Tag:

grief

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

{Na Pali Coast, Kauai, Hawaii}

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

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

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

Things You Should NOT Say To Someone Who Is Grieving:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

February 23, 2016 22 comments

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

Psychiatry therapy

Termination Point

written by freudandfashion

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

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

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

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

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

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

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

September 10, 2015 10 comments

Personal

Lessons of the Week

written by freudandfashion

{Playa Del Rey, California}

If you read my last post, you’ll know that my mood has been a bit off this week. Yet, now that it’s Friday, I can reflect on the positive lessons I learned from the experience.

1. Be cautious of making any crucial decisions when you’re feeling emotionally off. Let’s just say that losing control of my emotions led to an impulsive desire to regain control, which manifested as having the urge to make irrational decisions (regarding my job, therapy, and relationships). Fortunately, I gained enough insight and control of my emotions in time before committing to anything!

2. No matter how stressed, angry, or upset you may be, if possible try your best to remain present for others. I felt exhausted during clinic yesterday. Then, one of the last patients on my schedule tells me that I’m the only doctor she has who listens and doesn’t make her feel as if she’s being judged. I was touched by her comment (and I also thought, “wait shouldn’t every doctor be that way?”). I don’t suppress my feelings of lethargy (in fact, if my patients ask, I’ll be honest and tell them if I’m feeling a bit more tired), but I make sure that my energy levels and mood don’t interfere with the connection I have with my patients. If it does interfere with my interactions, then it’s a sign that I’m in need of a vacation!

3. Grief is tough and very confusing. Period. If support is available, please utilize them. It took me awhile to reach out, but I’m glad I did. And I appreciate all of you for reading, commenting, and helping me realize that I’m not alone.

April 17, 2015 6 comments

Personal therapy

Grief In Repeat

written by freudandfashion

{Upland, California}

Upon driving into my garage coming home from work this evening, I suddenly burst into tears as the garage door slowly closed behind me. I haven’t felt like myself at all this past week. I tried my hardest to discern the reason for my melancholic mood and pinpointed a series of events that occurred after the subject of death was brought up during my therapy session this past weekend. The subject of terminal illness and inevitable death is never an easy one, even as a physician who had to pronounce deaths in the hospital wards and was educated on how to talk to patients about advance directives (Do Not Resuscitate/DNR), hospice, etc. We all have triggers that may occur randomly during our day that may unleash suppressed feelings that go deeper beyond whatever triggered us in that present moment. A patient once told me that hamburgers made her sad because her deceased father cooked them all the time at family gatherings. For others, something as simple as a hamburger triggering profound emotions may sound ridiculous, but we must be empathetic to each individual because none of us know of the history, context, or meaning that a symbol (such as hamburgers) provided in a person’s life.

My initial trigger was watching the movie Furious 7 last week. Now, I know that millions of devoted Paul Walker fans (including myself) were profoundly impacted by his tragic death, but the uncontrollable amount of tears that I shed was far too disproportionate to the mild attachment I had for the actor. Since everyone I knew who watched the movie admitted to shedding tears, I didn’t think much of my emotional response at the time. But, during my group therapy session, I was extremely angered about an unrelated topic, and again, I couldn’t figure out the reason why. Leaving my therapy session in a pissed off mood, I contemplated quitting group because I didn’t want to be a part of anything that made me feel angry and unsupported. I looked at my phone and started scrolling Instagram to distract myself from my emotions, and stopped incessantly scrolling once I came across the picture below, which my sister posted for National Siblings Day with the following caption:

It was always the four of us. Although we’re all grown up with separate lives, we will always have the same love for each other, and share the same values that our Lola and Lolo (Grandma & Grandpa) taught us. My latepost In honor of ‪‎siblings Day 4/10 and my lolo’s birthday 4/7. I love you all. I miss you Lolo & Lola.

