Tag:

mental illness

World Mental Health Day 2016

I talk about the subject of mental health EVERY SINGLE DAY. Therefore, with today being World Mental Health Day, I thought long and hard about how I’m going to say something any different than what I wrote on this day last year and what I say in my job as a psychiatrist on a daily basis. So here’s what I came up with:

NOTHING.

No joke – I literally sat in front of my computer for hours typing idea after idea, sentence after sentence, complaint after complaint about our mental health system when I decided to scratch everything I wrote and opted instead to free write the following thoughts:

Issue 1: Mental health impacts EVERYONE…whether we choose to acknowledge it or not. The topic of mental health is considered taboo in many cultures and remains highly stigmatized in society. However, in order to break the pattern of silence which gets passed along generations, we must acknowledge our own mental health issues and create a sense of safety within our own families to feel open enough to discuss issues as they arise, thus modeling a healthier way of communicating.

Issue 2: We often tell people “don’t be afraid to ask for help,” yet when they finally decide to seek resources, the first place they may end up is on a long waitlist to see a mental health professional, yet mental health professionals are overworked and becoming burned out trying to meet increased demands and make up for the lack of resources. The bigger issue is that more funding and resources are needed to bridge the gap in order to meet the need.

Issue 3: If you Google ‘World Mental Health Day,’ the top articles on your feed likely consists of links that highlight the Duchess of Cambridge, Prince William and Prince Harry’s public appearance today to raise awareness of mental health and support the mission of Heads Together, the mental health organization they helped create. I love their theme for World Mental Health Day, which encourages people to celebrate anyone who has supported them through a difficult time using #ThereForMe. Support is absolutely necessary for everyone, especially those struggling with mental illness.

Personally, through each struggle I’ve experienced, I have always been thankful for the support I received. Often when my patients are struggling, they feel comforted knowing they have at least one person they trust to reach out to. I hope that someday each one of us could feel open enough to be that person to someone because addressing mental health isn’t something we should have to go through alone. Rather than waiting on legislation to create measures that prioritize mental health, we can each act now by identifying ways to address our own mental health and be more present for those close to us who might be in need of support.

By the way, I realize that I posted this blogpost quite late today, but I suppose there was no real sense of urgency because in my mind, World Mental Health Day is EVERY DAY.

October 11, 2016 8 comments

Series

Questions I Bet Your Psychiatrist Never Asked You

written by freudandfashion

Why I created this series:

Every psychiatrist has their own style, but I’ve always been interested in asking patients more open-ended questions if I think it will provide me with a greater understanding of who they are as unique individuals. Unfortunately, I believe that the art of psychiatry has dwindled down to a checklist which subsequently churns out a diagnosis and treatment plan based on the minimum criteria needed to properly meet billing requirements. Such a practice may lead to a lack of connection in the therapeutic relationship, therefore, I sought to create a series that explores the unspoken thoughts that a person may have when meeting with a psychiatrist. If you would like to contribute to future questions in this series, please email me at freudandfashion@gmail.com or add me on Snapchat (freudandfashion).

QUESTION OF THE WEEK:

How do you think medical doctors treat patients with mental illness differently than those without mental illness?

RESPONSES:

I didn’t really notice much of a difference in the way medical doctors treated me with a mental illness, until I had to get surgery on my wrist. My surgeon went on extensively that I was at a higher risk for abusing the pain medication post surgery. I had to go to lengths to prove to him that I would be able to minimize this risk, and wean myself off the pain medication as soon as possible. After this experience, I wondered if a patient without mental illness would have gone through as much scrutiny.

~ Logan, pre-med student

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Doctors treat patients with mental illness differently than those without a mental illness. From experience, doctors treat people with mental illness like they are stupid, incompetent, and incapable of doing anything for themselves. They get treated with less respect as well.

~ Allyson, student

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It depends on how much the doctors actually know about mental illnesses. The majority, unfortunately somehow equate people with mental illnesses as mentally challenged individuals. Most doctors know, before they even meet you, that you have a mental illness due to the fact that the doctors generally see what kind of medications you are currently on prior to walking into the examination room.

