Tag:

psychology

Boys Don’t Cry

As we approach the final days of Mental Health Month, one of the best ways to highlight this month’s theme – Life with a Mental Illness – is to feature inspiring individuals who are motivated to share their stories in hopes of breaking stigma and helping others. The first few emails I received from Richard Brea stood out to me due to his desire to write about a topic that is extremely important, but unfortunately not discussed often enough, as you’ll read below. Richard’s writing has been featured in several mental health websites, and his honesty and openness is what makes his writing so refreshing to read.

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Boys Don’t Cry

Boys don’t cry. At least that’s what society tells you nowadays. You’re not a real man if you cry and you’re not a real man if you wear pink. You’re not masculine if you show emotion. As a depressed teenager I kept everything bottled inside. I had no friends or anyone I could talk to. I felt alone. My battle with depression started when I was 15 years old. After a breakup with my first girlfriend (at the age of 17) I reached my breaking point. I tried committing suicide by overdosing on pain relief medicine mixed with alcohol. Nothing happened. I got a bit drunk and fell asleep. I didn’t tell my family what happened until two weeks later. Doctors told me the best thing I did was speak up and seek professional help. I wanted to die so their words meant nothing to me. I was upset that I failed at committing suicide.

During my first hospitalization at The Lowell Youth Treatment Center, I met a lot of kids like myself. Some were depressed, some tried committing suicide, some had abusive parents that were also drug addicts, and some of them were there until they were placed in a foster home. I enjoyed being around kids like myself. It was effortless for me to be open and honest with them. I appreciated everyone I met. I wish I could say the same for the doctors and counselors I encountered during my three week hospitalization.

While talking to one of the older counselors there he told me, “You don’t want to cut yourself. Only girls cut themselves.” I felt bad, but I nodded my head and said, “Yeah, you’re right.” That was the first time someone tried to make me feel ashamed that I hurt myself. The second time was when my writing was featured on a Borderline Personality Disorder website. Before my piece was published the owner asked me, “How do you feel being a man that hurts himself?” I was disgusted by her question. She wanted to include my response in the final piece but I told her ‘no.’ I said, “I don’t think about being a man when I hurt myself. I don’t want to include that in the piece. At the end of the day we are all the same. It doesn’t matter what my gender is.”

During the first and only meeting with one of the therapists at The Lowell Youth Treatment Center this doctor said, “You need to be a man about it.” He was talking about me being a man to get over my depression. He made it seem like manhood is based on how you handle depression. I know, it’s pretty ridiculous. When he said that statement I became infuriated. I felt no connection with him from the beginning and after that statement I got up and walked away. I told him, “I’m done. I’m not talking to you anymore.” Joe, one of the counselors I got along with very well, noticed I stormed into my room and he asked me what happened. I told him, “I’m not talking to that f*ggot. I’m not talking to him anymore.” Joe asked me, “Why? What happened?” I replied, “I just don’t want to talk to him anymore.” A few minutes later the doctor came to my room and tried talking to me. “What’s wrong Richard? I’m sorry if I said something to upset you. Do you want to talk?” I ignored him. I told him I didn’t want to talk to him. That was the last time I ever saw him.

From that point on, I refused to talk to male therapists. That may be an extreme way of thinking but I wasn’t going to deal with that type of nonsense again. I’ve always believed women are more understanding and compassionate than men are. When I had to move back to my hometown of Lynn, Massachusetts to get clean and sober, I ended up seeing two therapists – one female and one male. Dr. Moreno definitely changed my views on having a man as my therapist. I told him this numerous times. He smiled and thanked me. He told me, “Of course. Not all guys will be like that therapist in the hospital.”

I mentioned the therapist’s comments about “being a man” and Dr. Moreno was astonished when I told him this. “Really!? He said that?” I laughed and said, “Yeah. He did.” “He shouldn’t be a doctor if he’s making comments like that. I don’t believe it.” I agreed with him.

That hospitalization also served as the catalyst that shifted my views on homosexuality. Up to that point, I was like every teenage boy in America. I would use homophobic slurs to insult people (like that therapist) and make gay jokes when I was with my boys. During my hospitalization I met a kid named Luis. When I first met Luis I was with my roommate, AJ. AJ asked Luis why he was there. His answer truly broke my heart. “I’m here because I tried killing myself because I’m gay.” I felt his pain when he said those words. It’s sad that he tried killing himself because of his sexuality. I don’t blame him for his suicide attempt because I can only imagine what he had to go through on a daily basis to get to that breaking point. I blame the people around him for making him feel like he’s less of a man because of his sexual orientation. After meeting Luis, I never used another homophobic slur. I never made another gay joke again. I am proud to say that those two statements are still true.

