The Power of Creating a Routine

Routines provide both structure and organization. What this boils down to is pattern recognition. Humans are creatures of habit, and routines provide predictability and stability that helps us to stay calm, better manage stress, and have an improved sense of well-being.

When we don’t follow a routine we are often left feeling a little bit scattered and more on edge. We may worry more about getting things done in a timely manner, might feel like we are more behind with regard to task completion, and often rely on impulse as opposed to foresight which can have negative consequences on our health long term.

For example, if you are in the habit of meal prepping for lunch daily, you’re likely to make healthier choices when it comes to food. As opposed to not planning ahead, and eating whatever might be closest to you at the time hunger strikes ie. the office donuts, whatever is available in the vending machine, or whatever might be at the closest fast food joint.

Routines help us create consistency and predictability. When we create a reliable routine for ourselves, we don’t have to guess or worry about whether the important things on our list got done. We already know they did. This often means that we can sleep easier knowing there isn’t something important we completely forgot about, and can wake up knowing what we need to do which allows us to be more efficient and less stressed.

When it comes to creating a routine, start small. Getting into the habit of maintaining a routine takes practice and won’t manifest overnight. Small changes done consistently over time pay off in dividends.

For example, if you’re constantly looking for your keys in the morning and are almost late to work because of it. Try a key bowl. Whenever you get home, drop your keys in the bowl so there’s no guessing where they will be when you’re ready to leave the house the next day.

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Personal Boundaries and Why You Need Them

The topic of “boundaries” comes up frequently in conversation, particularly in the mental health context.

But what exactly are boundaries and why do we need them?

A boundary is basically a limit. It can be something tangible, like a “no trespassing” sign, or invisible, like choosing not to answer personal questions if they make you uncomfortable. When we talk about personal boundaries, we mean boundaries in relationships. And not just romantic ones. There are many different types of relationships including: familial, plutonic, collegial, etc. Identifying your limits in each of these relationships is the first step to developing and maintaining healthy boundaries.

Boundaries help you to determine what is acceptable and what is not in a relationship. For example, if someone asks you out on a date and you politely decline, but they keep asking you to go out again and again without taking “no” for an answer. This is violating your boundaries.

Healthy boundaries is the very first step in creating healthy relationships. The second step is to stick with the boundaries you have created, and have a plan in place for what happens if someone continues to violate those boundaries.

Boundaries are necessary for self-care. Without them we often feel: anxious, depleted, angry, burned out, resentful, hurt, or taken advantage of. While there are some actions that clearly cross boundaries for almost anyone, we all have different levels of comfort when it comes to setting boundaries especially around deeply personal things like privacy and intimacy.

Because of this, it’s important not to assume that other people know what your boundaries are. If you feel like someone is not respecting your boundaries, you have to let them know so they have an opportunity to correct the behavior. If you don’t speak up when a boundary has been crossed, it gives whoever you are interacting with the impression that you are okay with what just happened.  If they choose not to, that is when consequences for these types of behaviors become more important. The act of setting and sticking to boundaries is a skill, and isn’t something that happens overnight. It isn’t always comfortable, especially if this is a new practice for you. Sometimes people around you may push back and test your limits if they notice this is something new you’re trying. Just because you tell someone “no” and they get upset, doesn’t mean you should have said “yes.” The more clear and consistent you are with your boundaries, the more likely others are to adjust to the new way of interacting with you.

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Strategies for Parenting Children with ADHD

When we discuss parenting, one of the most important things to clarify is the difference between discipline and punishment.

Discipline is proactive. It allows for kids to be in control of their behaviors and to make decisions by providing them with a clear framework of what is expected of them. Positive behaviors are rewarded, and negative behaviors are subject to a consequence that is related to the problem and results from that specific behavior. The goal of discipline is to teach children skills that they are able to consistently rely on in the future including: self-control and self-regulation. 

Punishment is reactive and takes control from the child and puts it into the hands of the adult who then chooses what the outcome of their decision is. Punishments usually come in the form of taking away privileges or possessions, assigning unpleasant tasks or work, and sometimes corporal punishment which can increase aggression and other negative behaviors.  

When it comes to disciplining a child with ADHD, one thing that definitely doesn’t work is losing your temper. For children without ADHD, who rarely get in trouble, an adult raising their voice may have an impact. For a child with ADHD this is rarely the case. When a child with ADHD misbehaves frequently, and gets yelled at for these behaviors, eventually they get used to frequent yelling and then tune it out. Same with punishment. If a child living with ADHD is in a perpetual state of punishment, the punishment they receive loses effect. 

Positive attention for positive behaviors is much more effective than negative attention for negative behaviors. Positive attention not only feels good, but it helps to strengthen relationships, and helps children to be more open to instructions and limit setting. 

Actively ignoring minor behaviors is one of the most effective ways to manage outbursts. It’s important to note that active ignoring should only be used with behaviors that are not dangerous ie. whining or crying. Aggressive or destructive behaviors should not be ignored as these types of behaviors increase risk of injury to the child and to others. Active ignoring involves removing attention away from a behavior your child is engaging in that is unacceptable. While you are ignoring this type of behavior, you are waiting for a positive behavior to occur and as soon as it does, you want to provide positive attention so your child learns that positive behaviors are what get you to engage, not negative behaviors. For younger children time-outs can be a very effective means of discipline if done correctly.

Children with ADHD have a very difficult time with delayed gratification. They have an extraordinarily hard time waiting their turn, they get bored easily, and because of that they need a system that takes this into account. A token economy system can be very helpful with managing behaviors. An effective token economy system should be fun. The goal is to help your child get excited about working toward rewards, and should help with intrinsic motivation.

Parenting is one of the most difficult responsibilities a person will ever have, and sometimes that journey can feel lonely. Joining a parent support group, engaging in individual or family therapy, exercise, meditation, eating healthy, and getting enough sleep can go a long way toward managing stress. It’s difficult to have the bandwidth to take care of others if you’re not taking care of yourself. 



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Managing the “Sunday Scaries”

“Sunday scaries” or “Sunday blues” is the anxiety that starts to settle in on a Sunday due to impending responsibilities on Monday like returning to work or school.

This feeling can be due to an anticipated hectic work week, big presentation, a busy calendar, family activities, school events, etc. On Friday we’re excited because the weekend is arriving. Saturday is great because there is a full day off to enjoy. And although Sunday is a day off, sometimes it doesn’t feel like it. We often spend a large part of Sunday getting ready for Monday which can take some of the fun out of it. Sunday is the prequel to kicking of our week, and for many people there is a degree of anticipatory anxiety that comes along with that.

Here are some tips:

-Think of Monday through Friday as your work week and stick to that. That will allow you to enjoy as much of your weekend as possible. Try your best not to work on weekends.

-If you know things are coming up on Monday, like a big presentation, or meeting. Get ready for that early. Prepping your presentation, setting out your work outfit, and packing your laptop on a Thursday or Friday lifts the burden of having to use part of your weekend to do things related to work.

-Try to keep your mind off of work on your days off. Whatever you’re working on will still be there when you get back into the office on Monday.

-If you’re with your family, be with your family. If you’re out enjoying an activity. Enjoy that activity. Being present in the moment helps people to stay connected, enjoy the time they have off of work, reduces stress, and improves overall wellbeing.

-Worrying about things we cannot control is one of the biggest ways we waste emotional energy. When it comes to work or your personal life, try to really think about what is in your control and what isn’t. Then direct your energy toward things that are within your power to manage so you can start letting go of things that aren’t.

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Q&A: How to Give Your Partner Space When They’re Stressed

  1. If your partner is stressed, why might giving them some space be helpful? Is it always the correct reaction, or does it depend on the person?

We want to feel respected in any relationship we are in. Sometimes that means putting distance between ourselves and our partner, especially if they are asking for it. Providing your partner with space shows them that you respect their boundaries, and allows them to feel safe in the relationship. How much space a person needs will depend on the individual. If you’re not sure how best to support your partner, ask them.

2. What are your tips for giving a stressed-out partner some space?

Time – if you and your partner live together, especially after a long day, the last thing your partner may want is to have a conversation about your day, or theirs, the second they walk through the door. They may have had a rough day in the office, maybe had a long commute in traffic, and getting accosted at the front door may be the last thing they need or want. Sometimes having a general rule of thumb that each of you get 20 or 30 minutes to yourselves before getting into a conversation about the day can be the difference between a productive conversation and an argument.

Physical space – even if the house is quiet, sometimes a partner may just need a few minutes to themselves in a physical space that is their own. Think – man cave. Or she-shed. Having a safe space to relax and unwind for a few minutes can be immensely therapeutic especially after a stressful day. Allowing your partner that space provides non-verbal feedback that you support them and understand that they need some time to themselves before they are ready to interact with you.

3. What should you do if a partner asking for space hurts your feelings? Is it easy to take a request for space personally?

It’s easy to see a request for space as a personal attack. If it bothers you, say so. But also let your partner explain how they feel so you both can come to an understanding as to why the need for space is so important. If your partner is asking you for space, it is likely not because they don’t want to be around you. It’s more likely that they want to be their best when they do interact with you, and in order to do that they want to spend time decompressing from their day so they don’t take their frustration or anger out on you.

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COVID and Child Abuse

2020 has been filled with many unforeseen and unpredictable challenges, many of which have not changed in 2021. Rising unemployment, school closures, stay at home orders, social isolation, financial strain, food insecurity, and many more struggles have affected millions of children and their families. These stressors all contribute to an increase in stress which unfortunately increases risk of family violence including intimate partner violence and child abuse, especially among families where violence in the home was present even before the pandemic. The negative role stress plays on the quality of parenting is well studied, specifically in literature on child maltreatment. One example is the family stress model (Conger & Elder, 1994) which theorizes that an increase in stress which is often multifactorial increases risk for mistreatment of children.

Job loss also comes with a cascade of new stressors including: decreased income, loss of health insurance, decreased social interaction, loss of purpose, and potentially adoption of unhealthy coping methods like alcohol or substance use which are additional factors that increase risk of violence. Child maltreatment is a significant concern because of the negative effects it can have on a child throughout their lifetime mentally, physically, emotionally and behaviorally.

One of the best strategies to help children is to be proactive with their caregivers who are at risk or are actively struggling. Common reasons caregivers engage in violence is: untreated mental health problems, lack of effective coping strategies, and lack of support. There is help available. Particularly from educators, school psychologists, social workers, primary care physicians, mental health providers, etc.

It is important to view COVID-19 and its impact on families through a trauma focused lens. This will help immensely with understanding the cumulative effect the virus has had on children and families and also sheds light on potential interventions and treatments.

The House also recently passed a child abuse prevention bill as a response to experts and advocates raising concern about unreported abuse occurring during the coronavirus pandemic. The Stronger Child Abuse Prevention and Treatment Act cleared the House by 345-73, and is meant to better address child welfare in the United States.




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5 Tips for Promoting Independence in Children

It is not unusual for anxious children to avoid or withdraw from new or unfamiliar experiences. There is often an assumption by the child and from others that they are less capable than other children. However, it’s important to not mistake an aversion to acquiring new skills to lacking the ability to do so.

What might be happening is that the child may feel unprepared to attempt a new activity or challenge independently. There can be a tendency to hold back or rely on others which prevents the child from gaining the opportunity to master a task, which then leads to more anxiety when presented with another similar situation in the future.

It is human nature to have some reservations about engaging in a task where we may not be successful, however, through experience, practice, and temporary discomfort we learn that setbacks are part of the journey, and that fear and anxiety are transient. Each time a child is faced with an opportunity to persevere despite a challenge, they build confidence and a sense of mastery. A child who avoids new or difficult things misses out on the opportunity to gain these important life skills.

While encouraging an anxious child to try things for themselves may feel counterintuitive, it’s important for children to practice being independent in a supportive environment. It’s natural to want to help a child who signals that they are in distress and need assistance, and it may also be faster and easier for an adult to step in to help them, but this is counterproductive to creating a child’s sense of accomplishment. Stepping in and finishing a task for a child may send the message to the child that they are not able to manage a task on their own, further fueling uncertainty and anxiety about their capabilities.

We want to set children up for success, and the process of promoting independence starts with small tasks. Below are a few tips to help get you started.

  1. Decide on 3 age-appropriate tasks for your child. Examples can be: setting the table, washing the dog, or folding their own laundry.
  • Walk through it with them. After you have decided on what 3 tasks are appropriate, walk your child through each task as they come up, especially if it’s something they have never tried before. Talking through the steps, showing and explaining the task sets them up to execute the task confidently. Then, let your child try it.
  • Show confidence in your child’s abilities. Anticipate that there will be some level of discomfort when your child is trying something for the first time. Part of promoting independence is tolerating this discomfort in your child before stepping in to help them. Even if the task doesn’t go swimmingly provide praise for trying and reinforce the idea that with practice they will be able to complete the task themselves eventually.
  • Build up slowly. Over time with repeated positive reinforcement and praise parents will find that the amount of help they need to provide their child will decrease. Countinue to remain encouraging and stay calm during the process. Acknowledge that sometimes tasks are diffiuclt at first, but with practice they will get easier.
  • Be specific with praise. Generic praise like “good job today” is difficult for a child to feel good about and internalize. Praise goes much further when it is specific and timely. For example, “when we went to the store today, I thought it was great how you walked up to the counter to ask for your free cookie.”  

Anxious children may seem less capable of doing things for themselves compared to non-anxious children. But to help them build confidence, they need to feel supported when trying to do things for themselves. Parents can help by increasing their child’s level of independence through encouragement, praise, rewards, and modeling the desired behavior themselves.

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Collaborative Care with Mental Health

If you or a loved one has sought out mental health services recently, you are painfully aware of the long wait times to see a mental health professional. Depending on the resources in a particular area people can wait from weeks to months before seeing someone. For some the wait is too long which leads to poor outcomes like unnecessary suffering, suicide attempt, completed suicide, or self-medication with drugs or alcohol. The bottom line is… there are more people in need of services than there are providers to meet the need.

So… the questions remains, how do we provide access to quality mental health services given the numerous barriers to treatment including: cost, physical limitation, geographic isolation, transportation, stigma, etc.?

The Collaborative Care Model seeks to address these concerns.

What is the Collaborative Care Model?

The goal of this model is to integrate mental health treatment and physical health care into already existing and familiar settings. The mental health provider works directly with non-mental health providers to deliver quality mental health services.

This means that instead of referring a patient out to mental heath services, the mental health services come to the patient. This is of particular importance in rural or underserved areas where providers embedded into clinics is limited. Telepsychiatry is also a viable option to bridge this gap. Instead of having a provider physically in the office, a secure video chat system can link patients to licensed psychiatrists all over the world. This greatly expands the number of providers able to treat, thus increasing access to care.

Benefits of a Collaborative Care Model

  1. Primary care and mental health care can be delivered in a setting that is familiar to the patient
  2. Reduces risk for duplicate assessments
  3. Often leads to a better patient experience
  4. Strong evidence for better outcomes
  5. Patients are tracked in a registry to make sure they are not lost to follow up and are progressing toward their desired treatment goals
  6. Goals are measured by evidence-based tools, and treatment is changed based on level of improvement
  7. Providers are reimbursed for quality of care and good outcomes, not for the number of patients they see and the amount of care provided
  8. Significant cost reduction with regard to healthcare spending

Does it work?

Yes! There are over 80 randomized controlled trials that have shown collaborative care is more effective than the status quo. The evidence is not just for collaborative care in the United States. There is strong data that supports this model’s use worldwide.  

See the video below to learn more:


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7 Simple Money Tips You Can Actually Use

While it may be true that money cannot buy you happiness… it can make your life a lot easier when used appropriately or exponentially harder if used irresponsibly.

If your financial situation needs a makeover, try these few small changes and watch those dollar signs add up.

  • Track your spending

It is so easy to overspend if you have no idea where your money is going. If you’re not paying attention you could be essentially robbing yourself without even being aware of it. If you get to the end of the month and ask yourself “why do I have such a low balance in my account?” That’s a red flag. Your account has sprung a leak, and now it’s up to you to figure out where it’s coming from.

  • Start saving NOW not later

We are constantly bombarded by new trends, styles, gadgets, you name it. When we see something appealing, the tendency is to want to buy it thanks to the era of instant gratification. This means that saving usually gets put on the back burner. Word of advice.


I often hear things like “when I make more money, I’ll save then.”



When you make more money, the likelihood of increasing your spending to accommodate your wantsis high if you don’t get into the habit of putting money away now. It is better to put tiny bits of money away now, as opposed to large deposits later.


Compound interest.

In oversimplified terms – compound interest is basically interest on the interest. Here’s an example.

If you put $1000 into a savings account that pays 10% per year and is compounded annually.

That means that at the end of one year $1000 X 10% = $100.

This $100 is the interest that is credited to the account for that year which gives you a total of $1100.

That means in the following year the account will earn, $1100 X 10% = $110.

After a period of ten years. Your initial $1000 investment will become $2,143.59 which is more than double your original investment.

  • Trick yourself into saving

If you struggle with putting money away, try setting up a deposit schedule into an account you don’t regularly use. This can be done in the form of a regular monthly transfer from your primary account to the secondary account. Or you can talk to your employer and see if a portion of your paycheck can be automatically sent to the secondary account. That way if you don’t see it you can pretend like this portion of your check never existed and will hopefully be less tempted to touch it.

  • Get in the know

Ignorance is not an excuse for irresponsible spending. If you don’t know… learn. Listen to a money podcast on your way to work, pick up a newspaper and flip to the financial section, or look for free online articles written by finance gurus like Suze Orman, Barbara Corcoran, Neale Godfrey, Ali Velshi, and David Bach to name a few.

What you don’t know CAN hurt you. Not knowing about basic finance opens you up to the possibility of being taken advantage of by lenders, banks, and investors who ultimately have their best interests at heart not yours.

  • Bills bills bills

One word.


With work, family, errands, and the hundreds of other things we need to keep track of in our busy lives, bills should not be something we even need to think about paying on time. When it comes to automatic bill pay, set it and forget it. Of course, you should always review your bill when it comes in to make sure it’s correct, but you should NEVER use “I forgot” as an excuse to pay a bill late. Late bills mean late fees which means free money to whoever is sending you that bill. It’s money you worked hard for that someone else is taking from you for doing absolutely nothing.  

  • Be a quitter

Not only is quitting smoking good for your health, it can also be good for your wallet. The cost of smoking goes far beyond the price of a pack of cigarettes. Smoking means higher insurance premiums particularly when it comes to health insurance, life insurance, long-term care insurance and disability insurance. Not to mention the potential medical costs down the road. People who smoke are much more likely to develop heart disease, lung disease and cancer which not only mean pricey medical bills, but an additional financial hit in the form of inability to work.    

  • Shop it When it Drops

Take advantage of major holiday and seasonal sales to buy everything you need for a fraction of the cost. According to an article published in US News, look out for the following sales. 

  • Martin Luther King Jr. Day – clothes, linens, towels, home décor, and mattresses
  • Presidents Day – mattresses and appliances
  • St. Patrick’s Day – Irish-themed jewelry, travel packages to Ireland
  • Easter – before and after this holiday look for sales on spring attire, baskets, candy and flowers
  • Mother’s Day – jewelry, perfume, and clothing
  • Memorial Day – fridges, washers, dryers and other large appliances
  • Father’s Day – restaurant gift cards, tools and grills
  • Fourth of July – clothing, furniture, and tech
  • Amazon Prime Day – usually mid-July
  • Tax-free weekends – depends on which state you live in, but in August some states offer tax free weekends on items like clothing and school supplies
  • Labor Day – clothing, appliances and mattresses
  • Columbus Day – clothing, home goods and mattresses
  • Black Friday – TVs, smart home devices, tablets, computers, smart watches, beauty products, and much more
  • Cyber Monday – if you missed Black Friday don’t worry, Cyber Monday usually offers repeat deals that were previously offered on Black Friday
  • New Year’s Eve – holiday and New Year décor at rock bottom prices

The aforementioned article also mentions the best months to purchase certain items which is summarized in the table below.

MonthThings to Buy
JanuaryWinter clothing. These items are usually discounted to make room for spring fashion items.
FebruaryTV’s. Are usually discounted prior to Super Bowl. Jewelry. After Valentine’s Day concludes expect sales on leftover items.
MarchSki gear – end of snow season means major discounts. Cruise packages – look for discounts to book ahead for spring and winter break.
AprilAppliances. Spring formal attire.
MaySpring clothing. Large appliances.
JuneTrips to the Caribbean – there is some risk involved as hurricane season is between June and November, but vacation packages are often priced to sell.
JulyTech – look out for Amazon Prime Day. Furniture.
AugustSummer clothes. Swimwear. School supplies. Laptops.
SeptemberPatio furniture. Grills.
OctoberHalloween décor (the closer to Halloween the cheaper items become with best deals after the holiday is over). Older iPhone models.
NovemberElectronics. Beauty.
DecemberToys. Travel (look out for Travel Tuesday which follows Cyber Monday. You may find great deals on transportation, resorts, and travel packages).




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How to Explain Anxiety to Someone Close to You

There is no “right” time to tell someone you care about that you live with anxiety. It will likely happen when the time feels right, and when there is a level of trust between you that allows for an open conversation.

When you do decide to talk to your partner about your anxiety, be sure to take the time the discussion deserves. This is not a conversation that should take place in a time crunch, over text, during an argument or in a crisis. Having a truthful, calm, and distraction free conversation sets you and your partner up for success.

It is also not necessary to have just one conversation. Sometimes these discussions evolve over time, and there shouldn’t be any pressure to complete it in one sitting.

The conversation should include how you experience symptoms of anxiety. Be specific as people who do not struggle with anxiety may have a hard time understanding how anxiety affects you. Vague language can often lead to confusion and miscommunication. It is also important to let your partner know how best to support you in times of need, and what may cause your anxiety to worsen.

If you are feeling stuck, practice disclosure with your mental health provider or someone else you trust so you can feel confident when you talk about anxiety with your partner.

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5 Tips For Handling Difficult Conversations With Children

2020 was an immense challenge for children and their families, and the start of 2021 has also been rocky. Many of us were hopeful about the New Year being a lighter, happier, and less difficult year but there is still much turmoil in this country which is hard to ignore. The struggle facing many parents is how to raise children in this environment, and how to speak to them about life in an honest way, without causing fear and anxiety.

Children are like sponges; they soak up information from everywhere. Kids pick up on cues from their friends, family, news headlines and social media. Although discussing difficult events can seem intimidating, it doesn’t have to be.

Parents often have anticipatory anxiety when it comes to these discussions. On the bright side, the fear of what could unfold is often much worse than the actual conversation that takes place.

Many parents have concerns about potentially “pointing out” hot button issues to their children due to fear of drawing attention to something kids may not notice yet. As much as we might want that sentiment to be true. Children are very perceptive and are already quite aware of what is happening in their immediate environment.

One consistent attribute of children is their exploration of the world in the form of questions. If they have seen events either on the streets or in the news, chances are they have already asked someone about them.

It’s important to have these discussions with kids because difficult events that occur throughout history are not going away. Children are very vigilant and will directly observe how parents address these topics in their own lives – or how they don’t. Instead of thinking of this discussion as terrifying, think of it as an opportunity to help your child become a more understanding, empathetic, and caring human being.

Here are some tips to get you started:

1. Be open

Children are curious by nature. They are going to ask you tough questions. And it’s ok to not have all the answers. If they ask you a question you don’t know how to answer, tell them that. By doing so you’re successfully modeling that adults don’t have all the answers all the time, and taking time to think about your response is ok.

2. Differences and commonalities

Children are much more likely to see the world through a lens of what makes people different from one another. It’s easier to conceptualize what is different, as opposed to what is similar, especially for younger children. Acknowledge that their observations are valid. Share that while people may look different, or think differently we can still have many things in common.

3. Be curious

This is a stressful time and your children are likely to be feeling this too. Encourage them to talk to you about things they have on their mind, and to be curious about what is happening around them. If you don’t know how your child is managing with these stressors, ask them – chances are they have a lot to say but don’t know how to bring it up.

4. Check in with yourself first

Children will look to the adults in their lives for guidance. If you’re not sure how you feel about what’s going on, take some time to think about it. Talk to people you trust, read and educate yourself on current events so you feel comfortable with the questions your kids might ask you.

5. Explore

Exposing kids to different social groups helps improve cross-cultural communication, understanding and empathy. There are many fun and creative ways to bring diversity into your home. Try watching a foreign film and having a discussion about it at the end. Find a new recipe to try and help your kids research the country it came from and the people who live there.

Remember, your children don’t expect you to be perfect. And it’s ok to not have all the answers. This is a unique time in history, and presents an opportunity to talk to your children about kindness, compassion, diversity and respect.

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Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is characterized by a persistent pattern of symptoms that interfere with social and occupational/academic functioning.

ADHD begins in childhood, and to meet criteria for the diagnosis onset of symptoms must be before the age of 12 years, and symptoms must be present in more than one setting (e.g., home and school).

There are 3 main sub-types of Attention Deficit Hyperactivity Disorder (ADHD), each with common core symptoms that help us identify which subtype a child may fall under.

1. Inattentive

Common presenting symptoms include:

-makes careless mistakes

-easily distracted


-difficulty with focus/concentration

-trouble with organization

-task avoidance

-loses things


2. Hyperactive

Common presenting symptoms include:



-“on the go”

-interrupts others

-blurts out answers during class

-talks excessively

-unable to wait their turn

-low frustration tolerance

-unable to sit still

-unable to remain seated when being seated is expected

3. Combined: Inattentive symptoms + hyperactive symptoms

Early intervention holds the key to positive outcomes for children who live with ADHD. The earlier these symptoms are identified, the earlier they can be addressed.

A comprehensive assessment including: medical, educational and psychological evaluation can help determine whether a child is truly struggling with ADHD or a condition that may mimic it.

There is a strong heritability component to ADHD, especially in first degree relatives, although specific genes that cause ADHD have not been identified. ADHD is more common in males than females at a ratio of 2:1, and females are more likely than males to present with inattentive symptoms than hyperactive symptoms.

There are many different treatments for ADHD both non-pharmacologic and pharmacologic. While there are risks to treating ADHD with medication due to potential side effects, there are also risks to not treating ADHD symptoms.

Untreated ADHD can lead to difficulty with interpersonal relationships, school failure, underachievement, poor self-esteem, and substance abuse. By early adulthood, untreated ADHD is correlated with an increased risk of suicide attempt, particularly if there is a comorbid mood disorder or substance abuse. Children with untreated ADHD are more likely to: underperform academically, experience peer rejection, face a higher likelihood of unemployment as adults, are at higher risk for substance abuse and incarceration. Auto accidents are also more frequent in drivers with ADHD compared to non-ADHD peers.

Raising a child with ADHD can be challenging, and knowing how to proceed with evaluation and treatment can be overwhelming. Know that help is available. Below are helpful resources I regularly recommend to patients and families I see in my office.






American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

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How Meghan Markle Discussing Mental Health Can Help Others

For anyone who has yet to watch the Oprah interview with Meghan and Harry that aired on March 7, 2021 on CBS, please do. There are so many lessons to be learned and shared. One of the most remarkable pieces of the interview was when Meghan discussed the painful experience of living with suicidal thoughts. All while feeling forced to put on a happy smile and a brave face to live up to her royal duties. ⠀⠀⠀⠀⠀⠀⠀

Living with a mental health diagnosis is a different journey for everyone. There are some who are in treatment with a wonderful therapist, some who cannot afford treatment, some who suspect a diagnosis but have not been formally diagnosed, some who are struggling to accept their diagnosis, some who have seen a therapist who was not a good fit for them, some who focus on self-help and self-care, some who are afraid to look for a doctor for themselves, some who have a great doctor, some who have recovered, some who are actively working toward recovery, some with more than one mental health diagnosis, some who need medication, and some who opt not to take medication.

The act of Meghan Markle opening up about her mental health and suicidal thoughts is equal parts powerful and courageous. Stigma is still a very large part of why many people do not seek treatment. Her willingness to share her emotions and thoughts directly addresses the stigma associated with mental health. This interview is so important because it opens the door to conversations about what it feels like to struggle with mental health symptoms, the challenge of accessing resources, and stigma associated with mental health especially for women and people of color.

This interview also highlights the fact that mental health does not discriminate when it comes to race, gender, social status, or economic status. All people can be equally affected by mental health issues throughout their lifespan depending on the circumstances.

