Category:

Psychiatry

Holiday Mental Break

{With our new family dog, Levi}

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

December 28, 2014 11 comments

Psychiatry therapy

Mind Over Meds

written by freudandfashion

{Claremont, California}

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

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

Photos by Marlon Santos

December 20, 2014 2 comments

Psychiatry

Happy, Crappy Holidays!

written by freudandfashion

{Photo with my sister in Fairfield, CA}

While skimming research articles for scholarly information to include in a blog post on Seasonal Affective Disorder (SAD), I put the information aside for a bit in order to write about my own observations and experience dealing with seasonal mood changes.

Long story short…basically, A LOT of people get depressed during the holidays, fall, and winter seasons. But not everyone meets enough criteria to be formally diagnosed and treated for SAD . Yet, a lot of people feel BAD (no acronym…just “bad”) and guilty that they’re not as happy as expected to be during the joyous holiday season. Several of my patients say they feel down, need to force themselves out of bed, and lack motivation. Many also attribute feeling depressed due to missing family members and loved ones, especially since holiday celebrations tend to make their absence even more apparent.

I read quotes that spread throughout social media with phrases along the lines of “December is the last month of 2014…get off your butt and make it count!” Honestly, I myself would be content if I made it through December 2014 by accomplishing the bare minimum of my daily tasks.

And don’t get me wrong — the holiday seasons are a joyful time for many, and I love when people go all out with their decor, gift-giving, and traditions. But I want to acknowledge that there’s a range of how people feel this time of year and that it’s okay if you don’t feel peppy, super motivated, holiday cheery, and overjoyed because there are a lot of people who feel the same way. With my patients, I try to normalize and validate their feelings, focus on the general progress they’re making, and if their mood declines this season, we try to to work on ways to get through this difficult time of year and hopefully move forward once the holidays are over.

Now, here are some bullet points on SAD:

to meet criteria for SAD, one must experience at least 2 yearly consecutive episodes of depression (with a seasonal pattern), which causes significant impairment in daily functioning (for example: calling in sick for work, negatively impacting relationships, feeling suicidal, etc). For more details, please click here for a good summary on the NAMI website.
About 5% of the U.S. population experiences SAD, with symptoms lasting approximately 40% of the year
Cause may be due to a combination of factors, both biological and psychological which may include the following:
- One of the chief biological causes found in the literature is due to changes in our sleep/wake cycle (circadian rhythm) which tend to occur with seasonal changes (Anyone else struggle with winter daylight savings time? I definitely do). For more details, check out this research article by Dr. Alfred Lewy.
- more vulnerabilities to stress this time of year (as I mentioned above)
There are treatments that have been researched to help: light therapy, psychiatric medications, psychotherapy (specifically cognitive behavioral therapy)

If you are struggling with symptoms, you shouldn’t have to go through this alone. Please seek help by reaching out to your doctor, who can discuss possible treatments or even refer you to a psychiatrist or therapist.

And if you know someone who might be struggling with symptoms, you can help by showing them your support and encouraging them to seek help.

References:

Seasonal Affective Disorder

Rohan KJ, Roecklein KA, Haaga DA. Biological and psychological mechanisms of seasonal affective disorder:
a review and integration. Curr Psychiatry Rev. 2009;5(1):37-47.

December 8, 2014 8 comments

Psychiatry

Friday Reflection

written by freudandfashion

{My dad’s USAF retirement ceremony}

Though I enjoyed looking at all of the thoughtful, commemorative posts to acknowledge Veterans Day (I also posted a happy photo on instagram of me and my dad, who served in the Air Force), I felt a sense of suppressed, sad emotions as well. It was hard to pinpoint because I believe a part of me did not want to acknowledge the fact that behind several of the smiling faces could be a lot of pain, especially with the harsh statistic that 22 veterans commit suicide every day.

One of the most difficult patient cases I ever participated in was as a medical student doing psychiatric consultations on the medical floor. I was paged to see a man in the Intensive Care Unit (ICU), who was on a ventilator for over a week after he survived a suicide attempt jumping off of a highway bridge. He would likely never recover from the damage of his injuries and would stay in a hospital on a ventilator for the remainder of his life. I reviewed his history: he served in the Army, fought in the Vietnam War, was diagnosed with Post-Traumatic Stress Disorder (PTSD) and alcohol addiction, and never had psychiatric issues until he returned home from Vietnam. And there he lay in the ICU — he could not talk, move, nor write. He was essentially a vegetable. Family never came — I don’t think he had any. Yet, I sat there next to him and dedicated at least 10 minutes per day, whether he knew I was there or not, because I felt he deserved to be acknowledged and cared for, at the very least for his service and sacrifice for his country.