A few of the people I work with have a mental illness. You can look at them and realize that. You can look at me and think I’m “normal.” I was talking to my co-worker, Travis, on Friday and he said, “I may be wrong but from my point of view it seems like the people in the front of the office don’t mess with us in the back. But not you, you’re different.” It wasn’t the first time we talked but it was the first conversation we had. I told him, “You know what, you’re absolutely right. For whatever reason, a lot of them think they’re better than you guys. It’s unfortunate, but it’s the truth.”

I was reserved during our talk but as soon as he said that, I opened up regarding my struggles with mental illness. I showed him the visible scars on my wrists and shoulders from when I used to cut myself. I told him, “I have a mental illness. I struggle with depression and anxiety. I’ve tried killing myself before. At the end of the day, we are all the same. I like being around you guys. You guys appreciate life. Not to say I don’t, but you guys are positive. I want to be like you guys.” It’s a damn shame some of my co-workers think they’re above the telemarketers at my job, but that’s who they are. All I can do is make sure when people see me, they see love and equality. I want people to enjoy my company and find comfort knowing they don’t have to worry about being judged because of their past or how they look, dress, and/or live. We all seek and want the same thing. We all want love and to have our voices heard.

I don’t know why men don’t speak up regarding their mental illness, but I do understand why they are hesitant to do so. Society makes you feel like less of a man if you seek help. Society tries to shame you for speaking up and getting help. I can’t imagine what other men have to deal with if I’ve had doctors and a site owner trying to shame me for how I dealt with depression. I’ve heard statements that have made me feel bad, but I’ve never let them change who I am as a person. It’s hard being open, vulnerable, and honest but I know it’s worth it when I get comments on my BPD piece that is three years old. It’s worth it when I talk to Travis, my co-worker, and he tells me that he gets good vibes from me. I applied for a video project with a non-profit based in Canada. They received over 200 applications but only two men applied. I was one of those men. They ended up choosing females for the video project. I was heartbroken by their decision. Below is a screenshot of the conversation we had.

I don’t know why the stigma of mental health doesn’t affect me like so many other men. I never really worried about what other people thought. I was so focused on getting the help I needed so I could live a healthy and happy life. I spent the first two years I was depressed keeping everything to myself and bottling my emotions and feelings. I ran away from my problems. That type of behavior is destructive not productive. After being hospitalized, I realized that talking about my feelings was going to benefit me.

Over the past few years I have seen my story help others. That’s when I realized there was a purpose to my pain and suffering. Now, I don’t hold back when talking about my story. I help break down the stigma by being open and honest. I look forward to the day where people won’t be judged by their disability, sexual orientation, or color of their skin. Until then, I’ll keep sharing my story and living my life to the fullest no matter what. And when I have a bad day, I will cry because contrary to what this world tells me, boys DO cry.

Richard is 29 years old and living his dream in Los Angeles, CA. He is a believer in Jesus Christ and his faith has helped him in his struggles with mental illness. He is a writer and is working to publish his autobiography, Out of the Darkness, later this year. He loves music, movies, and reading. He strives to break down the stigma surrounding mental illnesses and disorders by sharing his story. He hopes to inspire the mental health community. Follow Richard on Instagram or email him at Rbrea1986K@aol.com.

May 26, 2016 5 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

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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 An Advocate With Bipolar Disorder Gained Strength From The Online Community

written by freudandfashion

When I first became active on social media, I was pleasantly surprised to find a number of mental health advocates who were so open about sharing their stories of living with mental illness to the public. Rudy Caseres was one of the first advocates I connected with. What impressed me the most about Rudy was his willingness to share his ups and downs of living with bipolar disorder. Attaining stability hasn’t been easy, and I find myself cheering him on because he is the type of person who pushes forward and embraces each triumph. He is the type of person who will motivate you and lead by example (even if the role might have been awkward at first, I find that to be one of his most endearing qualities). Therefore, I’m excited to have Rudy contribute to my blog as he discusses his motivation to share his story and become a speaker for the National Alliance on Mental Illness (NAMI).

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To have a sense of belonging — I used to not know what that felt like for the longest time. I was always the last person to be picked in team sports. I never got the lead role in school plays. I’ve been rejected by more women than I can count. Fun, fun, fun.

So, naturally, I was not too optimistic when I entered the world of mental health advocacy. To begin, I was already apprehensive about discussing my bipolar disorder in public. I had not yet told my dysfunctional family and was dreading having to explain myself to them. But I knew I could not hide the truth any longer. I did not want to feel ashamed.

It just so happened that during this time I began to be consumed by mania. I convinced myself that I was never mentally ill and that I didn’t need anyone’s help to “conquer the world.” Even though I kept telling myself it would never happen, I eventually crashed into a terrible depression. It felt as if the bottom had fallen out inside my brain. I had a real illness.

As debilitating as that experience was, I did not want it to get in the way of telling my story to the world. Well, such a task is easier said than done! My brain had tricked me into believing I was hopeless. Just getting words to appear on my laptop screen felt insurmountable. I was ready to give up on life just days after believing I had complete control over the world. This is bipolar.