If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online.

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How a Psychotherapist Deals With ‘Failing’ a Patient

It is certainly difficult to come to terms with treating a patient who seemingly may not be benefiting from therapy. It is also quite easy to view that as a failure on the part of the therapist. However, it is important to remember that patients come to the office with years of trauma. And the expectation on behalf of a therapist to lift the burden of that trauma in a short amount of time is a recipe for failure.

The truth is, as therapists we are not responsible for making every patient better. We are responsible for trying. The goal of therapy is to alleviate suffering which can take a tremendous amount of time, sometimes years before the benefits of therapy can be seen.

We have a responsibility to walk with our patients through their journey of suffering, and try to help where we can. But bearing the responsibility of “fixing” every patient’s problems sets the therapist up for failure and increases likelihood of burnout. This also sets the precedent that the therapist has all the answers, which is far from the truth.

The therapist provides an objective lens through which to see the patient and their struggles. To think that we have any power over the situation, or are somehow in a position to single-handedly and directly change patient outcomes is shortsighted.

At times this is difficult as we do grow quite close to our patients over time. We learn about them, care about them, and want the best for them. However, as therapists we are not in a position to judge what that should look like, or pull strings to make it so.

Therapy is about the patient, not the therapist. At the end of the day the patient, and only the patient is able to decide what they want out of therapy, what they get out of it, and what to do with the insight they gather.

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The Power of Journaling

There is a strong connection between mindfulness and wellness. Mindfulness is the act of calling the mind to attention in the present moment, focusing on what is happening in the now. This process involves switching from passively engaging with thoughts and actively observing and experiencing them.

Journaling is a mindfulness activity with multiple benefits including processing experiences, increasing self-awareness, improving self-confidence, all of which contribute to physical and emotional healing.

Journaling has been shown to decrease symptoms of anxiety and depression, lower stress, and improve sleep. Plus, journaling can be fun, it doesn’t have to be something you add to you already long to-do list.

There are many different types of journaling including free-writing also called “stream of consciousness” writing where you just write whatever comes to mind in the moment, guided journaling where you respond to a prompt or series of prompts, and gratitude journaling where you write down things that you are grateful for.

The nice thing about journaling is that you can do this activity as often as you want whether it be daily, several times a week, or once a month. If you want to get into the habit of journaling regularly, set a realistic goal about how often you think you will be able to write. You are much more likely to stick to your goals if they are specific and attainable. If you’re really busy, setting an intention to journal every day for the next 365 days may not be viable, maybe commit to writing once a week and adjust from there.



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How to Support Someone Who Tested Positive for COVID

Social restriction due to the pandemic is already challenging for many, and can be even more isolating if a loved one tests positive for COVID.

How can you support someone who has tested positive for COVID?

1.        Make a call. One of the easiest first steps to help someone connect is to reach out and call them to see how they’re doing. While sending a text may seen thoughtful, it can also come across as more impersonal. Making a phone call can mean so much to someone who is struggling in isolation.

2.        Schedule a surprise. If you can’t physically be with someone, there are other ways to try and support them. Try sending a care package with snacks, entertainment, or self-care items. Quarantine can be lonely, so helping someone make their environment more enjoyable can be helpful.

3.        Do a joint activity. There are several apps where you can play a game or watch a movie together that closely emulates spending time together in person. Doing a shared activity keeps people connected and engaged at a time they may be needing it the most.

4.        Drop off meals or groceries. If a person is sick, they may not have time or energy to stock up on necessities. Consider preparing a home cooked meal, bag of groceries or toiletries and schedule a contact-less drop-off for safety.

5.        Try snail mail. Sometimes receiving a tangible product in the mail can bring joy to someone’s day. A letter or a card is something a friend or loved one can read over and over when they need extra support and are feeling isolated.

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How to Deal With a Breakup the Empowered Way

Dealing with a breakup is difficult which can result in a resurgence of habits that take a toll on our mental health. Managing a breakup in an empowered way helps us to deal with hurt in a positive and productive way as opposed to taking the pain out on ourselves.

  1. Self-care is key. If your best friend called you and told you they broke up with their significant other, what would you do to make them feel better? Then do that for you.
  2. Cry it out. Don’t hold it in. Breakups are hard, and the feeling you have are valid. With each good cry you let go of the hurt a little bit more.
  3. Unplug. Especially from social media. It is human nature to want to see what your ex is up to after a break up. However, ask yourself the question… is looking at their photos, comments, likes, friends they added, etc. going to be helpful? Probably not.
  4. Create change. Sprucing up your room, home, or office space can breathe new life into a space that might feel empty after a break-up. It’s amazing how far a good clean, a scented candle, and a furniture switch-a-roo can go.
  5. Spend time with friends and family. We all need support when we’re feeling down.
  6. Get moving. Fresh air can lift your spirit, and exercise helps increase endorphins in your body which can help improve your mood.
  7. Enjoy being single. Relationships, especially difficult ones can take up a lot of time and energy. Break ups are a way to let go of a relationship that no longer serves your best interests. Sometimes being single is better than being in an unhappy relationship. Now is the time to focus on you and what makes you happy.
  8. It’s ok to ask for help. If you are really struggling talk to someone about it. There’s is nothing wrong with seeking professional help. Sometimes an objective party can help you to process the loss and painful emotions that come with it. They can also provide extra support that you may feel uncomfortable about asking friends and for, and may also be able to teach you new ways of coping.

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Talking to Kids About Mental Illness

Kids are very intelligent and naturally curious. If you or someone in your family struggles with a mental illness, there is a good chance that your child has some understanding of what that means. It is important to have conversations about mental health with children early, as confusion, misunderstanding, and misinterpretation can cause them a significant amount of distress.

For example, if a parent struggles with depression and has trouble getting out of bed, taking them to school, making it to their school events, or celebrating important events like birthdays. Sometimes kids will assume that they are unloved or unwanted. This is a narrative that is important to correct early. Children, especially young children often view things like a parent’s depression as their fault when in reality they don’t have any control over a parent’s depression or other mental illness.

How you talk to your child about mental health depends on their age. For younger children using age-appropriate words, short sentences, and fewer details can be helpful. Younger children are more visual, which means they focus more on what they can see.

Mental illness at times can be a difficult topic to discuss due to the often subjective nature of symptoms. Sometimes comparing the experience to a physical illness like asthma can be helpful. For example, people with asthma can live a healthy life with treatment that helps with symptoms. Sometimes the symptoms can get worse if there is environmental or physical stress, but rarely do people with asthma get so sick that they have to go to the hospital.

Older children are more inquisitive, so doing a little bit of homework before embarking on the path of conversation is helpful. Kids often ask questions like: what is a mental illness? What causes it? Who can have or get a mental illness? How it is treated? They are more likely to ask about specifics like “why does Daddy get so mad when he drinks?” or “why does Grandma talk to herself when there’s no one around her?” Kids are very perceptive, so it is important to answer their questions directly and honestly so their feelings are validated which in turn reassures them about their concerns and feelings.

Adolescents are generally capable of handling more information, and also asking more specific and difficult questions. Teenagers generally speak more openly with their peers as opposed to their parents, usually because there is more of a give and take when it comes to conversation. Adolescents tend not to tolerate conversations that are one-sided, they are much more engaged when there is an open discussion as opposed to a lecture. 

This is a conversation that should occur when there is enough time to sit down and talk undistracted. Times of crisis are not the best moments to have these important discussions. It will also be important to gauge your child’s response during the conversation. If they become upset or disengage this could be due to confusion or feeling overwhelmed. It’s ok to slow down, back up, or have the conversation over a period of time. It’s important to allow for questions as well. It is also okay not to have all the answers. Sometimes kids will ask questions about things that we don’t know how to respond to. Admitting that shows that we are human and still have a lot to learn as well.  

It is natural as a parent to want to avoid having difficult conversations. However, talking about mental health is important because it creates an opportunity for parents to connect with their kids, provide information, support, and guidance and to promote understanding and compassion for those who may be struggling.

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Emotional Support Animals for Mental Health

An emotional support animal is any animal that provides comfort by being with a person who needs them. These animals have not been trained to perform a specific task, which means that they are not synonymous with service animals as defined by the Americans with Disabilities Act. While emotional support animals do not require specific training, they should be well-mannered in public. If they are not, both you and your animal may be asked to leave an establishment.  

The first step toward getting an emotional support animal starts with a need for one. There are many mental health conditions in which an emotional support animal can be helpful. This includes but is not limited to: depression, anxiety, post-traumatic stress disorder, and claustrophobia. There is no official licensing or governing agency to obtain an emotional support animal. The best place to start is with a licensed mental health professional or your primary care doctor, especially if you already have an established relationship with them. That way you can discuss physical health, mental health, emotional health and get the appropriate care you need in addition to an emotional support animal letter if indicated.

There are many sites where you can pay to get an emotional support animal letter. It is important to use caution when searching these websites, as the people providing these letters may not have a background in physical or mental health. For a person to legally qualify for an emotional support animal, they must be considered to have an emotional disability as determined by a licensed mental health provider or a primary care physician. Many of these sites have disclaimers denying any responsibility for providing an emotional support letter that does not meet the legal requirements in a person’s state. It is important to go to a reputable source for this letter, as misrepresentation of an emotional support animal is not only unethical, but in some states may also be illegal. Individuals with emotional support animals are protected under the Fair Housing Act which means that their emotional support animal is able to live with their owner even in non-pet-friendly housing. There is also protection under the Air Carrier Access Act which allows both service animals and emotional support animals to travel with their owners in the cabin of an aircraft during a flight.




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COVID-19 and Children’s Mental Health

How has COVID-19 affected children?

COVID-19 has robbed children and adolescents of predictability, which is an important stabilizing factor in daily life for kids. Uncertainty, social isolation, parental stress, etc. all have an impact on the mental health of our children, especially those with previously diagnosed mental health conditions. There are many new worries that children are now faced with including whether or not they will be able to return to school in person, see their friends, visit relatives, become ill, have a friend/family member who gets sick, and it is also difficult for caregivers to assuage these anxieties given the uncertainty of our current circumstances. This can lead to an increase in nervousness, sadness, behavioral problems, sleep disruption, irritability, difficulty with focus and concentration which are several common signs of stress in children.

With increased stress and uncertainty, what do children need most right now?

Love, compassion and kindness can go a very long way to help with reduction of stress. It is not unusual for kids to regress when they are under stress. Younger children may become clingier, may have previously been potty trained and are now having more accidents, it is important to be patient with them.

Children are also naturally curious, which means they will have questions that may be difficult to answer. It’s okay to talk with your child about COVID-19. Answering questions in an age-appropriate manner can help decrease stress and worry your child may be experiencing. Limiting your child’s exposure to news coverage can also help to prevent exposure to unnecessary stress. Children may misinterpret what they hear on TV and can be easily frightened by things they don’t understand. Children are very observant, and are watching how we navigate this difficult time. By taking care of yourself, you are modeling for your child how to manage stress as they get older.

If a child has mental health condition, does that exclude them from mask wearing and/or following social distancing protocols?

The Centers for Disease Control and Prevention (CDC) recommends that children 2 years of age and older wear a mask when in public or around individuals they do not live with. The CDC also recognizes that wearing masks may not be possible for every child in every situation, especially if children have certain disabilities including cognitive delays, intellectual disabilities, developmental delays, and behavioral/sensory difficulties. In cases where children are unable to tolerate wearing a mask there are other protective measures that can be implemented.

It is very important to note that the following measures are not meant to replace evidence based preventative actions like mask wearing, hand washing, and social distancing that are known to reduce transmission of the virus and keep children and families safe.

The CDC recommends that children who are not able to wear a mask or are unable to tolerate wearing a mask should engage in activities virtually whenever possible. If there are activities done in person, choosing a space where there is greater ventilation and the ability to keep six feet from others is also beneficial. It is also important to try and avoid frequent touching of the face. Try your best to prioritize mask wearing when it is difficult to keep a six-foot distance from others to minimize exposure and transmission.  

What can you do to support children who are anxious, depressed, etc.?

One thing we all need right now, especially for our kids is optimism. Anxiety and uncertainty are a part of daily life, but there are ways to help children navigate the challenges 2020 has brought us, whether in our own household or in our professional practice as healthcare providers.

  • Model it – children will look to their caregivers for cues on how to respond to life stresses. As parents, it is important to model the characteristics you would like your child to exhibit. Why? Because kids are constantly watching and listening to you. Healthy habits, including optimism start with having an optimistic mindset yourself. 
  • Practice looking for the positive – daily life is full of unexpected challenges, and celebrating lessons learned from those difficulties can help your children to become more optimistic. Try encouraging your kids to share one positive experience they have every day. This gets them into the habit of looking for the positive as opposed to focusing on the negative. 
  • Encourage kids to accomplish tasks on their own – providing opportunities for your child to be successful goes a very long way with regard to developing a strong sense of self. When children are able to achieve success and are praised for doing so, this builds their sense of self-worth and self-esteem. Age-appropriate activities like chores, baking, art projects, etc. are great place to start. 
  • Allow kids to try new things – as a parent it is natural to want to protect your child from everything. However, it’s important to let kids explore and try new activities. Being too involved, or too supportive can inadvertently send the message that the child is unable to do things on their own and require parental intervention/reassurance to be successful. This is the opposite of what we are trying to instill in our children. 
  • Nip negative self-talk in the bud – just like adults, children can be very critical of themselves. If you hear your child saying things like “It’s too hard” or “I can’t do it” do your best to redirect these thoughts in the moment to statements that are more positive. Instead try to encourage statements like “this might be difficult right now, and with some practice this will get easier.”   
  • Keep it real – optimistic thinking is not the same as sugar coating. The truth is our kids are not going to be great at everything, and things will not always turn out the way they imagined. Struggle and disappointment is a part of everyday life. Optimistic thinking involves looking at a situation and accepting it as is, and choosing to view it with a positive lens. It is important to send your child the message that as long as they did their best, that is all that they can ask of themselves and is something to be proud of. This allows kids to see the innate value in their efforts even if they do not meet their own expectations. 




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Depression 101: FAQ, What Not to Say, & How to be Supportive

What are the symptoms of depression and what can cause it? 

Depression feels like there is no pleasure or joy in life. It’s so much more than being sad. Depression robs people of things they once loved, and for many people they feel like nothing will bring them joy again.

Concentration and focus becomes much more difficult, which can makes any kind of decision making very challenging. Sometimes people describe this as being in a fog as they are unable to think clearly or follow what is happening around them.

For many with depression it feels like there is no way out. Everything feels hopeless, like there is no light at the end of the tunnel. This can lead to feeling of failure, worthlessness, and lead to suicidal thoughts or action.

Depression also has a significant impact on sleep. This often manifests as trouble falling asleep, staying asleep, frequent night time awakening, feeling tired upon waking despite getting an adequate number of hours of sleep. This can lead to feeling of exhaustion and low energy which can prevent people from even being able to get out of bed, or perform daily activities like showering, eating and brushing their teeth. 

Sometimes depression can be physically painful. It is not unusual for people with depression to feel body aches, headaches, muscle tension, and even nausea.

There are several conditions that can cause depressive symptoms including hypothyroidism, anemia, and vitamin D deficiency to name a few. This is why it is important to also be evaluated for co-morbid medical causes that may be contributing to be sure the root cause of the symptoms is being treated.

Why does what you say to someone with depression matter? 

People with depression often feel like they are alone, a burden to others, like their depression is a weakness or a character flaw. Depression acts like a filter that screens out all things positive and only focuses on the negative. People amidst a depressive episode are already having a difficult time, and can be very affected by the things people say around them especially if the feedback they are getting is negative.    

What do you consider the most important things not to say to someone with depression and why?

“Snap out of it.” Living with depression is mentally, physically and emotionally exhausting. So when someone tells you to just “snap out of it” when you’re already trying your best, life can feel even more hopeless.

“It’s all in your head.” This phrase is unempathetic, dismissive and hurtful. People who live with depression may not know why they are depressed which can make them feel even worse. They often feel guilty for not being able to enjoy the things they do have in their lives that are positive.

“It could be worse.” The level of pain a person is experiencing is not a competition. While it is true that others may appear to have it worse than a person struggling with depression, it doesn’t negate the feelings a person living with depression has. What may seem like a small problem to others can feel insurmountable to someone living with depression.

Why is it bad to tell someone with depression to cheer up and what can you do instead that’s positive? 

A common mistaken belief is that depression is a choice. Family, friends, and other close to a person who is depressed can often become frustrated as they don’t see why a person can’t just turn their depression off like a light switch. People with depression are unable to simply turn the symptoms off, or decide one day to stop feeling depressed. Depression is a real mental illness and recovery is a process. And like any of us who have ever recovered from an illness, accident, surgery, etc. we all need help sometimes.

What can you say to someone instead of invalidating their feelings? 

Instead try asking them if they want to talk, remind them that they matter, and if you’re not sure what to do, ask how you can help.

Why is it bad to blame someone for their depression? 

There are many factors that can contribute to a person becoming depressed. Genetics, psychology, brain chemistry, chronic medical conditions, physical pain, environmental circumstances, inadequate nutrition, etc. can have an impact on whether or not someone develops depression. The bottom line is that depression is not a choice, so blaming someone for something they did not ask for and can not control is insensitive. 

Why is it bad to ignore someone with depression? 

People with depression are at increased risk of suicidal thoughts or self-injurious behaviors. Ignoring someone who is struggling is not only unhelpful, but it can also be harmful.

How can telling someone with depression that others have it worse or shaming them have negative consequences? 

Shaming is not helpful, and can actually make things worse. A common misconception is that people with depression are selfish, when in reality it’s quite the opposite. People living with depression care deeply about other people and the impact they have on their lives. They often experience guilt about being depressed, feel like they are a burden, and often blame themselves for not being able to feel better. 

What are ways to support someone with depression/help them get the treatment they need? 

Encourage them to see a doctor if they have not yet, and provide reassurance that there is nothing wrong with asking for help. Depression is treatable, but people often feel embarrassed or ashamed of their depression and may be skeptical of whether treatment is possible.

What should you do if someone has expressed harming themselves, others, or is having suicidal thoughts? 

Take those statements seriously and get help. The National Suicide Prevention Lifeline is open 24 hours a day at 1-800-273-8255 to assist.

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9 Ways to Kickstart the New Year

2020 has been a whirlwind of new challenges and hardship. In a year that has been filled with sad, dark, and at times depressing days we need a resolution remix for 2021.

Below are some new takes on an old tradition to help kick start the new year off right.

  1. Kick deprivation to the curb. Many of us have tried strict dieting in the past, and it’s no secret that this is unsustainable. It’s about moderation. The world will not end if you eat that scrumptious cupcake that’s staring at you in the bakery window. It’s also important to put things into perspective. In 2020 millions of people were faced with the possibility of their own mortality. Do a thought experiment. If you were to die tomorrow, what would you really want to do? Or say? Or feel? Think about that as we slide into 2021 and take charge of your life.

  2. Don’t take it personally. There are some people in our lives that can really mess with our positive vibes. Remember that when negative people try to bring you down. It’s not about you, it’s about THEM. Take it with a grain of salt and keep on moving. You cannot control others, you can only control how you react to them. Make the choice not to buy into the negativity. 

  3. Be kind to yourself. Sometimes the things we say to ourselves are things we would NEVER dream of saying to other people we care about. Words are so powerful and can influence the way we view and feel about ourselves. It is important to mind your words and your language because contrary to popular belief, words can hurt immensely.

  4. If you had a breakup this year, enjoy being single. Unplug. Especially from social media. It is human nature to want to see what your ex is up to after a break up. However, ask yourself the question… is looking at their photos, comments, likes, friends they added, etc. going to be helpful? Probably not. Enjoy being single. Relationships, especially difficult ones can take up a lot of time and energy. Break ups are a way to let go of a relationship that no longer serves your best interests. Sometimes being single is better than being in an unhappy relationship. Now is the time to focus on you and what makes you happy.

  5. Focus on the positive. Thoughts, behaviors, and feelings are all closely linked and thus influence each other. In other words, your emotions can change based on what you choose to focus on. One effective way to break out of a negative space (ie. much of 2020) is by choosing to focus on something positive. For example, is the glass half-empty or half-full? Well, that depends on how you choose to view it.

  6. Invite gratitude in. Gratitude is a purposeful practice of thinking about what you have in your life right now. Practicing gratitude teaches us that despite our missteps or mistakes, there are still people in our lives who love and care for us, and things in our lives that we can look forward to. Journaling, creating a gratitude box or jar, and meditation can go a very long way toward tapping into the power of positivity and a happier new year.

  7. Shape your environment. Our environment has a very big impact on our mental health. While there are many things in our immediate environment that we are not able to control, there are some things that we can. One of the best first steps you can take is one small act in the morning. Admiral William H. McRaven author of Make Your Bed: Little Things That Can Change Your Life…And Maybe the World is based on a 2014 graduation speech he gave at the University of Texas that went viral. In that famous speech he discussed the importance of your environment. He said,

    “if you want to change the world, start off by making your bed. If you make your bed every morning, you will have accomplished the first task of the day. It will give you a small sense of pride, and it will encourage you to do another task, and another, and another. By the end of the day, that one task completed will have turned into many tasks completed. Making your bed will also reinforce the fact that little things in life matter. If you can’t do the little things right, you’ll never be able to do the big things right. If, by chance, you have a miserable day, you will come home to a bed that’s made. That you made. And a made bed gives you encouragement that tomorrow will be better.”

  8. Take care of your physical and mental health. Staying hydrated, eating healthy, getting enough sleep, and exercise helps you manage the ups and downs of life. It is much harder to stay positive if you’re sick, tired, stressed or in pain. We all need help sometimes and maybe finding a therapist is a great way to kick start 2021. Talking to someone who is an objective party can help with creation of coping skills, provide extra support, and can also assist with identification of negative thought patterns that may be adversely affecting you. With the expansion of telemedicine, it’s possible to find a therapist online if you don’t feel comfortable going to an office. And you can see them in the comfort of your own home.

  9. Dream big. Goals and dreams are success in its infancy. What better way to start 2021 than to keep your eye on a new prize at all times. Goals and dreams give you purpose and help invoke drive, motivation, and many other emotions that inspire you to get to work.

Always remember that it’s about progress, not perfection. The above strategies are just suggestions to get you started. You have everything you need in you to live a more happy and peaceful life. It is not possible or expected that we be positive 24/7 365, the goal is to try to allow more positivity to shine through even in the darkest of days.

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6 Ways to Help Children Navigate the Challenges of 2020

One thing we all need right now, especially for our kids, is optimism. Anxiety and uncertainty are part of daily life. Still, there are ways to help children navigate the challenges 2020 has brought us, whether in our own household or our professional practice as health care providers.

1. Model it. Children will look to their caregivers for cues on how to respond to life stresses. As parents, it is important to model the characteristics you would like your child to exhibit. Why? Because kids are constantly watching and listening to you. Healthy habits, including optimism, start with having an optimistic mindset yourself.ADVERTISEMENT

2. Practice looking for the positive. Daily life is full of unexpected challenges, and celebrating lessons learned from those difficulties can help your children become more optimistic. Try encouraging your kids to share one positive experience they have every day. This gets them into the habit of looking for the positive as opposed to focusing on the negative.

3. Encourage kids to accomplish tasks on their own. Providing opportunities for your child to be successful goes a very long way about developing a strong sense of self. When children can achieve success and are praised for doing so, this builds their sense of self-worth and self-esteem. Age-appropriate activities like chores, baking, art projects, etc., are great places to start.

4. Allow kids to try new things. As a parent, it is natural to want to protect your child from everything. However, it’s important to let kids explore and try new activities. Being too involved or too supportive can inadvertently send the message that the child cannot do things on their own and require parental intervention/reassurance to be successful. This is the opposite of what we are trying to instill in our children.

5. Nip negative self-talk in the bud. Just like adults, children can be very critical of themselves. If you hear your child saying things like “It’s too hard” or “I can’t do it,” do your best to redirect these thoughts at the moment to more positive statements. Instead, try to encourage statements like “this might be difficult right now, and with some practice, this will get easier.”

6. Keep it real. Optimistic thinking is not the same as sugar coating. The truth is our kids are not going to be great at everything, and things will not always turn out the way they imagined. Struggle and disappointment are a part of everyday life. Optimistic thinking involves looking at a situation, accepting it as is, and choosing to view it with a positive lens. It is important to send your child the message that as long as they did their best, that is all that they can ask of themselves and is something to be proud of. This allows kids to see the innate value in their efforts, even if they do not meet their own expectations.

*Originally published on KevinMD.com



Empty Chairs at the Table This Holiday Season

There’s nothing like the holidays and a new year around the corner to remind us that 2020 is almost over. This year let’s try to take nothing for granted. Especially since millions of Americans will soon sit down to a holiday meal with one or more loved ones missing. Those empty chairs are a reminder of what we have endured this year. Whether it be loved ones who are sick, unable to travel or those we have lost, more people than ever are missing at tables around the country and the world.

In difficult times it is hard to stay hopeful. But especially this year, it’s important to remember that even before the pandemic, many of us have lived through other forms of sadness or loss. Kids grow up and move away, parents and grandparents pass, those who serve overseas are unable to come home to be with their families, and the list goes on. Although we may not know when the world will return to a sense of normalcy, we all await the day that the pandemic ends and the virus becomes a thing of the past.

For many of us, this will not be easy, but there is hope. We can still find meaning, connection, and cheer in the things we do have, even if it feels at times that we don’t have much.

In our household, the holidays were the best time of year because we always spent them together. Decked out holiday trees, apple cider, a lavish spread of entrees and sides, silly holiday outfits for the dogs. We all gathered at the table over great food, exchanged stories and memories, and talked about how this was our favorite time of year. But this is the fourth year that one of the seats at our table will be empty. And that is a reality my family faces every year. Sometimes learning by doing is the best we can do, and then we get better at it as the years go on. Since this year is my fourth time around since the loss, I learned a few things from previous years that I hope can be of help to others.

Know that parts of the holiday will be wonderful and that some will be sad. For me, the anticipation of the upcoming holiday season is usually worse than the actual holiday itself. I find myself becoming more anxious as the holidays grow closer, but then find that the holidays themselves provide some level of healing. That’s not to say there aren’t some days that I feel sad. There are many days like that, but the important thing to note is that not every day will be like that. Some days will be better than others, and as time goes on, the good days will eventually outnumber the bad.

It’s OK to feel the way you feel. Grief often recruits many different emotions within us, and when we’re feeling multiple emotions at once, untangling one particular emotion can be difficult. One feeling that is particularly difficult to handle is anger, given that it is socially unacceptable to be angry during the holidays. But pretending nothing is wrong won’t spare you any pain. It is important to acknowledge the way you feel, because stuffing this feeling down and repressing it will only amplify it, and it will manifest at a future time. Often when your emotional reserve is wearing thin. Acknowledging whatever emotions you may be feeling is the best way to understand them, sort them out, and move forward.  When your emotions feel out of whack, and you are having difficulty coping, do your best to remember the good times, laugh about funny memories, and acknowledge that you miss the person you loved so much.

Just be. Sometimes holidays can be difficult for peripheral family members, and by that, I mean in-laws, close family friends, work acquaintances, neighbors, etc. These times are often trying for them because they don’t know what to say or what to do. A good rule of thumb is, if you don’t know what to do, do nothing. Family gatherings can be tense, particularly if the loss is recent. When people are in pain, they tends to be more reactive due to having less emotional reserve than usual. Instead of focusing on trying to “fix” things, just be there. Chances are the family you are trying to support is grateful just for your presence. Remember that silence is powerful. So if you want to focus on something. Be a good friend, be a good listener, and just be present at the moment.

Take care of yourself. Try and follow your normal routine whenever possible, especially if it already includes eating healthy and exercising. When people are grieving, there can be a tendency to drown that pain in less healthy devices like sugar and alcohol. If alcohol is present, remember to drink responsibly or not at all if you’re worried about it being a problem. Keep up with exercise as this helps clear your mind and lower your stress. When you’re emotionally taxed, it is even more important to try to get good sleep.

Navigating family traditions. There is no easy answer when it comes to family traditions. It is usually best to discuss as a family what the best thing to do is. Sometimes family traditions can be a wonderful way to remember a loved one, but sometimes they can be too painful to bear without them. Finding a new normal is exceptionally difficult. Don’t feel obligated to come up with an answer for each subsequent holiday season now. Every year that goes by will be different, and plans can be adjusted accordingly.

