WHAT I'D TELL MY YOUNGER SELF REGARDING SUICIDAL THOUGHTS

I made this video for the Child Mind Institute. I’m grateful to be a part of their #myyoungerself project.

Child Mind Institute

Published on Apr 20, 2019

Sonia Patel is a physician and author. Patel is psychiatrist in Oahu and is passionate about helping teens work through emotionl obstacles. She is also the author of several books including, "Rani Patel in Full Effect," and "Jaya and Rasa: A Love Story."

#MyYoungerSelf by Child Mind Institute is an anti-stigma campaign. We are grateful to Sonia for her willingness to open up about her childhood experience with anxiety and depression.

ABOUT CHILD MIND INSTITUTE As an independent, national nonprofit organization dedicated to transforming the lives of children and families struggling with mental health and learning disorders, we deliver the highest standards of care, advance the science of the developing brain, and empower parents, professionals, and policymakers to support children when and where they need it most.

SAFE DIVERSITY IN YA LIT ISN’T ENOUGH DIVERSITY

While YA novels are increasingly diverse, safe diversity—with accessible and likable protagonists and their convenient struggles—is usually seen as enough. These unoffending books tend to be championed and more popular. Unsettling diversity, on the other hand, is often frowned upon, discounted, or misconceived.

I’m a practicing child and adolescent psychiatrist and a young adult novelist. To me, dismissing YA that’s outside the realm of palatable diversity is like a psychiatrist refusing to treat certain teen patients because they have “too many problems.”

I’ve spent over fifteen years treating diverse teens who suffer tremendous adversity—abuse of all kinds, neglect, parental mental illness or drug use, etc. Medical research proves that youth exposed to these types of adverse experiences have an increased incidence of chronic medical and mental health problems, increased risky behaviors, and less future success. That’s why I’m dedicated to being in the trenches with them, helping them dodge life’s bullets. Hoping to steer them to higher ground.

An example is in order.

Kai (not his real name), a seventeen-year-old Filipino-Hawaiian-Japanese-Korean boy, is sitting across from me, staring out the window. It’s been six months of almost weekly individual  talk therapy sessions. I bring up the heavy family issue. Kai presses his lips together. Suddenly he shoots up, a scowl covering his usual poker face. He takes three steps to the large window and slams his head, three times. A pause then three more slams.

I call his name. He glances over his shoulder, his eyes moist. In a gentle voice, I ask, “Will you sit down or should I call the police to keep you safe like last time?”

He punches his head three times. “It hurts so much in here,” he angry whispers, tears now streaming.

“Let’s talk about it,” I suggest.

He glares at me but then sits. “Fine,” he mutters.

That was Kai’s breakthrough moment. It was the first time he spoke about a feeling instead of showing it with alarming behavior. It was the moment we started translating his behavioral language (obsessions, compulsions that were often harmful to himself, bullying, social isolation, alcohol use, and truancy) into English words.

Still, healing took years. Negative coping strategies had been automatically reinforced, and eventually hardwired, in his brain. New, positive brain pathways took time and work to form.

I have personal experience with this. You see I grew up in a dysfunctional Gujarati Indian immigrant family with dark secrets. The opposite of the typical Bollywood family depiction. I started writing to cope. It was poetry and rap at first. It turned into my debut young adult novel Rani Patel In Full Effect.

I struggled with how to portray Rani, my Indian-American main character. In the real way teen survivors of sexual abuse present to my office? Or in a sugar coated way with righteousness, fully formed feminist strength and insight, and flowery perfect prose to make her more appealing to readers?

I decided on real. Real meant raw and flawed. Real meant making her an uncomfortable protagonist. As a reader, you invest time caring about her. But Rani doesn’t have gorgeous words to describe the pain of her abuse, she speaks by recreating her role as an object for men to use and ends up making obviously bad decisions. You want to scream at her.  That’s what it like supporting a person working to recover from trauma.

My next YA novel, Jaya and Rasa: A Love Story is based on amalgams of real teen patients. Sorry, but there’s nothing comfortable about walking in the shoes of a depressed, suicidal Indian-American trans boy and a sex trafficked mixed ethnicity girl.

