Staying Sane in Insane Times

“The end is nigh” I say under my breath as I see articles about the spreading wildfires in Colorado and California, read headlines about continued covid cases, see that hurricanes and tropical storms are bearing down on us, think about the draught, police brutality, homelessness, unemployment, online schools, and whatever else is out there right now (what happened to the murder hornets?) threatening the safety of the world and its inhabitants. I grew up attending religious school. Catholic school by week, Islamic school on Sundays. We learned a lot about the apocalypse, end of times, whatever you want to call it. As I watch the news unfold, I can’t help but notice a link to the stories in the testiments and Quran about how the end will come about. I have a sinking feeling of dread every time the news is on. If I let my mind wander too much, I worry that we are reaching the end. How will it all end? Will there be some survivors, or none? This leads me to wonder, what is the point of all of this? Should I bother worrying if nothing actually matters and we’re all going to die soon? This is definitely starting to leak into my daily life. Looking into the future, a small part of me thinks that everything is futile. Should I recycle? Is there any chance of saving the world now? Do I need to save money for my daughter’s education, or will we all be gone? Will the world end tomorrow, ten years from now, or a thousand years from now? I’m finding it harder to work with my patients who are worried about day to day problems, when I don’t think the world is going to survive. I have a young patient with autism who has been struggling for about a year now with suicidal thoughts in the context of not thinking there’s a point to living. Never has active thoughts, just questions about what the point is, why we’re alive, and why it’s necessary to feel pain. We call it the existential crisis of their time. It’s been hard for me and the parent to walk the patient through this, and increasingly I’ve felt helpless in trying to figure out a way to explain to this patient why they shouldn’t feel hopeless. And yet, even with all of this “end of the world” nonsense, I still find myself happier than I’ve ever been in my life. Things seem to be going well for my small family, with no major set backs. The stress though, seems to weigh on me. THe constant fear of something bad happening, or the stress of caring for people under stress, or the uncertainty of it all, can sometimes get to me if I’m not careful. And I can only imagine how hard it’s been on everyone else. So how do we manage and keep our sanity. The answer to that is different for everyone of course. However, I think there are common themes we can hold onto. 1). Try to create some form of structure in your day People really don’t think about how important structure can be. We all think it would be great to live a completely carefree, unscheduled life. The truth is, most humans strive off structure. We need some sort of routine to get through our day. Kids in particular need structure, and they need someone to help provide it for them. Work and school are great in providing a sense of structure and stability. We know when we have to get up, how to get ready, when we need to leave, what’s going to happen through the day, and when we go home. This has been one of the hardest things for us to give up. So if you don’t have school or a trip to the office to provide this for you, make a schedule for yourself each day. It doesn’t have to be as strict as it would be if things are “normal,” but something to keep you realizing that today is a separate day from yesterday, and this moment is a separate moment from the last. Otherwise everything feels monotonous and pointless. I like to tell families to wake up at the same time every weekday (even if it’s a little later than it would be for school), get dressed, eat breakfast together, and do something that signals the start of their work/school day. This could be going for a walk, or getting all their work organized. There should be a space that is dedicated to home work that is (if possible), different from where you eat, have fun, or sleep. You should hang out in that space during “work” hours, and set times for how you’ll get work done, breaks you’ll need, and meals to eat (no mindless snacking! Set meal/snack times!), and a specific end of work time. Once it’s end of work time, do something to signify that your day is over (like another short walk). Have dinner at a specific time, and go to bed at a specific time. You can allow some spontaneity in your day, but the skeleton of structure helps keep you focused. 2). Take care of your own health as best you can We all can do things that will keep us healthy even in an uncertain time. This includes washing our hands, socially distancing, wearing our masks, and not having big get togethers. We may not be able to control what everyone else is doing, but we can do our part. Even if no one else is cleaning down your work station, you can clean it before you start. You can choose not to spend time with people who refuse to wear masks. Eating healthy, exercising, and staying on a sleep schedule is also very important to staying healthy. Take your medications, go see your doctor for your medical needs, etc. This also involves taking care of your mental health, which is very tied into your physical health, and the other things I list below will be helpful with this step as well. Make some time for yourself. Take a shower. Do your hair. Try yoga. Take a day off from work if you can to relax and reset. Turn off the news. I only allow myself one hour tops of news a day. I check headlines a few times a day on my phone, read the most important articles, and leave the rest. Limit your time on social media, we don’t need that trash right now. Watch cat videos. Take up a relaxing hobby, something that can distract you from everything. 