Tag:

mental health

Let Go

{Ventura, California}

Several of my readers know how much I struggle with self-care and criticize myself on days that I feel less productive (I wrote about the subject here, here, and here). I’m starting to let go of the guilty, judgmental thoughts, which I’m sure are ingrained in the minds of many others like myself who’ve spent most of their lives incessantly working towards a degree and busy career. Last month, I disclosed to one of my patients that I sometimes sit on the couch and watch tv for hours on days I feel exhausted and overwhelmed. I regretted telling her the information because I realized my attempt to make her feel less guilty about doing a similar “lazy” regimen was really an attempt to validate my own actions of simply resting on my days off. I realized how much I still need to work on letting go. I need to let go of the pressures, demands, guilt, and self-criticism.

Well, I’m happy to report that I went to the beach this week, strolled, and stared out at the water as the surfers rode the waves. The thought of rushing home to answer emails popped up in my head a few times, but I surprisingly allowed myself to let the thoughts go. I’ve been working on this process of self-care for years, but I’m making progress. And that’s all that matters (no self-criticism involved).

What activities of self-care did you incorporate this week? I hope you all have a wonderful, relaxing weekend!

April 10, 2015 12 comments

Personal

Residency Memories

written by freudandfashion

{Voodoo Doughnut, Eugene, Oregon}

I enjoy taking a stroll down memory lane every once in awhile to reminisce about the past. While trying to find a photo for my next blog post, I came across pictures of fun times in Oregon during residency training. In effort not to embarrass my fellow colleagues (think trashy theme party, dancing to “Baby Got Back,” and movie nights with some of the most grotesque films ever made, to name a few examples), I limited the photos to the least embarrassing (not surprisingly, many photos were eliminated), pictures mostly of myself, or with the obtained consent from my residency friends (if identifiable in the photos). I may constantly mention the hardships of the journey through medical school and residency, but my three years spent in Oregon brought about many friendships, fun experiences, and memorable moments that I’ll treasure forever.

{Residency Retreat at Black Butte, Oregon}

{Wine Tasting in the beautiful Willamette Valley, Oregon}

{My 1st time golfing}

{Good thing I didn’t get graded on my Pictionary skills because I clearly would’ve failed}

{Oregon Medical Association conference in Bend, Oregon}

{My 1st time snowshoeing, Bend, Oregon}

{My Princess-themed party that my awesome co-residents threw for me before graduation}

April 2, 2015 6 comments

Psychiatry

Brain Injury Awareness

written by freudandfashion

{With my mentor after my sports concussion talk in San Diego last year}

I find that the more passionate I am about a certain subject, the harder it is for me to write about the topic in my blog (mostly because there’s so much I’d like to convey in a brief post). Today is the last day of Brain Injury Awareness Month and the theme for this year’s campaign is Not Alone. I’ve worked with several patients whose lives and their family’s lives are dramatically changed as a result of the injury. From mild concussion to post-concussion syndrome to traumatic encephalopathy — to be honest, I don’t believe there’s anything about brain injury that can be characterized as “mild” mostly because the injury can potentially lead to longterm, permanent damage and impact their lives forever.

My goal in treatment has been to improve their quality of life and restore daily functioning to as close to normal as possible. Unfortunately, restoration of baseline functioning is not possible for some. At that point, the focus shifts to recovery, acceptance, and how to move forward and cope with the sometimes debilitating symptoms. And acceptance doesn’t only need to be acknowledged by those injured, but also their families. One of the hardest, yet most rewarding parts of my job has been to help my patients find motivation within themselves to keep pushing forward and find a sense of purpose in their lives. And it’s crushing to see family members feel helpless as they watch their loved one struggle to overcome the physical and emotional barriers. However, recovery is possible and I work with several patients who find hope and are motivated to look for work, seek support from loved ones, and find ways to make their lives as enjoyable as possible.

The theme Not Alone refers to the estimated 12 million Americans who live with the impact of traumatic brain injury and the 5.3 million who live with resultant disabilities. These numbers don’t even account for the number of people who do not seek treatment. There are many misconceptions about when to seek help (which I plan to discuss in a future post), in addition to social pressures to underreport (especially in sports). Many often feel ashamed of their injury, but hopefully with increased awareness, the general public will recognize its prevalence and take part in providing support and understanding to those effected.

For more information on brain injury, please visit the Brain Injury Association of America website.

March 31, 2015 6 comments

Personal

Drift Away

written by freudandfashion

{San Diego, CA}

My whole week was a bit of a blur. I sometimes wish that I could take a vacation for a few months and have no responsibilities whatsoever. Where would I go? I have no idea. What would I do? No clue. Come to think about it, having no responsibilities for an extended period of time might be depressing. After all, my entire life has been devoted to my career, which is a huge part of my identity. Without my work, I’d lose my sense of purpose especially since being a physician makes up a large percentage of who I am. Perhaps that’s why retiring can be so hard (I have several retirees who present with depression). With that in mind, I suppose the better alternative to an extended vacation would be to continue working, but at a comfortable pace with firm limits and boundaries in place. It sounds so simple. After all, I know my limits and the workload I can handle before getting overwhelmed…but it’s my job to reinforce it. I guess reinforcing it is sometimes harder than the job itself.

