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class="text-gray-500 mt-[1px]">Psychiatric Times</p></div><div class="flex flex-wrap max-h-[24px] text-gray-500 mb-2"><span class="text-gray-500">Vol 33 No 7<div class="inline-block h-[16px] border-l-2 border-gray-400 mt-1 mx-1 relative top-[3px]"></div>Volume<span class="font-bold ">33</span> <div class="inline-block h-[16px] border-l-2 border-gray-400 mt-1 mx-1 relative top-[2px]"></div>Issue <span class="font-bold">7</span></span></div><h1 class="text-[26px] font-medium leading-8">Foster Care</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/sidney-kelt-jr-md">Sidney A. Kelt Jr, MD</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit "></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Foster Care" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="Foster Care" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">When you have been neglected, made to feel so unimportant, passed around from place to place as though your life doesn’t matter, any genuine caring attention you can give that young person means the world. </p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class=""><div style="width:auto%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;clear:both;cursor:pointer" class=" figure"><div class="flex-none relative text-center"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%271000%27%20height=%27676%27/%3e"/></span><img alt="© shutterstock.com" title="© shutterstock.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="© shutterstock.com" title="© shutterstock.com" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F7777d2ebb4596d372d49e48b38837de5632e0584-1000x676.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F7777d2ebb4596d372d49e48b38837de5632e0584-1000x676.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F7777d2ebb4596d372d49e48b38837de5632e0584-1000x676.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><p class="text-gray-500 italic text-sm">© shutterstock.com</p><div class="top-[-100%] block w-[1px] transition-opacity duration-500 ease-in-out opacity-0 overflow-hidden"><img class="m-auto absolute inset-0 max-w-[0%] max-h-[0%] border-[3px] border-solid border-white shadow-[0px_0px_8px_rgba(0,0,0,0.3)] box-border transition ease-in-out duration-500" src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/7777d2ebb4596d372d49e48b38837de5632e0584-1000x676.jpg?fit=crop&auto=format"/></div></div><style> #image-caption p{ font-size: 12px; max-width: 525px; margin: 0 auto; text-align: center; } </style></div><p class="pb-2">As I think back over the years I have been practicing, one encounter comes to mind that has had the most impact on my development as a psychiatrist.</p><p class="pb-2">Soon after I finished my residency at a large, urban hospital that served the poor and uninsured in Dallas, I found myself entering the world of private practice with patients who had insurance, jobs, homes, food, and transportation. I also started working part time at a psychiatric hospital in a nearby rural town. A psychologist I befriended at the hospital joined my practice and soon asked me to become a consulting psychiatrist at the foster care agency where he worked. I had no experience with foster children, but I thought I needed to take on whatever jobs I could find while I was building my practice. It was a relatively new foster care agency, so I only saw up to 8 teenagers a month.</p><p class="pb-2">One of the case workers from the agency brought the children to my office every month either for a medication follow-up or an initial evaluation. The agency was well-run and took care of these children in a most respectful and kind manner. As a result, the number of youngsters in the agency grew rapidly. They could no longer be brought to my office every month in the agency van, so I drove about 20 miles to see them at the agency’s center. It was hard hearing their stories of abuse, neglect, and difficult times at such a young age. I tried connecting with these young, neglected, and unloved children-but many of them were closed off to any human connection out of fear of rejection or being moved again and ripped away from their caring foster parents. Many were angry, defiant, oppositional, and I had to build some sort of trusting relationship if I wanted them to be compliant with the medication I was recommending.</p><p class="pb-2">One day I decided to gather up a bunch of cool, flashy pharmaceutical pens that had been left at my office that week. More pens than we needed . . . ones you couldn’t just buy at a store. These pens had different colored lights, bright colors, liquids in them, lights to read by, etc. I brought them with me and as I finished with each encounter, I invited the child or teen to pick the pen he or she wanted. Soon the kids were requesting to be the first in line to see me so they got first pick of the pens. They looked forward to their visits and couldn’t wait to see what kind of pens I had brought to their visit.</p><p class="pb-2">One of those children was an 11-year-old boy who had been terribly hurt by family members and was unable to trust anyone in authority. He was so sad and depressed; no sparkle in his eyes. He wouldn’t talk, or look at me, and was quite reluctant to even take one of the pens. He did want to feel better though, and I promised him I could help him. He started on an antidepressant and within weeks was smiling, laughing, and enjoying life again. I saw him every month for the next 3 years, and he manipulated the case workers so he could be seen first nearly every time to get the best pen. He would show his latest pen off to the other kids waiting for their appointment.</p><p class="pb-2">Unexpectedly, the boy was moved to a new foster home where his older brother lived. I didn’t even know where he was staying. I felt bad not getting a chance to say goodbye to him.</p><p class="pb-2">It wasn’t long after this encounter that the pens stopped coming to the office so I had no more fancy pens to bring to the children. By then I was visiting the agency twice a month and seeing 24 children.</p><p class="pb-2">Two years passed. And then one day the same young boy’s name was once again on my schedule. No one told me he was back at the foster care agency and that he was scheduled to see me.</p><p class="pb-2">When he came into the office, I hardly recognized him; he was wearing braces, growing facial hair, and had developed into a young man. He gave me a hug and sat down in his chair. When I asked what brought him in to see me, he said, “I don’t need any medication, Dr. Kelt. I just told my case worker I was depressed so I could come see you. I missed our talks and I missed my pens.”</p><p class="pb-2">I laughed and realized he still knew how to manipulate his way to get what he wanted and had to break the news that I no longer had any pens to offer. He grinned and said that was okay. Then he reached down under his chair and pulled out a shoebox and placed it on my desk. He asked me to open the box, and when I did I saw every pen that he had been given over the 3 years I had seen him. There must have been over 40 “one of a kind” pens in that shoebox. He looked up at me, got a little teary-eyed, and said he took them everywhere he went over the 2 years he was gone. He had changed foster homes multiple times but never gave up those pens. He told me that no matter where he was, he always felt connected when he had his pens.</p><p class="pb-2">I had no idea how important those objects were to him, or how important his relationship with me was to him until that moment. When you have been neglected, made to feel so unimportant, passed around from place to place as though your life doesn’t matter, any genuine caring attention you can give that young person means the world.</p><p class="pb-2">The boy stayed at the agency until it was time for him to graduate, and he left with his box of pens.</p><p class="pb-2">I continue to work at the foster care agency, and it has now been 28 years. I drive there 3 times a month and bring a third-year medical student with me as part of <em>her</em> psychiatry rotation. I have no more pens, but sharing this experience with my medical student is the most effective way I can teach young physicians the importance of finding a way to connect with their patients.</p><h4 class="text-lg pb-4 pt-2">Disclosures:</h4><p class="pb-2"><em>Dr. Kelt is Assistant Clinical Professor at Texas A&M Health Science Center, and Psychiatry Clerkship Director at the Dallas Campus of Baylor University Medical Center. He also has a private practice in Dallas, TX. </em></p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="mb-6"><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 pl-2 -ml-6 xs:ml-0 w-screen xs:w-full mb-4 "><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="jsx-19ede9f0a5a45918 text-white text-2xl md:text-3xl pb-2 md:pb-1">Articles in this issue</div><hr class="jsx-19ede9f0a5a45918 -mr-2"/></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4'"><div class="jsx-19ede9f0a5a45918 flex pt-8 gap-12 "><a id="issueContent" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline " style="scroll-snap-align:center;text-decoration:none" href="/view/powerful-storieswinners-our-writers-contest"><div class="w-full shadow-md shadow-gray-800 overflow-hidden relative bg-white aspect-video"><span 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style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="© lonely/shutterstock.com" title="© lonely/shutterstock.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F652ce69ff0ffaef45a46c5d109ae46fe8c6461cb-1000x1065.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F652ce69ff0ffaef45a46c5d109ae46fe8c6461cb-1000x1065.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F652ce69ff0ffaef45a46c5d109ae46fe8c6461cb-1000x1065.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, 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Berlin Creative Writing Award." width="288" class="jsx-ad50481d5ee26850 lg:w-[110px] lg:h-[100px] xl:w-[135px] xl:h-[125px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full xl:w-[70%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">May 26th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/simple-tasks?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent">Simple Tasks</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/sean-boyden">Sean Boyden</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/simple-tasks?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 gap-x-4"><a class="jsx-ad50481d5ee26850" href="/view/heart-failures?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/06578fe0e5b91939b476a808dcf38815a0aba11f-4000x3000.jpg?fit=crop&auto=format" alt="Presenting the first-prize winner of the 2022 Gerald F. 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italic text-sm text-gray-500 mt-[1rem] sm:mt-0">June 22nd 2017</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/unwanted-unconditional-how-one-mothers-love-changed-my-career?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent">From Unwanted to Unconditional: How One Mother's Love Changed My Career</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/rachel-shmuts-do">Rachel Shmuts, DO</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/unwanted-unconditional-how-one-mothers-love-changed-my-career?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 gap-x-4"><a class="jsx-ad50481d5ee26850" href="/view/solace?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/455f0b6e611ac83a23d6b5a694bbacd4997801e3-800x450.jpg?fit=crop&auto=format" alt="shutterstock.com" width="288" class="jsx-ad50481d5ee26850 lg:w-[110px] lg:h-[100px] xl:w-[135px] xl:h-[125px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full xl:w-[70%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">May 30th 2017</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/solace?