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stigma

Steps I Take To Be A Stigma Free Psychiatrist

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

Personal Psychiatry

Look You In The Eye

written by freudandfashion

Several friends have pointed out to me their observations of my interactions when in public places: that people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc. These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues. Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome.

Flashback to around twenty years ago when I was a loner preteen in the girls’ locker room, where my locker was located in the same aisle as the most popular girls at my school. As I stared at the floor too shy to make eye contact, I recall trying to muster the courage to say something to them…anything…in hope of some kind of acknowledgement, a wave, even a “hi” — anything to feel slightly less invisible than I already was. When I looked up directly towards them, words never left my mouth. All I had the courage to do was smile. A forced, awkward, and uncomfortable smile that caused my cheeks to fatigue.

And all that effort and energy exerted for the end result of coming off as creepy: “That girl is smiling too much,” was all they said. From then on and for quite some time, I became known as “that weird smiley girl.” As if smiling was a negative thing. And, as one could imagine, I didn’t smile for months thereafter. Little did they know how much of a hit to my self-esteem that one incident would have. Putting yourself out there only to get rejected sucks and may hinder further attempts to connect with others in the future.

One may perceive me as a highly sensitive, socially anxious person, and I don’t deny possessing those traits. However, rather than being identified with a label or descriptor (ie, “That weird, smiley girl” or “Vania is anxious and highly sensitive”), I prefer that people acknowledge the different facets of my personality that make up who I am as an individual (ie, “Vania has social anxiety and can be sensitive”). The general tone changes depending on the wording and language used. In the former statement, being “anxious” and “highly sensitive” are inferred to be words that define me, whereas the latter refers to “anxious” and “highly sensitive” as traits.

For many years, I viewed myself as abnormal. That is, until the last few years where I grew to appreciate the qualities that make me who I am as a unique individual, which I attribute to surrounding myself with an amazing support system, including my therapist, who helped me realize it. As a result, I no longer stare downward nor feel afraid to smile and chat with others.

An issue that I have with how Psychiatry is perceived is the tendency to create labels. Many people have enough anxiety about seeking psychiatric help in the first place, and the fear of being labeled and stigmatized might sit at the top of one’s list of concerns. I’ve encountered several patients who told me they were diagnosed with a specific mental illness after one brief, initial 30-minute interview. “The doctor told me I’m Bipolar without barely getting to know me” is a statement of different variations that I’ve heard several times in my practice. I try to maintain an open mind about my colleagues, especially those who are only allotted 20-30 minutes to meet with a new patient (which is ridiculous in medicine, especially in psychiatry) because the ability to see a high volume of patients within a short time frame AND fully get to know each patient seems unrealistic and virtually impossible to maintain.

However, the last thing any person, including any medical provider, should do is make you feel like another label and essentially invisible or judged. Often when people muster up the courage to reach out and seek help are in times of desperation and in highly vulnerable states. The most therapeutic thing any person (or provider) can do is look you in the eye (even if you might be too afraid to look directly at them) and acknowledge you for who you are.

September 2, 2015 8 comments

Medicine Psychiatry

Out of Isolation

written by freudandfashion

{Calistoga, California}

I noticed that my latest posts convey far less emotion than usual. My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip. Perhaps I should have requested two weeks off instead of one? Either way, I’ve felt numb in the past (as I wrote in previous posts), but my current state of numbness also included fatigue and the need for multiple naps throughout the day. At first, I blamed my tiredness on multiple potential causes (overexerting myself during workouts, not eating enough, lack of sleep). I returned to clinic with a massive inbox full of emails, prescription refill requests, and patient messages, but the one message that impacted me the most was a note documenting that one of my patients (whom I least expected to have a suicide attempt) was in the psychiatric hospital due to an attempted suicide by overdose. Normally, I’d breathe a sigh of relief knowing that my patient was alive, safe, and receiving care in a secure environment, however, something triggered me at that moment to feel even more anxious than usual, which led to a massive headache. Did I develop a headache because my mind can’t tolerate the thought of experiencing even more patient loss and grief?

