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

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depression

Psychiatry

Loss Hurts

written by freudandfashion
Loss Hurts

{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
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Psychiatrytherapy

Happy Enough?

written by freudandfashion
Happy Enough?

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
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Psychiatry

Go Green!

written by freudandfashion
Go Green!

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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)!

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October 7, 2014 4 comments
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Psychiatrytherapy

Are you ready?

written by freudandfashion
Are you ready?

IMG_3253The 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)

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September 25, 2014 4 comments
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therapy

Thankful Thursdays

written by freudandfashion
Thankful Thursdays

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Malibu Beach

People who meet me tend to perceive me as a positive person, but I’ll admit that I wasn’t always that way.  I was quite the complainer growing up and blamed others if things didn’t go my way.  My negativity improved through maturation over time, but my four years of psychiatric residency training certainly helped me become more self-aware. Learning about different psychotherapy techniques sharpened my skills even further, and one modality that I use involves Positive Psychotherapy.

What is Positive Psychotherapy (PPT)?

In a nutshell, Dr. Martin E.P. Seligman spearheaded the development and research of PPT as an intervention for treatment of depression and the theory consists of some of the following concepts:

– focus on the POSITIVE (factors that contribute to happiness and build upon one’s strengths)

– build POSITIVE EMOTIONS (about the past, present, and future)

– identify and utilize your STRENGTHS

  • for example, if you’re a creative person, do things that bring out your creativity (such as writing, photography, etc).  If you’re competitive, consider joining a recreational group or league

–  instead of letting your strengths and talents go to waste, apply them towards something MEANINGFUL (such as in your job, community, family, religious institution, etc)

Naturally, this can take a lot of work/effort especially since our minds may automatically take us down a negative spiral in the face of challenge and negativity.  With our often stressful and hectic lives, when something goes wrong, it seems like it requires more time and energy to switch to a positive mindframe.  With that in mind, Seligman’s team developed a series of exercises to help shift your mind towards more positive thinking, one of which includes listing “3 good things” that went well during your day.

So, with a slight twist and in the spirit of PPT, I created a new series on my blog called “Thankful Thursdays” where I will list 3 things I’m thankful for from the week and I encourage all of you to do the same!

Here’s my list from this week:

1.  Took advantage of living a few miles away from the beach and spent some time there to escape the triple digit California heat wave (picture above).

2.  I’m thankful for my family stopping by my office to visit and instead of my usual routine of going home to check email and watch tv, I enjoyed quality time with them over a delicious meal.

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Dinner in West Hollywood

3.  Received a “sign” today which steered me in a different direction regarding a work project.  I truly believe that when one door closes, another one opens, so I’m staying focused and optimistic!

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On a boat in South Lake Tahoe

What 3 things are you thankful for?

References:

Seligman, M. E. P., Rashid, T., & Parks, A.C. (2006). Positive psychotherapy. American Psychologist, 61, 774-778.

Photo Credits: Marlon Santos (Diamond Reel Media), Alex Manipod

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

September 18, 2014 9 comments
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Psychiatrytherapy

Stay or Leave?

written by freudandfashion
Stay or Leave?

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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
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Putting in work at my new office in West Hollywood
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Photos courtesy of Marlon Santos (Diamond Reel Media)
September 10, 2014 24 comments
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PsychiatrytherapyTravel

Delayed Journey

written by freudandfashion
Delayed Journey

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Sedona, AZ

Confusion about my career path, difficulties prioritizing, and a busy schedule are the only excuses I have for going eight whole months without writing a blog post.  If you asked me one year ago to describe how I envisioned my life would be post-residency, I would have said “happy,” “free,” “liberated,” “fun.”  However, a few months after buying my first house, getting my first paycheck, studying three straight months for the Psychiatry board exam, and passing the Psychiatry board exam, I thought to myself — “Is this it?  Is this really what I spent 12 grueling years after high school working towards??”  Survival was my primary goal throughout medical training, but once I gained confidence and knew I’d survive, I focused on sharpening my clinical skills.  Then, finally, I prioritized my time towards getting a job (after all, who wants to spend > $200K on an education and not end up with your dream job?).  Yet, throughout my education, there was never mention of the emotional toll that the transition from post-graduate school to real life could take.  After graduation, I experienced some “happy” and “free” moments, but had an equal amount of depressing moments (if you’ve read past blog posts, you’ll know this usually involves immersing myself in reality tv and slacking off on workouts).  At times, I wished I was back in the student role where you have a built-in support system of friends and supervisors to consult on a regular basis.  I have a wonderful job, but am still waiting for some form of delayed gratification.

