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.

Psychiatry

6 Things To Say (And Not Say) To Someone Who Is Grieving

written by freudandfashion

{Na Pali Coast, Kauai, Hawaii}

I always struggle with grief this time of year. Among other stressors, this month also marks the 14th year death anniversary of my grandfather, whom I was extremely close to. You’d think that after fourteen years, the grief wouldn’t hit me so hard, yet it still does. Grief is one of the most difficult emotions we experience as humans, yet is also one of the most commonly misunderstood.

Below are some actions and statements that I’ve found most helpful both personally and professionally in my office when I have patients coping with grief. I initially drafted this post last week while in a combined state of anger and sadness (predominantly anger) related to grief. I contemplated deleting the initial draft, which I titled “Things You Should Never Say To Someone Who Is Grieving.” However, since I try to maintain authenticity on my blog, I decided to leave the section I wrote while in an angered state, particularly because people frequently experience anger, yet often internalize and feel too ashamed to express the emotion. People need to recognize that grief does not consist of only sadness. Grief is a complex emotional roller-coaster that may involve one or a combination of emotions such as anger, rage, sadness, guilt, depression, joy, denial, shock, disbelief, confusion, frustration, exhaustion, apathy, numbness…(I think you get the point).

Since people often feel clueless about what to say to someone who is grieving (trust me, I struggle sometimes with what to say as well), I hope that you will consider the following when you or someone you know is experiencing grief:

Things You Should NOT Say To Someone Who Is Grieving:

1. “It’s been ___ days/weeks/months/years already…you should be over it by now.” Grief has no timeline. The closer a relationship someone has with the deceased, the longer it may take to overcome the painful emotions. As one of my amazing readers (whom I learned a lot from since he shared his experience with losing a child) pointed out: grief never fully goes away, but rather becomes more tolerable.

2. “Just try not to think about it.” Telling someone not to think about losing someone is like telling someone not to be human.

3. “‘So-and-so’ has already moved on…you should too.” Comparisons are terrible because each individual person has their own process of experiencing grief.

4. “Just be strong.” Saying this statement actually does the opposite and evokes a sense of weakness for not being able to overcome such strong emotions that may feel outside of one’s control.

5. “I know how you feel. My ____ died…” Don’t even try to make the difficult situation more about you. I once sought support from a peer and confided in my sadness only to have her shift the focus to herself and her past losses (and she was a psychotherapist!). Though I’m sure her intentions were good, a part of me wanted to punch her in the face for wasting my time and energy.

6. “He/she is in a better place now.” I’m a little mixed about this statement because it can be comforting if used in a thoughtful way, but annoying if said generically as a reflex response. For example, when my grandmother passed away, I felt comforted when a relative said “She’s in a better place now with your grandpa in heaven” because my relative knew of my grandparents’ enduring love for each other having been married for >50 years, in addition to our spiritual beliefs. However, when an acquaintance says the statement in a generic manner, it doesn’t feel genuine at all.

Bottom line — don’t say anything to someone who is grieving unless you truly, wholeheartedly mean it. If it doesn’t feel authentic to you when saying it, then it most definitely won’t feel authentic to the person who is grieving. And if you’re not good at verbally communicating your thoughts, then read on to see how your actions can be just as helpful (if not more).

Helpful Things To Do/Say To Someone Who Is Grieving:

1. Just be present. Actions speak louder than words, especially during such a difficult time when grief tends to be a very isolating experience. Being present shows that you’re aware of how difficult the experience is and that you won’t let them go through it alone.

2. Give a hug. Several years ago, I was sitting in a lecture during residency when I received news that my grandmother passed away. During the state of shock, I truly appreciated when my co-residents gave me hugs especially knowing that there was nothing they could say to make me feel better at that moment. Giving me a hug showed that they acknowledged the news and wanted to show that they cared.

3. “If you ever need to talk to someone, I’m here for you.” Again, showing your support and offering your help when needed demonstrates that you care.

4. “I’m so sorry to hear the news” or “I’m so sorry about your loss.” Often, when people don’t know what to say, they may avoid saying anything at all to the person grieving. Avoidance is one of the worst things to do to someone who is grieving because one might assume that you don’t care, which most likely isn’t the case. Saying something as simple as this statement acknowledges that you’re aware and recognize the impact of the person’s loss.

5. “I’ll be thinking/praying for you and your family/ (anyone else known to be deeply impacted by the loss).” Expressing that your thoughts (or prayers if the person is religious/spiritual) are with someone shows that you know this is a difficult/tough time for everyone involved.

6. “I know I can’t say anything to take the sadness away, but just know that I’ll be here to support you.” This is such a true statement — nothing you say can bring the deceased back to life nor take the pain away, so offering your support and presence speaks volumes to someone who is struggling during bereavement.

February 23, 2016 22 comments

Medicine Psychiatry

4 Reasons Why I Don’t Wear A White Coat

written by freudandfashion

I absolutely love this post written by Dr. Kristin Prentiss Ott about why she believes we shouldn’t wear white coats to work. To carry on with her sentiment, I thought I’d write a few of my own reasons why I personally chose to ditch my white coat even when required to wear one since completing my internship (except for professional photos, of course). Aside from the fact that I’m a psychiatrist, you’d be surprised to know there are still some hospitals where psychiatrists wear their white coats on the unit (the psychiatric hospital where I did my internship was one of them). I used to think it was a bit odd to wear white coats on the psych ward because the look can be intimidating, but I was an intern at the time so I complied. And yes, I recall asking one of the supervising psychiatrists the reason why white coats were worn and remember being told it was by choice? I may have also been delirious and sleep-deprived at the time, so don’t quote me on that.