3). Find people who are supportive of you Human beings are social creatures. Prolonged isolation is not good for us, even the self proclaimed introverts. We need to be able to interact with other people. Doing so over text message, zoom, or the phone doesn’t feel as comforting as in person, but it’s what we’ve got to reach out for. Make connections, talk to people, and ask for help when you need it. Find people who can give you love when you’re asking for it. Find people who understand your desires and needs. Set boundaries with those who can’t. As the days become weeks and months, it’s hard to remember when the last time I called my best friend was, but as soon as I do, I feel better. Check in with your support groups. 4). Practice “going with the flow.” This one is tough for a lot of us. Many people don’t like uncertainty, and it’s hard for plans to change so frequently. How do we plan for the future if everything is constantly changing? I find it so hard to pivot to a new plan when my plan goes to hell, but sometimes having multiple contingency plans helps me out. “If this happens, I’ll go do it this way, but if this happens, I’ll do it another way.” It’s a good exercise in flexibility. You get to be angry that your plans didn’t work out. All of this sucks, and that doesn’t change. And still being able to find a way to move forward and do what you can. 5). Take control of what you can, let go of what you can’t. This is similar to going with the flow, but more about knowing what you can change, can’t change, and how to be ok with those distinctions. For example, I can’t control whether my neighbors wear masks. But I can choose to always wear a mask when I’m out, not let anyone in my house who isn’t wearing a mask, and not engage in neighborhood parties. I can’t control that I’m back at work, but I can wear my mask and limit my other activities. I can decide I’m going to continue recycling whether others do, and teach my child kindness, and provide as structured of an environment as I can for my family. I can do my job within the systems, and work towards trying to change the system, without taking responsibility for everything. 6). Stay physically active “exercise releases endorphins, and happy people don’t kill their husbands.” If nothing else, remember this “Legally Blond” quote when you ask yourself why you have to get up and work out. Remember that there are multiple ways to be physically active. Running, swimming, biking, weight lifting, dancing, going for walks, or doing yoga/pilates are all important ways to get your blood flowing, keep you in good shape, and calm down your overactive nervous system. Making sure you plan breaks in your day to get up and move around. This is a great time to get involved in a home workout. Make it a family affair, have everyone go for a walk together. Or have it be your alone time. There are great apps and youtube videos for home workouts, no equipment needed! 7). Practice mindfulness Mindfulness is my new love affair. I used to think mindfulness was only about meditation, and I hated meditating. I’m learning that mindfulness is so much more. It’s the practice of being physically, emotionally, and mentally present in a moment. And now, more than ever, we need to be using mindfulness to cope with the uncertainty of the world. There are so many great apps, workbooks, webpages, and books about how to be mindful. My advice is to try a bunch of different things to see what suits you best. My favorite form of mindfulness is taking a moment to check in with myself. Between each patient, I take a huge, long, steady deep breath in and back out. I sometimes close my eyes for a bit. I willingly let go of all the stress I’m feeling in that moment so I don’t take it into the next appointment. This five second practice helps me get back into myself and calm down before I move on with my day. Other forms of mindfulness I use include actively stopping my thoughts (this take a lot of practice), listening to music, rubbing my fingers together while on a run to focus in on something else besides how much I hate running, taking some deep breaths, and doodling. I am not in love with meditation yet, but I like short ones. Progressive muscle relaxations help me get to sleep when I’m too anxious, or really short guided meditations from apps like Headspace. Practicing mindfulness helps you use it when you’re stressed. Because I do daily mindfulness exercises, when I get super stressed out I have the skills I need to bring me back (most of the time). I can actually use the deep breathing techniques to get me feeling better. Sometimes I have to do something bigger, like taking a break, or crying in the corner. But I’m less often getting to that point because I’m more in control of my emotions, and my baseline is low. 8). Keep hope alive. Imagine the future you want. I recently saw a cartoon in which two characters made comments about how important it is to imagine, dream, and day dream. “It keeps hope alive” the last caption said. I hadn’t thought of it before. If we can imagine a better world, we can keep hope alive that we can create it. And hope is what will get us through this. Having hope that things can get better is the first step in being willing to take action to make things better. Dream of that future, when all this is over. Create it in your mind how you want it to be, and then take steps to reach those goals. Allow the dream to change as things change. Most of all, remember that this is hard, and we’re going to get through it as best we can. Stay safe and healthy out there