My third YA novel, Bloody Seoul, will be released in July. The main character, Rocky is Korean and has aspects of Kai, other patients, and my imagination. If Rocky kept a journal, his abrupt sentences would reveal his brain’s ingrained survival reactions to the chaos of his mother’s abandonment and his father’s violence—a hard edge, limited empathy, emotional unavailability, and OCD behavior.

My fourth YA novel will follow suit. I can’t stop, won’t stop, introducing troubling protagonists because there are entire groups of diverse youth not yet represented.

YA lit needs to transcend safe diversity. It needs to be enthusiastically inclusive of disturbing realistic novels that purposefully miss the bull’s-eye of acceptability. Even when it’s really hard, we need to try to understand all teen protagonists who engage in incomprehensible behaviors. Even if we don’t agree, we need to try to empathize with them when they make upsetting choices. That is true tolerance. That is true diversity.






CHECK OUT THE HAWAII BOOK & MUSIC FESTIVAL! I’LL BE REPPIN’ YA LIT & MENTAL HEALTH ON 4 PANELS.

The Unrecognized Impact of Sexual Violence on Survivors

This essay was originally published in LENGUA LARGA, BOCA ABIERTA, edited by Isabel Quintero & Allyson Jeffredo, February 2017. I shared it on my blog soon after but took it down when I received threatening letters about the personal content.

Today, however, I’m reposting it. You see, I just finished watching the documentary LEAVING NEVERLAND and Oprah Winfrey’s AFTER NEVERLAND. I’m inspired by the bravery of Wade Robson and James Safechuck. As a psychiatrist who has treated survivors of childhood sexual abuse, this documentary does an excellent job of describing the grooming/seduction process, the immediate impact of sexual abuse, and the lifelong aftermath survivors must work through. Also, as a survivor myself, I will no longer be silent. No one in my life knows the entirety of my experiences except me. I didn’t think it was abuse. I flat out denied it or minimized it. It is still difficult to talk about it with those closest to me. But I can write about it. Writing is how I process my painful past. Writing is how I can dispel shame, secrets, and help myself move forward. I’m hope that my truth might aid someone.

The Unrecognized Impact of Sexual Violence on Survivors

by Sonia Patel

The truth of the matter is that “20 minutes of action” by men with privilege, power, and influence that “just kiss,” “grab ‘em by the p***y,” “don’t even wait,” and “can do anything,” can cause a lifetime of brain repercussions for their victims. And this is what is missing from the current discussion of sexual violence—that the effects on victims can be as biologically serious as brain injury induced by things such as concussions or crystal methamphetamine use.  

As a child & adolescent psychiatrist, I’ve spent over twelve years guiding sexual violence survivors on their paths to recovery. I’m also a young adult novelist and my debut, Rani Patel In Full Effect, details the negative impact of paternal covert and overt incest and date rape on a sixteen-year-old girl. My second novel,  Jaya and Rasa: A Love Story, addresses LGBTQ issues and one example of sex trafficking, including the profound damage that occurs to the development of a young girl when older men prey on her sexually from the time she’s twelve.

Sexual violence can damage a survivor’s brain at a cellular and physiological level. Time and time again medical research has shown that sexual violence can, for example, alter brain structure, change how the brain reacts to stimuli, deregulate neurophysiological interplay, and impair cognitive function. Children are particularly vulnerable to this devastation because their brains are still developing. These types of brain injuries can adversely alter everything about how children or adolescents approach and experience their life as they grow into adults. The normal development of their sense of trust, self-worth, ability to be assertive, and formation of their identity is thwarted. They are more likely to have pessimistic automatic thoughts, negative feelings, compulsive and self-destructive behaviors, and inability to maintain appropriate boundaries or form deep connections in relationships. Their brain injury might be expressed as one or more full blown psychiatric disorders.

Survivors may get lost in the cognitive and emotional manifestations of their impaired brain function. They may even accept that these symptoms are who they are instead of their brain’s unavoidable biologic response to the sexual violence.