Reflecting on that moment, I realize how much our system needs to prioritize support services for the men and women who protect our country. I currently see patients who have served in the military and are diagnosed with PTSD, but I can’t help but think of the majority of veterans who are limited in resources or ashamed to seek help due to the stigma attached to such diagnoses. I hope that some day soon all of our veterans will be able to receive the psychological services they rightfully deserve and need.

Image credit: www.army.mil

November 14, 2014 7 comments

Psychiatry

Loss Hurts

written by freudandfashion

{Serra Cross Park, Ventura, CA}

Every bit of me is fighting not to lay on the couch and immerse myself in reality tv to distract from experiencing the emotional distress of a recent loss. Doctors grieve the loss of patients. I have grieved. Unfortunately, the grief process is all too familiar in my line of work. In fact, tears stream down my face as I type this because I know I have to acknowledge my grief rather than having shock, anger, sadness, and a whole mixture of emotions take control of me. After receiving a call from the coroner’s office earlier that day, I drove home dazed and missed the entrance to my voter polling place…three times. And I almost got in an accident.

The worst part is knowing that suicide happens too often. The second worst part is a combination of feeling horrified, sorrow for my patient’s family, and disbelief (what did i miss? what did i do wrong?), wondering if there’s anything I could have done to prevent it. But worst of all is to think of the depths of severe, emotional pain that my patient must have experienced to reach that point — no words can describe, and nobody can empathize with my patient’s despair unless they’ve been to a similar dark place before, or know someone who has.

Which is perhaps one of the reasons why there are barriers to change the perception of mental illness — do we distance ourselves so much from those diagnosed with mental illness that we can not acknowledge, empathize, or even begin to understand that suicidal thoughts are symptoms of a true, neurologic disease? Or will society continue to turn a blind eye by continuing to believe that suicidal thoughts are feigned, a product of a hopeless mind, or a sign of weakness?

I can vividly recall the first time I lost a patient on the medical floor as an intern during my internal medicine rotation. Cause = Septic Shock. “Here’s where things went wrong and could have been prevented,” said an Attending physician when the case was reviewed. I wanted to quit my medical career that very moment. This time around, there is no Attending physician telling me what I did wrong — the voice is my own. The voice is always there, and I want to quit. I want to isolate and lay on my couch the entire day, but I can’t. I want to cry when I’m in clinic each time my coworkers kindly ask “how are you?” but I hold back the tears. I wish I could redo the last session with my patient, but instead, specific moments from our final conversation replay in my mind. It’s not until now, as I type, that I remember my patient’s last words to me as she gave me a hug on the way out. Touching words I will never forget and reinforce why I need to keep going.

November 6, 2014 16 comments

Psychiatry therapy

Happy Enough?

written by freudandfashion

When my patients struggle to identify reasons for a decline in mood, I try my best to help them make sense of their distraught emotions. In the last week, I’ve had patients share that they feel depressed due to difficulty finding a job, having injuries that prevent them from participating in sports, and the moving away of a best friend. Though there are several theories that can be applied to depression, one theory I often use is derived from Martin E. P. Seligman’s theory of Positive Psychology (Seligman spearheaded research to determine factors that contribute to happiness). One component of the theory involves the pursuit of living a life fully engaged in the following 3 domains:

work (not just having a job, but having one that utilizes one’s strengths/talents)
meaningful relationships (close friends, significant other, family, etc)
leisurely activities (participating in enjoyable activities such as hobbies, sports, etc)

For example, Mr. C comes from a loving, supportive family, feels passionate about art, and obtained a degree in graphic design. He rigorously searches for a job and is unable to obtain one that utilizes his degree. Despite having his family’s emotional and financial support, he falls into a depression when he realizes that he must settle for a job that has nothing to do with his talent in graphic design.

Now, does this mean that Mr. C must find a job in graphic design in order to be happy? Not necessarily because he may strike a balance by immersing himself more in leisurely activities that support his artistic talents such as painting or joining a local art group.

Thought of the Day: Do you participate in activities that utilize your strengths and talents?

References:

Seligman, M.E.P., Parks, A.C., & Steen, T. (2004). A Balanced Psychology and a Full Life. Phil. Trans. R. Soc. Lond, 359, 1379-1381.

