beloved partners plotting the perfect engagement proposal, top hotel ballrooms fully booked for weddings…all Valentine’s Day festivities sound so dreamy, however the majority of the nation’s singles probably want to vomit.

Since I’ve been writing about grief in my recent posts, I curiously looked up existing research on psychological aspects related to relationship breakups.  I found a few interesting studies and figured I’d share what I learned especially since National Singles Awareness Day is fast approaching:

1.  Up to one-third of active Facebook users go on the social networking website to “Facebook stalk” their exes.  I’m sure many of us have experienced how difficult it can be to avoid ANY contact with our exes soon after a breakup (previous research has shown continued contact offline to be associated with poorer functioning post breakup).  Well, a study conducted by Dr. Tara Marshall showed Facebook stalking to be even WORSE for recovery post breakup!  Those who de-friended their ex showed greater personal growth, which suggests that the best chance for healing a broken heart is to avoid them both online and offline.

2.  There is hope in breaking up, at least in terms of developing personal growth.  Another study led by Dr. Tara Marshall examined the association of attachment styles (see below for my attempt at a simplified explanation of this theory) as predictors of personal growth following romantic breakups.

  • One attachment style involves those who grew up in an environment where the caregivers were inconsistently available nor responsive.  As an adult, they tend to be clingy and require excessive reassurance especially when they feel insecure and unsafe in the relationship. Therefore, after a breakup, these highly anxious individuals developed heightened distress, which ultimately led to greater self growth.  Why so?  Perhaps experiencing high distressing emotions acted as a catalyst to promote self-reflection and growth.
  • In contrast, when someone grows up in an environment where the caregivers were never around nor available, then as an adult they grow up to be highly self-reliant and mistrustful of others.  Therefore, after a breakup, these individuals aim to restore their self-sufficiency and take on the role of parenting themselves.  In this study, they were found to exhibit low amounts of distress and less personal growth likely due to experiencing little motivation to change as a result of the split.

3.  Changes in your brain activity occur after a breakup.  One study published in the American Journal of Psychiatry (2004) conducted brain scans and found altered brain activity in women actively grieving from a recent breakup.  Therefore, you’re bound to experience some changes in emotions, especially sadness, and there’s a scientific reason to account for this.

Thought of the Day:  Ready, set…stop stalking your ex! (at least until you’ve healed and moved on.  I admittedly get a kick out of Facebook stalking my exes every once in awhile as well).

February 13, 2015 21 comments
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Psychiatrytherapy

Shock and Denial

written by freudandfashion
Shock and Denial

I review the 5 Stages of Grief with my patients all the time.  Yet, no matter how many times I review them, nor how many patients or people I lose in my life, experiencing these stages never gets easier nor avoidable.

Stages of Grief:

  • Shock/Denial
  • Depression/Sadness
  • Anger
  • Bargaining
  • Acceptance

The following was written last week:

Today, I shall focus on shock/denial.  Why focus on the shock/denial stage?  I received a call from the medical examiner (aka coroner) today.  I hold my breath each time I answer my office phone in fear that the medical examiner’s office is on the other line.  The worst sentence to hear upon answering the phone is “Hi doctor, this is (insert name here) from the medical examiner’s office.”

My biggest fear became a reality today, yet again.

Currently, I am in the shock/denial phase and I’m coping by intellectualizing (a defense mechanism that many of my colleagues employ to deal with difficult news; mostly because I’m more comfortable processing the loss clinically rather than emotionally at this point, hence, the reason I am focusing on writing a blog post that teaches the stages of grief), carrying on with work, and going about my day, with the occasional few tears and blank stares when I have downtime.  These moments of sadness are periods that I try to avoid, especially after glancing at my fully-booked patient schedule.  According to the medical examiner, “cause of death is not known, the toxicology results are still pending.”

Each and every one of us go through this phase when we experience loss.  I blogged about the subject of grief recently when I lost a patient to suicide two months ago.  I am aware that my demeanor is currently “off” because I’m quite tense and impatient right now as well.  I might be going through the motions of a regular day, but in no way am I taking this loss lightly.  I know the anger stage will approach soon.  For me, the worst stage is sadness/depression because I generally want to isolate and hide.

