Category:

Psychiatry

Steps I Take To Be A Stigma Free Psychiatrist

It’s a busy week for raising mental health awareness. Today is World Mental Health Day (October 10th), which is a day observed for discussing issues, garnering support, and mobilizing efforts to improve the treatment and public attitudes towards people living with mental illness worldwide (this year’s theme is “Dignity In Mental Health”). Today is also the final day of Mental Illness Awareness Week (Oct. 4-10), which falls each year during the first week of October to recognize the efforts of the National Alliance on Mental Illness (NAMI) to fight stigma, provide support, and educate the public. This year’s theme is #IAmStigmaFree. As a psychiatrist, I wanted to utilize this opportunity to identify the steps that I regularly take to eliminate stigma in my practice. My process has required a lot of personal work — learning, self-examination, self-reflection, patience; and I acknowledge that I am still a work in progress. However, I want to emphasize that I am working on myself to ensure that my patients receive the best care possible because I know what it’s like to be judged prematurely based on others’ hurtful perceptions.

Our own misconceptions of people living with mental illness are reflected in our interactions. As a physician, I believe it’s important that my fellow colleagues especially be aware of how their actions and words impact patients (ie, anger, impatience, frustration, labeling, etc). Even mental health professionals can perpetuate stigma by not utilizing proper language nor acknowledging how our own stigma impacts the therapeutic relationship (to all of you who’ve ever looked at your patient schedule and uttered phrases such as “greatttt, another psych case,” or “oh geez, it’s that one guy again who can’t stop drinking,” or “she’s so borderline and difficult,” etc — YES, I’m talking to YOU). And again, I admit that I’m not perfect because I’ve mumbled similar phrases in the past myself. Therefore, the following are steps that I take in my own life to ensure that my patients feel understood, rather than stigmatized and judged:

Be open to changing your perspective towards mental illness
- As I’ve mentioned in previous posts, earlier in my training I was quick to label patients as being “non-compliant,” “agitated,” etc. A stark contrast to my current way of practicing, I didn’t allow proper time to get to know my patients beyond going through a checklist of DSM diagnostic criteria (though one factor may have been naivete as a “green” intern physician, the predominant factor was the influence of the broader society’s stigmatization of the mentally ill population). However, I noticed a drastic shift immediately after I switched residency programs and was introduced to a more humanistic way of practice (the way Psychiatry SHOULD be practiced), where my mentors immediately encouraged me to eliminate words such as “non-compliant,” “agitated” and to get to know patients for who they are as people, NOT just their diagnosis.
- I remember initially resisting my new program’s approach (mostly because I realized that it requires far more effort to be humanistic than it does to robotically rehearse a checklist of information and churn out medication recommendations based on symptoms alone, while minimizing any type of emotional connection with a patient), but welcomed the change in order to grow both personally and professionally.
- Note: For all the providers out there who feel there’s no time allotted in your jam-packed schedule to have empathy while seeing > 20 patients in one day, I feel your pain. The moment I realized the negative impact that being an overworked physician had on my interactions with patients, I decided to quit.

Separate my own issues from my patients
- When meeting patients for the first time, I admit that sometimes I’m exhausted from work and the last thing I want to do is meet a new patient because, in general, it takes far more effort to meet someone new than it does to see someone whom I’m already familiar with (this sentiment applies to social interactions in day to day life as well). I may start the session off feeling a bit irritable, however, once I start talking to my new patient, my anxiety settles (because I realize their anxiety levels about meeting a new doctor far exceed mine) and realize that my exhaustion and irritability interferes with giving my patient the attention he/she deserves.
- I recall the first time I met my psychotherapist and how high my anxiety levels were during session. How horrified would I have felt if my therapist was quick to judge me for reasons such as wanting to complete the interview within the the shortest time-frame possible rather than taking the time to get to know me? The moment that I identify my own anxiety brought to session when with a patient, I allow myself to relax, which in turn helps my patients feel more at ease as I proceed to ask not only my standard questions, but also thought-provoking questions about their lives in order to better understand them as unique individuals.

Learn and educate yourself
- When I first had a patient with autism, borderline personality disorder, eating disorder, traumatic encephalopathy, etc, I prioritized researching and gathering as much information as possible in order to better understand and help them. Oftentimes, stigma regarding a specific illness is propagated due to lack of willingness to learn and understand a person’s experience. If I want to fully understand what my patient’s experience with having a specific disorder is like beyond the literature, I ask them! I noticed that my patients appreciate when I ask because inquiring demonstrates that although I may not have firsthand experience with what they’re going through, I truly have an interest in wanting to know what it’s like to live in their shoes.

