Tag:

mental health

Reach Out And Connect With Someone

{Rancho Cucamonga, California}

I’m approaching a new phase in my life by moving on to a new practice, which will be my second job out of residency. As excited and hurried as I was to leave my first job and move on to the next, with this being the last week in clinic, I’d have to say that I’m quite sad. I’ve had several friends tell me that they don’t get along with their coworkers, that they haven’t developed friendships with anyone on staff, that they mostly are “in and out” of clinic to see their patients and get all the documentation done while minimally interacting with their peers. How fortunate am I to have developed a sense of family and strong teamwork with those whom I work with?

I hear that one of the drawbacks of going into private practice is a sense of isolation not having a team of professionals to bounce ideas off of or interact with on a daily basis. However, I do know that the practice I’m joining will provide valuable experience learning what it’s like to practice psychiatry in a different clinical setting. And even cooler is that the actions and morale of the group I’m joining have given me enough confirmation to prove that I’ve made the best choice for myself and my career.

If you notice a theme in several of my posts, it’s the concept of “family” and teamwork. I have several patients whose stress levels and depression gets triggered or exacerbated by a sense of loneliness and isolation due to lacking the friendship, camaraderie, sense of belonging, and the support we as humans need. Numerous studies have found that social relationships provide emotional support and contribute to stress relief and better quality of life. The following are some examples of how social support enhances mental and physical health:

Addiction
- Recovery from substance use often leads to the dissolution of former friendships that were associated with an individual’s propensity to use drugs or alcohol. Therefore, recovery-oriented support (such as 12-step programs) are critical early in treatment as someone begins to build and develop a healthier network of support. Higher levels of social support are linked to decrease in substance use whereas lower levels of social support prospectively predicted relapse.

Post Traumatic Stress Disorder (PTSD)
- for childhood sexual abuse survivors, a combination of self-esteem and appraisal support (an individual’s perception of being valued by others and that he or she is capable of getting advice when coping with difficulties) was useful in preventing the development of adult PTSD.
Cancer
- Supportive group intervention for women with metastatic breast cancer has been associated with lower mood disturbances and less maladaptive ways of coping with terminal illness.
Work Stress
- Social support at work has been shown to have direct benefit on workers’ psychological well-being and productivity.

THOUGHT OF THE DAY: Identifying and building your own support network can take quite some time and effort, but the enhancement on your quality of life will make it well worth it. Which supports do you identify as being most integral in your day to day life?

October 22, 2015 21 comments

Featured Guest Blogger

Why A Social Worker Turned His Passion for Bicycling Into a Mission

written by freudandfashion

One of the best things about blogging is the opportunity to meet like-minded, motivated people in the mental health field who are passionate about making a greater impact in the community. When I first came across Bike and Brain on Facebook, I was impressed by Matt Ryan, LMSW (the founder of Bike and Brain) and his selfless goal to successfully blend his career as a social worker and love for bicycling into a mission that promotes bike riding’s benefits on mental health. What started as a blog one year ago has evolved into an active operation that organizes group rides, provides free bicycles to New York City residents, and is expanding its efforts by becoming a nonprofit organization (continue reading to learn how you can support his cause and enter to receive a free bicycle below). Therefore, I am excited to feature Matt as my first guest blogger as he discusses bicycling and its positive impact on mental health.

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Life can quickly become chaotic. We deal with stress from work, relationships, children, and health, to name a few. Too much stress can cause us to feel out-of-control, which can be extremely uncomfortable. In fact, excess stress can be detrimental. As life stressors build, we may experience anxiety and even depression. We may feel like giving up when life appears too much to handle. We may begin to neglect our priorities. Unfortunately, giving in to this feeling only exacerbates the situation. So how do we regain our sense of control?

Whether you’re in control of your own company or the TV clicker, control can be a great feeling. People exert a great deal of effort in life to gain control. You can certainly argue that having too much control may be problematic, but possessing a certain level of control is crucial in order to lead a fulfilling life. It’s important to be in control of your emotions, diet, exercise regimen, sleep patterns, relationships, etc. Furthermore, it’s key to be aware of your role in all of these facets of life. There are obviously things that we can’t control such as when we are mistreated by a friend, loved one, or a rowdy neighbor who keeps us up all night. However, we can control how we respond or how we choose to handle these situations. Learning to control yourself within the important facets of your life can help build confidence, which in turn can make life more enjoyable.