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent">Solace</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/amy-l-christianson-md-ms-mba">Amy L. Christianson, MD, MS, MBA</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/solace?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Foster Care","datePublished":"2016-08-05T21:44:04Z","dateModified":"2020-11-16T03:04:17Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/7777d2ebb4596d372d49e48b38837de5632e0584-1000x676.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.psychiatrictimes.com/view/foster-care"},"publisher":{"@type":"Organization","name":"Psychiatric Times","logo":{"@type":"ImageObject","url":"https://www.psychiatrictimes.com/PsychiatricTimesLogo.png"}},"keywords":"Writer's Contest","articleBody":"\n\nAs I think back over the years I have been practicing, one encounter comes to mind that has had the most impact on my development as a psychiatrist.\n\nSoon after I finished my residency at a large, urban hospital that served the poor and uninsured in Dallas, I found myself entering the world of private practice with patients who had insurance, jobs, homes, food, and transportation. I also started working part time at a psychiatric hospital in a nearby rural town. A psychologist I befriended at the hospital joined my practice and soon asked me to become a consulting psychiatrist at the foster care agency where he worked. I had no experience with foster children, but I thought I needed to take on whatever jobs I could find while I was building my practice. It was a relatively new foster care agency, so I only saw up to 8 teenagers a month.\n\nOne of the case workers from the agency brought the children to my office every month either for a medication follow-up or an initial evaluation. The agency was well-run and took care of these children in a most respectful and kind manner. As a result, the number of youngsters in the agency grew rapidly. They could no longer be brought to my office every month in the agency van, so I drove about 20 miles to see them at the agency’s center. It was hard hearing their stories of abuse, neglect, and difficult times at such a young age. I tried connecting with these young, neglected, and unloved children-but many of them were closed off to any human connection out of fear of rejection or being moved again and ripped away from their caring foster parents. Many were angry, defiant, oppositional, and I had to build some sort of trusting relationship if I wanted them to be compliant with the medication I was recommending.\n\nOne day I decided to gather up a bunch of cool, flashy pharmaceutical pens that had been left at my office that week. More pens than we needed . . . ones you couldn’t just buy at a store. These pens had different colored lights, bright colors, liquids in them, lights to read by, etc. I brought them with me and as I finished with each encounter, I invited the child or teen to pick the pen he or she wanted. Soon the kids were requesting to be the first in line to see me so they got first pick of the pens. They looked forward to their visits and couldn’t wait to see what kind of pens I had brought to their visit.\n\nOne of those children was an 11-year-old boy who had been terribly hurt by family members and was unable to trust anyone in authority. He was so sad and depressed; no sparkle in his eyes. He wouldn’t talk, or look at me, and was quite reluctant to even take one of the pens. He did want to feel better though, and I promised him I could help him. He started on an antidepressant and within weeks was smiling, laughing, and enjoying life again. I saw him every month for the next 3 years, and he manipulated the case workers so he could be seen first nearly every time to get the best pen. He would show his latest pen off to the other kids waiting for their appointment.\n\nUnexpectedly, the boy was moved to a new foster home where his older brother lived. I didn’t even know where he was staying. I felt bad not getting a chance to say goodbye to him.\n\nIt wasn’t long after this encounter that the pens stopped coming to the office so I had no more fancy pens to bring to the children. By then I was visiting the agency twice a month and seeing 24 children.\n\nTwo years passed. And then one day the same young boy’s name was once again on my schedule. No one told me he was back at the foster care agency and that he was scheduled to see me.\n\nWhen he came into the office, I hardly recognized him; he was wearing braces, growing facial hair, and had developed into a young man. He gave me a hug and sat down in his chair. When I asked what brought him in to see me, he said, “I don’t need any medication, Dr. Kelt. I just told my case worker I was depressed so I could come see you. I missed our talks and I missed my pens.”\n\nI laughed and realized he still knew how to manipulate his way to get what he wanted and had to break the news that I no longer had any pens to offer. He grinned and said that was okay. Then he reached down under his chair and pulled out a shoebox and placed it on my desk. He asked me to open the box, and when I did I saw every pen that he had been given over the 3 years I had seen him. There must have been over 40 “one of a kind” pens in that shoebox. He looked up at me, got a little teary-eyed, and said he took them everywhere he went over the 2 years he was gone. He had changed foster homes multiple times but never gave up those pens. He told me that no matter where he was, he always felt connected when he had his pens.\n\nI had no idea how important those objects were to him, or how important his relationship with me was to him until that moment. When you have been neglected, made to feel so unimportant, passed around from place to place as though your life doesn’t matter, any genuine caring attention you can give that young person means the world.\n\nThe boy stayed at the agency until it was time for him to graduate, and he left with his box of pens.\n\nI continue to work at the foster care agency, and it has now been 28 years. I drive there 3 times a month and bring a third-year medical student with me as part of her psychiatry rotation. I have no more pens, but sharing this experience with my medical student is the most effective way I can teach young physicians the importance of finding a way to connect with their patients.\n\nDisclosures:\n\nDr. Kelt is Assistant Clinical Professor at Texas A&M Health Science Center, and Psychiatry Clerkship Director at the Dallas Campus of Baylor University Medical Center. He also has a private practice in Dallas, TX. ","description":"When you have been neglected, made to feel so unimportant, passed around from place to place as though your life doesn’t matter, any genuine caring attention you can give that young person means the world. ","author":[{"@type":"Person","name":"Sidney A. Kelt Jr, MD"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-5V9L5PL" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class="w-full bg-primary flex flex-col items-center justify-center"><div class="container w-[1340px]"><div id="footerInnerWrap" class="bg-primary w-full py-12"><div class="py-4 pl-4 flex flex-row items-center"><div class="flex flex-row flex-wrap w-[55%] h-full"><div class="w-[33%] p-1 my-0 cursor-pointer text-footer-text-color hover:text-footer-text-color/80 hover:underline"><a class="text-md" target="_self" href="/about">About</a></div><div 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He did want to feel better though, and I promised him I could help him. He started on an antidepressant and within weeks was smiling, laughing, and enjoying life again. I saw him every month for the next 3 years, and he manipulated the case workers so he could be seen first nearly every time to get the best pen. He would show his latest pen off to the other kids waiting for their appointment.","_key":"iL0Iozue"}],"_type":"block","upload_doc":null},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"NuspprZ1","markDefs":[],"children":[{"_key":"ymPExcN1","_type":"span","marks":[],"text":"Unexpectedly, the boy was moved to a new foster home where his older brother lived. I didn’t even know where he was staying. 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Berlin Creative Writing Award, introduced by a brief note from the author. The Gerald F. Berlin award recognizes exceptional prose and poetry written by medical, nursing, and doctoral students; residents; and fellows. To learn more about the award, see “","_key":"1cd2756b9f29","_type":"span","marks":["em"]},{"_type":"span","marks":["0d7b5d7e415a","em"],"text":"A Headlong Act of Love","_key":"76d9178f038c1"},{"_type":"span","marks":["em"],"text":"” by Richard M. Berlin, MD.","_key":"76d9178f038c2"}],"_type":"block","style":"normal","_key":"63af7aa36c2e"},{"_key":"72fb63a0174f","markDefs":[],"children":[{"marks":[],"text":"","_key":"f4c3500b684c0","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I wrote this piece on a whim one Saturday morning, partially to procrastinate my studying for a few more hours, but mostly to articulate the complex range of emotions I had been experiencing over the course of a year. It flowed out of me in less than 45 minutes. I have come to see the practice of writing as a way of processing and healing from the many challenges that arise in medical school (and outside of medical school), while also honoring the celebrations. I was motivated to submit this essay for the Berlin prize after the piece was published on a UMass community blog, and I received an incredible outpouring of praise and support from my peers with whom it resonated. This award honors not only the piece, but the authenticity of the experiences detailed therein, and I am deeply grateful to the Berlin family for this recognition.","_key":"24d1e532ebc30"}],"_type":"block","style":"normal","_key":"c3e2f07e5a0d"},{"markDefs":[],"children":[{"text":"","_key":"08970e01dcd20","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"067a0610341a"},{"children":[{"_type":"span","marks":["strong"],"text":"Simple Tasks","_key":"da8a5f311ec50"}],"_type":"block","style":"normal","_key":"7d5213196e8f","markDefs":[]},{"markDefs":[],"children":[{"text":"“I would open it,” he snaps, staring intently at me. I’ve already grasped the door handle, but I suppose I hesitated a moment too long. The resident doesn’t take his eyes off me as I yank the door open and flatten myself behind it, making as much space as possible for him and the rest of the team to leave the room. The patient, a kind but chatty man, has been talking for 15 minutes, and we were only here to ask him a brief question. It’s well past noon, rounds have gone late, and it’s Friday: we’re all ready to leave.","_key":"de828934636e0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ea78ac2f7bcd"},{"markDefs":[],"children":[{"text":"As we walk back to the elevator, the resident educates me on “one of the best skills to develop as a med student”: the ability to sense when everyone wants to leave and open the door so that they can. “It’s because you guys are always in the back by the door. You need to relieve the obstruction.” He hurries past me to board the elevator, and I follow him in, taking my position in the back.","_key":"7d56d7150a540","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"645bb559404d"},{"_key":"db03f4295738","markDefs":[],"children":[{"_type":"span","marks":[],"text":"This is the second-to-last rotation of my third year of medical school. The curtain was pulled back for me