Be connected
- The first time I met someone living with mental illness was when my aunt, who has been diagnosed with profound intellectual disability and schizophrenia, came to live with my family when I was in my early teens. Rather than live in fear and avoidance of my aunt (fear and social distancing are contributors to stigma), I made a goal to connect with her on a regular basis (say “hello,” ask questions about her day, shake her hand, comb her hair, etc). Eventually, she warmed up to me and I appreciated her unique qualities such as her love for simple things (dog stuffed animals, a glass of water, sitting outside to get fresh air) and the rotation of her favorite phrases that she’d randomly blurt out (usually pertaining to wanting to visit the Philippines and her sister’s guide dog). Having the connection with my aunt taught me early on of the importance of looking beyond someone’s mental illness.
- Being active on social media also allows me to connect with mental health advocates and people living with mental illness. Outside of clinic, I find that reading their posts and being a part of the social media community provides a deeper perspective of their experiences as clinicians and consumers within the mental health system.

Share and teach others
- Sharing my experiences and advocating for a humanistic approach to psychiatry is exactly the reason I blog. I recall attending a meeting while working on an inpatient psychiatric hospital during residency and my supervisor yelled at the staff members for laughing at a stigmatizing quip made about one of the patients (staff members clearly felt ashamed and never made such comments during meetings thereafter). I admired my supervisor for standing up for the patients and from that moment on, I never tolerated stigmatizing remarks made in the various places I have worked. Sure, I’ve been the buzzkill during meetings in various clinical environments, but such comments should not be made in the first place. If I can change someone’s perspective and reduce the perpetuation of stigma, then I’ll keep advocating, buzzkilling, sharing, and fighting.

October 10, 2015 17 comments

Psychiatry therapy

The Crucial Transition From Work to Home

written by freudandfashion

{Beverly Hills, California}

One of my patients told me that the most frustrating part of his day occurs the moment he arrives home from work when his family accuses him of being isolative and uninterested (due to his first activity upon arrival consisting of sitting in his parked car in the driveway and/or watering the lawn instead of immediately engaging in family affairs). When my patient told me this, I actually thought about my own behavior upon arriving home from work, and to be honest, I can be pretty bitchy. That is, unless I allow proper time to switch gears from work mode to home mode. Those who live with me have observed that my mood typically goes from snappy/serious/irritable to talkative/cheery/joking over the course of 30 minutes.

Not much research exists on this topic, but I assume that there are various reasons that the lingering effects of work can have a negative impact upon arriving home. Here are a few factors to consider that may contribute to the tough transition:

Traffic congestion – feeling trapped in your car, moving inches on the freeway, dealing with aggressive drivers, running behind in your schedule due to delays, and the potential threat of car accidents are all factors that can easily raise one’s heart rate, blood pressure, level of arousal, and automatically trigger you to go into a protective/defensive mode.
Work stress – having an extensive to-do list, meeting project deadlines, dealing with coworkers’ differing personalities, tolerating conflicts in opinions of supervisors or administration, etc, are all situations in the work environment that require excess mental energy to deal with, leaving incomplete tasks and unresolved issues that may carry over into the home environment.
Home responsibilities – in a perfect world, we might be able to come home after a stressful day and be able to relax and worry about absolutely no other responsibilities. Yet, in reality, leaving work means moving from one set of responsibilities to another (children or a spouse demanding your attention, chores to complete, dinner to prepare, bills to pay, friends’ events to attend, etc).

How to make the transition:

Establish a routine that works for you. This involves evaluating your current routine going from work to home and incorporating practices that help you eliminate or get around triggers and negative thoughts. The Wall Street Journal published an article about “rethinking your after-work routine” and I definitely agree with Cali Williams Yost‘s recommendation to think about the transition from work to home in terms of three stages: leaving the workplace, getting home, and walking through the door.

Stage 1: Leaving the Workplace
- To ward off negative feelings, consider a routine that acknowledges your accomplishments of the day or think about positive things that occurred during your day.
  - I make sure to leave 10 minutes at the end of the workday to look at my list of accomplishments (ie, the items I checked off on my to-do list) and prioritize tasks left to complete the following day. This routine works for me because I’m left with a sense of accomplishment focusing on the tasks that I actually DID complete, rather than focusing on what I did not complete. I also like to organize and tidy my desk so that upon arrival to work the next morning, I feel as if I’m starting new rather than being left with a sense of disorganization from the previous day. I also try to check in with the nurses and thank them for all their hard work from the busy day.
Stage 2: Getting Home
- As mentioned above, the commute from work to home can evoke excess stress, so consider methods to minimize aggression.
  - I always admired one of my mentors during residency because he’d bike home from work (something I’d consider doing if I still lived in Oregon rather than southern California), but since it’s far easier for me to drive, I make sure to blast uplifting music on the radio or talk on the phone with one of my close friends (who is also a psychiatrist that commutes home around the same time of day). I also may volunteer to make a stop at the grocery store, which allows additional buffer time before arriving home.
Stage 3: Walking Through The Door
- Identify triggers that may set you off upon arriving home (ie, your children demanding your attention, the need to cook dinner, a messy home in need of cleaning, etc) and figure out ways to get around the triggers.
  - For example, I suggested to my patient above that he communicate to his family the need for a few minutes of alone time each day after work to water the grass or sit in his car.
  - For me, I am easily triggered when I come home to a messy kitchen, so in the morning I try to empty the dishwasher and load any dirty dishes left on the counters or sink.