I am a social worker in NYC and it’s safe to say things can feel pretty out-of-control. One of the things I do to stay grounded, motivated, and focused is ride my bicycle. I ride daily and can truly say it plays a crucial role in my life. Bicycling gives me a feeling of control and confidence that transcends into the other compartments of my life. You may be asking how this could be possible — how can riding your bike help any other area of your life?

First off, riding the bicycle provides me with a tangible feeling of control. I determine how fast the bike travels, where it goes, what gear it’s in, and when it stops. The ability to manipulate the bicycle is a reminder that I do have the ability to control things. Merely having the knowledge that I can be in control is beneficial to my daily life. If all else fails, I can utilize my experiences on the bike as a reference point.

Second, riding the bike forces me to direct all of my attention on one thing, which is the road. I am in the moment while on the bike. There is no time to dwell on the stresses of life since distractions could potentially cause an accident. All five of my senses are engaged and my mind is focused. I can feel the wind in my face, the pedals on my feet, and the bars in my hands. Being completely focused on the moment is an extremely powerful tool also known as mindfulness. Essentially, I am putting aside my stress for the duration of the bike ride. This does not eliminate the stresses I may be experiencing. Rather, it is creating free space in my mind so that I may deal with the stress in a more constructive way once I am off the bike.

Finally, cycling makes me happy. Not only does the physical activity release endorphins, but it is the one hobby that provides me complete joy. When everything else may feel out of control, I know that I can hop on my bike to re-charge. In essence, my bicycle acts as my safety net. Cycling will always reinstate a level of confidence and control that is needed to regain my motivation.

And for the record……

I am in the process of creating a nonprofit organization in NYC. We work to provide functional bicycles to people who may not have any other means to obtain one. We believe that there is no reason why we can’t provide people with a FREE bicycle in a city as wealthy as NYC. We have donated a handful of bicycles to date. Each donation has an amazing story attached (Check them out here!).

We will also be giving away a free bicycle (pictured below) on Thanksgiving. Anyone can win this and we will ship it anywhere in the USA. Completely free. All you have to do is like our page on Facebook to enter.

For more information on Bike and Brain, check out their website here.

Photos courtesy of Matt Ryan

October 13, 2015 7 comments

Psychiatry

Steps I Take To Be A Stigma Free Psychiatrist

written by freudandfashion

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

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

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

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

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

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

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

October 10, 2015 17 comments

Psychiatry therapy

The Crucial Transition From Work to Home

written by freudandfashion

{Beverly Hills, California}

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

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

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

How to make the transition:

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

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

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

October 1, 2015 12 comments

Personal therapy

Weekly Insights

written by freudandfashion

{Ventura, California}

I am a perfectionist (sometimes to a fault) and most of my writing is edited at least 10 times until each and every word is as perfect as can be (at least in my mind). One of the reasons that I don’t post more frequently is due to my perfectionism, because I’d much rather NOT post than write anything that doesn’t meet my standards. So I am trying really hard to let go of my strong inner self-critic. Even during residency, my psychiatry supervisors would find me at the clinic after hours typing notes documenting my patient visits. However, the reason I was there late was not due to having a pile of tasks to complete — it was because I took way too long typing and perfecting each note.

During my training, I recall a free association exercise that my psychoanalytically-trained Program Director had us do as part of an intro to psychoanalytic theory. Free association is a psychotherapy technique where a patient talks or writes freely about whatever comes to mind in relation to a specific topic, with the goal of bringing unconscious thoughts to the forefront or the emergence of repressed memories, which can provide valuable insight of a patient’s problems.

So, with this exercise in mind, here goes my attempt at free associating by typing nonstop for 3 minutes whatever comes to my mind regarding the following topic: lessons learned from this week. And, go:

that it’s extremely hard to say goodbye to several of my patients. a part of me wants to take all of my patients with me to my practice, though I know that it’s probably in some of their best interest to stay within a system with resources to monitor them more closely.

