Tag:

mental health

Being Me

{Chino, California}

My group therapy session last week left me feeling rejected, embarrassed, sad, self-conscious, and angry (all in that order). Somehow, I became the focus during group and the subject matter stirred up emotions of being an outcast preteen, which I thought I’d outgrown. I didn’t have very many friends in elementary school. Kids often made fun of me and singled me out for various reasons (one was related to race since there weren’t very many Asians at my school at the time). I clearly still remember the boy who called me names as I was shooting hoops by myself on the playground as he repeatedly told me to go back home to China (I am Filipino). Apparently, as I experienced during group therapy, the memory still effects me with just as much emotion today as it did when I was a kid, which sounds ridiculous especially since I’m a grown adult who has accomplished so much in my life. Yet, I’m sure we all have memories as a child that we either vividly recollect, suppress, or completely block out of our minds due to the pain they once caused. As much as I hated having these feelings come to the surface, I trusted in the therapeutic process and knew that re-experiencing the emotions would lead to greater insight.

Now that one week has passed, I felt different going back into my group therapy session this weekend. I was able to consciously separate the feelings I had as a kid from the grown adult I am today. During group, I shared the wave of my emotions I had experienced in the interim, as well as how my cultural background and traditional upbringing impacts my communication with others (ie, in Filipino culture, assertiveness is often viewed as being arrogant and disrespectful, whereas in American culture, assertiveness is often expected and rewarded). The outcome was a sense of validation from my group cohort, for they wanted to understand the reasons why it’s so hard for me to talk and express my opinion during group. Sure, I had to feel like crap and relive components of the hurtful experience, but the outcome is that I’m able to distinguish how those deeply ingrained feelings continue to impact my interactions with others today (ie, fear of feeling misunderstood, withholding my opinion due to fear of being judged, feeling prone to scrutiny, etc). There’s something therapeutic about being consciously aware of the origins of your emotions, whereas prior to this exchange, I felt out of control of the emotions as they were triggered. I realize that I’m not the self-conscious, shy kid I used to be. During my latest group therapy session, I recognized my ability to let down the walls that I had built to protect myself from criticism/judgment. The ultimate outcome = feeling more open to being myself.

As a result of this experience, I have even greater respect for those in therapy. It’s not easy processing painful emotions and many have experienced far more difficult and traumatic events in their lives compared to me. For anyone who believes that therapy is designed to make you feel good after each and every session, you’re wrong. Therapy takes far more work and courage than anyone can even imagine.

Photo by Marlon Santos

May 26, 2015 12 comments

Personal Psychiatry

A Cluttered Mind

written by freudandfashion

Current state of mind = disorganized.

My typical morning routine before heading to work looks pretty turbulent and disjointed. I usually hit the snooze button several times, check my email and various social media accounts in bed with my eyes half open (and probably “like” the most random, obscene pictures on Instagram and Facebook while in a somnolent state), slowly get up to conduct my basic hygiene rituals, throw numerous pieces of clothing on my bed while selecting an outfit based on my mood, then run downstairs to grab all of my belongings (purse, food, coffee), then proceed to get into my car when I suddenly realize that I forgot something, rush back inside to recover the forgotten item, then speed off in my car and head to work. Monday-Friday = same routine. I used to get jealous of my friends who’d wake up early enough to sip their morning coffee, read the paper or watch the news and get ready for work at a leisurely pace. I wish my routine could be more linear. However, my routine has existed for years and works for me. No harm is caused, other than leaving a mess that looks as if a tornado ripped through my bedroom.