Gift-giving. Gift-giving can be one of the toughest parts of the holidays because the lost loved one’s absence is so profound. It can be helpful to give a gift on behalf of the person who died to honor their memory. Donate to a hospital, assemble care packages for veterans, donate to a food bank, serve meals at a homeless shelter, adopt a pet, donate clothes or school supplies, etc.

One final word about loss during the holidays. It is often difficult to reflect on the holidays when we are grieving positively. One thing to keep in mind is that the loved one/ones we lost would want us to remember them fondly and enjoy the holiday season. The holidays are rare occasions when families who are often separated by long distances come together. That time is precious, and as we well know, is limited. Making the most of the time, you have together will be a work in progress and a pathway to healing.

*Originally published on KevinMD.com



What Presidential Elections Can Teach Us About Losing Gracefully

For the winner of any election, the moment of victory brings joy, applause, laughter, relief, and often champagne.

Losing the presidency, however, is felt like a crushing defeat. The hours of travel, giving speeches, campaigning, fundraising, stress, and sleepless nights are all for naught. The feeling of defeat is experienced by the candidate and their support staff, family, and the millions of people who believed in them and thought they would win.

One of the most memorable losses in recent history was in 2016. Hillary Clinton started Election Day ahead in most of the polls, with the opportunity to be the first female president on the line. This was followed the next day by calling her opponent Donald Trump to concede the election.

Losing an election by any margin is difficult, but losing as the incumbent, as Herbert Hoover in 1932, Jimmy Carter in 1980, and George H.W. Bush in 1992 did, is probably even harder. Especially since an incumbent president, statistically speaking, is much more likely to win.

History records not only the loss of an election, but also how the losing candidate handles defeat. In the 2008 election against Barrack Obama, John McCain’s concession speech is arguably one of the most heartfelt concession speeches in history. Even in the face of losing a historic election, McCain was able to speak of unity, prosperity, and hope for our nation’s future. During his speech, he said, “It’s natural tonight to feel some disappointment, but tomorrow we must move beyond it and work together to get our country moving again.” He also gave moving remarks about his challenger, “I wish Godspeed to the man who was my former opponent and will be my president.”

How someone handles wins and losses reveals much. Competition does not create character. It unveils it. Both winning and losing gracefully are skills all humans need. Why? Because anytime people are on opposite teams — there will inevitably be a winner and a loser. Losing is an unavoidable part of life, even for the most successful people. None of us can traverse through life without ever facing the experience of defeat.

In the face of loss, how do you want to be remembered?

*Originally published on KevinMD.com



The Many Firsts of the 2020 Election

There is something special about being a “first.” First to go to college; first to start a business; first write a book, etc. Becoming the first person to achieve something is remarkable because it sets a precedent for what is possible. What once seemed unattainable is now alive and well in living color.

Kamala Harris has made history as the first female vice president-elect of the United States and will also be the first woman of color to hold this title.

She joins several women in politics who have become the first in many categories. Alexandria Ocasio Cortez, the youngest woman ever to serve in Congress. Republican Stephanie Bice, the first Iranian-American to serve in the House. Cori Bush, the first African-American woman to serve in the U.S. House of Representatives from Missouri. Yvette Herrell, the House’s first Republican Native American woman. And Sarah McBride, the first openly transgender female senator, to name a few.

Kamala Harris stepping into the White House is a symbol of change and finally puts an end to the question of whether a woman in power can be “electable.” She has shattered a political glass ceiling that creates a brighter future for women everywhere, not just in politics. This history-making moment is likely to further the conversation about women earning a seat at the table in industries like law, medicine, academia, finance, tech, and more.

Her position in the highest level of government helps show women and girls that they can be anything they want. Vice president may be the highest office attained by a woman today, but there are generations of women who undoubtedly have set their sights even higher. Perhaps one of them growing up and witnessing this moment may even be president someday.

Of course, having more women in government does not automatically solve inequality, but it does open the door for more voices of women to be heard.

Even though the election is over, this is no time to coast. We have real and pressing issues to attend to—immigration, unemployment, COVID-19, health care, the economy, etc. The past is behind us, and now is the time to focus on the opportunities that lie ahead. I hope that women everywhere who are witnessing history in the making feel empowered to make their voices heard and come to the table to help build a better future for us all.

*Originally published on KevinMD.com



Election Anxiety and Post-election Depression

To know our history is to predict our future. We’ve been here before. To be more specific, we were in this very position in 1920. It was an election year amidst a pandemic, the Spanish flu that began in 1918. The Republican nominee, Warren Harding, claimed victory. Given the circumstances at the time, it is not difficult to imagine that what people are feeling now is akin to what people were feeling then.


Anxiety is a worry or fear about the future. As opposed to depression which is sadness or regrets about the past.

There is naturally a great deal of angst conjured up in people during an election. Likely due to our two-party system and heavily partisan politics. Being amidst a pandemic only adds fuel to the fire.

The reality of an election is there is a winner and a loser. Once the election anxiety has run its course and a victor is announced, that does not mean the saga is over. There will be a wave of emotions that follow. Notably, happiness on the winning side and despair on the other.

This is the nature of politics, which is important to keep in mind whatever side you happen to be on. Whoever wins will certainly shape the country over the next four years, but unlike a monarchy, this will not be permanent. Four years pass faster than we think, and when the time comes we will be right here again.

The cycle of election anxiety and post-election depression is to be expected. On the bright side, these emotions don’t last forever. Sooner or later whichever party you belong to, your party will win. And then sometime after that, your party will lose. The ebb and flow of politics are just this way. No matter how much we try to control it, we can’t.

The good news is we have been here before. In 1920 to be exact. We made it through then and we can make it through now. Win or lose.

*Originally published on KevinMD.com



The Painful Side of Narcissism

Narcissism is a term which has roots in Greek mythology, and as the story goes, a nymph named Echo fell in love with a handsome young man named Narcissus who loved nobody but himself. Echo had previously been cursed by a vengeful goddess who took from her the ability to form her own words. Thus, she was only able to repeat the words of others. One day Narcissus came across his reflection in a pool of water and self-proclaimed “I love you.” Echo, only able to repeat his words uttered the same but was unable to capture his attention. She watched as Narcissus stared endlessly at his reflection until he wasted away and died.  

When someone reads this story it’s difficult to imagine how narcissism could potentially be helpful to anyone, but this provides the opportunity to make a distinction between healthy narcissism and pathologic narcissism.

Narcissism itself is not a disorder, disease, or inherently pathologic. We see it in parents, teachers, doctors and even children. If you look hard enough you will find that narcissism is everywhere. Therefore, narcissism only becomes relevant when a person with this character structure interacts with others.

Healthy narcissism (more appropriately referred to as self-esteem) stems from how anxiety is dealt with in childhood. When anxiety is had by child, and parents reinforce/strengthen the child’s identity and personality, the child’s sense of security is solidified. This is a process through which there is constant acknowledgment of the core idea that the child is loved, valued, strong and worthwhile. This allows the child to develop just enough healthy narcissism to serve as their first primary defense. Because of this intrinsic level of parental involvement, healthy narcissism includes the opportunity for healthy object-relations and thus healthy relationships.

This is in stark contrast to pathologic narcissism, where a child’s upbringing is inadvertently arranged in such a way that they develop behaviors that can be quite harmful to themselves and people around them. In this type of narcissism, the opportunity for healthy object-relations and thus healthy relationships is precluded. Why? Because acknowledging a desire for a relationship implies a need which is unacceptable to a pathologic narcissist. The act of needing means they are imperfect on their own which is not suitable to them. Pathologic narcissists maintain that the world is perfect because they have no needs, which leads to an illusion of omnipotence.

When people, particularly adults behave in a narcissistic fashion, observers often make the assumption that they are choosing to behave as such. We often forget that development of a personality structure is a process that requires input from others in order to come to light. As such one can make the argument that the childhood of a pathologic narcissist was arranged in such a manner that they could only turn out one way. This would imply that the traits we see in them were done to them as a child.

The question then becomes. What went wrong?

There are many wrong turns in which child development can find itself, pathologic narcissism is but one. Pathologic narcissism is simply a model for the failures of parenting without prescribing fault to the parents because we know that they too have their own childhood experiences which affect the way they parent.

In healthy narcissism childhood anxiety is managed in a way that encourages the child to be seen and heard. In pathologic narcissism there is an opposite reaction. This manifests as a retreat from anything that could possibly endanger them, basically a retreat from life. Specifically, the biggest thing that might endanger a person, a relationship. This leads to an embrace of omnipotence where an individual is denying their ability to need.

The narrative becomes:

I don’t need anything.  I certainly don’t need anybody. I have everything. I can do everything. I am completely self-sufficient.

There is a deflection of object-relations, and if the child keeps using it as they get older, they keep returning to it.  The goal is to never be dependent, or lacking in any way, because to depend means to be vulnerable.  Everyone is their enemy, they trust no one, with the single exception being when they are confronted with adulation. Which is often short lived and unsustainable.

The pathological narcissist then finds that this defense works to a limited degree, and not very well. There is a deep sense of lack of fulfillment as they do not experience a sustained feeling of love or support which means they are constantly hungry for these, and never satisfied. This is akin to trying to survive off designer chocolates. They are beautiful and delicious, but won’t keep you alive. Once you finish one, you want another one, but there are never enough, and you constantly need more.

Externally and superficially pathologic narcissists look perfect. They are often invested in a finding a “trophy” partner that serves as a testament to their own perfection and is thus a reflection of themselves. This doesn’t bode well for relationships because they are not much interested in the needs of the other person. There is a difference between a union where you are emotionally invested and a union where the other person functions as an appendage as opposed to an equal.

This dynamic becomes even more complicated when children are involved.

Pathologic narcissism is a highly dysfunctional defense that interferes in the life of the narcissist and of course others’ lives which they are involved. They are toxic to people around them, and thus have significant difficulty with interpersonal relationships, particularly romantic ones, and because of that never seem to be very happy. They are constantly losing relationships which supports this narrative that they can trust no one, depend on no one, and at the end of the day are able to only rely on themselves.

When we see these people, interact with them, and find that they are difficult we develop assumptions and attitudes about them, usually negative. What I think allows us to be more compassionate is when we realize that they are a product of their childhood and in essence are responding to their upbringing. When someone not raised within this framework asks of them “what’s wrong with you?” The short answer will be “my parents made me this way.”

*Originally published on KevinMD.com



Tips for Raising Optimistic Kids

1. Model it – children will look to their caregivers for cues on how to respond to life stresses. As parents, it is important to model the characteristics you would like your child to exhibit. Why? Because kids are constantly watching and listening to you. Healthy habits, including optimism start with having an optimistic mindset yourself. 

2. Practice looking for the positive – daily life is full of unexpected challenges, and celebrating lessons learned from those difficulties can help your children to become more optimistic. Try encouraging your kids to share one positive experience they have everyday. This gets them into the habit of looking for the positive as opposed to focusing on the negative. 

3. Encourage kids to accomplish tasks on their own – providing opportunities for your child to be successful goes a very long way with regard to developing a strong sense of self. When children are able to achieve success and are praised for doing so, this builds their sense of self-worth and self-esteem. Age appropriate activities like chores, baking, art projects, etc. are great place to start. 

4. Allow kids to try new things – as a parent it is natural to want to protect your child from everything. However, it’s important to let kids explore and try new activities. Being too involved, or too supportive can inadvertently send the message that the child is unable to do things on their own and require parental intervention/reassurance to be successful. This is the opposite of what we are trying to instill in our children. 

5. Nip negative self-talk in the bud – just like adults children can be very critical of themselves. If you hear your child saying things like “It’s too hard” or “I can’t do it” do your best to redirect these thoughts in the moment to statements that are more positive. Instead try to encourage statements like “this might be difficult right now, and with some practice this will get easier.”   

6. Keep it real – optimistic thinking is not the same as sugar coating. The truth is our kids are not going to be great at everything, and things will not always turn out the way they imagined. Struggle and disappointment is a part of everyday life. Optimistic thinking involves looking at a situation and accepting it as is, and choosing to to view it with a positive lens. It is important to send your child the message that as long as they did their best, that is all that they can ask of themselves and is something to be proud of. This allows kids to see the innate value in their efforts even if they do not meet their own expectations. 


What to Say When Someone Loses a Pet

Anyone who has lost a pet knows the pain is very real, and in that moment there is nothing that can take away the sadness. Animals bring so much joy into our lives, and for many, pets are considered family members. 

The most important thing to remember is to be sensitive and understanding of someone’s loss.

The passing of a pet leaves a huge void, and their absence can be just as traumatic as a loss of a human family member.

The best words to provide are those of sympathy and support. If you are struggling with what to say, start with listening. There is a great deal of information you can gather by listening to how someone is feeling, and if you sense that kind words could be helpful, share positive memories that you have of their pet. Quality is better than quantity. You don’t have to say much to convey compassion and sensitivity.

If you notice that the individual who lost a pet is struggling to manage with the loss, offer to help. Ask what you can do to support them. Sometimes clearing out toys and bedding can be difficult, and having a supportive person there can go a long way toward healing.

If you struggle to come up with comforting words in the moment, writing a sympathy card is also a great way to convey concern and care.

It is also important to remember that what to say, is just as important as what not to say. To many people pets are family, so saying things like “get over it” or “it’s just a dog” or “you’re better off” or “just get another dog” come across as hurtful and insensitive.


Can There Be Hope Amid Politics?

I consider myself to be an apolitical person. I try to stay informed. I vote. But when it comes to politics, I prefer to listen to what others have to say more than I like to talk about what I think.

But after watching the first woman of color accept the nomination for the vice president of the United States of America, it’s hard to only watch. Especially because I am from the part of California she is from, am of Indian heritage, identify as the daughter of an immigrant father and experience the world as a mixed-race woman.

There are four generations of women in my family that are alive today. And this is the first time in any of our lives that a woman in a position of power looks like us. I am here because of the generations before me. As I watched this historic moment, tears of four generations of women flowed.

Amid the fight against coronavirus, structural racism, police brutality, and a world in chaos, there is this sensation that hope is waning. Although this chapter in our nation’s history may be dark, it’s important to realize that many things in our democracy were broken before the pandemic, but we still remain organized, persistent, and are working toward change.

Ernest Hemingway once said, “The world breaks everyone, and afterward many are strong at the broken places.”

It’s ironic to think about strength coming from broken things. But when a woman shot in the head from less than 3 feet away is able to stand, walk, and speak, I see hope.

When children stand on a national platform and passionately discuss gun violence, climate change, and immigration, I see hope.

When I see a woman who looks like me accepting a nomination to the ticket of a major political party, I see hope.

Humans are complex. Humans are multifaceted. Humans are capable of grit and determination. This means that humans are also worthy of hope.

If I learned anything from watching this moment in history, I realize that it’s not about being a “Democrat” or a “Republican” it’s about being human.

What we do now will echo through future generations. My hope is that we choose to be better tomorrow than we are today.

*Originally published on KevinMD.com


Running Ragged

I’m a child psychiatrist. Psychiatry has historically had a reputation of being a more “touchy feely” specialty compared to something more “Hulk smash” like orthopedic surgery. Regardless of the specialty, the same ideas apply.

What I find ironic about the whole institution of medicine is that we teach empathy and compassion in the delivery of patient care while simultaneously rewarding terribly unhealthy behaviors in our own profession behind the curtains.

We “cash out” physicians if they don’t take vacation or sick days, we turn our noses up at mental health days, we call our trainees lazy when they ask to leave early for a family event. We rapid fire questions at them, then tell them they’re stupid and need to study more if they get an answer wrong. And when they start to internalize the message we send them that they’re not smart and won’t be good doctors we call them weak and threaten to drop them from the program because “maybe you’re just not cut out for this.”

We also do a terrible job of helping trainees navigate through the other parts of their life, the non-medical side including:

-financial planning
-interpersonal relationships
-transitioning from a medical student to a resident to a fellow to an attending
-becoming a homeowner
-paying off debt
-managing stress
-talking about depression/anxiety/addiction/physician suicide

We don’t teach our kids to be confident, compassionate and competent by telling them they need to study more or they’re going to get kicked out of school. So why do we treat our trainees this way?

As responsible educators our goal should be to inspire, guide, and help them manage and navigate the struggles they are experiencing so they become capable, empathetic and successful beings.

I just finished my fellowship. It took me 14 years (5 years of college, 4 years of medical school, 3 years of residency, 2 years of fellowship) to get here and I’m exhausted. I feel like I’ve been running myself ragged these last few years doing somersaults through flaming hoops and obeying commands from the “powers that be” like a circus animal.

What sustains me is my love for what I do, the support from my family, and my ability to compartmentalize. But not everyone is lucky enough to have these supports available to them.

Just because academic medicine has historically been stoic, cold and Machiavellian, doesn’t mean it should continue to be. In the realm of research science we reward innovation, ingenuity and progress. In my opinion academic medicine should be no different. We should not continue to teach by humiliation, sleep deprivation, competition or allow the mistreatment of trainees simply because “that’s how it’s always been.” When our generation of physicians is gone our trainees will be our legacy. And we should ask ourselves, is this the mindset we want to perpetuate?

I argue that there is a better way, and ideas for what that looks like should come directly from our trainees. They have the brightest minds and biggest hearts. Because despite the inherent struggles, astronomical debt, and personal sacrifice that is asked of them, they knowingly take on the imperfections and challenges of the system to take care of patients.

They should be the beacon we follow not the ship we allow to crash against the rocks.


Finding Gratitude

It’s hard to tell in the photo but the wine glass says “FUN” on the side. I didn’t realize that when I pulled it out of the cabinet. As I was pouring wine into it late at night I read the glass and had to laugh because nothing about that moment was lowercase “fun” let alone uppercase “FUN.”

I was tired after a long day of work, feeling especially emotionally drained because child abuse cases are my kryptonite, it was hot as hell in our house, our AC works as well as it can while contending with a giant hole in our ceiling (a pre-COVID project we’re finding it hard to get someone to finish amidst COVID), our nephew-son is flexing his 21 year old attitude right when I’m ramping back up to full time hours, all of my spare time is going into my upcoming book launch, I haven’t been sleeping well, I haven’t been making time to work out, nor have I been eating as well as I should, and the truth is I miss my pre-COVID life. I miss seeing my friends, going out to restaurants, taking day trips and doing occasional shopping.

All of it just hit me at once seemingly without warning. I was sitting in the kitchen sweating my ass off, ugly crying, and sipping wine in the dark thinking to myself… being a new attending was supposed to be this glorious launch into real adulthood. And after sitting with that cognitive distortion for a minute I realized that there is no difference between the life I had when I finished fellowship and the life I’m living as a new attending a whole 34 days in, it’s just a continuation.
There is no “I made it!” There is no finish line because life is the marathon that doesn’t end until you die.

When my ugly cry was over I texted a friend who offered to FaceTime with me. We exchanged stories and struggles.

During that conversation she reminded me of a few important things:
-we all carry our own burdens-growth and change happen during hardship-the struggles you have now will pay off down the road in ways you may not have thought of-right now, in this moment, maybe you’re just where you’re supposed to be

These few simple thoughts really helped put things into perspective. I was able to shift from feeling overwhelmed and anxious about what was happening around me to being grateful for the things I do have.

My hope is that even when life seems difficult we are able to find happiness in the things that are going well (even if it may not be much), and help each other to remember that we truly are in this together.


Supporting Gender Fluid Kids

Data clearly shows that members of the LGBTQI community endure a disproportionate amount of discrimination, abuse, harassment, and violence which can have grave impacts on both mental and physical health.

Let’s talk key terms

When we discuss gender we first need to be on the same page when it comes to terminology. Here are some useful definitions to jumpstart this discussion.

Assigned sex: when babies are born they are assigned a gender “male” or “female” based on their external genitalia.

Gender identity: how an individual personally identifies. Basically, who they feel they are and know themselves to be. A person’s gender identity may differ from their assigned sex.

Gender expression: how an individual chooses to express their gender. There are many ways gender can be expressed. A few examples are clothing, hairstyle, hair color, makeup, chosen name, etc.

How does gender identity develop?

Children develop a basic sense of gender when they are quite young, as early as 2-3 years old. At this stage of development children can generally identify themselves as a “boy” or “girl” which may not necessarily match the sex they were assigned at birth. It is not unusual for young children to alternate between identifying themselves as a “boy” or a “girl.” This is normal.

As children grow they begin to have a more stable gender identity and become aware of gender stereotypes e.g. masculine versus feminine toys. Although gender identity becomes more pronounced, it can still change over time. This may be a stressful time for children who feel their gender identity is different from their assigned sex. Especially when they notice differences between themselves and their peers.  

Adolescents and teens are continuing to discover who they are as they age. It is not unusual for gender identity to change especially around puberty. Navigating hormonal changes, physical body changes, peer groups, academics, and gender identity can be a confusing and anxiety provoking time. Families are encouraged to keep an open mind and be available to provide support to their child.

How to support your child

Children thrive when the people closest to them love and accept them for who they are.

If you’re curious about how your child identifies, ask them. This will provide an opportunity to open the door for discussion.

Try your best not to pressure your child to change who they are. Rejection is incredibly painful and can lead to depression, anxiety, substance abuse, self-harm, acting out and even suicide.

If you are a parent struggling please reach out. There are many resources available including national organizations, local community resources, school services, support groups, health care providers and much more.

The most common tools/tips I share with parents of gender fluid children I see in my practice are below:


  1. Q Chat Space – a safe online discussion group for LGBTQI teens between the ages of 13-19. Chats are facilitated by experienced staff who work at LGBTQI centers nationally, and discussions occur at scheduled times just like regular in-person support groups.
  2. Gender inclusive books – organizations like Common Sense Media have a list of books that include topics like race, gender, ethnicity, and other diverse themes.
  3. Find your local gender resource center. In the Sacramento area we have the Gender Health Center which provides counseling, advocacy, and outreach resources for patients and families.
  4. Know your rights- one important aspect of advocacy is knowing your rights and where to get assistance if you need it. Lambda Legal is a national non-profit organization that advocates for the civil rights of the LGBTQI community and all living with HIV.
  5. Additional Resources: The Trevor Project, National Center for Transgender Equality, Human Rights Campaign.

COVID and Children’s Mental Health

COVID has brought to our doorsteps much unexpected change, anxiety and stress. The current atmosphere is challenging for adults, but is also trying for children in different ways. Thinking about how to begin a conversation with a child about the current climate can be daunting. Know that there are strategies and resources available to help.


The first and most necessary step before speaking to your child about COVID is to educate yourself. Seek out resources that focus on what can be done to manage today’s unique challenges. Once you have an understanding of how COVID is spread, and precautions that can be taken to keep your family safe, think about how you’re feeling. Getting in touch with your worries, concerns and anxiety will help you anticipate the way your children may be feeling. This will help you to be at your most calm when you decide to talk to your kids.

The Conversation

Once you have gathered your thoughts and feel ready, sit down with your child and start by asking them what they know or have heard about COVID already. By doing this, you’ll have an idea of where they are mentally and emotionally and can meet them where they are at. This allows you to share information, and help them navigate any misconceptions or inaccurate information they may have.

Limit Exposure

Children are very observant and perceptive. They are like sponges and absorb information from everywhere. They will be looking to you to make sense of the current climate and may need frequent reassurance. Try to keep life as “normal” as possible. Attempt to keep a schedule, limit exposure to the news and adult conversations ie. mortgage payments, bills, layoffs, as these additional worries can lead to an increase in both fear and anxiety.

Stay Active

With kids learning remotely, they may not have as much access to exercise as they would if they were able to go to school and participate in activities/recess. Physical activity and play are healthy ways for kids to relieve stress and anxiety, and is a vital part of childhood. A few health benefits of exercise are improvement in mood, reduction of sadness/anxiety and better sleep.

There are different ways to engage in exercise that you may not have thought of before. Try talking a walk or bike around your neighborhood or stream a live fitness class. Now is the time to get creative.

Hope for the Future

While COVID is a stressful time for both adults and children, not every child will experience COVID as traumatic. The best way to help kids through this challenging time is to keep things moving as smoothly as possible. Creating a schedule, frequent check-ins about their thoughts/feeling and exercise can make a big difference.

If additional help is needed look into local resources in your school district, faith services and other community resources for assistance or counseling. Know that help is out there and that you are not alone.

*Originally published on the Inpathy Bulletin


Talking to Children About Racism

Talking about race can be a daunting endeavor and many parents struggle with where to begin.

Children are like sponges; they soak up information from everywhere. Kids pick up on cues from their friends, family, news headlines and social media. Although discussing race can seem intimidating, it doesn’t have to be.

Parents often have anticipatory anxiety when it comes to these discussions. On the bright side, the fear of what could unfold is often much worse than the actual conversation that takes place.

Many parents have concerns about potentially “pointing out” race to their children due to fear of drawing attention to something kids may not notice yet. As much as we might want that sentiment to be true. Children are very perceptive and are already quite aware of differences in people. As an example, take height, weight, age, hair color, stature, style of dress, and many other attributes of a person’s presentation. Skin color is just one aspect of many that make up a person’s identity.

One consistent attribute of children is their exploration of the world in the form of questions. If they have seen protests on the streets or in the news, chances are they have already asked someone about them.

It’s important to have this discussion with kids because this historically taboo topic is not going away. Children are very vigilant and will directly observe how parents address the topic of race and racism in their own lives – or how they don’t. Instead of thinking of this discussion as terrifying, think of it as an opportunity to help your child become a more understanding, empathetic, and caring human being.

Here are some tips to get you started:

1. Be open

Children are curious by nature. They are going to ask you tough questions. And it’s ok to not have all the answers. If they ask you a question you don’t know how to answer, tell them that. By doing so you’re successfully modeling that adults don’t have all the answers all the time, and taking time to think about your response is ok.

2. Differences and commonalities

Children are much more likely to see the world through a lens of what makes people different from one another. It’s easier to conceptualize what is different, as opposed to what is similar, especially for younger children. For example, if your child asks why their skin color is different from another child’s, acknowledge that their observation is valid, and also acknowledge that although people are different they also have similarities. Share that while people may look different, we can still have many things in common.

3. Be curious

This is a stressful time and your children are likely to be feeling this too. Encourage them to talk to you about things they have on their mind, and to be curious about what is happening around them. If you don’t know how your child is managing with these stressors, ask them – chances are they have a lot to say but don’t know how to bring it up.

4. Explore

There are many fun and creative ways to bring diversity into your home. Try watching a foreign film and having a discussion about it at the end. Find a new recipe to try and help your kids research the country it came from and the people who live there. Exposing kids to different social groups helps improve cross-cultural communication, understanding and empathy.

5. Check in with yourself first

Children will look to the adults in their lives for guidance. If you’re not sure how you feel about what’s going on, take some time to think about it. Talk to people you trust, read and educate yourself on current events so you feel comfortable with the questions your kids might ask you.

Remember, your children don’t expect you to be perfect. And it’s ok to not have all the answers. This is a unique time in history, and presents an opportunity to talk to you children about racism, equality, kindness, empathy and respect.

*Originally published on the Inpathy Bulletin


Embracing Change

It’s been said that the only constant in life is change. If that is the case, then why is change sometimes so difficult to cope with when it happens?

Perhaps it is that when change occurs, it doesn’t provide much warning, so there’s little time to prepare. When we are caught off guard, we are forced to react instinctively as opposed to being able to tackle events proactively. Although change in and of itself may be scary, and at times anxiety provoking, change doesn’t always have to be synonymous with something bad.

Perhaps if we look at change in a more positive light we can start thinking of it as a means for personal growth, forward progress, and a pathway to meeting challenges we didn’t know we were capable of. This is not to say that adapting to change is easy. At times the process is uncomfortable, painful, and nerve-racking. But the beauty of change is that it keeps us on our toes, provides new opportunities to push ourselves further than we thought possible, and prove to ourselves that we are still capable of growth no matter where we are in life.

Besides, how boring would life be if every day was the same? No surprises, no speed bumps, no road blocks. What would we talk about? How would we connect with others?

One of the main reasons to get comfortable with change is that the world around us is in constant flux. Things are being transformed, converted, altered, modified, repurposed, and revolutionized on a daily basis. Change is an inevitable process, and fighting it is an uphill battle that nobody can win, and trying to keep everything exactly the same, so that nothing is different is exhausting and unsustainable.

