Category Archives: depression

Reopening: Community Mental Health Clinic

Dear Friends:

This week, I reopened the community mental health clinic I’ve been running for over 18 years, started by my previous beloved mentor, Dr. Neil Schiff. We have been closed since March for safety reasons. I am indebted to the community in Washington DC and Maryland for giving me the trust that they have all of these years. As we maintain extreme precautions, I am also grateful for again seeing the local community that I care for deeply.

While gratitude helps me through each day, my gratitude is tempered with outrage. Longstanding and deeply rooted health care inequities—based on race, ethnicity, and income—have been thrown into relief by the COVID-19 pandemic that cannot be minimized. Everyone is suffering, but communities of color are suffering more. The shortcomings of our system with respect to caring for the elderly are painfully visible. The risks associated with incarceration are vivid. While none of these problems originated with this pandemic, the crisis has exacerbated these injustices in devastating and tragic ways.

I am striving in joining with others to do the urgent work needed to dismantle the barriers to health that persist for so many. As you know, while this has been a long-term focus of mine, this crisis presents an opportunity to design and demand real change. These barriers threaten all of us, not just those who face them directly. COVID-19 has indubitably demonstrated that fact. None of us are untouchable.

A few years ago, the gifted Vermont artist Stephen Huneck, who suffered from chronic pain, died by suicide. He was soon thereafter followed by his wife, Gwen.

He ran a beautiful chapel near the Canadian border in Vermont, called Dog Mountain, in honor of dogs and love. His artwork graces my office. In 2015, my English Lab, Asia, and I hiked the mountain to pay homage. It was a moving experience.

In 2019, there were 1.5 million suicide attempts in the United States, that were documented. On average, there are 132 suicide attempts per day, with notably numerous ones listed as ideation and undoubtedly more that are not documented at all.

Please visit the American Foundation for Suicide Prevention for more info and suicide statistics.

  

6 Big Takeaways Regarding the Restaurant and Bar Industry

This morning I had the pleasure of meeting with government officials from the DC Department of Health and the DC Council. We discussed anxiety and coping strategies for the many service Industry employees heading back to work. Also included were local restaurant leadership/owners, business leaders, and legal experts. It was very informative, and more info to come.

Virginia is starting phase 2, Maryland is 1.5, and DC is taking a slower and more measured approach, even though throngs of protesters certainly make that a challenge.

6 Big Takeaways Regarding the Restaurant and Bar Industry

1. You can and should call in sick if you need to. You cannot be penalized or retaliated against by employers.

2. Similarly, if there are health practices in your business establishment that make you uncomfortable, you are protected as a whistle blower.

3. My point: Restaurant leadership needs to inform patrons about the procedures and protocols. Often, people who seem to have bad behavior, simply don’t know what they are supposed to be doing and not doing. Information needs to be readily available on websites and in restaurants.
People are excited to go back to restaurants, but this is not a one-sided deal. Respect those who feed you. 

4. The biggest concerns that front line restaurant and bar workers expressed to me:
–  The trade-off between potential financial hardship and risking your life and your family’s on a daily basis to do your job. Remember, that patrons do not wear masks while eating, talking, and drinking. There is inherent risk.
–  The complete uncertainty of what’s going to happen next. There could be another shut down in the near future, and there is no way to predict what’s going to happen. Business is certainly going to proceed at a lowered capacity.
–  The porous lines between Virginia, Maryland, and DC. Workers and patrons going back-and-forth, making it harder to control safety regulations. 
– The pivot. 20% of restaurant jobs, and likely restaurants that are privately owned, will be gone. How does one transfer the considerable skills that restaurant folks have to other fields?
– The importance of communication and feeling heard. I suggested that every restaurant have a team of people that are assigned to work with front of the house and back of the house workers as emotional coaches.

5. Mental health is just as important as physical health. During the pandemic, clinical depression hit the highest national average recorded, in May 2020. That month, 50% of Americans met the criteria for major depression. ( US Census Bureau)

6. Self-care is crucial. In the best of times, the industry is one of the highest for levels of stress. Sleep well, eat healthy, exercise, meditate or follow personal spiritual practices, rest, and have a strong social support network.

Seek therapy or teletherapy when needed. Resources are available.