I literally have had some very rude doctors that would be new to me and upon opening the door, they don’t say hello…my name is…or anything. They will have their nose in the charts or x-rays and then don’t look you in the eye and tell you what they recommend and then just walk out. It really pisses me off when they act so arrogantly. I generally never do return back to see a doctor who treats me like that. Then there are those that seem a bit nervous about meeting me; however, once I start talking like the college-educated woman that I am, they seem impressed and/or astonished that a person with a mental illness could have such insight.

So it angers me and depresses me that most doctors will tag a “stupid idiot” label on someone who is taking psychotrophic medications or acts as though nothing I say is true for I might be having delusions…yet, with each new doctor I encounter, I hope to go away feeling satisfied that I for one don’t meet the stereotype that our society has created for people with mental illnesses.

~ Anonymous

_____________________

My family medicine doc never follows up on anything, ever. I have to remind them of everything so if I don’t bring it up, it never gets addressed. And when I try to bring it up, they look at me like I’m crazy. I guess it’s a good thing that I’m smart, knowledgeable and know a lot, but I can’t imagine what it must be like for people who don’t know anything. I just finished reading Black Men, White Coats and that book is really honest. I see it happen all of the time. I think patients are disregarded in all aspects and I think with African Americans, they treat us differently when it comes to mental health. But i don’t want to pull the race card, this is my perception of what i see.

~ Sherita, pre-med student

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Personally, sometimes I think some people don’t consider mental health as important as physical health. Maybe that’s why some doctors do not pay attention to this point.

~ Anonymous, student

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If you have any thoughts or experiences pertaining to the question, please comment below!

May 14, 2016 11 comments

Featured Guest Blogger

How a Nurse Practitioner Living With Bipolar Disorder Takes Control In the Workplace

written by freudandfashion

I first came across Ann Roselle, an acute care nurse practitioner, via Twitter after reading the extremely personal and brave post that she wrote for the online magazine, Ravishly, which poignantly highlights the humiliation she experienced during one of her numerous psychiatric hospitalizations. Given the stigma that surrounds mental illness, many may feel ashamed to disclose their diagnoses (especially as a professional in the medical field). However, Ann writes so openly about living with postpartum onset bipolar disorder as a guest contributor on several websites and in her blog, Bipolar&Me. She dispels the misconception that people diagnosed with bipolar disorder can’t live fulfilling lives, have a successful career, balance numerous roles and responsibilities (wife, mom of 3 boys, mental health advocate, blogger, to name a few), AND cope with the fluctuations in mood characteristic of bipolar disorder. I am a huge fan of Ann’s writing and am honored to have her contribute to my blog as she discusses her commitment to maintaining stability in her personal and professional life.

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“It’s stylish to talk about mental health, especially how we maintain our own.” As a nurse practitioner who lives with a serious mental illness, bipolar I disorder to be exact, how could I not fall in love with a blog with a psychiatrist who talks so frankly about mental health and her practice?

I am a surgical nurse practitioner, specializing in cardiac surgery. I am fortunate enough to be able to be open about my disorder in the workplace. I had fears initially about being open, however with time I believe it has proven to be a positive experience. In my case, living with bipolar disorder never proved troublesome with my training as I was diagnosed after I had been in active practice for six years. So, the questions that beg to be asked are — How does my illness impact my patients or influence my interactions with them? And how do I maintain stability with full-time employment in a stressful environment?

First, it starts with the moment you accept that you have an illness. That you have an illness you are going to need to learn to manage as one manages any chronic illness. And, I won’t lie — accepting the diagnosis is hard. I didn’t want to accept my diagnosis for a long time. I cried and mourned the vision of the life that I thought I was going to have, that I was supposed to have, thinking everything changed in the moment I received my diagnosis. It took a long time for me to realize nothing had actually changed and that the life I wanted and envisioned was still there waiting for me to seize it.

Part of my seizing the day, so to speak, was to commit myself to doing what I needed to do and stop fighting with my treatment team. Stop fighting the need for medication. To stop being the non-compliant patient I would roll my very eyes about as a practitioner. I showed up for appointments, attended groups faithfully in the early days, and took my medications. I played with my diet trying to find a proper nutritional balance. I quit drinking on a regular basis. I became fanatical about ensuring proper sleep hygiene and getting rest. I fully admit that I am not great about the exercise piece as my work hours limit my ability to get to a gym on workdays and I am so busy with my family on days off. I’ll get there, though. Exercise helps mood and I feel infinitely better on the days I’m physically active.