I contemplated writing a post that provides tips on how to be more organized, but refrained since there’s plenty of articles and books on the subject. Plus, I’d be the last person anyone would listen to on the topic of organization. I’ve had family members, friends, exes, teachers, tutors, medical directors, etc, try and teach me strategies to better organize my life. And did I listen? Sometimes, but mostly no. I experimented with various methods and eventually cultivated my own process that works best for me. Therefore, I will at least list my tactics since sometimes it’s helpful to know what works for others:

Start the morning with a to-do list: if you’re one who can keep your to-do list straight in your mind, then more power to you. I, however, have to jot down my list otherwise nothing gets done.
Keep only one planner/organizer: at one point, I was writing things in my planner, penciling appointments into a separate calendar, entering activities into my google calendar, sticking post-its in random places = STRESS trying to keep track of everything. I’m old-school and like writing things down, so I keep one planner and make sure I list all my notes, to-do list, appointments, etc, in my planner so that I know exactly where to look.
Recognize patterns in your disorganization:
- Prioritize sleep — productivity, cognition, concentration, and overall ability to function, are directly correlated with sleep. I am most disorganized if I don’t sleep well the night before. Once I was able to identify this pattern, I learned not to be so hard on myself on those days and made sure to prioritize getting a good night’s rest on subsequent days.
- Maintain your routine as much as possible — when my weekly routine changes (for example, due to travel, etc), I have a much harder time getting re-situated upon my return. However, recognizing this pattern reminds me that I need to either be more proactive or go easier on myself if my house or office looks even more disastrous than usual (yes, I’m one of those people who takes several days to unpack my suitcases).

Though I’m currently a bit more disorganized than usual, I know that I’ll eventually get back on track. Today, I wrote my to-do list and proudly checked off half of the items listed. Over the years, I’ve learned not to beat myself up if I wasn’t able to complete everything on my list. Tomorrow is a new day and it’s not the end of the world if I have a few extra items listed and has a negligible impact in the grand scheme of things.

Therefore, my main advice is to discover what works for you. The most validating statement ever made to me about my perceived disorganization was when my mentor told me that it’s okay to find comfort in chaos. While some people prefer neat, tidy, and systematic, others may function better in a less controlled environment. Just because my routine isn’t the same as my friends’ doesn’t mean that I’m abnormal.

Thought of the Day: Which techniques help you most with organization?

Photo by Marlon Santos

May 21, 2015 12 comments

Personal Psychiatry

Social Toughness

written by freudandfashion

{Ventura, California}

I may be an extrovert, but I grew up struggling with social anxiety and still find myself battling it to this day (if this combination of extrovert/socially anxious sounds confusing, you can check out a post I wrote here). I remember being in pre-school and the teacher reporting to my parents that I never talked (I was selectively mute, meaning I kept silent while at school but talked in other environments such as home), which made it hard to befriend other kids. Therapy and pushing myself to be in uncomfortable settings (I took public speaking courses, ran for leadership office positions in high school even though I didn’t speak, and continue to be in group therapy which is extremely difficult for me) have helped me tolerate the anxiety, though I still get overwhelmed each time I go somewhere new or unfamiliar.

The first time I ever ate out at a sit-down restaurant alone was after working late as a post-graduate researcher at UC Davis. I felt nervous and swore everyone was staring at me, but felt accomplished after finishing my meal and leaving the restaurant. Even though I work part-time, I usually spend my off-days running errands, cleaning, blogging, catching up with paperwork, etc…most of the time staying at home in my comfort zone. I try to plan solo outings every once in awhile to reinforce my copings skills, so this week, I decided to take a break and enjoy an outing alone for at least a few hours with no responsibility and no to-do list except to explore downtown Ventura. I remember the fun days of residency when my friends and I would explore random towns in Oregon, though I hardly get the opportunity to do the same since moving back to southern California (showing friends around Hollywood and all the LA touristy spots doesn’t count).

I’ve had several patients whom I’ve helped work through their symptoms of social anxiety and it’s always rewarding to hear them tell me about their recent outings. So here’s a few pictures that I took from my solo outing this week:

{Shopping for a good cause}

{windy Ventura Pier selfie}

Thought of the Day: If you struggle with anxiety, which techniques have you found helpful to overcome it?