Thought of the Day: What are some practices that you can incorporate into your routine to ease the transition from work to home?

October 1, 2015 12 comments

Psychiatry therapy

Termination Point

written by freudandfashion

Saying “goodbye” can stir a variety of emotions including sadness, anger, and relief. The whole experience can feel quite uncomfortable, so is it better to say “goodbye” or to say nothing at all? Clearly, the more thoughtful and courteous action would be to leave with at least some type of acknowledgement (a wave, a handshake, the verbalization of “goodbye,” etc), though it might be less anxiety-provoking to slip away unnoticed.

In the context of terminating treatment in Psychiatry, there are various reasons why treatment between the psychiatrist and a patient may end:

a patient wishes/chooses to end treatment
the psychiatrist gets a new job, retires, or leaves the practice
the patient changes insurance plans
the patient moves
the psychiatrist passes away

For the sake of this post, I will focus on what I’m currently experiencing — saying goodbye to patients due to a new job. In this situation, the ending of treatment is not the patient’s choice, which can stir a combination of emotions such as abandonment, sadness, loss, betrayal, anger. Though some psychiatrists may feel that sending a letter or written notice informing of their leave will suffice (I won’t get into the complex legal aspects here), effort should be made to ensure that the patient does not feel at fault for the termination of treatment (ie, a patient may feel that the doctor is ending treatment because the doctor doesn’t like them, etc). Which is exactly the reason a termination phase (or at the very least, a final session) is crucial to help process emotions that may come up, allot a decent amount of time to coordinate transfer/continuity of care, and most importantly, to provide closure (for both the patient and psychiatrist).

In the last few days, I’ve experienced random moments of feeling sad and numb. Some of my followers on Snapchat may have noticed my absence of posts for over one week (I usually post on a daily basis). My videos are generally motivated by something exciting from my day or a psychiatric tidbit of knowledge that I wish to share, however I haven’t been as inspired lately. Even while writing this post, I’m interrupted by moments of abruptly staring into space and my mind wandering to more superficial thoughts such as shopping, what to make for dinner, and celebrity gossip.

With only a few weeks left until my final day in clinic, I fight the urge to flee and avoid the discussion of termination. But then I refocus and put my psychiatrist hat on and consider the potential impact that avoidance of the topic may have on my patient. However, the professional aspect of fulfilling my duty and ensuring proper transition to another provider for continuation of care is the easier part. The more difficult aspect is letting go of the strong connections that I’ve built with my patients, especially those who watched me grow from a newbie psychiatrist straight out of residency to one they grew to depend on and trust.

Despite the complex mixture of emotions, I know that I’m doing what’s best for me personally and professionally by taking this next step in my career. Yet, if I’m having a tough time, imagine how my patients must feel.

September 10, 2015 10 comments

Personal Psychiatry

Look You In The Eye

written by freudandfashion

Several friends have pointed out to me their observations of my interactions when in public places: that people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc. These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues. Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome.

Flashback to around twenty years ago when I was a loner preteen in the girls’ locker room, where my locker was located in the same aisle as the most popular girls at my school. As I stared at the floor too shy to make eye contact, I recall trying to muster the courage to say something to them…anything…in hope of some kind of acknowledgement, a wave, even a “hi” — anything to feel slightly less invisible than I already was. When I looked up directly towards them, words never left my mouth. All I had the courage to do was smile. A forced, awkward, and uncomfortable smile that caused my cheeks to fatigue.

And all that effort and energy exerted for the end result of coming off as creepy: “That girl is smiling too much,” was all they said. From then on and for quite some time, I became known as “that weird smiley girl.” As if smiling was a negative thing. And, as one could imagine, I didn’t smile for months thereafter. Little did they know how much of a hit to my self-esteem that one incident would have. Putting yourself out there only to get rejected sucks and may hinder further attempts to connect with others in the future.

One may perceive me as a highly sensitive, socially anxious person, and I don’t deny possessing those traits. However, rather than being identified with a label or descriptor (ie, “That weird, smiley girl” or “Vania is anxious and highly sensitive”), I prefer that people acknowledge the different facets of my personality that make up who I am as an individual (ie, “Vania has social anxiety and can be sensitive”). The general tone changes depending on the wording and language used. In the former statement, being “anxious” and “highly sensitive” are inferred to be words that define me, whereas the latter refers to “anxious” and “highly sensitive” as traits.