The following are the reasons why my white coat remains unworn and in pristine condition hanging in my closet:

1. White Coat Syndrome. Yes, such a syndrome exists and is also known as “White Coat Hypertension.” The condition is self-explanatory: a person’s blood pressure is elevated while in the doctor’s office, but is normal in other situations. I was initially quite surprised to learn that anywhere from 15-30% of people experience the syndrome, though I’d have to say the statistic is quite synonymous (frankly, I believe the percentage is even higher) with my own experiences in practice, especially when meeting patients for the first time.

Though one explanation for the fear-based physiologic response might be the association of hospitals/clinics with disease and illness, I believe psychiatric patients are even more prone to anxiety when in the psychiatrist’s office due to disclosures of more personal information and possibly also from bad experiences with previous doctors who weren’t empathetic to their psychiatric issues.

2. Prioritize the doctor-patient relationship. In a study done in an outpatient psychiatry clinic in Upstate New York, 96% of the patient population surveyed preferred that their psychiatrist not wear a white coat, while 58% did not think it would make a difference in their doctor-patient relationship.

Having an aligned doctor-patient relationship is important in any specialty, but even more so with psychiatry due to the personal content discussed. Due to the pressures of time constraints and also the trend of several behavioral health clinics having patients see whomever random psychiatrist has availability, patients are less likely to establish a therapeutic connection, which I imagine would exacerbate anxiety during each visit. I mean, would you want to re-hash your story to a new psychiatrist during each follow-up appointment (but then again, most psychiatrists don’t have enough time to review your whole history, so sessions become mostly limited to a discussion of symptoms only)? Minimizing any factors that can contribute to anxiety (such as wearing a white coat) would at least help a patient feel more at ease.

3. They’re filthy and teeming with bacteria. I have traits of OCD (Obsessive-Compulsive Disorder), yet vividly recall disgusting moments during internship (where I rotated in various hospital departments) when I knew that my white coat was dingy and long overdue for dry cleaning, yet was way too busy to wash it (think buildup of splattered bodily fluids from various orifices and the numerous times that my white coat sleeves probably brushed my face or came into contact with food I’d scarf down during quick breaks…ewwww). Dr. Ott points out in her post that research has shown that a mere 8 hours of routine patient contact leaves white coats teeming with infectious microbes. These days, the average work week of all medical residents is limited to 80 hours/week and most practicing physicians work an average of 40 to 60 hours/week, which equals a heck of a lot of microbial buildup.

4. Sure, a white coat has maintained its iconicism as a symbol of power, prestige, and intelligence, but a doctor’s identity shouldn’t depend on wearing one. Obviously, I was excited when I received my short white coat during my medical school induction ceremony, but later hated being identified as a novice med student as I walked the hallways of the hospital. Meanwhile, other health professionals from various levels of training wore long white coats indistinguishable from those worn by physicians. After graduating from medical school and transitioning to the longer white coat, I was so excited, yet recognized that I formed too strong of an attachment to my white coat. My dependency on an object didn’t sit well with me. I felt as if I had to wear one in order to possess a sense of worth and importance.

By first acknowledging that I attributed much of my value to an external object (the white coat), I took steps to detach myself from it. I began to curate a wardrobe that conveyed professionalism and my individual sense of style. I made sure that I properly introduced myself to patients and staff, especially when I was mistaken for a nurse or psychotherapist. And I’m not going to lie — initially, I was frustrated by having to correct people on a regular basis, but as I gained confidence in myself (yes, psychotherapy helped) and my skills as a physician, to this day I am rarely ever bothered. Interestingly, I am acknowledged to be a physician far more frequently and I believe it’s because I project a much greater sense of who I am, both personally and professionally. No white coat needed.

PS: A special “thank you” to my friends on Snapchat (freudandfashion) for contributing your opinion when I posed the question of whether or not you’d want your psychiatrist to wear a white coat (11% said “yes” to wearing a white coat and 89% said “no” ).

February 9, 2016 18 comments

Series

Questions I Bet Your Psychiatrist Never Asked You

written by freudandfashion

During new patient evaluations, psychiatrists generally have a standard set of questions that are asked to help formulate a diagnosis based on diagnostic criteria and to develop a treatment plan. Every psychiatrist has their own style, but I’ve always been interested in asking patients more open-ended questions if I think it will provide me with a greater understanding of who they are as unique individuals. I also assume that my questions might be a bit different than the norm because I’ve grown accustomed to patients making statements such as “You know, nobody’s ever asked me that before.” Oftentimes, I believe that the art of psychiatry has dwindled down to a checklist which subsequently churns out a diagnosis based on the minimum criteria needed to properly meet billing requirements. Such a practice may lead to a lack of connection in the therapeutic relationship, therefore, I sought to create a series that explores the unspoken thoughts that a person may have when meeting with a psychiatrist. If you would like to contribute to future questions in this series, please email me at freudandfashion@gmail.com.