Discussion of sexual violence is not typically encouraged and in fact society tends to at least partially blame the victim. In addition, because abusers put their own wants first and lack empathy (both of which can be hallmarks for serious psychiatric issues such as the Narcissistic Personality Disorder), their cavalier stance on the ramifications of their actions reinforces the view that the guilt rests with the victim.  So survivors of sexual violence may suffer in silence. Stifled, they can’t focus on how harmful the abuse was. Rather, they are stuck in “speaking” and “living” through their troubled cognitions and emotions and end up in a vicious cycle of helplessness and shame that can lead to a lifetime of dangerous choices and various addictions, including drugs, alcohol, and sex.

Of course there are multiple factors that can alter the biological brain effects of sexual violence—chronicity of the abuse, genetic susceptibility, family and peer support, etc. But there is no doubt that sexual violence can change a victim’s brain functioning. Still, healing is possible. It takes time because it requires a survivor to essentially “retrain” their brain to think, feel, act, and connect with people in a positive way. I often tell my patients that depending on how many years they’ve lived with their dysfunctional brain wiring, it might take them that many years to fully recover. This is not to make them lose hope but rather to foster empathy for themselves about the severity of the abuse they suffered. Empathy for themselves, as it turns out, is an important part of gaining insight into their ordeal. And insight is the first step on the path to healing. As survivors gain insight into the sexual violence they suffered, they escape the muteness of their trauma and learn to find words to separate themselves and verbalize their brain’s biologically conditioned cognitions, emotions, behaviors, and connections to people. This leads to empowerment because they begin to realize they are not what their thoughts and feelings tell them. They become aware that they are worthy of being more than sexual objects for others. They figure out that they can reinvent themselves independent of the sexual violence they suffered.

And I should know. Because besides my medical training in the effects of sexual violence on patients and the years I’ve spent treating them, I’ve spent years individuating myself from my role as my father’s intimate object. I’ve thought the worst of myself. I’ve felt the depths of depression. I’ve hated myself and wanted to die. I had years of nightmares about being kidnapped and gang raped by older men. I’ve indulged in quick fix self-destructive behaviors and made impulsive, bad decisions that hurt me and those I loved.

Eventually I gained insight into my brain’s negative hardwiring and it became clear to me that I’d have to work hard to overcome the existing circuits. Many tears and years later I succeeded in creating new ways of thinking, feeling, behaving, and relating to people. My self-worth is solid and my boundaries and decision making much improved. I am my own person.

Given the recent revelations of sexual violence by many high-profile men in a wide range of industries, I am hopeful that we as a society can use this political moment and the conversation it has provoked to reshape our understanding of sexual violence. We can do this by fully supporting victims and survivors of sexual violence on their journey to recovery. We can do this by not standing for any of the excuses for unacceptable behavior thrown around by abusers. And we can do this by eliminating once and for all the disgrace surrounding victim status.


SUICIDAL THOUGHTS ARE A SYMPTOM & SOMETIMES I'M SYMPTOMATIC.

“Every year close to 800,000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15–29-year-olds globally in 2016.

Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 79% of global suicides occurred in low- and middle-income countries in 2016.

Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multi sectoral suicide prevention strategy is needed.”

--World Health Organization Fact Sheet on Suicide 8.24.18 https://www.who.int/news-room/fact-sheets/detail/suicide

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Yesterday, Keith Flint, the frontman for the band Prodigy, took his own life. He was 49. His suicide hit me hard. As hard as Chester Bennington’s, lead vocalist of Linkin Park who was 41. Being a first generation Gujarati Indian American, my life experiences didn’t align with theirs, but I found solace in their powerful music. As did many other people. That and I’m also in my 40’s. And I’ve had suicidal thoughts. The shit is real.

But I haven’t taken the thoughts to the next level—the attempt level or the deadly level.

How am I lucky enough not to have taken it to the next level when so many people have?

Maybe it’s because I’ve spent years in medical school and residency training studying trauma, depression, anxiety, and suicidal thoughts on a biologic level. Or maybe it’s because I’ve spent thousands of hours putting myself in the shoes of numerous youth and adults with suicidal thoughts and attempts and trying to help them survive. Or maybe it’s because I remind myself that I don’t want to hurt my husband and children. And I’m fortunate to not be abusing drugs or alcohol.

