Tag:

psychotherapy

Grief In Repeat

{Upland, California}

Upon driving into my garage coming home from work this evening, I suddenly burst into tears as the garage door slowly closed behind me. I haven’t felt like myself at all this past week. I tried my hardest to discern the reason for my melancholic mood and pinpointed a series of events that occurred after the subject of death was brought up during my therapy session this past weekend. The subject of terminal illness and inevitable death is never an easy one, even as a physician who had to pronounce deaths in the hospital wards and was educated on how to talk to patients about advance directives (Do Not Resuscitate/DNR), hospice, etc. We all have triggers that may occur randomly during our day that may unleash suppressed feelings that go deeper beyond whatever triggered us in that present moment. A patient once told me that hamburgers made her sad because her deceased father cooked them all the time at family gatherings. For others, something as simple as a hamburger triggering profound emotions may sound ridiculous, but we must be empathetic to each individual because none of us know of the history, context, or meaning that a symbol (such as hamburgers) provided in a person’s life.

My initial trigger was watching the movie Furious 7 last week. Now, I know that millions of devoted Paul Walker fans (including myself) were profoundly impacted by his tragic death, but the uncontrollable amount of tears that I shed was far too disproportionate to the mild attachment I had for the actor. Since everyone I knew who watched the movie admitted to shedding tears, I didn’t think much of my emotional response at the time. But, during my group therapy session, I was extremely angered about an unrelated topic, and again, I couldn’t figure out the reason why. Leaving my therapy session in a pissed off mood, I contemplated quitting group because I didn’t want to be a part of anything that made me feel angry and unsupported. I looked at my phone and started scrolling Instagram to distract myself from my emotions, and stopped incessantly scrolling once I came across the picture below, which my sister posted for National Siblings Day with the following caption:

It was always the four of us. Although we’re all grown up with separate lives, we will always have the same love for each other, and share the same values that our Lola and Lolo (Grandma & Grandpa) taught us. My latepost In honor of ‪‎siblings Day 4/10 and my lolo’s birthday 4/7. I love you all. I miss you Lolo & Lola.

Last week was my grandfather’s birthday. The theme of losing such a devoted and integral part of a family is the theme that resonated most with me about the movie. And watching the ending somehow re-opened the wound in my heart that I experienced when I first received news that my grandfather passed away from cancer thirteen years ago. I continue to re-experience feelings of grief each year around his birthday and this year is no exception. I wrote about my grandfather’s influence and my difficulties coping with losing him in previous blogposts (here, here & here). Last week, a few of my patients discussed their own grief, which is always a hard subject to process. I always do my best to provide them with as much support as possible because I know what it’s like to feel isolated, angered, and confused by a complex mixture of emotions.

I used to want to believe that “time heals all wounds,” but one of my inspiring readers modified my perspective of the statement to make it more accurate: time may help make the grief a bit more tolerable. Grief never goes away, but rather is re-experienced in different, sometimes confusing ways. But, just like the goal of the movie, I try to shift my focus from sadness to embracing my grandfather’s strength and legacy. I can already feel the wound close a tiny bit as it starts to repair itself yet again.

April 15, 2015 16 comments

Lifestyle Personal

Finding Balance

written by freudandfashion

{McDowell Sonoran Preserve, Scottsdale, AZ}

During my stay in Arizona, I was fortunate to reunite with friends from my residency training program and was especially excited to spend time with one of my closest friends from medical school. One of the subjects we talked about most was the struggle to obtain or achieve work/life balance. Balance and avoidance of burnout is essential for overall emotional and physical health. Burnout has been shown to be more prevalent in medical students, residents, and early career physicians compared to the general U.S. population.

My life is much more balanced than it has ever been, and I believe the biggest barrier towards accomplishing this in the past was the perceived lack of time as an undergrad, medical student, and psychiatry resident. I emphasize the word perceived because I truly believed that sacrificing my personal life for the sake of my future career was well worth the burnout. Well, by choosing to become a physician, yes, an immense degree of sacrifice is required. If I failed at any point in the process, would I have been upset? Hell yes! And I actually did almost fail because I put so much pressure on myself to do well that my anxiety sky-rocketed and impacted my test-taking abilities. Therefore, my scores were in no way reflective of the amount of time I spent studying, which really sucked (no need for a more formal term for my emotion; “sucked” pretty much sums it up). At that point, I broke down, cried, and told my parents that I wanted to quit medical school. And it wasn’t until then that I realized they didn’t care which profession I chose — they just wanted me to be happy. What a huge relief! All this time I thought I’d dishonor my traditional Asian family if I didn’t become a physician. Suddenly, at that moment, the weight and pressure to please my family lifted. I felt liberated. However, the remaining pressure I possessed was the pressure I placed on myself because I didn’t know of any other way to approach life while working towards my medical degree.