QUESTION OF THE WEEK:

What goes on in your mind when a new psychiatrist asks if you’re suicidal?

RESPONSES:

It’s been some time since I’ve seen a new psychiatrist; thankfully I’ve been (somewhat) stable and happy with the treatment I’ve been receiving with my current one. But I do remember going through what was round-robin of mental health professionals before I found my current doctor. The situation is horrible, as I’m sure most people who have gone through the same process can testify. Although someone may be a professional who’s gone through years of grad school and training about what may be wrong with me, why would I want to share my darkest, deepest pain to someone I just met? It never felt right.

The two psychiatrists whom I connected with most during my care have been the ones that treated me like a person (and even a friend) first. No, I’m not that textbook case study you read in Psychology 407 back in grad school. Nor am I willing to try new psych medications with the script you’ve given me after our 5 minute visit.

There are no 100% effective cures for mental illness, but you can still treat those living with mental illness like human beings. It’s not that hard.

Brandon Ha, Creative Director @BreakYoStigma

facebook.com/breakyostigma

instagram.com/breakyostigma

First thing that springs to mind is: “I can’t tell you I’m suicidal because you’ll hospitalize me and that will just ruin everything I’ve worked so hard for.” (as strange as that sounds…)

However, I always think there’s no point in outright lying to my psychiatrist if I genuinely want to get better. So, usually, I just tell them what I’m thinking, even if it means telling them I’m suicidal. But, I make sure I explain exactly what I’m thinking. Usually my thoughts are more of a passively suicidal nature and I don’t have a concrete plan in mind. My current psychiatrist is well aware of that. I haven’t had suicidal ideation with a plan for quite some time now. The last time was with my first psychiatrist, two years ago. And even then I’d tell her the truth. I only got hospitalized once, when I told her I genuinely couldn’t guarantee that I wasn’t going to do it. I guess the fact that I’m always honest about what goes on in my mind is precisely what has helped me not get hospitalized more than once. I’ve always thought of the patient-psychiatrist relationship as one built on trust. If they can’t trust me then they can’t help me to the best of their capacity and I’d just end up self-sabotaging.

Dana S, medical student (borderlinemed.wordpress.com)

‘I’d never kill myself. Wanting to die to end my misery and actually going through with it are completely different. But that’s probably not the answer you were looking for…’

Rudy Caseres, Voice on Mental Health

Facebook.com/Rudy.Caseres

Twitter: @RudyCaseres

First thought in my head if asked if I was suicidal would be something sarcastic like this: ‘Would I be sitting here if I was [suicidal]?’ and/or ‘Yes and to be honest, you’re just having a visual hallucination of myself right now.’

Anonymous

What goes on in my mind? Terror yet the need to be honest and tell the psychiatrist if I’m feeling that way. From experience (I was hospitalized several times for suicidal ideation) I know I had to be truthful about feeling suicidal because despite the intense compulsion, I didn’t want to do it and leave my two young daughters without their mom. I needed to be kept safe so I didn’t go through with it and I knew I needed hospitalization. I got better, and if the feelings return I will be honest with my current psychiatrist. I realize that he would most likely place me on a 5150 hold, but I accept that.

Dyane Leshin-Harwood, author of “Birth of a New Brain – Healing from Postpartum Bipolar” (Post Hill Press, 2017). Blog: www.proudlybipolar.wordpress.com, Twitter: @birthofnewbrain

The first thing that comes to mind is that I need to justify why I’m there seeking help at this appointment and I wasn’t really sure how I need to respond. I was asked to rate my suicidal thoughts on a scale of ‘1 to 10’ (1 being the least severe and 10 being the most severe) and thought to myself, ‘do I need to respond with a high number so that I can get the help that I need, or will a low number not make them take me seriously enough?’ I remember feeling like I needed to justify that I needed help and it seemed as if a number was supposed to prove it. I get that a number is supposed to reflect my thoughts and feelings, but I didn’t feel like it was a genuine representation of my situation.

Anonymous, Psychotherapist

Having seen a psychiatrist in the past, I remember feeling anxious about this question because I knew what to expect in an evaluation, even though I didn’t feel suicidal. Fortunately, I knew the psychiatrist came highly recommended, was well-established in the community, and was someone I could trust, but what if I had no choice but to see a random psychiatrist (quite similar to the experiences many of my patients have encountered in the past) who was a novice, unskilled, or didn’t care to take the time to get to know or properly assess me? A psychiatrist’s job is hard and safety is our utmost concern, but building trust and mutual respect in a physician-patient relationship also needs to be a priority.

Vania, Psychiatrist and writer of Freud & Fashion

Photo by Marlon Santos

January 22, 2016 14 comments

Psychiatry

Quick Reflections From The Week

written by freudandfashion

{Napa, California}

I’d like to think that I’m quite mindful and reflect on almost anything that stands out in my day causing me to raise an eyebrow or feel that a mini light bulb went off in my head. I truly believe that the more mindful we are and the closer attention we pay to cues and details, the more meaning we can get out of even the most routine of days. The following are some of my own reflections from the week, and I hope to encourage you to reflect and do the same!