I eventually grew tired of sitting around and waiting, so I went on trips in hopes to gain clarity and direction on the next steps to take in life.

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I stopped beating myself up about having a lazy exercise routine and joined a Crossfit gym.

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Photos courtesy of CFA

Then, moved into my new home.

I’m not 100% certain of what’s next in my life journey, but I’m happy to say that I’m stronger than ever, finally moving forward, and excited to find out!

What types of things have you done to gain clarity when you’ve felt stuck?

September 5, 2013 18 comments
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Psychiatrytherapy

New Beginnings

written by freudandfashion
New Beginnings

Taking in the scenery from my balcony on my last day in Oregon

I’m currently sitting on my couch wearing gym attire contemplating whether or not to head to the gym.  Five minutes into a repeat episode of “The Real Housewives of Beverly Hills,” I convince myself of an alternate plan to work out at 5am tomorrow before going to clinic (I confess that this is the 10th time I’ve created this plan, but have executed it only once).

My lackadaisical behavior doesn’t surprise me.  Previous blogposts exhibit this behavior (here/) and I attribute the laziness to a recent move.  My childhood memories relate the experience to the song “Kindergarten Wall:”

“And remember the seed in the little paper cup:

First the root grows down and then the plant grows up!”

I was uprooted when I moved to Oregon, then eventually established my community and made it my home.  Moving is a huge transition.  One may need to adjust to a new work environment or find a new job, meet new people, discover the least traffic congested roads, join a new gym, etc.  I have several patients who present with depression related to a recent move.  Though each case is unique, I don’t automatically treat the depression by adding a new medication because mood may improve over time.  I empathize with their struggles and generally offer support through the adjustment phase.

It took me about six months to feel comfortable living in Oregon, though i criticized myself each time I felt sad, homesick, and overwhelmed with change.  Now that I’m back in so-cal, it’s taking a bit longer than expected to create a daily routine, but I’m familiar with my pattern of establishing roots in a new area of residence (the exercise routine will get there…eventually).

November 21, 2012 4 comments
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PsychiatryTravel

Vacation Time

written by freudandfashion
Vacation Time

One thing I’ve mastered during residency is the timing of vacation and making the most of those few days of freedom.  Four months without vacation is far too long, one month intervals is too soon, but a vacation every 2.5 months comes out to be just right.  I’m at the point of yearning for some much-deserved time off, which I plan to spend soaking up sun to boost my Vitamin D and eating/shopping/partying in one of my favorite cities.  My key to surviving residency incorporates a balance of combining work, relaxation, and fun, because the former can easily dominate over time, resulting in high anxiety, struggles to get up in the morning, a shorter temper, less sleep, and less people wanting to be around me.

November 1, 2010 0 comment
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Psychiatry

Pill Pusher

written by freudandfashion
Pill Pusher

I have a simple theory that I like to follow when it comes to psychotropic meds: “Simple is Better.”  Pretty straight-forward. 

When I inherit a new patient with a list of meds the length of the Declaration of Independence AND they’re still depressed despite all the designer brand name drugs at their disposal, I don’t think it takes a medical degree to figure out that something’s not right. 

Question 1:  Question the diagnosis.  Question 2:  They’re still depressed—what the heck am I supposed to do about it?

Whereas most might seek comfort in adding yet another miracle drug to the list, I was inspired by one of my Attendings and made a goal to venture in the opposite direction of the less anxiety-provoking intervention and instead take a medication out (slowly, of course, before withdrawal throws them into a far worse state) and maximize the therapeutic benefit of a truly helpful medication at the same time. 

And, the outcome?  Well, it’s worked out in many of my patients thus far.  Maybe my warmth and reassurance helps as well.  Only thing I need now is the research to show it (my next residency venture).

Image via ramoscentral jpg

October 23, 2010 3 comments
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