Last week was my grandfather’s birthday. The theme of losing such a devoted and integral part of a family is the theme that resonated most with me about the movie. And watching the ending somehow re-opened the wound in my heart that I experienced when I first received news that my grandfather passed away from cancer thirteen years ago. I continue to re-experience feelings of grief each year around his birthday and this year is no exception. I wrote about my grandfather’s influence and my difficulties coping with losing him in previous blogposts (here, here & here). Last week, a few of my patients discussed their own grief, which is always a hard subject to process. I always do my best to provide them with as much support as possible because I know what it’s like to feel isolated, angered, and confused by a complex mixture of emotions.

I used to want to believe that “time heals all wounds,” but one of my inspiring readers modified my perspective of the statement to make it more accurate: time may help make the grief a bit more tolerable. Grief never goes away, but rather is re-experienced in different, sometimes confusing ways. But, just like the goal of the movie, I try to shift my focus from sadness to embracing my grandfather’s strength and legacy. I can already feel the wound close a tiny bit as it starts to repair itself yet again.

April 15, 2015 16 comments

Personal therapy

Numb

written by freudandfashion

I honestly didn’t want to write a blogpost today. The main reason being that I’m not in a peppy mood, but why should blogging only be about happy thoughts when reality is that human beings experience a full range of emotions?

My current emotion = numb. I participated in a suicide debriefing at work today, which is a meeting where we review a recent suicide, process grief, and provide support for staff members involved. I have been open about my feelings surrounding patient loss (here, here, and here), and experiencing this sort of numbness is somewhat new to me. The intellectual part of me feels inclined to look up research articles to find meaning behind this numbness, however the emotional side of me lacks motivation to perform the work. We may sometimes experience a mixture of confusing, unfamiliar emotions, which may contrast from what one might perceive to be normal or expected. But that leads to criticism for feeling a certain way. How nice would it be to have freedom to be yourself and feel a certain emotion without being judged?

Yesterday, one of my newer patients wanted me to tell her where her anxiety is coming from and I replied, “I’m actually not sure, but perhaps you have an idea what might be triggering it?” My patients often expect me to identify the reason behind a specific emotion, but I find it difficult to formulate my thoughts without the patient’s own input. If I switched roles right now and sat in the patient chair and the psychiatrist asked me where I think my numbness is coming from, I’d say “I feel too overwhelmed and there’s no room for extra stress in my life.” (Then, the light bulb goes off in my head). I have too much going on in my mind and don’t have the reserve to tolerate more emotions at this current moment. Hence, feeling numb. Now that I think about it, feeling numb isn’t much different from the hours I spent watching House of Cards last night (Note: it’s out of character for me to watch that much tv on a regular basis). Either way, I am trying to avoid some unsettling feeling that I’m not quite ready to process. However, I’m bracing myself because I know the time to process the difficult emotions will eventually come. Until then, I still have two more seasons to watch.

March 5, 2015 20 comments

Psychiatry

Valentine’s Day Healing

written by freudandfashion

{Malibu, CA}

Oh, the chatter of couples reserving a spot at their favorite romantic restaurants, enamored significant others shopping for the ideal gift, beloved partners plotting the perfect engagement proposal, top hotel ballrooms fully booked for weddings…all Valentine’s Day festivities sound so dreamy, however the majority of the nation’s singles probably want to vomit.

Since I’ve been writing about grief in my recent posts, I curiously looked up existing research on psychological aspects related to relationship breakups. I found a few interesting studies and figured I’d share what I learned especially since National Singles Awareness Day is fast approaching:

1. Up to one-third of active Facebook users go on the social networking website to “Facebook stalk” their exes. I’m sure many of us have experienced how difficult it can be to avoid ANY contact with our exes soon after a breakup (previous research has shown continued contact offline to be associated with poorer functioning post breakup). Well, a study conducted by Dr. Tara Marshall showed Facebook stalking to be even WORSE for recovery post breakup! Those who de-friended their ex showed greater personal growth, which suggests that the best chance for healing a broken heart is to avoid them both online and offline.

2. There is hope in breaking up, at least in terms of developing personal growth. Another study led by Dr. Tara Marshall examined the association of attachment styles (see below for my attempt at a simplified explanation of this theory) as predictors of personal growth following romantic breakups.