Maybe it's all just anxiety after all

I graduated medical school eight years ago. I've been practicing psychiatry as an attending for the past three years. I'm definitely still fresh out of the water and onto land in my evolution as a doctor. I have not seen it all or heard it all. Yet my experience is pointing me towards an interesting understanding of the world. As I'm working more with patients, myself, my friends, and my family, I'm seeing the world particularly through the veil of anxiety. Not so much my own anxiety, but more that almost everything can be explained in some way by anxiety. What is anxiety? Fears, worries, nervousness, overwhelming sense of dread. Everyone feels anxiety at some point. I feel anxious Sunday night, worrying about the week I have ahead of me. I get anxious before a test or a performance. Anxiety is adaptive. It's an evolutionary advantage. If we didn't feel anxiety, we wouldn't know when we were in danger. If I didn't feel anxiety before a paper was due, I'd never finish it. There are many anxiety disorders in the DSM. I can't say this for certain, but I think there are more disorders that fall under the header of "anxiety disorders" than any other. There's generalized anxiety, social anxiety, PTSD, ATSD, separation anxiety, OCD, specific phobia, selective mutism, hypochondriasis, symptom anxiety syndrome (is that it's real name? I might be making that up), panic attacks, agoraphobia. The list goes on and on. When I'm asking patients about symptoms of anxiety, there are so many subtle hints. People who have headaches, or stomach aches. Kids who refuse to go to school. People who get so overwhelmed by everything they shut down. Sweating. Easily frustrated. tearful. Won't leave the house. Etc, etc, and so forth. When I look at my own anxiety, I've recognized it as a short fuse. I get so easily overwhelmed. I'm on high alert. Everything feels like an attack on my senses. I can be fine with a level of noise, then get overwhelmed, and all of a sudden I can hear every sound around me as if it's in stereo. If there are too many people around me, my sense of touch goes haywire, and I feel every brush of someone as if it were a slap. I get so tense, as if my every nerve fiber is taut. I want to scream, I can't breathe, I can't think, my ears ring. My mind races with "I've got to get out of here." Everyone has a fight or flight system. This is the part of your body that says "hey there's danger, you want to kick it's ass or run away?" Without your conscious awareness, your body prepares for this. Your heart starts pumping faster, your breath is more shallow, your digestive system goes on hold, your muscles tense up, your vision becomes more narrow. Everything is ready for whatever the danger is. Once the danger has passed, your body goes into rest mode. You're tired, your heart slows down, you might need the bathroom. The problem we see with anxiety is that your fight or flight is always going. Your mind thinks everything around it is dangerous, whether it truly is or not. And with our evolution, we're in different types of danger. We're rarely faced with a predator that we have to flee from, but our brains have decided that going to school when we're anxious is just as dangerous. And if our fight or flight is always going, we can't recognize when true danger is around. This level of hyper-alertness is exhausting. I so often hear my anxious patients say they feel tired all the time. It's understandable, given how much energy goes into the anxiety response. Both physical and mental energy. It takes so much work to be worried all the time. It uses up so much of your energy stores to feel tense, alert, and waiting for the next danger. And then, when it's finally time to sleep, and your defenses are lowered, the anxious thoughts start in. The tossing and turning. There's no break from it. So much of this happens on an unconscious level. We might not even know what the perceived danger is. All of a sudden we just feel it, headaches, stomach aches, tense, tired, sensory overload. The symptoms are different for everyone. And our unconscious minds do an amazing job of protecting us from these dangers. The amount of information our unconscious minds can take in, that are never put fully into our awareness, is amazing. But that makes it harder for us to realize that our mind has picked up on some bit of danger, and sets our fight or flight back into action. Information can be mis-perceived as danger. We see this with trauma responses. Someone who has experienced a truama often has what we call hypervigilance, or increased startle response. You see this when someone jumps up when they hear the smallest noise. Or need to constantly have their back to the wall when sitting. They're constantly looking over their shoulder. They think something bad is always right around the corner. And can you blame them? They've lived through something that was bad. They relive their bad situations. They feel like they're constantly triggered, but don't always have in their conscious awareness what that trigger might be. It could be the anniversary of the event, and they've buried it so deep they don't remember. But the body remembers, and acts up. We also see this in people who live in constant chaos. Multiple adverse life events can affect people the same way one big, terrible trauma can. We don't always recognize it for what it is, because we aren't always getting that history from someone about multiple small attacks to their safety. And we don't always recognize that something happening now is being perceived as a threat to safety by the unconscious mind. For instance, an child of a single parent might do really well when that parent remarries, but then start acting up when a new sibling comes around. That child's mind is telling him that he's being replaced by the sibling, and even though they might be very excited on a conscious level, their unconscious level could be stirring up trouble. Without the ability to recognize what is making the child feel uncomfortable, they might start acting out, having more explosive or angry behavior, and truly not know why. So often I have anxious patients tell me they feel paranoid. We generally think of paranoia as a sign of psychosis, but it's a mis-perception of the danger around us. Some anxious people think people are following them, or watching them. They perceive judgement from strangers, and misunderstand cues happening around them. On a lesser level, we see this when we think our boss is mad at us for something, and then every interaction with our boss that day can reinforce that, the wrong look, them not greeting us like usual, or being called into their office. More often than not, it's nothing. On a larger scale, people can think that the government has installed cameras in their house to monitor them. And in between is a level of anxiety driven paranoia that wouldn't be considered psychotic. I think the same can be said for certain hallucinations. Many people say they hear voices, which is usually a sign of psychosis. Sometimes though, that is also just our mind playing tricks on us. Or, our mind protecting us from our feelings/anxiety, because we've taught ourselves that feelings are dangerous, by convincing us there are voicing saying all of the negative things we were thinking. Mood swings and lack of sleep are the same. If we're too anxious, we can't sleep. Our bodies will keep us up for days if they think we're in danger. When we don't sleep, we definitely start losing our grips with reality. And when we're too anxious, we can't always manage our moods. One minute we can be fine, the next something throws us completely over the edge. How do we make this all better? Treating anxiety can decrease a number of symptoms we weren't even aware we were having. By improving our self awareness, we can recognize our triggers and responses. We can then adjust how we respond to our triggers. We can also use mindfulness and meditation to "reset" our fight or flight system. Exercise is a fabulous way of doing this. We physically wear out our bodies, make them stronger, increase endorphins, and lower our resting heart rates through exercise. Therapy gives us tools to be able to recognize and mitigate responses. In my own life, recognizing how my anxiety manifests, and how that might be different for others, has helped me become a better provider of care. It's also helped me understand myself and find tools that can keep me healthy and happy. I still, and will always, have anxiety. But through a combination of medication, therapy, and healthy living, I'm able to say I have better control over it. I hope that through education I can help others feel the same way