Some thoughts on depression – Q&A

I was honored to be recently named as a Top Doc. It’s always gratifying to be recognized for good work, and this kudo comes with the bonus of having an active Q&A section on their website, where readers (and potential patients) can anonymously ask questions.  I’ve tried to find time to answer a bunch of these, and thought it might be helpful to share some of those questions, and answers, here.

This first batch all deal with depression.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can social workers suffer from depression?
Yes absolutely. Mental health workers have some of the highest burn out and that includes rates of depression, substance abuse, and anxiety. Self-care is crucial. It used to be done that social workers and psychologists were required to be in therapy as part of their training, and although that cannot be mandated by programs, I believe it’s a good thing to be in treatment at various stages of our own professional and personal lives.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can a divorce drive people toward depression?
In psychology there is a list of daily stressors or daily hassles. Going through a divorce or separation is one of the top stressors. Unfortunately, divorce is usually also combined with financial stress, location changes, shifting of social groups, family related issues, and at times issues related to children. It’s essential to make sure that you fit in time for self-care, and do some consults with a therapist to come up with a plan for coping and support.

There are many more questions on the site, on a variety of topics including stress management, OCD, anxiety and more. I’ll share more of those here, sometime in the near future.

Anxiety Toolkit

1.  Mindfulness Exercise
Start by taking a few deep breaths … breathing in through your nose … and then out through your mouth … in through your nose … and then out through your mouth. Then, while you continue to do so, gradually try to make yourself aware of:

  • 5 Things You Can See:  For example, the table in front of you, the nice painting on the wall, the fridge magnet that your daughter made, the clear blue sky outside, and the leafy green tree across the road.
  • 4 Things You Can Feel:  Once you’ve gotten in touch with five things you can see, then – while you continue breathing in through your nose, and out through your mouth – try to bring awareness to four things you can feel. For example, the chair that’s holding up your weight, your dress against your legs, the soft carpet beneath your feet, or a loose strand of hair brushing against your face.
  • 3 Things You Can Hear:  Next, bring awareness to three things you can hear. For example, the ticking of a clock, a bird chirping outside, or the sound of your children playing in their bedroom.
  • 2 Things You Can Smell:  Then, try to get in touch with two things you can smell. If you try but don’t find yourself able to smell anything, then try to summon up your two favorite smells. For example, the scent of freshly cut grass, or the aroma of a steaming mug of hot chocolate.
  • 1 Emotion You Can Feel:  Lastly, be mindful of one emotion you can feel.

Put all together, this 5-4-3-2-1 grounding exercise is really helpful for when you’re trapped in the “depression fog” and sinking deeper and deeper. It does this by getting you out of your head and in touch with your surroundings – thereby creating some separation between you and your racing thoughts and thus calming you down. Not only that, but it can be used as a preventative exercise too, for the purpose of helping you relax a little bit before something difficult – such as a job interview you’re really nervous about, or meeting someone who’s capable of triggering your depression or anxiety.

2.  Grounding Exercise with Picture Frames
If you find yourself somewhere, where you cannot do a full mindfulness exercise, this is a strategy that works almost anywhere. Find a picture on the wall, or any rectangular framed objects, such as a mirror. In school, and office, classroom, or home, you will usually be able to find something. Walk over to the framed picture. Look at the framed object, and note  the four corners.  While breathing in through your nose slowly, and out through your mouth slowly, mentally count the four corners of the picture. Keep repeating until you find yourself feeling calmer.

3.  Give yourself a timeout
When you’re trapped in the “depression fog”, it’s extremely helpful if you can calm yourself down and put a stop to your racing thoughts. As an alternative to a grounding exercise, another effective way of achieving this is through relaxing self-care practices – for example, by going for a walk, getting lost in your favorite video game, playing with your dog, taking a hot bubble bath, listening to your favorite playlist, reading a good book, watching your favorite series on Netflix, or doing anything else that mellows you out.

4.  Journaling
When you feel yourself suffocated by negative thoughts, worry, fear, or any other difficult emotions associated with “depression fog”, then another way of dealing with them is to try to “release” them. This is not only extremely cathartic – and therefore likely to calm you down – but also, when you have a healthy way to release your pent-up emotions, you’re also able to distance yourself from them, which makes it much easier for you to be able to gain clarity over those thoughts and be able to work through them.