long ago, revealing the extent of the illusion I was promised. That year of bold entry into the world of clinical medicine—filled with life-changing patient encounters, vibrant with educational opportunity—has turned out to be mostly moments like this: being made to do menial tasks, and being told I’m not doing them well enough. I’ve held doors, filed papers, cut suture strings, and printed lists for eight months. I’ve been referred to as “kid” or “the student” far more often than my name. I’ve been ignored, infantilized, and demeaned. Month after month, rotation after rotation, this year has often felt like death by a thousand cuts.","_key":"0d55886d632f0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"And yet, this year has also been transformative. I have delivered babies. I have stood through 6-hour surgeries, sidelining all my bodily needs for longer than I ever have. I have watched as a neurosurgeon pulled fourteen nails out of the head of a man my own age, a man who shot those nails himself in a desperate attempt to silence the voices he couldn’t stop hearing. I have sat for hours with a patient deep in the throes of psychosis, as he pleaded with me to believe him that he was indeed reading the minds of everyone in the building and we were all in grave danger. I have made friends, lost friends, laughed, cried. I got engaged to my partner of four years, and I have felt love deepen in ways that still surprise me every day. I have learned and grown and changed, and yet some days I feel as though I am still where I was at the outset of this year: at the back of the room, at the bottom of the hierarchy, being told that the one thing I did was not done well.","_key":"41ab6b3adfee0"}],"_type":"block","style":"normal","_key":"699c83158aca"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think it would surprise no one to hear that medicine, with all its selflessness and service, is a field plagued by cynicism and misdirected passive aggression. Healthcare worker burnout is at an all-time high. Now rounding into its third year, the COVID pandemic has left the medical world downtrodden. And I think it would surprise no one to also hear that in an environment where tensions run high and fuses are short, these frustrations are often let out on the most junior person in the room. Part of me understands it. Two years in the classroom (especially a virtual one) is ill preparation for navigating the hospital ecosystem, and so often it takes twenty minutes to teach us how to do something that an experienced intern could do themselves in five. And I’ve met and worked with so many incredible teachers and colleagues this year. But, for all the good there is in this year, it doesn’t make the bad any easier to endure.","_key":"42f87606de660"}],"_type":"block","style":"normal","_key":"f16c0b54e43a"},{"style":"normal","_key":"0b6dc3d94b57","markDefs":[],"children":[{"_type":"span","marks":[],"text":"How do we approach a problem so pervasive? A permanent solution seems unlikely to appear, at least while I am still in medical school. Our current grading system—one that places great emphasis on our seniors’ subjective evaluations of our skill and professionalism—keeps us firmly held in the lower end of the power dynamic. Should we swear to ourselves that we will never treat our students this way? Should we let ourselves grow jaded and cynical? Should we continue to go into the hospital, putting on a brave front day after day, and save our feelings of inadequacy and frustration for our loved ones, in tearful conversations and inconsolable moments? I’ve tried all of the above, but none seem to work quite as well as I’d like.","_key":"e6ac397560510"}],"_type":"block"},{"children":[{"marks":[],"text":"While no permanent solution may exist, I do offer one that I have found most sustainable—one for which the simple tasks of the third-year med student have prepared me well. It is a solution that I am reminded of that same day, in the next patient’s room. We step off the elevator into the emergency department, and fan around a small bed currently occupied by a man in his nineties. It is impossible to look at him and not notice the length of his ears. When he recounts his story of the fall that brought him here, he has an undeniably spry wit that makes me smile beneath my mask. Though he wears the same johnny and yellow socks with fall-proof rubbered bottoms as every patient in the hospital, he still has his own slippers on, a glimmer of the identity that he has mostly been stripped of here. I recognize these slippers. They’re LL Bean moccasins. I have a pair that looks almost exactly the same, given to me by my fiancé last Christmas. When the attending removes them to test the man’s Achilles reflexes, she leaves them at the foot of his bed. I know these slippers; I love how comfortable they are, how warm they keep my feet, how they help me get out of bed on the coldest of mornings. If I were in this place, this unfamiliar territory of beeping machines and crowded hallways and the constant shouting of another patient down the hall, I would cling to these slippers and the small comfort they provide as much as I could.","_key":"e3a02c823b4a0","_type":"span"}],"_type":"block","style":"normal","_key":"e852e63d7d3e","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"I think of another kind of moment I have witnessed over and over again this year. I remember the resident who held the hand of an elderly woman as she began to cry, filled with the mortal terror of the cancer diagnosis she’d received just yesterday. I remember the scrub tech who followed me out of the hospital on my last day of surgery, after I’d left before he had the opportunity to say goodbye, just so he could shake my hand and wish me all the best. I remember my classmate kneeling in front of her co-student, who has nearly fainted from exhaustion, as she peels the lid off a cup of apple juice for her. If death comes by a thousand cuts, resilience is made in a thousand acts of kindness. ","_key":"4c5ace08ea720","_type":"span"}],"_type":"block","style":"normal","_key":"a01eeb59f3da"},{"widthP":20,"disableTextWrap":false,"disableLightBox":true,"_type":"figure","imgcaption":[{"children":[{"_type":"span","marks":[],"text":"Sean Boyden","_key":"1af4324d7a070"}],"_type":"block","style":"normal","_key":"af996bae6b89","markDefs":[]}],"_key":"2089351740c6","alignment":"right","asset":{"_ref":"image-01fbaaa54c2a5be504932288db6ecc30fb535043-326x680-jpg","_type":"reference"}},{"markDefs":[],"children":[{"marks":[],"text":"It is in these little moments that we are reminded of the humanity we all share, of the reason we all answered the call of medicine in the first place. I twist the engagement ring on my finger. It’s like falling in love: it doesn’t take the pain of the world away, but rather gives you the strength to go on despite it. Kindness is a pair of slippers for the soul.","_key":"f5feb1a847bb","_type":"span"}],"_type":"block","style":"normal","_key":"9c278deb0226"},{"style":"normal","_key":"97a5c8914e27","markDefs":[],"children":[{"_type":"span","marks":[],"text":"As the team files out of the room, I stop at the foot of the bed. “Would you like me to put your slippers back on?” I ask the man.","_key":"6c6196480dfe0"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"5b9d70011acc0","_type":"span","marks":[],"text":"“Yes, please,” he smiles, “if you don’t mind.”"}],"_type":"block","style":"normal","_key":"74f09056c229"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I pick up each moccasin, gently sliding them on one foot at a time, and wish him a good day before I run after my team down the hall.","_key":"939f5d4316070"}],"_type":"block","style":"normal","_key":"e3bf7eeff216"},{"markDefs":[],"children":[{"_key":"5bb6487a10a20","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"931f1fe12af4"},{"_key":"4426a1e25e4f","markDefs":[],"children":[{"text":"Mr Boyden","_key":"f9cb242285750","_type":"span","marks":["strong"]},{"_type":"span","marks":["em"],"text":" is an MD candidate, class of 2023, at the University of Massachusetts Medical School.","_key":"f9cb242285751"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"832cc9cb0cdd"}],"_type":"block","style":"normal","_key":"dde388d407db"}],"factCheckAuthorMapping":null,"targeting":{"content_placement":["cultural-corner/writers-contest"],"document_url":["simple-tasks"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Simple Tasks","url":{"current":"simple-tasks","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"Presenting the second-prize winner of the 2022 Gerald F. 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Berlin Creative Writing Award, introduced by a brief note from the author. The Gerald F. Berlin award recognizes exceptional prose and poetry written by medical, nursing, and doctoral students; residents; and fellows. To learn more about the award, see “","_key":"dd78405279a9"},{"_type":"span","marks":["7e6be2aa3dee","em"],"text":"A Headlong Act of Love","_key":"68b1cb07d0221"},{"marks":["em"],"text":"” by Richard M. 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While my medical training is teaching me the pathologies relevant to solving medical diagnoses, I hope developing a compassionate bedside manner and reflecting regularly through writing will help me to become a well-rounded person and physician to my future patients. I am glad this award recognizes these goals, and I hope you enjoy this piece.","_key":"7abd12c895190"}],"_type":"block","style":"normal","_key":"034d4bbd6fa7"},{"_key":"7b5379b52dff","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2f107e901f4b0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Heart Failures","_key":"91accb9e976d0"}],"_type":"block","style":"normal","_key":"fa04e2e6f30b","markDefs":[]},{"markDefs":[],"children":[{"text":"Mohan peered outside his hospital window, allowing the rays from the Palo Alto sun to glisten against his rheumy eyes. He saw a cohort of hospital staff, clad in blue medical scrubs and armed with coffee travel mugs, approach the rolling greens of Embarcadero Road. It seemed they arrived to the hospital the same way they left: craving for sustenance, or sleep, or provisions. It wasn’t unlike Mohan’s attitudes during the war.","_key":"bb0c7197d9650","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"bf6f92ff25e6"},{"markDefs":[],"children":[{"text":"He returned his gaze to his shining, hairless legs, which were now embossed by the warmth streaming from the open windows. Sometimes, when he was nervous, he would press the nape of his thumb on his shin, easily creating an indent that would slowly resolve to normal shape. It was what his doctors described as a sign of his “heart failure.” He learned that over his lifetime, his heart’s pump function became weak. Fluid now pooled in his extremities, resulting in his now-nervous tick. He couldn’t believe that after everything they warned would be his mortal falling during the war—the cries of typhoid fever, malaria, or consequences of war trauma—he was succumbing to his own heart.","_key":"824022fcaba50","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d361b617e24c"},{"children":[{"_type":"span","marks":[],"text":"He returned to picking his shins, seemingly grazing his skin with the utmost concentration, though his mind was elsewhere and anywhere. He received word that there was a possibility Selvi was to visit today. Mohan stroked his neck, evaluating the possibility. He couldn’t bear the sensation of his now taut, edematous flesh underneath his collar. ","_key":"926b785f38ce0"},{"_type":"span","marks":["em"],"text":"What would Selvi think of me now? ","_key":"926b785f38ce1"},{"_key":"926b785f38ce2","_type":"span","marks":[],"text":"he wondered. He closed his eyes, longing for Selvi to collapse in the youthful strength he used to embody. He must look so different from when Selvi last saw him, when he was emaciated and energetic in fighting for the Tamil Liberation Movement forty years prior."