The importance of teamwork. As a psychiatrist who values coordination of care and hearing other clinicians’ perspectives, I had the opportunity to connect and discuss cases with an awesome psychologist whom I share several patients with. Being in private practice can feel a bit isolating at times compared to working in a multidisciplinary setting, so I welcome the opportunity to meet and discuss any complex psychological issues that might be impacting my patients. As several of you may know, I place a much stronger emphasis on psychotherapy than pharmaceuticals when treating my patients. Therefore, knowing that therapists value my opinion on psychotherapy just as much (or even more) than my expertise in pharmacology helped me feel connected and valued as a team member.
Be authentic and speak up. Since I posted my latest blogpost on physician burnout, I’ve received amazing responses from people telling me that they could relate to my post. As someone who was always afraid to share my opinion (yes, I’d go to leadership meetings and literally sit there and say NOTHING), it was a testament to how much personal work I’ve done to overcome barriers that got in the way of me voicing my opinion. I think clinicians can be hypocritical by simply telling patients to exercise more, think positive, stop thinking so much, eat healthier, etc, and even worse if they label patients as ‘non-compliant’ for not executing such changes by their next follow-up appointment. As if breaking years worth of habits is that easy. Well, I can say that it took me years to overcome my overwhelming fear of judgment in order to speak up and I’m just happy to have the support of empathetic people who helped me achieve it.
Normal vs Pathological. During sessions with patients, I try to help them discern whether the symptoms they’re experiencing are normal reactions given their circumstances. This week, several patients chose to hold off on increasing medications after recognizing that they were coping with issues in a fairly healthy manner. Often times when people are diagnosed with mental illness, any anxious feeling, sense of fatigue, anger outburst, difficulty sleeping, etc, is automatically perceived as problematic rather than a ‘normal’ response. I’m far more collaborative in my approach, and part of the treatment involves determining whether or not a symptom is ‘normal.’ The decision-making process of determining whether or not to adjust a patient’s med is geared towards first helping my patients gain insight rather than automatically assuming that their symptoms are pathologic.
“To find health should be the object of the doctor. Anyone can find disease.” ~ A.T. Still. I am currently reviewing osteopathic principles for an upcoming presentation, and while reading I came across this quote. There are times during appointments when I’m stuck on which medication to prescribe next, though I noticed that I experience clarity the moment I get an opportunity to practice the above quote with my patients. I have several patients who have tried an extensive list of meds, yet start to observe more improvement when the sessions shift from solely focusing on meds to helping them heal from years of trauma, neglect, medical illness, heartbreak, addiction, etc. Doing so reminds me of the reason I pursued a career in medicine in the first place.

January 16, 2016 5 comments

Lifestyle Medicine

Say ‘No’ To Burnout: A Renewed Physician’s Goal for 2016

written by freudandfashion

{Napa, California}

2015 was a year to regroup and reassess my professional goals. Immediately after residency, I did as most physicians do — apply and hope to get a job that pays well and is in a good location. Similar to the personalities of most physicians, I am a workaholic and overachiever. Therefore, since graduating residency, I strove to perform well at my job, treated my patients to the best of my ability, passed my psychiatry board exams, in addition to participating in extra professional activities on the side (gave psychiatry talks, restarted blogging again, enrolled in a psychoanalytic course, etc) while attempting to balance my personal life. However, after the first two years as a practicing physician, I became disillusioned by the sad reality of our broken healthcare system.

When I first started working, I was an enthusiastic, energetic psychiatrist ready to use all the knowledge and expertise I acquired in my training to make an impact and help improve the lives of many. But, then I recognized my limitations. I noticed that the pressures exerted by the system to deliver cost-effective care, see a high volume of patients, and obtain exemplary patient satisfaction scores while maintaining my ideal ways of practicing, were nearly impossible to sustain. I noticed a decline in my ability to balance life outside of work and took my frustrations out on those around me. I participated in psychotherapy, group therapy, exercised, went to church, ate a healthy diet — basically, did everything that you’re “supposed” to do to manage stress. It may have helped for one day, but then I still dreaded waking up the next morning to go to work. And once I noticed a decline in my passion for practicing Psychiatry, I knew that such a decline in my quality of life was NOT the type of life I deserved after busting my ass throughout college, medical school, internship, and residency. I deserved to be happy. I deserved my ideal practice.

I have written posts about my personal experience with burnout, have read numerous articles about physician burnout, yet still struggle to fully describe how debilitating the experience is because it evokes a sense of failure, a “system malfunction” of everything we were programmed to do since day one of medical school. This article by Dr. Dike Drummond most precisely describes the factors that lead to physician burnout. As much as I would like to do so, I cannot fully fault my employer because I understand their methods from a business perspective. In order for the organization to thrive, physicians are key components to meet the organizational goals. And we allow it. We adjust. Most of us don’t know any better. Medical school doesn’t teach us to be business savvy, nor how to market ourselves, nor give us the tools needed should we decide to venture out on our own to create our own practice. And most notably, we are not taught how to prioritize self-care nor how to advocate for ourselves when stressed and overwhelmed. Often such behaviors of speaking up for one’s self are viewed as weaknesses. To this day, I still have the mentality that I’d need to be on my deathbed in order to miss a shift out of fear of being perceived as less than superhuman by my Attendings and peers.