May 14, 2015 11 comments

Psychiatry

May Is For Mental Health

written by freudandfashion

It seems just like yesterday that I wrote about Mental Health Awareness Week (see my post here), and I’m happy that the entire month of May is devoted to educating the public about such a prime aspect of our wellbeing. I hope that communities will continue to grow and strengthen in their understanding of mental health so that nobody ever has to feel isolated in their struggles. For me, each day provides an opportunity to educate about mental health (though my siblings have to constantly remind me to “stop working”/psychoanalyzing on my days off). If you follow me on Instagram, I plan to post daily information related to the field for the remainder of the month of May.

When brainstorming something to write to commemorate this month, I felt that my response to a question that MedDebate asked me during an interview seemed appropriate:

In your opinion, How do we eradicate the stigmas associated with mental health conditions?

I believe that eliminating stigma requires empathy, self-awareness, and normalization of mental health discussions. Many still believe that mental illnesses are signs of weakness rather than the fact that they are true neurologic diseases. Educating and raising awareness are important factors for understanding issues in mental health, but education can only go so far without empathy. To be completely honest, even I had my own stigma going into the psychiatric profession and it wasn’t until I acknowledged my own mental health issues that I was able to be more open, relate even more to my patients, and reduce stigma in my mind. The more people are willing to talk about their own mental health, the more people can connect with one another to normalize discussions of mental health-related issues.

May 11, 2015 6 comments

Psychiatry

Trapped In A Role

written by freudandfashion

I met some of my most memorable patients while moonlighting on an inpatient psychiatric ward during my final year of residency. One of the patients I was assigned to was labeled as the highest-risk for agitation (he was restrained and placed in seclusion two nights prior), so the staff warned me, remained on standby, and closely monitored the cameras as I approached the patient to conduct my first interview. Instead of standing during the meeting, I sat in a chair to take a more submissive stance. After all, I am the doctor and patients with chronic mental illness and histories of multiple involuntary hospitalizations understandably perceive psychiatrists as possessing the power and ability to determine their length of stay and which medications they must take. Sitting in a chair below his eye level demonstrated my attempt to even out the perceived sense of power and control.

He remained standing and proceeded to yell at me: “You’re the psychiatrist?! You don’t look like a typical psychiatrist! Are you going to ask me if I’m suicidal ‘cus I’m not. Are you afraid I’ll hit you? I don’t want to talk to you!”

I wanted to bolt out of the chair immediately, but instead remained calm and allowed him to scream his frustrations, for he was likely projecting onto me a build up of anger based on past experiences with psychiatrists. I assumed psychiatrists kept interviews brief and never asked in-depth questions beyond those pertaining to his psychotic symptoms. As a medical student, I observed meetings that lasted as quickly as one minute, which usually consisted of the standard questions: Are you hearing voices? Are you suicidal? Do you want to harm others? Did you take your meds?

Once he finished yelling, I told him that I read his chart, but emphasized that I wanted to hear his side of the story. After a few minutes of allowing him to talk without interruption, he eventually sat in the chair across from me. He paused a few times with suspicion, but when he saw that I remained engaged with the conversation, we later moved on to discuss topics such as his hobbies and interest in art. When I asked about medications, he told me that his antipsychotic made him tired during the day, which tends to make him angry. He tries to fight the sedation side effect in order to stay awake, so he often refused to take it (patients get marked as “noncompliant” when they refuse their meds). I asked if he’d be willing to take the med if switched to nighttime dosing in order to help with sleep. He agreed. I slowly got up from my chair and thanked him for allowing me to speak with him. As I extended my hand out to shake his hand, I caught a look of shock on his face (perhaps doctors never shook his hand?), then he informed me that he doesn’t like shaking people’s hands. I told him, “no problem, I understand” and we both left the room.