}],"_type":"block","style":"normal","_key":"a458ef195427","markDefs":[]},{"_type":"block","style":"normal","_key":"592dc84a9d2a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Mohan?” a familiar voice softly emerged against the backdrop of his omnipresent heart monitor.","_key":"59ea4b8ca2890"}]},{"_key":"67f24ad59c8b","markDefs":[],"children":[{"_key":"81eb91f209f50","_type":"span","marks":[],"text":"Mohan’s eyes gleamed to the door. There, at the entryway of his room stood Selvi. He didn’t hurriedly cover the exposed legs he was ashamed of with hospital bed covers or hide the skin on his neck with a fresh polo. Seeing Selvi transported him to Sri Lanka in the 1980s, where he was a member of the Tamil Liberation Army while she was a doctor-in-training from Chennai, India. At the time, she was voluntarily serving to help casualties in one of the largest civil wars in recent world history."}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"Selvi approached Mohan, clutching the silk overhanging of her scarlet-colored saree. She was adorned in traditional South Asian wear. The smell of jasmine wafted in the air as she approached him—she had a tuft of flowers tucked within her thick braid, as she often wore on special occasions. Mohan made note of the lack of traditional red powder at the front of her hairline. Perhaps Selvi never ended up marrying, he wondered.","_key":"1909047c43930"}],"_type":"block","style":"normal","_key":"1fb3758dda11","markDefs":[]},{"style":"normal","_key":"369b4a18c357","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Mohan, ","_key":"5948ca6cac870"},{"_type":"span","marks":["em"],"text":"yennaachu? ","_key":"5948ca6cac871"},{"text":"What happened?","_key":"5948ca6cac872","_type":"span","marks":[]},{"marks":["em"],"text":"” ","_key":"5948ca6cac873","_type":"span"},{"_type":"span","marks":[],"text":"Selvi sat on the edge of the hospital bed, observing the indents overlaying his shins. She grasped his hands as was her nature, their now calloused palms touching for the first time.","_key":"5948ca6cac874"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"Mohan knew Selvi understood what was going on. She was at the top of her class at Chennai Medical College, and he had heard she continued to practice general internal medicine for decades. With that experience, observation itself may lend to proper deduction. And though he begrudgingly assumed she had asked “what happened” in reference to his medical condition, he silently hoped she was asking “what happened” on the topic of their relationship, that which consumed his thoughts since he left her.","_key":"264ab00ab0af0","_type":"span"}],"_type":"block","style":"normal","_key":"7b3b416ecdd9"},{"style":"normal","_key":"1ec208bdff58","markDefs":[],"children":[{"_type":"span","marks":[],"text":"But hearing her immediate usage of Tamil dialect, in a voice so familiar, felt like the juice from ripe mangoes dripping at the back of his throat, a sensation his fellow soldiers only received during the rare victories. It was a sensation he desperately longed for.","_key":"fb14727c679c0"}],"_type":"block"},{"_key":"7118caf7f48a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"She asked again, not accepting Mohan’s pregnant pause.","_key":"020e5424c9330"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"9e1b6018543f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Mohan looked into her eyes. Though her face was newly adorned with crow’s feet and smile lines, the raven-colored, prominent eyes he fell for in 1980 consumed him instantly. He remembered meeting her for the first time in the medical unit she was managing. An unexpected attack erupted in Colombo city center, and he suffered an ankle fracture in the fallout. He was mesmerized by her eyes and her astute prudence to medical detail. She meticulously sutured his ankle, rattling off standard questions about his medical history. Most women from India would not dare set foot in war-torn Sri Lanka whereas Selvi actively came to provide.","_key":"e5c69863ba610"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"At the time, Sri Lanka was under the midst of a civil war between the majority native Sinhalese and the minority Tamil population, the latter of which migrated to Sri Lanka from Tamil Nadu, India several generations before and made their home in the new land. Mohan was a 5th generation Tamil Sri Lankan. He didn’t want to go to war; he never felt any nativism growing up with Sinhalese classmates. 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I wanted to bring you a present,” she reached into her tethered shoulder purse and pulled out a keychain of a skeleton.","_key":"d0839b92e78d0"}]},{"_key":"7c6b2a8513b6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Mohan grinned. He couldn’t believe Selvi harbored this tender memory of their second meeting together.","_key":"2028c92f11cb0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"637ff39e57d8","markDefs":[],"children":[{"marks":[],"text":"“Does this ring a bell to you?” Selvi sang, half-smiling in anticipation.","_key":"4b6b461b26bf0","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"d3571cb0a30e0","_type":"span","marks":[],"text":"“"},{"text":"Pinna? ","_key":"d3571cb0a30e1","_type":"span","marks":["em"]},{"text":"Of course!” Mohan chuckled. After Selvi healed his ankle during their initial meeting, he didn’t immediately leave. He badgered her with questions about herself—Why medicine? What did she like to eat? What were her hobbies? He thought perhaps he could thoughtfully surprise her with something she missed from India one day during her time on the island.","_key":"d3571cb0a30e2","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"9e9cf5551b0b"},{"style":"normal","_key":"f4d46a63625b","markDefs":[],"children":[{"text":"Selvi was amused. She told him that she would tell him more if he were to go get her belongings from a corner room of the medical tent. But when he entered the room, he saw a full-sized skeleton the students use for anatomy lessons cowering in the dark, and he gasped in surprise.","_key":"c51722bfb1ba0","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"He blushed, taking a cursory glance at Selvi’s reaction. She was doubling down in laughter, rubbing the tears emerging from the inner corners of her eyes with her uniformed saree hanging. He shook his head, craving more from this woman.","_key":"b97e8b1dbb070"}],"_type":"block","style":"normal","_key":"b4be4e67fd73"},{"_type":"block","style":"normal","_key":"f861db89b7b1","markDefs":[],"children":[{"_key":"76efdec30e450","_type":"span","marks":[],"text":"Selvi smirked, happy with her purchase. She grazed her pruned fingertips over Mohan’s exposed legs. She recalls mornings spent in secret love, where their legs remained intertwined for hours under bed covers. In those moments, they were in solace, away from the screams of civilians above them and the announcements of bomb warnings over loudspeakers."}]},{"_key":"904b703eca62","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Mohan twisted the skeleton keychain, curious about what Selvi was thinking at that present moment. He liked it when she traced parts of his body. She often did this when they had disagreements. Mohan would back away and raise his voice, while Selvi would get close to him. It always made him feel calm and loved, even during their most intense arguments.","_key":"6c3facc8c8d10"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"“Mohan, ","_key":"817727790ac30"},{"_key":"817727790ac31","_type":"span","marks":["em"],"text":"enkalukku yennaachu"},{"_type":"span","marks":[],"text":", what happened to us?”Selvi whispered, continuing to not meet his eyes.","_key":"817727790ac32"}],"_type":"block","style":"normal","_key":"9a234ea6ef50","markDefs":[]},{"style":"normal","_key":"03c716b829ed","markDefs":[],"children":[{"_key":"92b82d565c140","_type":"span","marks":[],"text":"Mohan exhaled. The excess accumulation of fluid in his body made it hard for him to breathe. And the thoughts of the regrets of losing Selvi added on to his physiological stress."}],"_type":"block"},{"style":"normal","_key":"d58958e2c4af","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The war had never really ended. Deployments of various international armies and amnesty groups expedited the conclusion of the formal war, but discrimination continued. Mohan couldn’t bear the thought of continuing to stay in a land where so many of his brethren sacrificed themselves. He idolized the thought of moving to exotic-sounding areas in the western world, like Mountain View or Palo Alto, California.","_key":"f0a11e32b1bd0"}],"_type":"block"},{"_type":"block","style":"normal","_key":"9b118981c6fb","markDefs":[],"children":[{"text":"But Selvi wouldn’t have it. She couldn’t fathom rearing children who would lose their Tamil knowledge, reading Hemingway and Hawthorne in school instead of her treasured Subramania Bharati. In no world was she to start serving Mission burritos for meals instead of the staple Tamil meals of curd rice with mango pickle. Selvi voluntarily joined a war for the thought of her people; Mohan had no choice but to join.","_key":"1e349abd0f670","_type":"span","marks":[]}]},{"style":"normal","_key":"3de75d3cdb9a","markDefs":[],"children":[{"_key":"06c6287f7eed0","_type":"span","marks":[],"text":"In the midst of their disagreements, various cities across the world were offering limited refugee immigration portals for Sri Lankan civilians. Mohan qualified as a citizen of Sri Lanka, but Selvi did not."}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"He saw photos of Palo Alto in ","_key":"6d18f9c7278c0"},{"_type":"span","marks":["em"],"text":"Time Magazine’s","_key":"6d18f9c7278c1"},{"_type":"span","marks":[],"text":" coverage of the internet boom in the ‘90s. He shared photos of the year-long sun and blue skies with Selvi, which was in contrast to Colombo’s smog-covered clouds from years of ammunition accrual. Perhaps they would have children who could grow up safe in suburban California. They could easily make friends with the children of well-educated South Asian immigrants who were heading in droves to work as Apple and Microsoft engineers. Perhaps their children would go on to Stanford Medical School, stay near their parents, and carry on the legacy of their mother.","_key":"6d18f9c7278c2"}],"_type":"block","style":"normal","_key":"8fb87d3a950c","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"Selvi considered this. Mohan made promises to bring her over and figure out immigration information once he settled into Palo Alto. Time passed, international phone calls became more expensive, and she never came.","_key":"60a84a5107890"}],"_type":"block","style":"normal","_key":"f3898da31f8b","markDefs":[]},{"_type":"block","style":"normal","_key":"1bb47822887c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Selvi looked at Mohan. Her eyes were glassy, the black ","_key":"fed7881b00b60"},{"_type":"span","marks":["em"],"text":"kajal ","_key":"fed7881b00b61"},{"_type":"span","marks":[],"text":"blanketing her inner eye linings were wet with tears. She approached him, nestling the side of her head underneath his chin. He crossed his legs in between hers and adjusted the hospital blanket over their torsos, side by side. It was like 1980 again. They were lying together, protected from the physical noise of their surroundings and the voices of regret in their heads.","_key":"fed7881b00b62"}]},{"_key":"b2e3cfbb0861","markDefs":[],"children":[{"marks":[],"text":"","_key":"e9accbf4db9b0","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_key":"96fc6ac37f110","_type":"span","marks":["strong"],"text":"Ms Kumar "},{"_key":"96fc6ac37f111","_type":"span","marks":["em"],"text":"is a fourth-year medical student at the University of Massachusetts in Worcester, Massachusetts."