How we can reframe this concept if accepting change is difficult, is to try and see things from a different perspective. One way is to manage expectations of ourselves and of those around us. People are malleable, and when exposed to different experiences like life events, job transition, higher education, or a new skill/hobby they might be a little bit different than they were before. If we become comfortable with the idea that our environment and the people around us are constantly changing, then it’s not so jarring or unexpected when they do.

Learning to accept change is a work in progress. Sometimes we have to just breath deeply when we are exposed to events or life circumstances that make us uncomfortable knowing that the discomfort is often temporary. Meditation, journaling, exercise, and talking to others around us can help us better understand who we are, how we see the world, and put us in a frame of mind in which we can see things in ways we didn’t initially.

*Originally published on the Inpathy Bulletin


Alcohol and the Holidays

When it comes to celebrations, particularly during the holidays, perceptions of hospitality and alcohol usually go hand in hand. Alcohol is so frequently associated with social events that people are surprised when alcohol is not present at a gathering.

But what if you choose not to drink?

Either due to health reasons, volunteering to be a designated driver, just don’t feel like it, or because of a history of addiction.

Sometimes the social setting itself and/or the people in it can cause someone who chooses not to drink to feel pressured to do so. Most people have experienced the awkward moment when you politely refuse an alcoholic drink from either a guest or the host and are made to feel guilty about your decision. The message can often be subtle, but it is very clearly communicated that somehow you violated group norms by not drinking in a social situation.

It is likely that people who treat non-drinkers in this manner are unaware of the impact their comments and behaviors have on others. They more often than not want to be sure that their guests are having a good time, and often associate fun with everyone having a drink in their hand. They may also be a few drinks in themselves and aren’t thinking logically about why you may be refusing.

It’s important to remember that just because someone offers you a drink doesn’t mean you have to drink it. It’s not rude to respectfully refuse an alcoholic drink and choose an alternative. Sometimes a host may be trying to keep their guests entertained, but your contribution can be as simple as reassuring the host that you are having a good time, even if you’re not drinking.

If you’re worried that non-alcoholic beverages will not be at a gathering, bring your own that you can share with the group. There are plenty of mixers like soda, tonic water, sparkling water, juice, etc. that you and others can enjoy. There may even be someone in the same boat as you who is trying to cut down on alcohol use or maintain sobriety but feels uncomfortable about not drinking at a gathering. This is a perfect way to model good behavior for someone who may be struggling.

Some people are very understanding of another person’s personal choices, but unfortunately there are others who are not. It is a good idea to have a planned response if someone ends up pressuring you to drink. Some very reasonable responses that don’t require an explanation are things like, “I’m the designated driver tonight,” or “I don’t feel like one right now,” or “I have to work early tomorrow” or “I’m getting back in shape.”

Curiosity is a normal human trait and it’s important to be prepared for intrusive people who may want to know exactly why you’re not drinking. If you’re a woman people may ask if you’re pregnant, and if you’re a man you may be asked why you’re not drinking “like all the other guys.” Just remember that your reasons for choosing not to drink do not need to be justified to someone else. In other words, it’s nobody’s business why you choose not to drink. If you feel comfortable sharing your reasons for not drinking, then by all means, but if someone asks you are not obligated to provide them with an explanation.

If even after you stand your ground and people are still trying to pester you to drink, you can always leave. If people are unable to respect your decisions perhaps you should evaluate whether they are the types of people you want to keep in your life.

Alcohol and Accidents

It is no secret that alcohol and accidents often go hand in hand.

The legal limit for blood alcohol concentration nationwide is 0.08 g/dL. However, even if your blood alcohol level is under the legal limit, this does not mean that you are safe to drive.

Binge drinking which is defined as 4 or more drinks for women or 5 or more drinks for men in one sitting often exceeds 0.08 g/dL. The average adult drinks about 8 drinks per binge which can lead to severe consequences. Bingeing can lead to alcohol poisoning, symptoms of which include: vomiting, slowed or irregular breathing, seizures, loss of consciousness, hypothermia, and in the worst case scenario death.

According to the Centers for Disease Control six people die every day from alcohol poisoning. The majority of people who die are Caucasian men. The number of deaths per million people varies by state, Alaska has the most alcohol poisoning deaths per million people and Alabama has the least. The National Council on Alcoholism and Drug Dependence estimates that 100,000 people die every year as a result of drinking and driving or other accidents like: falls, fires, suicides, and homicides related to alcohol consumption.

The holiday season is one of the most dangerous times of the year for alcohol-related accidents and deaths. More people are consuming alcohol during this time of year, even people who don’t regularly drink. Those who binge drink only during major holidays have a much lower alcohol tolerance and often drive when they shouldn’t. During the holidays people who struggle with alcohol dependence are often able to drink more freely with others given that the holidays are a much more socially acceptable time for people to consume alcohol. Although people with alcohol dependence have a higher tolerance for alcohol, they don’t show signs of intoxication as easily as non-drinkers and they are more likely to drive while under the influence. Winter conditions also create hazards when driving. Rain, ice, fog, and snow make roads treacherous but when you take into account holiday stress and people rushing to get everything done on time, and then throw alcohol into the mix it is not too difficult to understand why the alcohol related death statistics during the holiday season is so staggering.

Alcohol sales also help explain this trend. The Distilled Spirits Council of the United States reported that 25% of the yearly distilled spirit industry profits ($49-billion-a-year) are made between Thanksgiving and New Year’s. Trends show that sales spike on Thanksgiving, Christmas Eve, and New Year’s Eve which coincides with increased alcohol consumption.

Tips for a Safer Holiday Celebration

  • Know your limits. Many people think that one drink is equivalent to one glass, when in reality one glass could actually account for well over that. A drink is defined as 1.5 ounces distilled spirits, 5 ounces of wine or 12 ounces of beer. If you’ve never measured your alcohol consumption give it a try, it adds up much faster than you think.
  • Never pressure anyone to drink. Respect the choices of people who choose not to drink alcohol. They probably have very good reasons as to why they make that choice and are not obligated to provide an explanation.
  • Bring or offer non-alcoholic beverages. This way guests have alternatives readily available to them.
  • Last call. In the same way bars offer a last call before they close, as a host you can do the same. Stop serving alcohol at least an hour before the event ends and offer people non-alcoholic options instead. Even if it’s before “last call,” If a guest is intoxicated stop serving them alcohol
  • Don’t let anyone drive drunk. In this day and age it is so easy to call a cab or use a ride-share app to get home. It’s not worth it to try to drive home intoxicated to save a couple bucks. The potential consequences are not worth the risk.

*Originally published on the Inpathy Bulletin


The Opioid Crisis

It is difficult to turn on the television or radio, or pick up a newspaper and not notice some mention of the opioid crisis in the United States. The volume on this hot button issue is also likely to increase the closer we get to the 2020 presidential election.

Before we delve into the very important discussion regarding the opiate epidemic, addiction and mental health, and treatment/prevention of opiate use disorders, let’s first talk about how we got here. 

The Opioid Crisis in the United States

In the 1920’s through the 1980’s there was growing concern that medical providers were not paying enough attention to treatment of patients in pain. This so called “opiophobia” or fear of analgesics was deemed the culprit for under-treatment of pain. In response to this worry the American Pain Society decided to include pain as an additional vital sign. This meant that along with standard vital signs like pulse, blood pressure, weight/height and temperature, pain would become known as the “fifth vital sign.” While the push to adequately treat pain was well-intended, it led to disastrous consequences.

The Decade Against Pain

2000-2010 is known as the “decade against pain.” This stems from a multitude of systemic interventions that although well-meaning, ultimately put patients at significant risk for becoming addicted to and/or dying from opioid overdose due to overprescribing.

During this time period the Food and Drug Administration (FDA) allowed drug companies to advertise pharmaceutical drugs on TV which allowed direct to consumer marketing. This piqued interest in analgesic medications and over time opiates became a commodity that was highly sought after. To complicate matters further, there was a case of a physician in California who was convicted of battery for undertreating pain which drastically changed the medical treatment landscape, forcing medical providers to lean toward prescribing analgesic medications. To make matters worse, in 2005 Medicare linked reimbursement to pain management. This created an incentive to prescribe patients with opioids whether they were clearly indicated for treatment or not. This practice directly stems from the move toward pain management being an indicator of quality of care.

While it is a reasonable expectation that patients receive adequate pain management in the context of grave injury, surgery, serious medical illness, etc. Responsible prescribing of these medications is of the utmost importance given the potential negative effects opioids can have on a person’s life. The reverberations of overprescribing are still felt today.

Rise in Death Toll

In 1990 there was a sharp rise in opioid related deaths which was followed by an increase in heroin overdose deaths in 2010. This is particularly important because those who are addicted to opioid analgesics are 40 times more likely to use heroin in their lifetime. Heroin overdose deaths were in part due to the decrease in price of the drug which became seven times cheaper than it was in the 1980’s.

Between 1999 and 2017 there was a six-fold increase in opiate overdose fatalities. This is an increase from 8,048 to 47,600 people across the United States. In 2013 synthetic opioids contributed to 130 overdose deaths per day, 80% of these deaths were attributed to fentanyl.

Fentanyl is particularly dangerous because it is 50-100 times more potent than morphine. Ease of manufacturing and transport contributes to easier access. Fentanyl is often mixed with other substances including heroin and cocaine in unknown quantities. This means that people often don’t know what they are taking which increases risk of overdose and death.

Dual Diagnosis: Substance Use & Mental Health

People who struggle with addiction are also more likely to have a mental health disorder and vice versa. Let’s take chronic pain for example. Chronic pain is often comorbid with major depressive disorder. The converse is also true. Those with major depressive disorder are also more likely to have comorbid chronic pain. What this means is that depression and addiction is often a two-way street. Depression is associated with increased risk of opioid misuse and overdose. And those with a history of addiction are more likely to experience depression which may be increased during durations of opioid use.

Why is it important to recognize?

Because individuals with a history of depression are more likely to receive higher daily doses and a larger supply of opioid medications. More than half of people who use psychotherapeutic drugs are consumers of prescription analgesics for non-medical reasons. This is particularly concerning because 16% of adults in the United Sates have a mental health disorder… but they account for 50% of all opioid usage. Data shows that 19% of adults with a mental health disorder use opioids as opposed to 5% without a mental health disorder use opioids.

Responding to the Opioid Epidemic

We know that the opioid epidemic has claimed thousands of lives. The next question is… what can be done to address the problem? Responsible prescribing is a great place to start because no one is immune to addiction. Opioid prescribing practices is a key place to intervene given that 36% of overdose deaths involved a prescription opioid medication. It is also important to provide consumers of these medications with a reversible agent in the case of overdose. Access to opiate antagonists is critical and can save lives in the event of an overdose. Access to addiction treatment is perhaps one of the services most lacking in the United States. Only 12% of Americans who need addiction treatment have access to it.

Responsible Prescribing of Opioids

  • Opioids should not be treated as a first-line therapy for pain, other options should also be carefully considered
  • Clinicians should establish goals for pain and function with patients as complete elimination of pain may not be possible
  • Clinicians should discuss the risks and benefits of opioids with patients particularly risk of addiction, overdose, and death
  • Use lowest effective dose for adequate pain management
  • Prescribe short durations for acute pain
  • Evaluate benefits and harms frequently
  • Use strategies to mitigate risk i.e. including offering overdose reversal therapies
  • Avoid concurrent opioid and benzodiazepine prescribing given increased risk of respiratory suppression and death

Prevention of Opioid Use Disorder

Primary prevention

  1. Consider other options i.e. Physical therapy, rest, ice, and non-opioid medications
  2. Try to reduce medical exposure – Research has shown that patients prescribed opioid medications for pain can become addicted even when drugs are taken as prescribed
  3. Responsible prescribing- over-prescription of opioids for acute pain is the main source of drug diversion
  4. Unused opioids- should be returned to pharmacy to minimize risk for potential misuse or abuse

Secondary Prevention

  1. Early detection of opioid misuse/abuse is critical, if you suspect someone is struggling with addiction encourage them to seek help
  2. Prescription Drug Monitoring Programs (PDMPs) – a system currently used by 49 out of 50 states to track prescribing and dispensing of controlled substances to patients. In California it is called the “CURES” system. This is an attempt to curb “doctor shopping” where people go to doctors in different towns or states in order to get opioid prescriptions. It is illegal for providers to prescribe opiate medications without first checking this database

Reversing Opioid Overdose

Rescue kits save lives, and education and distribution are key. Opioid overdose kits are necessary for people with a history of addiction, overdose, or who are prescribed opioids or benzodiazepine medications. Opioid reversal agents are very effective, but they do wear off which means that

individuals who recently overdosed may not be completely out of danger. Although these reversal kits provide a short-term solution, there needs to be a long-term plan in place to help those at risk receive the addiction treatment they need.

Treating Opioid Use Disorders

One of the many excuses we hear regarding lack of available substance use treatment programs is the cost. However, it is important to note that for each dollar that goes toward substance use treatment, society saves on average 8-10 dollars. This makes sense if you think about the cost of calling 911, dispatching an ambulance, stabilizing a person during the ambulance ride, and the cost of emergency medical intervention and a multi-day hospitalization.

Unfortunately, there is no one size fits all approach to addiction treatment. However, the more

multi-modal the treatment strategy, the longer it lasts, and the more likely it is to be successful. Multi-modal or multi-faceted approaches to addiction treatment include psychosocial, pharmacotherapy, and harm reduction.

The harm reduction approach is geared toward those who do not do well with treatment or cannot be treated given the complexity of their circumstances i.e. Homelessness, lack of health insurance, serious mental illness, etc. This is where interventions like needle exchange programs and overdose rescue kits come into play. The idea is to reduce the potential harms that can happen when a person is struggling with addiction i.e. Minimizing transmission of blood borne pathogens, infections, and overdose deaths.

The reality is there are far more people affected by addiction than there are specialty physicians to treat them. What we need is to come together, collaborate, and work toward providing treatment to those who are suffering. It is important to remember that no one is immune to developing an addiction, and by getting involved and making a difference, the next life that could be saved is yours or someone you love.

*Originally published on the Inpathy Bulletin


The Power of Silence

We live in a world filled with noise. If you start from the beginning of your day, think of the number of things you hear from the time you wake up until the time you go to sleep. Alarm clock, dog barking, television/radio, stranger’s cell phone conversations, work telephones ringing, automobile traffic, honking horns, subway trains running, doors slamming, yelling, laughing, and millions of other things. In a world filled with noise, it’s easy to understand why we often forget the power of silence.

Finding silence in a busy life is a skill.


Because most of us are not good at sitting with silence. Think of the last time you were given the “silent treatment,” or experienced a long awkward pause in a conversation and felt like you desperately needed to fill the space. Silence can be difficult.

Before we continue, let’s explore why silence is important, and at times necessary.

Silence can have a meaningful impact on multiple aspects of your life. Harnessing silence can positively affect your work performance, interpersonal relationships, and your own mental health.


Whether we are discussing business, work, or personal relationships; at the core of every successful partnership is a foundation of trust. Who do you find you have the best working relationship with? Is it the person  who is the loudest person in the room constantly talking over or interrupting others? Or is it the person who is making eye contact with the individual speaking, and listening to them without interruption?

We have all been in a situation where a person we meet is trying to establish a working relationship but ends up doing all the talking… usually about themselves. They introduce themselves, ask generic questions about you, and simultaneously communicate that they have no interest in listening to your responses.

Active listening, which includes purposeful silence conveys to others that you are interested in what they have to say and are thus interested in what they think. You are acknowledging their presence, ideas, and are communicating that you respect them and their ideas.

Interpersonal Relationships

In any relationship conflict arises. The way you and your partner communicate your differences can make or break a relationship. For example, are you able to sit and have a calm, respectful conversation giving each person time to speak, and taking turns listening to each other? Or are you engaging in a verbal duel where you and your partner are left emotionally battered and bruised at the end? In order to have a conversation, silence is an essential part. Without silence, you’re just engaging in a monologue that is likely to get you nowhere.

Taking a breath and pausing before you respond to a question allows you to collect your thoughts before saying something you may regret. Those extra few seconds can help you see the situation differently, slow down and focus on the moment, and lead to a more loving relationship.

Overall Mental Health

Silence is important because it provides a much-needed balance to all the noise we experience daily. Silence allows us to reflect on our thoughts and feelings, and can also help us connect to our needs, wants, and desires.

Here are a few suggestions to help you find silence in your life:

  1. Create a quiet corner at home where you can pursue calming activities uninterrupted. Try reading, coloring, drawing, or journaling.
  2. Sip your morning tea or coffee outside instead of inside. Maybe on the porch, patio, or balcony. Indulge in nature and enjoy the sense of calm before beginning your day.
  3. If you’re feeling overwhelmed at home, work, or in other settings take a few seconds to close your eyes and breathe deeply. Limiting stimulation of your senses can help reduce stress, even if it’s only for a short while.
  4. Try to enjoy an evening without electronics. Just sit and relax in peace.
  5. Create an art piece. Make your own greeting cards, try painting, drawing, or coloring. If you’re not into drawing your own pieces, there are many free coloring pages you can print out and enjoy.

Most importantly, be creative.

“Adulting” is difficult, and at times is no fun. We all need a break from the seriousness of our everyday lives now and then. Think about activities you loved when you were younger and rekindle your inner child.

*Originally published on the Inpathy Bulletin


Mental Health Awareness Month

Mental Health Awareness Month was created by the organization Mental Health America (MHA) and has been observed in the United States since 1949.

That’s 70 years ago!

Each year for the entire month of May organizations like Mental Health America (MHA), National Alliance on Mental Illness (NAMI) and others take an active role in raising awareness about mental health in our communities. They host events, screenings, and reach out via social media to connect with people all over America.

Inpathy and InSight are joining the nationwide effort to increase awareness about the importance of mental health. This year, we’re embracing the idea of “Mental Health Starts With Us.” In that spirit, we are providing resources, strategies and information to highlight the importance of mental wellness for everyone.

Mental Health Awareness Month is a special time of year, because it reminds us to take time to acknowledge the struggle of individuals living with a mental health disorder, and help reduce the stigma so many people experience in their lifetime.

We all experience ups and downs that coincide with the stressors in our daily lives. So a question I’m often asked as a psychiatrist is, “if everyone has ups and downs… how do I distinguish between stress of daily life and a more serious condition that warrants treatment?”

Yes, everyone at some point in their life experiences intense emotions both good and bad. As a mental health provider, we often discuss treatment of a mental health condition when there is marked impairment in social, occupational, and/or academic settings that is not consistent with an individual’s baseline level of function.

Some examples of when to seek treatment are:

  • Excessive worry, fear, tiredness, low energy, and sadness
  • Difficulty with focus and concentration
  • Extreme mood changes
  • Prolonged irritability or anger
  • Isolation
  • Changes in sleeping habits
  • Changes in eating habits (significantly decreased or increased appetite)
  • Difficulty telling the difference between what is reality and what is not (delusions or hallucinations)
  • Substance and/or alcohol abuse
  • Suicidal thoughts or action
  • Inability to perform activities of daily living or handle daily problems and stressors

If you or someone you know is struggling, know there is help out there.

Mental health disorders are medical conditions and should be treated as such.

As a society we don’t shame people with cancer. We rally around them and support them. The same principles should apply to mental health.

Mental health is also not only about identifying a cluster of symptoms and coming up with a diagnosis. There are many different elements that go into making a mental health diagnosis including: genetic makeup, environmental exposures or stressors, and social relationships. Each of these elements is important because it helps us formulate an individualized treatment plan.

There are many evidence based treatments available that can be tailored to a person’s individual presentation and their treatment philosophy. The goal of treatment is to help people better manage symptoms of their illness, learn to better cope with stresses that may exacerbate those symptoms, and help people reach their full potential which allows them to meaningfully engage with the world around them.

*Originally published on the Inpathy Bulletin


Fierce Female Advocates for Mental Health

What initially started out as “Women’s History Week” in 1981 has evolved into “Women’s History Month” thanks to strong advocates and Congress who passed multiple joint resolutions over a period of years to get to this point. In 1987 Congress designated the month of March as “Women’s History Month” and passed additional resolutions authorizing the President of the United States to make an annual proclamation that March of each year will remain as such. This has been supported by multiple national leaders including: Presidents Clinton, Bush and Obama who have all issued annual proclamations while in office.

In honor of March being National Women’s History Month, let’s talk about how some celebrity women are changing the conversation about mental health.

  1. Demi Lovato

Demi Lovato is likely one of the most recognized faces when it comes to mental health advocacy. She has been open about her struggles with body image, substance abuse, self-harm, eating disorders, and bipolar disorder. She is the face of the “Be Vocal: Speak Up for Mental Health” initiative. In February of 2017 she partnered with director Shaul Schwarz and executive produced “Beyond Silence,” a documentary that follows three very diverse people who live with different mental health disorders. The documentary can be streamed at (http://www.bevocalspeakup.com/documentary.html) and is definitely worth watching.

  1. Lady Gaga

In 2012 Lady Gaga along with her mother established the “Born this Way Foundation” which “is committed to supporting the wellness of young people and empowering them to create a kinder and braver world. To achieve these goals, the “‘Born This Way Foundation’ leverages evidence-based programming and authentic partnerships in order to work with young people to build kinder communities and improve mental health resources.”

  1. Mariah Carey

Mariah Carey had been living with Bipolar Disorder for years before opening up about her condition. She received the diagnosis in 2001, and finally started talking about her struggles in 2018. It is difficult to imagine what it would be like trying to keep this to herself for so many years, but her willingness to discuss her diagnosis is remarkable and inspiring.

  1. Carrie Fisher

The late Carrie Fisher was arguably one of the most outspoken advocates for mental health when she was alive. She had a reputation for being very candid about her diagnosis of Bipolar Disorder, substance abuse, and her journey through illness and treatment. Many clips of her interviews can be found easily on YouTube. And in true outspoken fashion, Carrie Fisher’s ashes were placed in an urn shaped like a giant antidepressant capsule, which according to her family was one of her favorite belongings.

  1. Halle Berry

In an interview with Parade magazine in 2007, superstar Halle Berry spoke openly about her suicide attempt in 1997 after her marriage to athlete David Justice ended. She was quoted as saying ”because someone didn’t love me didn’t mean I was unlovable.” She reported thinking about her mother during the attempt and attributes that moment to saving her life.

  1. Chrissy Teigan

In March of 2017 Glamour magazine published a piece written by Teigan. She crafted a beautiful piece about her struggle with postpartum depression after giving birth to her daughter. In the article she wrote “I’m speaking up now because I want people to know it can happen to anybody and I don’t want people who have it to feel embarrassed or to feel alone.”

Chrissy Teigan is not the only celebrity to be open about their experience with postpartum depression. Superstars like Hayden Panettiere, Kristen Bell, Alyssa Milano, Sarah Michelle Gellar, Adele, Gwyneth Paltrow, and Brooke Shields have also shared their experiences publically.

Chrissy’s article can be read at: https://www.glamour.com/story/chrissy-teigen-postpartum-depression

  1. Ariana Grande

After the horrific bombing at her concert in Manchester, England in 2017 Ariana Grande has talked about how this traumatic experience has affected her mental health. She has done several interviews, and has also been active on social media sharing how she copes with the trauma and anxiety associated with it. A clip of one of her interviews after the tragedy can be seen on YouTube https://www.youtube.com/watch?v=N3vDsTGx6j8.

  1. Taraji P. Henson

In 2018 the award winning actress launched “The Boris Lawrence Henson Foundation” in honor of her father a Vietnam War veteran who struggled with mental health after returning from the war. The goal of this organization is as follows; “we are committed to changing the perception of mental illness in the African-American community by encouraging those who suffer with this debilitating illness to get the help they need.” The organization is also committed to reducing recidivism rates. This is particularly important given that minority populations are disproportionately affected by mental health disorders, are much less likely to seek treatment, and are at greater risk of incarceration due to an underlying mental health disorder. It is not uncommon for mental health conditions in this population to be undiagnosed and thus untreated which contributes to the overrepresentation of minorities in the incarcerated population.

  1. Ellen DeGeneres

In 1997 Ellen DeGeneres “came out” publicly as a lesbian. She has spoken openly about the bullying she experienced from Hollywood including cancellation of her show “Ellen” very shortly after her announcement. She started experiencing severe depression and described her experience of moving out of Los Angeles, seeing a therapist, and starting medication for depression to help her get back on track. She came back to Hollywood with a vengeance and has a well established career as a stand up comedian, television host, is the beloved voice of Dory from the Finding Nemo and Finding Dory movies. She is also the recipient of the Presidential Medal of Freedom given to her by President Obama when he was in office.

  1. Fergie

Stacy Ann Ferguson known professionally as “Fergie” is likely most well known for her contribution to the group The Black Eyed Peas. She has been very open about her history of addiction, and her journey to sobriety. She shared that she struggled with addiction to methamphetamines and was using so heavily that she was experiencing severe hallucinations that didn’t fully go away until a year after she stopped using drugs.

The bottom line is, mental health doesn’t discriminate with regard to age, sex, race, religion, sexual orientation, celebrity status, etc. Mental health conditions are very common, and according to the National Alliance on Mental Illness (NAMI) 43.8 million adults experience mental illness every year, that boils down to 1 out of every 5 individuals. In the way society at large comes together to support people diagnosed with cancer, mental illness should be no different. Mental illness is treatable and is nothing to be ashamed of.

A special thank you to all celebrities, both men and women, who use their voices to change the way we think and talk about mental illness.

*Originally published on the Inpathy Bulletin


Creative Expressions: Art Therapy

If you can remember back to your school age days, try to think about your favorite art projects, drawings, talent shows, etc. Do those experiences bring back fond memories? As adults, sometimes it is difficult to remember back to those days when we have work, bills, family, kids, pets, and many other responsibilities at the forefront of our minds. It is also unfortunate that society often looks at art as a taboo adult activity if you don’t work professionally as an “artist.”

Art is a therapeutic endeavor, and is a great platform to build on for someone who is interested in therapy, but is nervous about having to speak directly to a therapist. The premise of Art Therapy is using art as a basis of expression combined with a therapeutic modality. Art Therapy can be done individually with an art therapist, or it can be done in a group setting.

Art Therapy groups provide a safe environment for people to express their emotions, hear from others who may be struggling with similar problems, and allow for emotional healing. However, Art Therapy itself does not have to be applied only as a treatment. Art can be used as a healthy outlet to relieve stress and tension from everyday life.

Art Therapy involves creative outlets like sketching, painting, coloring, sculpting, writing, music, etc. and helps people express themselves artistically. Art therapists are trained to look for and examine the psychological and emotional undertones that a person may be trying to express through their art. The idea is to help someone better understand their thoughts, feelings, and behaviors that may be causing distress in their lives.

The great thing about art therapy is that anyone can participate in it. You don’t have to consider yourself an “artist” to be involved. Scrap booking, creating a vision board, crafting, poetry, etc. can all be used. Additionally, for those who struggle communicating with words, art allows them to express themselves without having to speak. This can be particularly relevant in cases of individuals with trauma, Autism, and developmental disabilities.

Art Therapy can be useful in all age groups from childhood all the way through late adulthood. Because of this wide range there are many settings in which Art Therapy can be used. Some examples are early intervention programs, schools, hospitals, correctional institutions, rehabilitation facilities, community mental health programs, senior centers, etc.

According to the American Art Therapy Association “Art Therapy is used to improve cognitive and sensory-motor functions, foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and distress, and advance societal and ecological change.” The National Coalition of Creative Arts Therapies Associations, Inc.​ is an organization that includes Art Therapy, Dance/Movement Therapy, Drama Therapy, Music therapy, Poetry therapy, and Psychodrama. Their organization seeks to address major societal issues like:

  • School violence
  • Alzheimer’s disease
  • Suicide
  • Domestic violence
  • Substance abuse
  • General health
  • Breast cancer

For a sneak peek into Art Therapy, take a look at the following educational videos:

Art Therapy and trauma

Art Therapy and adolescents

Art Therapy and Memory Care



*Originally published on the Inpathy Bulletin


Staying Healthy at Your Desk

Sitting down all day is one of the worst things we can do for our health. A sedentary lifestyle increases risk for weight gain, heart disease, and pain in muscles and joints among other things. But what about those of us who have a job that requires us to sit at a desk for the majority of the day?

We only get one body, so it’s important to take care of it.

Here are some ideas to help get you started.