For many years, I viewed myself as abnormal. That is, until the last few years where I grew to appreciate the qualities that make me who I am as a unique individual, which I attribute to surrounding myself with an amazing support system, including my therapist, who helped me realize it. As a result, I no longer stare downward nor feel afraid to smile and chat with others.

An issue that I have with how Psychiatry is perceived is the tendency to create labels. Many people have enough anxiety about seeking psychiatric help in the first place, and the fear of being labeled and stigmatized might sit at the top of one’s list of concerns. I’ve encountered several patients who told me they were diagnosed with a specific mental illness after one brief, initial 30-minute interview. “The doctor told me I’m Bipolar without barely getting to know me” is a statement of different variations that I’ve heard several times in my practice. I try to maintain an open mind about my colleagues, especially those who are only allotted 20-30 minutes to meet with a new patient (which is ridiculous in medicine, especially in psychiatry) because the ability to see a high volume of patients within a short time frame AND fully get to know each patient seems unrealistic and virtually impossible to maintain.

However, the last thing any person, including any medical provider, should do is make you feel like another label and essentially invisible or judged. Often when people muster up the courage to reach out and seek help are in times of desperation and in highly vulnerable states. The most therapeutic thing any person (or provider) can do is look you in the eye (even if you might be too afraid to look directly at them) and acknowledge you for who you are.

September 2, 2015 8 comments

Fashion Psychiatry

Schizophrenic Connection

written by freudandfashion

{Schizophrenic.NYC tank top}

As a psychiatrist, I treat nearly all mental health diagnoses, but among the patients that have been most memorable and have broken the most stereotypes in my mind are those diagnosed with schizophrenia. As an intern and resident physician, I allotted more time to talk with my patients with schizophrenia because they were generally the ones who spoke the least and typically given the least amount of time to interview during patient rounds on the inpatient psychiatric wards. I recall the shock on several staff members’ faces during the staff morning meetings when I’d discuss my schizophrenic patients, for I had a tendency to present unexpected, personal info such as a patient’s favorite food, previous hobbies, where they grew up, and more specifics regarding their background (brief patient case presentations typically consisted of logistical info pertaining to timeline of their involuntary holds, compliance with medications, reports of agitated behaviors/incidents, participation in group meetings, etc). They are human beings with stories of struggle trying to cope with their illness, and when stable, have the potential to live normal lives.

Unfortunately, many people diagnosed with schizophrenia lack support and access to the care they need, and many end up living homeless on the streets. The 2012 U.S. national survey by the Substance Abuse and Mental Health Services Administration reported that an estimated 46% of homeless adults staying in shelters live with severe mental illness and/or substance use disorders. Among the most vulnerable are those living with schizophrenia and bipolar disorder.

Given those alarming statistics, I was ecstatic to discover Schizophrenic.NYC, a clothing line whose founder, Michelle, was diagnosed with schizophrenia at age 22. Fueled by their vision to see less mentally ill people living on the streets of NYC, their goal is to donate and support organizations that support the struggle of the mentally ill homeless population. I had the wonderful opportunity to connect with Michelle and get more info about Schizophrenic.NYC and her thoughts on living with mental illness:

Being diagnosed with schizophrenia, what do you believe is the most common misconception of people who have schizophrenia?

I would have to say that the most common misconception about schizophrenia is that people believe that schizophrenic people cannot live normal lives. Most people’s experience with schizophrenics are the homeless people on the streets who are yelling, screaming, or just plain talking to themselves. It’s hard to understand that there are people living with this illness who live normal lives and can thrive in society (with medication of course). The problem is that these functioning schizophrenic people keep their illness a secret. If everyone would share their story it would make people more aware that mental illness is extremely common and can afflict anyone. Just because you have a mental illness does not mean that you’re “crazy.”

2. Research shows that early identification and assertive intervention of a person’s 1st psychotic episode can improve longterm outcomes. What advice would you give to the youth who might be struggling with early symptoms of schizophrenia, but are too afraid or unsure how to navigate ways to seek help?

It is very hard for a youth with schizophrenia to get help. People with schizophrenia often believe that the people around them are trying to hurt them and are plotting against them. Early identification can only happen if the person has the self-reflection to understand that they are having a problem. Teens need to learn in school about the signs and symptoms so they can understand if they are having a problem. I would advise anyone who thinks they are having symptoms of mental illness to try to talk to someone they trust. Admitting that they see a problem is just the first step…and it’s the hardest one of all.

3. What organizations/people/resources have been most integral in your ability to manage your symptoms?

I am lucky enough to have a great support system. I have my friends, family and doctor that I rely on. My best friends, who are my former roommates, know all of my struggles and without them I would have never made it through college. My family has always supported me and has never treated me differently. My doctor is a great person to talk to and of course provides me with the medication I need to control my illness.