}],"_type":"block","style":"normal","_key":"07a30f67d2e2","markDefs":[]},{"_key":"64c751d6028c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"56c75ff877120"}],"_type":"block","style":"normal"}],"taxonomyMapping":[{"_updatedAt":"2020-06-10T19:45:36Z","_createdAt":"2020-03-26T06:11:21Z","_rev":"BmvClBuXMtNlljYu6nhdr9","_type":"taxonomy","pixelTrackingCode":null,"name":"Writer's Contest","_id":"pst_taxonomy_3704_writerscontest","identifier":"cultural-corner/writers-contest","parent":{"_rev":"wprjukSzaYWKhfPX4FSq9A","_type":"taxonomy","name":"Cultural Corner","_id":"pst_taxonomy_53200_culturalcorner","parent":null,"_updatedAt":"2021-10-07T14:43:41Z","identifier":"cultural-corner","_createdAt":"2020-03-26T06:11:21Z"}},{"name":"Cultural Corner","_updatedAt":"2021-10-07T14:43:41Z","identifier":"cultural-corner","_createdAt":"2020-03-26T06:11:21Z","pixelTrackingCode":null,"_type":"taxonomy","_id":"pst_taxonomy_53200_culturalcorner","_rev":"wprjukSzaYWKhfPX4FSq9A","parent":null}],"authors":[{"displayName":"Dhanya Kumar","url":"dhanya-kumar"}],"documentGroupMapping":null,"factCheckAuthors":null,"summary":"Presenting the first-prize winner of the 2022 Gerald F. 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As a premiere psychiatric publication, we were compelled to provide crucial information on the psychiatric sequelae of climate change, which was the genesis of this exclusive series from the Climate Psychiatry Alliance (CPA). We urge you to follow the series in upcoming issues and our website as we cover climate-change related issues such as ethical implications and denial as well as transformational resilience.","_key":"kbAt04oN","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":" ","_key":"MUpALjSj"}],"_type":"block","style":"normal","_key":"GdRSN4Lt"},{"_type":"block","style":"normal","_key":"7dTyC2V4","markDefs":[],"children":[{"text":"Psychiatrists and other mental-health clinicians are being increasingly called upon to respond to patients’ worries about the destabilization of many aspects of our world. Within a longer series about the psychiatric aspects of climate change, this is the first of two articles dealing specifically with climate anxiety. The majority of Americans are now worried about climate change and a record 21%, one in five Americans, are ","_key":"Wl3z2GZY","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"very worried","_key":"Q290MoiN"},{"text":" about climate change.","_key":"TcqYwxrJ","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"1","_key":"cwct81uf"},{"_type":"span","marks":[],"text":" Recent hurricanes, floods, and wildfires have been reminders of climate change. Although no one event can be solely attributed to climate change, the trend to more severe storms, more heat, and overall destabilization of the climate is clear.","_key":"ElffNIOr"},{"marks":["superscript"],"text":"2","_key":"WPh2uN0Y","_type":"span"}]},{"_key":"c655gAub","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Further reading:","_key":"xnbMzdNP"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["href_1585580130825850083","strong"],"text":"In the Room With Climate Anxiety: Part 2","_key":"YBtY9QYs"}],"_type":"block","style":"normal","_key":"TyCgQ6Fi","markDefs":[{"_type":"link","href":"room-climate-anxiety-part-2","_key":"href_1585580130825850083","blank":true}]},{"_type":"block","style":"normal","_key":"8R0Gae2S","markDefs":[{"blank":true,"_type":"link","href":"climate-change-and-its-impacts-mental-health","_key":"href_1585580130444546978"}],"children":[{"_type":"span","marks":["strong","href_1585580130444546978"],"text":"Climate Change and Its Impacts on Mental Health","_key":"sqVlQvCN"}]},{"children":[{"_type":"span","marks":["strong","href_1585580130812292712"],"text":"The Changing Face of Psychiatry in the Age of Climate Change","_key":"8NZa4g4K"}],"_type":"block","style":"normal","_key":"v2HufWV6","markDefs":[{"_key":"href_1585580130812292712","blank":true,"_type":"link","href":"changing-face-psychiatry-age-climate-change"}]},{"children":[{"_type":"span","marks":["strong","href_1585580130541411102"],"text":"Climate Change and Mental Health","_key":"FETH1p4l"}],"_type":"block","style":"normal","_key":"m7AL10nv","markDefs":[{"href":"climate-change-and-mental-health","_key":"href_1585580130541411102","blank":true,"_type":"link"}]},{"markDefs":[{"blank":true,"_type":"link","href":"why-psychiatrists-should-go-green","_key":"href_1585580130978683624"}],"children":[{"_type":"span","marks":["href_1585580130978683624","strong"],"text":"Why Psychiatrists Should Go Green","_key":"rs9Yk9Rk"}],"_type":"block","style":"normal","_key":"kGKZW3Jc"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our patients are exposed through the news, and sometimes via personal experience, to an increasing pace of climate disasters and species extinctions and to reports of inadequate response by leadership. Patients who are well informed also know that, because of the long existence of many greenhouse gases in the atmosphere and because of the many positive feedback loops in the climate system, we are not simply dealing with a “new normal” of increased heat, fires, flooding, and storms. Rather our collective situation is even more serious and urgent, in ways that are difficult to fully take in emotionally. Further adding to this large psychological task of grappling with the reality of climate change is the knowledge that we are all participating in the fossil-fuel–based social, cultural, and economic systems that have brought on and that are worsening this slow-moving disaster.","_key":"ZqO6Cpk3"}],"_type":"block","style":"normal","_key":"PxUgRASz"},{"children":[{"_key":"Ywi0Wdtt","_type":"span","marks":["strong"],"text":"Understanding the anxiety resulting from this reality"}],"_type":"block","style":"normal","_key":"K7vm4Q69","markDefs":[]},{"_type":"block","style":"normal","_key":"VaNy3ETQ","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Worry over climate change can be seen as appropriate and is usually not maladaptive. A quantitative and qualitative study done using online surveys showed that people who describe habitual worry about the environment can be functioning quite well. They tend to have pro-environmental attitudes and engage in “pro-environmental behavior.”","_key":"4Yp2nBNy"},{"_key":"lgsu6eNg","_type":"span","marks":["superscript"],"text":"3"}]},{"_type":"block","style":"normal","_key":"pJIsGnTu","markDefs":[],"children":[{"_type":"span","marks":[],"text":"However significant distress over climate change is being described. Some of these descriptions are in populations that are being particularly affected. For instance, indigenous peoples have close relationships to the land and some are losing their lands-cherished aspects of their cultural identities-to climate change, producing significant distress.","_key":"DN8EuRYA"},{"marks":["superscript"],"text":"4","_key":"rdr6XBy1","_type":"span"}]},{"style":"normal","_key":"2uHw9xvj","markDefs":[],"children":[{"_type":"span","marks":[],"text":"From Australia, where there have been noteworthy droughts, came the first reported climate change delusion: a 17-year-old with delusional guilt about drinking water stopped drinking water.","_key":"w76NzigH"},{"_key":"HIvySLKz","_type":"span","marks":["superscript"],"text":"5"},{"_type":"span","marks":[],"text":" In a study of OCD patients in Australia, 28% of the participants in the study had spontaneous descriptions of OCD concerns related to climate change, such as compulsively checking to make sure that the faucets were all the way off or checking lights to make sure electricity was not being wasted.","_key":"5yYuI5gN"},{"text":"6","_key":"Um19ZUdM","_type":"span","marks":["superscript"]},{"marks":[],"text":" A quantitative study of Australians, half of whom lived in urban areas, documented significant distress over climate change, particularly among women, and in those aged younger than 35 years.","_key":"j0yohduY","_type":"span"},{"_type":"span","marks":["superscript"],"text":"7","_key":"v58EF6x3"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Distress over climate change is described in a cluster of related terms such as “climate anxiety,” “eco-anxiety,” “eco-paralysis,” and “climate grief,” all of which could be considered psychoterratic syndromes. The term “psychoterratic,” coined by the philosopher Glenn Albrecht, refers to mental conditions arising from our relationship with the natural world. One so-called psychoterratic syndrome is solastalgia, another term coined by Albrecht. The word “solastalgia” joins the Latin word for comfort with the Greek word meaning pain. It refers to the distress one experiences when a well-known environment has changed and no longer offers the same solace. It is a kind of nostalgia one can feel while still at home, an experience of loss that can be very difficult to put into words.","_key":"AFtJnS7y"},{"_type":"span","marks":["superscript"],"text":"8","_key":"lAYiGoI9"}],"_type":"block","style":"normal","_key":"LQGo7uQw"},{"_type":"block","style":"normal","_key":"Uco1bq21","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The concept of solastalgia is gaining a research base. A qualitative study of Great Lakes residents, using semi-structured psychoanalytic interviews of the residents, documented in their descriptions of their relationship with their environment an “arrested mourning.” Interestingly, these study subjects were individuals who were not particularly environmentally active.","_key":"8OEgkvYg"},{"_key":"LYqTN1zK","_type":"span","marks":["superscript"],"text":"9"}]},{"_type":"block","style":"normal","_key":"xWb51Ixq","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Place-based distress has also been documented in Australian family farmers, and in Australian residents of an area changed by mining.","_key":"3X68VBdx"},{"_type":"span","marks":["superscript"],"text":"10","_key":"C40gXA95"},{"_key":"l9bWo4cD","_type":"span","marks":[],"text":" A quantitative study of emergency room visits in Kentucky suggested a greater risk of depressive and substance use disorders in areas where there was mountain top removal mining, a process that drastically changes the landscape."