It’s important to remember that when it comes to long-term health, it is about progress, not perfection. Small changes add up over time, and help maintain consistency as opposed to a complete overhaul of our daily routine. There is no need to try to incorporate everything on this list. You can pick and choose what is easiest and most helpful for you to maximize your health.

  1. Ergonomics

Chances are if you sit at a desk all day for work, you’re staring at a computer screen for most of the day as well. Try to setup your desk in a way that doesn’t strain your body and maximizes good posture.

  1. Screen Time

Staring at a screen all day can also take a toll on your eyes. Be sure your office has good lighting so you’re not straining to see. You can adjust the screen settings in a way that best suits you. Too bright and too dark can be stressful on the eyes, so finding a setting in the middle is likely your best bet. Your eyes also need a break from the screen regularly throughout the day. Remember your eyes are attached to muscles, and like any other muscle in the body, if we use it too much it gets tired. The muscles of the eye relax when we look at something far away. Try to take 10-15 seconds regularly throughout the day to stare at a distant object to help the muscles relax and prevent fatigue.

  1. Take breaks

When you’re busy it’s particularly easy to use that as an excuse to keep working. However, movement is very important when it comes to concentration, focus, and stamina to get through the work day. Taking a few minutes an hour to get up and walk to the printer, water cooler, bathroom, window, or to a colleague’s desk can have a tremendous impact on efficiency and work performance.

  1. Stretch

The body is not designed to sit stationary all day. It is important to get up and stretch regularly. Bring a yoga mat to work and roll it out when you need a stretch break, and then roll it up when you’re done. Your body will thank you.

  1. Walk

Use any excuse you can to move during the day with a goal of 10,000 steps per day. It sounds like a lot, but it’s doable. If you have to go up or down a floor take the stairs instead of the elevator. Smart watches and smart exercise bands allow you to set reminders to move. Take advantage of those perks. During your lunch break consider walking around the building once or twice, and invite co-workers to join you. You might be the one to start a new trend at work.

  1. BYOL

Bring your own lunch. There are hundreds of great websites that you can look to for healthy recipes that are fast and easy to make. If you’re trying to be efficient use one of these recipes for dinner, and then take leftovers for lunch. When you don’t prepare your own food you don’t know what ingredients are in it. Fast food and sit-down restaurant foods can be loaded with fat, sugar, and salt. That mixed with a sedentary lifestyle is a recipe for weight gain and health problems.

  1. Snack time

Avoid the workplace vending machine at all costs. Chips, candy bars, and other “health” bars have a ton of sugar and/or salt in them. Instead keep a bag of nuts or dried fruit in your desk for those days when you have a craving for something sweet or salty.

  1. Hydrate

It’s amazing how often we forget to drink water when we’re busy. Keeping a reusable bottle on your desk helps remind us to drink water throughout the day. Water helps fight fatigue, prevents overeating, and can help with cravings for unhealthy foods.

  1. Will power

People often mean well when they circulate pastries, bagels, cookies, and other sweets around the office. Just say thank you and decline. Just because someone offers you something, you don’t have to eat it. If you’re snacking throughout the day and are not “starving” because you were too busy to eat, saying no will likely be much easier. It’s hard to say no to a donut when you’re ravenous.

  1. Meditate

Work can be very stressful at times and it is important to have a strategy to manage the stress and worry. Meditation is a great way to help yourself recover. There are several great apps that you can use if meditating on your own is a struggle. If you’re the type of person who can’t sit still there are active meditation options you can pursue as well.

  1. When you gotta go… go!

Sometimes there is so much to do during a work day that we put off one of the most important bodily functions that take place everyday. Going to the bathroom! When you have to go… go. Holding in urine can create long-term health problems. The bladder, like every organ in the body, does not function optimally when overworked. When you “hold it” in it weakens the pelvic floor muscles over time which makes bladder leakage more likely in the future. “Holding it” also increases risk of urinary tract infections, and if urine flows backward toward the kidneys this can lead to kidney infections as well. Instead of doing the pee-pee dance and waiting until the last minute, when you gotta go…just go.

*Originally published on the Inpathy Bulletin


Mental Health and Juvenile Justice

The relationship between mental health and juvenile justice is complicated. According to the National Alliance on Mental Illness (NAMI) approximately 2 million youths are arrested in the United States every year and up to 70% of these youths have an identifiable mental health and/or substance use disorder. This is a much higher percentage compared to the average youth population with a prevalence of mental illness of 9-22%.

Unfortunately due to the difficulty of integrating mental health treatment into correctional settings, it is not uncommon for mentally ill youths to wait in custody before receiving mental health treatment they need. This is due to the interplay between ethics, legality, and logistical difficulty of treating youths in a jail or prison setting.

Correctional facilities are not hospitals, thus facilities are staffed primarily by people with experience in law enforcement, and most have little to no training in mental health. The setting of a correctional facility is also not ideal for youths with mental illness given that the facility can be loud, different staff work at different times and other juvenile offenders are coming and going which means there is very little consistency, and it is difficult to sleep in a correctional setting. They can also be antagonized by other offenders, are more likely to spend time in isolation, and are more likely to get write-ups or disciplinary action if they cannot understand or do what is expected of them. The correctional setting is also challenging because mentally ill youth have limited access to familiar faces like family and close friends which can cause additional stress.

Racial and ethnic disparities are clear when it comes to the diagnosis and treatment of mental health conditions in the juvenile justice system but also in the community at large. Youths of color are less likely to receive mental health or substance use treatment, are more likely to be referred to the juvenile justice system, and receive fewer services in the foster care and child welfare populations compared to white youths. Even in the juvenile justice system, youths of color are still less likely to be treated for mental health disorders than white youths even after researchers controlled for age, gender, and detention center location.

Gender also appears to play a role with regard to treatment. Some studies indicate that females are more likely than males to receive mental health placements as opposed to being incarcerated. Girls in the juvenile justice or foster care system are also more likely to be referred for treatment. The explanation for these trends is not clear, but is likely multifactorial.

It also appears that younger youths, typically under 15 are more likely to be referred for mental health placements as opposed to being incarcerated. This suggests that the older the youth, the more punitive the approach as opposed to younger youths where the approach is more rehabilitative.

Mental Health and Violence

A common misconception is that people with mental illness are more likely to be violent. When in fact most people with mental illness are not violent, and are much more likely to be a victim of violence as opposed to a perpetrator. It is difficult for the public to accept that most violent crimes are committed by people without mental illness. This is likely because it leaves us devoid of an explanation as to why sane people still commit violent crimes.

Given that people with mental illness are often portrayed negatively in the media, it is that much more important to discuss relevant data on the matter. Researchers have found that the prevalence of violence among people with a treated mental health condition, was the same when compared to the general population (people not affected by a substance or mental health disorder). This means that people with treated mental health conditions are no more or less likely to engage in violence compared to non-mentally ill, non-substance abusing controls.

Early Intervention

This is why early intervention and treatment for youths with mental health and substance use disorders is so important. If these conditions can be identified and treated early, two of the greatest risk factors for incarceration are now eliminated. Early intervention programs have the potential to drastically alter the trajectory of a youth’s life, and is a more effective, healthier, and much less costly alternative to incarceration.

Reintroduction into Society

Upon release from incarceration, individuals with mental and behavioral health issues face many barriers to successful reentry into the community. A few examples are lack of health care, limited job skills and/or education, inability to find stable housing, and poor connection with community behavioral health providers. All of which may jeopardize their recovery and increase their probability of relapse and re-arrest. Individuals leaving correctional facilities often have lengthy waiting periods before attaining medical and mental health services in the community which puts them at high risk for re-incarceration.

What can be done?

The best first step is to identify high risk individuals and screen for mental health and substance use disorders before a crime is committed. This would allow for early intervention, treatment, and additional support. The idea being that with these systems in place, incarceration may be avoided altogether.

If the youth has already entered the juvenile justice system, they should still be screened and assessed for underlying substance or mental health disorders. This is to ensure both recognition of their condition, treatment, and connection with services prior to release from incarceration. This method of practice is much less costly, and is also more effective than providing treatment solely when the youth is incarcerated.

Mental health training for professions that are likely to come into contact with the mentally ill is also important. These professions include but are not limited to law enforcement, probation, juvenile and family court judges, teachers, and other first responders. If mental illness can be identified early, the process of linkage to community services can be achieved much earlier in the course of illness and significantly increases chance of recovery.

What types of treatment have been successful?

Cognitive–behavioral therapy (CBT) has shown positive results. The premise of CBT is helping youths understand that their thoughts play a very big role in their behaviors. The goal is to help them to modify their thinking and behaviors as they relate to delinquency and crime. There is some evidence that this treatment modality can be effective in decreasing recidivism rates.

Functional Family Therapy (FFT) is a family-based program. The focus is on decreasing risk factors for high risk behaviors, and increasing protective factors. The setting of FFT often depends on the severity of the behaviors. Outpatient therapy is common, however if there is a lot of conflict in the home, services can often be provided in the home. There is some evidence that when families engaged and adhered to the FFT model, there was a significant reduction in felony crimes and violent crimes.

Multisystemic Therapy (MST) is also a family based therapy and is designed for youths who have very serious problems such as substance use and severe criminal behavior. The level of intervention is more intense compared to the other two modalities discussed above. MST usually involves multiple therapist–family contacts each week. The goal of this modality of treatment is to increase prosocial behavior while decreasing problem behavior. Due to the severity of the behaviors the youth is engaging in MST generally uses a home-based model. Research suggests that MST has an impact on decreasing re-arrest rates in the youth population.


Provides information and assistance with obtaining health insurance after release from incarceration

National Alliance on Mental Illness (NAMI)

GAINS stands for “Gather, Assess, Integrate, Network, and Stimulate.” This organization supports people who work in behavioral health and criminal justice, helps communities facilitate the integration of mental health and substance use services, and information about funded grand programs.

The National Reentry Resource Center
Provides information on reentry resources including family engagement, housing, substance use treatment, mental health and many other topics.

*Originally published on the Inpathy Bulletin


Baby Sign Language

When a baby is in distress and crying, it is not uncommon for parents to struggle with figuring out what their child desires. This process can be frustrating especially if there are no obvious signs of events needing a remedy. Ie. diaper is clean, baby just ate, baby isn’t too warm or too cold, baby was fine being held just a second ago and with seemingly no stimuli baby is now inconsolable. Although babies are able to communicate their distress through crying, they lack the ability to verbalize their needs, so telling parents exactly what they desire is next to impossible. Imagine what this is like for baby. Picture knowing what you want, but not be able to communicate it.

However, if given extra tools, the process of better understanding one another without the use of words becomes much easier.

How is this possible?

Just because babies are unable to formulate words, it doesn’t mean they aren’t able to communicate. They just need to be shown how.

What is baby sign language?

Baby sign language is a method in which to communicate prior to acquiring the ability to speak. Babies are taught the meaning of different gestures to help them better communicate their needs. The goal is to reduce frustration and meltdowns associated with the inability to converse verbally. During this process you are simultaneously flooding baby with language visually (observing signs directed toward them), verbally (hearing people speak to them), and mechanically (baby learning to use signs as a means to express themselves).

How early can baby sign language start?

In theory you can start as early as you would like, but it is important to keep in mind that while babies may be learning the signs, they are unlikely to have the ability to use them effectively until about 6-8 months of age.

How do I start?

There are online tutorials, books, and classes you can take to educate yourself on how the process works. It’s also important to have realistic expectations. In the same way learning any new language takes time, baby sign language is no different. Patience is key. Think of it as an opportunity to spend more time with baby and increase the bond you already have with your child. The idea is to make the learning process fun. There is no need to set aside time during the day to “teach” baby sign language. The idea is for baby to learn organically by putting things into context. For example, associate signs with things you do in everyday life as they’re happening… like “hungry” or “thirsty” or “sleepy” to help baby communicate their needs. It’s also important to remember to continue to incorporate spoken word along with signing to continue to facilitate baby’s speech development.

*Originally published on the Inpathy Bulletin


Electroconvulsive Therapy

Electroconvulsive therapy (ECT) was first introduced in the 1940’s and is arguably one of the most misunderstood treatments in psychiatry. This is likely secondary to the stigma associated with it. ECT is still suspect to many based on its dark history. In the 1940’s electric shock was administered without any type of anesthesia which led to serious and painful side effects. However, ECT today is significantly safer and the practice is much more humane.

What is ECT?

The premise of ECT involves a small electric current transferring through electrodes placed on the head. The electricity applied induces a controlled seizure that usually lasts around 1 minute. Electrodes can be placed one of three places on the head: unilaterally on either the left or right temple, or bilaterally (on both sides) of the temple.

ECT is done after general anesthesia is administered so the patient does not experience any pain. A bite block is placed in the mouth when the patient is asleep to protect the teeth and jaw, and a muscle relaxer is also given so the body is loose when the seizure is induced. This is meant to help mitigate physical side effects after treatment is completed. During ECT the patient is monitored for the entirety of treatment and also during recovery. The ECT administration team usually consists of an anesthesiologist, nursing staff, and a psychiatrist.

Having seen ECT in several patients for multiple sessions over the years, it is safe to say that the process itself is quite underwhelming. Prior to the first time observing ECT I was expecting a violent seizure with a thrashing body as it has been depicted on TV. Instead the procedure was frankly boring. It takes more time to setup the equipment for treatment than it does to administer the treatment itself. The actual application of electricity takes about 30 seconds. The patient’s movements are very minimal secondary to the muscle relaxer given prior to treatment. At most a patient makes a grimacing facial expression, an arm or leg may contract or tremble slightly, and then it’s over. They are taken to the recovery room and monitored, and in about an hour or two, once the anesthesia wears off they can resume regular activity.


Although ECT is quite safe, it is not without risks. The most common side effects include:

  • Usually lasts for a short period of time, but can last for several days.
  • Memory loss. Retrograde amnesia, or trouble remembering events that occurred before treatment is possible. Most of the memory loss comes from recent memory, but can rarely come from previous years. Memory usually improves after treatment is concluded.
  • Physical side effects.Nausea, headache, muscle ache that can be easily treated
  • Medical complications.There are always risks associated with any type of medical procedure particularly with procedures that involve anesthesia. This is why a full medical evaluation should take place before ECT treatment begins.

What conditions does ECT treat?

ECT is used to primarily treat the following conditions:

  • Treatment-resistant depression
  • Severe mania, a state of intense euphoria that is a symptom of bipolar disorder
  • Catatonia,which includes symptoms like: lack of movement despite the physical ability to do se, fast or strange movements, lack of speech, refusal/inability to eat, and stupor. Catatonia is associated with both psychiatric disorders and some medical illnesses.
  • Agitation and aggression associated with psychiatric disorders and medical disorders like dementia
  • Psychosis

When is ECT used?

ECT is typically the treatment of choice when less invasive treatments like medication or therapy have not worked, or when the need for treatment response is dire due to the severity of the patient’s condition. ECT can also be used when medication is not a viable option ie. during pregnancy where medications could put the fetus at risk, or in people who prefer not to use medication to treat mental health conditions.

The effectiveness of ECT is acknowledged by reputable organizations like the American Psychiatric Association, the American Medical Association, and the National Institute of Mental Health. More information can be found on these organization’s websites.


American Medical Association

American Psychiatric Association

National Alliance on Mental Illness

National Institute of Mental Health

*Originally published on the Inpathy Bulletin


Hallucinations in Children

A hallucination is an experience of sensing something that is not actually there. There are several different types of hallucinations: auditory, visual, and tactile. Auditory hallucinations are the most common type of hallucinations. There are many reasons children experience hallucinations. This is why when it comes to discussing hallucinations in children, context is important. Hallucinations in children is fairly common and isn’t always pathological. Hallucinations also need to be distinguished from normal development and age-appropriate play.

For example, if a child sees a flitting shadow at night it would be reasonable especially for young children to say something like “I saw a ghost.” Another example is a child that has an imaginary friend.  This is often due to children having unbounded imaginations and a strong inclination to use make-believe scenarios in their play. So when they vividly describe what is occurring during play, they are describing fantasy.

True hallucinations can have many precipitating factors that do not necessarily stem from organic psychiatric illness. A few examples include: physical or emotional trauma, stress either in the home or at school including bullying, lack of sleep, mood disorders like depression, adverse medication reaction, toxic ingestion, substance use, and physical illness ie. seizures, infection, hyperthyroidism and others.

True psychosis in young children is very rare, however, when it is present the symptoms are usually severe and significantly inhibit the child’s ability to function. According to the Mayo Clinic the earliest signs of schizophrenia in childhood may include: language delays, late/unusual crawling/walking, or abnormal motor behaviors. It is important to note that these symptoms are not unique to schizophrenia so a full evaluation should be done to rule out other conditions like developmental/learning disabilities and learning disorders.

If a child develops persistent hallucinations and has a disorganized thought process where they are not making sense, confuse things like television with reality, become isolative, suspicious of others, or become agitated/aggressive, etc. immediate evaluation is warranted. Since children spend the majority of their day at school, the first signs of decline may be noticed by your child’s teacher.

If you have concerns about your child know that help is out there. There are clinicians including psychologists, pediatricians, and child and adolescent psychiatrists that specialize in mental health in children who can help with management of both physical and mental health concerns.

*Originally published on the Inpathy Bulletin


Learn How to Love Your Spine: The Lost Art of Sitting

The probability of something life changing happening to me on the way to work is slim. But recently one morning when I was in the car driving to work I listened to a segment on NPR that changed my life.

Let me preface this article by saying I’m an active person. I exercise regularly, eat healthy, and live a busy lifestyle. My favorite types of classes are cycle, kickboxing, dance and yoga. But when I’m at work I’m forced to sit for hours and hours on end in front of a computer. Despite regular standing and stretching breaks, frequent walks to the printer, and bathroom breaks I was finding that my back was hurting almost all day. At work I’m busy enough that I am able to ignore the vast majority of the pain, but when I’m in the car on my way home attempting to destress and reflect on my day that deep soreness in my lower back starts steadily increasing. I find myself shifting my weight side to side, frequently trying to sit up straighter with no relief.

Enter National Public Radio (NPR)

I’m a radio buff. When I drive to work I enjoy listening to current events and intriguing news stories because it makes my commute go by much quicker. On one auspicious day there was a segment on posture which focused on sitting. This made me think about what percentage of my week I spend sitting.

A conservative estimate for most people would be a 40 hour work week, which means that a person spends 33% of their work week sitting. But if you break it down even further and add things like: sitting in a car or on public transportation, coming in early or staying late at the office, sitting down for lunch, sitting down at meetings, waiting at the doctor’s office, watching you kid’s soccer practice, hanging out with the family watching a movie, sitting down for dinner, etc. We spend much more time than we think just sitting.

Work Does Not Have to Be Painful…

And yet for so many people… it is.

2015 data from The National Health Interview Survey (NHIS) a major data collection program of the Centers for Disease Control and Prevention (CDC) is telling. The NHIS collected data on low back pain attributed to work, and created a chart depicting prevalence of back pain in the population by industry, and also by occupation.

The most affected industries are agriculture/forestry/farming, construction, and healthcare.

The most affected occupations are construction/extraction, personal care and service industries, and transportation/material moving.

Quality Over Quantity

There are many industries and occupations that are more prone to lower back pain than others, but not everyone who works in those jobs has back pain. So what makes the difference? Of course everyone’s anatomy is different, and there are some attributes that make certain individuals more prone to low back problems. However, there is growing sentiment that it’s not how long a person sits that creates the problem… it’s how.

Learning How to Sit

Scott Donkin, an internationally published author, experienced chiropractor, and author of Sitting on the Job is an expert in balance and physical performance. He presented a TED Talk in Lincoln, Nebraska and demonstrated how to sit in a healthier way.


Jean Couch the author of The Runner’s Yoga Book and founder and director of the Balance Center in Palo Alto, California is an expert in all things spinal health including: yoga, movement, stretching, and balance. She suggests 3 easy ways to sit comfortably with good posture in any chair.

  1. Sit on the edge
    • Aim for the front part of the chair which is usually the hard part
    • This keeps you from adopting a “C” shaped spine and helps you sit more like an exclamation point
    • You want your knees below your hip sockets, not in line with them
  2. Build a perch
    • A perch is an item you use to sit on to help improve your posture
    • The idea is to place it toward the front of the chair and then sit on it with an untucked pelvis
    • The nice thing is you can build a perch out of almost anything
    • If you don’t have a pillow you can use a jacket, rolled up towel, blanket, wallet, or even your purse
  3. Special Circumstances
    • You definitely won’t be able to sit toward the front of your chair when driving or flying, nor should you try for safety reasons
    • Most airplane seats and car seats are terrible for your back because they force your spine into a “C” shape
    • How you combat this is by creating a support for your back
    • You can use the same item you use to build your perch and place it at your mid back
    • This serves to straighten out your spine and sit more comfortably

Love Your Spine

I never thought as an adult that I would need to retrain myself how to sit. I also wasn’t prepared for how challenging it would be. When you’ve been sitting one way for decades, and then decide you want to change that it takes a lot of practice and patience. But the good news is, it’s possible. I tried several of the above techniques with such great success that I wanted to share what I learned. It’s amazing how such small changes can make such a big difference.

*Originally published on the Inpathy Bulletin


Disability and Mental Health

Mental health as a whole is one of the most stigmatized areas of medicine and as such comes with its own unique challenges when talking about mental health and disability. Unlike the deficits seen with a stroke or broken leg which are obvious, people with serious mental health conditions may on the surface seem to others as “normal.” However, just because symptoms associated with mental health disorders are not always seen, does not mean that they don’t exist, or seriously interfere with a person’s life.

In fact, sometimes mental health conditions can become so severe that a person’s ability to function is substantially decreased. This may lead to difficulties taking care of activities of daily living, keeping up with demands at work, social isolation, substance use, hospitalization, or even suicide attempt.

Like physical health conditions, mental health conditions also take time to heal. In the same way a person with open heart surgery after a heart attack is instructed to keep stress low, eat healthy, take their medication, get adequate sleep, follow up with their doctor, and not rush back to work… the same principles apply to someone who is struggling with a mental health condition.

How to be proactive

Since “don’t get sick,” “don’t get hurt,” and “don’t get diagnosed with a mental health condition” is not a viable plan there are ways you can be proactive and take charge of your health. Diet, exercise, and regular health check-ups are some of the best ways to prevent both physical and mental health conditions. Your primary care physician can also screen you for symptoms of depression or anxiety with a short questionnaire and refer you for services if indicated. However, sometimes despite our best efforts, the combination of our genetic make-up, environment, and unexpected life events can leave us in a very difficult position.

Many people decide to purchase disability insurance in the event they become disabled. Not all disability insurance plans are created equally, so doing careful research and talking to several experts before making a decision is crucial. Ask questions that are relevant to your situation, personal history, and family history. An important example being, does disability insurance cover mental health related disabilities or just physical disabilities? When it comes to being proactive, it is better to have disability insurance and not need it, then become disabled unexpectedly and not have it. But you also want to be crystal clear with regard to the exact coverage you’re getting. You don’t want to find out in a crisis that your disability insurance doesn’t cover what you thought it did.

What can I do if I need help?

A serious mental illness like schizophrenia, bipolar disorder, major depressive disorder, panic disorder, post-traumatic stress disorder, etc. should be treated as seriously as physical conditions like diabetes, heart disease, cancer, or stroke because all of the above conditions negatively impact a person’s health, cause an immense amount of stress to the individual and their families, and are deserving of alleviation of suffering.

If you are struggling, it may be time to see a professional.

If you don’t know where to start, your primary care doctor is a good place to begin. They are often knowledgeable and should be able to point you in the right direction to facilitate referral and connection to mental health services if indicated.

What happens if I can’t work?

Sometimes mental health diagnoses can become so severe that people are unable to work.

Two programs run by the United States Social Security Administration help many people who have a physical or mental health condition(s).

One such program is Supplemental Security and Income also known as SSI. This is different from Social Security Disability Insurance or SSDI which will be discussed below. SSI is meant for individuals who are disabled and low income. Qualification is determined by current income and assets. Slightly over eight million people in the United Stated received SSI as of September 2018.

The other program is Social Security Disability Insurance or SSDI. This program provides monthly financial assistance to individuals who qualify for either a physical or mental disability. According to an article written by NAMI, a mental health advocacy organization, approximately nine million people received SSDI as of 2013. And 35.2% of SSDI recipients met disability criteria for a mental health condition. Data from the Social Security Administration as of December 2013 revealed the number of individuals afflicted with a mental health condition and were receiving SSDI was over 3.5 million. Diagnoses included mood disorders, autism spectrum disorder, developmental disorders, intellectual disability, and schizophrenia/other psychotic disorders.

The determination of qualification for a disability is not done by a person’s regular primary care physician or psychiatrist. The Social Security Administration has certain criteria that must be met to qualify, and they employ physicians that specialize in disability evaluations to help them make a determination on whether or not a person qualifies for disability.

Myths about disability

Many patients I speak to often say things like, “I don’t want to be on disability because I’ll never get off.” Or “I’m not weak.” Or, “I don’t need help.” Unfortunately the concept of disability is often met with negative connotations, however, temporary disability can help a person take the time they need to heal with the goal of getting back to their previous level of functioning. The overwhelming majority of patients I’ve seen do not want to be on disability long-term. Instead, they want to live happy and productive lives including having social relationships, employment, and a sense of contribution to society.

Disability is not about weakness or shame, it’s meant for the very real situations discussed in this article. It is a means to help those struggling get back on their feet, and is a source of support for those who cannot. There will be a point in everyone’s life where help is needed in some capacity. My hope is that as a society we support those who are courageously asking for help instead of passing judgement and perpetuating stigma.

*Originally published on the Inpathy Bulletin


Now Trending: Microweddings

Think about the last time you went to a wedding. Were there extravagant sprays of flowers, glimmering table decorations, bridesmaids with flawless hair and makeup, hundreds of guests fawning over the tiniest of details, and of course… an open bar? The answer is most likely… “yes.” And as you enjoy a celebration full of love, family, friends, and fun on someone else’s dime, the question that will undoubtedly slip into your mind at some point during the event is… “how much did this all cost?”

Wedding Facts and Figures
In 2017 the Knot surveyed almost 13,000 couples who were married that same year and found they spent an average of $33,391 on their wedding. And that’s not including one major big ticket item, the honeymoon. The cost of weddings have increased significantly over time. In 2009 the average price per guest was $194 and is roughly $268 per guest now. But interestingly, the average amount of money couples are spending on weddings is decreasing. How is this possible? Well, couples appear to be moving from the much more expensive formal black tie wedding to more non-traditional weddings which are not as pricey. For example, there is a very big difference in price tag between a posh hotel and a rustic barn.

The following statistics were gleaned from the Knot 2017 report:

  • Average Wedding Cost: $33,391 (excluding the honeymoon)
  • Most Expensive Place to Get Married: Manhattan, average spent $76,944
  • Least Expensive Place to Get Married: New Mexico, average spent $17,584
  • Average Spent on a Wedding Dress: $1,509
  • Average Marrying Age: Bride, 29.2; Groom, 30.9
  • Average Number of Guests: 136
  • Average Number of Bridesmaids: 5
  • Average Number of Groomsmen: 5
  • Most Popular Month to Get Engaged: December (16%)
  • Average Length of Engagement: 14.0 months
  • Most Popular Months to Get Married: September (16%), June (15%) and October (14%)
  • Popular Wedding Colors: Ivory/Champagne (37%), Dark Blue (32%) and Gold (30%)
  • Percentage of Destination Weddings: 25%

The top 10 most expensive places to get married were determined to be:

  1. New York – Manhattan: $76,944
  2. New Jersey – North/Central: $62,074
  3. New York – Long Island: $61,113
  4. New York – Westchester/Hudson Valley: $55,357
  5. Massachusetts – Cape Cod: $55,083
  6. Rhode Island: $52,777
  7. Illinois – Chicago: $52,332
  8. Connecticut: $47,435
  9. New York City – Boroughs Outside of Manhattan: $46,808
  10. Pennsylvania: Philadelphia/Delaware: $46,211

And the top 10 most affordable places to get married were determined to be:

  1. New Mexico: $17,584
  2. Utah: $18,516
  3. Oregon: $20,652
  4. Montana: $20,814
  5. Iowa: $21,982
  6. Idaho: $21,987
  7. South Dakota: $22,107
  8. Ohio – Toledo: $22,171
  9. Oklahoma: $22,373
  10. Mississippi: $22,645

So, for those who can’t fathom parting with ~$30,000 but also want to have a “real” wedding celebration as opposed to an elopement. What are their options? Let’s talk about microweddings.

