Tag:

depression

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

{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

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

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

Featured Guest Blogger

Why A Pre-Med Student With Bipolar Disorder Posted on YouTube Against Medical Advice

written by freudandfashion

{Logan’s transformation leading up to disclosure of his mental illness}

I recall browsing through Logan Noone’s Instagram last year, taking note of his scenic photos of the great outdoors and noticing the huge smile on his face pictured standing on snowy slopes or sitting among friends at sporting events. His profile stated he was a mental health advocate, and other than that, my assumptions of him were based on his seemingly happy and active lifestyle. Fast forward to a few weeks ago when I received a thoughtfully edited email from Logan informing me of his status as a non-traditional pre-medical student in pursuit of a career in medicine, particularly Psychiatry. What stood out and impressed me the most about Logan was his tenacity — little did I know that behind his picturesque Instagram posts was a man who battled and has since gained control of his bipolar disorder. After watching his viral YouTube video about recovering from bipolar disorder, I knew that he’d make a valuable asset to the medical community to advocate for change and reduce stigma, especially since the culture of the medical field tends to discourage such disclosures of having mental illness. Therefore, I’m excited to have Logan contribute to my blog as he discusses his motivation to become a physician and how the school shooting at Sandy Hook influenced his decision to go public with his diagnosis.

__________________________________________

“There is an old story about a blind man heading towards a well, and there’s a guy who’s watching. If the blind man falls into the well, who gets the blame? If you’re watching something you can prevent, you’ve got to do something.”

– Manoj Bhargava

It’s February of 2013, about two months after the devastating shooting at Sandy Hook Elementary School in Newtown, Connecticut. The total fatalities are still hard to swallow: 20 children, 6 staff members, and the mother of the shooter were found dead on December 14, 2012. The entire world was shaken and struggling to find a reason for this senseless tragedy. The storyline seemed all too familiar: a person suffering from mental illness committed horrific gun violence.

Now, let’s rewind the clock about 8 months. I was 22 years old and newly graduated from college. While the rest of my classmates were celebrating after graduating or starting up a new job, I found myself in the emergency psychiatric ward. Two years of severe mood swings, alcohol abuse, insomnia, anxiety, and a breakup culminated in my first manic episode. I found myself overwhelmed with euphoric feelings, rapid speech and grandiose thoughts. This feeling continued to evolve over the course of 5 days with no sleep, paranoia, and auditory hallucinations.

I displayed the basic symptoms of bipolar disorder. Also, considering my family’s history of the disorder, it was pretty easy for my psychiatrist to diagnose me with Bipolar Disorder Type 1. The medical staff outlined how I would have to live my life with the support of medication, therapy, and support systems. However, the medical staff also indicated I needed to be cautious whom I disclose my bipolar disorder to. “People’s opinions could change when they find out you have bipolar disorder. It could hurt your employment, housing, or social life.”

Fast forward back to February 2013. I hardly told anyone about my mental illness, I was insecure and utterly hopeless. Images of the Sandy Hook shooting were everywhere. It seemed like the public stigma towards mental illness literally could not get any more intense.

To understand my struggle, consider that I grew up about 40 minutes north of Sandy Hook elementary. My mom is an elementary art teacher, and my father served on the public school board in our town for nearly a decade. I knew I could never commit a crime like Sandy Hook. But, because of this tragedy and other similar shootings, the public perceived my mental illness as a threat.

People with mental illness can recover, and they are more often victims of violence rather than the perpetrators. If I continued to remain silent about my mental illness, there was no way I could expect the stigma surrounding mental illness to change. I knew that I had to help repaint society’s poorly painted picture of mental illness and lead by example.

Living openly with my mental illness would require bravery, or so I thought. During February of 2013, I finally joined a mental illness speaker’s bureau and shared my Bipolar Disorder Recovery Video online. I quickly realized my expectations for being publicly open about my mental illness were different from reality. Saying that I received an overwhelming amount of positive support would be an understatement. Within two weeks, the video had over 15,000 views. The video was shared by many of my friends, reposted on numerous mental health websites, and featured on Fox News. I connected with old friends and even new people from all over the world.