},{"_type":"span","marks":["superscript"],"text":"11","_key":"uSl5y7Xe"},{"marks":[],"text":" The study controlled for other demographic factors such as socioeconomic status.","_key":"QFNVnc7S","_type":"span"}]},{"children":[{"marks":[],"text":"Another proposed psychoterratic syndrome is the so-called nature deficit disorder, a term coined by the journalist, Richard Louv, best known for his book, ","_key":"PI4KJvyv","_type":"span"},{"_type":"span","marks":["em"],"text":"Last Child in the Woods","_key":"ms3tyD9O"},{"_type":"span","marks":[],"text":". He defines nature deficit disorder as the human costs of alienation from nature, claiming that there is a “diminished use of the senses, attention difficulties, and higher rates of emotional and physical illness” as a result of our being alienated from nature.","_key":"vPYLUVVi"}],"_type":"block","style":"normal","_key":"QQOw600h","markDefs":[]},{"_key":"poB6inE0","markDefs":[],"children":[{"text":"There is some support for this concept. There are many documented salutary effects of nature exposure, including effects relevant to psychiatric disorders and treatment, such as effects on attention, rumination, and social bonding. This topic of the mental health benefits of involvement in the natural world will be explored in a future article in this climate series.","_key":"XcX5Jgb7","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"A growing psychoanalytic literature is also exploring our relationship to climate change. In addition to other psychoanalysts, Sally Weintrobe, a British psychoanalyst, editor of the book ","_key":"fFi6koQj"},{"_type":"span","marks":["em"],"text":"Engaging with Climate Change","_key":"XrhhUFRL"},{"_type":"span","marks":[],"text":", has recognized that climate change can be seen as a developmental issue. As Weintrobe describes it, just as in the development of the small child, we are collectively seeking to move from a relationship with nature as a “breast and toilet mother” to a more mature relationship where we recognize that Mother Earth has limits.","_key":"kvvePpU9"},{"_type":"span","marks":["superscript"],"text":"12","_key":"rXbGZgPa"}],"_type":"block","style":"normal","_key":"1AljaIHm"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Psychoanalysts are documenting climate distress. Rosemary Randall describes distress over the experience of ecological debt. Once someone becomes deeply aware of the fact that, in their ordinary Western life, they are engaged in activities that are negatively affecting the environment, harming both the people of today and future generations, it can be a crisis for the individual. She describes that sometimes this understanding of debt can lead to depression, masochism, or bitterness. She recommends “a sense of proportionality” about one’s guilt, including understanding the social problems that contribute to our situation, and describes how engaging in reparation in response to the sense of ecological debt can potentially reframe one’s identity.","_key":"bt2nUbDP"},{"text":"13","_key":"hfqot2t6","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal","_key":"EVX7pqZq"},{"_key":"DXza9XV6","markDefs":[],"children":[{"text":"Psychoanalyst Susan Bodnar describes cases of climate distress in young adults who engage in self-destructive lifestyles because they feel hopeless about their future lives on what they see as a damaged planet. She recommends the “environmental metaphor” as a helpful therapeutic intervention. This involves linking the patient’s self-neglect and self-destructiveness to the behavior of humanity towards the Earth and emphasizing the importance of not perpetuating this pattern but instead fighting this neglect and abusiveness. For these patients, she emphasizes the importance of working on respect for limits, boundaries, and space within their own lives. These cases are explained by understanding that the environment functions as an internal object, just as parents or siblings do. Therefore, when the environment is being treated destructively, this can influence personality development in sensitive individuals.","_key":"xbhADChJ","_type":"span","marks":[]},{"_key":"4RjThgkr","_type":"span","marks":["superscript"],"text":"14"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Working with distressed patients","_key":"HBRQd8We"}],"_type":"block","style":"normal","_key":"XI1SRPTM"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"It is generally agreed that the mental-health effects of climate change, including climate anxiety, require more research. The astute reader will recognize many possible causes of climate-related distress in the above review, including the direct traumatic effects of extreme weather events, economic effects, possible physiological effects of heat, vicarious traumatization, in addition to concern for current and future generations and ecosystems. For research purposes one might wish to parse out the multiple pathways by which climate change affects mental health. However, when we deal with a patient in our office we must accept that the multiple pathways are often overlapping and intersecting.","_key":"lLbvD7df"}],"_type":"block","style":"normal","_key":"NXykHxdr"},{"children":[{"text":"Anxiety about climate change is a bit different than other anxieties we often treat, in that our goal should not be to eliminate what in this case is usually an appropriate anxiety. As therapists, we know the importance of exploring and validating people’s feelings in a process that can help them come into a clearer relationship with reality. This is no less important when patients are distressed about climate.","_key":"BlfS5NF8","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"tpkGwllR","markDefs":[]},{"_type":"block","style":"normal","_key":"bF53WYNi","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Many patients experience deep distress as they contemplate the suffering wrought by climate change and the circumstances their children and grandchildren are facing. Such patients require witnessing in a manner that does not minimize the real basis of their distress. In our work with these patients, witnessing and validating feelings is essential and also insufficient.","_key":"leuRDj0A"}]},{"_type":"block","style":"normal","_key":"GmVJn3wV","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Given the threatening nature of climate change and its complexity, paralysis and hopelessness can easily occur. Throughout the literature on climate distress, experts counsel that we should foster active hope, emphasizing engagement. Whereas fear can produce a freezing response, action may overcome freezing via known neurophysiologic pathways.","_key":"A4XA5qKU"},{"_type":"span","marks":["superscript"],"text":"15","_key":"jv2scQAP"},{"text":" Failing to help the climate-distressed patient figure out what actions they can take may reinforce paralysis.","_key":"QTsa7fYv","_type":"span","marks":[]}]},{"children":[{"marks":[],"text":"From a psychological point of view, engagement in concert with others should be recommended for two reasons. Relationships help provide containment for potentially overwhelming feelings. The second reason for doing this work with others is the phenomenon of disavowal.","_key":"OqcmeVEG","_type":"span"}],"_type":"block","style":"normal","_key":"cjkhV5gn","markDefs":[]},{"_type":"block","style":"normal","_key":"mKVz12N8","markDefs":[],"children":[{"text":"In our awareness of climate change and its implications, we are all emerging from various degrees of disavowal, a defense mechanism described by psychoanalysts, whereby one both knows and does not know something at the same time. Being actively at work with others can foster ongoing engagement and mitigate discouragement. Otherwise one’s own tendency to disavowal can easily impede efforts, leading to further discouragement and distress.","_key":"Digyx1Jx","_type":"span","marks":[]}]},{"_type":"block","style":"normal","_key":"yCAJJm6z","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What we can do to fight and prepare for climate change","_key":"tDbTjiek"}]},{"_type":"block","style":"normal","_key":"BhWZ6s9S","markDefs":[{"blank":true,"_type":"link","href":"http://climatepsychiatry.org","_key":"href_1585580130232753445"}],"children":[{"_type":"span","marks":[],"text":"Many communities and faith groups have climate-related organizations. The Climate Psychiatry Alliance website (","_key":"bL26kTTp"},{"_key":"vZMgEIsv","_type":"span","marks":["href_1585580130232753445"],"text":"climatepsychiatry.org"},{"_key":"e66GlpBX","_type":"span","marks":[],"text":") also lists many organizations that a concerned individual might join. Actions can be taken in many realms, including:"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"• Reducing the use of fossil fuels","_key":"5g0gdXJ7"}],"_type":"block","style":"normal","_key":"9jLV9lQx"},{"_key":"DArqsibB","markDefs":[],"children":[{"marks":[],"text":"• Reducing meat consumption","_key":"ZbAv71zY","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"eZiKEv2U","markDefs":[],"children":[{"_type":"span","marks":[],"text":"• Engaging in political activity to challenge corporate and political leaders out of their denial or complacency","_key":"aVKFhaa5"}]},{"_type":"block","style":"normal","_key":"I4AKpqkl","markDefs":[],"children":[{"_type":"span","marks":[],"text":"• Financially divesting from fossil fuels and encouraging organizations with which one is affiliated to divest from fossil fuels","_key":"CxtDGcr8"}]},{"_type":"block","style":"normal","_key":"V1rI0sNM","markDefs":[],"children":[{"_type":"span","marks":[],"text":"• Contributing to the building of strong resilient communities and to the preservation of ecosystems","_key":"Pa02lMuy"}]},{"children":[{"_type":"span","marks":[],"text":"• Helping others reconnect with nature to experience our good-enough mother Earth","_key":"466ySEht"}],"_type":"block","style":"normal","_key":"nhPTlcQy","markDefs":[]},{"_key":"9FHYigZ0","markDefs":[],"children":[{"text":"• Helping raise awareness of climate change in the general public and in specific groups","_key":"FQNuFfFo","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Moreover, there are many specialized climate related projects within particular areas and professions that psychiatrists or patients can volunteer for or professionally pursue. An upside of the complexity of climate is that there are uses for everyone’s interests or skills. Any climate-anxious patients can be encouraged to engage in a way that feels right and empowering for them.","_key":"uiiLKpDb"}],"_type":"block","style":"normal","_key":"eMcCvzMk"},{"_type":"block","style":"normal","_key":"PE3gJSA1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In part 2 of this discussion of Climate Anxiety, specific psychotherapeutic and countertransference issues in dealing clinically with climate change will be described.","_key":"lrhwOYfZ"}]},{"markDefs":[{"blank":true,"_type":"link","href":"climate-change-and-its-impacts-mental-health","_key":"href_1585580130566330775"}],"children":[{"text":"READ MORE: ","_key":"C3dmW4Gj","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":"See last month’s climate change coverage: ","_key":"nfKq3VN1"},{"marks":["href_1585580130566330775"],"text":"Climate Change and Its Impacts on Mental Health","_key":"KCcyYfeX","_type":"span"}],"_type":"block","style":"normal","_key":"ZMlSdqao"},{"markDefs":[],"children":[{"_key":"mH0uIujT","_type":"span","marks":[],"text":"Disclosures:"}],"_type":"block","style":"h4","_key":"oSQXfRwG"},{"style":"normal","_key":"oZFNaRgE","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Dr Lewis is Clinical Assistant Professor, Department of Psychiatry, University of Rochester, NY, and in private practice in Penn Yan and Ithaca, NY.","_key":"kV8UeSeO"}],"_type":"block"},{"_key":"wGSDZn0x","markDefs":[],"children":[{"_type":"span","marks":[],"text":"References:","_key":"EVUiRVyn"}],"_type":"block","style":"h3"},{"_type":"block","style":"normal","_key":"NmgKC7sz","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"1.","_key":"G3Y0lUTc"},{"_type":"span","marks":[],"text":" Leiserowitz A, Maibach E, Roser-Renouf C, et al. Climate change in the American mind: March 2018. Yale Program on Climate Change Communication. New Haven, CT: ","_key":"VgexbSSf"},{"_key":"UQFj8kr0","_type":"span","marks":["em"],"text":"Yale University and George Mason University"},{"_type":"span","marks":[],"text":"; 2017.","_key":"eQc2Mb7t"}]},{"markDefs":[],"children":[{"_key":"fGnyGeS3","_type":"span","marks":["strong"],"text":"2."