What is a microwedding?

Think of a microwedding the same way you would think about different sizes of candy bars. Most candy bars come in a jumbo size which is more expensive than the regular size. And the mini version of that very same bar is pennies to the dollar compared to the regular size. The same thought process applies to a microwedding. You will still be getting the fulfillment of having a wedding, with the relief of not having to break the bank to do it. In essense, microweddings are just the “fun size” version of a traditional wedding. Microweddings are usually quite small, and the number of guests can range from 5-50 people. Because the number of attendees is less, the celebration is often less expensive, more intimate, allows for more creativity and flexibility compared to a traditional wedding, and also tends to be less stressful both emotionally and financially.

How do I know if I want a microwedding?

So… that depends on what you’re looking for. If you are the type of person who likes to stick to a small budget and are comfortable with inviting just your closest friends and family, then it may be a viable option for you. The fewer guests you have, the less expensive your wedding will be. Why? Because fewer attendees means a smaller venue, less food and drink that needs to be supplied, fewer invitations, fewer bridesmaids, fewer table decorations and party favors, and the list goes on.

The other plus side of a microwedding is that a small guest list means that you can do almost anything to celebrate your marriage. If your dream is to get married on a glacier in Alaska imagine how much easier it is to get 5 people up there as opposed to 500. The microwedding allows you to do unique things you would never be able to do with a huge guest list, and it also gives you the flexibility to be creative with your choices and let your personality shine through.

Plus, if you’re one of those people who wants to celebrate the love and commitment you have for one another, ask yourself how important it is for family members you see a few times in your life and barely remember their names are to your big day. Your wedding day should be special, not stressful.

You should definitely not have a huge wedding because other people want you to. It’s easy to be swayed by the allure of having an extravagant expensive wedding, but remember there is no correlation between how much money you spent on a wedding and how long you will remain married. It is even more important to remember that finances are one of the biggest reasons people get divorced. So starting your marriage off debt free and enjoying your life together is a much better start than fighting tooth and nail figuring out how you’re going to pay everything off over the next few years.

How to break the news?

So you’ve decided that a microwedding is for you, but are afraid of the pushback you’ll get for bucking tradition. Once you’ve made your decision, stick to it. When people start talking to you about the big day and make helpful suggestions that have dollar signs written all over them, be polite, but stay firm. Whenever it comes up, make sure that you are confidently vocal about your wedding plans. Every person has different expectations in mind when they hear the word “wedding” so start setting people up for what your expectations are early.

Cost cutting tips

  1. The Dress: Have fun and get creative with budget friendly finds. If you find something you love that fits, and you feel incredible in it, then that’s it. Don’t let people talk you into getting something that you don’t want. Half the fun is looking at vintage shops, or consignment stores for a dress that looks “bridal” without the wedding price tag.
  2. The Venue: the nice thing about having a small wedding is that you can spend quality time with everyone instead of doing a quick meet and greet with people who sometimes travel a very far distance to attend. The possibilities are endless. You could rent out a community center, park, small restaurant, Airbnb, library, bar, zoo, and the list goes on. You could literally do anything you wanted to.
  3. The Food: instead of paying several hundred dollars a head for a professional caterer, think about making a reservation for you and your guests at your favorite restaurant. Or call up your favorite food truck and see if they will come to your venue for a few hours.
  4. The Flowers: it’s generally a good idea to not say anything “wedding” related when you’re talking to vendors. Even if your wedding is small, just the whiff of the word “wedding” means that whatever you’re purchasing will come with a wedding price tag. Look for flowers that are in season, and save money by creating simple arrangements. You can also get more bang for your buck if you use your flowers in multiple ways. For example if you decorated your wedding arch with flowers, use these same flowers to decorate the tables at your reception.
  5. The Officiant: the cost of an officiant can sometimes be steep. Think about having someone close to you be ordained so they can officiate your wedding. It adds a nice personal touch when the person marrying you knows you both very well, and they are often more than willing to do it for free.
  6. The Photos: do your research. Sometimes you can find great photographers that are in photography school, or have recently completed a program and are trying to get into the business, but they don’t have a large enough portfolio to book regular jobs. Take a look at some of the work they have done. Chances are you can get a great deal, and recommend them to others you know to return the favor.

Where do I start?

There is nothing wrong with wanting a big wedding, as long as that is what you and your partner want. It’s often difficult to stand your ground when the people closest to you are telling you how they think you should spend your wedding day. But remind yourself that your wedding is a once in a lifetime event, and you can take one day out of your life to be selfish. Take the time to think about what the word “wedding” means to you and your partner and go from there. At the end of the day you will have to find what works for the two of you, and once your family and friends see how much that means to you they should get the message and get on board. And if they don’t then they did you a favor and helped make your guest list a little bit shorter.

*Originally published on the Inpathy Bulletin


Creative Ways to Exercise Indoors

Winter weather can be a significant barrier to many people getting to the gym. It’s cold, rainy, icy, snowing, dark, none of which make us particularly motivated to do much of anything let alone go to the gym. When given the option between putting on sweats and sitting in front of the fireplace with a hot beverage and braving the cold to venture to the gym. It’s not difficult to imagine what most people would choose. Being from the West Coast battling harsh winters was never something I needed to worry about. However, after going to medical school on the East Coast, I became very familiar with what a “real” winter was very quickly. On the days the ground was slippery due to black ice, my car was buried in at least a foot of snow, and the temperature was -8 not accounting for wind chill, the last thing on my mind was going to the gym. So I had to get creative, and so can you.

Create your own indoor boot camp

Use items you already own like chairs, steps, and exercise equipment to create your own multi-station workout. You can also purchase a boot camp DVD or stream a class from a number of different apps and websites so you can complete your workout at home.

A Family Affair

If you have an interactive game console like an Xbox or a Wii you can easily have a dance off, play a game of tennis or bowling, and also spend time with your family. This is a lot of fun and encourages everyone in the household to be active.

Burn Calories While Cleaning

If you’re into multitasking, you can accomplish two tasks at once by doing labor intensive house cleaning tasks like vacuuming or mopping vigorously. There is some evidence that if you turn on music with faster beats per minute you are likely to move your body faster and get a better workout.

Have a Dance Party

Pop in a hip-hop, Latin or Bollywood dance instructional DVD and lose weight while having fun.  Or just put on your favorite music station or stored music and dance like nobody is watching.

Find Your Zen

Take time to do some mindfulness with either guided meditation or yoga. This is an opportunity to decompress, destress, and clear your mind which is much needed after a long week.

Cycle to Your Heart’s Content

If you have the ability to invest in an in-home stationary bike you can cycle to your favorite movie, television show or music. You can take this time to catch up on your favorite series you haven’t had the time to binge watch. Some stationary bikes come equipped with monitors that allow you to subscribe to live streamed classes, so you are actually exercising with a live group of people but are in the comfort of your own home.

Take it Back to the Days of Elementary School

Do you remember being a kid and jumping rope either on your own or with a group? If double dutch and other jump rope games like helicopter make you feel a tad bit giddy inside, tap into that love you had when you were younger. Get out the rope and practice. It’s definitely harder as an adult, but it’s still a lot of fun and is a killer workout.

When In Doubt, Plank it Out

If you’re not sure where to begin work on your core strength. Try holding a plank position for 15 seconds at first, and then repeat. You can also practice your side planks for a little extra exercise. You’ll feel the burn in no time.

Play a Game of Cards

So, if you are familiar with a deck of cards you know there are 4 suits: spades, hearts, clubs, and diamonds each with a number or face on the card. Face cards are designated as a 10, and ace cards can either be a 1 or an 11 depending on how motivated you’re feeling.

Get creative and assign one exercise to each suit. Shuffle the cards together, and then lay them face down. Flip over one card and then do that exercise for the number of repetitions listed on the card. For example if you assign the hearts suit as squats and you pull a 9 of hearts that would equal 9 squats.

This is a fun exercise to split with family or friends. Since 52 cards is a lot of exercises and repetitions for just one person, it’s fun to split the deck with others so you can work together toward a common goal. You also don’t have to complete the deck if it’s just you doing the workout. Take it easy at first, and build up your stamina and strength as the days go on.

*Originally published on the Inpathy Bulletin


Exploring Traditions: The History of Halloween

Costumes, jack o’lanterns, candy, haunted houses, and trick-or-treating are all words that invite us to think about Halloween. In America this annual holiday is celebrated on October 31st of each year. But where did this widely practiced tradition originate, and how has it changed over the years?


The origin of Halloween dates back thousands of years to the geographic area presently known as Ireland, the United Kingdom, and France. Celtic people celebrated the ancient festival of the Celtic New Year on November 1st, as well as Samhain the night prior to the New Year, October 31st. Samhain was believed to be the day where the worlds of the living and dead interfaced, and spirits of the dead returned to the earth. In an attempt to ward off ghosts people would make sacrifices, leave offerings, and light bonfires. If there was a need to leave the house people would wear masks and slip out after dark to pass as spirits themselves.

An American Halloween

Eventually the tradition of Halloween migrated to North America, however the celebration of this holiday was limited secondary to strict religious beliefs. Over time the blending of different customs and cultures between Europeans and Native Americans led to the creation of a new American version of Halloween. Initially this tradition consisted of fortune telling, harvest celebrations, and ghost stories. But after taking cues from European traditions the American Halloween experience started to involve dressing up in costumes. And with continued influx of immigrants from different countries, the tradition of Halloween continued to evolve. For example, the practice of carving pumpkins into jack-o-lanterns is attributed to Irish immigrants in the 19th century. This tradition was meant to honor souls that were trapped in purgatory.

It is best estimated that the tradition we know of as “trick-or-treating” started with what is known as All Souls’ Day which started in England. During this event the poor would beg for food and they were given pastries called “soul cakes” with the agreement to pray for relatives of the family who had died.

As time passed Halloween become a more communal and family friendly holiday where friends and neighbors would get together to celebrate. There was less focus on the gruesome aspects of the ancient tradition and more focus on party games, seasonal foods, and costumes.

How is Halloween Celebrated Internationally?

There are many different countries that celebrate traditions similar to the Halloween we know and love, with a few fun twists.

In Mexico Dia de los Muertos also known as the “Day of the Dead” is celebrated on November 1st and 2nd annually. Participants dress up as deceased family members and build altars to honor them, offering gifts, food, and drinks.

In China the “Hungry Ghost Festival” involves offerings of food to the deceased as well as parades and opera to keep the spirits entertained.

In Haiti the “Festival of the Ancestors” or Fed Gede is what is known as a “voodoo” holiday where participants light candles, and visit ancestral burial places.

In South Korea, a harvest festival called “Chuseok” is celebrated by visiting one’s hometown and participating in a feast to honor their ancestors.

In the Philippines “Pangangaluluwâ” is celebrated on November 1. Children go from door to door and sing. In return they are given sweet treats.

In Japan the tradition of “Obon” is a 3 day Buddhist festival which honors spirits of ancestors. The living take trips to their ancestor’s graves and celebrate with traditional dances.

In the United States Halloween is an event that many children and adults look forward to. Whether it means passing out candy to trick-or-treaters, decorating a haunted house, throwing a party, or putting a costume on the family dog, the idea is the same… to have a good time. However, it is also important to remember that certain precautions should be taken to be sure Halloween is safe for all involved.

There’s No Such Thing as Being Too Careful

According to the National Safety Council (NSC) children are greater than 2X as likely to be hit by a vehicle and killed on Halloween compared to any other day of the year. Data from 2017 indicated that October was ranked number 2 in deaths by car accidents, only second to the month of July. In 2017 there were over 3,500 deaths in July, and over 3,500 deaths in October.

Sometimes kids can be so excited about the prospect of trick-or-treating and getting to eat their candy that they don’t think of the potential dangers of such a celebrated activity. It is important to remind kids that they need to be especially vigilant when it comes to watching where they are walking, and pay attention to drivers and traffic. Remind kids that even though they are excited, that is not an excuse for doing dangerous things like running across the street without looking, entering houses without an adult, or eating candy before it has been inspected by adults for safety.

Halloween Safety Tips

Regardless of how you decide to spend your Halloween, remember to celebrate it safely.

If you are trick-or-treating with children, the Centers for Disease Control and Prevention (CDC) has an acronym called “S-A-F-E H-A-L-L-O-W-E-E-N” which reminds parents and chaperones of potential dangers to look out for, and to better teach our kids safe habits.

S- Costume accessories should be “short, soft, and flexible”

A- “Adult.” Do not trick or treat alone.

F- “Fasten” reflective tape to your costume to help drivers see you

E- “Examine” all treats/candy for potential hazards. Do not eat anything that has already been opened or is suspicious looking

H- “Hold” a flashlight so you can see and be seen

A- “Allergies,” make sure to test new products i.e. makeup on a small area of skin before applying fully in case there is a negative reaction to a product

L- “Look” both ways before crossing the street

L- “Lower” risk for eye irritation by avoiding non-prescription contact lessons

O- “Only” use sidewalks or the far side of the road when walking from house to house

W- “Wear” clothing and accessories that fit well to avoid tripping, falling, and decreasing field of vision

E- “Eat” only factory prepared sealed treats/foods. Do not eat homemade items made by strangers.

E- “Enter” homes i.e. haunted houses only if accompanied by an adult. Do not get into a stranger’s car

N- “Never” walk near candles especially given that many costume fabrics are flammable.

Whenever possible wear flame resistant costumes.

Have fun. Be safe. And have a Happy Halloween!

*Originally published on the Inpathy Bulletin


Permanent Art: The Significance of Tattoos

Whether you agree or disagree with the practice of tattooing, think about the last time you saw someone with visible tattoos. Did you ever find yourself asking questions like, who is the artist that designed and applied the art? Why was that particular piece chosen? What do the tattoos mean? What is this person’s story?

According to data obtained by the Pew Research Center that was published in 2010:

  • 72% of adults with tattoos say their tattoos are hidden from view
  • 70% of millennials say their tattoos are not usually visible
  • 73% of adults 30 and older say their tattoos are not usually visible
  • Men are more likely than women to have visible tattoos
  • 1 out of 10 women say the visibility of their tattoo/tattoos depends on what they are wearing

History of Tattoos

The word tattoo is believed to come from the Polynesian word “ta” which means “striking something,” and also the Tahitian word “tatau” which means “to mark something.” Prior to the discovery of electricity, tattoos were done completely by hand and depending on size were time consuming, labor intensive, not to mention painful. The history of tattoos dates back thousands of years. The oldest known tattoo is from 3000 BC and was found on a mummy called “Ötzi the Iceman” discovered in 1991.

Individualized art

The most common tattoos are decorative or symbolic. Even with the advancement of technology the general principle of tattooing is the same – the artist uses a sharp object to deposit ink into the skin. However there now exist machines with different types of needles, and many different types of ink that can be used to create an infinite amount of designs. Gone are the days of just black and grey and color options for tattoos. There is even black light ink that will only glow if the design is placed under a black light. There is also glow in the dark ink that absorbs natural light when exposed to it, and then glows when a person moves into a darker space. There is also vegan ink for people who prefer to use ink that doesn’t contain any animal products.


Although one might make the assumption that tattoos are obtained just for the purpose of showing off an artful display, developing an individual identity, or to rebel against common social norms. Sometimes tattoos serve a more functional purpose. Take microblading for example, a tattooing technique that serves to create a more natural semi-permanent aesthetic look usually done on eyebrows. However, people can also have other procedures done to apply semi-permanent makeup like eyeliner, and even lip color. The needles used for microblading are much smaller than traditional tattoo needles, and the pigment is not deposited as deeply into the skin as body tattoos and usually need to be touched up more often.

There are also tattoo artists who specialize in tattoos meant to cover up scars from injuries, illness, or surgeries. Take breast cancer survivors who have had unilateral or bilateral mastectomies with breast reconstruction. It is possible for women to have very realistic, and anatomically accurate nipples tattooed onto the breast reconstruction to help women heal from their experience, and embrace their post-surgery bodies.

Symbols of Commitment

The art of tattooing wedding rings has also become more common. And these wedding ring tattoos are as unique as custom made wedding rings. For people who are non-traditional, or non-materialistic, and/or don’t see the value in spending hundreds or even thousands of dollars on engagement and wedding rings, tattoos are a much lower cost option. Even celebrities like Beyoncé who is married to Jay Z, Behati Prinsloo who is married to Adam Levine, and Dax Shepard who is married to Kristen Bell each have a unique tattoo on their ring finger.

There are also many different jobs where wearing a wedding ring isn’t always possible or practical. A couple examples are fields like construction and healthcare. Sometimes it isn’t wise to wear expensive jewelry, like when travelling which might result in misplacement, theft, or loss. Couples who gravitate toward a wedding band tattoo tend to like the idea that the tattoo is a much deeper symbol than a piece of jewelry. For one the ring is permanent. It can’t be taken off, lost, or misplaced. The tattoo becomes a part of you, and is a constant reminder of the love and devotion two people share with one another.

*Originally published on the Inpathy Bulletin


What Every Parent Should Know About School Accommodations

A common occurrence in my office is parents who come in with the concern that their child is struggling in school, but they often don’t know where to turn. Knowing what resources are available to your child is the first step in your ability to advocate for them. There are two main federal laws that describe the services that children are eligible for and the services provided for particular disabilities.

Section 504 of the Rehabilitation Act of 1973

This is a federal law that disallows discrimination against individuals with disabilities. This law helps ensure that there are no barriers to a child learning a classroom and allows equal access to learning opportunities. In order to be eligible for a 504 a child must have any one of a number of disabilities that affects a major life activity ie. Learning. The definition of what constitutes a disability is much broader for a 504 than it is for an Individualized Education Plan (IEP) which will be discussed later in this article. Section 504 of the Rehabilitation Act of 1973 applies to all federally funded programs which includes all public schools.

A 504 plan is less structured than an IEP, but will include a list of accommodations that schools can implement to help a student obtain equal access to the educational curriculum. Unlike an IEP, parents are unable to request an evaluation of the child that is paid for by the school district, however if parents would like to have an evaluation done they are able to pay for it themselves and provide it to the school.

A 504 plan is created by a team that usually involves the child’s parents, general curriculum teachers, special education teachers, and the school principal. A 504 is usually a written document, but it does not have to be, as opposed to an IEP that must be a written document. The 504 should include child specific accommodations or services to better support the child. It should also designate who will be providing each particular service and identify the person responsible for making sure the plan is implemented appropriately. The frequency which 504 plans are reviewed depends on the state the child lives in. They are usually reviewed once a year with a reevaluation every 3 years.

Individuals with Disabilities Education Act (IDEA)

This is a federal special education law that applies to children with disabilities. This law is a Civil Rights Law and governs who is eligible for special education services, what disabilities qualify for special education services, who participates in the creation and oversight of an Individualized Education Plan. This law applies to all state and local public school districts.

An IEP is a formalized special education plan that is tailored to a specific child’s needs based on their disability. Because of the legality and formality of this process there is a great deal that needs to be done in writing. For example a parent must request evaluation for an IEP in writing, and the school district must respond. If a child does qualify for an IEP any changes to the plan, any meetings to discuss the IEP, and any evaluations that need to be completed must be done in writing. Parents must consent to both a school evaluation as well as implementation of an IEP.

In order to be eligible for an IEP a child must have a disability that is covered under the IDEA law, and the disability must impact learning ability or educational performance which warrants need for special education. Children will need to be evaluated to determine if they qualify for special education services. Parents can ask the school district for an evaluation which the school is responsible for paying for, or parents can pay for an outside evaluation themselves. Depending on the school district, they may prefer to have the evaluation completed by someone in the school district as opposed to a private evaluator outside of the school district. Once a child is deemed eligible, an IEP is created by a team. The members of that team include the child’s parent, at least one of the child’s general education teachers, at least one special education teacher, a school psychologist or equivalent, and a district representative who is responsible for oversight of special education services. Other can be involved as well if they are invited.

An IEP is a very specific document and there are many components that make up an entire IEP. In a nutshell an IEP identifies specific learning goals for a child, and specifically states what the school will do to help the child reach those stated goals. The IEP documents a student’s current school performance, and the school is responsible for tracking that progress over the course of a year. IEP meetings take place at a minimum of every year. Every three years the child will be reevaluated to determine whether special education services are still needed. If a child is not deemed to meet criteria for an IEP, they may still be eligible for a 504 plan.

There are many different accommodations that can be made as part of a 504 or an IEP. A few examples are:

  • Providing a set of class materials for home, and another identical set that stays at school
  • Providing audio books instead of written material
  • Allowing use of a computer to complete written work
  • Changing seating arrangements so a child can sit closer to the front of the room
  • Posting a visual schedule at the front of the classroom or on the student’s desk
  • Extra bathroom breaks and movement breaks
  • Giving additional time to complete an activity
  • Intermittent timing reminders to help students stay on task
  • Giving directions orals as opposed to written
  • Use color coded materials for each subject or class

Remember that every child is unique, and that the process of obtaining a 504 or an IEP can take time so don’t give up. There are many great resources that are available to parents. The more you know, the better you can advocate for your child.

*Originally published on the Inpathy Bulletin


Understanding Bullying in School Age Children

What is bullying?

The Centers for Disease Control and Prevention (CDC) defines bullying as “unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance.”

In a 2011 Pew Research study:

  • 12% of all teens report being bullied in person in the last 12 months
  • 9% of all teens say they were bullied by text message in the last 12 months
  • 8% say they have experienced some type of online bullying – such as through email, a social network site or instant messaging
  • 7% of teens say they’ve been bullied by voice calls over the phone

And as a result:

  • 25% of social media-using teens had an experience on a social network site that resulted in a face-to-face argument or confrontation with someone
  • 22% had an experience that ended their friendship with someone
  • 13% had an experience that caused a problem with their parents
  • 13% felt nervous about going to school the next day because of an experience on a social network site
  • 8% got into a physical fight with someone else because of something that happened on a social network site
  • 6% got in trouble at school because of an experience on a social network site

What does bullying look like?

A common misconception is that a child can only be bullied if they are harmed physically. Bullying does not have to be only physical. There are many different acts that constitute bullying. A few examples are:

  • Threatening to harm someone
  • Spreading disparaging rumors either in person or online
  • Physically attacking someone ie. Hitting, kicking, tripping, pushing, etc.
  • Verbally attacking someone ie. Name-calling, using racial, gender, or sexual orientation slurs, etc.
  • Taunting someone
  • Taking someone’s belongings and not giving them back
  • Forcing someone into a room or space and barricading the door

Lasting Effects

Bullying can have serious long-term consequences for youths including depression, anxiety, anger or violent outbursts, substance abuse, low academic performance, truancy, and even an increased risk for suicide. Although there is data that shows bullying and suicide are related, we are unable to say whether bullying is the direct cause of suicide. It is more accurate to say that bullying is one risk factor that increases the chances of suicidal behaviors in youths. Of note, the majority of children and youths who are bullied do not exhibit suicide related behaviors.

Bullying in Specific Populations

Of concern is bullying in populations of youths who are already vulnerable. These include youths with physical disabilities, intellectual disabilities, LGBTQ youth, and ethnic minorities.

According to the National School Climate Survey done in 2013:

  • 1% of LGBT students were verbally bullied (e.g., called names, threatened) in the past year because of their sexual orientation and 55.2% because of their gender expression
  • 2% of LGBT students were physically bullied (e.g., pushed, shoved) in the past year because of their sexual orientation and 22.7% because of their gender expression
  • 49% of LGBT students experienced cyberbullying in the past year
  • 5% of LGBT students feel unsafe at school because of their sexual orientation, and 37.8% because of their gender expression
  • 3% of LGBT students missed at least one entire day at school in the past month because they felt unsafe or uncomfortable, and 10.6% missed four or more days in the past month

What can be done by schools?

Schools can help by engaging with their students to help them feel more connected and involved. Simple interventions like learning the student’s names, and asking them how they are doing shows that the school cares about the child’s wellbeing.

Encourage students to get involved in clubs, sports, or other group activities at school. Try to create a designated “safe space” where students can come work on homework, art projects, etc. in the presence of caring adults, and other children.

Sometimes lunch and recess can be the most isolating times of day, and kids who are bullied may be ridiculed for sitting alone, or may try to hide somewhere they are not noticed. Having a safe place for them to go gives them the ability to interact with others, and decreases social isolation.

Teaching coping skills, and problem solving skills at a young age provides students with the tools to build resilience, and aids them in seeking healthy outlets and resources when they are in distress.

Having a clear and firm anti-bullying policy can also be helpful. Schools should have protocols in place with regard to reporting, investigating, and stopping bullying.

It is also important to provide support to children who are bullying others. This behavior may stem from stress or abuse in their home, existing issues at school, or may indicate that they could benefit from mental health service. Including families in the process is also important, especially if the bullying behavior is a product of stresses in the home. Punitive actions alone by schools are unlikely to be helpful because it doesn’t address the origin of the bullying behavior.


Family Online Safety Institute

Helps parents with the challenge of monitoring online content, keeping their children safe when they are online, and tips on how to speak to children about their online presence and social media

Provides information about education, prevention, and management of bullying and cyberbullying. There is also a list of anti-bullying legislation that is categorized by state.

The Tyler Clementi Foundation

This website provides excellent resources for bullying in all age groups from elementary school through college. It also provides resources for workplace bullying and other useful categories.

*Originally published on the Inpathy Bulletin


Organic Art: Living Walls

The concept of a vertical garden which is commonly referred to as a living wall was initially introduced by French Botanist Patrick Blanc. In the last few years the concept of vertical gardening and living walls has inspired people to essentially paint with plants. The beauty of this art form is that almost anything can be used as a canvas. Some of the most stunning vertical gardens are displayed in hotels, art galleries, museums, airports, corporate offices, and adorn the outside of high rise buildings.

Types of Living Walls

There are 3 main categories of living walls: wall-climbing, hanging-down, and module.

Wall-climbing plants don’t usually require much by way of support since they are either planted directly into the ground, or in pots or planters. These plants grow upwards without much assistance. However, if a certain pattern or shape of growth is desired, a trellis can be used, and vines can be “trained” by being manually directed and gently fixed to the trellis or other structure.

Hanging-down plants are planted in a container that is raised off of the ground, and requires a solid support structure to manage the weight of the planter especially when it contains water. That is when the pot/planter will be the heaviest.

Module plants are usually small, and the construction of this type of design takes more planning as the water system it requires is vertical, as opposed to horizontal in the other categories. Due to the setup and more advanced design elements, this design method is usually the most expensive.

Health Benefits

Plants have restorative effects which help reduce stress, help boost the immune system, and enhance creativity. Plants also help with concentration, productivity, and have a positive effect on mood. In the same way pets can help people feel like they have a sense of purpose, creating a beautiful garden can have the same effects. There is even some evidence that having plants in hospitals promotes faster healing. In a study published by NASA in July of 1989, house plants were shown to remove toxins like benzene and trichloroethylene in a controlled environment.

Environmental Benefits

Plants are helpful when it comes to cooling the environment around them in two main ways. One is by providing shade, and another is through a process called evaporate transpiration. Plants are known to be capable of filtering pollutants from the air and help to improve air quality and reduce carbon dioxide. In areas that are subject to large amounts of precipitation, living walls can even help prevent flooding by absorbing excess water that would otherwise runoff into storm drains. Interestingly living walls can also reduce noise. Plants are capable of absorbing different frequencies of sound which decreases noise burden. Depending on the size of a living wall, it can also help with insulation. This means that less energy is required to cool a building during the summer and heat it during the winter.

Why Create a Living Wall?

Planting vertically saves space which is especially important for people who live in small spaces. Living walls are aesthetically pleasing, and with a little bit of inspiration, you can bring these gorgeous pieces of art into your home. The decorating possibilities are endless. You can also create a living wall that is more practical for your lifestyle. For example, you can create one with garden herbs you regularly use for cooking. Or you can grow your own tomatoes, lettuce, strawberries, and other produce which might save you a trip to the grocery store and help save some money. The possibilities are endless.

*Originally published on the Inpathy Bulletin


Navigating Life Transitions

There is something about a big life transition that often forces you to reflect on the life you have lived this far.

