Self-Care

Oludeniz Beach, Turkey

Recently, I was feeling a bit sluggish at work. Responding to emails a little slower than normal, putting off filling out invoices, being a bit more haphazard with my accounts, etc. I started to notice the signs and symptoms of work exhaustion, known in its most severe form as the dreaded, "Burn-out." (Cue ominous dun-dun-duunnn music.) I wasn't quite at burn-out levels, I still enjoyed my job, still found joy and reward in my weekly sessions with clients but I didn't have that same level of vim and vigor for my practice that I had earlier in the year. All very self-aware of me to notice this, no? Well, I'll confess that it was somewhat brought to my attention when I was conducting a group clinical supervision session for a couple of graduate-level social work students. I was inquiring as to the students' level of burn-out and exploring what self-care strategies they had devised for themselves, if any. Which of course got the mental juices working and I slowly came to the realization that I, myself, have been neglecting that all-important concept of "self-care."

Self-care sounds just a bit too cheesy and jargon-y for me which is probably why it's not really in my normal vocabulary, but admittedly it gets right to the point. No matter what job you're in and no matter how much you love it, there will likely come a point when you find yourself to be inordinately tired, physically, mentally, and emotionally, by the mere thought of getting up in the morning and going to work. The red light blinking on your phone fills you with dread because you just know someone, or likely several someones, has left you a voicemail with tasks, requests, and possibly criticism.

Come Tomorrow

I'm guilty. I'm guilty of putting things off until the last minute. I've been this way my whole life. Procrastination, it feels like a weight bearing me down until I am almost crushed. But at the same time, I'm infused with a sense of responsibility and integrity. Procrastination and responsibility do not go hand in hand, in fact it's more like they are in constant conflict with one another. Why can it feel so impossible to begin, much less finish, a necessary task right now rather than tomorrow or the next day or the next until all of a sudden you're far behind and have to climb out of the hole you've dug for yourself? What would have been easy to do today becomes nigh impossible when you finally get around to it. It's not like I'm unintelligent, I'm fully aware of the argument for being timely with tasks I'm not so excited to accomplish. And yet, somehow I manage to convince myself time and time again that this time, it's not a big deal, I really can do the job tomorrow and be completely fine. I read a blog post today on Huffington Post written by Sadhguru, an Indian philosopher who founded the Isha Foundation which administers yoga centers around the world. He writes about the phenomenon of procrastination in a beautiful way that I never thought of before.

Quality vs. Quantity

The most popular article on nytimes.com right now discusses the changing face of psychiatry in the United States. A psychiatrist tells a sad story of how his practice has changed from one of care and careful attention serving individual patients with names and stories to one of cold efficiency administering medications in a veritable factory of nameless faces. Dr. Levin laments the loss of humanity in his practice due to the nature of health insurance reimbursement. In psychiatry, insurance companies will not reimburse physicians for their time spent getting to know the patient's life and narrative. They pay a set amount per quantifiable action which is often valued quite cheaply forcing physicians (and mental health clinicians) to pack as many patients into as short a time as possible in order to make a living and pay off education and training loans. This makes developing a personal relationship with patients next to impossible which in turn leads to decreased job satisfaction on the part of the healthcare provider. Perhaps this system might make some sense for conventional medical doctors, but a psychiatrist must depend in large part on the personal side of appointments to come to an accurate and appropriate diagnosis and consideration of treatment options.

Psychotherapists who do not prescribe medication, bill insurance companies for the cost of a 50-minute therapy session and often have to fight with insurances to authorize mental health treatment and obtain reimbursement in a timely fashion. The back-and-forth phone calls with insurance companies - being transferred from one operator to another, put on hold, and receiving conflicting information from different people - is arduous, time-consuming, and frustrating.

HIV and Mental Health

I was recently approached by a writer for Yahoo's Associated Content to answer a few questions about HIV and mental health in children and youth and it's been published at this link.

Here's a good chunk from the interview, let me know what you think!

What type of a mental and emotional impact does HIV on a child?
"A child who is HIV positive has to cope not only with his or her own uncertainty of their future health but also their parents' anxiety. The stigma associated with HIV makes it extremely difficult for the child and their family to be open about the illness to relatives, friends, and loved ones. In fact, in many cases, the child him or herself may not be aware of their own diagnosis. As a therapist and social worker, I met many mothers who were concerned their child would let it slip that they were HIV positive or that someone in their family was HIV positive to teachers, school friends, or fellow church goers. The burden of holding such a painful secret follows the child through each of their milestones particularly as they enter adolescence and the world of dating and the inevitable questions of sexual intercourse. It's not uncommon for HIV positive youth to be dealing with depression, suicide, anger, and self-imposed isolation."

How can a child with HIV cope with their condition?
"First, parents or guardians can create an environment that actively refutes the stigma of HIV, whether or not the child is aware of his or her diagnosis. When the parent feels the child is old enough to have good judgment regarding disclosure of the diagnosis to others, it is important to very sensitively and carefully explain the HIV status to the child and allow the child to ask any and all questions he or she might have particularly surrounding the concept of mortality. Make it clear to the child who he or she can turn to for support and make certain these individuals are prepared and able to answer tough questions. Families may find that there are support groups for HIV positive children and their HIV negative siblings at their hospital or clinic, which can provide an outlet for youth to talk with peers who have a unique understanding of one another. There are also many summer sleep-away camps that have medical facilities on site to care for children with illnesses, allowing these kids to have a typical summer camp experience that they may not have been allowed to have otherwise. It's important for the child to be given opportunities to be a kid, first and foremost."

What type of professional help is available for a child infected with HIV?
"Unfortunately, the answer to this question is somewhat dependent on the personal financial resources of the family. For youth who can afford it, they can certainly seek out a psychotherapist who can be a non-judgmental sounding board, someone who the child doesn't have to worry about worrying. Therapy can help the child to develop strong, positive coping mechanisms and encourage self-esteem even in the face of societal stigma. However, youth with limited resources may not be able to access mental health services so readily. Particularly now, when public and foundation funding is moving more and more towards prevention and away from direct services. It is becoming more difficult to find qualified professionals in non-profits who provide free or low-cost mental health care. Moreover, health departments often pay more attention to the mental health needs of adults over children, again, limiting the resources available to HIV positive youth."

Wanna talk to Amy Chua?

Guess what DC? Amy Chua is going to be Politics and Prose doing a book signing and answering questions. If only I was going to be in town for this! But sadly, no. Anyone interested in heading over, checking it out, and reporting back?!


For more details on her appearance here in DC, check out this link.