Looking back, if I had the opportunity to offer my past medical school self any advice, I’d tell her the following:

To sacrifice a few hours of studying a week in order to instead go out and do something enjoyable to enhance personal growth and interests.
To be less self-critical. Little does she know that she’ll be just fine if she doesn’t graduate from the most prestigious, academic medical school or get accepted into the most renowned residency program.
Just try your best and don’t beat yourself up in the process. After all, one of the top 5 things people regret most on their deathbed is “I wish I hadn’t worked so hard.” I definitely know that I’d never say I regret not working or studying more. Simple activities, such as enjoying nature and going on hikes, are far more memorable in my mind compared to the insomnia I experienced trying to squeeze in last-minute studying for a histology exam.

March 17, 2015 7 comments

Personal therapy

Numb

written by freudandfashion

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

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

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

March 5, 2015 20 comments

Personal Psychiatry

Casual Fridays – Join the Cause

written by freudandfashion

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

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

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

February 27, 2015 6 comments

Personal therapy

Sticking To It

written by freudandfashion

{midweek hike in Malibu Creek State Park}

My “Monday Motivation” consists of posting my continued efforts to maintain my New Year’s goals for 2015. I truly appreciate all of you because you’re part of my support system — you’re helping me hold myself accountable to stick with these goals! I can’t emphasize enough how important self-care is to maintain a sense of well-being, which is the reason my last few posts have been dedicated to the topic. Most of my patients struggle with the same issue, which leads to burnout, increased stress, uncontrolled anxiety, worsened health, and much more. The photos in my post are proof of my activities from last week, and serve as my motivation to continue this week. If you’d like to join me in my efforts to prioritize self-care, would love for you to share how you’ve been doing so thus far!

{Took a REAL lunch break & caught up with celeb gossip and world news}/ {went to two amazing yoga classes, even though I was initially too lazy to go and wanted to back out (pic taken before class)}

{Took a stroll on the beach of Playa Del Rey after my weekend therapy session}

January 27, 2015 11 comments

therapy

Restful Week

written by freudandfashion

Have you ever felt guilty about having an unproductive week? That’s how I initially felt regarding this week, but in retrospect, I believe it was necessary to take it easy.

To be easier on myself (which is difficult for a self-critical person like me), I had to keep in mind two of my goals for 2015 (which I discussed in my previous post):

be mindful
be aware of my need for self-care

I felt ill this week and wanted to sleep most of the days, and therefore, couldn’t complete most of my tasks. However, I needed to listen to my body and its need for rest and recovery, whereas in the past, I’d push myself to go to the gym and stay up late until I completed everything on my to-do list. I also had insightful, yet emotionally-draining group and individual psychotherapy sessions, which resulted in me not wanting to write a blog post due to how much thought and psychological overtones I put into my posts. Yet, this is a pattern that has occurred in the past since I first started blogging in 2010, which resulted in large gaps between posts. I am trying to avoid those large gaps this time around and want to let you all know of the reason I’m late with this weekly posting.

What made me feel better was reading statements such as “it’s okay to not be okay,” which is definitely true, however, society makes you feel as if you have to be running on all cylinders ALL OF THE TIME. Which is fine, as long as you take necessary breaks and don’t wear yourself out. However, we are all human, and I often try to help my patients overcome barriers towards being less judgmental on themselves.

As you can see, I’m trying to take my own advice 🙂

January 18, 2015 7 comments

Psychiatry

Holiday Mental Break

written by freudandfashion

{With our new family dog, Levi}

Whenever I visit my parents’ home, I regress to a childlike state and become the complete opposite of how I am in my normal, adult life (i.e. instead of my usual high stress, on edge, active, rigid self, I wake up late, lounge around in sweats, and enjoy writing “nothing” on my to-do list). Hence, I’ve taken a brief mental break to reset/recharge and in my relaxed state, I realize this is the first time in eight years that I’ve had time off during the holiday (consider 2 years of hospital rotations during medical school, 4 years of residency training, and 2 years being the newbie doctor at my first job). I initially felt guilty about being away from the clinic for so long, but am aware that my ability to provide quality care declines the more burned out and overwhelmed I feel. I know how hard it can be to prioritize yourself, especially if you’re the caregiving type who’s used to putting others’ well-being before your own. I hope you are able to find time to care for yourself during the remainder of the year, and if not this year, then consider as a possible New Year’s resolution to put self-care amongst the top of your list.