What I know for sure is that it isn’t easy because sometimes the suicidal thoughts are so intense, so real, so seemingly inescapable. Vivid swirls of GRAB THAT KITCHEN KNIFE AND STAB YOURSELF IN THE HEART…RUN INTO ONCOMING TRAFFIC…  

See that’s what happens sometimes to people with hardwired anxiety and/or depression. The suicidal thoughts are SYMPTOMS of this hardwiring. The suicidal thoughts are not a character flaw. They are not a cop-out. Suicidal thoughts can be misguided, automatic thoughts aimed at exerting the ultimate control over overwhelming chaos.

A person with well-treated asthma isn’t in a constant state of an asthma attack, but can have symptoms such as wheezing when triggered by weather changes or exercise. In this type of case, breakthrough asthma symptoms can be treated quickly, allowing the person to return to normal functioning. Similarly, a person with well-treated anxiety and/or depression can have suicidal thoughts when triggered by tremendous stress, conflict, loss, reminders of painful pasts, etc. That’s how it is for me. I’m not in clinical depression or anxiety. But things can trigger symptoms. I’ve learned to manage these breakthrough symptoms immediately so that I can return to my normal, healthy baseline in no time. If the breakthrough symptoms include suicidal thoughts, I remind myself that my brain is playing tricks on me because I’m overwhelmed. I tell myself to listen to music instead, it will pass. Or I tell myself to write, it will pass. Or maybe take a nap, it will pass. Cry if needed, it will pass. Go for a hard run, it will pass. Ask for a hug and reassurance, it will pass. Now is not the right time for the glass of cabernet, it will pass. I repeat the mantra IT WILL PASS.

And it does.

But the breakthrough symptoms, including suicidal thoughts, may come back because that’s how my brain is wired to automatically handle massive stress and I understand that. But I’ve got an arsenal of coping strategies at the ready to help me pull through no matter how many times symptoms such as suicidal thoughts breakthrough.

If you are depressed or have suicidal thoughts, please call the National Suicide Prevention Hotline 1-800-273-8255. https://suicidepreventionlifeline.org/











YUP, RANI PATEL IN FULL EFFECT IS FEMINIST AF.

I’m passionate about providing psychiatric treatment to diverse teens who are struggling through various hardships. Along the way, these teens make poor choices in relationships and in self-care because that’s how real life often plays out when youth are raised in chaos. It’s important to me that their imperfect journeys aren’t dismissed. That’s why I’m also dedicated to translating their struggles into realistic young adult fiction that isn’t written to please but rather to expand narrow-minded views of mental health issues and diverse life experiences.

Real life isn’t perfect prose. Real life isn’t a perfect plot. Real life isn’t a perfect, happy ending. Real life can be brutal, scattered, mistake-filled, and beautiful. And when these real-life teens embrace their worth and learn to use their voice, they are fierce. They are feminist AF. Like my teen patients. Like Rani.

This School Library Journal blog post lists amazing, diverse feminist YA books. I’m delighted that RANI PATEL IN FULL EFFECT is on it!

Click on this link:

Feminist AF: Feminist YA That Does Not Disappoint, A Guest Post by Mary Ellis

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IF YOU’RE GOING TO TAKE FROM MY CULTURE (YOGA), DON’T F&*@ IT UP!

Cultural appropriation is generally defined as the dominant culture stealing aspects of a minority culture, such as fashion, music, traditions, symbols, etc. It is often viewed as harmful, especially since it stems from colonialism and oppression.

Personally, I think the concept is taken too far sometimes. It’s not that I’m down with the disrespectful stealing of another’s culture, but I think the sharing of cultures can be beneficial. It can promote tolerance and empathy if done right.

I’m the first person in my Gujarati immigrant family to be born in America and honestly, there are times I feel Indian, times I don’t. There are times I feel American, times I don’t. And the culture I most identify with is hip hop culture, a culture born out of the black experience in New York City. Hip hop culture has influenced me in many positive ways and at times even saved my life. I’m thankful to hip hop, so much so that I gave it a central role in my debut young adult novel, Rani Patel In Full Effect. I intend no disrespect to the founding black culture, only gratitude. Hopefully, I succeeded in giving it the mad props it deserves.