I struggled at first to find peers I could be myself with. I felt insignificant amidst all of the established and well connected advocates. At first I tried to fit in like the new kid on the playground. But, like I experienced during middle school, I felt left out. Rather than giving up like I had with so many goals, I began reaching out to people online with similar stories who were also struggling and feeling lost. I was amazed by how many wonderful people were out there speaking up about mental illness in their own little corners of the world. We accepted each other and they encouraged me to also speak up and not settle for pessimistic fatalism. It was as if none of us were lost as long as we had each other’s back. So, speak up I did. Not only do I continue sharing my story online (like this wonderful blog ran by one of my many allies in the mental health world!), but I am also a speaker for the National Alliance on Mental Illness (NAMI) where I share my story across the Greater Los Angeles area.* And, someday across the world!

My friends and I don’t always get along and, for sure, mental illness can make one do and say very regrettable things. But we’re all one great big, very interesting family. We have to live with our terrible, terrible illnesses, but we’re still eager to make our mark.

Despite our minor differences, we all want to live in a world that possesses the following: no one is ashamed of their mental illness, no one is discriminated based solely on their mental illness, and the word ‘mental illness’ does not have such a negative connotation. It is possible. I believe this. They do, too.

I never used to consider myself an ‘advocate.’ But, now that I know what ‘advocate’ truly means, I own the title proudly. This world is constantly revolving. People fall off while others are getting on. Some even get back on. I’m still new to this. But, I’m not the only one. I brought my family with me and together, we’re ready. We are the new advocates and we have found our place.

*Opinions expressed in this story are solely my own and may not necessarily reflect those held by NAMI. I’m only speaking for myself.

Bio: Rudy Caseres is a public speaker and writer sharing his story of living with bipolar disorder. He loves engaging with people far and wide, both online and off. You can follow him on Facebook and find the rest of his social media presence at RudyCaseres.com. Mr. Caseres was born in San Pedro, Los Angeles, CA and currently resides there today.

May 7, 2016 4 comments

Medicine

How I Connect With Our Future Doctors

written by freudandfashion

Latino Medical Student Association National Conference 2016

I realize it has been a few weeks since my last blogpost and the reason is because I have been even busier since receiving wonderful opportunities to speak at conferences. Blogging and being active on social media has provided an amazing outlet to share my views on mental health, yet speaking at conferences would also be a great way to directly connect with our future doctors and health care professionals. I’m pretty open on my blog about my previous struggles with social anxiety, so although public speaking can be challenging and highly anxiety-provoking, it has been one of my best methods for overcoming my anxiety.

The video above is a quick edit of my participation as a speaker for the Latino Medical Student Association’s National Conference, which was held at my medical school, Western University of Health Sciences College of Osteopathic Medicine of the Pacific. I hosted a workshop on ‘medical student burnout’ and was also a panelist for the Women In Medicine panel. Speaking at my medical school was a reminder of how I’ve come full circle as a former struggling medical student and returning as a physician sharing my knowledge and experiences!

Video by Marlon Santos

April 26, 2016 5 comments

Medicine Psychiatry

Why I Chose Psychiatry As My Specialty

written by freudandfashion

{Rancho Cucamonga, California}

I am often asked why I chose psychiatry as my specialty, yet as one of my readers pointed out, I’ve never described my reasoning in a blogpost! So here goes my short story of why I chose the path to become a psychiatrist…

The time to solidify your choice in medical specialty and apply for residency training programs occurs during the Fall of the 4th (and final) year of medical school. Students have various reasons for choosing a specific specialty, some knowing which specialty they wanted to go into since childhood, others typically contemplative until right before application season. Some people even change their minds in the midst of residency training and decide to switch specialties.

As a medical student, I attended most class lectures, yet spent majority of the time passively writing notes while chatting on instant messenger. However, when it came to psychiatry, I woke up every morning with excitement to attend each lecture (quite unheard of since I practically dragged myself to every other lecture series), paid attention (and even turned off my instant messenger), thoroughly read the textbook, diligently took notes, and excelled at every exam.

During third year of medical school, students start clerkships, which consists of rotating through various primary care specialties (typically family medicine, internal medicine, Ob/Gyn, pediatrics, psychiatry, and surgery). When interacting with patients during each rotation, regardless of the specialty I was assigned, I ALWAYS spent more time with my patients asking about their psychological and social backgrounds. As a result, I eventually became identified by my senior resident and Attending physicians as the student who would generally be assigned the patients with a history of mental illness or medically-related psychiatric issue. Also, if a patient was admitted to the hospital for physical symptoms, yet the extensive medical workup failed to determine any causative explanation for the symptoms, I was told to assess if there were any emotional issues that might be contributing to a patient’s intractable symptoms (such as cyclical vomiting syndrome, intractable pain, etc).