4. How has Schizophrenic.NYC impacted the mental illness community thus far?

Schizophrenic.NYC is growing everyday. I love to tell people about my mission to help the mentally ill homeless by donating to organizations in NYC that help them. I am trying to start a movement and people like that idea. It’s all about raising awareness. The more people who are aware the faster changes can be made.

5. What can we expect from Schizophrenic.NYC in the future?

I wish I knew the answer to that question! Who knows what the future will bring. As of right now, we are getting more shirts, tanks and accessories made. We will continue to spread our mission and work to make a difference. Stay tuned!

{Rorschach inkblot test design}

Photo credit: Alex M (@fitgodzilla) and Schizophrenic.NYC (middle photo)

August 25, 2015 13 comments

Medicine Psychiatry

The Other Side

written by freudandfashion

Written on August 11, 2015

My psychotherapy supervisor taught me a tip during residency — to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session (because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning). I struggled to come up with a topic to discuss on my blog today. At first, I uploaded chipper, smiley pictures taken from a recent spontaneous trip to the coast, but there was something about my grin and carefree expressions that didn’t seem quite appropriate to post today. I try my best to ensure that my blogposts are reflective of my current state of mind, and my current mood is actually quite solemn.

I know that today marks the one-year death anniversary of Robin Williams, yet avoided news articles, tweets, and Instagram posts that paid tribute to the iconic, inspirational actor. While sitting on the couch and staring blankly at the television screen, a short reel of Robin Williams popped up on entertainment news. Not content with the mainstream, flowery piece which strung together brief clips of some of his finest, Oscar-winning work followed by a quick moment of silence in remembrance, I picked up my phone. While scrolling through Instagram, I focused on a long, detailed post written by a young man in which he describes his own personal battle with depression and multiple, near fatal suicide attempts. Robin Williams’ lost battle to mental illness motivated this man to share his story rather than isolate in shame and silence. The words authentically describe the powerless experience of succumbing to the disease. The depression takes exclusive command and overrides any attempt at rationalization. And I know the story to be true because the writer is a dear friend of mine who miraculously survived.

Several of my patients have described similar experiences. Several people living with mental illness whom I follow on social media share similar stories. Every morning that I arrive in clinic, I log on to my electronic medical records and pray not to see a message from the coroner’s office. As a psychiatrist, getting that dreaded phone call from the medical examiner is probably my equivalent to the oncologist receiving a call from a family member or hospice staff. As a young teen, I vividly recall accompanying my family for routine, frequent visits to my grandparents’ apartment, where my grandfather passed away, rid of the suffering he endured from colon cancer. A few years later, my grandmother peacefully died from multiple myeloma. Her last words to me before she passed was that she wished for the opportunity to pay for my education and witness me become a doctor. My other grandfather, as he approached the end stages of his battle with cancer, fulfilled his wish to fly back to the Philippines, where he comfortably spent his final days in his homeland with our large, extended family by his side. When the medical examiner’s call ends, my immediate response is to shut the door and sit alone in silence.

Finally recognizing the mixture of emotions that I suppressed the entire day, I could no longer hold in my tears. Rather than isolating (as clinicians tend to do when it comes to coping with patient loss), I attempted to share my thoughts and emotions on social media, with the goal to make others aware of the difficult emotions that we, as mental health practitioners, face when dealing with patient suicide. The loss not only permanently impacts us professionally in our practice, but also as human beings. I left the post on my feed for 20 seconds, then immediately deleted it. Shame, embarrassment, and fear of judgment overrode my hope to break the norm of silence and connect with others too afraid to open up about their own experiences losing a patient to suicide.

As you can see, I waited a few days to publish this post after much contemplation. The truth is that the fear of losing a patient to suicide weighs heavily on my mind almost every day.

August 13, 2015 16 comments

Psychiatry

Summertime Sadness

written by freudandfashion

{Santa Monica, California}

I’ve been intermittently unmotivated lately and am trying to analyze the reason why. Then I realize how hot, humid, and sweaty I feel as I scroll Facebook and view photos of my friends’ fabulous summer vacation trips as I sit at my desk all by my lonesome. Perhaps my current mood is triggered by the summer season? If you have a tendency to feel lazy, unmotivated, or depressed during the summer season, you’re not alone. There are several reasons that the summer months may bring about a drop in mood. The good news is that there’s ways to overcome these feelings and bring some pep to your mood this time of year.

What are some potential reasons for the shift in mood?

1. Changes to your regular schedule. Basically, anything that throws off one’s routine can contribute to a change in mood and motivation. The kids are out of school, which means increased responsibilities monitoring them and taking them out on activities to keep them occupied throughout the day (this also means decreased “alone/me” time). And although summer vacations are usually planned and much-needed, it takes time to adjust back to your regular routine upon return. Many also travel to different time zones, which contributes to even more difficulty to readjust.