Initially, I blamed myself for not being able to keep up with the heavy workload and for feeling so defeated. But then I realized that I had a choice: either 1) Quit and seek my ideal practice, or 2) Adjust to the system and forego any sense of autonomy and watch my passion to make an impact in the field of Psychiatry further dwindle away.

I quit and spent 2015 working a reduced schedule and essentially recovering from my entire medical career thus far. Throughout the process, I had to re-train my mind to let go of the standards that were ingrained since medical school: the need to be a workaholic, the need to be a genius and know everything (otherwise risk being ridiculed), the need to be superhuman, the need to suppress and hide my struggles, the need to be a perfectionist at all times, the need to function at 110% amidst exhaustion and fatigue.

A patient doesn’t benefit from a burned out physician (in fact, it has been shown to lead to greater medical errors). And if a fellow physician is struggling to maintain, we must not consider them as weak. Please understand that they deserve just as much care and attention because they sacrifice their own well-being for the sole purpose of providing care to others.

I will never forget one regretful time that I was on-call: already worn out from the day’s clinic, I angrily dialed the number on my pager and spoke to another physician on the other line, who paged in hopes of getting advice to help a fellow physician struggling with suicidal thoughts. My reflex response was uncharacteristic of me, lacked empathy, and to this day makes me cry with regret:

“I’m sorry, but I can’t help you. Tell him to go to the ER.”

I would never even fathom giving such an insensitive response to one of my patients. Just knowing that I turned my back on one of our own…someone who very well could’ve been me had I stayed and felt trapped in my job…someone who represents the growing number of depressed and suicidal physicians, makes me sick with disgust. I vowed to never again lose myself so much in a job that I risk losing my empathy and compassion. However, as I type this, I recognize that as much as I blamed myself, I see how that “programming” from medical school, which taught us that any sign of struggle represents weakness, overrode my empathy.

Therefore, my goal for 2016 is simple: to maintain balance. For the first time in my life, I feel deserving of breaks and time off, feel open to share my struggles (and view them as signs of strength, not weakness), and feel confident in who I am as a physician deserving of a practice that supports my lifestyle (rather than one that consumes me).

And one last note: I’ve observed the new class of aspiring doctors, have connected with them via social media, have met with the shining future leaders of our future healthcare system — and they are a population unafraid to support one another and voice their needs. They are students who are starting to open up about their desire for self-care and balance. They are students who are championing wellness programs in their medical schools. They are students who are tech savvy and understand marketing tactics (because they have the tenacity to reach their own international following that closely watches and looks up to them as they develop as authentic role models on social media). They will detect the bullshit of organizational “wellness” programs and any false attempts at showing they are being “cared for,” when in reality they are being appeased only long enough until thrown back into the same working environment that led to their decline…and the cycle continues. Although most posts on physician burnout are pessimistic about the potential for change, with what I’ve observed, I have even more hope that our future doctors will come together and do what they can to put a stop to the cycle.

Photo by Alex Manipod

January 8, 2016 38 comments

Lifestyle Psychiatry

New Year’s Resolution Ideas To Enhance Your Mental Health

written by freudandfashion

Not sure about you, but I got tired of writing down the standard New Year’s resolutions on my list (such as losing weight, making more money, etc) several years ago. Research has shown that people typically lose momentum to carry out their resolutions within the first 6 months, so why not make a list that enhances your life and contributes to happiness for the long run rather than relying on a number (ie, pounds lost, money earned, etc) to determine whether or not you succeed?

Achieving your resolution is a process…it has ups and downs…successes and failures. If we learned to embrace the process, we’d likely maintain momentum (ie, “okay so I ate a lot of chocolate and pastries on Valentine’s day — I’m going for a run the next day,” rather than the negative self-talk such as “I’m such a fatty and a failure because I ate a piece of chocolate”). I say, get over it and move on — after all, you’re human. You either have the option of stressing and obsessing about that one piece of chocolate (thus increasing your cortisol levels leading to increased fat storage) or owning up to eating that piece of chocolate and viewing it as fuel for your workout or a well-deserved treat. Perhaps self-love and forgiveness can also be a resolution? Since awareness of the importance of mental health has been gaining more traction lately, let’s make 2016 a year to focus on your overall mental health and well-being.

The following are some ideas that I share with my patients on a regular basis, in addition to some resolutions that I plan to incorporate into my own list for 2016:

1. Improve your sleep patterns. I listed this as #1 because it’s actually at the top of my own list since I stay up way too late despite having to wake up early in the morning for work. Sleep is correlated with your health (insomnia is related to hypertension while too much or too little sleep increases the risk of stroke, for example), levels of concentration, and mood. So how much sleep do you need? You can check out the National Sleep Foundation’s recommendations for amount of sleep here.

2. Substitute some of your least healthy food habits with more nutritious options. It has been shown that those with better quality diets were less likely to be depressed and people who eat higher amounts of processed food was associated with increased anxiety. Here are a couple of substitution ideas:

Instead of soda: try flavored sparkling water, fruit-infused water, unsweetened iced tea. (This is how I quit drinking soda about 4 years ago)
If you eat fast food on a regular basis, aim for an option that perhaps is charbroiled instead of fried (ie, grilled chicken sandwich instead of battered).
If you want to fulfill the craving for fried food, be sure to use oil from healthier sources (ie, coconut, olive, and grapeseed oil).
Instead of snacking on white or milk chocolate, switch to dark chocolate.