A great way to do this is by journaling. Start with a pen and a blank piece of paper, take a few deep breaths, and then, just write what you feel (you could type your thoughts up on a computer as well, but using a pen and paper is generally recommended since it doesn’t come with distractions like Facebook and your email). Like I said, the process of writing down your thoughts is likely to relax you a little bit, and by “getting them out there” instead of keeping them trapped inside your head, you’ll find it easier to sort them out and gain some control over them.

Write down your thoughts without editing. It’s been shown to be very cathartic.

5.  Talk to an emotion buddy or coach
Just like journalling, talking to someone who you feel comfortable with and trust can also be really cathartic when you’re experiencing “depression fog”. Not only that, but someone you’re close with can also give you a new perspective on the thoughts or the situation that you’re struggling with. This can be particularly helpful, because when you’re in the midst of “depression fog”, your perspective is often negatively distorted, so talking with someone can often result in you seeing things in a more positive or less catastrophic light.  Find one or two trusted people you can talk to in times of trouble.

Dearest Loved One: A Letter About My Depression

Many people find it nearly impossible to talk about their depression, especially to their loved ones. I’ve found that for some of my patients, it helps to put it in writing. I’ve drafted this letter for anyone and everyone who thinks it might be useful. Customize and share as you wish.

Dearest (loved one),

It was hard for me to write this letter because avoidance comes more easily to me. I am writing this because you are somebody who is very important to me. I like to think that if you were going through a difficult time, you would feel free to talk to me openly, and feel listened to and supported.

I care about you so much and yet it’s really hard for me to talk about this to you. I am going through some very difficult times right now, and I want to help you understand why I might have been acting in ways that might not seem like me lately. I want to explain, and maybe ask you to support me in some helpful ways, if you would like to.

You may be wondering why I have not asked you to talk about this before. I’m writing instead of calling or speaking to you in person, because it’s a really difficult thing to talk about. It’s also not something I’m used to doing. Expressing myself in writing feels safer right now. One day I hope to be able to talk with you about my depression and anxiety, in the same way that we talk about every day stuff.

The big D, depression, is a daily struggle in my life. It’s hard for me to articulate what this illness feels like. It’s like having a fog between you and everything else in life. It’s like having a backpack full of rocks that you carry with you everywhere. It wears you down. It’s like walking through quicksand that no one else can see and hoping that today is not the day that you go under. Sometimes it’s one minute at a time.

It’s hard to talk about, because you tell me all of the beautiful things in my life I should be grateful for. How I have so much. I cannot argue, but it does not minimize the fact of the darkness.  I understand that your understanding of depression may not match my own experience. Also, because depression has a stigma and it’s not talked about much in our family, social circle, or in the world, it’s unfortunately common for people who have never been through it themselves to underestimate just how painful, difficult, and burdensome it can be.

The most important thing that I want you to understand is that suffering from depression is much more than having a bad day or feeling stressed out. A bad day is just that, a bad day, and for most people sadness may be a temporary emotion.

Depression can make people feel miserable for weeks and months, or even years at a time. It is exhausting. It can make people hate themselves and their life. Surviving can become the goal of the day and surpasses all other ambitions. It is a gut wrenching, torturous, and incredibly courageous thing to live with depression.

I also want you to know that depression is an illness. It’s to be taken very seriously, and not something where you can just pull yourself up by the bootstraps. It’s a complicated one, with no easy fix. There are literally hundreds of millions of people who suffer, often in silence.

Yes, every day I try to fight it, with all my tools. Some days I win and others not.

This letter may leave you feeling helpless. If you’d like to help, there are some things you can do. Although they may seem small, they are incredibly significant.

First, please don’t judge me. It’s hard enough to have to deal with it without feeling that I am  minimized for it. People who are depressed often feel extremely alone or abandoned. They feel incredibly vulnerable and exposed.  Second, just listen. It can be very cathartic to talk about what hurts.You have no idea how wonderful it feels to know that I can talk to you and vent without fear. Third, even when I don’t respond, and you text me or check in, it makes me feel cared for. Sometimes I don’t have the energy to respond right away. But I know that you are there. Last, it helps me if you remind me that it’s possible to overcome. Depression is an evil sorcerer that makes your brain think that this is all there is.

Without being fake, when you remind me that there is hope, that I have won the battle previously, there is light ahead, and that things will change, it makes me want to get help and keep on fighting.

Thank you, and I love that you were able to read this. It means more than I can say in words. Writing this letter makes conversations possible.

(Your name).

 

 

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.