March 28, 2015 6 comments

Psychiatry

Teaching Influence

written by freudandfashion

{Malibu, CA}

Current thought: I’m glad I turned out to be a decent psychiatrist.

I remember being an eager medical student during an internal medicine rotation and asking a consulting psychiatrist the reason he diagnosed two of my elderly patients with schizophrenia. I anxiously awaited his response (Note: I highlight the word elderly because diagnosing schizophrenia at such a late onset in life is rare) and he gave me the most nonchalant, dismissive response: “because they’re having hallucinations.” He got up and walked away before I could ask him any more questions. Well, Mr. Psychiatrist, if I knew what I know now, I would’ve told you back then that you were a horrible doctor because you did not even talk to my patient nor put any thought into your diagnosis, nor care that giving a frail 70-year old woman excessive doses of antipsychotic medication might actually make her worse (excessive doses of antipsychotics may increase risk of confusion, oversedation, and pneumonia in the elderly population).

The accumulation of my experiences working with various attending physicians (aka supervising physicians) have shaped the way that I practice psychiatry today. One of the first lectures I attended during my psychiatry residency was about the emphasis of humanism in mental health, which was a concept that was markedly different than what I observed during internship (I had made the decision to switch to a different residency program after internship). I remember feeling ashamed during the lecture because I recalled how I used to write orders for “B-52’s” (the nickname for a cocktail of medications given by injection for acute agitation; a chemical restraint) so frequently and unhesitatingly during internship. Needless to say, that lecture set the tone and confirmed that I made the right decision to change training programs. My whole perspective and approach to psychiatry changed by working with the most caring and compassionate psychiatrists, therapists, and nurses. I obviously recall interacting with a few terrible psychiatrists, which actually turned out to be a useful learning experience: I learned how NOT to practice psychiatry. So, if you are interested in pursuing a career in the mental health field, I hope that you train with amazing supervisors, remain open-minded (psychiatry is not so clear cut as reading the DSM 5, our diagnostic manual), maintain empathy, and remember that each individual/client/patient has a story.

The greatest compliment that I’ve received from several of my patients is also a sad reality about the spectrum of practitioners in my field: “You’re not like any psychiatrist I’ve met before. You actually try to get to know me.”

March 25, 2015 36 comments

Lifestyle Personal

Thankful Thursdays – Time Off

written by freudandfashion

{Fairfield, California}

Time off from work couldn’t have arrived at a better time. It has been awhile since I wrote my last “Thankful Thursdays” post (see previous ones here and here), so I think it’s appropriate to write one given my current state of mind (which is more relaxed and centered). My vacation started off with a quick, last minute trip to visit my family in northern California, which is usually my preferred travel destination each time I get the urge to feel more rooted and have the need to reset. During a stroll with my sister, I realized the grassy hilltops are gorgeous landscapes that I’ve taken for granted ever since my family first moved to the area when I was in junior high. For some reason, the lush hills appeared immaculate and majestic this time around. I enjoyed reuniting with family visiting from the Philippines, tasting my mom’s traditional filipino dishes, and playing card games with my cousins and siblings. I truly savored my brief stay.

Currently, I am sitting in a hotel lobby located in the flourishing city of Scottsdale, Arizona. I stare outside at the backdrop of pristine mountains, pale blue skies streaked with thinly layered clouds, and adobe fountains and fixtures at the forefront. Everything seems extremely tangible – from the texture of the furniture to the warmth of the sun hitting my face. While attending a conference, I am also aware of the numerous psychiatry and neurology residents here preparing to take their board exams tomorrow, as they lay out by the pool with heads buried in flashcards and exam prep books.

“I remember being in your same position two years ago,” I said to one of the girls who studied while lounging on the chair next to me. All I could remember from that day two years ago was memorizing the diagnostic criteria for various psychiatric diagnoses, the treatment for alcohol and drug withdrawal, etc. I never would have imagined noticing the simplistic, yet characteristic details of the locale like I am able to observe now. Fortunately, I passed the horrific test, yet I reflect on the past and a part of me wishes I was more mindful of the details from that experience. However, as the saying goes, “better late than never.”

Photo by Marlon Santos

March 12, 2015 6 comments

Personal therapy

Numb

written by freudandfashion

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

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

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

March 5, 2015 20 comments

Personal Psychiatry

Casual Fridays – Join the Cause

written by freudandfashion

I started blogging during psychiatry residency training a few years ago not only because I needed a creative outlet, but also because I felt lonely and isolated living in a new town without an established support system. I initially coped by laying on the couch watching excessive amounts of television, but then the idea to start a blog popped up in my mind. Since I rarely shared my feelings with colleagues and supervisors, imagine how embarrassed I felt when my medical director told me that he read my blog! He said that he learned far more about me within minutes of reading a few blog posts compared to the last few months since I joined their program. Since I never felt comfortable enough to verbalize my thoughts nor struggles, I realized that my writing provided a necessary outlet of expression. Over time (through my training and participating in both group and individual psychotherapy), I let down my guard, however, it’s still a significant work-in-progress (ask the members in my current group therapy cohort). However, my experience allows me to empathize with my patients, especially when they describe the difficulties of discussing their issues with others.