2. Expectations to have a fabulous summer. Several of us continue to work, attend summer classes, or stay home during the summer months (due to budget, other responsibilities, etc) and with modern life dominated by social media, we are bound to come across our friends’ seemingly exciting vacation photos. Not spending a few weeks in Hawaii or the Hamptons? That’s okay, but one can’t help but feel the pressure and envy to be on vacation especially when it appears that everyone else is jet-setting away.

3. Increased pressures to have the ideal swimsuit body. I used to hate summers in so-cal as there’s nothing that made me more self-conscious than being surrounded by model’esque women in bikinis. I vividly recall skipping out on pool parties as a teen (partially because I didn’t know how to swim) because I was body-conscious and oblivious on how to choose a flattering swimsuit.

4. Summer seasonal depression. Seasonal Affective Disorder (SAD) is a recurrent depression that is experienced only during a specific season, but is NOT experienced during the rest of the year. Though the prevalence of SAD during the winter time is much higher compared to summer, studies have shown a correlation between summer seasonal affective disorder and higher, hotter temperatures.

5. Losing a sense of purpose during the summer months. People who have time-off during the summer months (ie, teachers, school employees, etc) may have difficulty shifting their priorities from work to something else around this time of year. It’s well-known that utilizing skill and having a career that strengthens and contributes to a person’s sense of identity tends to improve mood. When a sense of purpose is taken away (even if for a few months), one’s mood may decline.

6. Weather change. Some people just don’t like basking in the sun or going out when temperatures are high. Period. But the distaste for heat can lead to social isolation and difficulty leaving the comfort of an air-conditioned home, which can contribute to a decline in mood and lack of motivation. Also, the heat and longer days can cause insomnia, which may cause a decline in energy levels as well.

WAYS TO BREEZE THROUGH THE SUMMER MONTHS

1. Seek help from a professional. If you feel that the summer season is causing impairment in your daily life, then seek help from a professional (physician or therapist). Medications, such as antidepressants, might be an option to help you get through the season. Also, therapy (particularly cognitive behavioral therapy) has been shown to help seasonal depression.

2. Stay active. As I wrote in a previous post, exercise has been shown to be just as effective as antidepressants for the treatment of depression. While on vacation, try to maintain an exercise routine as much as possible. Many people understandably avoid outdoor exercise due to the heat, so consider exercising later at night, early in the morning, or join a nicely air-conditioned gym for a few months.

3. Get some rest! Our circadian rhythm plays a large role in the maintenance mood. Despite the temptation to stay up late, try your best to maintain a regular sleep schedule as variations (especially lack of sleep) contribute to irritability, increased anxiety, and depression. Also, if you’re tired after a busy or stressful day, allow yourself to get some rest instead of overexerting yourself.

3. Keep your environment cool. I’m admittedly cheap at times and avoid turning on the air conditioner unless absolutely necessary, but if the heat makes you moody, then your wellbeing will hopefully prevail as the utmost priority over cost.

4. Don’t let social media bring you down. Keep an open mind and remember that pictures on social media generally display near perfect appearances. Get annoyed by the person in your group who obsessively snaps away trying to obtain the perfect photo instead of engaging in the activity at hand? I get irritated and would love to throw their phone in the toilet, but I exercise restraint. I’d like to think I’ve learned to maintain good boundaries by allotting only a few minutes to take pictures per each activity (if any of my friends or family think otherwise, please let me know). I found this article, which explains the concept of perfection in social media, quite interesting.

5. Carve out time for yourself. I emphasize the concept of self-care so much in my blog that no further explanation is needed, but if so, please refer to my entire blog 🙂

August 5, 2015 10 comments

Psychiatry

Overcoming Social Anxiety

written by freudandfashion

{Claremont, California}

To continue my series on conquering our fears (see Part 1 here), Part 2 consists of one of the more common phobias: Social Phobia. I struggled with social anxiety since childhood (as I discussed in a previous post) and often felt uncomfortable in any situation that involved interacting with people. It wasn’t until six years ago during my psychiatry residency training that I finally gained control of my symptoms. Some of the common thoughts that would race through my mind:

– “Are people judging my appearance?”

– “What should I say so that I don’t sound stupid?”

– “Hurry up and say something so that people don’t think I’m shy and quiet”

– “What I said was so stupid, they must think I’m an idiot”

– “What excuse can I give to avoid going to the event?”

My social anxiety dominated a huge part of my daily life.