I was pleasantly surprised by the amount of support I had received from my disclosure. Perhaps people are more accepting of mental illness than I expected. I originally thought being open about my mental illness would require a courageous effort. I was wrong.

Being open about my bipolar disorder is simply a logical and honest choice. 1 in 4 adults suffer from some type of mental illness. It’s only logical that our society start to recognize and accept that we all will be personally impacted by mental illness in our own life or through someone we love. The mere statistics prove that there is an incredible amount of people just like you in the world.

I’d be lying if I said living openly with my mental illness was all “smooth sailing.” Of course, I’ve met people that aren’t supportive of mental illness or its treatment. Numerous times, I’ve had people tell me mental illness isn’t real, or my medication will simply turn me into a zombie. I’ve even been congratulated that I am not violent because of my bipolar disorder. Um, thanks…

But I don’t let these negative incidents regret my decision. When I first encountered these opinions, I was furious and insulted. But now, 3 years after my disclosure, I’ve grown wiser in my demeanor. It would be naïve of me to think that a social change could occur without a few bumps in the road. Now, rather than be upset by ignorance, I get motivated by it, and do my best to change opinions through a healthy and respectful dialogue.

My openness has changed what I want out of my career. I found that simply acknowledging my mental illness allowed others to feel comfortable talking to me about their mental health challenges. There is no better reward than knowing that you helped someone also fight mental health stigma, pursue professional help, or better yet, stop them from hurting themselves.

Shortly after disclosing my mental illness, I decided I wanted to work in the mental health industry in some capacity. I felt I could make the biggest contributions to mental health if I help improve the scientific understanding of our brains and mental illness. Frustrated by my own personal experiences with psychiatrists, I want to be a psychiatrist that could connect with their patients in a more natural manner and help inspire them to tackle stigma head on as well. With that in mind, I am currently preparing to apply to medical school in 2016.

Being open about my mental illness helped me find my own inspiration, passion, and drive. I couldn’t simply be a bystander to a problem I knew I could help fix. That’s my style.

For more info on Logan Noone, check out his YouTube Videos below. You can also find him on Instagram.

Bipolar Disorder Recovery Video: https://www.youtube.com/watch?v=bvdrFowzG94

Sacramento NAMI Walk Speech 2013: https://www.youtube.com/watch?v=KRKQSyPYIEE

November 17, 2015 5 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

Personal

Brighter Days

written by freudandfashion

{Napa, California}

I am so appreciative of the supportive comments I received after sharing my personal experience of physician burnout. I’ve had similar experiences, especially during medical school and residency, but never felt comfortable enough to share until recently. In my practice, I work with so many patients who suppress their emotions. I identify with them wholeheartedly because I am just like them. During residency, I made excuses to avoid meetings with my supervisors because rather than discuss patient cases, the meetings would somehow turn into therapy sessions where I’d cry and feel embarrassed for exposing my vulnerabilities. At the time, suppression and isolation were the only ways I knew how to cope, but it’s a pattern I am actively trying to break ever since I started seeing a psychotherapist during my fourth year of residency.

A common phrase that I mention to my patients (which was told to me by my amazing sister, who is a marriage and family therapist) is that “if you suppress yourself, you depress yourself.” We all suppress ourselves to some degree, but once able to overcome the barriers {our own internal barriers (i.e. cultural, self-criticism, etc), in addition to external barriers (such as the immense pressures and expectations placed on physicians)}, then we have a better chance at achieving wellness and exerting more control in our lives and our careers.

June 27, 2015 6 comments

Medicine Psychiatry

Out of Isolation

written by freudandfashion

{Calistoga, California}

I noticed that my latest posts convey far less emotion than usual. My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip. Perhaps I should have requested two weeks off instead of one? Either way, I’ve felt numb in the past (as I wrote in previous posts), but my current state of numbness also included fatigue and the need for multiple naps throughout the day. At first, I blamed my tiredness on multiple potential causes (overexerting myself during workouts, not eating enough, lack of sleep). I returned to clinic with a massive inbox full of emails, prescription refill requests, and patient messages, but the one message that impacted me the most was a note documenting that one of my patients (whom I least expected to have a suicide attempt) was in the psychiatric hospital due to an attempted suicide by overdose. Normally, I’d breathe a sigh of relief knowing that my patient was alive, safe, and receiving care in a secure environment, however, something triggered me at that moment to feel even more anxious than usual, which led to a massive headache. Did I develop a headache because my mind can’t tolerate the thought of experiencing even more patient loss and grief?