The purpose of my blog has been to create an openness to discuss mental health, so I was excited when I came across the conscious clothing line, Wear Your Label, which shares a congruent mission: to create conversations around mental health and ultimately end the stigma. Each garment creates a sense of connection and empowerment by emphasizing positive messages in each piece. For example, their “Stuggle vs. Strength” tee (worn in photo) highlights the co-existence of both strength and struggle, for, the “most valiant strength develops through times of struggle.”

Many organizations, advocates, social media forums, etc, are rising with the same goals in mind of providing support, education, and resources to prioritize mental health. However, each one of us can contribute to this goal simply by opening up about our own individual struggles. That way, none of us ever have to feel alone.

February 27, 2015 6 comments

Psychiatry

Friday Reflection

written by freudandfashion

{My dad’s USAF retirement ceremony}

Though I enjoyed looking at all of the thoughtful, commemorative posts to acknowledge Veterans Day (I also posted a happy photo on instagram of me and my dad, who served in the Air Force), I felt a sense of suppressed, sad emotions as well. It was hard to pinpoint because I believe a part of me did not want to acknowledge the fact that behind several of the smiling faces could be a lot of pain, especially with the harsh statistic that 22 veterans commit suicide every day.

One of the most difficult patient cases I ever participated in was as a medical student doing psychiatric consultations on the medical floor. I was paged to see a man in the Intensive Care Unit (ICU), who was on a ventilator for over a week after he survived a suicide attempt jumping off of a highway bridge. He would likely never recover from the damage of his injuries and would stay in a hospital on a ventilator for the remainder of his life. I reviewed his history: he served in the Army, fought in the Vietnam War, was diagnosed with Post-Traumatic Stress Disorder (PTSD) and alcohol addiction, and never had psychiatric issues until he returned home from Vietnam. And there he lay in the ICU — he could not talk, move, nor write. He was essentially a vegetable. Family never came — I don’t think he had any. Yet, I sat there next to him and dedicated at least 10 minutes per day, whether he knew I was there or not, because I felt he deserved to be acknowledged and cared for, at the very least for his service and sacrifice for his country.

Reflecting on that moment, I realize how much our system needs to prioritize support services for the men and women who protect our country. I currently see patients who have served in the military and are diagnosed with PTSD, but I can’t help but think of the majority of veterans who are limited in resources or ashamed to seek help due to the stigma attached to such diagnoses. I hope that some day soon all of our veterans will be able to receive the psychological services they rightfully deserve and need.

Image credit: www.army.mil

November 14, 2014 7 comments

Psychiatry

You Are Not Alone

written by freudandfashion

{OCD Awareness Week}

As a kid, I guess I had strange habits: tip toeing on floors to avoid picking up germs, blinking each eye a certain number of times on each side, tapping my fingers as if I was playing an imaginary piano, and the list goes on. I never thought my habits were a problem until kindergarten when my mom was called to pick me up at school. Apparently, it was wrong for me to pee in my pants because I thought the bathroom in my classroom wasn’t clean enough to use. Fortunately, I outgrew most of these habits (yes, I no longer pee in my pants), but some of my symptoms still persist to some degree. Though I do NOT have OCD (Obsessive Compulsive Disorder), I have several patients who suffer from the disorder and feel tormented by their debilitating symptoms.

In support of OCD Awareness Week (October 13-19, 2014), I want to share some knowledge and facts about OCD.

In the United States, OCD is the 4th most common psychiatric diagnosis
- this means that 1 out of every 40 people in this country may suffer from OCD
Internationally, 1 in 100 adults, and up to 1 in 200 children likely have OCD

Therefore, if you have OCD YOU ARE NOT ALONE.

OCD is more detailed to discuss in one post, but the explanation I give my patients includes some of the following points:

Everyone experiences anxiety to some degree. Some may cope with the anxiety by cleaning, organizing, and checking behaviors (such as checking doors to make sure they are locked), but those with OCD repeat these behaviors to the point that their symptoms cause impairment in their day to day lives. Their symptoms can be quite distressing, time-consuming, and debilitating to the point that relationships, school, and work are negatively impacted.
One misconception is that people with OCD are perfectionists, rigid, controlling, domineering, and have a “my way or the highway” mentality. This is not necessarily true because most people with OCD recognize that their symptoms are excessive and problematic, and more often feel embarrassed, ashamed, and far from perfect.

Now, if you’re wondering about my mismatched socks outfit — I’m wearing them to show even more support for OCD Awareness Week. Though the week is almost over, you still have time to show your support and participate in promoting the discussion of OCD by wearing mismatched socks and posting a picture through social media (use hashtags #sockittoocd, #ocdweek).

For more details on OCD and its symptoms, please visit the International OCD Foundation website.

October 16, 2014 4 comments

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