I don’t relate to most aspects of my Gujarati Indian culture. But I do relate to yoga, a Hindu tradition that encompasses physical, mental, and spiritual practices. I focus on the physical and mental aspects in a Westernized way in a Western studio. For me, yoga, like hip hop, provides tremendous relief to the internal anguish that still plagues me given my family of origin issues. This, and because I’m a psychiatrist, I’m overjoyed that many people in the West practice yoga and find it helpful.

Not all Indians feel like that. There are Indians who consider westernized yoga to be harmfully appropriated, especially given the high commercialization of it and how far removed it’s become from ancient Indian philosophy and purpose.  

More recently, I’ve felt the sting of this cultural appropriation in my yoga classes. But for me, it’s quite specific. Usually, I’m the only Indian person in class and when I hear practitioners, mostly women, talking about being on “detox juice cleanse diets,”  “going vegan,” “deciding to quit all carbs,” or praising each other on weight loss, I feel angry. I mean do these people know that 15% of India’s population is undernourished? Do they know that most Indians in India are lacto-vegetarian? Do they know that it’s highly disrespectful when they talk about bodies like pieces of meat (which of course, they don’t eat)? Do they know that they’re perpetuating misogyny? I wonder if they talk to their children, especially their daughters, like that. More than angry, that makes me sad and scared for the future.

The worst was when a frequent practitioner began reeking of ketones during and after class. I know the smell from medical school and residency training and from my work with eating disordered patients. It’s not normal. Simply put, it represents the body breaking down. It can be dangerous, even fatal. It was common knowledge that this particular practitioner had been taking 3 classes a day. Every single day. Without eating in between. And not eating very much of anything all day. Personally, I found this to be the ultimate in disrespectful appropriation of yoga. I’m no expert on yoga philosophy, but I know for sure that it’s not meant to be harmful. And then how healing is it if a fellow practitioner dies in class because privilege allows them to take 3 classes a day and choose not to eat?

I expressed my concerns to the practitioner and the studio. I’m happy the studio made positive changes to their policies to assist practitioners in making more balanced, and less deadly, yoga choices.

I’m still all about sharing culture, but not about letting entitlement and privilege turn someone’s culture into something toxic.


ENABLING IS TOXIC.

People typically seek therapy for themselves or their children to find relief for emotional distress or improve behavior or habits. Therapy can be useful for personal and family insight, growth, and empowerment. However if therapy becomes a place for a person or family to simply confide and vent without any actual relief or improvement, then it may not be helpful.

In my work with patients, I advocate that one of the goals of therapy can and should be to not need it anymore. And this means that the therapeutic work by nature should involve understanding of thoughts and feelings as well as behavior change. One of my jobs is to listen to patients in a non-judgemental way, but if I do not use therapeutic techniques to point out how patients may be perpetuating patterns or not allowing themselves to make emotional gains, than I would be allowing them to stay in the sick role. This is called enabling. It is something I will not do. And by being aware of this potential therapeutic hazard and drawing firm boundaries against it, I can give patients and families opportunities to seek true improvement though it is difficult.


Enabling is toxic. The enabler (the person—a health professional, partner, family, or friend—trying to help) usually has good intentions but without expectations for the enabled (the person in need of help who is likely stuck in a cycle of poor decisions and distress) to make behavior change, he or she is only allowing or fostering the dysfunction to continue. The enabler thinks they are helping but the truth is they are scared and trying to control the situation that the enabled is not yet willing to fully address.

As long as the enabler keeps enabling, the enabled will never get a chance to make positive change. And this is what differentiates enabling from healthy, appropriate help. The healthy, appropriate helping approach allows for the control and decision making to be put in the correct, albeit unpracticed, hands.


TODAY I HAD THE HONOR OF DELIVERING THE ARGOSY UNIVERSITY, HAWAII COMMENCEMENT SPEECH!

Check it out for a different kind of inspiration that includes Post Malone, Gandhi, AND Michael Jackson quotes!

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Good afternoon Argosy graduates and faculty, family and friends. I am honored to be here on this momentous occasion. And thank you for that kind introduction, President Guerrero.

We’re all gathered here today to celebrate these outstanding Argosy graduates. Congratulations to you all in the various areas of study!