How was I a racist today?

My husband and I have been having more and more conversations about race, racism, and equity. Being a biracial (sort of, I mean, Arabs are considered "White") couple, the issue of race probably comes up for us more than some of our friends. I've been drawn deeper into the world of racial equity and wanting to be more of an activist and advocate in my own right. We decided to listen to "How to be an Antiracist" together on audibles. We listen to a chapter each night (started two days ago, so we're two chapters in). I'm also listening to "So You Want to Talk About Race" by Ijeoma Oluo. In my learning about racism, privilege, and fragility, I'm taking stock of all the times I've been a racist. Sure, I don't go around using racial slurs, or burning crosses, or truly believing that people deserve to be offered less or valued less because of their race. Yet, I have often said racist things, thought racist thoughts, and held racist beliefs. Being able to sit with that knowledge has been uncomfortable and humbling, to say the least. It's strange to wake up and realize you aren't as "woke" as you thought you were. In this journey of self discovery in order to be an advocate, the one thing I've truly learned to do well is be wrong and learn from it. My reckoning last night was that I can be a racist and still be striving towards being anti-racist. I have to learn what I'm doing that is racist, and then stop, and try to topple the system allowing it. So I've been thinking back to some examples of when I was distinctly thinking I was not a racist, and still upholding racist ideas. I remember listening to a discussion about Black health disparities within psychiatry, and not being able to stand the notion that psychiatrists were racist. When given information about how Black people are more often prescribed older medications, instead of being able to see that this can be racist, I retorted with "maybe it's because we know our Black patients can't always afford the more expensive medicines, adn they don't work that much better anyway." When faced with "Black patients are more likely to be seen as aggressive in an ER" I came back with "sometimes a very loud, agitated patient can seem psychotic in that moment." I was so defensive, and standing up for psychiatrists. I honestly felt like because I was White appearing but not White, I had a better understanding of and ability to articulate what psychiatrists were actually trying to do, instead of listening to these Black advocates explain to me how my profession can be racist. At the time, I was so proud of my "performance" in this discussion, but now I'm ashamed of how I behaved. Anyone there would have been hard pressed to label me a "racist" but I sure was allowing a racist system to continue to go unchecked. This past weekend I was working in the psychiatric emergency room and a Black woman came in after being sexually assaulted. She told me she was in pain and asked for pain medication. My immediate thought was "she just wants narcotics." Why am I so quick to judge another person's pain? I ended up giving her medicine (non-narcotic, as I don't like prescribing opioids anyway), but when I went home, I had to seriously reflect on how much of the racist teaching we get about Black people in medicine (they have less pain, or thicker skin) that I don't even remember learning, had been imbedded in me. How much was my response due to her being Black. How much of it was bias towards pain in general, which (like sleep), I have difficulty wanting to medicate away. On Monday, I was waiting for my second patient of the morning to show up. As I was disgruntledly thinking "my Hispanic patients are always late" I remembered chapter two of Ijeoma's book, where she specifically gives an example of how this is a racist thought. Why am I always assuming my Hispanic patients will be late? Why, when a White patient is late, do I not have that same reaction? Why am I willing to generalize all of my Brown patients this way? I thought more about it, and realized that being "on time" is a construct of a White society. Many Brown people view time as more fluid. So my Brown patients are often late, but maybe it's not the same value to them as it is to me. Maybe, in reality, my White patients are just as often late (they are) but I don't assume they will be because of the color of their skin. How was I racist today? How will I be racist tomorrow? I've also been actively anti-racist, which definitely takes more work. Learning about what it truly means to be anti-racist (more than just saying I'm not racist) has been eye opening. Today I made sure my White students were able to acknowledge the racism within medicine. Today I was also able to call out a friend who had made racist comments on social media. Today, I actively made sure I was offering my Spanish speaking patient the same explanation of medication and offerings of services that I would my native English speaking patients. I'm actively trying to learn and teach and preach anti racism. What a strange journey this is. I apologize for all the times I was racist in the past, and hope to minimize the number of times I'm a racist in the future.