I specifically remember one patient — a young woman with intractable nausea/vomiting, who was unable to keep down food and fluids. Her medical workup was normal and the medical team could not identify a cause. While the medical team spent only a few minutes to check in on her (to do a quick medical exam and see if she had eaten), I went to visit her after rounds to chat. My intuition told me that there was more to her issue than solely a physical complaint. She was quite shy and spoke only a few words, yet after a few minutes of engaging in conversation, I believe she saw that I wholeheartedly cared about her wellbeing. As it turned out, she experienced ongoing stressors at home due to a recent move with her boyfriend and often felt isolated since she was often home alone with no friends in her new area of residence. I promised to check in on her after daily rounds and she thanked me for taking the time to speak with her.

On the third day, I saw her untouched food tray, and after a few minutes of talking, I asked if she liked ice cream. I brought her vanilla ice cream from the supply in the nurses’ station. We talked about how she missed her family back home. After several minutes into the conversation, I watched her open up the ice cream cup and slowly start nibbling on small scoops. After eating 25% of the cup’s contents, she politely asked for a cup of water. I quickly got up to pour ice water and asked about her little brother as she took a few sips from a straw. Before I left the room, I closely watched her for a few minutes to observe if she’d vomit the contents. She appeared comfortable with no sign of nausea.

The following morning, I viewed the nurses’ report, which noted that she had no episodes of vomiting overnight and even ate a jello snack. I said ‘goodbye’ to her that morning since our medical team informed her that she’d likely be discharged home after lunch. I couldn’t help but wonder if she’d be okay returning home to the same environment that triggered her symptoms. However, the empty plate on her breakfast tray was an indicator that she ate that morning, which reassured me.

Others docs may feel this way about their own specialty, but in my view (currently and as a medical student at the time), there is an art to psychiatry. There are no labs to rely on and although psychopharmacology is of importance, I immediately noticed the value of a therapeutic connection and communication necessary to fully understand an individual’s situation and the context of their symptoms. Despite such a strong emphasis on pharmacology during medical school, I recognized early on how much certain symptoms (even physical) could not be improved solely by medications and standard treatment alone. I recalled reading The Diving Bell and the Butterfly as a medical student, which inspired me to try various different creative ways to communicate with other patients who struggled to verbalize their needs, and had a bit of success with many.

I have several other reasons that contributed to my decision to pursue psychiatry, but wanted to emphasize how much the nature of my connections with patients empowered me as a medical student. The psychological components of a person’s history are often not prioritized when it comes to a patient’s medical care. Throughout medical school, I often felt inferior particularly because I didn’t achieve the highest grades compared to my classmates. However, I knew one thing for certain when the time came to apply for residency: as a psychiatrist, I could play a vital role in emphasizing the importance of an individual’s psychological and social background in order to fully address health and wellness. And I felt confident that I’d do whatever I needed to be damn good at my profession.

Photo by Marlon Santos

March 18, 2016 24 comments

Series

Questions I Bet Your Psychiatrist Never Asked You

written by freudandfashion

During new patient evaluations, psychiatrists generally have a standard set of questions that are asked to help formulate a diagnosis based on diagnostic criteria and to develop a treatment plan. 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:

What do you wish you could tell your doctors when they makes changes to your meds that you don’t agree with?

RESPONSES:

I have definitely been through this experience! I WANT to say that increasing the dose scares me as the side effects I’ve experienced were horrible. I also feel that some (not all) psychiatrists barely ask you any questions about your research on medications. I feel that they don’t want to believe that you are actually capable of being educated on the topic.

Paramedic Nat (Blog: paramedicnatsmentalhealthjourney.wordpress.com, Twitter: @paramedicnat1)

Ever heard the word ‘advocate?’ Did you get your degree for the high status and income, or are you sincere about helping those of us trapped in this system? Why not take a stand against the big pharmacy industry and be true to your patient and what is best for him or her?

Anonymous

Well, to be honest, I don’t think it would be something to say but more to feel. For example, for me, as the side effects were horrible, and as I wasn’t feeling better, she kept upping my dosage. I wish she would have FELT my side effects. I described it as best I can, but I’m not sure all docs felt brain zaps. I wish doctors would listen more to how we feel instead of maybe just push various pills and dosage on us. Those are pills for our brain, it’s nothing to joke about. I’m sure it affects us all differently. But I wished they’d be more open to the fact that for some of us, medications (or SSRIs and such) just aren’t doing any good.

Natalie, Teacher (Twitter: @natricher)

What I absolutely love and appreciate about my psychiatrist is that he lets me choose what I’m comfortable with taking. I don’t know if other patients are like this, but I know my diagnoses and I do research on different meds. I haven’t found anything that’s working greatly yet since I do have a lot of different disorders, but knowing that my doctor validates what I’m comfortable with doing makes me feel that much better.

