Tag:

mental health

Explore

{Bubblegum Alley, San Luis Obispo, California}

I know that the end of year 2015 is fast approaching, but I’m declaring a resolution for the remaining months: to be spontaneous and feel free to explore. The restrictive years of medical education, training, and work, can be so draining. Some of you may know that I work in clinic part-time (a career decision that I will explain in a future post), however, the majority of the time, I utilize my days off to recover from work. Though I take absolute pride in my work as a psychiatrist, my profession is only a part of my identity and I refuse to let it dominate my life. I’d much rather spend my time exploring new places, trying new activities, and doing whatever I can to make up for lost time spent with my head buried in books and research articles. So, if you ever see me outside of clinic, please don’t call me “Doctor” (unless you don’t know what else to call me, or by chance are a patient of mine). My name is Vania, and I enjoy spending time outdoors, trying a variety of sports activities, poking fun at myself while educating followers on Snapchat, getting carded at any alcohol-serving establishment, and I find beauty in even the ickiest of things (like a gum wall…how cool is that?!).

Have an exploratory weekend!

August 15, 2015 21 comments

Medicine Psychiatry

The Other Side

written by freudandfashion

Written on August 11, 2015

My psychotherapy supervisor taught me a tip during residency — to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session (because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning). I struggled to come up with a topic to discuss on my blog today. At first, I uploaded chipper, smiley pictures taken from a recent spontaneous trip to the coast, but there was something about my grin and carefree expressions that didn’t seem quite appropriate to post today. I try my best to ensure that my blogposts are reflective of my current state of mind, and my current mood is actually quite solemn.

I know that today marks the one-year death anniversary of Robin Williams, yet avoided news articles, tweets, and Instagram posts that paid tribute to the iconic, inspirational actor. While sitting on the couch and staring blankly at the television screen, a short reel of Robin Williams popped up on entertainment news. Not content with the mainstream, flowery piece which strung together brief clips of some of his finest, Oscar-winning work followed by a quick moment of silence in remembrance, I picked up my phone. While scrolling through Instagram, I focused on a long, detailed post written by a young man in which he describes his own personal battle with depression and multiple, near fatal suicide attempts. Robin Williams’ lost battle to mental illness motivated this man to share his story rather than isolate in shame and silence. The words authentically describe the powerless experience of succumbing to the disease. The depression takes exclusive command and overrides any attempt at rationalization. And I know the story to be true because the writer is a dear friend of mine who miraculously survived.

Several of my patients have described similar experiences. Several people living with mental illness whom I follow on social media share similar stories. Every morning that I arrive in clinic, I log on to my electronic medical records and pray not to see a message from the coroner’s office. As a psychiatrist, getting that dreaded phone call from the medical examiner is probably my equivalent to the oncologist receiving a call from a family member or hospice staff. As a young teen, I vividly recall accompanying my family for routine, frequent visits to my grandparents’ apartment, where my grandfather passed away, rid of the suffering he endured from colon cancer. A few years later, my grandmother peacefully died from multiple myeloma. Her last words to me before she passed was that she wished for the opportunity to pay for my education and witness me become a doctor. My other grandfather, as he approached the end stages of his battle with cancer, fulfilled his wish to fly back to the Philippines, where he comfortably spent his final days in his homeland with our large, extended family by his side. When the medical examiner’s call ends, my immediate response is to shut the door and sit alone in silence.

Finally recognizing the mixture of emotions that I suppressed the entire day, I could no longer hold in my tears. Rather than isolating (as clinicians tend to do when it comes to coping with patient loss), I attempted to share my thoughts and emotions on social media, with the goal to make others aware of the difficult emotions that we, as mental health practitioners, face when dealing with patient suicide. The loss not only permanently impacts us professionally in our practice, but also as human beings. I left the post on my feed for 20 seconds, then immediately deleted it. Shame, embarrassment, and fear of judgment overrode my hope to break the norm of silence and connect with others too afraid to open up about their own experiences losing a patient to suicide.

As you can see, I waited a few days to publish this post after much contemplation. The truth is that the fear of losing a patient to suicide weighs heavily on my mind almost every day.

