child and adolescent psychiatrist

WRITING IS HEALING

I often assign homework to my teen patients as part of our ongoing talk therapy, because healing doesn’t just occur in the office. Sometimes the homework is writing. It can be a poem, or prose, or a letter. The format doesn’t matter as much as the eventual outcome-that writing can facilitate the processing of complex thoughts and emotions. Not only can writing lead to healing but it can be used as a positive coping strategy during difficult, triggering times in the future.

I practice what I preach. Here’s a poem I wrote this morning to help me resolve old wounds that opened up a little…

DOOMED

When it all fell apart

It was me, my heart

That was blamed

Tossed into the fires of women shamed

Yet I scratched and crawled, dragged

My soul up the jagged

Mountain of healing

Saved myself by kneeling

To insight, not your God

No fraud

That daughters of narcissists

Are primed to exist

Solely as objects for abusive men

Cloaked in normalcy, again and again

She’s vulnerable to predators

Recreating traumatic metaphors

She reeks of selfish lies

Groomed, doomed, to repeat father-daughter highs

Four decades later I reached the mountain’s peak

And learned to speak,

Roar, because understanding is my dominion

I reject your ignorant opinions

Your blind accusations

Making my own declarations

I DON’T CARE WHAT YOU THINK.









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.






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/











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.


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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