One attachment style involves those who grew up in an environment where the caregivers were inconsistently available nor responsive. As an adult, they tend to be clingy and require excessive reassurance especially when they feel insecure and unsafe in the relationship. Therefore, after a breakup, these highly anxious individuals developed heightened distress, which ultimately led to greater self growth. Why so? Perhaps experiencing high distressing emotions acted as a catalyst to promote self-reflection and growth.
In contrast, when someone grows up in an environment where the caregivers were never around nor available, then as an adult they grow up to be highly self-reliant and mistrustful of others. Therefore, after a breakup, these individuals aim to restore their self-sufficiency and take on the role of parenting themselves. In this study, they were found to exhibit low amounts of distress and less personal growth likely due to experiencing little motivation to change as a result of the split.

3. Changes in your brain activity occur after a breakup. One study published in the American Journal of Psychiatry (2004) conducted brain scans and found altered brain activity in women actively grieving from a recent breakup. Therefore, you’re bound to experience some changes in emotions, especially sadness, and there’s a scientific reason to account for this.

Thought of the Day: Ready, set…stop stalking your ex! (at least until you’ve healed and moved on. I admittedly get a kick out of Facebook stalking my exes every once in awhile as well).

February 13, 2015 21 comments

Psychiatry therapy

Shock and Denial

written by freudandfashion

I review the 5 Stages of Grief with my patients all the time. Yet, no matter how many times I review them, nor how many patients or people I lose in my life, experiencing these stages never gets easier nor avoidable.

Stages of Grief:

Shock/Denial
Depression/Sadness
Anger
Bargaining
Acceptance

The following was written last week:

Today, I shall focus on shock/denial. Why focus on the shock/denial stage? I received a call from the medical examiner (aka coroner) today. I hold my breath each time I answer my office phone in fear that the medical examiner’s office is on the other line. The worst sentence to hear upon answering the phone is “Hi doctor, this is (insert name here) from the medical examiner’s office.”

My biggest fear became a reality today, yet again.

Currently, I am in the shock/denial phase and I’m coping by intellectualizing (a defense mechanism that many of my colleagues employ to deal with difficult news; mostly because I’m more comfortable processing the loss clinically rather than emotionally at this point, hence, the reason I am focusing on writing a blog post that teaches the stages of grief), carrying on with work, and going about my day, with the occasional few tears and blank stares when I have downtime. These moments of sadness are periods that I try to avoid, especially after glancing at my fully-booked patient schedule. According to the medical examiner, “cause of death is not known, the toxicology results are still pending.”

Each and every one of us go through this phase when we experience loss. I blogged about the subject of grief recently when I lost a patient to suicide two months ago. I am aware that my demeanor is currently “off” because I’m quite tense and impatient right now as well. I might be going through the motions of a regular day, but in no way am I taking this loss lightly. I know the anger stage will approach soon. For me, the worst stage is sadness/depression because I generally want to isolate and hide.

The following was written today:

One week has passed since hearing the tragic news about my patient. I enter the clinic, greet my usual “good morning” as I observe everyone going about their busy day as normal. I enter my office and suddenly have a desire to punch my computer as it takes forever to reboot. I settle for slamming my palm against the keyboard instead. Note that this is my usual morning routine, minus the angry/”I wanna punch something” part. The anger stage is here.

I see my first few patients and notice a decline in my usual empathetic statements, my mind drifts more frequently, however, I remain fully aware of my thoughts and am able to re-focus. The 20 minutes that I have with each of them is their designated time and I must not let my grief impact any medical decision. I take my lunch break and run into one of the therapists, who was also involved in my deceased patient’s care. I decide to open up about the struggle I’m having today, in hopes that we can provide comfort and support each other during this difficult time. Instead, I get a remark that pisses me the hell off, or at least that’s how I interpreted her curt comment. I essentially wanted to tell her she was an insensitive idiot and to f*** off, but I held my composure. I normally wouldn’t be bothered by such a comment, but I’m clearly more irritable than usual. I let it go and tried to have compassion for her especially since she might be grieving as well, or thought that perhaps she’s a cold witch and doesn’t care, then thought that perhaps I misinterpreted her comment. Perhaps I feel that nobody understands, and maybe no words can make me feel better at this moment anyway.

February 5, 2015 23 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

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

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