A short story

When I was 24 I just got to medical school. And at my white coat ceremony one of the attendings was speaking and she said “my hope for you all is that you have a serious illness from which you fully recover.” My immediate reaction was… why would you ever say that? Particularly because I’m not a lucky person and after the words came out of her mouth I felt a heaviness in my stomach.

So fast forward a few months after that white coat ceremony. I came home for Thanksgiving to visit my parents. Was diagnosed with metastatic thyroid cancer. Had major surgery right around my birthday was stuck in the hospital around Christmas, and needed multiple rounds of radiation thereafter. The only thing I was excited about at that time was that if I lived through this my car insurance rates would drop because I was now 25.

Thankfully I survived. And then clawed my way through medical school because I wanted to graduate with my matriculating class and despite my parents wanting me to take time off I said no and went back anyway. When I started medical school I was initially on a military scholarship. When they found out I was sick. They dropped me and said I could reapply in 5 years when I was healthy again. To which I said no thank you, because I didn’t want to be part of an organization I was willing to commit a lifetime of service to, only to be dropped flat on my face at such a difficult time in my life.

Then I came to residency where I was fortunate to have incredible supervisors and mentors. I learned all about therapy, how to treat complex cases of PTSD, was taught to think critically and to see things from different angles. To always question what I think I know about a case, and to always be intellectually curious. I was taught to value strong leadership, and to push myself to be better than I was the day before. I was reminded that our humanity is the difference between being a good doctor and a great one.

What’s the point?

The point is that life happens to us whether we are ready for it or not. Sometimes we just have to ride the waves. There are times in our lives where things are going to go swimmingly, and there are other times in our lives where it seems like everything is going wrong. It’s easy to take a look at social media where we tend to portray the best versions of ourselves, look at someone we know who appears to have the perfect life and beat ourselves up because we don’t look like that. But the reality is that even people who appear to be perfect take their turn when it comes to personal difficulties. The ebb and flow of life is part of the human experience and is something that we all have in common.

A few words of wisdom

When it comes to navigating major life transitions the first step in any situation, particularly a stressful one is to take a few moments to breathe. Taking a few seconds to calm the mind and slow the heart puts us in a better position in which to think more clearly. It is very difficult to think logically and rationally when our senses are on overdrive.

Sometimes taking a few deep breaths isn’t enough time for us to really think through a difficult situation. If it’s not a life or death emergency, sleep on it. Give yourself the time you need to make the best decision you can.

If you’re still stuck talk to people you trust. Take their advice into account, and consider the angles they are coming from. However, it’s important to not let your actions be dictated by other people’s opinions. At the end of the day your life is yours, and you get to decide how you want to live it.

One of the best ways to prevent yourself from learning the hard way when it comes to major life transitions is to find someone who is a good mentor. Someone who you feel lives life well, in a manner that is in line with your goals and values. Being open to learning from others can potentially save you quite a lot of heartache and headaches in your life.

And remember, life at times is difficult. There are days when it feels like we can’t win but it is important to remember that we are not alone in our difficulties. We all take turns when it comes to enduring struggles. You just have to ride the wave.

*Originally published on the Inpathy Bulletin


Overcoming the Millennial Stereotype

Pew Research Center defines Millennials as being born between the years of 1981 and 1996. For any of us that fall into this category, we are astutely aware of the negative connotations associated with this label. A simple Google search of “Millennials are” returns: lazy, entitled, and broke within the top 10 results. When it comes to proving ourselves in the work place we may be at a significant disadvantage because of the reputation the Millennial generation currently holds. How can we overcome this when the odds of making a positive impression seem to be stacked against us?

Don’t just say you’re different. Be different.

Actions speak much louder than words. Demonstrate your skills, don’t just talk about them. Show that you mean business by coming in early, appropriately dressed, and ready to work. Slinking into the office late with a wrinkled half tucked in shirt gives people around you a reason to doubt your abilities. Even if you are the youngest person in the office, lead by example. Take advantage of the likelihood that those around you underestimate you, and use the opportunity to over deliver. Remember, first impressions are important, and once perceptions of you are formed they are very difficult to change.

Communicate. Communicate. Communicate.

One thing that Millennials as a whole tend to value is efficiency. However, efficiency can be seen by others as laziness. For example, sending an e-mail instead of walking to a colleague’s office to chat can be viewed as lazy even if you see it as timesaving. It’s important to make the effort to speak with people face to face. It gives them an opportunity to get to know you better and is also a collaborative gesture that most will appreciate.

Be Humble

Growing up in a world where knowledge is at our fingertips, and the term “instant gratification” is just that – instant, it’s easy to behave like you are the smartest person in the room. And sometimes you will be. But even if that’s the case it’s important to keep in mind that information is not a substitute for experience. There are other people around you with a vast array of experience that also have valid thoughts and ideas. It’s important to be coachable and teachable so you can learn from those who came before you.

Check Your Attitude

Because Millennials grew up with things like lightning fast internet, overnight shipping, apps that allow you to hail a car with a few taps, and same day grocery delivery we have a tendency to get frustrated when things take longer than we’re used to. When you’re waiting on someone to finish their part of a project when you’ve completed yours it is very easy to come across as irritated and communicate that with body language, tone of voice, or word choice. Being huffy with people you work with does not help your cause, it gives the impression that you’re not a team player, have low frustration tolerance, are unprofessional and immature. Having a collaborative mindset and a degree of pleasantness goes much further than frustration and rudeness.

Be Open

One of the worst ways to perpetuate the Millennial stereotype is to appear closed off or closed minded. There are many ways we may be communicating this unintentionally. A few examples are playing on cell phones during a meeting, slouching in your chair when someone is talking to you, crossing your arms when having a discussion, and even leaving your office door closed. There are many times in a day when it is necessary to close your door, but having it shut all day communicates to others that you are not approachable. If it’s difficult for you to focus on work with the door wide open, consider leaving it ajar a few inches with a sign on the door that says “come in.” This changes the dynamic from people being afraid they’re bothering you, to a more welcoming environment.

Try to Avoid the Label in the First Place

When thinking about intra-office dynamics, it’s important to think about running a good offense as opposed to a well-crafted defense. It’s hard for people to negatively label your work ethic, intelligence, dedication, and loyalty if you hit the ground running. Focus on putting out the best product you can and believe in the work you’re doing. It’s impossible to go wrong with strong work ethic combined with professionalism.

A few things that have helped me break the Millennial stereotype in my career is being observant, anticipating the needs of others, and the desire to be genuinely helpful to them. I think of my office similar to the way I think of a bee hive. We are all on the same team, and have the same goals. Working against each other is counterproductive and detracts from the ultimate end point. One of the ways to set yourself apart is to do things that help the collective, even if it’s not in your job description. Sometimes Millennials can seem “too good” for certain tasks like making photocopies, filing, putting paper in the printer if it’s empty, restocking office items in cabinets, or replacing the jug on the water cooler in the break room. Sometimes a small gesture goes a long way, and people are likely to follow your lead. The “well… it’s not my job” attitude gets you nowhere and encourages the perpetuation of that sentiment around you.


One of the talents Millennials have due to the generation we grew up in is an inherent understanding of technology. Particularly when it comes to computers, social media, and quick information/data gathering. If you see someone struggling, offer to help them. Efficiency in the work place benefits everyone. Assisting others also sets the stage for cooperation and collaboration. The effort you put into being helpful sets you up for success, because when the time comes and you need help, wouldn’t you want someone to do the same for you?

*Originally published on the Inpathy Bulletin


Talking to Family About Advance Care Planning

In 2005 the Pew Research Center published a survey on end of life planning. Of the people surveyed 35% said they gave end of life planning a great deal of thought, and 36% said they gave it some thought, but only 27% put their wishes in writing.

According to a 1996 paper published by Miles, S.H., Koepp, R., and Weber, E. “research does show that advance planning catalyzes important, memorable, and therapeutic discussions between patients, providers, and family members about emotionally and conceptually difficult issues.”

What is advance care planning?

Advance care planning is the process of making decisions regarding the type of medical care you would like to receive in the event you become incapacitated and are unable to speak for yourself. The decision is based on your personal values and preferences for end of life care. Advance care planning gives you the opportunity to educate yourself about different life-sustaining treatments, deciding which treatments you would want or not want, and sharing those decisions with the people who matter the most to you. After your decision has been made, it can be put into an advanced directive which is a legal document that communicates your wishes in the event you are incapacitated. This document is used only in the event that you are unable to speak for yourself.

Summary of legal terms you may encounter in the planning process

Advance directive– is made up of 2 different types of documents, and allows you to communicate your wishes regarding future care

  • Durable power of attorney for health- this document may also be called a medical power of attorney, or health care proxy. This document allows you to name the person you want to make medical decisions on your behalf in the event you can not make decisions yourself
  • Living will- this is where you communicate what kind of care you want or don’t want in the event you become incapacitated

General power of attorney- lets you name the person you want to act on your behalf; this power will end if you become incapacitated

Wills/trusts- allows you to name the person you want your money and assets to go to after you die

Are advance directives permanent?

No. Advanced directives can be changed as often as you would like, and are commonly adjusted as situations change. A few circumstances where changes are commonly made are with increasing age, better knowledge/understanding of medical care options and outcomes, or worsening of a medical condition. Some decisions that often come up in the hospital setting are whether someone wants to undergo cardiopulmonary resuscitation (CPR) in the event their heart stops, intubation or ventilator use in the event they can not breathe on their own, or tube feeding in the event that a person can no longer feed themselves.

How do I start?

There are often many uncomfortable conversations that occur among families, but talking about end of life care is usually at the top of the list. These conversations are tremendously difficult for families to have due to the context of the material discussed. Although this topic is one that is difficult to venture into, it is very important to talk about before something tragic occurs.

The best conversations about difficult topics occur when families are calm, collected, and not in distress. Thus, the midst of a tragedy is not the optimal time have “the talk.” Instead start before a crisis occurs so that in the event something happens everyone is prepared because they asked the right questions, talked about wishes, desires, and are aware of how their loved one would like to spend their final days.

Who do I tell?

It is best to communicate your wishes to your loved ones, and your doctors. That way everyone is on the same page with regard to your health care decisions. Having this conversation early prevents your family members from making decisions on your behalf without knowing what you would want. If you’re finding it difficult to have this conversation with your family there are medical providers that specialize in end of life care. These practitioners are known as hospice or palliative care doctors and nurses and can help provide additional information about what to expect, which can also help you make better decisions for yourself.

Common end of life myths

  • I have to be sick before I can create an advance care plan
  • Advance care plans are only for older adults
  • Advance directives can’t be changed
  • An advance directive means I won’t get medical treatment
  • If I name a healthcare proxy, I won’t be able to make decisions about my medical care while I’m healthy


The Conversation Project is an organization that was created in 2010 and is “dedicated to helping people talk about their wishes for end-of-life care.” To make the process easier they have developed a Conversation Starter Kit that is designed to help adults articulate their wishes before a crisis happens. There is also a Pediatric Starter Kit that helps parents with talking to their gravely ill child. There is also an Alzheimer’s/Dementia starter kit for families of loved ones that are afflicted with the illness. All of the starter kits are free to use.

Other resources include:

Alzheimer’s Association www.alz.org
Caregiver Action Network www.caregiveraction.org
Hospice Foundation of America www.hospicefoundation.org
National Alliance for Caregiving www.caregiving.org
National Institute on Aging www.nia.nih.gov
Well Spouse Association www.wellspouse.org

*Originally published on the Inpathy Bulletin


The Significance of Honesty

National Honesty Day observed nationally on April 30th was created by author M. Hirsch Goldberg who wrote The Book of Lies. In an article he wrote for the Baltimore Sun in 1993, he stated that the purpose of National Honesty Day was to counteract April Fool’s Day observed on April 1st which celebrates the tradition of telling lies. He wrote “I was astonished with how much our history has been affected by lying and how deception is becoming an increasing part of our society.” He notes that National Honesty Day provides an opportunity to “renew and refresh our sense of values and ethics.”

Pamela Meyer is a Certified Fraud Examiner, author of Liespotting: Proven Techniques to Detect Deception, and CEO of Calibrate, a company that specializes in “customized, leading edge deception detection training to public and private sector entities worldwide.” In July of 2011 she presented at TEDGlobal and stated that on average we are lied to anywhere between 10 and 200 times a day. She goes on to say that we lie more to strangers than coworkers, extroverts lie more than introverts, men lie 8 times more about themselves than they do about other people, women lie more to protect others, married couples lie to each other 1 in every 10 interactions, and unmarried couples lie to each other 1 in every 3 interactions.

So, in a world where everyone seems to lie, where is the value in telling the truth?

Being honest encourages others to do the same. When you change, the people around you change as well because we all have some influence over our environment and our response to it. Think about it. How much better would our daily interactions be if we all just told the truth and used it to further communication, collaboration, and productivity instead of hiding behind partial truths or flat out lies?

Honesty is important because it tells you something about what you stand for. At the end of the day it is most important to be honest with yourself. After all, if you can’t be honest with the real you, how can you be honest with others?

This is particularly relevant in relationships. Feigned interest in activities you can’t stand to gain favor with someone you’re attracted to means your relationship is resting on a foundation of deception. And then what? Keeping up that lie takes effort. In a world demanding of your time, focus, and energy do you really want to devote what limited physical and emotional reserve you have to supporting a lie? It’s also not fair to the person who is interested in getting to know the real you. And the reality is, you can’t keep up pretenses forever. People deserve real love which starts with genuine connection. If you can’t start a relationship with trust, then why start one at all?

It’s also important to remember that lying is self-perpetuating. The more we do it and get away with it, the easier it is to continue the process. And just like anything we practice, the more we do it, the better we get at it. At what point does it stop? When we lose our job? When we lose our relationship? When we irreparably damage a friendship?

If lying comes naturally to you, it’s important to think about why it’s difficult for you to be truthful. Is there a particular short-coming or emotion that makes it hard to tell the truth? These questions are important to answer so you can discover your own truth, which gives you the opportunity to change the course of your life and become a better you.

*Originally published on the Inpathy Bulletin


How to Talk to Your Partner about Your Mental Health Diagnosis

One of the most difficult parts of living with a mental health diagnosis is deciding when and with whom to share your journey. There can be fear of how they may react, it may be difficult to explain, and it could be hard to find what feels like a good time to talk about it.

One thing to keep in mind is there is no “right” time to tell someone you care about that you live with a mental health diagnosis. It will likely happen when the time feels right, and when there is a level of trust between you that allows for an open conversation.

When you do decide to talk to your partner about your diagnosis, make sure you take the time the discussion deserves. This is not a conversation that should take place with the TV on or while texting. It also should not happen during an argument or in a crisis. Having a calm and rational conversation sets you and your partner up for success. It is also not necessary to have just one conversation. Sometimes these discussions evolve over time, and there shouldn’t be any pressure to complete it in just one sitting.

The conversation you have should be honest so your partner knows what to expect and how to help support you in times of need. Be specific when discussing the symptoms you experience as vague language can often lead to confusion and miscommunication. If you are feeling stuck, practice disclosure with your mental health provider. It can be helpful to anticipate questions that your partner may ask. NAMI (National Alliance on Mental Illness) is an excellent resource. On their website you can find informational pamphlets, and suggestions on how to disclose your mental illness to others. If you to tell your partner and they are struggling, it can be helpful for the two of you to see your mental health provider together so they can ask questions in a safe space.

Unfortunately there is often stigma and misunderstand surrounding mental illness, so it is important to be prepared if the conversation doesn’t go well. Try to keep an open mind about how your partner may react. The right person will be understanding and supportive of you, and if they are not that tells you a lot about their character. It is not fair of your partner to throw your illness in your face, or use it against you in arguments. You deserve to feel comfortable in your own skin. Your illness is part of who you are. It doesn’t define you, but it is a piece of you, and you shouldn’t be punished in your relationship because of it.

*Originally published on the Inpathy Bulletin


Healthy Ways to Destress After Work

Regardless of how much we love our jobs, work can be stressful. Some days we keep an eye on the clock waiting in anticipation for the day to be over, and are often consumed by the thought of how we can relax after a difficult day. The trouble is, life doesn’t stop after we get home. Kids have homework, the dog needs to be fed, the house needs cleaning, laundry has to be done, and the list goes on. It is important to remember that although our lives are busy, we need to make time for ourselves. We need to find the time to rest and recover, even if it’s only for a few minutes a day.


Exercise is one of the best ways to de-stress after a long work day. This is the perfect opportunity to work out our frustrations on the treadmill or with weights so we’re not carrying that animosity with us. This also prevents us from taking our anger out on the people closest to us. Exercise helps with mood, focus, and concentration which are all important aspects of our daily lives. The day goes a lot smoother when we are at our best. If time is limited, then there are multiple fitness apps that you can bring with you anywhere. Some apps keep working professionals in mind and sessions are as short as 8 minutes and don’t require any exercise equipment.

Take 5

Sometimes a 5 minute power nap is all it takes to recharge. If the house is usually in a state of chaos and a nap isn’t possible, spend 5 minutes in your car before coming inside. Use that time to breathe, collect your thoughts, and switch from work mode to home mode. You can also take a minute to walk out to get the mail which gives you some additional time to yourself.

Treat yourself

Sometimes what we need after a long day is “me time.” But as busy professionals, time is often in limited supply. If you’re pressed for time you can stop at your favorite coffee shop and pick up your favorite drink, get an express mani/pedi, take a stroll and window shop, get a quick chair massage.


Sometimes it’s not possible to take a break between work and coming home. If that’s the case, then you can bring the spa to you. Essential oil diffusers are relatively inexpensive, as are the oils. A few drops into a diffuser and you can get the luxurious scent of a high end spa right in your living room. Scented candles are also a nice touch. Sometimes just dimming the lights and taking a few minutes to sit down on the couch can make a big difference.


Nothing says work mode more than work clothes. When you get home, switch off work mode with the action of changing into more comfortable clothes. Sweats and house slippers, are a good start. When we are comfortable we are more relaxed which is much deserved after a long day.

*Originally published on the Inpathy Bulletin


Making Peace with Jealousy

Jealousy is a natural human emotion and is often incited at the most inconvenient of times. It is frequently unavoidable given that it usually springs up without warning. Nobody pencils into their calendar, “I plan to be jealous of X today,” but the reality is that this emotion can hold tremendous power over us if we let it. Jealousy frequently stems from some sense of lack in our lives. It very often comes from a desire to either have something that doesn’t belong to us, or be something/someone we are not.

A few examples of events that may spark this emotion are the birth of a baby if one was lost, celebrating the engagement of a friend after a break up, or working tirelessly for a promotion but finding it went to someone else. What all of these examples have in common is that they result in significant pain. I think it’s fair to say that most of the time the people around us don’t do things to purposely make us jealous. It’s more often that we see something going on around us, identify a void in ourselves, and inflict this emotional pain inward.

This process of internal degradation is emotionally exhausting and physically draining. We invest so much focus and energy into the void that someone else’s happiness leaves us that our own emotional bank account starts to run dry. This can start to affect things like job performance, interpersonal relationships, and most importantly damage the relationship we have with ourselves. We may start second guessing our skills, worth, and value. If we allow ourselves to get caught up in this spiral, it becomes very difficult to claw your way out of it. And the question is, once you’re in the vortex, how do you make it stop?

One of the first steps to making peace with jealousy is recognizing that it’s there in the first place. It is often uncomfortable to confront the idea of being jealous of another person, particularly when it is someone we care about or are close to ie. our partner, friend, sibling, parent, child, co-worker, etc. Acknowledging the emotion and then thinking about where it is coming from puts us on the path to healing. Denial of its existence just prolongs the process. The real work comes after you’ve accepted that jealousy is the emotion you feel. Walking through the emotion, acknowledging its presence, and paying attention to the harm it is causing you is important. The trick is not to get stuck there. It is easy to revel in the feeling, and perpetuate its poison with gossip and trash-talk either internally or externally, and recruiting others to participate in this with you. By allowing yourself to wallow in it, you have essentially handed over your internal locus of control, and are losing yourself in the process.

Quelling jealousy means finding the light at the end of the tunnel. This starts with taking the acknowledgement of your jealousy and finding out what it means. What is it about this particular situation that makes you feel this way? Is it a sense of inadequacy? Is it that you don’t feel like you are getting the recognition you deserve? Are you longing for love in your life? Finding out where this emotion is really coming from helps us discover our own personal void, and also provides the road map to how to fill it. It gives us the answer to our pain. Maybe it’s a job change, or taking a chance with online dating, or starting your own business.

But sometimes, despite our best efforts, we find that the root cause of our jealousy is something that can not be fixed easily or at all. Sometimes the answer is that of acceptance, and the realization that your path is uniquely yours. Nobody else can walk your path for you, and you are unable to walk someone else’s.

Sometimes when things don’t work out the way we hoped, we don’t realize the value of the experience until much later down the road. Sometimes life’s greatest missteps provide us with our greatest joys later in life. Instead of focusing on the things that are missing in our lives, perhaps the answer is to find the beauty in the life we do have and express gratitude for the meaning we find in our own happiness, as opposed to focusing on the perceived happiness of others. When you create your own happiness, you find that it isn’t something that anyone can take from you. It’s not conditional, or contingent on others.  Your happiness is a gift. And the beauty of it is, it’s one that you can share whenever and with whomever you choose.

*Originally published on the Inpathy Bulletin


Making Long Distance Relationships Work

Throughout my life I’ve heard that long distance relationships never work: it’s too hard, it’s too far, you never see your partner, you can’t meaningfully connect, you don’t get to spend any time together, and the list goes on. Although most people can agree that dating someone local is easier than dating someone long distance, that does not mean long distance relationships are impossible. Due to my career path, I’ve often had to move. And although moving for additional education or a job is easy, transplanting relationships is much harder. So in a way, I had to practice getting good at long distance. Here are a few things that helped me along the way.

Discuss your expectations and needs prior to starting a long distance relationship

One of the most important first steps when deciding whether or not to start a long distance relationship is to figure out the end game. Figuring out your expectations, the expectations of your partner, and goals for the relationship is essential. Will there be a time limit to your living apart? Who is going to be the one to move closer to the other? If one of you has to move (which often requires quitting an old job and finding another one), how will the finances be split if one of you isn’t working? While you are apart will you both agree to be monogamous or will the relationship be open? How do both of you feel about the prospect of marriage? Do you eventually want children? It’s easy to avoid the difficult conversations particularly when a relationship is new, but being in a long distance relationship (especially if the agreement is to stay monogamous) does require a specific end game and desires should be communicated honestly.

Communicate regularly, but don’t overdo it

Sometimes with long distance relationships the desire to feel connected to each other can make people feel obligated to talk to each other as often as they can, and sometimes overdo it. At times there can be intense pressure to talk to each other every free minute of every day. This puts unnecessary stress on both partners which can strain the relationship. There are errands, work, family, friends, and other obligations to take care of, and sometimes communication can feel like a burden. If that starts to happen, take a break from talking. Maybe send a text, or e-mail, or negotiate that you don’t necessarily have to physically talk on the phone every day.

Make the most of your visits

In long distance relationships the greatest challenge is finding time to spend together. Although it’s important to have discussions about how you both are doing, feeling, how the relationship is going, etc. try to avoid getting into heated debates or discussions about the big things all at once. It is important to talk about goals, and do a relationship check to see how things can be adjusted or improved, but it’s also important to not hold grudges. Sometimes there can be a tendency to harbor grievances that happened during old discussions, and want to air them all out at once the next time you see your partner, but this can sour a visit fairly quickly.

Resurrect snail mail

A fun way to stay in touch with your partner is via snail mail. It’s romantic to get a handwritten letter or post card in the mailbox, especially after a long day. There are things that are difficult to say in a text, e-mail, or phone call. Sometimes the most sincere and meaningful things said to one another are through prose.

Make use of video chat

Depending on how far apart you are from your partner, getting face to face time together is difficult. Thanks to technology, spending time together even when you’re far apart becomes a little bit easier. With video chat you can schedule dates, watch a movie together, play a game, talk about your day, and have the ability to see each other in real time. If your time zones are so different that real time conversations are not possible, think about recording short videos and sending them to your partner to keep them updated about your day.

Don’t punish your partner

Sometimes things get lost in communication when conversations take place via text or during a phone call. When we communicate in this way, we don’t get the benefits of seeing body language, facial expressions, and other cues that let us know how our partner is feeling. These miscommunications can be frustrating, and depending on how often they happen can lead to behaviors that are not helpful to a relationship. A few examples are the silent treatment, purposely waiting to text back knowing that this will make your partner uncomfortable, ignoring phone calls, etc. If you’re not in the mood to talk to your partner at that time, it may be a good idea to communicate that to them so they aren’t worrying about why you’re not answering your phone. Remember, distance means that people have longer to reflect on things, and they may worry about whether or not you’re safe, if something bad happened to you, and that’s not a fair position to put them in. Frankly it’s cruel.


Trust is a corner stone to any relationship. Finding a way to trust another person when they’re far away is critical. Are you going to be ok with your partner going out with friends on a Friday night, or are you going to sit and worry about what they may be doing until they get in touch with you again? Will you be supportive of their desire to let off some steam and relax for a weekend, but be upset if they go somewhere without cell phone service? Will you be happy for them if they are invited to a weekend getaway with new work friends, or will that invoke feelings of jealousy that you can’t be there? This is another reason to negotiate expectations, so that you both can agree on what types of behavior and levels of communication are acceptable or unacceptable in the relationship.

Don’t force it

Like all relationships there will be tough times, and there will be blissful times. Sometimes the fastest way to ruin a relationship is to try and force your relationship into being something it’s not. Sometimes you want it to look like the relationships you see around you. That can cause you to plan every detail, control each situation, and execute every part of your relationship to try and achieve relationship perfection all the while neglecting the beauty of spontaneity, discovery, and surprise. All relationships are different. What may be acceptable for one person may be worrisome for another, so comparing your relationship to that of your friends is often unhelpful. It’s not a competition. Learn to accept that sometimes things will not go smoothly, despite adequate thought and planning. Relationships at times are difficult, but hanging in together during the hard times can make your relationship much stronger in the long run.

*Originally published on the Inpathy Bulletin


Quality Over Quantity: Discerning Who Your Real Friends Are

Just because you know a lot of people, that doesn’t mean they’re your friends. When we get older there’s a part of us that wants to believe we’ve left the school yard social dynamics and high school drama behind us. Why? Because we’re supposed to be “grown-ups” now, and as such we don’t indulge in this Mean Girls mindset anymore. Right?

But the reality is, not everyone around us operates this way. And yes… it is quite disappointing when you realize that despite reaching a time in our lives when we should all be grown up enough to tell the people around us the truth about how we feel, sometimes we are forced to read between the lines when it comes to their interactions with us.

When we’ve known people for a while we may be inclined to automatically assign them the title of “friend,” and we sometimes make the incorrect conjecture that they mean well. It’s important to remember that real friendship is earned, and is based on the principle of genuine care and consideration for another person. No strings attached. If you are the only one contributing to your so-called “friendship” then it isn’t really a friendship at all.

Why is the distinction between friend and pseudo-friend so important to make? Why does it matter?

In the world we live in time is extraordinarily valuable. We often find ourselves rushing from point A to point B, trying to cram everything we need to do in the minutes of spare time we have, and make sacrifices to make everything work, which means that we have to prioritize the important things in our lives. What this means is that we don’t have the luxury of spending time with people who don’t genuinely value us because we could be spending those precious moments investing our time in more meaningful areas of our lives.

So, how do you know if your “friend” isn’t really a friend at all?

They contact you only when they want or need something

If you find that the only time your “friend” is calling you is when they’ve had a rough day, got into it with their significant other, or want to just gripe about something, that should raise a red flag. If you spend an entire conversation only talking about them, and they don’t even ask how your day was or how you’re doing it might be a good idea to reevaluate that friendship.

They talk negatively about everyone around them

Pay particular attention to people who have a tendency to speak negatively about everyone else around them. Because chances are if they don’t have anything nice to say about anyone, what are the chances that they’re saying nice things about you when you’re not around?

They share your secrets with other people without your permission

One of the most important qualities in a friend is trust. If your “friend” is causally sharing things you told them in confidence, or spreading your business with everyone who enjoys good gossip you should probably consider scratching that person off your friend list.

 They throw you under the bus to make themselves look good

Real friends stand up for each other, and do the right thing when nobody is watching. If your so-called friend is willing to trample over you to get ahead, then they’re not your friend at all.