When I returned the following day, the report from nursing staff was that my patient willingly took his medications and there were no reported issues with agitation. One staff member even said they were able to have a short and pleasant conversation with him for the first time. I was pleased, though I also felt bad because I was his psychiatrist temporarily for the weekend only. Later that day, I told him that another psychiatrist will be seeing him tomorrow. He proceeded to scream obscenities at me, but this time I ran into the medical room and slammed the door shut. I was scared, but not upset with him the slightest bit. My intuition told me that in that moment, I became just like all the other psychiatrists who proceeded me, who made headway only to leave him in an even more vulnerable state. When the nurses asked whether or not they should give him a PRN (a medication given “as needed,” in this case for agitation), I quickly said “no.” He allowed himself to open up to me and in a sense, I abandoned him. Based on his history, he has experienced abandonment from several others throughout his life.

I can’t automatically change a patient’s pre-existing, negative perceptions of psychiatrists, but he changed my perspective of patients labeled as “agitated.”

Total Time for my first one-on-one session with him = 13 minutes + a sense of feeling heard + a developing therapeutic alliance.

Total Time to call security, obtain back-up staff to restrain the patient, and monitor the patient while placed in seclusion = several hours + long-lasting, negative, traumatic experiences that the patient will forever associate with psychiatrists and the psychiatric ward.

Photo by Marlon Santos

May 7, 2015 10 comments

Personal

Home Sweet Home

written by freudandfashion

{Fairfield, California}

As a fledgling adult who moved away from home for college then medical school, my family often made trips to visit me, especially to drop off or prepare a home-cooked meal (I lived 30 minutes away from home for college and 7 hours away for medical school). Now that I’ve completed all my training, I return the favor for all the support I received and visit them in northern California as often as I can (except I’m not the best cook, so my family probably prefers that I NOT make the home-cooked meals). I am currently staying at my parents’ place this weekend for a mini family reunion and feel pretty excited that I get to reunite with family members visiting from the Philippines whom I haven’t seen in years (and apparently there’s a boxing match everyone’s watching tonight). We all have our own priorities in life and at one point my education and career took precedence over family, but I learned my lesson after missing out on numerous momentous events. Having a lucrative career can bring a sense of satisfaction, but true happiness can’t be attained unless balanced with those who support you the most.

I hope you have a balanced weekend!

May 2, 2015 11 comments

Personal

Something New

written by freudandfashion

{Upland, California}

My life throughout medical school was pretty monotonous: wake up, attend lecture, eat, go to anatomy lab, study, eat, sleep. I started to exhibit more signs of life once residency started, though limitations to participate in enjoyable activities always existed. I could never rid of feeling guilty each time I did something other than study because there was always an upcoming crucial exam (licensing exams, PRITE, etc) to prepare for. My cognitive distortion was that I’d perform terribly unless I spent every waking hour reviewing for the test, therefore I rarely experienced a day where I felt totally relaxed and present. Fighting the little voice in my head telling me to do something more productive, I’ve been giving myself permission to do more fun activities and am amazed that the self-critical voice is starting to diminish.

So, in continuation of my New Year’s resolution to be aware of my need for self-care, I took a break from paperwork this week and joined my cousin and friend on a trip to their local rock climbing gym. I completed a couple routes belaying for the first time and rediscovered how much I enjoyed the adrenaline rush. It was so much fun!

Therefore, I’d like to encourage all the students and any slightly rigid readers out there (like myself) to try a new activity this coming week. Anything from taking a different walking path to trying a new coffee shop, or avoiding the couch after work/school (seriously, anything to break the monotony is worth something and brings you a little bit out of your comfort zone). If you’re open to sharing or maybe you already participated in something new this week, post in comments below!

Have a wonderful weekend!

April 24, 2015 15 comments

Psychiatry therapy

Choose Your Therapist

written by freudandfashion

The one thing that has made me the most self-aware, insightful, and empathetic towards others, especially my patients? Psychotherapy. Everyone can benefit from going to therapy. I probably refer 80% of my patients to a psychotherapist, especially since I believe that the best treatment plans consist of more than just medications (or may benefit from therapy alone, depending on the case). When choosing a therapist for myself, I was fortunate to have a trustworthy former supervisor refer me to two great therapists since I first started therapy during residency, though I realize that most people don’t have the luxury of having a go-to person to help them navigate their local mental health resources. I pride myself and put effort into referring my patients to therapists whom I believe will be a good fit. If you’re wondering whether or not you’re ready for therapy, I wrote a previous post that addresses that question here.