Now, what about nursing practice you ask? What about those patients? Ultimately, if you are in treatment (on meds, working with a therapist, a prescriber, or even have a support group to fall back on) and stable, the disorder has no bearing on your practice. None. I hold the view my bipolar disorder is a chronic manageable condition no different than diabetes or hypertension. I learned (and am still learning) to manage my moods in the same vein that a diabetic learns to count carbohydrates and manage their blood sugar.

Emotionally, I have always had the ability to hold myself together for the hours I am at work and dealing with patients. My patients will never know I carry this diagnosis. I may fall apart once I get home and feel safe to do so, but never within the walls of my employment. I also make it a rule that no matter what happens, no matter the co-morbid psychiatric diagnosis my cardiac patients may carry, I never reveal myself to them. They come for cardiac care and not to hear my story. I do find I have become more empathetic to those who carry psychiatric diagnoses. I discourage staff from saying inappropriate and stigmatizing things both in and out of earshot of patients. There is a huge difference in a patient who is emotionally labile because of a mood disorder and a patient who is emotionally labile trying to cope with their physical illness. I view it as my responsibility to help staff understand such a critical difference. Emotional lability in and of itself does not a bipolar make. I make sure my patients’ home medication regimens are adhered to as closely as possible. And when a patient is acutely decompensating in terms of their mood or mental status, I make sure that medically we have dotted our I’s and crossed our T’s before calling the psychiatry consult service.

I’m not perfect. I have days I need to take a time out and walk away. This is beyond the usual code blue that may have been upsetting for staff or seeing a patient I really cared about suffer from a devastating complication. I have colleagues who respect that need and allow me the moments I need to compose myself and come back calm and ready to do my job.

I am fortunate to do what I do. And I am fortunate to be able to practice with both the patient and provider perspective.

While I am only human, at the end of the day, I think all those I encounter are better for it.

For more of Ann Roselle’s writings, check out her blog, Bipolar&Me. You can also find her on Twitter and Facebook.

October 27, 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

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

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

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

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

Psychiatry

Loss Hurts

written by freudandfashion

{Serra Cross Park, Ventura, CA}

Every bit of me is fighting not to lay on the couch and immerse myself in reality tv to distract from experiencing the emotional distress of a recent loss. Doctors grieve the loss of patients. I have grieved. Unfortunately, the grief process is all too familiar in my line of work. In fact, tears stream down my face as I type this because I know I have to acknowledge my grief rather than having shock, anger, sadness, and a whole mixture of emotions take control of me. After receiving a call from the coroner’s office earlier that day, I drove home dazed and missed the entrance to my voter polling place…three times. And I almost got in an accident.

The worst part is knowing that suicide happens too often. The second worst part is a combination of feeling horrified, sorrow for my patient’s family, and disbelief (what did i miss? what did i do wrong?), wondering if there’s anything I could have done to prevent it. But worst of all is to think of the depths of severe, emotional pain that my patient must have experienced to reach that point — no words can describe, and nobody can empathize with my patient’s despair unless they’ve been to a similar dark place before, or know someone who has.

Which is perhaps one of the reasons why there are barriers to change the perception of mental illness — do we distance ourselves so much from those diagnosed with mental illness that we can not acknowledge, empathize, or even begin to understand that suicidal thoughts are symptoms of a true, neurologic disease? Or will society continue to turn a blind eye by continuing to believe that suicidal thoughts are feigned, a product of a hopeless mind, or a sign of weakness?

I can vividly recall the first time I lost a patient on the medical floor as an intern during my internal medicine rotation. Cause = Septic Shock. “Here’s where things went wrong and could have been prevented,” said an Attending physician when the case was reviewed. I wanted to quit my medical career that very moment. This time around, there is no Attending physician telling me what I did wrong — the voice is my own. The voice is always there, and I want to quit. I want to isolate and lay on my couch the entire day, but I can’t. I want to cry when I’m in clinic each time my coworkers kindly ask “how are you?” but I hold back the tears. I wish I could redo the last session with my patient, but instead, specific moments from our final conversation replay in my mind. It’s not until now, as I type, that I remember my patient’s last words to me as she gave me a hug on the way out. Touching words I will never forget and reinforce why I need to keep going.

November 6, 2014 16 comments

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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