You know, as I was writing this speech, I kept hearing the Post Malone song Congratulations in my mind’s ear. Some of you know the lyrics. Worked so hard, forgot how to vacation…look we made it. And yes, graduates, you made it!

Argosy has nurtured you with an excellent education, immersed you in diversity, and provided you a safe community. In return, you’ve made the university proud. And let’s not forget all the mothers, fathers, sisters, brothers, grandparents, uncles, aunts, spouses, kids, and friends, who’ve supported you on your journey to this moment. This is a great moment. Relish it like the wonderful meal I hope you are treated to tonight.

You’ve worked hard to get to this point. And there will be more hard work in your future. There will be bills to pay, maybe mouths to feed, or other circumstances that require hard work and money. But I’m not going to talk about hard work.

I’m going to talk about you. Well, your life. More specifically the journey of your life. For it’s your journey, with all its varying stretches of smooth roads, potholes, and epic cracks, that tells you who you are. It is the journey that unlocks your true potential.

But graduates, beware on your journeys! Because society, whether it’s on television, in magazines, on social media streams, in the honeyed words of some well meaning people you know, or in the lingering mist of the fear of missing out, society tells you that success and achievement define you. That you are most worthy if you have a great career, or wealth, or a fancy car, or a perfect body. “Success makes you great,” society whispers while sucking you dry of your soul.

Don’t take the bait, graduates, because there is danger lurking in the shadows of this type of success. This type of success, you see, is a drug and society is the dealer. Society it brazen. It stands out in the open as it slips you free samples of success. One or two hits might be all it takes to get you hooked. Then you might crave the intoxication. Too much and you might overdose with privilege and entitlement. I am special. I deserve this. Privilege and entitlement can be taken to the extreme and people who purport to serve others can end up serving only themselves.

Just turn on the news. It’s full of examples of these success junkies. They lie, cheat, steal, evade taxes. Whatever it takes. Some of these people lead our nation. Many of them take what they want, the way they want it, when they want it—women, votes, campaign funds, etc.

Most of us don’t engage in this kind of extreme behavior to achieve our success. Still, it’s easy to get swept away in mainstream society’s success messages and lose sight of who you really are and what you really stand for. It can happen to anyone. It can cross all political, racial, and religious lines. In all sorts of professions. On all sorts of scales from the White House to more humble homes.

I hear about it all the time in my office when smart, hard working people tell me their stories. Many of these good people have tons of higher education but that doesn’t make them immune to seduction by success goals. Many of them end up ignoring their life journeys and they make poor decisions in the moment that hurt either themselves or others.

There was this attorney who wanted to succeed in advancing his career to partner and earn the biggest bucks to support his family and send his kids to private school. But he became blind to his marital struggles and ignored his children. He and his wife fought all the time and their kids began acting out to the point where one was kicked out of the very private school he was working so hard to pay for.

Then there was this physician who was driven by the goal to be voted by her colleagues onto Honolulu Magazine’s Top Doctors list. She spent her time networking and made the list. But she didn’t spend enough time with her patients and some of them ended up hospitalized for things that could’ve been easily treated in her office.

And for some of the teens I see, there’s that success goal of straight A’s and a prestigious college. They study, study, study without sleeping or eating enough. Their parents allow it because hey, their kids are studying in their rooms, not out shooting up heroin under dark bridges. Some of these teens develop depression, anxiety, eating disorders. They hate themselves. They hurt themselves. They hurt their peers by withdrawing without explanation. But they get straight A’s and great SAT scores.

In all these cases, were the end goals of success worth it? One thing’s for sure, their day-to-day journeys were painful and harmful.

And then there’s me. I know all too well the downsides of focusing on success. But how could I not focus on it? It was, is, the American dream after all and my parents were immigrants from Gujarat, India on a quest for this dream in the land of endless opportunity. From the outside they achieved the sweet American dream of success. Their child was born and raised in the stars and stripes and they owned two businesses and a house. I had more opportunities than they did, the most important being access to great education. My parents worked hard. I worked hard. I graduated valedictorian of Molokai High, went to Stanford for my B.A., got my M.D. at U.H. then did residency and became a child & adolescent psychiatrist. Bam! My parents couldn’t have been more proud of their “successful” doctor daughter.