Disclaimer: this post describes one therapeutic technique and should not be used to replace treatment with your primary clinicians

October 24, 2014 6 comments

Psychiatry

You Are Not Alone

written by freudandfashion

{OCD Awareness Week}

As a kid, I guess I had strange habits: tip toeing on floors to avoid picking up germs, blinking each eye a certain number of times on each side, tapping my fingers as if I was playing an imaginary piano, and the list goes on. I never thought my habits were a problem until kindergarten when my mom was called to pick me up at school. Apparently, it was wrong for me to pee in my pants because I thought the bathroom in my classroom wasn’t clean enough to use. Fortunately, I outgrew most of these habits (yes, I no longer pee in my pants), but some of my symptoms still persist to some degree. Though I do NOT have OCD (Obsessive Compulsive Disorder), I have several patients who suffer from the disorder and feel tormented by their debilitating symptoms.

In support of OCD Awareness Week (October 13-19, 2014), I want to share some knowledge and facts about OCD.

In the United States, OCD is the 4th most common psychiatric diagnosis
- this means that 1 out of every 40 people in this country may suffer from OCD
Internationally, 1 in 100 adults, and up to 1 in 200 children likely have OCD

Therefore, if you have OCD YOU ARE NOT ALONE.

OCD is more detailed to discuss in one post, but the explanation I give my patients includes some of the following points:

Everyone experiences anxiety to some degree. Some may cope with the anxiety by cleaning, organizing, and checking behaviors (such as checking doors to make sure they are locked), but those with OCD repeat these behaviors to the point that their symptoms cause impairment in their day to day lives. Their symptoms can be quite distressing, time-consuming, and debilitating to the point that relationships, school, and work are negatively impacted.
One misconception is that people with OCD are perfectionists, rigid, controlling, domineering, and have a “my way or the highway” mentality. This is not necessarily true because most people with OCD recognize that their symptoms are excessive and problematic, and more often feel embarrassed, ashamed, and far from perfect.

Now, if you’re wondering about my mismatched socks outfit — I’m wearing them to show even more support for OCD Awareness Week. Though the week is almost over, you still have time to show your support and participate in promoting the discussion of OCD by wearing mismatched socks and posting a picture through social media (use hashtags #sockittoocd, #ocdweek).

For more details on OCD and its symptoms, please visit the International OCD Foundation website.

October 16, 2014 4 comments

Psychiatry

Go Green!

written by freudandfashion

I spent this Sunday partaking in what practically 50% of Americans are fans of: watching pro football. I looked in awe at the stylishly bright, slick, and sporty pink athletic gear that each team member wore in support of Breast Cancer Awareness Month. I wished that Mental Illness Awareness Week (October 5-11, 2014) received just as much media and support.

For me, Mental Illness Awareness Week means promoting empathy rather than sympathy. With empathy comes understanding and lessening of stigma. Even as a psychiatrist, there are times when I feel awkward asking friends about depression, so I can imagine how difficult it might be for anyone to openly discuss and start a conversation about mental illness. But keep in mind that mental illness is far more prevalent than you may think:

– 1 in 4 U.S. adults suffer from mental illness

– 1 in 10 Americans take antidepressants

– Almost 50% of children ages 8-15 with a mental illness received NO treatment last year

Yet, despite how prevalent it is, suffering from mental illness is often lonely and isolating and nobody should have to feel that way.

So what can YOU do?

– Go Green! Wear lime green this week to serve as a reminder and trigger discussion among others about raising awareness and destigmatizing mental illness

– check out the Nami website to learn more facts about mental illness, treatment, and resources

– try to lend support rather than avoid. If you sense that someone you know is struggling, please check in on them. It sounds so simple, but you can make a difference and potentially save someone’s life

THOUGHT OF THE DAY: Share one thing you did this week to show your support (post in comments below)!

October 7, 2014 4 comments

Psychiatry therapy

Are you ready?

written by freudandfashion

The Great Sand Dune, Point Mugu

I may prescribe psychiatric medications, but the one treatment I advocate for the most is psychotherapy.

Psychotherapy = general term for talk therapy, counseling; meeting with a mental health clinician for support, insight, and development of coping skills for life challenges.

Patients often ask me whether or not I think they should see a therapist. My general answer: “I think everyone can benefit from therapy. I think therapy will help you for (insert reason I believe patient will benefit from psychotherapy here based on my formulation of his/her issues).” However, despite my recommendation of therapy, the more important question is: “Are YOU ready for therapy?”