The following was written today:

One week has passed since hearing the tragic news about my patient.  I enter the clinic, greet my usual “good morning” as I observe everyone going about their busy day as normal.  I enter my office and suddenly have a desire to punch my computer as it takes forever to reboot.  I settle for slamming my palm against the keyboard instead.  Note that this is my usual morning routine, minus the angry/”I wanna punch something” part.  The anger stage is here.

I see my first few patients and notice a decline in my usual empathetic statements, my mind drifts more frequently, however, I remain fully aware of my thoughts and am able to re-focus.  The 20 minutes that I have with each of them is their designated time and I must not let my grief impact any medical decision.  I take my lunch break and run into one of the therapists, who was also involved in my deceased patient’s care.  I decide to open up about the struggle I’m having today, in hopes that we can provide comfort and support each other during this difficult time.   Instead, I get a remark that pisses me the hell off, or at least that’s how I interpreted her curt comment.  I essentially wanted to tell her she was an insensitive idiot and to f*** off, but I held my composure.  I normally wouldn’t be bothered by such a comment, but I’m clearly more irritable than usual.  I let it go and tried to have compassion for her especially since she might be grieving as well, or thought that perhaps she’s a cold witch and doesn’t care, then thought that perhaps I misinterpreted her comment.  Perhaps I feel that nobody understands, and maybe no words can make me feel better at this moment anyway.

February 5, 2015 23 comments
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Personaltherapy

Sticking To It

written by freudandfashion
Sticking To It

{midweek hike in Malibu Creek State Park}

My “Monday Motivation” consists of posting my continued efforts to maintain my New Year’s goals for 2015.  I truly appreciate all of you because you’re part of my support system — you’re helping me hold myself accountable to stick with these goals!  I can’t emphasize enough how important self-care is to maintain a sense of well-being, which is the reason my last few posts have been dedicated to the topic.  Most of my patients struggle with the same issue, which leads to burnout, increased stress, uncontrolled anxiety, worsened health, and much more.  The photos in my post are proof of my activities from last week, and serve as my motivation to continue this week.  If you’d like to join me in my efforts to prioritize self-care, would love for you to share how you’ve been doing so thus far!

{Took a REAL lunch break & caught up with celeb gossip and world news}/ {went to two amazing yoga classes, even though I was initially too lazy to go and wanted to back out (pic taken before class)}

{Took a stroll on the beach of Playa Del Rey after my weekend therapy session}

January 27, 2015 11 comments
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therapy

Restful Week

written by freudandfashion
Restful Week

Have you ever felt guilty about having an unproductive week?  That’s how I initially felt regarding this week, but in retrospect, I believe it was necessary to take it easy.

To be easier on myself (which is difficult for a self-critical person like me), I had to keep in mind two of my goals for 2015 (which I discussed in my previous post):

  • be mindful
  • be aware of my need for self-care

I felt ill this week and wanted to sleep most of the days, and therefore, couldn’t complete most of my tasks.  However, I needed to listen to my body and its need for rest and recovery, whereas in the past, I’d push myself to go to the gym and stay up late until I completed everything on my to-do list.  I also had insightful, yet emotionally-draining group and individual psychotherapy sessions, which resulted in me not wanting to write a blog post due to how much thought and psychological overtones I put into my posts.  Yet, this is a pattern that has occurred in the past since I first started blogging in 2010, which resulted in large gaps between posts.  I am trying to avoid those large gaps this time around and want to let you all know of the reason I’m late with this weekly posting.

What made me feel better was reading statements such as “it’s okay to not be okay,” which is definitely true, however, society makes you feel as if you have to be running on all cylinders ALL OF THE TIME.  Which is fine, as long as you take necessary breaks and don’t wear yourself out.  However, we are all human, and I often try to help my patients overcome barriers towards being less judgmental on themselves.

As you can see, I’m trying to take my own advice 🙂

January 18, 2015 7 comments
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Personal

Fresh Start

written by freudandfashion
Fresh Start

{Napa, California}

I’m excited about the new year, but must admit that I’m in a strange transition phase where my professional identity and personal identity are at odds with one another.  Most of my life has been devoted to my education and in many ways I believe those years halted my personal development.  When most of my childhood friends were getting married and starting their own families, I spent most of my days studying, memorizing, listening to lectures, getting grilled by senior physicians, studying so that I don’t look like an idiot in front of senior physicians, eating, sleeping (then repeat).  My free time was spent either catching up on sleep or celebrating to make up for the fact that I spent several straight weeks studying (I think I’ve used the word “studying” way too many times in this post already).