August 13, 2015 16 comments

Personal

Find The Light

written by freudandfashion

{San Luis Obispo, California}

Sometimes in the darkest moments, it’s hard to imagine that there’s light at the end of the tunnel. Friends, family, or therapists may try and provide reassurance that life gets better, things get better, fate will lead you to something better, and that you deserve better. Such thoughts sound so passive in nature, as if we have to wait and rely on fate or other external factors, rather than rely on ourselves, in order to see any change and progress. I’ve become more proactive lately and in some ways feel as if I’m cleansing myself of any major factors in my life that have suppressed me in any way because, frankly, I’m tired of living a life filled with constraints. However, more often the restraints we have are those placed upon ourselves. I know my writing in this post may sound vague, but the ultimate point I’m trying to make is that only you can set yourself free of anything in life that makes you feel trapped. The imperative tool needed is the courage to advocate for yourself and take action instead of being a passive bystander in your own life. Have a wonderful weekend.

“I learned this, at least, by my experiment: that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours.”
― Henry David Thoreau, Walden

August 8, 2015 11 comments

Psychiatry

Summertime Sadness

written by freudandfashion

{Santa Monica, California}

I’ve been intermittently unmotivated lately and am trying to analyze the reason why. Then I realize how hot, humid, and sweaty I feel as I scroll Facebook and view photos of my friends’ fabulous summer vacation trips as I sit at my desk all by my lonesome. Perhaps my current mood is triggered by the summer season? If you have a tendency to feel lazy, unmotivated, or depressed during the summer season, you’re not alone. There are several reasons that the summer months may bring about a drop in mood. The good news is that there’s ways to overcome these feelings and bring some pep to your mood this time of year.

What are some potential reasons for the shift in mood?

1. Changes to your regular schedule. Basically, anything that throws off one’s routine can contribute to a change in mood and motivation. The kids are out of school, which means increased responsibilities monitoring them and taking them out on activities to keep them occupied throughout the day (this also means decreased “alone/me” time). And although summer vacations are usually planned and much-needed, it takes time to adjust back to your regular routine upon return. Many also travel to different time zones, which contributes to even more difficulty to readjust.

2. Expectations to have a fabulous summer. Several of us continue to work, attend summer classes, or stay home during the summer months (due to budget, other responsibilities, etc) and with modern life dominated by social media, we are bound to come across our friends’ seemingly exciting vacation photos. Not spending a few weeks in Hawaii or the Hamptons? That’s okay, but one can’t help but feel the pressure and envy to be on vacation especially when it appears that everyone else is jet-setting away.

3. Increased pressures to have the ideal swimsuit body. I used to hate summers in so-cal as there’s nothing that made me more self-conscious than being surrounded by model’esque women in bikinis. I vividly recall skipping out on pool parties as a teen (partially because I didn’t know how to swim) because I was body-conscious and oblivious on how to choose a flattering swimsuit.

4. Summer seasonal depression. Seasonal Affective Disorder (SAD) is a recurrent depression that is experienced only during a specific season, but is NOT experienced during the rest of the year. Though the prevalence of SAD during the winter time is much higher compared to summer, studies have shown a correlation between summer seasonal affective disorder and higher, hotter temperatures.

5. Losing a sense of purpose during the summer months. People who have time-off during the summer months (ie, teachers, school employees, etc) may have difficulty shifting their priorities from work to something else around this time of year. It’s well-known that utilizing skill and having a career that strengthens and contributes to a person’s sense of identity tends to improve mood. When a sense of purpose is taken away (even if for a few months), one’s mood may decline.

6. Weather change. Some people just don’t like basking in the sun or going out when temperatures are high. Period. But the distaste for heat can lead to social isolation and difficulty leaving the comfort of an air-conditioned home, which can contribute to a decline in mood and lack of motivation. Also, the heat and longer days can cause insomnia, which may cause a decline in energy levels as well.

WAYS TO BREEZE THROUGH THE SUMMER MONTHS

1. Seek help from a professional. If you feel that the summer season is causing impairment in your daily life, then seek help from a professional (physician or therapist). Medications, such as antidepressants, might be an option to help you get through the season. Also, therapy (particularly cognitive behavioral therapy) has been shown to help seasonal depression.