If you also struggle with social anxiety, the following are some steps you can take to work towards overcoming your fear:

1. Avoid Avoidance

One of my supervisors always emphasized “avoiding avoidance” in application to overcoming all forms of anxiety, and the statement definitely applies to social situations. The more you avoid, the more you reinforce your anxiety symptoms. Sure, it might be far less anxiety-provoking in the moment to stay at home, but how will you cope with anxiety-provoking situations in the long run? Social anxiety impacts all facets of daily life, from something as common as participating in a regular conversation or going to the grocery store to giving a talk at work.

An example of avoiding avoidance: one of my patients rarely left her home during the day (and would run errands only at night to avoid the crowds) due to social phobia, except to attend her appointments with me. Therefore, in order to encourage avoiding avoidance during the day, I made sure she scheduled weekly, daytime appointments with me in order to challenge her fears of running into people during the day.

2. Climb the social anxiety “ladder”

If you don’t have too much difficulty with shyness and feel motivated enough to expose yourself to a series of social situations, then create a list of approximately 10 situations and rank them in terms of level of anxiety (1 = lowest anxiety situation, 10 = highest anxiety situation). Start with #1 and work your way up. And be sure not to skip because you run the risk of getting too overwhelmed and exacerbating your anxiety, which could lead to increased discouragement, self-doubt, and feelings of failure.

For example, my hierarchy would look something like this:

1 = speak to the cashier at the grocery store

2 = go to the bank after work when it’s busy

3 = attend a new exercise class at the gym

(I’m skipping #4 – 9 for the sake of brevity)

10 = Give a talk/lecture to a large group of people (#10 should be a goal to work towards)

3. Get a self-help manual, workbook, or internet-based self help program for social anxiety

Cognitive behavioral therapy (CBT) is one treatment modality shown to be effective for social anxiety disorder. One study found that an internet-based self-help program helped university students with social phobia and public-speaking fears. CBT examines the engrained, negative patterns of thinking (for example, “everyone at the party is judging me” or “anything I say is going to sound stupid”) in order to modify and challenge these irrational thoughts/beliefs. CBTrequires commitment, a lot of homework, and practice of the techniques in order to be successful. After all, the origins of such distorted ways of thinking have likely been engrained since childhood.

The following is a list of recommended resources (if you are currently seeing a therapist, please be sure to run the resources by them before using):

The Shyness & Social Anxiety Workbook

In The Spotlight, Overcome Your Fear of Public Speaking & Performing (for public speaking anxiety)

Overcoming Social Anxiety: Step By Step (Audio/Video Series)

3. Work on self-acceptance and feeling comfortable with being less than perfect

This is something I definitely struggle with, especially since much of our social anxiety centers around our fears of being judged and wanting to maintain a “close to perfect” image, yet at the sacrifice of openly being ourselves. How many times have you been at a meeting or lecture and are hesitant to ask a question or verbalize an opinion, but then someone else speaks up and says the exact same thought before you (this has happened to me numerous times)? Or maybe you have a fear of doing something embarrassing in front of a group of people? Recognize that your opinion is just as valuable as others and that as a human, something clumsy or embarrassing is bound to happen from time to time (even celebrities have major televised fail moments).

4. Seek help from a competent mental health professional

Seeking support from a professional who specializes in anxiety disorders is always an excellent option especially if your social anxiety is preventing you from enjoying and/or moving forward in life.

So, how did I overcome my social anxiety? Well, I went into a field that forced me to learn more about myself, started seeing a psychotherapist, participated in group therapy with my co-residents (a requirement in my residency program, which I believe should be mandated in all programs), exposed myself to situations that challenged and forced me to learn to cope with being in uncomfortable group and public settings (becoming chief resident was among the more challenging roles, yet provided the most growth), among other things. Not to say you have to do ALL these exact same steps to conquer your fear, but that’s the process I underwent in order to feel confident and comfortable being myself in social settings. And yet I STILL have to put in work on a regular basis to prevent my anxiety from getting the best of me (one of the reasons I’m in a weekly psychotherapy group). I took a one year break from therapy after graduating from residency and noticed that my ability to work through my anxiety didn’t come as easily, which motivated me to restart group psychotherapy last year.

Medications can help alleviate your symptoms, but fully gaining control and overcoming the anxiety for the long term requires work, so you have to be willing to expose yourself to uncomfortable situations, willing to keep learning, and willing to face and challenge your fears on a regular basis.

If you also struggle with social anxiety, would love to know which techniques you find most helpful to cope with social situations.

Photo by Marlon Santos

July 30, 2015 11 comments

Psychiatry

Conquer Your Fears (Part 1)

written by freudandfashion

{Lake Tahoe, California}

At the request of one of my awesome readers, I am writing a post on conquering our fears. Being an ENFP personality type (Extroverted, Intuitive, Feeling, Perceiving), I interpreted this in a more global, existential sense: getting over the fears and barriers that may interfere with moving forward in life and/or discovering one’s life purpose. However, others may be more interested in something more specific such as the treatment of specific phobias and social phobia, so I will be writing on conquering symptoms of those diagnoses in future posts next week.