Fatigue continued to hit me on a daily basis. And how ironic that I recently wrote a blog post on tiredness and neither of the reasons I listed seemed to fit my case. However, I neglected two important, plausible causes (one that I even listed in my post) — Burnout & Depression. One of my closest friends asked if I might be depressed and I quickly replied, “no, I just need to eat better.”

I thought to myself, “How can I be depressed? I make a good living, I chose to enter this field, people respect me and tell me I’m a great doctor, I have amazing family and friends…”

Yet, after fighting the idea that I may in fact be burned out and depressed, I became more accepting and relieved at finally pinpointing the cause — yes, I was burned out and depressed. I was experiencing loss of interest, fatigue, poor concentration, lack of motivation, and increased naps during the day. How dumb of me not recognize the signs, especially since I’m a psychiatrist??? (Depression obviously impacts cognitive abilities as well)

Later that day, I randomly thought of one of my patients whom I haven’t seen in clinic for quite some time. He missed his last two appointments with me and never returned follow-up calls. I quickly searched for his name and confirmed my biggest fear once I saw the word “obituary” next to his name. Tears filled my eyes, which led to uncontrollable sobbing. I seriously wanted to quit my job that very moment.

My attempt at self-care and setting healthy boundaries:

Whereas in the past, I would’ve dealt with the news by isolating, throwing myself into work as a form of distraction, or having several glasses of wine once I came home, I knew that I’d eventually hit rock bottom unless I sought help from others. I reached out to my close friends, sought support from my clinic manager, opened up about my issues in my therapy group, and talked to other staff members who knew my deceased patient. I allowed myself to cry rather than holding in the tears.

Feelings of detachment had also replaced my propensity to engage with others, which made practicing psychiatry and being fully present for my patients much harder. I scheduled a trip to visit my family in northern California for Father’s Day because I knew that visiting home would alleviate my detachment and make me feel like myself again. Also, in further effort to prioritize self-care, I requested a two-week long vacation in the following month because I knew that more time off was necessary to fully recover my emotions, energy, and drive.

Why am I sharing my experience? We may read research, statistics, and articles about physician burnout, yet the majority of people in the medical field still do not feel open nor comfortable enough to share due to fear of stigma, criticism, and feelings of guilt and shame. A part of me even feels somewhat embarrassed posting this, but if someone out there can identify with my experience, then why not share? Physician burnout is more common among physicians than other workers in the United States and has been linked with the following: negative impact on patient care, more likely medical errors, depression, and increased risk of suicide among physicians and medical students.

Staying silent about our struggles and trying to cope on our own does not solve the problem, especially since the rate of physician burnout is on the rise. If we can’t advocate and stand up for ourselves, then who will?

June 25, 2015 26 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

Psychiatry

Go Green!

written by freudandfashion

I spent this Sunday partaking in what practically 50% of Americans are fans of: watching pro football. I looked in awe at the stylishly bright, slick, and sporty pink athletic gear that each team member wore in support of Breast Cancer Awareness Month. I wished that Mental Illness Awareness Week (October 5-11, 2014) received just as much media and support.

For me, Mental Illness Awareness Week means promoting empathy rather than sympathy. With empathy comes understanding and lessening of stigma. Even as a psychiatrist, there are times when I feel awkward asking friends about depression, so I can imagine how difficult it might be for anyone to openly discuss and start a conversation about mental illness. But keep in mind that mental illness is far more prevalent than you may think:

– 1 in 4 U.S. adults suffer from mental illness

– 1 in 10 Americans take antidepressants

– Almost 50% of children ages 8-15 with a mental illness received NO treatment last year

Yet, despite how prevalent it is, suffering from mental illness is often lonely and isolating and nobody should have to feel that way.

So what can YOU do?

– Go Green! Wear lime green this week to serve as a reminder and trigger discussion among others about raising awareness and destigmatizing mental illness

– check out the Nami website to learn more facts about mental illness, treatment, and resources

– try to lend support rather than avoid. If you sense that someone you know is struggling, please check in on them. It sounds so simple, but you can make a difference and potentially save someone’s life

THOUGHT OF THE DAY: Share one thing you did this week to show your support (post in comments below)!

October 7, 2014 4 comments