2. Stay active. As I wrote in a previous post, exercise has been shown to be just as effective as antidepressants for the treatment of depression. While on vacation, try to maintain an exercise routine as much as possible. Many people understandably avoid outdoor exercise due to the heat, so consider exercising later at night, early in the morning, or join a nicely air-conditioned gym for a few months.

3. Get some rest! Our circadian rhythm plays a large role in the maintenance mood. Despite the temptation to stay up late, try your best to maintain a regular sleep schedule as variations (especially lack of sleep) contribute to irritability, increased anxiety, and depression. Also, if you’re tired after a busy or stressful day, allow yourself to get some rest instead of overexerting yourself.

3. Keep your environment cool. I’m admittedly cheap at times and avoid turning on the air conditioner unless absolutely necessary, but if the heat makes you moody, then your wellbeing will hopefully prevail as the utmost priority over cost.

4. Don’t let social media bring you down. Keep an open mind and remember that pictures on social media generally display near perfect appearances. Get annoyed by the person in your group who obsessively snaps away trying to obtain the perfect photo instead of engaging in the activity at hand? I get irritated and would love to throw their phone in the toilet, but I exercise restraint. I’d like to think I’ve learned to maintain good boundaries by allotting only a few minutes to take pictures per each activity (if any of my friends or family think otherwise, please let me know). I found this article, which explains the concept of perfection in social media, quite interesting.

5. Carve out time for yourself. I emphasize the concept of self-care so much in my blog that no further explanation is needed, but if so, please refer to my entire blog 🙂

August 5, 2015 10 comments

Personal

Finding Your Way

written by freudandfashion

{Yountville, California}

I woke up yesterday morning with a sense of dread and struggled to get out of bed, yet ended the day feeling energetic and liberated. Lately, I’ve been making conscious efforts to prioritize myself for the sake of maintaining my sanity. As a result, my mood and anxiety levels have improved almost instantaneously after making a crucial decision regarding my work schedule and the next step to take in my career. If you have any important decisions to make, I strongly recommend holding off on any impulsive, irrational decisions unless you’ve had time to relax and get in the right state of mind. So often our minds get bombarded by all the stressors in our lives that we lack any reserve to think clearly. So take a break, talk it out with others, weigh your options, and trust that your instincts will take you down the right path.

August 1, 2015 6 comments

Psychiatry

Overcoming Social Anxiety

written by freudandfashion

{Claremont, California}

To continue my series on conquering our fears (see Part 1 here), Part 2 consists of one of the more common phobias: Social Phobia. I struggled with social anxiety since childhood (as I discussed in a previous post) and often felt uncomfortable in any situation that involved interacting with people. It wasn’t until six years ago during my psychiatry residency training that I finally gained control of my symptoms. Some of the common thoughts that would race through my mind:

– “Are people judging my appearance?”

– “What should I say so that I don’t sound stupid?”

– “Hurry up and say something so that people don’t think I’m shy and quiet”

– “What I said was so stupid, they must think I’m an idiot”

– “What excuse can I give to avoid going to the event?”

My social anxiety dominated a huge part of my daily life.

If you also struggle with social anxiety, the following are some steps you can take to work towards overcoming your fear:

1. Avoid Avoidance

One of my supervisors always emphasized “avoiding avoidance” in application to overcoming all forms of anxiety, and the statement definitely applies to social situations. The more you avoid, the more you reinforce your anxiety symptoms. Sure, it might be far less anxiety-provoking in the moment to stay at home, but how will you cope with anxiety-provoking situations in the long run? Social anxiety impacts all facets of daily life, from something as common as participating in a regular conversation or going to the grocery store to giving a talk at work.

An example of avoiding avoidance: one of my patients rarely left her home during the day (and would run errands only at night to avoid the crowds) due to social phobia, except to attend her appointments with me. Therefore, in order to encourage avoiding avoidance during the day, I made sure she scheduled weekly, daytime appointments with me in order to challenge her fears of running into people during the day.

