mental health

YOU DON’T HAVE TO LOVE ME, YOU DON’T EVEN HAVE TO LIKE ME, BUT YOU WILL RESPECT ME (LYRICS FROM BOSSY, BY KELIS)

Yup, I live by those lyrics in my work as a child, adolescent, and adult psychiatrist. Let me explain.

Behavior is often driven by unconscious triggers, feelings, and biases (race, gender, etc.). When people behave without awareness of what they are doing and/or why they are doing it, their actions and choices can leave them isolated, caught up in anxiety, depression, or other mental health difficulties, and unable to form meaningful relationships. My job is to help patients become self-aware of their unconscious behaviors and biases so they can “live their best lives.”  Often these unconscious behaviors and biases are linked to their past experiences (with family, environment, etc.). 

Interestingly though, it’s not uncommon for some patients to consciously behave in negative ways towards me, but lack understanding about why they’re doing it. Here are some examples:

  • Not showing up to scheduled appointments

  • Not paying copays on time, or at all, when they possess the financial means

  • Wanting to be friends

  • Attending appointments high or drunk

  • Expecting or demanding that I fill out forms that are not medically necessary

  • Expecting or demanding that I prescribe medications that are not medically appropriate

  • Not attempting or following through on treatment recommendations but then expecting or demanding that I do what they say when they say it

  • Being flirtatious 

  • Making subtle misogynistic, racist, or belittling comments

  • Lying


It’s difficult to withstand these types of behaviors sometimes, and I’m not perfect, but I understand the psychological link between maintaining strict boundaries and patient improvement. I understand the importance of turning misbehavior towards me into therapeutic gains for patients because the goal of therapy is to not need it anymore. If patients are willing to work with me on getting through the strict boundaries I set forth, and trying to change their behavior towards me, then we can explore the unconscious reasons that motivated them to do so in the first place. And that is where the money’s at. You see, that psychotherapeutic work can lead to increased self-awareness and lifelong improvements in self-worth, decision-making, and relationships.



Giddy in all the good feels from this BLOODY SEOUL review in CLEAVER LITERARY MAGAZINE

I appreciate this review by a strong advocate of diverse children’s books…

https://www.cleavermagazine.com/bloody-seoul-a-young-adult-novel-by-sonia-patel-reviewed-by-kristie-gadson/

cropped-Cleaver-Litmag-Header.jpg

BLOODY SEOUL
by Sonia Patel
Cinco Puntos Press, 276 Pages
reviewed by Kristie Gadson

To Rocky, the city of Seoul is truly something to behold. Sprawling skyscrapers dare to kiss the sky, thousands of lights rival the sun at night, and millions of people bustle through at any given moment, while the Han River remains a calm force through it all. And it will soon be his to rule, just like his father, the leader of the city’s most notorious gang, Three Star Pa.

However, despite Rocky being the sole heir and next in line to become the big boss, his father refuses to turn the gang over to him. Frustrated, Rocky isn’t entirely surprised. It’s one of too many unanswered questions that plague him, especially since his mother’s faded memory threatens to slice the edges of his own mind like a knife.

Aim. Throw.
Sixteen times, one for every year of my life.
Aim. Throw.
Ten times, one for every year mom’s been gone. 
Aim. Throw. 
Ten times, one for every year Dad’s been the most pissed off person I’ve ever known.

In Sonia Patel’s poetic, fast-paced and electrifying second novel Bloody Seoul, the thread of Rocky’s past unravels the life he has carefully planned. Molding his life to mirror his father’s, he leads his own Three Star Pa gang made up of his closest friends. He beats up his weaker classmates, fist fights to defend his turf against rival gangs, and torments Ha-Na, a mixed Korean and Indian girl whom he regards as an easy target. Rocky’s life is structured to form the future he desires; but his mind frequently dives into the pool of reverie, where the ghost of his missing mother beckons and the needles of his fractured family sting.

What makes Rocky’s story so tangible is how Patel invokes memory and stitches it throughout the first-person narrative. Rocky’s past comes forth by means of his senses: he sees a family photo and remembers a time when his father was happy, he feels his mother’s love within the careful stitch work of the handkerchief he keeps, and smells her scent when he smokes her favorite brand of cigarettes. He also hears her humming when he plays his favorite songs and feels the presence of his uncles when he eats their favorite dishes. Memory is naturally triggered by the five senses, and Patel uses these to further develop Rocky’s character and have us connect with him.

The memories of his past reveal many open wounds, forcing Rocky to confront his father about what really happened to his uncles, his mother, and their family. But his father answers Rocky’s questions with threats and bruises, a direct violation of the first code of Three Star Pa: Family comes first. Family is to be protected at all costs. His father’s blatant disregard of that code forces Rocky to realize his father’s true nature and the lengths his father will go to get what he wants.

There are many ways I’m like my dad, many ways I want to be like my dad, but killing people isn’t one of them.