December 28, 2014 11 comments

Psychiatry therapy

Mind Over Meds

written by freudandfashion

{Claremont, California}

Some of you may have noticed that although I am a psychiatrist, I rarely comment nor write about my thoughts on psychiatric medications in my blog. I did write a post as a resident physician-in-training in 2010 titled Pill Pusher, which briefly describes my general approach to simplify, minimize, and streamline medication regimens to the least amount of meds needed to provide symptom relief. In some cases, I have successfully worked with my patients to wean off and discontinue all of their psychiatric medications, though the process requires much patience, toleration of uncomfortable withdrawal symptoms, and numerous non-medication approaches to maintain stability off of meds. And most importantly, I believe a trusting doctor-patient relationship is needed to provide education of potential withdrawal symptoms, encouragement to push forward, and processing fears that may arise from being off medications for the first time in years.

Now, please do not mistake me for a protester against pharmaceuticals — I witness the positive impact that medications can have on enhancing the quality of life of my patients on a daily basis. However, I do not attribute the improvements primarily to medications. My treatment plans generally promote the development of insight and self-awareness of mood patterns, anxiety triggers, etc, and oftentimes explore how past suppressed emotions may contribute to current symptoms, all of which are topics I aim to emphasize in my blog. Medications may stop working or provide temporary relief, but knowledge of one’s self can last a lifetime.

Photos by Marlon Santos

December 20, 2014 2 comments

therapy

Fight the Blues

written by freudandfashion

{Emerald Bay, South Lake Tahoe}

I’ve written about the subject of laziness several times in my blog (here, here, and here), and this week has been exceptionally rough to get through. I attribute my dysphoria to a combination of factors: mental exhaustion (struggling with recent loss that I wrote about here, weekly sessions with my therapist exploring the origins of my overwhelmingly self-critical tendencies), the weather changes (hello, hibernation mode), and the upcoming holidays. Rather than writing a deeply emotional post, I felt it would be appropriate given my current mood to instead write about 3 things I did this week to combat the seasonal blues. I may be a psychiatrist who inherently gives advice, but I seriously learn a lot from my patients and others. Would love to hear about any techniques you apply to prevent from feeling down this time of year as well!

1. Write a simple to-do list. I used to be overly-ambitious with my lists, but that just left me feeling worse and unaccomplished if I couldn’t get everything done. This week, I listed 3 mandatory responsibilities plus a few smaller, easier tasks (yes, I even listed getting the mail as a task and felt great when I checked it off my list!).

2. Get moving. Though the couch and Netflix seem far more appealing than going to the gym, I struck a balance by going out for a quick jog. Even a 15 minute run helped provide some exercise and made me feel less isolated.

3. Schedule an activity with a friend..and don’t flake! When I have something planned, I hold myself more accountable and am less likely to cancel, especially if it’s with a friend. Even something as simple as putting on makeup for an outing made me feel more like my usual self again.

Thought of the Day: What different techniques do you utilize and find helpful?

November 20, 2014 8 comments

Psychiatry therapy

Happy Enough?

written by freudandfashion

When my patients struggle to identify reasons for a decline in mood, I try my best to help them make sense of their distraught emotions. In the last week, I’ve had patients share that they feel depressed due to difficulty finding a job, having injuries that prevent them from participating in sports, and the moving away of a best friend. Though there are several theories that can be applied to depression, one theory I often use is derived from Martin E. P. Seligman’s theory of Positive Psychology (Seligman spearheaded research to determine factors that contribute to happiness). One component of the theory involves the pursuit of living a life fully engaged in the following 3 domains:

work (not just having a job, but having one that utilizes one’s strengths/talents)
meaningful relationships (close friends, significant other, family, etc)
leisurely activities (participating in enjoyable activities such as hobbies, sports, etc)

For example, Mr. C comes from a loving, supportive family, feels passionate about art, and obtained a degree in graphic design. He rigorously searches for a job and is unable to obtain one that utilizes his degree. Despite having his family’s emotional and financial support, he falls into a depression when he realizes that he must settle for a job that has nothing to do with his talent in graphic design.

Now, does this mean that Mr. C must find a job in graphic design in order to be happy? Not necessarily because he may strike a balance by immersing himself more in leisurely activities that support his artistic talents such as painting or joining a local art group.

Thought of the Day: Do you participate in activities that utilize your strengths and talents?

References:

Seligman, M.E.P., Parks, A.C., & Steen, T. (2004). A Balanced Psychology and a Full Life. Phil. Trans. R. Soc. Lond, 359, 1379-1381.

Disclaimer: this post describes one therapeutic technique and should not be used to replace treatment with your primary clinicians

October 24, 2014 6 comments

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