Psychiatry stigma in medicine

Today I led a small group session for 3rd year medical students on their first week of their psychiatric service. Every week they do a reflective writing piece based off of a prompt, and come together to discuss this. I vaguely remember doing this in medical school when I was a student. Normally the course director leads the group, but he was busy today and asked me to instead. Each of the four students sent me their reflection ahead of time. This week's was general: what are you nervous about for your psychiatry rotation? I decided to write my own reflection, but I couldn't really remember the start of that rotation. It was the last one I did in my third year (well, except for surgery which I had to make up at the end of the semester. I had failed my board exam and was pulled out of the surgery rotation to study). Maybe by that point I wasn't as fearful about a first day. Maybe I've just forgotten about it. Either way, I could only reflect on my first day of intern year instead. Having not planned to go into psychiatry, and only having done one rotation in pediatric psychiatry, I was pretty scared of psychiatric patients. I wasn't sure what to expect, or what I was going to do. I wasn't sure about what medicines to use, or how to treat people. I felt like I'd be going in at a distinct disadvantage to everyone else. And yet, I loved it. It was the start of my love affair with psych. The students all had somewhat similar reflections. Worries about 3rd year in general (this is only their second rotation of the year). Wondering how to talk to psychiatric patients. Worries that they'd be in harms way. What were they supposed to do with a psychotic patient? How does one even talk to a person who is sharing their trauma? What if I say something wrong and insult someone? or make them feel worse? Even though I remember worrying about these same things when I started my internship, now, years later, it makes me sad how nervous people are to be on their psychiatry rotation. Specifically, how different, other, and scary the patients seem. The preconceived notions people have about our patients, like they aren't "normal" or are somehow more dangerous or fragile. And I recognize how we perpetuate this stereotype within medicine. On the general wards, as soon as someone mentions depression, they're "one of those psych patients." A consult is called and everyone else ignores the problem. The patient is then treated differently for the rest of their stay. In medical school, we are teaching the students to fear their psychiatry rotations. Everyone has images of violent, aggressive, "crazy" patients that they couldn't possibly relate to. If even our doctors carry that bias, that psychiatry is somehow "other" or scary, how can our patients feel supported and safe in our communities? Imagine already being so scared by the voices you hear that no one else can, and yet you're seen as the scary one. How do we help patients get the care we need, if we continue this way of seeing our psychiatry patients? I don't think many of the other rotations ask for reflective writing. I imagine a general prompt of "what are you worried about starting your medicine rotation" would bring responses of "I'm worried I don't know anything, or I'll fail my patients, or hurt someone with my inexperience." I doubt they walk into a room fearful of the patient themselves, or the disorder they are presenting for. Yet there's no difference between the patients. They're all human beings asking for help, needing medical care. I asked the students today to think about this bias. I reminded them that psychiatric patients are more likely to be the victims of violence than the perpetrators. I expressed to them all the joy they could find in psychiatry. I tried to give them tips and pointers in how to talk to patients, be present with them, acknowledge their life stories, and remember they are regular, normal, human people needing and deserving of our care. There's such a shortage of psychiatrists in this country, and all over the world. How can we get our medical students more interested in this rotation? If we can't end the stigma of psychiatry within medicine, how will we be able to continue providing care for these vulnerable patients. I remember loving psychiatry in my third year, but not even considering it as a career for a second. I had to be a pediatrician. A "real doctor." I couldn't imagine enjoying this forever. I couldn't understand going through medical school to be "just a psychiatrist." I thought I'd "hang up my stethoscope forever." What would my family think of me? Or my community? Psychiatry had never crossed my mind until third year. Even with all the joy it brought me, I didn't give it much of a thought. I was blessed enough to not get into pediatrics. It was a tough blow at the time, but a blessing from God himself nonetheless. And yet, there are still some times when I feel like I'm "not a real doctor." I feel like I don't really help people. I'm not saving lives like a surgeon or a pediatrician. If they asked for a doctor on a plane, I'd be terrified. Why do we allow psychiatrists to feel ostracized like this? Why do we stigmatize psychiatry so much that even the profession has to face the bias. Being a psychiatrist still didn't stop me from being so biased against my own patient population that it took me years to get back on Zoloft, when I knew I needed help yet refused to ask for it. It's made me wonder whether I would want my daughter on the medicine I prescribe so many other children. Would I make her suffer unnecessarily with symptoms that can be treated because I'm worried what other people will think of me? How do I reconcile these warring thoughts and feelings in my head. Thankfully, I'm have a robust response to Zoloft. Being able to feel my mind clear, and my anxieties become more manageable, has helped me become a stronger advocate for my patients. Why should people suffer because of some stigma we've put out there? I'm hoping we can all continue to do better. I'm hoping I can help future doctors, one medical student at a time.