For example, I really dislike the weight gain side effect that a lot of medications for bipolar disorder have. I suffered major self-esteem issues in middle school because I put on 50 lbs from lithium and depakote combo. He knows how hard I worked to get that weight off and feel better about myself, so we only talk about combinations that will make me feel comfortable taking…so that I actually take my medicine.

Alexandra, Advocate

I wish they would have taken the time to explain (simply) what the medication will be doing to my body/brain and why it’s more efficient than what I was previously taking.

Anonymous

I honestly would tell the doctor my concerns. I wouldn’t be rude, but I would openly say that I have concerns over it. My hopes would be that it could open up a two-way conversation regarding my care and I could find out what they have to say (and have them see where I’m coming from).

Tom V, 1st year Medical Student

I wish I could’ve sat down with her and said clearly: “I’m sorry I called you two times today freaking out, but this medicine you gave me just isn’t working right–it’s making me worse. I’ve never taken any meds before and I’m running scared here and I need someone to understand me and sit with me and talk about my options. I know we didn’t meet under ideal circumstances and you don’t know me or I don’t know you, but don’t treat me like I’m one of the people who bug you all the time. Please help me. That’s all I need is some help.”

But, I now have someone who I think is amazing and he talks to me about options and is more of a collaborative force in my health care. He is in charge of my meds, but he has listened to me and I’m glad to say I haven’t had to take one benzo, not one single one in over 6 months so the fact that a doctor will collaborate makes me very happy, and listens.

Anonymous

Photo by Marlon Santos

March 2, 2016 20 comments

Psychiatry

6 Things To Say (And Not Say) To Someone Who Is Grieving

written by freudandfashion

{Na Pali Coast, Kauai, Hawaii}

I always struggle with grief this time of year. Among other stressors, this month also marks the 14th year death anniversary of my grandfather, whom I was extremely close to. You’d think that after fourteen years, the grief wouldn’t hit me so hard, yet it still does. Grief is one of the most difficult emotions we experience as humans, yet is also one of the most commonly misunderstood.

Below are some actions and statements that I’ve found most helpful both personally and professionally in my office when I have patients coping with grief. I initially drafted this post last week while in a combined state of anger and sadness (predominantly anger) related to grief. I contemplated deleting the initial draft, which I titled “Things You Should Never Say To Someone Who Is Grieving.” However, since I try to maintain authenticity on my blog, I decided to leave the section I wrote while in an angered state, particularly because people frequently experience anger, yet often internalize and feel too ashamed to express the emotion. People need to recognize that grief does not consist of only sadness. Grief is a complex emotional roller-coaster that may involve one or a combination of emotions such as anger, rage, sadness, guilt, depression, joy, denial, shock, disbelief, confusion, frustration, exhaustion, apathy, numbness…(I think you get the point).

Since people often feel clueless about what to say to someone who is grieving (trust me, I struggle sometimes with what to say as well), I hope that you will consider the following when you or someone you know is experiencing grief:

Things You Should NOT Say To Someone Who Is Grieving:

1. “It’s been ___ days/weeks/months/years already…you should be over it by now.” Grief has no timeline. The closer a relationship someone has with the deceased, the longer it may take to overcome the painful emotions. As one of my amazing readers (whom I learned a lot from since he shared his experience with losing a child) pointed out: grief never fully goes away, but rather becomes more tolerable.

2. “Just try not to think about it.” Telling someone not to think about losing someone is like telling someone not to be human.

3. “‘So-and-so’ has already moved on…you should too.” Comparisons are terrible because each individual person has their own process of experiencing grief.

4. “Just be strong.” Saying this statement actually does the opposite and evokes a sense of weakness for not being able to overcome such strong emotions that may feel outside of one’s control.

5. “I know how you feel. My ____ died…” Don’t even try to make the difficult situation more about you. I once sought support from a peer and confided in my sadness only to have her shift the focus to herself and her past losses (and she was a psychotherapist!). Though I’m sure her intentions were good, a part of me wanted to punch her in the face for wasting my time and energy.

6. “He/she is in a better place now.” I’m a little mixed about this statement because it can be comforting if used in a thoughtful way, but annoying if said generically as a reflex response. For example, when my grandmother passed away, I felt comforted when a relative said “She’s in a better place now with your grandpa in heaven” because my relative knew of my grandparents’ enduring love for each other having been married for >50 years, in addition to our spiritual beliefs. However, when an acquaintance says the statement in a generic manner, it doesn’t feel genuine at all.

Bottom line — don’t say anything to someone who is grieving unless you truly, wholeheartedly mean it. If it doesn’t feel authentic to you when saying it, then it most definitely won’t feel authentic to the person who is grieving. And if you’re not good at verbally communicating your thoughts, then read on to see how your actions can be just as helpful (if not more).