3. Make more of an effort to connect with others. This can be as simple as smiling or saying “hi” to people that you walk by on the street to making more of an effort to talk to a co-worker whom you normally don’t speak to, or re-connecting with an estranged family member. Social interactions with those you are close to, in addition to acquaintances, are linked to a greater sense of belonging and happiness.

4. Give back by volunteering. Volunteer work increases social connectedness and has been shown to lower levels of depression, especially for people over age 65.

5. Discover the exercise/sport/gym/physical activity that you love so much it becomes part of your regular routine rather than a chore/hassle. Rather than committing to losing weight, why not first find the physical activity you enjoy and desire to participate on a regular basis? Then, the benefit of engaging in the activity leads to getting in better shape. It’s really all a matter of perspective. If you focus on a specific number of weight to lose, then you’re more focused on the end outcome (and that could entail unhealthy habits such as yo-yo dieting, starving yourself to meet that number, or overexerting yourself at the gym — basically, methods that are unsustainable and add excess stress to your body).

6. Take up a new hobby. In effort to live a more balanced life, having a hobby can be a healthy distraction away from your everyday stressors. I’ve been meaning to improve my golf skills ever since I first played a round during residency several years ago (okay, maybe I didn’t play all 18 holes, but still). I’ve already bookmarked a few golf courses to check out and plan to go to the driving range in January. Anyone care to join?

7. Spend less time on your smartphone/social media and more time engaging in real conversation (and life in general). Americans have been found to spend an average of 4.7 hours/day on their smartphones. This is going on my list as well because I’m definitely on my phone way more than I should be. Although social media can be a great source of support to connect over mental health issues, it has also been linked to insomnia and increased anxiety in the teenage population. I believe that adults are likely also impacted by social media in a similar manner, so reminding ourselves to unplug more can lead to less distraction and greater productivity to accomplish the other resolutions on your list.

Photo by Marlon Santos

December 29, 2015 26 comments

Personal therapy

Recognize Your Limit

written by freudandfashion

(Unflattering sick post from my Snapchat)

Well, in addition to the stress of the holidays (which I wrote about here), among other stressors, was also the added stress on my body having made an impulsive decision to switch from a high protein (mostly animal-based) diet to a Vegan diet practically cold turkey. I watched several Netflix documentaries that turned me off to carnism and found myself repulsed at the thought of even eating my daily hard-boiled egg for breakfast (those who know me know this has been my routine to start my morning for the last 2 years). Well, in addition to also getting a stomach bug, all the combined stress culminated a few nights ago when I experienced the symptoms listed above (see photo) and was out of commission the following days. I welcomed the opportunity to rest (fortunately it was my day off, then had the weekend) especially since I haven’t been sleeping well in the last few weeks.

{more Snapchat (username = freudandfashion) posts}

Well, I guess my quick (because I really want to go out for a run since I have more energy today) and main point of this experience is the importance of listening to our bodies and being aware of the need for self-care when we’re overwhelmed and approaching our limit. I could’ve forced myself to sleep earlier (but I didn’t), could’ve more properly planned a better way to ease into eating more plant-based protein (but I didn’t), and could’ve allowed myself to relax rather than stress about the perfect gifts to buy (I’m still not done with my Christmas shopping, but whatevs), but sometimes we get so wrapped up in the moment that our own needs become an afterthought.

If any of you identify with me and the stress I’m experiencing, then it’s nice to know I’m not alone. And if so, I hope you start this week being kinder to yourself and take the proper measures to maintain your sanity for the remainder of the year (and thereafter).

December 20, 2015 9 comments

Psychiatry

The “No Bullsh**” Guide For Getting Through The Holiday Season

written by freudandfashion

Ahhh yes, the television commercials convey cheerfulness and joy with the contrived images of gift giving and preparing for a massive holiday feast, but the reality is that people probably identify more with Ebenezer Scrooge than Martha Stewart. If a part of you feels too guilty and ashamed to admit that you’re not filled with holiday glee, then consider the following questions:

Do you want to roll your eyes when asked how excited you are about spending the holidays with your in-laws?
Do you feel obligated and forced to buy gifts for everyone?
Have you lost loved ones and the holidays serves as a reminder that they’re not present to celebrate with you and the family?
Did you recently go through a divorce or breakup and feel even lonelier now that you have nobody to drag to holiday parties or kiss on New Year’s Eve?
Are you struggling financially and can’t afford much of anything except to spend a quiet, typical night at home?
Are you trying to stay sober and the holidays tend to trigger using again?
Do the holidays cause more anxiety and depression because you’re expected to be happy even though you’re really not?
Do you hate dealing with annoying crowds of shoppers trying to get those last minute gifts?
Do you beat yourself up for waiting until the last minute to buy gifts (and then tell yourself that you’ll get all your Xmas shopping done early next year, yet repeat the same pattern. I’m raising my hand for this one)?
Have you been good about diet and exercise, but worry that Thanksgiving, Christmas/Hannukah/Kwanzaa/”insert celebrated holiday here” and New Year’s will test your discipline and make you gain all the weight you’ve worked so hard to lose?
Would you much rather say “screw it” and purchase an extravagant gift for yourself instead of trying to find the perfect gift for everyone else?