},{"marks":[],"text":" Walsh J, Wuebbles D, Hayhoe K, et al. Climate change impacts in the United States: the Third National Climate Assessment. Melillo JM, Richmond TC, Yohe GW, Eds. US Global Change Research Program; 2014.","_key":"sGYBUTVc","_type":"span"}],"_type":"block","style":"normal","_key":"EYbEzUe0"},{"_key":"gNW0uwat","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"3.","_key":"2vjJ0YVx"},{"_key":"OzGd0SIA","_type":"span","marks":[],"text":" Verplanken B, Roy D. My worries are rational, climate change is not: habitual ecological worrying is an adaptive response. "},{"_type":"span","marks":["em"],"text":"PLoS One","_key":"CRxJlvo1"},{"marks":[],"text":". 2013;8:e74708.","_key":"Jms9T436","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"4.","_key":"gDdazIfI"},{"_type":"span","marks":[],"text":" Cunsolo Willox A, Harper SL, Ford JD, et al. From this place and of this place: climate change, sense of place, and health in Nunatsiavut, Canada. ","_key":"fo5US3bw"},{"_type":"span","marks":["em"],"text":"Soc Sci Med","_key":"WmiTgqSq"},{"_type":"span","marks":[],"text":". 2012;75:538-547.","_key":"8CZMP32P"}],"_type":"block","style":"normal","_key":"WUZvXsvX"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"5.","_key":"OjpzttA1"},{"text":" Wolf J, Salo R. Water, water, everywhere, nor any drop to drink: climate change delusion. ","_key":"07ClYNxv","_type":"span","marks":[]},{"text":"Aust NZ J Psychiatry","_key":"4NqVrJoZ","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2008;42:4,350.","_key":"8Xzvf2jA"}],"_type":"block","style":"normal","_key":"P9SxnuWo"},{"_type":"block","style":"normal","_key":"Vkdsq1k4","markDefs":[],"children":[{"_key":"SAamQU7z","_type":"span","marks":["strong"],"text":"6."},{"text":" Jones KJ, Wootton BM, Vaccaro LD, Menzies RG. The impact of climate change on obsessive compulsive checking concerns. ","_key":"4jH3sJWx","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"Aust NZ J Psychiatry","_key":"YrWjwlaQ"},{"_type":"span","marks":[],"text":". 2012;46:265-270.","_key":"ZWEv9isp"}]},{"markDefs":[],"children":[{"marks":["strong"],"text":"7.","_key":"7bSUigx5","_type":"span"},{"_type":"span","marks":[],"text":" Searle K, Gow K. Do concerns about climate change lead to distress? ","_key":"Vqrxapfs"},{"_type":"span","marks":["em"],"text":"Int J Clim Change Strat Manage","_key":"kJfksvce"},{"_type":"span","marks":[],"text":". 2010;2:362-379.","_key":"bpx5I2Ct"}],"_type":"block","style":"normal","_key":"sQrhdJwa"},{"_type":"block","style":"normal","_key":"tmfKUhZM","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"8.","_key":"Rj1TMd7R"},{"_type":"span","marks":[],"text":" Albrecht G, Sartore GM, Connor L, et al. Solastalgia: the distress caused by environmental change. ","_key":"7dBFMVdt"},{"_type":"span","marks":["em"],"text":"Australasian Psychiatry","_key":"gw0MAEp3"},{"_type":"span","marks":[],"text":". 2007;15:S95-S98.","_key":"vr3uYxUe"}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"9.","_key":"rdDeNVUB"},{"marks":[],"text":" Lertzman R. The myth of apathy. Weintrobe S, Ed.","_key":"B1o37oHG","_type":"span"},{"_type":"span","marks":["em"],"text":" Engaging With Climate Change: Psychoanalytic and Interdisciplinary Perspectives","_key":"9IVGam5q"},{"_key":"8ONq1Cij","_type":"span","marks":[],"text":". London, New York, NY: Routledge; 2013: 117-133."}],"_type":"block","style":"normal","_key":"qWWqIHVZ"},{"children":[{"_type":"span","marks":["strong"],"text":"10.","_key":"DfIW8pRE"},{"_type":"span","marks":[],"text":" Ellis NR, Albrecht GA. Climate change threats to family farmers’ sense of place and mental wellbeing: a case study from the Western Australian wheatbelt. ","_key":"pOKdvaWe"},{"_type":"span","marks":["em"],"text":"Soc Sci Med","_key":"HGXUk88V"},{"_type":"span","marks":[],"text":". 2017;175:161-168.","_key":"B8WDuw5P"}],"_type":"block","style":"normal","_key":"27wQdnMj","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"11.","_key":"ObXSl4BE"},{"_type":"span","marks":[],"text":" Canu WH, Jameson JP, Steele EH, Denslow M. Mountaintop removal coal mining and emergent cases of psychological disorder in Kentucky. ","_key":"v0lkROcJ"},{"_key":"Cg2RNqKr","_type":"span","marks":["em"],"text":"Comm Mental Health J"},{"_type":"span","marks":[],"text":". 2017;53:802-810.","_key":"TXHK5rVu"}],"_type":"block","style":"normal","_key":"v8wpcMJI"},{"_type":"block","style":"normal","_key":"mPn5IAcH","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"12.","_key":"PDGNRsmY"},{"_type":"span","marks":[],"text":" Weintrobe S. The difficult problem of anxiety in thinking about climate change. Weintrobe S, Ed. Engaging With Climate Change: Psychoanalytic and Interdisciplinary Perspectives. London, New York, NY: Routledge; 2013: 33-47.","_key":"8t2CbnTD"}]},{"_key":"whKnRYhV","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"13.","_key":"Qx78G1Nu"},{"_type":"span","marks":[],"text":" Randall R. Great expectations: the psychodynamics of ecological debt. Weintrobe S, Ed. ","_key":"E1ZJu7XU"},{"_type":"span","marks":["em"],"text":"Engaging With Climate Change: Psychoanalytic and Interdisciplinary Perspectives","_key":"Td9VTiIn"},{"_key":"qHBmVX4l","_type":"span","marks":[],"text":". London, New York, NY: Routledge; 2013: 87-102."}],"_type":"block","style":"normal"},{"children":[{"text":"14.","_key":"U6n4pOEH","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Bodnar S. Wasted and bombed: clinical enactments of a changing relationship to the earth. ","_key":"rfTZ8DaB"},{"_type":"span","marks":["em"],"text":"Psychoanal Dial","_key":"SElerLhc"},{"marks":[],"text":". 2008;18:484-512.","_key":"Zk2fHjVA","_type":"span"}],"_type":"block","style":"normal","_key":"Y5MSsERT","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"15.","_key":"Wd6fUHeq"},{"_type":"span","marks":[],"text":" Gorman SE, Gorman JM. ","_key":"hYSaBn9j"},{"_key":"2zLRycol","_type":"span","marks":["em"],"text":"Denying to the Grave: Why We Ignore the Facts That Will Save Us"},{"_type":"span","marks":[],"text":". New York: Oxford Press; 2017.","_key":"adV27tQE"}],"_type":"block","style":"normal","_key":"tKcLj9rY","markDefs":[]}],"summary":"Psychiatrists and other mental-health clinicians are being increasingly called upon to respond to patients’ worries about the destabilization of many aspects of our world.","documentGroup":{"_rev":"CQmLKQ3I6JbLHo2MV4Sq5X","_id":"pst_documentGroup_3500_climatechange","identifier":{"_type":"slug","current":"climate-change"},"parent":{"parent":null,"_createdAt":"2020-03-26T06:12:02Z","_rev":"xOG5peVv8n6C7S2w86PQEH","_type":"documentGroup","name":"Series","_id":"pst_documentGroup_53204_series","_updatedAt":"2021-10-08T09:12:25Z","identifier":{"current":"series","_type":"slug"}},"pixelTrackingCode":null,"_type":"documentGroup","name":"Climate Change","_updatedAt":"2022-12-16T16:09:19Z","_createdAt":"2020-03-26T06:12:02Z"},"factCheckAuthors":null,"_rev":"rAA8V5lK4JeGCaMLUfKPeX","published":"2018-11-27T05:00:00Z","url":"room-climate-anxiety","title":"In the Room 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Dr Shmuts is Assistant Clinical Professor and Director of the Women’s Mental Health Program at Rowan University School of Osteopathic Medicine in Cherry Hill, NJ. She serves as the university’s Course Director for the pre-clerkship medical student program.","_key":"JFZkYR7J"},{"_type":"span","marks":[],"text":"\n\nUp until my last year of my psychiatry training, I was convinced I only wanted to consult in the hospital-that is, until I met Ms. B, a 31-year-old expectant mother. She presented to the women’s mental health clinic where I was biding some elective time during my psychosomatic medicine fellowship. She came in initially about 25 weeks’ pregnant, about 13 weeks further along than I was (which I did not disclose to her at that time).\n\nUnlike me, however, she was not overjoyed about expecting a child. In fact, she was completely appalled by the notion of becoming a mother. She had been pregnant twice before in her 3-year relationship with her boyfriend, but she had made it clear to him that she did not-under any circumstances-want children. Before this relationship, she had identified as homosexual and was exclusively dating women (and never once considered adoption) until she fell in love with her cuddly and kind boyfriend.\n ","_key":"mdxTbn35"}],"_type":"block","style":"normal","_key":"kjbS6JLa"},{"style":"normal","_key":"p7tubHNc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Related content: ","_key":"MJbDBBD7"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Antidepressants in Pregnancy: Balancing Needs and Risks in Clinical Practice","_key":"Qml4SUBP"}],"_type":"block","style":"normal","_key":"aBCBWSPt"},{"_type":"block","style":"normal","_key":"d0uJ5P4A","markDefs":[],"children":[{"_type":"span","marks":[],"text":"She had a strained relationship with her mother, to say the least, and part of her apprehension with becoming a mother stemmed from never once encountering a good, or even “good enough,” parenting model. Yet, somehow, she ended up in my office, gravid, and extremely anxious.\n\nMs. B’s case was challenging in many ways. Pharmacologically, she had a complicated history with multiple medication trials for depression and anxiety, as well as ADHD, few of which were effective, with the exception of the stimulants. With the limited data we have on psychotropic medication use during gestation, the pregnancy presented another challenge as to how to proceed.\n\nIn therapy, Ms. B would ultimately view me as a protective and safe mother figure. My own pregnancy called our situations into stark contrast-both of us pregnant, yet I the trained physician with seeming financial stability, and she the unemployed, unmarried college dropout with an unwanted child on the way. And there was my countertransference to consider when I thought, “You don’t want a baby? How can you not want a baby?!” Despite all this, I liked this patient a lot, and I yearned to help her become more comfortable with the idea of parenting. She really had no other choice, and I wanted to help her be happy with herself and her situation.\n\nThank goodness, I had a supportive and experienced supervisor. We treated her severe ADHD symptoms (with a stimulant), and she got better. She became less anxious and depressed within several weeks. Yet, she could never come to terms with being pregnant. She admitted she kept the pregnancy out of love for her boyfriend, but she had fears of resenting him, and of more concern, of resenting the baby for “ruining her life.”\n\nI had discussions with her that dispelled the popular notion that giving birth automatically leads to instant and total love of the baby. I reminded her that breastfeeding can be hard but her life won’t be ruined. I challenged her rigid notions that she would lose all sense of identity and be “only” a mother from here on out.\n ","_key":"0Kn4IEbq"}]},{"style":"normal","_key":"nmvlfIg1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"After I left the rotation, I woke up one day and said, “I want to do this. Every. Single. Day.\"","_key":"I0YnYtoj"}],"_type":"block"},{"_type":"block","style":"normal","_key":"YY2zSoIs","markDefs":[],"children":[{"text":"She gave birth, and she came in to see me 10 days’ postpartum. Things were not easy for her, but she was managing. She did not “imprint” on her child like we said she wouldn’t; she noted she was exhausted, anxious, couldn’t sleep, all complaints we had anticipated. We employed some as needed anxiolytic to help her relax. She was then able to sleep and to come into sessions.\n\nOver the next 4 weeks, Mrs. B slowly fell in love with her son. She chose his name. He was hers. She made plans for her life that involved him. She couldn’t imagine life without him. She became grateful for him. She became his mother, but she also returned to herself in the process.\n\nAfter I left the rotation, I woke up one day and said, “I want to do this. Every. Single. Day.” I changed my job search in between researching double-strollers. I developed a program for women’s mental health at my institution while rocking my newborn to sleep. Now I see patients like Ms. B every day. 