Here’s a few reasons why I believe this question is so important:

– Therapy can be challenging. As humans, we develop defenses to help prevent us from feeling the full extent of deep, emotional pain. Therapy may lower your defenses, which allows you to experience and process painful emotions in a safe environment. The well-known phrase “no pain, no gain” applies to therapy as well. With pain = growth and healing.

– Talking about yourself can be uncomfortable. You might feel like you’re being judged, which is especially difficult. And if you’re one who loves talking about yourself, perhaps talking about yourself (and not acknowledging others) may be the reason for your problems (a good therapist should be able to point this out).

– You can never predict what might come up in therapy, so being open to the process can lead to development of great insights. There might be times when you want to stop therapy or may question if it’s even helping. Being open to processing your resistance may lead to great insights as well (i.e. any material that comes up in therapy may have meaning and be subject to processing during session).

I write this post not only as a clinician, but also as one who has experienced all I mentioned above in my own therapy process. Even as a psychiatry resident physician, I resisted starting therapy because I feared what I might learn about myself. I grieved the loss of my grandfather, struggled to adapt to my move to Oregon for residency, and felt depressed because I wasn’t performing as well academically, and various other reasons. In effort to avoid therapy, I first turned to exercise, shopping therapy (not the best on your credit card), and talked to friends, which helped temporarily but didn’t help me learn to better cope with my issues. I eventually gave in, faced my fears, and as a result I’m much more self-aware, insightful, and comfortable with myself as a person. I’m also a much better psychiatrist to my patients (nothing makes you more empathetic towards your patients than putting yourself in their shoes and sitting in the patient’s chair).

P.S. Not all therapists are the same. If you don’t have a connection with your therapist, don’t give up on finding the right one! (stay tuned for a future post on how to find the right therapist)

September 25, 2014 4 comments

Psychiatry therapy

Stay or Leave?

written by freudandfashion

Office Balcony Sunset

I recently made a difficult decision regarding my job, which triggered feelings of uncertainty, fear, and self-doubt. In the process of contemplating my decision, I recalled one of my patients, a college student who struggled with depression. Despite going to a prestigious university, his overwhelming fear of not getting accepted into law school further exacerbated his depressive symptoms. I responded with seemingly consoling statements such as “you’re still young…you’ll get there…you have a lot going for you…I went through the same situation and it worked out okay.” However, my attempts to reassure really weren’t reassuring at all (it’s well known in psychiatry that reassurance generally doesn’t reassure mostly because the statements fail to validate the patient’s current experience). Reflecting back, I realized that in the moment I didn’t want to relive my own pain, uncertainty, and fears that I experienced in my process of applying to medical school. I recalled the discouragement I felt with each rejection letter I received. And I was still feeling discouraged at my current job. Since I gained insight from connecting his experience with my own, I looked forward to validating his feelings at his next appointment. Unfortunately, he cancelled his appointment and never returned.

I realize that contemplating decisions regarding a career path, relationships, love, and pretty much anything pertaining to life in general, makes us vulnerable and uncomfortable. The idea of change can trigger fear and act as a barrier towards future ventures. After a year long process, I finally decided to resign. My anxiety peaked even more because I felt uncertain of the next step to take. Where do I go from here? Will I feel happier? Will I regret my decision?

Seeking motivation to push forward and take risks, I read quotes by famous writers, all with similar themes to never give up, choose the “road less traveled,” try new things, and learn from your mistakes.

The dangers of life are infinite, and among them are safety. ~ Goethe

Yet, it took being on a plane last night watching The Amazing Spiderman 2 hearing Gwen Stacy (played by Emma Stone) give her valedictorian speech to make me realize how mainstream and pervasive this dilemma is:

“…I say it today of all days to remind us that time is luck. So don’t waste it living someone else’s life, make yours count for something. Fight for what matters to you, no matter what. Because even if you fall short, what better way is there to live?”

As mentioned above, my decision involved resigning from my highly-desired, well-paid job in order to take control of my life, practice, and career. Since my last day, I have mixed emotions of feeling liberated, hopeful, excited, yet completely scared at the same time.

I made the right decision.

“…you can fail at what you don’t want, so you might as well take a chance on doing what you love.”

~Jim Carrey

Putting in work at my new office in West Hollywood

Photos courtesy of Marlon Santos (Diamond Reel Media)

September 10, 2014 24 comments

Newer Posts

Older Posts