They don’t ever seem to be happy for you

Real friends are happy for you when you achieve great things. If someone is trying to undermine your achievements, and are behaving in a jealous manner, that speaks volumes about their character. And you have to ask yourself, do you want to be surrounded by people like that?

They hang good deeds over your head and expect adequate compensation

Remember that one time I helped you plan your niece’s birthday party? Well, now I need you to plan my entire wedding that’s three months from now for free… so chop chop! When people take advantage of your good nature, or use their relationship with you as leverage to get things they want… run, because that continuous treadmill of wants and desires will never stop. It will feel like you’re indebted to them forever.

So what does a real friend look like?

They tell you the truth even when it hurts

Sometimes the truth is hard to hear, especially if it hurts our feelings. Our real friends will tell us the truth without being mean. They don’t attack our character or try to poke holes in our self-esteem, they present a problem and help us find a solution.

Real friends love you for who you are

Nobody is perfect, and our true friends understand this. They know we are all capable of making mistakes. Real friends will love us despite our imperfections, and through the process of being friends with us, help us to become better people.

They’re present during the tough times

True friendships are revealed when we go through the most difficult times in our lives. Real friends will be there for us no matter what and don’t expect some type of compensation because they were there for us when we needed them. They’re there because they want to be, not because they have to be.

*Originally published on the Inpathy Bulletin


Mental Wellness in the Workplace

Work stress is quite often a significant component of everyday life, and can be hard to handle when your financial well-being is directly tied to your job. While there can still be some stigma against mental health in the work place, attitudes toward such issues are changing. There may be resources either at or through your work place you may not even be aware of. Take a moment to look through your company’s website, or speak with someone in HR to find out more information on services/programs available to you. In the meantime, check out these tips on how to boost mental wellness in your work environment which you can start today.

Set reasonable goals
When there are multiple things that need to be done in a day the sheer volume of work can be overwhelming. It often helps to make a list, and prioritize the most important projects first. This gives you a sense of which things need to be done expediently, and which ones can wait until tomorrow.

Take a break
When we are at our busiest, particularly if there is a deadline involved, there can be a tendency to keep working without taking a break. People often think that if they work more, that things will get done better or faster. However, the key is to work better. Taking a break, even if for a few minutes can be very helpful. Breaks help to refuel the brain, recharge the body, and enhance focus. One of the best types of breaks is a brief walk, or stepping outside for fresh air. Exercise helps significantly with work stress, and getting outside provides an opportunity to think about things from a different point of view.

Don’t give up on self-care
When work is getting us down, and the stress starts to take over, there can be a tendency to let our self-care slide. Try not to sacrifice the things that help you recharge ie. monthly massage, quarterly haircut, dinner with friends once every other week. Keeping up on the things you find enjoyable can significantly reduce stress, and add to your quality of life.

Keep it healthy
Sometimes stress can lead to poor eating habits. We start scarfing down the donuts in the break room, or eating fast food instead of packing lunch, or even over-caffeinating ourselves because we’re having difficulty sleeping. If time is of the essence, and you’re finding it hard to make healthy meals every day. Keep a whole fruit or a protein bar in your desk or in your bag to be sure you have a healthy option available to you just in case.

If you’re struggling, don’t keep it to yourself
When times are tough there is a tendency to isolate. But the opposite is really what’s needed. Talking is a great way to get your thoughts out into the open. Whether it’s talking to a friend, family member, or confidante, the important thing is to get it out. Bottling our feelings is the path to burnout, exhaustion, and even depression. If talking to people close to you is daunting, or you feel that you would rather speak to an objective neutral party, therapy is a great place to start.

*Originally published on the Inpathy Bulletin


How to Ace Your Next Interview

Interviews can often be an intimidating process, especially if you’re out of practice. Below are a few tips to prepare for your next interview, and dust off your interviewing skills if it’s been a while.

Do your homework

It is immensely important to do your research on the position you are applying for. Look at the mission statement of the school or company you would like to be a part of. Look at their website and find out as much about the institution as you can. Knowledge is power. Knowing about the position will convey that you’re interested, and will allow you to ask specific and targeted questions about the type of work you will be doing.


If you’ve been invited for an interview, chances are you have been deemed qualified to fill the position. The next step is to find a way to connect with your interviewer. This is important because interviews are often the litmus test for “fit.” People want to know who you are, what you’re about, and whether or not you will be a good fit for the institution. They want to know if you will be able to work well with others, can handle the type of work you will be doing, and what skills/expertise you bring to the table.

Think before you speak

It’s no secret that we don’t perform to the best of our ability when we get nervous. There is a tendency to want to answer an interview question quickly to appease the interviewer, but speaking too quickly can backfire when you don’t think before you speak. If there is a question that comes up, and you don’t know the answer try saying something like, “good question, let me think about that for a second…” instead of firing off the first thing that comes to mind. Once you speak you can’t take it back, so choose your words wisely.

First impressions are often the only impression you get

Dress to impress, but don’t overdo it. When deciding what to wear, always go for the more professional option. In general stick with dark colored suits like black, gray, or navy. Keep jewelry simple and classic. Make sure your hair is neatly groomed. If you have long hair make sure it is away from your face. You do not want to be playing with your hair during an interview. A lot of times people do this subconsciously when they become nervous and you don’t want to look distracted during your interview. Keep nails neatly trimmed, make sure teeth are brushed, and try to keep makeup as natural looking as possible. You want your skills to be the focus of your interview, not your attire.

Be on time

Nothing good ever comes from being late. Tardiness communicates lack of organization, poor time management, low reliability, aloof character, and many other negative attributes that you definitely do not want to be associated with. It is better to be an hour early than one minute late. If you have time, go to the place you will be interviewing the day before so you have a sense of where you will be going the next day. If you have access to the building, try to find the exact room you will be in and familiarize yourself with the area. This will help you to be less anxious on your actual interview day.

Tell No Lies

It is highly likely that the person interviewing you has done this many times before. Which means, it’s not their first rodeo. Seasoned interviewers can often sense dishonesty as it is unfolding in front of them, so don’t even go there. It is acceptable to speak highly of your experience and your skills, it is entirely different when you embellish your achievements and stretch the truth.

Come prepared

Organization is the key to success. One of the best ways to stay organized is to bring a folio with a notepad and pen in it. These folios often have spaces for business cards. If you have business cards keep several in there in case the opportunity arises to provide someone with your card. It also makes it easier for you to store someone else’s card if they give it to you. It doesn’t hurt to keep several copies of your CV as well. If you have a tendency to forget the questions you’d like to ask during your interview. Write them down on your notebook so you can quickly reference them.

Have fun

Although interviews themselves involve a degree of seriousness and professionalism, try to have some fun along the way. Interviews often require travel, so it’s the perfect opportunity to check out a new city and meet new people.

*Originally published on the Inpathy Bulletin


Moving Forward After Loss

In my profession I am sometimes asked how one manages to move on after the loss of a loved one. 

Early in my training my go to answer was always something along the lines of “time.” However, having given that advice without actually experiencing any devastating personal tragedy, it seemed as though my advice to others somehow lacked validity and meaning because what I was proposing was mere suggestion, and not really based on any real life experience. 

So when personal tragedy hit, in the form of my beloved teenage nephew choosing to end his life, I found myself asking the question… How do I move on from this? And over the days and weeks that followed when I was wrecked with sorrow, guilt, and unanswered questions, I came to realize that the process of healing is not about moving on… it’s about moving forward. 

The difference being that moving on implies that you forget, drop everything and run toward the future without looking backward. While moving forward involves the exact opposite… remembering. 

While burying the past and trying to wipe the mind of any tragic event is likely a natural reaction to a tragic or devastating situation. Moving forward involves remembering the good things about a person, and the way that person touched your life and the lives of others around them. 

And in the act of remembering, we are able to learn how to take steps forward and adjust to life without them, all the while incorporating the small gifts they gave us when they were alive: memories, advice, photographs, new perspectives, etc. 

Moving forward is about living the lives we have left with intention and purpose, and finding a way to honor not only ourselves, but the people we have lost along the way.  


Disaster and Mental Health

If you have picked up a newspaper, searched the web, or turned on the TV recently you have likely come across news about one or more natural disasters and the severity of the devastation caused by them. Reasonable reactions to hearing of these events likely brings forth feelings of:

  • Disbelief and shock
  • Fear and anxiety about the future
  • Disorientation
  • Feeling “numb” emotionally
  • Irritability
  • Anger
  • Sadness
  • Depression
  • Feeling powerless
  • Changes in appetite
  • Difficulty making decisions
  • Somatic symptoms ie. headaches and stomach problems
  • Difficulty sleeping
  • Excessive drinking or drug use

Most of these reactions should decrease as time passes which should allow you to focus your attention on daily activities. However, because everyone experiences stress differently, don’t compare your progress with others around you or judge other people’s reactions and emotions.

Try instead to:

  • Talk about it – not expressing your feelings will keep you from being able to work through what happened. By talking with others, you will have the opportunity to relieve stress and may realize that other people share your same feelings and worries.
  • Get plenty of rest.
  • Try to exercise.
  • Stay hydrated.
  • Eat well.
  • Avoid alcohol and drug abuse.
  • Spend time with your family – if you have any children, encourage them to discuss their concerns and feelings with you.
  • When it feels comfortable, go back to your usual routine.  
  • Do things that you find relaxing/comforting.
  • If you feel overwhelmed by the disaster, ask for help. It’s not a sign of weakness. Talk with a trusted relative, friend, social worker, or clergy member.

If you have strong feelings that won’t go away or if you are struggling for longer than several weeks or months consider seeking professional help.  People who have existing mental health problems and those who have survived past trauma may also want to check in with a mental health care professional.  Being unable to healthily manage your responses to the disaster and resume your regular activities may be symptoms of post-traumatic stress disorder (PTSD), a real and treatable illness. Help is available. For information and resources please visit the links below. 







“Why Psychiatry?”

“Why psychiatry?” is a burning question I frequently get asked by people from all walks of life. The people who have asked this question include but are not limited to: family members, close friends, acquaintances, people who happen to read my hospital badge in the elevator, colleagues whose children are thinking about a career in medicine, patients, and sometimes even people in the grocery store who happen to strike up a conversation while standing behind me in line.  

And I usually get one of two reactions from people when I tell them I’m a psychiatrist. 

  1. “Oh!” accompanied by a scrunchy face with a look of disdain and disbelief. “You don’t look like a psychiatrist.” And the conversation awkwardly and abruptly changes to something much less personal like the weather, and the person I am talking to suddenly has absolutely no interest in continuing the interaction and looks for any possible excuse to escape. To which I immediately wonder… what exactly is it that you think a psychiatrist looks like? And am I really that scary?
  2. “Oh my goodness, I could definitely use one of you” usually followed by “I have a family member with…” or “I have struggled with” or “I know someone who has had a really hard time with…” This response is the one that makes me hopeful about reducing mental health stigma in the future. It reminds me that mental health diagnoses do not discriminate when it comes to age, race, country of origin, socioeconomic status, or gender. It also makes me wonder how many people I’ve talked to who have ridiculed the profession as a whole but have themselves struggled with their own mental health diagnoses and have never seen a psychiatrist. 

When I was in medical school psychiatry was the only clinical specialty that came naturally to me. There was an art in the way I watched my attendings practicing. Each psychiatrist had their own style, their own flow, and although there were great differences in the way each practiced, there was a common thread that tied them all together. There was a very strong instinctual component each of them possessed that went far beyond traditional lab tests and imaging. There was a certain intuition, a strong attention to detail, the ability rely on all of the innate human senses to truly elucidate the inner workings of another human being. And I remember thinking to myself in my third and fourth year clerkships “I want to learn how to do that.” It was that moment when I decided that psychiatry was the only specialty for me.  

As a resident psychiatric assessments take place multiple times a day, every day, and each assessment is uniquely fascinating because the process involves a mix of analytical interpretation, subjective deductions, and the ability to rely on our primitive human senses. This organic, difficult, complicated process makes each evaluation different and exciting. In the same way that no two people in the world have the exact same set of finger prints, no two psychiatric evaluations are ever identical. 

When I complete a psychiatric evaluation I am forced to pay incredibly close attention to even the most subtle of observations. What do I see when I look at someone? Are they well groomed, do they gesture with their hands a great deal, are they speaking with loud animated words, are they using profanity, is there any slurring noted, are their pupils dilated, is their breathing rapid, are they looking around the room checking for exits, do they look comfortable or scared? Do they appear restless or agitated? And then I focus on my senses, and that I feel when I interview someone. Does my heart beat faster when someone raises their voice, does their presence and body language make me nervous, does the hair on the back of my neck stand up when they provide me with an intense and suspicious stare, is my posture straight and rigid in an attempt to appear unintimidated, or am I slightly slouched with my legs crossed to project a sense of warmth and calm? What do I hear when I interview someone? Are they tapping their foot on the floor because they are nervous, are they picking at their fingernails because they are uncomfortable or bored, does their voice become more tense when they describe a traumatic event, do they whisper to themselves to try and keep calm? Do the questions I ask make someone more forthcoming, or do they express feelings of irritation or defensiveness, do they get angry when asked certain questions or become tearful with others? 

The give and take between two people speaking to each other is what makes the psychiatric interview more of an art than a science. There is a step wise beauty of the dance that takes place during an interview that I still find incredibly fascinating, exciting, but also meaningful. When interviewed people have a choice as to how much of themselves they want to share. And sometimes people tell us things they haven’t had the strength or ability to tell anyone else in the world. There is a sense of honor and privilege in that. People tell us their darkest thoughts, their deepest secrets, their most heartbreaking trials and tribulations, and trust us with them. Patients trust us to keep their secrets safe, and when that sacred connection is made between psychiatrist and patient, there is an incredible opportunity for lasting change.  

Psychiatry is important because it is one of the few fields left that still places an intense focus on the holistic understanding of how physical, mental, biological, and social aspects of a person’s life can come together and affect the presentation, expression, and thus treatment of illness. We see people who are often in very difficult places in their lives. And to have an opportunity to help them recover, watch them get better, and move forward with their lives is truly incredible. There is so much joy, meaning, and satisfaction in playing a role in the patient’s success. 

It is also important to recognize that the science of psychiatry is continually evolving. The mind is incredibly complex, and we live in a very exciting time where neuroscience is furthering our understanding of the brain and it’s inner workings. This research is so important because it is pushing the limits of understanding what makes us human. The knowledge obtained from further study of the brain will pave the way for new treatment modalities which can help transform people’s lives.

The brain is arguably the most complex and vital organ system in the body. The inner workings of why people think, behave, and react the way they do to different stimuli and circumstances is extraordinarily complicated. And we have barely scratched the surface when it comes to unlocking and understanding all that the brain does. Psychiatry and mental health is not a field to be mocked. It is not a pseudoscience, it is not magic, it is a work in progress and should humble us because despite how long scientists have researched the brain we still know very little about it. Thus psychiatry and related fields should be fields we look at with awe, and is a specialty to be proud of. Because the hope is that one day we can stamp out mental illness so people afflicted with a mental health condition or conditions never have to suffer in silence again.


Easy, Scrumptious, 5 Minute-Whole Meal Salad

I am a busy physician, and work anywhere between 40-70 hours a week. Some days I come home exhausted and ravenous which means I need to have easy recipes at my fingertips to continue eating healthy. I also happen to be obsessed with salads. This recipe is my go-to salad specifically designed for those days where the last thing I want to do is cook. It is delicious, simple, and most importantly takes only 5 minutes to make. 

Serves 1 


  • 1 large zucchini, spiralized (or cubed)
  • 1 sprig of fresh basil, thinly sliced
  • 1 cup of pre-cooked wild caught shrimp
  • ½ cup of cherry tomatoes
  • choice of salad dressing


  1. Cut off top and bottom of zucchini so edges are flat
  2. Place zucchini into a spiralizer to create beautiful zoodles (if you don’t own a spiralizer, cube the zucchini)
  3. Place zoodles into a medium size bowl
  4. Add thinly sliced fresh basil leaves, shrimp, and cherry tomatoes
  5. Add salad dressing and mix thoroughly
  6. If desired add salt and pepper for seasoning
  7. Serve and enjoy!

Agreeing to Disagree in Relationships

Have you ever asked yourself why some of the biggest arguments you get into with your partner are often over the smallest, seemingly most unimportant things? I ask myself this frequently. Especially after engaging in an argument that in retrospect seemed so pointless. I certainly don’t relish in the idea of arguing. Especially since it seems to take up so much energy that I would rather use for more important and meaningful things. But for some reason, being “right” is something that I and so many people struggle with in relationships. A common question that gets asked is … Is being right more important than being happy? My question is, why can you have both? It is possible for both you and your partner to be right in your own ways, based on your own life experiences? And it is also possible to not agree and still be happy? I think so.  

Finding connection in our differences
When you and your partner don’t disagree, it may seem like the world beneath you has crumbled because “they’re not who I thought they were.” On the contrary, they probably are exactly who you thought they were, they just happen to take a different stance on an issue, or opinion. These differences are important because discussions about how we differ is opportunity for growth in a relationship. It is an opportunity to learn about the other person, to become more connected, and to see things in a way you may not have thought about them before. 

Tolerating discomfort
It is natural to often have a visceral reaction when our partner doesn’t agree with us. We may start thinking that they don’t agree with us because ie. They don’t support us, they don’t believe in us, they don’t’ care about us… when in reality, they don’t see the world exactly the same way we do. And why should they? Every person has unique experiences including challenges, adversity, loss, grief, happiness, relationships, and the list goes on. The key is to listen to the reason someone thinks or feels the way they do. This is the perfect opportunity to sit with the discomfort you may feel when your partner doesn’t agree with you, listen, and allow their experience to broaden the way you see the world around you. Allow their strengths to bolster your own. Besides, if your partner was exactly like you, the odds are good that you would be bored beyond belief and looking for a way out. 

Don’t tear your partner down
Sometimes there when we are trying to prove why we’re right. We often take jabs at our partners in an effort to prove why they are wrong. Instead of talking to each other, and finding a way to work through the discomfort, we pick at each other and pit ourselves against each other widening the divide, when what we really want is to narrow it. This way of communicating is detrimental to a relationship because it often comes at the expense of belittling, humiliating, or disrespecting our partner. And what relationship really thrives under those circumstances? By doing this it eliminates a safe space in which to safely discuss things like experiences and feelings. 


Why I Don’t Let Men Buy Me Drinks

In my early twenties, I used to be a participant in a female sport known to most as “man-hunting.” Whenever I happened to go out with my girlfriends, the goal was to see how many drinks we could get men to buy for us. We would put on tiny little dresses, sky high heels, our most scintillating perfume and go “hunting.” 

We schmoozed with the hot, not-so-hot, intelligent, clearly not intelligent, tall, short, old, young, rich, broke, and entrepreneurial. But now, having freshly turned the corner from 29 to 30, my thoughts about this are pretty much…

“What the hell were you thinking!?!”

Especially now that in my “old age” I have seen over 100 episodes of shows like CSI, NCIS, and Criminal Minds. I think back to those times and wonder… why did I do that? Was I broke? Was I insecure? Was I bored? What was the point? And to this day I don’t really have a satisfactory answer aside from, it seemed like fun at the time. 

Now that the frontal lobe of my brain has solidified, and I belong to an entirely different decade of life, I thank my lucky stars that myself and none of my friends ever got roofied. But I also look back on my 20’s with a tinge of disappointment because back then I thought my looks were all I had. 

I guess at the time it didn’t matter that I was doing well in college, was on the right track to getting into medical school and achieving the career I dreamed about since I was 5 years old. 

I will admit that when I was younger “man-hunting” was occasionally fun. Sometimes I met really nice guys, most of the time I didn’t. But what I gleaned from my own experiences, and those of my close girlfriends, is that nothing good ever really came from “man-hunting.” 

While being found interesting enough to buy a drink for was nice at the time… it’s what came after the initial exchange I found bothersome. While not everyone agrees with me (and that’s okay), I now view drinks as a type of sexual currency. 

Most men I’ve encountered seem to be under the impression that if they spend $10 on a gin and tonic that you have now entered a legally binding alcohol contract that requires you to give them something in return… and stimulating conversation is usually not at the top of the list. 

The fine print can be as small as your phone number, escalate to a hand on your leg, or an arm around your waist, or be as big as expecting to see you naked after last call. Personally, the way I feel about it is… 

I am not a zoo animal. Buying me a drink does not give you the right to fondle or pet me without an invitation. 

And you certainly won’t be seeing me naked after last call or anytime in the future. 

Bottom line… Thank you for the offer, but I respectfully decline. Why? I’m worth way more than 10 bucks.

Now if you’re the type of man who wants to look into my eyes instead of at my backside, or ask me my name before staring at my chest, then by all means sit down next to me, and start a conversation. I don’t need you to buy me a drink because I’m more than capable of buying my own. That is the type of man I would love to catch. 


Things to Ask Yourself Before and After Starting Psychiatric Medications

  1. When was the last time I saw my primary care doctor?

Contrary to popular belief, psychiatric diagnoses are not doled out like candy on Valentine’s Day. In fact, a psychiatric diagnosis should only be made when medical conditions that share common symptoms with psychiatric disorders have been ruled out. If you haven’t had a thorough physical exam and routine labs in the last 6 to 12 months your primary care physician should be your next stop. 


There are common medical conditions with symptoms that can look a lot like psychiatric disorders. In order to treat the root cause of the ailment, and not just the symptoms it is important to have a basic medical work up. Let’s take depression for example. Symptoms typically include: fatigue, weight gain, lethargy, lack of interest in activities previously enjoyed, low energy, poor concentration, sleep disturbance, and lack of motivation. Medical conditions like hypothyroidism, anemia, pregnancy, heart disease, uncontrolled diabetes, excessive alcohol or drug use, etc. can masquerade as depression. By treating the depression alone, that may help with the symptoms, but doesn’t address the root cause which could have a significant impact on your long term health.   

  1. What symptoms am I having and when?

Take note of the symptoms you have been experiencing. Write them down and bring them into your appointment. There are many medical and psychiatric disorders that can be identified based on clusters of symptoms. A timeline of when each symptom started, any inciting triggers, what makes the symptom worse or better, and if the symptom changes throughout the day or throughout the year can be very helpful to your medical provider.

An example seen commonly in practice is chest pain. Chest pain related to heart disease presents differently than chest pain associated with panic attacks. Context and history of your symptoms helps providers get you feeling better faster. 

  1. Do I really need medication?

During your appointment your provider should discuss with you what they are seeing clinically, propose a diagnosis, and discuss the risks, benefits, side effects, and alternatives to evidence based and off label treatments for your condition. The decision to take medication or not is a personal one, and nobody can make the decision for you. If you’re not sure whether or not you want to start a medication, and your condition is non-life threatening and non-urgent take some time to think about it. Do your research and make a follow up appointment to discuss your concerns.  

  1. What can I do to get healthier if I decide I don’t want to start medication right away?

Good nutrition, adequate restful sleep, staying away from drugs and alcohol, and regular exercise are the best non-pharmacological ways to improve both physical health and mood symptoms. If lab tests reveal abnormalities like iron-deficiency anemia, or low vitamin D talk to your doctor about supplements you can take to help your body function optimally. Stress also plays a big role in overall physical and mental health. Relaxation techniques like meditation, guided relaxation, decreasing time on electronic devices, and improving sleep habits are other effective ways to boost your health without taking a medication. 

  1.  So, my doctor suggested that I try medication… now what?

Be honest about addiction. If you have a history of addiction, be sure to share this with your doctor. There are medications that are clinically indicated for short term use, that can increase risk of addiction, particularly in someone who is genetically predisposed. There are often alternatives to potentially addictive medications that can be used instead.  

Be patient. Sometimes it takes time to notice if the medication is helping or not. Frequently medication needs to be adjusted over time to be sure that you are taking a therapeutic dose and having minimal side effects. Medication is not a one size fit all process. Every person metabolizes medication differently, which means that a particular medication may work very well for one person, but cause significant side effects in another. Although medication can help with psychiatric symptoms, there is no “magic pill” that will make all your problems or worries go away. You will still need to put in work to help yourself get better.   

Take medication as prescribed. All medications come with specific instructions. It is important to follow the directions on the prescription to maximize benefit of the medication and mitigate side effects. Therapeutic effect of a medication depends on the level of medication in your bloodstream. The goal is to keep that level steady over time. Taking the medicine at the same time every day without skipping doses is ideal. If it’s hard for you to remember to take your medicine set an alarm on your phone. It is also a good idea to carry one or two pills in a small pillbox on your person just in case you leave the house and forget to take it.  

Don’t increase or stop medication on your own without talking to your doctor. As tempting as it may be to want to adjust your own medication, don’t. Playing with your medication dosing can put you at risk for serious side effects, accidental overdose, and toxicity. If you are experiencing adverse effects to your medication call your doctor and let them know. They can advise you on how to proceed in a way that does not jeopardize your health.   

Limit access. Always remember to keep your medication stored in a safe and secure place. Small portable safes are a good option given that they are easily obtained and are not too expensive. This helps limit accidental access by children and pets, and can be invaluable in the event of a disaster like a fire or a flood.   

Be in the know. Lastly, knowing what medication you are taking is just as important as knowing why you are taking it. If you find the names hard to remember, write them down on a piece of paper with the doses and keep it in your wallet. It is better to be prepared by knowing what you are taking or have easy access to the information. This will help providers update your medical record so it accurately reflects what you are currently taking, minimizes risk for being prescribed a medication that may negatively interact with your current medication, and if you are in an accident and can not communicate the list of medication can be very helpful to the medical providers taking care of you. 


Maintaining Your Relationship When Politics Divide

It is no secret that the current political climate has left many people divided. Hot topics of discussion can cause both emotions and tensions to run high, which can destroy relationships… if we let it. It is easier to tactfully avoid political discussions in places like work, the gym, or at the grocery store. However it is exponentially more difficult to dodge the topic when you share a household, relationship and a life with someone. So how do you manage the discussion when you strongly believe in one party, but your partner deeply identifies with another?

A common theme among individuals and couples I see in my office revolves around the very heated political divide that our nation is facing at present. Individuals and couples say things like – 

“I thought I knew my partner… but now I’m not so sure.” 

“If we voted so differently does that mean we don’t share the same ethics, morals, and values?”

“I love my partner, but I’m not sure I can be with someone who thinks this way…”

Some of my patients are so bothered by the difference between the way they voted versus the way their partner voted that they are thinking of dissolving their relationships. Even if they have been together for a significant period of time, for some, years. They express anger, frustration, passion, concern and fear. Volume and tone of voice rises, body language escalates, hand gestures become more frequent and animated, vernacular and vocabulary simplifies, and the list of signs consistent with intense discomfort continues.  

After having spoken to many people including: patients, friends, family, co-workers and colleagues this is a scenario that is quite familiar to many people. Although it seems to be a fairly common interaction given the political climate we live in, it was surprising to me how many people weren’t actually talking about their feelings with regard to this issue. It became clear to me that when people stated that they were “talking” to each other about politics, the reality is that many were “fighting” about politics. Often talking over each other, making snide remarks to each other, assuming the thoughts and beliefs of the other person instead of clarifying, speaking more than listening, and trying to convince their partners about why there were wrong, and attempting to sway their partner to their side.  

If this is a dynamic you have witnessed, or have been a participant in, below are a few strategies to reconnect with your loved one and move forward together. 

  1. Take a deep breath. This can help you to take an extra second to ground yourself before saying something you may regret. 
  2. Don’t assume. A great deal of miscommunication comes from making assumptions. You can’t read each other’s minds. So don’t try. If you have questions… ask. If you don’t understand something someone said or what they may have meant… clarify
  3. Don’t speak out of anger. Some things we say in anger can be very damaging to our partner. Remember that even if you disagree on something, there is still room to respect each other’s differences. 
  4. Be flexible. Sometimes we can become very invested in being “right” but at what cost? Being willing to listen to your partner and see things from their point of view is a recipe for success. 
  5. Listen more than you speak. Sometimes silence is the best strategy for avoiding confrontation. Listen. Absorb. Reflect. Then speak. 

At times politics can be messy and emotional. 

When we’re highly invested in a point of view and are constantly trying to prove we’re “right” we may be completely oblivious that what we’re doing is undermining, isolating, attacking, and invalidating the person we love most. 

It’s not about “converting” the other person to your way of thinking, it’s about understanding your partner’s position even if you don’t agree.