But that was all a paper-thin guise. Under the veil of good intentions, the American dream didn’t erase the toxic stains of my parents’ very different and difficult upbringings. In fact the American dream turned out to be my mother’s personal nightmare. Our seemingly happy family was a lie. Their arranged marriage was a pernicious sham where my father treated everyone else better than he treated my mother yet she just took it because she couldn’t forget the lesson her own father had taught her—that husband is god. What made it worse was that she had no voice. I watched and learned the underlying message their actions taught me—Shut up, smile, look pretty, and do as you’re told. My stifled voice only found release in the safety of the classroom. No where else. The boundaries at home were blurred and, without going into the icky details that my father vehemently denies, my mother and I were ultimately reduced to nothing more than objects for him, while he was out “saving the world” with his activist goals.

To survive in that traumatic environment my developing brain became hardwired with anxiety, I’d over-think everything to avoid rocking our family’s already leaky boat. My thoughts became negative and sometimes turned into depression, suicidal urges, and poor decisions.

And the “successful” physician who helped youth and adults all day in the office ended up making some terrible personal decisions that hurt herself and the people she loved the most.

Graduates, success in and of itself isn’t worth it if you end up hurting yourself or others along the way. It seems obvious. Especially when most of us, including me, never intend to hurt anyone while aiming for success. But it can and does happen.

Don’t get me wrong, I’m not saying forget your dreams. I’m saying what matters is the journey. The journey defines us. Not the end goal. The journey is about right here, right now and that’s where the magic is.

Before I really understood this, I was future tripping and past living. I was anywhere but right here, right now. I was future tripping hard on my goal of being a physician so that my self-worth was completely attached to achieving that goal. But at the same time I was past living by recreating my family relationships with everyone else in life. My distant relationship with my mother and her inability to be assertive to protect herself or me turned into difficulties in forming female friendships and my own voicelessness. And the role I had as my father’s object, I continued with other older men.

And it’s not uncommon to future trip or past live. Most people don’t realize they’re doing it. My therapeutic work with patients often focuses on identifying and changing these patterns. I challenge you to take some time one of these days to think about it. Are you future tripping or past living? Are you letting fear of not achieving or fear of some horrible future drive your actions? Are you repeating old patterns that are not serving you well?

Dare to fix these things so that you can stride nobly on your journey.

I wish I’d figured that out sooner. Before I blew up my life. So I was in this deep, dark pit of shame, anxiety, and depression. I didn’t know how to get out. One day I picked up a pen and pad and wrote what was in my head. That was the start of being in the moment for me. I wrote and wrote and wrote. It happened to be rap and spoken word poetry that flowed onto the pad I think because I had the good fortune of growing up during the golden age of hip hop. I rhymed about issues important to me and my patients in the moment—the detrimental effects of patriarchy, misogyny, abuse, the beauty myth. I wrote about empowerment, voice, feminism, courage, friendship, and love. Whatever was going on in the moment. I performed my pieces. The confidence and power of my delivery formed new connections in my brain and quieted the anxious pathways. I was letting go of my painful past by speaking up and realizing that my worth was not based on achievement or attention from men. That helped me set boundaries. I wasn’t living in the past or trying to control the future anymore. I was in the moment. I was right here, right now. I was becoming the real me. And it felt so good.

I ended up with a binder full of rap and poetry. At some point I was flipping through the pages and I found that if I put them in a certain order it turned into a young woman’s story! My story plus that of some young women I’d treated. The story got published as a young adult novel. I was, am, humbled and inspired. But what’s most humbling and inspiring is when I receive emails that express gratitude from young women and teens who’ve been sexually abused or grown up in dysfunctional families, I cry tears of relief and hope. I’ve realized that I can live the words of one of my heroes, Mohandas K. Gandhi: “Be the change that you wish to see in the world.”

Be the change that you wish to see in the world. Eleven powerful words that beseech you to be on a noble journey so that you will be part of a positive ripple effect. Eleven words that don’t care what your career is, how much money you make, how much recognition you have. Eleven words that don’t care if you’ve achieved. Eleven words that don’t judge you. Eleven words that are a cool, gentle breeze caressing your face on a hot, humid day whispering, “The journey is the great equalizer.”