Patel’s writing shines. Her words flow across the page like a poem – descriptive yet succinct, observant of an entire world in so few phrases. Her writing style reflects Rocky’s character. It is observant, wastes no time equivocating, and takes everything in while focusing on what’s most important with sharp precision. The language may seem shallow at first – like Rocky’s perception of his own life and goals – but the more Rocky plunges into his memories, the deeper the language pulls readers in.

Patel explores how the interconnectivity of memory and family shapes one’s identity. Rocky’s identity is hugely shaped by his relation to his father and Three Star Pa, which had always remained unchallenged. Memories of his past and, most importantly, of his mother undermine this identity, causing it to crack and break. His journey toward redefining himself is a difficult one that readers can relate to. Who are we if not an extension of our family? When memories of a difficult past cause us to break away from our families, how do we go about defining ourselves without them? And who do we let in to our chosen family?

To these questions, Rocky learns there is no easy answer. Discovering who we are is simply that: discovery. And there is no end to it. It’s a journey with no set destination, and in the face of hardship all we can do – all we must do – is keep moving forward. Bloody Seoul teaches us this lesson through colorful and subtly powerful storytelling, gripping readers from beginning to end. A one-of-a-kind read.

New life just around the bend.
More happiness than I can comprehend.

◊◊

Kristie Gadson is a recent graduate of the University of Pennsylvania with a Bachelor’s in English. But, formalities aside, she knew that children’s books would become her passion when she found herself sneaking into the children’s section of Barnes & Noble well after she turned eighteen. She is a strong advocate for diverse children’s books, and writes diverse children’s book reviews on her blog The Black Sheep Book Review.

THE MORE TRUMP AND HIS SUPPORTERS REJECT & HARM DIVERSITY, THE MORE MANY OF US WILL EMBRACE & ADVOCATE FOR IT.

MY CONTRIBUTION OF THE DAY: A PROCLAMATION TO PUSH THE BOUNDARIES OF WHAT IS SEEN AS DIVERSE IN YA FICTION.

DEAR YA FICTION, NOT ALL DIVERSE TEENS CELEBRATE THEIR CULTURE(S) 

By: Sonia Patel

In June, my husband and I took our two half Filipino-half Indian teenagers and their three half Filipino-half white cousins to a Little Simz concert in Chicago. Little Simz, a black rapper from England, delivered nothing less than powerful, feminist bars. Her inspiring lyrics seemed to light up Lincoln Hall’s dimness and hypnotize the eager crowd. My family and I head nodded, deep in the zone. And when Little Simz spit the words “the Philippines” in a hook, our kids, nephews, and niece exploded with pride, their fists thumping their chests then pumping high over their heads. I stood behind pressing my hand on my heart and smiling, overcome with a mix of awe and happiness for them. But then a thin layer of sweat formed on the small of my back. I peeled my shirt as guilt and grief took turns trying to tug the corners of my lips down. 

Why can’t you be that proud of being Indian?

You know why.

Sure, but it’s not like you’ve ever been starving or had acid thrown on your face so get over yourself.

But things were bad in a different way.

I don’t celebrate my Indian culture. I never have. I don’t know how to because I was raised around it, not in it. Growing up, it was as if I was an outsider sitting in a dark theater watching our Indian relatives and family friends on the big screen like a Bollywood film. I studied the intricacies of my mom and grandmother’s daily Hindu worship of Thakorji. I noticed the way my mom lent a helpful ear and hand to everyone, despite some of her in-laws putting her down. I plopped down on the sofa next to my mom when she was engrossed in one of her pirated Indian movies depicting perfect, loving families. I was fascinated by the beautiful, intricate saris and gold and diamond jewelry Indian ladies wore to weddings and garba...the delicious, complicated food my mom and aunties made......the emphasis on hard work and education...the sacrifice to help my generation make it in America….

Still I didn’t feel Indian. I felt worthless. What no one knew was that at home, my family’s way of life, our secret culture, was that of isolation, conflict, and abuse. 

Now as an adult I recognize the elements of patriarchy, misogyny, and intolerance long present on one side of our extended Gujju network but the culture of dysfunction (COD) at home was its own terrible beast. Simply put, my dad was a charming tyrant. My role was his wife. My mom was his servant. My mom and I existed, voiceless, to accomodate my dad in every way. 

Instead of getting a shot at normal teen emotional development, I was in a perpetual state of anxiety to keep the peace at home, and then in my future relationships, even if that meant making poor decisions. Instead of having the opportunity to build my separate identity and self-worth, I learned that my only value was in pleasing my dad, and then men like him who similarly lavished me with attention in exchange for my emotional and/or sexual usefulness. And instead of developing skills to maintain healthy, nuanced peer relationships, especially with girls, I didn’t trust anyone.

Looking back I’ve come to understand that my family’s COD trumped any protective effects of my Indian background. Why? Because the COD was the lens through which I saw everything Indian. And since there wasn’t a single day of my youth that I experienced my Indian-ness independent of the COD, the two became inextricably linked for me. Being Indian was foreign to me yet I equated it with pain. 