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She acknowledged ongoing depression with subclinical PTSD symptoms from the suicide attempt.","_key":"0tRSEgS5"}],"_type":"block","style":"normal","_key":"ts52UAXL"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"During one of our early sessions, I asked her to elaborate on her suicide attempt. She described, in detail, being on the roof of a 6-story building, looking over the side-no, too many trees, the branches would break the fall. The next side-no, she could get hung up in the electrical wires. A third side-no, kids were playing in the street, and she didn’t want to traumatize them. Finally, the fourth: perfect.","_key":"dmhpg8Z6"}],"_type":"block","style":"normal","_key":"LpaLVcar"},{"_type":"block","style":"normal","_key":"QEMc6wiZ","markDefs":[],"children":[{"_type":"span","marks":[],"text":"She described walking to the stairway entrance to the roof, kicking off her shoes and neatly arranging them next to the door. She described pausing, taking a deep breath. Then, a running leap, hurtling over the edge of the building. But in that brief moment, a car had parked next to the curb. She plummeted onto its hood, totaling the car and terrorizing the driver. She described the pain, and the memory of him kneeling over her, pleading, panic in his voice, to stay with him, to wait for the ambulance.","_key":"k3xV7yVF"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"She was rushed to the hospital. Her multiple injuries required multiple surgeries, but she survived.","_key":"ZNTAdIZp"}],"_type":"block","style":"normal","_key":"xG8lHkJ1"},{"_type":"block","style":"normal","_key":"cOJUCrV0","markDefs":[],"children":[{"_key":"VrKi019i","_type":"span","marks":[],"text":"I was curious, wanting to know what had been going on in her head. At that time, I was processing the suicide of one of my own family members; more importantly, I wanted to understand her. How could a person willingly fling herself off the top of a building, in hopes of killing herself? Somewhat incredulously I asked, “What were you thinking?”"}]},{"_key":"OKAMWQkf","markDefs":[],"children":[{"text":"She appraised me without speaking, then nodded almost imperceptibly. Crossing her hands and laying them over her heart, she stared at the ceiling as she struggled for words. Slowly, emphatically, she replied, “I just hurt, here . . .” Her interlocking fingers tapped her chest, once, and her face winced at the memories. “I wanted it to end!”","_key":"Voi0RDUE","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"“But what about your family, your kids?”","_key":"0Lq6bdGa"}],"_type":"block","style":"normal","_key":"8fCZG84D","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"She shrugged sheepishly. “I wasn’t thinking of ANYTHING else-just how to make it stop!”","_key":"KfmABFgG"}],"_type":"block","style":"normal","_key":"Qh1qIg4J","markDefs":[]},{"style":"normal","_key":"clfbKjZs","markDefs":[],"children":[{"marks":[],"text":"We talked about it again over the next few weeks. Each week, she discussed her ongoing stressors, including chronic pain from the surgeries and frustration from her new physical limitations. Each week, she insisted that she was coping adequately and maintaining her newly found sobriety. Each week, she denied further suicidal thoughts.","_key":"PzYgaeSl","_type":"span"}],"_type":"block"},{"children":[{"marks":[],"text":"After about a month and a half, she missed an appointment. But she’d been rather flighty with her appointments, missing when scheduled and then showing up without notice. I wasn’t particularly concerned.","_key":"1vRKLAHh","_type":"span"}],"_type":"block","style":"normal","_key":"2aVvvHT3","markDefs":[]},{"children":[{"_key":"sdAqC1ig","_type":"span","marks":[],"text":"Then one day, the clinic social worker caught me in the hallway. “Ms. Davis is your patient, isn’t she?” I nodded, and her eyes brimmed with compassion. “I thought so. She committed suicide.”"}],"_type":"block","style":"normal","_key":"Td4uIhYr","markDefs":[]},{"_key":"CyUlN345","markDefs":[],"children":[{"_type":"span","marks":[],"text":"* * *","_key":"AbAiG4sW"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"The next week passed in a blur as the details emerged. My patient had alcohol and drugs, both legal and not, in her system. She’d taken herself to the top of a 20-story building. This time, when she jumped, there was no car to save her.","_key":"ov0ZH5h8","_type":"span"}],"_type":"block","style":"normal","_key":"CSJQcY9A","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Within days, the whole clinic knew. One colleague approached me with horrified fascination, staring at me like I was the dissected earthworm in biology lab, and commented, “And you’re one of the good ones-no one thought this would happen to you, of all people!” Another colleague intoned, “I know you did the best you could,” unintentionally highlighting that my “best” simply hadn’t been good enough. Another colleague confided, “God, I just don’t know what I would DO if that happened to me!” And another quipped, “Well, they say that most psychiatrists will have a patient commit suicide-at least you’re done with your quota!” Sickened, I found myself distancing, pulling away from all but my closest friends.","_key":"RpJ9rzof"}],"_type":"block","style":"normal","_key":"yLp3sSyO"},{"style":"normal","_key":"zdyBo8oh","markDefs":[],"children":[{"_type":"span","marks":[],"text":"My mentors staunchly supported me, and the risk management representative assured me that I wasn’t at fault. Still, I found myself replaying the last interactions in my mind, reaching for clues. Even with the certainty of hindsight I was baffled, unable to identify any telltale signs. I began to question myself as a psychiatrist-would I miss other clues, in other patients? Maybe I wasn’t cut out for this profession?","_key":"nNALsS0e"}],"_type":"block"},{"_type":"block","style":"normal","_key":"xOdJk3vK","markDefs":[],"children":[{"_type":"span","marks":[],"text":"And through it all, I grieved the death of my patient, a person who had come to me for help.","_key":"y00AUHHw"}]},{"_type":"block","style":"normal","_key":"Dq9yZD36","markDefs":[],"children":[{"_type":"span","marks":[],"text":"* * *","_key":"6Pq9boV4"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Now, I view this encounter as a kind of gift, and I feel almost privileged to have met her. This patient, for all intents and purposes, should have been dead after her first attempt. This was no cutter, who scratched the skin whenever she had a fight with her boyfriend, or pill popper, who took 4 Tylenol and then insisted that family rush him to the hospital for his “suicide attempt.” No, her attempt had been coldly calculated and very nearly lethal. Yet she’d been insightful and intelligent, and she’d trusted me enough to confide in me.","_key":"SmpTMrYN"}],"_type":"block","style":"normal","_key":"W9qt1xsc"},{"_key":"aNdxu2E1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"She’d allowed me a glimpse into the suicidal mind. And, in that way, she taught me a lot.","_key":"TT77NN5c"}],"_type":"block","style":"normal"},{"style":"normal","_key":"MVl0FvBF","markDefs":[],"children":[{"_key":"f4Mt5yst","_type":"span","marks":[],"text":"I’ve learned not to be afraid to ask the sensitive questions: "},{"marks":["em"],"text":"Are you having thoughts of suicide or of wanting to be dead? By doing what? What stops you? If you’ve tried in the past, how do you feel about not having succeeded?","_key":"quK8tGLd","_type":"span"},{"_key":"1Kpyknwy","_type":"span","marks":[],"text":" Sometimes patients seem taken aback, since it’s not considered socially acceptable to talk about killing themselves. But I ask calmly, clinically, like a gynecologist taking a sexual history. And, with rare exceptions, patients respond in kind. Most indicate that they’re not having suicidal thoughts, but some admit that they are. And some, with relief washing over their faces, thank me for asking, because they were afraid to bring it up. But if they can’t discuss suicide in a psychiatrist’s office, where can they?"}],"_type":"block"},{"_type":"block","style":"normal","_key":"YpzZgqj1","markDefs":[],"children":[{"marks":[],"text":"I’ve now been privy to that horrible suffering-gut-wrenching soul pain, the kind that morphine or nerve blocks won’t touch. I’ve seen how that pain can be blinding, to cause an otherwise reasonable person to behave in ways that he or she might not even have previously considered, to forgo everyone and everything that’s held dear. That insight has given me an understanding of my own family history of suicide and allowed me some element of closure.","_key":"jCrUfZN7","_type":"span"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"And I’ve learned that, even though I try my very hardest, not everyone can be saved. I’ve learned to accept, and to know that there’s no guilt in that. Only a resigned sadness.","_key":"6ckoNynm"}],"_type":"block","style":"normal","_key":"M7SmKLo2"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"* * *","_key":"6Nu0dx4x"}],"_type":"block","style":"normal","_key":"Ynq3zm8m"},{"_key":"LFdvOK6Q","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It’s been years since her death. I did remain in the field of psychiatry, and I continue to treat patients for depression. And on a societal scale, I work to raise awareness of the risk of suicide: severe depression, if unaddressed, is a mortal illness.","_key":"eadPf6C9"}],"_type":"block","style":"normal"},{"_key":"PcnbAuKe","markDefs":[],"children":[{"_type":"span","marks":[],"text":"But I still vividly remember her. Occasionally, in the elevator of a tall building, I feel a momentary chill as I push the button for my floor.","_key":"mZSpOeUf"}],"_type":"block","style":"normal"},{"style":"normal","_key":"otq4oQuz","markDefs":[],"children":[{"_key":"iQPnjJ2m","_type":"span","marks":[],"text":"I wish her peace. "}],"_type":"block"},{"style":"normal","_key":"lSi0X3em","markDefs":[],"children":[{"_type":"span","marks":[],"text":" ","_key":"VhmFbzwW"}],"_type":"block"},{"_type":"block","style":"normal","_key":"pWQFAuTu","markDefs":[],"children":[{"_key":"heSEC22T","_type":"span","marks":["strong"],"text":"Editor’s Note:"},{"marks":["em"],"text":"When","_key":"QjRMPf5m","_type":"span"},{"_type":"span","marks":[],"text":" Psychiatric Times h","_key":"aXmrmNWN"},{"_type":"span","marks":["em"],"text":"eld a writer’s contest last year, we invited readers to send us their story of one memorable patient who stood out-someone who taught them a valuable lesson and ultimately helped them become a better psychiatrist. The stories we received told of intimate bonds forged between doctor and patient under extraordinary and dire circumstances-tales of connections shared by 2 unique individuals that transcend medicine and run soul deep. Dr. Christianson’s essay was notable among the many memorable essays we received.","_key":"lGxtqXoq"}]},{"_type":"block","style":"h4","_key":"sxFr2fFW","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Disclosures:","_key":"zPdRO2LU"}]},{"children":[{"_type":"span","marks":[],"text":"Dr. Christianson is a Psychiatrist at Cedars-Sinai Medical Center in Los Angeles, specializing in solid-organ transplant patients.","_key":"Aw0WRFkb"}],"_type":"block","style":"normal","_key":"SitJ8tip","markDefs":[]}],"_createdAt":"2020-02-25T15:39:29Z","is_visible":true,"published":"2017-05-30T21:47:08Z","title":"Solace","summary":"My patient allowed me a glimpse into the suicidal mind. 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