anxiety

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.

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

IMG_0255.jpg


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/











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.