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.


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.


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


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.


I am grateful to have my thoughts included.


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?


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



There are no solid medical studies (randomized placebo controlled trials) to prove that any type of dietary restriction (plant-based diets, veganism, vegetarianism, gluten-free, sugar-free, cleanses, etc.)  has definitive long-term benefits on growing children and teens (or adults, for that matter). Yet, many parents and youth are seduced by the lure of dietary extremism. As a physician who provides psychotherapy to kids and teens with depression, anxiety, eating disorders, PTSD, adjustment issues, etc., I need to express my deep concern about this. There are multiple levels of physical and emotional damage that can occur as a result of engaging in restrictive food behavior. And no matter how mature youth may seem, their abstract thinking is still in development and they may not fully comprehend that "cutting out carbs" may not just be "cutting out carbs." It may be a way to feel more in control of their chaotic lives. It may be a way to lose weight because they think that'll make them feel better about themselves. It may be a subtle holier-than-thou attitude they pick up from grown-ups in their lives. The list goes on.

Today’s food restriction culture is dangerous, especially for our youth. Even if well-meaning parents, adults, documentaries, and magazines don’t say the following exactly, many teens tell me that the underlying nutrition lessons are: “deny yourself and you’re better,” “restricting is not an option,” “if you don’t eat organic, you might as well eat fast food.” These smart youth describe first world food restriction as "privileged" and "elitist"  but they nevertheless feel compelled to subscribe to it. They feel alienated from their parents and peers who follow extreme diets but can't help but to follow suit. And then...oh the dark, dark places they reveal their vulnerable, developing minds go…

Bottom line: unless a youth has a serious, diagnosed medical condition that requires dietary restriction or is being raised in a family with longstanding religious dietary guidelines, it's worthwhile to take a step back from all the food hoopla and consider the potential harm in unfounded claims of miracle, cure-all, one-size-fits-all food plans and diets. 

I advise parents of my patients to keep it simple. Eat well-balanced, nutritious, and home-cooked meals with your kids as often as possible. Briefly express gratitude to the cook or comment on the deliciousness of the food, but avoid negative or black-and-white food judgments or opinions that aren't backed by science  (like “bread is crap,” “the piece of fat on the steak is so gross,” “sugar is horrible,” etc.). Kids will learn to choose good, nutritious, varied foods in appropriate portions if it’s role modeled at family meals.

Food is fuel. Meals and snacks bring people together and teach social skills and reinforce positive self-worth. Beyond that, thinking, controlling, and restricting food isn’t necessary and can be harmful.

Here are some “food for thought” articles about the pitfalls of food extremism:





My Own Hero

It took decades to escape the prison

Of Indian & American patriarchy and I’m newly arisen

Sober from the narcosis of Bollywood heroin: to be a heroine-

long-haired, buxom woman in need of a male “good samaritan”

To save her. To validate her worthiness.

Not so anymore. These days I am my own hero, impervious

To misogynistic fog, walking tall in my Timberlands

Stomping over narrow-minded hoopla, ready to withstand

The negativity that keeps coming when I’m brave & use my well-intentioned voice

To help others discover their truth and choices.

Free from the shackles of giving a fuck what you think

Cuz you haven’t lived in my skin or been on my brink.


Tomorrow is July 26, 2018. US District Judge Dana Sabraw ordered that by then, all migrant children separated from their parents who are eligible for reunification must be reunited. This deadline will most likely not be met. Either way, damage to those children has been done.

In light of this, I'd like to share a few of the slides from the continuing medical education lecture I'm giving to pediatricians and psychiatrists tomorrow at a local hospital.









Anxiety Sucks, but Trump Could Use Some.

I don’t normally wish a psychiatric disorder on anyone, but I wish Trump had Generalized Anxiety Disorder (GAD). See then he’d overthink everything instead of being so brazen. Then he’d get stuck on thinking and thinking and thinking about how other people viewed him. His anxious brain would force him to attend to other people’s feelings before his own. I’m convinced that a Trump with GAD would be a toned down more empathetic human being.