Live for the journey and watch the beautiful ripple effect in the lake of your life. Your noble journey will change the world. So, graduates, congratulations on this step. Now, how will you continue your journey from this day forward?

Let me end with one more story. When I was in elementary school, I lip synced and danced to Billie Jean at a talent show—curly hair, jacket, sequined glove, moonwalk, and all. It was cool but I wish I’d understood the deeper meaning of the words I was lip syncing, especially the line: Be careful of what you do because the lie becomes the truth. That line was like a personal gift I didn’t, couldn’t, unwrap until I was an adult. I’ll leave you with another set of Michael’s lyrics—a gift to you that I encourage you to unwrap and use now. I'm starting with the man in the mirror. I'm asking him to change his ways. And no message could have been any clearer. If you want to make the world a better place, take a look at yourself, and then make a change. Thank you and congratulations!


Personal Boundaries

Think of personal boundaries as the barriers we set with others to demarcate which of their behaviors towards us are permissible and which are not. Personal boundaries can encompass the following categories: intellectual, physical, emotional, social, and spiritual. My patients who have difficulty knowing and setting their personal boundaries usually lack self-worth or adequate role models from whom to learn these skills. Some lack both.

I lacked both. Growing up, my father crossed boundaries with me and my mother couldn’t maintain any for herself or me. This became my blueprint for life. I was an object that existed first to please my father and later to please others. I did not see any inherent value in myself. It set me up to live and repeat the torturous cycle of poor self-worth, inability to set boundaries, bad decisions, poor self-worth, and on and on.

Fortunately, this is no longer the case for me. These days, my self-worth is strong. I know my boundaries. I set my boundaries. No exceptions. My decisions are better. I can take care of myself and others.

It took much pain and practice to get to this point. And now that I’m here, I want nothing more than to help my patients on their journeys towards healthy self-worth and boundaries.

It takes time, I tell my patients. Generally, we start by identifying family patterns that may have contributed to their ongoing struggles. Then we see how they might be repeating these patterns in their current lives. Next we figure out what their boundaries should be and how they might begin to set them. Setting the boundaries requires assertiveness (being able to verbalize their true thoughts, feelings, wishes, and decisions) and the ability to tolerate the negative feelings that initially accompany not doing what they think other people want. We discuss how they can practice these skills in the here and now of their lives.

There are times when my patients can grasp the theories we discuss, but have a difficult time stopping their own cycles of poor self-worth, inability to set boundaries, and bad decisions. In these cases, involving their families or significant others can be helpful. Sometimes the patients end up repeating their cycles in their therapeutic relationship with me, and on some of those occasions I may have to set strong boundaries with them to role model appropriate behavior. And in order to avoid enabling the cycles that keep them stuck, I might even have to stop treating them. During our final session, I remind them that they are worthy and that it is imperative that they work on knowing and setting limits with others so that they can nurture their own self-worth and sustain and nurture their most important relationships.


Hawaii's Lack of Psychiatrists

Check out this informative article in Honolulu Civil Beat- Hawaii’s Mental Health Care Crisis: The lack of psychiatrists is a particular problem for people who rely on the state’s public health insurance for low-income residents.

https://www.civilbeat.org/2018/09/hawaiis-mental-health-care-crisis/

I am grateful to have my thoughts included.

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Thank you, San Jose Public Library!

I am a HUGE fan of BTS, so this blog post from San Jose Public Library made my day! Click this link to check it out:

YA Friday: Welcome! This is your first time with BTS, right?

SO I WRITE

Fragile men veiled in narcissism
Raised me, taught me to speak. The rule of thumb—
Tell me but let me have my way
A fluent protégé 
To selfish masters disguised as teachers
True believer
Sequestered in the open
Socially inarticulate, friendships partial or broken
I. Still. Can’t. Say. What’s. Really. On. My. Mind. To. The. People. That. Matter. The. Most.
My true words tie me a whipping post
Flog me with self-hate
Seal my fate
Deaf and mute but to men’s jargon
Visibly hidden behind wrinkled curtains
Frowning at my bad decisions
Unable to verbalize my true wishes

SO I WRITE.