Helpful Things To Do/Say To Someone Who Is Grieving:

1. Just be present. Actions speak louder than words, especially during such a difficult time when grief tends to be a very isolating experience. Being present shows that you’re aware of how difficult the experience is and that you won’t let them go through it alone.

2. Give a hug. Several years ago, I was sitting in a lecture during residency when I received news that my grandmother passed away. During the state of shock, I truly appreciated when my co-residents gave me hugs especially knowing that there was nothing they could say to make me feel better at that moment. Giving me a hug showed that they acknowledged the news and wanted to show that they cared.

3. “If you ever need to talk to someone, I’m here for you.” Again, showing your support and offering your help when needed demonstrates that you care.

4. “I’m so sorry to hear the news” or “I’m so sorry about your loss.” Often, when people don’t know what to say, they may avoid saying anything at all to the person grieving. Avoidance is one of the worst things to do to someone who is grieving because one might assume that you don’t care, which most likely isn’t the case. Saying something as simple as this statement acknowledges that you’re aware and recognize the impact of the person’s loss.

5. “I’ll be thinking/praying for you and your family/ (anyone else known to be deeply impacted by the loss).” Expressing that your thoughts (or prayers if the person is religious/spiritual) are with someone shows that you know this is a difficult/tough time for everyone involved.

6. “I know I can’t say anything to take the sadness away, but just know that I’ll be here to support you.” This is such a true statement — nothing you say can bring the deceased back to life nor take the pain away, so offering your support and presence speaks volumes to someone who is struggling during bereavement.

February 23, 2016 22 comments

Medicine Psychiatry

4 Reasons Why I Don’t Wear A White Coat

written by freudandfashion

I absolutely love this post written by Dr. Kristin Prentiss Ott about why she believes we shouldn’t wear white coats to work. To carry on with her sentiment, I thought I’d write a few of my own reasons why I personally chose to ditch my white coat even when required to wear one since completing my internship (except for professional photos, of course). Aside from the fact that I’m a psychiatrist, you’d be surprised to know there are still some hospitals where psychiatrists wear their white coats on the unit (the psychiatric hospital where I did my internship was one of them). I used to think it was a bit odd to wear white coats on the psych ward because the look can be intimidating, but I was an intern at the time so I complied. And yes, I recall asking one of the supervising psychiatrists the reason why white coats were worn and remember being told it was by choice? I may have also been delirious and sleep-deprived at the time, so don’t quote me on that.

The following are the reasons why my white coat remains unworn and in pristine condition hanging in my closet:

1. White Coat Syndrome. Yes, such a syndrome exists and is also known as “White Coat Hypertension.” The condition is self-explanatory: a person’s blood pressure is elevated while in the doctor’s office, but is normal in other situations. I was initially quite surprised to learn that anywhere from 15-30% of people experience the syndrome, though I’d have to say the statistic is quite synonymous (frankly, I believe the percentage is even higher) with my own experiences in practice, especially when meeting patients for the first time.

Though one explanation for the fear-based physiologic response might be the association of hospitals/clinics with disease and illness, I believe psychiatric patients are even more prone to anxiety when in the psychiatrist’s office due to disclosures of more personal information and possibly also from bad experiences with previous doctors who weren’t empathetic to their psychiatric issues.

2. Prioritize the doctor-patient relationship. In a study done in an outpatient psychiatry clinic in Upstate New York, 96% of the patient population surveyed preferred that their psychiatrist not wear a white coat, while 58% did not think it would make a difference in their doctor-patient relationship.

Having an aligned doctor-patient relationship is important in any specialty, but even more so with psychiatry due to the personal content discussed. Due to the pressures of time constraints and also the trend of several behavioral health clinics having patients see whomever random psychiatrist has availability, patients are less likely to establish a therapeutic connection, which I imagine would exacerbate anxiety during each visit. I mean, would you want to re-hash your story to a new psychiatrist during each follow-up appointment (but then again, most psychiatrists don’t have enough time to review your whole history, so sessions become mostly limited to a discussion of symptoms only)? Minimizing any factors that can contribute to anxiety (such as wearing a white coat) would at least help a patient feel more at ease.

3. They’re filthy and teeming with bacteria. I have traits of OCD (Obsessive-Compulsive Disorder), yet vividly recall disgusting moments during internship (where I rotated in various hospital departments) when I knew that my white coat was dingy and long overdue for dry cleaning, yet was way too busy to wash it (think buildup of splattered bodily fluids from various orifices and the numerous times that my white coat sleeves probably brushed my face or came into contact with food I’d scarf down during quick breaks…ewwww). Dr. Ott points out in her post that research has shown that a mere 8 hours of routine patient contact leaves white coats teeming with infectious microbes. These days, the average work week of all medical residents is limited to 80 hours/week and most practicing physicians work an average of 40 to 60 hours/week, which equals a heck of a lot of microbial buildup.