I am sad and exhausted usually by the end of clinic because i didn’t realize saying goodbye would be harder than I thought.

i hate feeling lazy when I get home, but I’m so tired that all I want to do sometimes is lay on the couch and watch shark tank, hotel impossible, or other reality tv-type shows mostly because I don’t want to think. But then I feel bad because I feel like I should be cleaning my house, writing a blogpost, exercising, going grocery shopping, going out for a run, or anything else that makes me feel like i’m not being useless.

i wish I had the energy i once did because I feel guilty knowing that I need rest, need more sleep, get injured when working out, takes me longer to recover from workouts and pretty much anything that makes me aware that i’m getting older.

i look at other bloggers and wish that I blogged more often like them, wish it didn’t take me so long to write wish that i could go eat a cheesecake or something that was fattening and sweet like a lot of skinny bloggers posting food shots on their social media sites as if they actually eat those things. how much of reality is blogging anyway, how can we believe anything that people actually write or say and how i can we tell if someone is being authentic or not. i can’t be fake and maybe that’s why it’s so hard for me to write yet at the same time I don’t know how my image will be perceived and that takes editing that i wish i didn’t have to do.

Thought of the Week: Interesting that my recurrent body image issues and fear of judgment appeared in this post. Perhaps a sign that I should process this material with my therapist?

September 26, 2015 20 comments

Personal therapy

Love Thyself

written by freudandfashion

{Sonoma, California}

Sure, when I first heard Hailee Steinfeld’s single, “Love Myself,” on the radio, I initially became excited that such a popular song celebrated a love for one’s self. And even after dissecting the song’s lyrics (to discover the actual allusion to masturbation), I still remained inspired to write a post that paid homage to myself, particularly because I have been feeling more self-conscious and self-critical lately. The thought of writing about oneself may stir some anxiety due to fear of being judged as narcissistic, self-centered, self-absorbed, conceited, etc, etc. However, our inner critic can be the worst critic of all (I swear my therapist points out my harsh self-criticism at each and every therapy session). And as cliche as it sounds — if we can’t love ourselves, how can we expect anyone else to love us? For me, promoting a healthy sense of self-worth outweighs any risk of judgement.

I vividly recall having to write an acrostic name poem during elementary school and struggling to come up with words that described me. So, as I sit on my couch tonight full of regret for eating pastries brought home from clinic and guilt for not waking up early enough to hit the gym this morning, hear goes my attempt to write a positive ode to myself:

Thoughtful, caring, interactive

I’m reliable, proactive

Down for an outing or adventure

If something new, you’ll be my mentor

Comfortable with leading

Will call you out if misleading

Advocate for those in need

A dog lover of many breeds

A perfectionist constantly inspired

Motivated to grow by those I admire

Smart, sarcastic, smiley

Environmentally-friendly, candid, kindly

Family comes first

Friends down to earth

Finds beauty unrehearsed

Always something to converse

Discount shopping in bursts

Will gladly help unless you’re curt

Spiritually immersed

So hardworking that it hurts

I know what I’m worth

Thought of the Day: Care to try writing one for yourself? (much respect to you if it comes easy…this took me longer to write than I’m willing to admit!)

September 19, 2015 10 comments

Psychiatry therapy

Termination Point

written by freudandfashion

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

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

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

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

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

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

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

September 10, 2015 10 comments

Personal Psychiatry

Look You In The Eye

written by freudandfashion

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

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

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

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

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

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

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

September 2, 2015 8 comments

Fashion Psychiatry

Schizophrenic Connection

written by freudandfashion

{Schizophrenic.NYC tank top}

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

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

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

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

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

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

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

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

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

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

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

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

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

{Rorschach inkblot test design}

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

August 25, 2015 13 comments

Lifestyle Medicine

Thankful Thursdays

written by freudandfashion

{Venice Beach, California}

For this week’s Thankful Thursdays, I would say that I am very thankful for one of my best friends from medical school, who flew into town for a quick visit. My resolution for the remainder of the year (mentioned in my previous post) included being spontaneous and free to explore. Surprisingly, in all my years living in southern California, I have never experienced biking along the beaches of Santa Monica and Venice, nor have I ever gone shopping on Abbott Kinney (a well-known boulevard located in Venice lined with trendy/urban shops, earthy/cool restaurants, and more). We had a wonderful time catching up, eating delicious food, and discovering new fixtures in the area that we’d never noticed before. I figure that Los Angeles still has a LOT to explore, therefore, to kick off my resolution, I might as well begin locally!

Thought of the Day: What are you thankful for from this week?

For background information of the reasoning behind my Thankful Thursdays posts, check out my 1st post of the series here! (And subsequent posts here, here, and here).

August 20, 2015 8 comments

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