If you answered yes to any of the questions, then you’re definitely not alone. The above questions are just a few of the common issues that I heard from my patients and friends within the last few weeks. I’d say that the majority of my patients and people that I know perceive the holidays as far more stressful than joyful. I recall the holidays being so much fun as a child due to getting time off from school, receiving Christmas presents, building sticky gingerbread houses that were actually made of graham crackers, and going on trips with the family, but the holidays are definitely not as fun when you’re the adult responsible for planning the festivities. If you are one who tends to struggle during the holidays, then the following are a few tips to help you get through the next few weeks until New Year’s Eve is over (then you at least have some time to breathe until Valentine’s Day comes around):

1. Set boundaries, boundaries, boundaries. If you’re a “Yes Man/Woman” (someone who always says “yes” and has a hard time saying “no”), then you not only have to deal with the stress of planning for the holiday, but also the overwhelming pressure to please everyone since you’re the reliable person whom everyone depends on (or the schmuck whom everyone takes advantage of), which leads to internal feelings of guilt, exhaustion, anger, and resentment if you can’t carry out all the duties expected of you, but then blame everyone else for not helping you (you probably also don’t feel comfortable asking for or accepting help, right?).

If you fit some components of the description above, here are a few ideas to try:

Talk to your therapist (and if you don’t have one, you might want to consider getting one because your issues with setting boundaries probably aren’t limited to the holiday season).
Use the Yes/No Method.

2. Don’t overexert yourself if you don’t want to attend so many holiday gatherings. As mentioned in #1, the key is learning to say “no.” Weigh the risk/benefit of attending each event, and attend the ones where the benefit outweighs the risk (ie, attending your boss’ holiday gathering may have more benefit than attending a coworker’s potluck dinner/white elephant gift exchange). And if for some reason you actually have to attend a party that you can’t get out of, then stay for a bit and come up with an exit plan (I used to make up excuses such as “I promised to dog-sit for a friend” or that I’m not feeling well, but now tell the truth because I find that people are generally pretty understanding or can tell when you’re lying).

3. If you know you’re going to eat a feast and have a hard time avoiding all the amazing holiday desserts and egg nog, then plan ahead yet also be realistic. Stressing out about your exercise regimen and what you’re going to eat causes even more stress. Weight gain and disease is not caused by one or a few days of eating unhealthy during the holiday, but rather the trajectory of your lifestyle choices over time. If you eat a lot during Christmas dinner, then utilize those carbs with a good workout the following day, or plan on making healthier food choices thereafter. It’s truly better to move on after a day of indulgence rather than perseverating on the guilt (trust me, it took me over a year of living with my brother, who is a personal trainer/unofficial psychotherapist, for me to get over the guilt of eating unhealthy a few days at a time).

Here’s another article that might be useful for managing your diet/fitness goals during the holidays.

4. Make sure you set up appointments with your therapist or psychiatrist during the holiday for preventative measures. Although many health professionals are away on vacation during the holiday, plan ahead by setting an appointment before your therapist or psychiatrist leaves to make sure you have enough med refills or to check-in for support and maintenance. There should be coverage in case any urgent issues arise while they’re away, so make sure you have the contact information handy. And, of course, if safety becomes a concern, then call 911.

5. If you have a known seasonal component to your mood, put into action what has typically helped your mood to get you through the year (med and non-med approaches). I wrote a previous post on Seasonal Affective Disorder (SAD) and another post on how to cope with Summer seasonal depression, though the general principles apply to Winter seasonal depression as well.

6. Plan on staying sober during the holidays. Similar to #4 above, I always ask my patients if they’ll need a follow-up appointment with me during the holiday season to check-in and provide additional support to maintain sobriety. The holidays can be quite triggering for relapse, especially if everyone around you is inebriated by the plentiful cocktails, champagne, and spiked egg nog. The following resources provide great tips for getting through the holidays sober:

5 Ways to Survive The Holidays Sober
HOME Podcast by Holly (of Hip Sobriety) & Laura (of I Fly At Night): The Holidays

7. Coping with grief. I found this post quite informative for the bereaved during the holiday. One tip that I found most valuable was the importance of surrounding yourself with those who support you the most rather than undergo the exhaustion of trying to suppress your grief and sadness at numerous social gatherings.

8. Treat yo self. Okay, I admit it — the first few items I bought while Christmas shopping were for myself, but I couldn’t help it! It’s far more anxiety-provoking trying to come up with which item to buy for someone else than it is for myself (I mean, at least I know that I’ll appreciate what I bought for myself, whereas I have to risk feeling butthurt (this word is actually in the dictionary) if someone returns an item that I bought for them). To some degree, buying myself a gift is a form of stress relief in addition to a reward for getting through the entire year. And if buying something for yourself is not within budget, then deduct the cost from the gift you planned to buy the person you like the least.