Fatigue continued to hit me on a daily basis. And how ironic that I recently wrote a blog post on tiredness and neither of the reasons I listed seemed to fit my case. However, I neglected two important, plausible causes (one that I even listed in my post) — Burnout & Depression. One of my closest friends asked if I might be depressed and I quickly replied, “no, I just need to eat better.”

I thought to myself, “How can I be depressed? I make a good living, I chose to enter this field, people respect me and tell me I’m a great doctor, I have amazing family and friends…”

Yet, after fighting the idea that I may in fact be burned out and depressed, I became more accepting and relieved at finally pinpointing the cause — yes, I was burned out and depressed. I was experiencing loss of interest, fatigue, poor concentration, lack of motivation, and increased naps during the day. How dumb of me not recognize the signs, especially since I’m a psychiatrist??? (Depression obviously impacts cognitive abilities as well)

Later that day, I randomly thought of one of my patients whom I haven’t seen in clinic for quite some time. He missed his last two appointments with me and never returned follow-up calls. I quickly searched for his name and confirmed my biggest fear once I saw the word “obituary” next to his name. Tears filled my eyes, which led to uncontrollable sobbing. I seriously wanted to quit my job that very moment.

My attempt at self-care and setting healthy boundaries:

Whereas in the past, I would’ve dealt with the news by isolating, throwing myself into work as a form of distraction, or having several glasses of wine once I came home, I knew that I’d eventually hit rock bottom unless I sought help from others. I reached out to my close friends, sought support from my clinic manager, opened up about my issues in my therapy group, and talked to other staff members who knew my deceased patient. I allowed myself to cry rather than holding in the tears.

Feelings of detachment had also replaced my propensity to engage with others, which made practicing psychiatry and being fully present for my patients much harder. I scheduled a trip to visit my family in northern California for Father’s Day because I knew that visiting home would alleviate my detachment and make me feel like myself again. Also, in further effort to prioritize self-care, I requested a two-week long vacation in the following month because I knew that more time off was necessary to fully recover my emotions, energy, and drive.

Why am I sharing my experience? We may read research, statistics, and articles about physician burnout, yet the majority of people in the medical field still do not feel open nor comfortable enough to share due to fear of stigma, criticism, and feelings of guilt and shame. A part of me even feels somewhat embarrassed posting this, but if someone out there can identify with my experience, then why not share? Physician burnout is more common among physicians than other workers in the United States and has been linked with the following: negative impact on patient care, more likely medical errors, depression, and increased risk of suicide among physicians and medical students.

Staying silent about our struggles and trying to cope on our own does not solve the problem, especially since the rate of physician burnout is on the rise. If we can’t advocate and stand up for ourselves, then who will?

June 25, 2015 26 comments

Personal

Reconnect

written by freudandfashion

{Miami Beach, Florida}

Lately, my ability to write and stay connected via my blog and social media requires far more effort than usual. I’ve written in previous posts that when life gets overwhelming, one of the first things that fall to the wayside is my blog. I’m trying hard to stay consistent on posting because the last time I put my blog aside, I ended up taking a one year hiatus from September 2013 through September 2014. I sound like a broken record when I find myself regularly struggling with life balance, though I’m well aware that the ability to find balance is an ongoing process.

This weekend, I’m headed to northern California to visit my family for Father’s Day and am looking forward to reconnecting again. I also have group therapy today before catching my flight, so i hope to get some feedback from my therapist and group members regarding my disconnect and self-critical self.

I know that I am human, “nobody’s perfect,” and we’re entitled to our good and bad days. Yet, I just can’t help getting frustrated when I don’t feel like myself. I’m sure several of you out there can relate?

June 20, 2015 8 comments

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