2. Climb the social anxiety “ladder”

If you don’t have too much difficulty with shyness and feel motivated enough to expose yourself to a series of social situations, then create a list of approximately 10 situations and rank them in terms of level of anxiety (1 = lowest anxiety situation, 10 = highest anxiety situation). Start with #1 and work your way up. And be sure not to skip because you run the risk of getting too overwhelmed and exacerbating your anxiety, which could lead to increased discouragement, self-doubt, and feelings of failure.

For example, my hierarchy would look something like this:

1 = speak to the cashier at the grocery store

2 = go to the bank after work when it’s busy

3 = attend a new exercise class at the gym

(I’m skipping #4 – 9 for the sake of brevity)

10 = Give a talk/lecture to a large group of people (#10 should be a goal to work towards)

3. Get a self-help manual, workbook, or internet-based self help program for social anxiety

Cognitive behavioral therapy (CBT) is one treatment modality shown to be effective for social anxiety disorder. One study found that an internet-based self-help program helped university students with social phobia and public-speaking fears. CBT examines the engrained, negative patterns of thinking (for example, “everyone at the party is judging me” or “anything I say is going to sound stupid”) in order to modify and challenge these irrational thoughts/beliefs. CBTrequires commitment, a lot of homework, and practice of the techniques in order to be successful. After all, the origins of such distorted ways of thinking have likely been engrained since childhood.

The following is a list of recommended resources (if you are currently seeing a therapist, please be sure to run the resources by them before using):

The Shyness & Social Anxiety Workbook

In The Spotlight, Overcome Your Fear of Public Speaking & Performing (for public speaking anxiety)

Overcoming Social Anxiety: Step By Step (Audio/Video Series)

3. Work on self-acceptance and feeling comfortable with being less than perfect

This is something I definitely struggle with, especially since much of our social anxiety centers around our fears of being judged and wanting to maintain a “close to perfect” image, yet at the sacrifice of openly being ourselves. How many times have you been at a meeting or lecture and are hesitant to ask a question or verbalize an opinion, but then someone else speaks up and says the exact same thought before you (this has happened to me numerous times)? Or maybe you have a fear of doing something embarrassing in front of a group of people? Recognize that your opinion is just as valuable as others and that as a human, something clumsy or embarrassing is bound to happen from time to time (even celebrities have major televised fail moments).

4. Seek help from a competent mental health professional

Seeking support from a professional who specializes in anxiety disorders is always an excellent option especially if your social anxiety is preventing you from enjoying and/or moving forward in life.

So, how did I overcome my social anxiety? Well, I went into a field that forced me to learn more about myself, started seeing a psychotherapist, participated in group therapy with my co-residents (a requirement in my residency program, which I believe should be mandated in all programs), exposed myself to situations that challenged and forced me to learn to cope with being in uncomfortable group and public settings (becoming chief resident was among the more challenging roles, yet provided the most growth), among other things. Not to say you have to do ALL these exact same steps to conquer your fear, but that’s the process I underwent in order to feel confident and comfortable being myself in social settings. And yet I STILL have to put in work on a regular basis to prevent my anxiety from getting the best of me (one of the reasons I’m in a weekly psychotherapy group). I took a one year break from therapy after graduating from residency and noticed that my ability to work through my anxiety didn’t come as easily, which motivated me to restart group psychotherapy last year.

Medications can help alleviate your symptoms, but fully gaining control and overcoming the anxiety for the long term requires work, so you have to be willing to expose yourself to uncomfortable situations, willing to keep learning, and willing to face and challenge your fears on a regular basis.

If you also struggle with social anxiety, would love to know which techniques you find most helpful to cope with social situations.

Photo by Marlon Santos

July 30, 2015 11 comments

Personal

Will Return

written by freudandfashion

{Yachats, Oregon}

Still on vacation and giving my brain a chance to rest. Will be back to reality and blogging more extensively when I return from my break next week!

Hope you’re having a wonderful weekend!