If you have any other tips to cope with the stress of the holiday season, would love to hear from you! And rather than saying the generic “have a happy holiday,” I’ll end this post by saying “Hope your holiday is low-stress and may you enjoy (or tolerate) the season as much as you possibly can.” 🙂

Photo by Marlon Santos

December 11, 2015 9 comments

Personal

Mixed Feelings

written by freudandfashion

{Inland Empire, California}

I contemplated skipping my weekly blogpost today, mostly because I got a headache each time I sat down to type. But then I recalled my previous pattern of taking brief hiatuses from blogging, which eventually turned into a year long hiatus, and were mostly triggered by feeling too overwhelmed or stressed at the time. Not going to repeat that pattern again this time around. Social media has become so perfectly curated, which I believe is necessary to maintain to some degree (not sure anyone wants to see a photo of me taken immediately after I wake up in the morning), however, real life is far from perfect. I know my trigger was the horrific mass shooting in San Bernardino, which is only minutes from where I grew up and nearby Arrowhead Regional Medical Center (the hospital that treated several of the victims), where I completed my medical internship and most of my medical school clerkships. Whereas I’m normally cheerful, goofy and chipper on my Snapchat videos, I wanted to be real and instead talked about my shock and dismay. Oftentimes people are afraid to show their true emotions due to fear of negative perceptions, but I wanted to be truthful about my sadness, anger, and frustration. And as much as I’d like to write something profound about the psychological manifestations of how we might all be feeling, I don’t have much to say other than that I’m still in shock that something so horrifying could happen, let alone reach so close to home. I believe that in the next few days, I’ll be more cognizant of how I plan to respond. But until then, rather than beat myself up about not having a plan of action, I think I’ll allow myself to be human and experience whatever mixed emotions may arise.

Photo by Marlon Santos

December 4, 2015 9 comments

therapy

Express Gratitude Daily

written by freudandfashion

I rarely used to tell people that I appreciated them. I recall rejecting and criticizing kind things done for me, gifts given to me, etc, mostly because I focused more on the superficial/material aspect rather than the thoughtfulness and intent. When people tell me that I possess a “positive energy,” I’m often a bit surprised because I used to exude such negativity. One way that I was able to shift my perspective was by expressing gratitude on a regular basis. Such a feat isn’t as easy as people may believe. Solely telling someone that they “just need to be more positive” doesn’t help much, or at least I find those statements quite annoying because such statements negate the fact that there’s probably an underlying reason for the lack of optimism (ie, low self-esteem, depression, traumatic upbringing, grief, etc). The expression of gratitude takes time and practice, and when you’re not used to sincerely telling people that you’re thankful, then it’s going to feel awkward at first. For example, if a relative buys you a hideous Christmas sweater, focus more on the kind gesture rather than the dissatisfaction of the gift itself. As time goes by, the practice takes less effort and feels more sincere (ie, “Thanks Aunt Sally, the sweater will keep me warm during the winter months”).

If you need even more motivation to be thankful, the expression of gratitude also has many benefits: increased happiness, better physical health (more willingness to seek medical help, more involvement in physical activity), and increased self-esteem, to name a few.

In addition to sincerely saying “thank you,” the following is a list of strategies that may enhance feelings of gratitude (experiment and find out which ones work best for you to carry out on a regular basis):

1. Write a “thank you” note. Some people feel more comfortable with writing than verbalizing. Giving someone a note shows that you took the time and effort to write a few kind words.

2. Keep a gratitude journal. Take some time at the end of your day to recall 1-2 things that you were thankful for, or you can also designate one day per week to reflect on the things you were thankful for from the week. I’m not organized enough to carry a journal (I ended up writing on post-its which would clutter up my nightstand), but think it’s a great way to keep track of things you’re grateful for on a regular basis. My variation of journaling is doing a weekly “Thankful Thursday” post on my Snapchat (my username = freudandfashion if you’re interested in my weekly reminders).

3. Think of what you’re grateful for (as a regular practice, or during prayer if you’re religious). If you’re like me and can’t remember to write in a journal, then practice thinking or saying aloud to yourself what you’re thankful for from the day. Choose the time of day (I prefer bedtime right before sleep) and make it routine.

4. Express gratitude directly in person. This is my preferred route. As a psychiatrist, I strive to make sure I communicate directly because I believe it’s integral in relationships, including the development of good therapeutic connections with my patients. Ways to express gratitude directly includes buying coffee for coworkers (coffee at work always makes me happy!), taking a friend out to lunch, stopping by to visit a friend, etc.

5. Shift your perspective from negative to positive. If you find yourself in an angry mood, try shifting your focus by thinking of something that went well during your day. If you’re stuck in traffic and find yourself getting tense and irritable, try to express gratitude at that very moment. Saying what you’re thankful for can shift your mood as it changes your focus.

A lot of people tend to think that you have to express thanks for only major things such as having a supportive family, an education, a decent job, etc, but you can definitely be thankful for even the smallest thing that went well during your day. I’ve expressed gratitude for things such as hitting all green lights on my commute to work, seeing a cute dog that made me smile, not getting a parking ticket while out in Hollywood, etc. Basically, you can always find something to be thankful for. And with today being Thanksgiving, no better day to start implementing this practice than today!

I wish all of you a happy Thanksgiving! xoxo, Vania

Photo by Marlon Santos

November 26, 2015 19 comments

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