examining my own privilege

In any discussion of white privilege, I think it’s important to recognize that at some point, a lot of us have experienced some kind of privilege. It is not necessarily something to be ashamed of, because it’s often something we cannot control. And privilege doesn’t mean that we haven’t worked for what we got. When we say white people have privilege, we mean that the color of their skin doesn’t get in their way. It means white people start out at an advantage, even when disadvantaged. It doesn’t mean that white people have not experienced adversity, or don’t work hard for what they have. I don’t always recognize my privilege, and I’m not great at being objective about it. I’m often embarrassed by my privilege, or worry that people will think I didn’t earn what I’ve had. So I know how hard it can be to have conversations about privilege. My privilege doesn’t just come in the form of looking white. I grew up comfortably middle class. My grandpa was a surgeon. All of his children went into healthcare. They lived in the same town as us, so when I was growing up he was always around. I saw him practice, saw my mom work as a pharmacist, saw my aunt and uncle become physicians. I went to private school. We were definitely in the poorer group of people who went there, and I grew up thinking I was a lot poorer than I was, but we were comfortable. We took trips, went to camps, had a car when we turned 16, and knew we’d go to college. I worked as a babysitter and always raised my own money to take school trips, but I lived in a nice enough neighborhood that I could solicit. I was able to work in the daycare at school, never had to work in the service industry. I got a scholarship to college and picked a school that was inexpensive enough that I wouldn’t have debt. My grandma bought me a car after I graduated. I was awarded a Fulbright scholarship and able to travel abroad. I didn’t get into medical school right away but I found a job to pass the year. I was able to live at home through med school and my grandpa paid my tuition, so I barely have any debt. My family is well respected in our community. I’m a physician, putting me in a place of power and authority (sometimes) in the hospital hierarchy. I live in a nice house in a safe neighborhood. I have healthcare. I am relatively healthy. I have access to a gym. My husband is supportive of my career and is an equal partner in parenthood. Our daughter came into this world healthy and has remained so. My privilege to me feels like blessings more than anything else. And I suspect that’s how privilege feels to most. I have little control over this privilege, I didn’t ask for it. I recognize though, that each piece of this puzzle is built upon the privilege that comes before it. With privilege comes responsibility. I’m learning now that I need to use my privilege to be an ally for others who don’t have the same privilege. I don’t always do this well. This is where I’m learning the most. I have often said “I probably wouldn’t have gotten into medical school if my grandpa, aunt, and uncle hadn’t been alumni of the school. I had a wonderful application, a lot of heart, and I make a great doctor. I recognize that this may not have been enough. I may have never been accepted, no matter how hard I worked. Knowing the right people helped boost me. I see that, and am grateful for it, and am also shamed by it. It increases my imposter syndrome, I feel like I didn’t do enough, and don’t really belong. That makes it hard to have a conversation about privilege. When you feel shame because of it, and worry that you wouldn’t have been enough without it. Without being able to put those feelings aside, it’s hard to know what to do with my privilege. If I’m so overwhelmed by the feelings of shame, I can’t recognize that I need to use my privilege to help others. My favorite phrase to talk about privilege is “you can’t pull yourself up by your bootstraps if you don’t have boots or straps.” It helps me remember that hard work isn’t the only way to succeed. Many people work so hard and don’t get anywhere because of other circumstances and lack of privilege. I have to not only recognize my privilege, but recognize that others don’t have it. It’s particularly important in healthcare. When I’m giving recommendations, I have to know they are reasonable. How can I ask a patient to take a medicine every day if they don’t have access to a pharmacy, or don’t have a home to keep their medicine? How can I ask them to get on a sleep schedule if I don’t know where they sleep at night? Health disparities happen on a daily basis. Bias in medicine is real. Racism exists. Stating these facts is shameful, yet we can't overcome them and truly set up a system of care that works for everyone if we aren't willing to acknowledge these basic facts I have privilege. I choose to use mine to try to level the playing field for others. What will you do with yours?