July 25, 2015 4 comments

Personal

Set Free

written by freudandfashion

{International Rose Test Garden, Portland, Oregon}

Okay, I’ll be honest. I’d much rather watch a documentary on Netflix (anyone have any suggestions?) and let my mind wander than write a blog post right now. Escaping to Oregon earlier this week for the first leg of my vacation provided a perfect combo of nostalgia, tranquility, and connection. Rather than psychoanalyze and process the impact that my trip had on my psyche (as I usually do in my posts), I’m instead going to reminisce and share pictures from my trip, which hopefully captures the essence of my time spent there. I still have one more week of vacation left, so if my writing doesn’t have as much structure and depth as usual, that’s because my writing is characteristic and reflective of my current, free-flowing state of mind.

{Washington Park, Portland, Oregon}

{Portland Japanese Garden}

{Yachats, Oregon}

{Devil’s Churn, Oregon}

July 18, 2015 15 comments

Personal Psychiatry

Open Doors

written by freudandfashion

Up until a few years ago when I graduated from residency, life appeared to have a linear, predictable path: obtain high school diploma, finish undergraduate degree, get accepted into medical school, graduate from residency, secure a well-paid job as a psychiatrist.

Yet, throughout the entire process, I encountered several challenging experiences trying to adjust to each new phase. When I moved away from home for college, I was so excited to live with four girlfriends and finally feel independent enough to lead an exciting college life. However, I can vividly recall the day my parents helped me move and when they left, I cried. For several days, all I wanted to do was isolate in my room. Eventually, I became more comfortable with my living situation and newfound independence, but my initial desire was to flee back home as often as possible.

For medical school, I was fortunate to get accepted into a school within 30 minutes from my hometown, so I was familiar with the area and lived with family that first year while adjusting to the grueling academic demands. It was so nice to come home to a hearty meal prepared by my grandmother or aunt after a full day of lectures, anatomy lab, and studying.

However, when I moved away to Oregon for residency (a state I never even visited let alone knew anybody who lived there), I felt extremely lonely and isolated. At some point, my program director suggested that I see a psychiatrist because I wasn’t performing very well on tests. I felt like a failure. Yet, finally realizing that I needed help was when I started to evaluate myself in order to create change. It’s the time that blogging became an outlet for social support and connection that I felt was missing at that point in time. It was the period of my life when I became more self-aware, made long-lasting friendships, discovered my leadership ability, and became chief resident. Such a pivotal point in my life motivated me to evaluate myself and discover my resiliency based on how I overcame my struggles.

When I rotated at the student psychological center at the local university, I saw several patients who struggled with transitioning to college life. I completely identified with them. I currently have several patients going through major changes (divorce, moving away for school, starting a new job, recently losing their job, getting married, expecting their first child, etc). I emphatically listen and validate their experiences — going through life change WILL challenge your usual ways of coping (ie, one may cope by isolating, keeping thoughts to themselves, working out at the gym more, confiding in a friend, etc). And sometimes, depending on the stressor, the usual copings skills may not be enough to overcome the challenge.

And here lies the dilemma — Even the most linear path in life has its challenges. Do you face the challenge head on, or do you recognize your limitations and choose a different path, or do you justify ways to avoid the situation altogether?

Photo by Marlon Santos

July 15, 2015 11 comments

Personal

Thankful Thursdays

written by freudandfashion

{Los Angeles, California}

I haven’t done a Thankful Thursday post on my blog in awhile (though I do a weekly “Thankful Thursdays” series on my Snapchat account), but figured I’d do one this week especially since my two week vacation is coming up the following week, which I’m long overdue and looking forward to. As I mentioned in one of my previous posts, I have been experiencing burnout from work, which has led to general feelings of detachment, mood changes, and decreased ability to efficiently maintain my responsibilities at work. Though my vacation isn’t until next week, I’ve been trying to relax and enjoy myself this week, which was accomplished by taking a spontaneous trip through Los Angeles, including the amazing Getty Museum. I am thankful not only for the break I’ll get, but for the fact that I recognized my need for self-care not only for the sake of myself, but also so that I can better support, care for, and be present for my patients.

Though 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 and here).

{Santa Monica sunset}

July 9, 2015 8 comments

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