But, for most people afflicted with any of the anxiety disorders, especially kids and teens, life is extra challenging.

A major component of anxiety disorders is overthinking. So when presented with a situation, a youth with anxiety disorder will automatically and effortlessly come up with every possible cause and effect of said situation. If the situation is dangerous, than this overthinking is a good thing. A biologic, rewired brain, protective thing (Anxiety disorders like PTSD can develop after or during exposure to adverse experiences such as abuse). But when the situation is no longer dangerous and it’s just plain old life, the overthinking is detrimental. It prevents the youth from being in the moment, developing their complete identity & positive self-worth, and making good decisions. They end up trapped in an endless loop of negative automatic thoughts, feelings, and behaviors based on what they perceive will keep others happy even if they harm themselves or someone else. Here’s a common example of overthinking that teen girls tell me about in the office: “I was at a party, the parents were out of town. And the guy I was kind of dating wasn’t there. This popular boy started talking to me. I used to like him so I was all giddy inside. Anyway, he gave me a beer and I didn’t really want to drink it but I did. He started touching me and it was cool at first. But then I wasn’t sure. I tried to move his hand away, but he was like, ‘Come on, I’ll be gentle. Don’t give me blue balls.’ I told him I had a boyfriend but he said ‘he doesn’t have to know.’ I knew that was wrong but he kept trying to convince me. I’d never had sex before and I didn’t want to but I couldn’t say no. If I said no he would get mad. He’d tell everyone I was a loser. He’d hate me and then everyone would hate me. So I let him. Hey, I’d rather deal with it than risk having him mad at me.”

Woah, right? But that is how powerful anxiety is. It makes youth do things their rational selves wouldn’t do.

In addition to overthinking, anxiety disorders can also make youth hold the opinions of others as definitively true. They have difficulty creating thought and feeling boundaries and are often unable to cling to rational thoughts of themselves. And this can have tragic effects. A common example of poor thought and feeling boundaries that teens tell me about: “The kids at school teased me about being fat ever since I was in second grade. It was so bad. I didn’t tell anyone. No one helped me. I even started making fun of myself. I hated what they said but I hated myself more. I started skipping meals. Exercising in my room at night. By the time I got to high school, I was binging and throwing up everyday. I still got teased. Nothing I did made me lose weight. I couldn’t stop thinking about what a worthless piece of shit I was. Am. I wanted to die. I tried to kill myself a couple of times…”

In med school and residency, I’ve gotten top notch training on how to help kids and teens with anxiety disorders. But more than that, I have an anxiety disorder and I’ve come to understand how it almost destroyed my life—this has made me passionate about helping anxious youth find their way through the quagmire of overthinking. And I practice what I preach. I practice being mindful and in the moment. I practice doing cognitive behavioral therapy on my automatic negative thoughts. I get enough sleep. I eat regularly. I exercise regularly. I don’t partake in social media. I try to work on expressing my true thoughts and feelings in the moment even though it takes everything inside of me to do so sometimes.

My latest battle is not internalizing the harsh negative online reviews people have posted about me as a psychiatrist. Things like, "I didn't like her at all" or I'm "unprofessional." My personal favorite, I'm "the worst psychiatrist." Luckily, these days I can fight off the anxious overthinking that tries to make me ignore all the evidence that points to the opposite of their disapproving opinions—that there are more positive reviews online than negative, that reviews shouldn’t really matter at all because I know in my heart that I give my all to my patients in every session (even if that means pointing out things that they don’t want to hear since I know this will give them a better chance of truly healing), that I don’t just do fifteen minute medication checks, that I will not prescribe medication unless it is medically necessary, that I insist on family therapy if indicated because youth don’t exist in a vacuum, that I do intensive talk therapy with youth with the goal of making them assertive, self-confident, and able to utilize a myriad of coping strategies to recover from—and/or live with at a manageable level—whatever psychiatric disorder(s) that plague them. All that and I’m not Trump.