The lens through which I see the world

I want to dedicate this post today to my own journey through privilege, race, identity, fragility, and activism. Growing up Arab and Muslim in the US, pre and post 9/11, I’ve been on this journey for a long time. However, I’m realizing I’m still very new to this journey. I live in a strange reality where I'm both white and not white. Throughout my life I’ve grappled with this dichotomy of identity. I often talk about it jokingly, saying things like “I’m white when it’s convenient and Arab when it suits me,” but it’s not a joke that I’m struggling so hard to recognize my own place in this world. I’ve faced racism and Islamophobia, Xenophobia, sexism, while at the same time experiencing privilege, white fragility, and colorblindness. I learn something new every day. I see so much more by being able to move between the groups (white vs person of color) but I often don’t feel like I fit in any one of them. Recently someone said that creating an inclusive environment is about allowing people to be their complete, authentic selves. When I was reflecting on this statement, I realized I’ve rarely felt comfortable being my authentic self. Mostly, it’s because I’m not sure who my authentic self is. This is not a new experience for me. My previous therapist wanted to focus on my cultural split quite a bit, but I wasn’t ready to do so at the time. I wish I had been, because now it’s all I can think about. I never feel truly Arab, but I don’t identify as white. I worry both that people will see me as a white person and that they’ll see me as a scary POC. I worry that people don’t know I’m Arab, but at the same time I worry that when they do, they’ll see me differently. I recognize the privilege in this. I don’t have dark skin, so I can walk through the world with less fear than my darker skinned friends. They don’t have the option of appearing white, they are always seen as the “other.” Every experience they have is through the lens of someone seeing their race, whereas I get to sometimes be “colorblind.” Yet at the same time, I often feel like my experiences aren’t as valid, or I wonder if things that happen are due to my being an Arab/Muslim, since I don’t know if people even know that I am. I sometimes think about wearing hijab specifically so that people know I’m Muslim. I want them to see me, and know me, and treat me the way they’re going to treat me. Yet this kind of motivation isn’t really the point of hijab. And of course, I’m terrified of the response I’d get. This is part of the lens through which I see the world. I’ve found it very handy to be white and not white though, since I feel like I can relate and talk to both groups. I can bring up issues other people might not feel safe enough doing. I can be a “safe person” for my friends who are white to ask questions, and for my friends of color to talk to. It is also an obligation though, to use my place to amplify the voices of the unheard or unseen. I hope to do that partially through this blog. Stay tuned for more