I’m not alone. Many of the diverse teens I treat who live in COD don’t have strong connections to their birth culture(s) either. Let’s face it—COD is universal. In my office, when these teens reveal their agonizing stories of abuse, neglect, parental drug use, parental mental illness, and/or other severe adverse childhood experiences, their mental suffering is similar regardless of their backgrounds. It’s true that they may manifest some culturally specific variations in symptoms, but there are undeniable commonalities in their negative thoughts, feelings, and behaviors. That and the medically proven trauma-induced brain changes are the same. 

In order for youth to survive traumatic experiences that are out of their control, dysfunction can become hardwired in their developing brains. They can become stuck in survivor mode as COD clouds their vision and becomes the blueprint for future relationships, leaving them prone to an endless cycle of repeating and recreating what they’ve endured at home with others. This is largely why the buffering effects of their birth culture(s), such as positive relationships with extended family members or participation in traditional activities and religious practices, can remain out of reach.

It’s crucial to understand that these diverse teens are often alienated from their backgrounds because they never experience it apart from their COD. They are shoved onto different playing fields of development far apart from teens being reared in healthy families where culture isn’t shrouded in toxicity. So to expect all teens, particularly those from cultures stereotyped as nerdy and family-oriented immigrants, to rise above their struggles is unrealistic. More likely these vulnerable teens living in COD may have extreme difficulty making friends. Or, they may choose another family of  “bad kids.” They may not be able to set limits with people. They may engage in repeated risky, quick feel-good behaviors (sex, drugs, alcohol, etc.) not condoned by their birth culture(s).

Let’s take fifteen-year-old Kaya (not her real name), a part Native Hawaiian-Filipino-Japanese girl who I began treating recently. She wants to feel connected to her family’s blended way of life but can’t. She’s spent her youth battling recurrent negative thoughts, flashbacks, depression, suicidal thoughts, and worthlessness. Our talk therapy to this point has given her insight into why her neural circuitry hardwired with depression and anxiety—it allowed her to survive the abuse. Her symptoms told her that the abuse was her fault, thus giving her a sense of control in a situation that’s been totally out of her control. It’s my fault. I’m bad. I deserve it. Why else would the people who say they love me the most hurt me the most? Why else would the people who’ve taught me cultural values of family, respect, and honor treat me and each other like this? She wants to feel pride when her family participates in Native Hawaiian activism but ends up feeling disgust. Her profound emotional burdens have denied her the mental free time to be a “regular teen.” She hasn’t dreamt about her future or romance or hobbies or college or achievement or the next party. She can’t help but feel like an imposter at family gatherings and traditional ceremonies. She hasn’t had a fair chance to form strong female friendships. She hasn’t been able to set limits with boys—she’s allowed them to push her around and she hasn’t been able to say no to sex like she wants to. She also hasn’t been able to come out as lesbian though she identifies as one.

This brings me to YA fiction. Obviously teens read for different reasons. Some of my diverse teen patients enjoy escaping the hardships of their lives by immersing themselves in YA fantasy, dystopia, or paranormal. Some are drawn to YA romance. There are some, however, who seek to find themselves in books. But diverse teens being raised in COD have a difficult, if not impossible, time finding themselves in existing YA fiction. At this time most of it celebrates different cultures. Most of it includes at least one functional parent who protects against the occurrence of COD and therefore makes it possible for the birth culture(s) to be appreciated. 

Kaya hasn’t found herself represented. How can she when COD has prevented her from experiencing her birth cultures without bias? How can she when she feels distant and, at the same time, repulsed by her birth cultures?

When I was Kaya’s age, I couldn’t find any Indian or Indian-American YA novels. There are some these days but I can’t relate to any of them. That’s one of the reasons I wrote Rani Patel In Full Effect. It’s why I decided to keep writing (Jaya and Rasa: A Love Story, Bloody Seoul, and a fourth YA novel in the works). 

Teens living in the complex dynamics of COD may not be able to see themselves in diverse YA fiction, including realistic bestsellers, that happen to be by or about people of their same background. To think otherwise—from my point of view as a child and adolescent psychiatrist in the trenches with vulnerable teens—is short-sighted, minimizing, and insulting to those in the midst of survival and in the most need of empathy from sources outside of the family. 

YA fiction needs to expand its boundaries beyond safe, popular stories that affirm and praise different cultures. It needs to push past the expectation that all diverse teens can conquer adversity in a tolerable way. It needs to depict the ugliness of when COD hijacks birth culture. It needs to represent the unpalatable perspectives of teens who don’t have the luxury of enjoying their cultures and working through typical teen concerns. It needs to embrace painful reality, not just what’s convenient. It needs to champion these types of troubling diverse stories the way it does those stories that make people feel comfortable, content, and less guilty. Afterall, the Kayas of the world are worth it even if they themselves can’t feel worth it yet. 

 



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.

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.

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.


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.


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.

BCDBC99E-E66A-4FCD-9186-8F974E2C9507.JPG