4. Sure, a white coat has maintained its iconicism as a symbol of power, prestige, and intelligence, but a doctor’s identity shouldn’t depend on wearing one. Obviously, I was excited when I received my short white coat during my medical school induction ceremony, but later hated being identified as a novice med student as I walked the hallways of the hospital. Meanwhile, other health professionals from various levels of training wore long white coats indistinguishable from those worn by physicians. After graduating from medical school and transitioning to the longer white coat, I was so excited, yet recognized that I formed too strong of an attachment to my white coat. My dependency on an object didn’t sit well with me. I felt as if I had to wear one in order to possess a sense of worth and importance.

By first acknowledging that I attributed much of my value to an external object (the white coat), I took steps to detach myself from it. I began to curate a wardrobe that conveyed professionalism and my individual sense of style. I made sure that I properly introduced myself to patients and staff, especially when I was mistaken for a nurse or psychotherapist. And I’m not going to lie — initially, I was frustrated by having to correct people on a regular basis, but as I gained confidence in myself (yes, psychotherapy helped) and my skills as a physician, to this day I am rarely ever bothered. Interestingly, I am acknowledged to be a physician far more frequently and I believe it’s because I project a much greater sense of who I am, both personally and professionally. No white coat needed.

PS: A special “thank you” to my friends on Snapchat (freudandfashion) for contributing your opinion when I posed the question of whether or not you’d want your psychiatrist to wear a white coat (11% said “yes” to wearing a white coat and 89% said “no” ).

February 9, 2016 18 comments

Series

Questions I Bet Your Psychiatrist Never Asked You

written by freudandfashion

During new patient evaluations, psychiatrists generally have a standard set of questions that are asked to help formulate a diagnosis based on diagnostic criteria and to develop a treatment plan. 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. I also assume that my questions might be a bit different than the norm because I’ve grown accustomed to patients making statements such as “You know, nobody’s ever asked me that before.” Oftentimes, I believe that the art of psychiatry has dwindled down to a checklist which subsequently churns out a diagnosis 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.

QUESTION OF THE WEEK:

What goes on in your mind when a new psychiatrist asks if you’re suicidal?

RESPONSES:

It’s been some time since I’ve seen a new psychiatrist; thankfully I’ve been (somewhat) stable and happy with the treatment I’ve been receiving with my current one. But I do remember going through what was round-robin of mental health professionals before I found my current doctor. The situation is horrible, as I’m sure most people who have gone through the same process can testify. Although someone may be a professional who’s gone through years of grad school and training about what may be wrong with me, why would I want to share my darkest, deepest pain to someone I just met? It never felt right.

The two psychiatrists whom I connected with most during my care have been the ones that treated me like a person (and even a friend) first. No, I’m not that textbook case study you read in Psychology 407 back in grad school. Nor am I willing to try new psych medications with the script you’ve given me after our 5 minute visit.

There are no 100% effective cures for mental illness, but you can still treat those living with mental illness like human beings. It’s not that hard.

Brandon Ha, Creative Director @BreakYoStigma

facebook.com/breakyostigma

instagram.com/breakyostigma

First thing that springs to mind is: “I can’t tell you I’m suicidal because you’ll hospitalize me and that will just ruin everything I’ve worked so hard for.” (as strange as that sounds…)

However, I always think there’s no point in outright lying to my psychiatrist if I genuinely want to get better. So, usually, I just tell them what I’m thinking, even if it means telling them I’m suicidal. But, I make sure I explain exactly what I’m thinking. Usually my thoughts are more of a passively suicidal nature and I don’t have a concrete plan in mind. My current psychiatrist is well aware of that. I haven’t had suicidal ideation with a plan for quite some time now. The last time was with my first psychiatrist, two years ago. And even then I’d tell her the truth. I only got hospitalized once, when I told her I genuinely couldn’t guarantee that I wasn’t going to do it. I guess the fact that I’m always honest about what goes on in my mind is precisely what has helped me not get hospitalized more than once. I’ve always thought of the patient-psychiatrist relationship as one built on trust. If they can’t trust me then they can’t help me to the best of their capacity and I’d just end up self-sabotaging.

Dana S, medical student (borderlinemed.wordpress.com)

‘I’d never kill myself. Wanting to die to end my misery and actually going through with it are completely different. But that’s probably not the answer you were looking for…’

Rudy Caseres, Voice on Mental Health

Facebook.com/Rudy.Caseres

Twitter: @RudyCaseres

First thought in my head if asked if I was suicidal would be something sarcastic like this: ‘Would I be sitting here if I was [suicidal]?’ and/or ‘Yes and to be honest, you’re just having a visual hallucination of myself right now.’

Anonymous

What goes on in my mind? Terror yet the need to be honest and tell the psychiatrist if I’m feeling that way. From experience (I was hospitalized several times for suicidal ideation) I know I had to be truthful about feeling suicidal because despite the intense compulsion, I didn’t want to do it and leave my two young daughters without their mom. I needed to be kept safe so I didn’t go through with it and I knew I needed hospitalization. I got better, and if the feelings return I will be honest with my current psychiatrist. I realize that he would most likely place me on a 5150 hold, but I accept that.