Seek help, get opinions from the right people

I’d like to start a #stopthestigma series. This post would actually be continuing it, as my other psychiatry related posts have been in an effort to stop the sigma. This post is about seeking help. I started thinking about this post a few days ago, when a friend of mine was talking about the possibility of starting medication. I’ve known this friend for a long time, and over the past few years I’ve noticed increasingly levels of anxiety in her. I’ve casually mentioned medication and therapy to her before, but more recently she told me she was thinking about medications. She talked to a therapist, who reached out to her doctor, who recommended a trial of an antidepressant. We were chatting about it and she said “I was talking to my other friend, and she was telling me how I don’t need medications. I just need to exercise and eat better and blah blah blah.” I’ve heard this a million times from a million people. Everyone is making suggestions about why you don’t need psychiatric medications. And it’s always bothered me a bit, but for some reason, this time it really pissed me off. It was the first time that I was able to process through the reason I get so upset. It’s because people shouldn’t be offering medical advice if they didn’t go through the schooling and training that’s necessary to understand and make these decisions. Think about it. You probably don’t have a lot of friends who would tell you not to take medicine for your diabetes if your doctor recommended it. Or that you don’t need an inhaler for your asthma if you just take deeper breathes. But everyone feels like they can tell friends and loved ones that they don’t need psychiatric care. What makes you an expert on psychiatric medications? I can tell you what makes me an expert: four years of medical school, five years of post-graduate training (residency), and almost 3 years of independent practice. I’ve got a medical school diploma, my residency certificates, and board certification in both adult and child/adolescent psychiatry The stigma around mental health is so strong that people spend years of their lives in misery so that they don’t get “shamed” for accepting care. Why are we so willing to allow this to continue? Even as a psychiatrist it took me years to accept my own need for medication. Accepting help doesn’t make us weak. Having a psychiatric disorder doesn’t make us weak. Don’t accept medical opinions from non-medical people. Take care of yourself out there.

Welcome back, it's been awhile

It’s been awhile since I started this blog and only one post on it so far. My goal this year is to increase the number of posts, and make this something meaningful. One of the hardest parts of starting something, for me, is the starting of it. Or the res-starting if I’ve lapsed. I was extremely excited to start this blog, but as I kept putting off new posts, I started doubting myself more. It because harder to start back up the longer I waited, because it felt like I had to explain my absence, or pick a really interesting or meaningful post to start with. One of my goals for the new year is to overcome my imposter syndrome. This blog will be a huge step in the right direction for that. For those of you who don’t know, imposter syndrome is the idea that one’s accomplishments are not deserved, or that one is a fraud. This is a very common phenomena and tends to plague people of minority status the most. It can take on many forms. For me, it’s the idea that all the hard I have done is not enough, that I’m just scraping by, that other factors have influenced my progression through life and medicine. The all too common dismissal of praise, or the idea that I am not as smart as everyone thinks I am. If you’ve read my medical school blog, you know I had struggled a lot. I constantly felt inferior to my classmates. Instead of understanding that within the context of everyone in medical school is smart and worthy, and that my prior accomplishments still mattered, I took it to mean that my prior accomplishments were fraudulent, or granted to me by “other means” and that I didn’t belong in such esteemed company. I’m constantly doubting my own ability to be a good physician or a knowledgeable person. I’m terrified by anyone asking me questions. I answer a lot with “I’m not really sure” and try to deflect it onto others. Even things I am sure of, I don’t give myself enough credit in my knowledge. I’ll constantly say things like “but I might be wrong.” When people compliment me, I push the compliments aside. Especially comments like “you must be so smart.” I don’t know how I’ve been so conditioned to disbelieve any evidence that I am, in fact, intelligent. How does this relate to a blog? Well, not believing I’m smart enough or expert enough makes it hard to post a blog. “what if I post the wrong information? What if someone asks a question I can’t answer? What if I sound dumb?” All of these are real worries for me. But this year I need to do things for myself, and to build myself up. How does one conquer their imposter syndrome? I’m sure there are a million articles out there about the steps we should take. My plan may be a bit different than that. First off, I’m going to accept compliments. I think women are conditioned throughout life not to accept compliments and to be too hard on ourselves. Whenever someone tells me I look good, I’m going to thank them. Maybe throw my hair over my shoulder and bat my eyelashes. When someone says I’m smart, I’m going to thank them. I’m not going to try and contradict anyone’s good thoughts about me. I’m also going to celebrate and use the way I learn instead of feeling like I learn “wrong.” I learn best by someone teaching me. Reading an academic article is not helpful to me. I get caught up in the details and very bored by the comment. I prefer when someone summarizes things for me. I like hearing someone explain to me why something works or going to conferences to learn new things. I do well with short podcasts or lectures. I don’t do well with literature reviews. That doesn’t make me less worthy or intelligent that others. When people ask for my opinion or advice, I’m going to be confident in my ability to give it. I’ve been through many years of schooling, training, and practice. I know what I’m doing. I’ll volunteer to teach and provide consultations. Although I love to call this the “year I conquer my imposter syndrome,” I know that this might not be accomplished in one year. It’s taken me years to get here, it’ll take me years to get out of it. There have been so many subtle, learned, and engrained instances that have reinforced my imposter syndrome. It’s like a weight I’ve been carrying on my back all these years. I won’t be able to drop it all forever, but being able to slowly lighten the load will be a victory. As they say, one day at a time. So join me on my journey of self discovery, information, and hopefully, we can stop the stigma around mental health.