“I wanted to become a doctor so I could serve others.  And because of that I’ve lost everything.  But I’ve also gained everything.”  ~ ‘Patch Adams’

Being in my mid-30’s, I certainly miss the vibrancy that came effortlessly as an energetic 20-something year old.  I recall working a 12 hour overnight shift in the Labor & Delivery unit, then heading straight to the airport (with only 1 hour of sleep) and boarding the plane in my scrubs in order to attend my sister’s graduation that day in San Francisco, then flying back the next morning (in my scrubs) to make it in time for another 12 hour shift.  Time flew by way too fast.  Before you know it, I’m at it again struggling to get a few days off in order to attend my sister’s wedding.  I barely had any time to think…and little time to fully enjoy life outside of school.  But that’s the path I chose and I am grateful with no regrets.   Now that I have a bit more free time, I am mindful that the more I allow myself to savor the present moments and especially invest in my own self-care, the better a person and physician I become.  After all, how can I care for others if I can’t take care of myself?  In the past, my new year’s resolutions consisted of external measures such as losing weight, getting high grades/scores on exams, etc.  But this year my goals are more internal and self-fulfilling…

My goals for 2015:

  • be present
  • be mindful
  • be open to self-discovery
  • be aware of my need for self-care.

Thought of the Day:  What personal goals would you like to achieve in 2015?

Photos by Marlon Santos

January 8, 2015 11 comments
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Psychiatry

Holiday Mental Break

written by freudandfashion
Holiday Mental Break

 {With our new family dog, Levi}

Whenever I visit my parents’ home, I regress to a childlike state and become the complete opposite of how I am in my normal, adult life (i.e. instead of my usual high stress, on edge, active, rigid self, I wake up late, lounge around in sweats, and enjoy writing “nothing” on my to-do list).  Hence, I’ve taken a brief mental break to reset/recharge and in my relaxed state, I realize this is the first time in eight years that I’ve had time off during the holiday (consider 2 years of hospital rotations during medical school, 4 years of residency training, and 2 years being the newbie doctor at my first job).  I initially felt guilty about being away from the clinic for so long, but am aware that my ability to provide quality care declines the more burned out and overwhelmed I feel.  I know how hard it can be to prioritize yourself, especially if you’re the caregiving type who’s used to putting others’ well-being before your own.  I hope you are able to find time to care for yourself during the remainder of the year, and if not this year, then consider as a possible New Year’s resolution to put self-care amongst the top of your list.

December 28, 2014 11 comments
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Psychiatrytherapy

Mind Over Meds

written by freudandfashion
Mind Over Meds

{Claremont, California}

Some of you may have noticed that although I am a psychiatrist, I rarely comment nor write about my thoughts on psychiatric medications in my blog.  I did write a post as a resident physician-in-training in 2010 titled Pill Pusher, which briefly describes my general approach to simplify, minimize, and streamline medication regimens to the least amount of meds needed to provide symptom relief.  In some cases, I have successfully worked with my patients to wean off and discontinue all of their psychiatric medications, though the process requires much patience, toleration of uncomfortable withdrawal symptoms, and numerous non-medication approaches to maintain stability off of meds.  And most importantly, I believe a trusting doctor-patient relationship is needed to provide education of potential withdrawal symptoms, encouragement to push forward, and processing fears that may arise from being off medications for the first time in years.

Now, please do not mistake me for a protester against pharmaceuticals — I witness the positive impact that medications can have on enhancing the quality of life of my patients on a daily basis.  However, I do not attribute the improvements primarily to medications.  My treatment plans generally promote the development of insight and self-awareness of mood patterns, anxiety triggers, etc, and oftentimes explore how past suppressed emotions may contribute to current symptoms, all of which are topics I aim to emphasize in my blog.  Medications may stop working or provide temporary relief, but knowledge of one’s self can last a lifetime.

Photos by Marlon Santos 

December 20, 2014 2 comments
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