Dyane Leshin-Harwood, author of “Birth of a New Brain – Healing from Postpartum Bipolar” (Post Hill Press, 2017). Blog: www.proudlybipolar.wordpress.com, Twitter: @birthofnewbrain

The first thing that comes to mind is that I need to justify why I’m there seeking help at this appointment and I wasn’t really sure how I need to respond. I was asked to rate my suicidal thoughts on a scale of ‘1 to 10’ (1 being the least severe and 10 being the most severe) and thought to myself, ‘do I need to respond with a high number so that I can get the help that I need, or will a low number not make them take me seriously enough?’ I remember feeling like I needed to justify that I needed help and it seemed as if a number was supposed to prove it. I get that a number is supposed to reflect my thoughts and feelings, but I didn’t feel like it was a genuine representation of my situation.

Anonymous, Psychotherapist

Having seen a psychiatrist in the past, I remember feeling anxious about this question because I knew what to expect in an evaluation, even though I didn’t feel suicidal. Fortunately, I knew the psychiatrist came highly recommended, was well-established in the community, and was someone I could trust, but what if I had no choice but to see a random psychiatrist (quite similar to the experiences many of my patients have encountered in the past) who was a novice, unskilled, or didn’t care to take the time to get to know or properly assess me? A psychiatrist’s job is hard and safety is our utmost concern, but building trust and mutual respect in a physician-patient relationship also needs to be a priority.

Vania, Psychiatrist and writer of Freud & Fashion

Photo by Marlon Santos

January 22, 2016 14 comments

Psychiatry

Quick Reflections From The Week

written by freudandfashion

{Napa, California}

I’d like to think that I’m quite mindful and reflect on almost anything that stands out in my day causing me to raise an eyebrow or feel that a mini light bulb went off in my head. I truly believe that the more mindful we are and the closer attention we pay to cues and details, the more meaning we can get out of even the most routine of days. The following are some of my own reflections from the week, and I hope to encourage you to reflect and do the same!

The importance of teamwork. As a psychiatrist who values coordination of care and hearing other clinicians’ perspectives, I had the opportunity to connect and discuss cases with an awesome psychologist whom I share several patients with. Being in private practice can feel a bit isolating at times compared to working in a multidisciplinary setting, so I welcome the opportunity to meet and discuss any complex psychological issues that might be impacting my patients. As several of you may know, I place a much stronger emphasis on psychotherapy than pharmaceuticals when treating my patients. Therefore, knowing that therapists value my opinion on psychotherapy just as much (or even more) than my expertise in pharmacology helped me feel connected and valued as a team member.
Be authentic and speak up. Since I posted my latest blogpost on physician burnout, I’ve received amazing responses from people telling me that they could relate to my post. As someone who was always afraid to share my opinion (yes, I’d go to leadership meetings and literally sit there and say NOTHING), it was a testament to how much personal work I’ve done to overcome barriers that got in the way of me voicing my opinion. I think clinicians can be hypocritical by simply telling patients to exercise more, think positive, stop thinking so much, eat healthier, etc, and even worse if they label patients as ‘non-compliant’ for not executing such changes by their next follow-up appointment. As if breaking years worth of habits is that easy. Well, I can say that it took me years to overcome my overwhelming fear of judgment in order to speak up and I’m just happy to have the support of empathetic people who helped me achieve it.
Normal vs Pathological. During sessions with patients, I try to help them discern whether the symptoms they’re experiencing are normal reactions given their circumstances. This week, several patients chose to hold off on increasing medications after recognizing that they were coping with issues in a fairly healthy manner. Often times when people are diagnosed with mental illness, any anxious feeling, sense of fatigue, anger outburst, difficulty sleeping, etc, is automatically perceived as problematic rather than a ‘normal’ response. I’m far more collaborative in my approach, and part of the treatment involves determining whether or not a symptom is ‘normal.’ The decision-making process of determining whether or not to adjust a patient’s med is geared towards first helping my patients gain insight rather than automatically assuming that their symptoms are pathologic.
“To find health should be the object of the doctor. Anyone can find disease.” ~ A.T. Still. I am currently reviewing osteopathic principles for an upcoming presentation, and while reading I came across this quote. There are times during appointments when I’m stuck on which medication to prescribe next, though I noticed that I experience clarity the moment I get an opportunity to practice the above quote with my patients. I have several patients who have tried an extensive list of meds, yet start to observe more improvement when the sessions shift from solely focusing on meds to helping them heal from years of trauma, neglect, medical illness, heartbreak, addiction, etc. Doing so reminds me of the reason I pursued a career in medicine in the first place.

January 16, 2016 5 comments

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