The following are some guidelines/tips that I use when choosing a therapist for my patients or suggestions I would give friends/relatives if they were looking for one themselves:

Keep in mind that the most crucial factor for effective therapy is the connection you have with your therapist. The connection is important for feeling safe, developing trust, and creating a mutual understanding of your goals in therapy. Even if the therapist listed trained at the most elite programs or was Dr. Phil himself, if the connection doesn’t develop over time, then it’s best to move on to a different therapist.
If you see a psychiatrist and feel that he/she knows you pretty well…Ask them for a therapist referral based on your history and goals in treatment. Note: if your psychiatrist does NOT know you very well and solely focuses on medications and symptoms, then see bullet points below. I work part-time for a Health Maintenance Organization (HMO) where we have designated therapists/case managers (who may or may not know the patient/client) make the referral, yet I’ve made efforts to connect with the contracted therapists so that I have a sense of their therapeutic style to gauge which therapists would work best with my patients.
If you have a friend or family member currently in therapy…Ask if they’d be open to inquiring with their therapist to provide any recommendations for you (Note: make sure your friend/relative actually likes their therapist and trusts their recommendation).
Nuts & Bolts:
- if it’s important to see a therapist who accepts your insurance:
  - take a look at the in-network provider list, or search online directories such as Psychology Today (there’s a section under the profile of accepted insurance plans) and research information on the therapists online. I recently gave a close friend the gift of psychotherapy sessions as a birthday present (yes, I try to be both creative & meaningful with my gift-giving ideas) and since I didn’t live in the area, I resorted to an online therapist search.
- Whether or not you need to see an in-network provider, when narrowing down your list, consider the following:
  - Gender preference
  - Photograph – this is not intended to be superficial. Since having a connection is important, you’d likely want your therapist to appear like someone you can feel comfortable sitting across from and opening up to.
  - Location – if transportation is a crucial component, then limit your search to local therapists. I personally drive one hour to see my therapist in Los Angeles, but I’m okay with the distance because I’m willing to drive further in order to see my therapist, who came highly recommended, versus seeing someone questionable, yet closer.
  - Cost – if on a budget, there are several therapists who offer discounted fees on a sliding scale dependent on your income. If you’re a student, be sure to look into your school’s counseling and psychological services (usually covered if you pay for student health benefits). If you work for a large employer, they may have Employee Assistance Programs (EAPs) that provide confidential counseling services for their employees. However, if choosing to pursue out-of-network providers, mental health professionals in private practice may charge anywhere from $50 to over $200 a session depending on location, credentials, and experience, though cost can be greater in larger, metropolitan areas (for example, in Los Angeles, a psychiatrist who provides both medication management and psychotherapy may charge around $400/hour).
When in doubt, try it out. Yes, I’ll admit that some of my referrals haven’t worked out, but for the most part, the initial experience may solidify even more which qualities you prefer in a therapist. I’ve even had a few patients request to see a a different psychiatrist other than me for specific reasons (usually because I look too young) and that’s okay because this is your treatment and we each have our preferences. When you meet for the first time, take note of how you feel while interacting with the therapist (do you feel invited to share, does the therapist have a genuine interest in understanding you, does the therapist seem invested in working with you to help determine the issues impacting you the most?). Keep in mind that just like any relationship, building the therapeutic relationship may take some time, but as long as there’s forward movement in the process, then I hope you commit and stick with it!

Any other comments or suggestions?? If any of you are in therapy, I would love to hear of tips/information you found helpful when choosing a therapist, or, if you’re a mental health professional, I truly welcome your thoughts on how to choose a therapist as well!

April 22, 2015 13 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

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