Every psychotherapist has their own style, but the following are questions that I may ask my patients when it comes to conquering some of their biggest fears (if they can even put a name to what their biggest fears are because oftentimes, people are not even sure of what they’re afraid of):

1. Identify your fear. Once you’ve identified your biggest fear (ie, when it comes to a certain situation, such as pursuing a new job, finding love, etc), what is the very 1st thought that comes to mind if I was to ask you to close your eyes and think of the following question: When it comes to _______ (insert goal here), what is the one thing you are most afraid of??

Once aware of the biggest barrier/fear getting in the way of your goal, being consciously aware of this fear puts you more in control.

2. Origins of the fear. Where do you think this fear stems from? Have you experienced a similar, familiar sense of fear in your past or during your childhood?

Having a certain level of fear is normal because the reaction helps identify danger and take action to protect, but when the fear becomes excessive, there’s usually an origin to such fears based on past experience. Recognizing the connection with your past and how irrational the fear is in the present time can be enough for one to take action towards handling the fear more effectively this time around.

3. Take the next step. What small steps can be taken to slowly start working towards overcoming your fears?

For example, someone who is afraid of heights may start by going up to the roof of lower level buildings and working their way up to whatever their end goal might be to conquer the fear of heights (ie, skydiving, looking down while at the top of the empire state building, etc). Or, someone who is afraid of pursuing their dream career might start out by researching how to achieve the career, reach out to others to get advice, or start submitting applications to obtain the educational requirements or job experience needed to improve chances of getting their dream job.

4. Be open to disappointments and any challenges that come along the way. Fear of failure is a common barrier towards taking risks in life. Overcoming fears takes time and practice, so try to be as open as possible to learning and growing from the process. Surround yourself with those who support you in your goals and failures, and motivate you to stay on track. Wanting to give up is a normal feeling (I’ve experienced this numerous times, especially in the process of becoming a doctor) and NOT a sign of weakness.

But each time you get overwhelmed by the fear, ALWAYS REMEMBER and believe in yourself enough to recognize that you have a choice: either have power over your fears, or give power to your fears. So visualize the end goal, look your fear straight in the eye and say “f*** you, I’m the one in control” (yes, I’ve actually told some of my patients to say this).

July 23, 2015 4 comments

Personal Psychiatry

Open Doors

written by freudandfashion

Up until a few years ago when I graduated from residency, life appeared to have a linear, predictable path: obtain high school diploma, finish undergraduate degree, get accepted into medical school, graduate from residency, secure a well-paid job as a psychiatrist.

Yet, throughout the entire process, I encountered several challenging experiences trying to adjust to each new phase. When I moved away from home for college, I was so excited to live with four girlfriends and finally feel independent enough to lead an exciting college life. However, I can vividly recall the day my parents helped me move and when they left, I cried. For several days, all I wanted to do was isolate in my room. Eventually, I became more comfortable with my living situation and newfound independence, but my initial desire was to flee back home as often as possible.

For medical school, I was fortunate to get accepted into a school within 30 minutes from my hometown, so I was familiar with the area and lived with family that first year while adjusting to the grueling academic demands. It was so nice to come home to a hearty meal prepared by my grandmother or aunt after a full day of lectures, anatomy lab, and studying.

However, when I moved away to Oregon for residency (a state I never even visited let alone knew anybody who lived there), I felt extremely lonely and isolated. At some point, my program director suggested that I see a psychiatrist because I wasn’t performing very well on tests. I felt like a failure. Yet, finally realizing that I needed help was when I started to evaluate myself in order to create change. It’s the time that blogging became an outlet for social support and connection that I felt was missing at that point in time. It was the period of my life when I became more self-aware, made long-lasting friendships, discovered my leadership ability, and became chief resident. Such a pivotal point in my life motivated me to evaluate myself and discover my resiliency based on how I overcame my struggles.

When I rotated at the student psychological center at the local university, I saw several patients who struggled with transitioning to college life. I completely identified with them. I currently have several patients going through major changes (divorce, moving away for school, starting a new job, recently losing their job, getting married, expecting their first child, etc). I emphatically listen and validate their experiences — going through life change WILL challenge your usual ways of coping (ie, one may cope by isolating, keeping thoughts to themselves, working out at the gym more, confiding in a friend, etc). And sometimes, depending on the stressor, the usual copings skills may not be enough to overcome the challenge.

And here lies the dilemma — Even the most linear path in life has its challenges. Do you face the challenge head on, or do you recognize your limitations and choose a different path, or do you justify ways to avoid the situation altogether?

Photo by Marlon Santos

July 15, 2015 11 comments

Newer Posts

Older Posts