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Physicians, mental illness, and the problem with ‘passing’

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M.The patient sits with her back bent, her gaze fixed on the taupe-colored industrial carpet as if she were fervently avoiding Medusa’s gaze. She tells me about the depression that has haunted her life, undermined her career, and infiltrated her relationships. She tells me about the drugs that she tried that “failed” as if patients were failing and not the other way around. She tells me about lovers and friends who burned out and fell by the wayside. In short, she tells me about the loss, shame and despair that accompanies life on the edge in an experience-rich war zone.

And while she is speaking, she does not know that all of this is terribly, incredibly familiar to me.

I’ve spent the past two decades leading a double life. Outwardly, I’m a psychiatrist – I’ve worked in hospitals, clinics, and private practices. Internally, I often struggle with hopelessness and depression. During my assistantship I spent many days wondering who was more depressed, my patient or me. On ward rounds and at staff meetings, I spoke professionally about patients with mental illness, as if the experiences of despair, isolation, shame, and regret were not reverberating within me.

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Most of my 20 year struggle with depression, littered with lost jobs and relationships and riddled with unsavory experiences such as hospitalization and electroconvulsive therapy (ECT), is in the past. I no longer go to the supermarket to buy a banana and a can of yogurt because the future seems uncertain. Yet every time I talk to a patient about ECT or ketamine, or one of the numerous drugs I have personally tried, every time I sit with someone who is deeply depressed, my lived experience feels very close.

Erving Goffman, a sociologist who studied hierarchical and relational patterns between groups of people, would have called my experience “temporary”. In his seminal 1963 book, Stigma, Goffman identified the ways in which individuals with “undesirable traits” experience interactions with those who lack these traits. Goffman’s subjects varied widely, from those with physical differences, character defects (people who were incarcerated, people with mental illness, and the like) and those of a race or religion other than the cultural norm. Goffman’s genius was that his work was utterly indifferent: it involved indicting the effects of discrimination without ever using the language of social justice. As Goffman wrote, “By definition, of course, we believe that the person with a stigma is not entirely human.”

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Goffman made an important distinction between those whose difference was visible or discernible and those to whom it was hidden; the “discredited” vs. the “discredited”. To some extent, the problems of these groups diverge. The person with an invisible stigmatizing quality is constantly afraid of being exposed. The individual, like me, acquires a double life: there are those who know about the person’s undesirable state and those who do not.

It becomes essential for the individual concerned to keep these groups separate and to protect his secret in general society. Goffman defined such a precarious, tense existence as “temporary”. As he noted, the effort to persist creates an effort.

Psychiatrists often tell people that there is no shame in being mentally ill. The illness is an illness or the product of traumatic experiences or both, depending on the camp – in any case, the patient is not to blame. Yet clinicians eagerly guard their own history of mental illness. A doctor patient of mine goes to another city to fill out prescriptions so that the pharmacist does not recognize him as a doctor. Another asked me to provide her with drug samples so that her insurance company would not be informed of her psychiatric medication.

My patients go by like me.

When doctors crouch down to diagnose mental illness, how can we expect patients to hold their heads?

During the pandemic, I decided to join a peer supervision group with other psychiatrists in my area. The group meets monthly to discuss both clinical and administrative issues in private practice. Zooming on a person, I call her Dr. A., worked in a private psychiatric clinic where I was inpatient 15 years ago. Years ago I had trained with him as a specialist; In fact, I had been looking after him as an inpatient since I was a year ahead.

When doctors crouch down to diagnose mental illness, how can we expect patients to hold their heads?

When looking for a new therapist, a few years ago I had a second doctor, Dr. B., consulted. Even though we had decided not to work together, he knew quite a bit about my psychiatric history.

When I saw Drs. A. and B. on the screen, I felt my heart racing and sweat collecting on my neck. I was concerned about the way I spoke and how I looked. The two stared at me over the security of the internet with huge smiles on their faces. My daughter, who knows Paul Ekman’s work on micro-expressions from the family-friendly television series Brain Games, would have named this fake smile.

During the meeting, we talked about our practices, who specializes in what, who accepts patients and who doesn’t. In other words, clinical discussion. Neither Dr. A. nor Dr. B. asked me how I was doing or admitted in some way that they knew “my secret”.

Of course, it would have been inappropriate for either of them to say, “So Susan, what’s the depression like?” Or “Have you been in the hospital lately?” But I also felt forbidden to acknowledge my previous encounters with them.

After the meeting ended, I felt first relief, then shame, and then anger. I was ashamed to be reminded of my history and I was angry that I had to be ashamed that, as a psychiatrist who was also a patient, I was not allowed to be fully seen. I felt that if I had acknowledged my history, that fake smile would have grown even wider and more fake. Because doctors are not allowed to exceed this limit: We shouldn’t become patients.

My first medical school class, like so many other students, was human anatomy. At the end of the course, I published an essay on the importance of anatomy as a first introduction to medical education. In it I argued that by dissecting the corpse, by objectifying a human body, medical students are accepted into the society of doctors and that the lesson of anatomy is essentially one of hubris.

However, I added that a second lesson is actually the opposite: humility. I held the corpse’s hand and thought that it must have held a trowel, a child’s hand, or a pencil a thousand times. The body we dissected belonged to an elderly woman. She was covered with cancer, and yet there was still some residue of pink nail polish on her fingernails. Even though she was dying, she still loved painting her nails. It is impossible not to be humiliated by the complexity of the human body and the strength and endurance of the human mind.

I want to distinguish compassion from humility. There has been much discussion of a lack of compassion in medicine, and all of this is perfectly justified. But compassion is recognizing another’s plight and wishing to alleviate it. Humility is the realization that one only goes there for the grace of God or neurotransmitters. Compassion creates care; Humility also creates respect.

It seems to me that many doctors lose sight of the principle of humility somewhere in their medical training, during the strenuous internship and assistantship or later during years of practice. We speak encrypted and refer to patients based on their illness identity, such as “Mrs. X. is a 56 year old diabetic with peripheral neuropathy “instead of her actual identity as a teacher, musician or housewife. In fact, young doctors are practiced on rounds the ability to be concise and to use as many doctoral words as possible instead of normal words.

We lose sight of or deny our own weakness and susceptibility to disease. Our patients see us as intact and invulnerable, and this illusion becomes part of our own consciousness. As I wrote in my anatomy paper, doctors draw a metaphorical line in the sand and expect death – or illness or ailment – to respect it.

Doctors are notoriously bad at treating themselves for physical and mental health problems. In a 2016 study of more than 2,000 female doctors, almost half said they thought they had a mental illness and didn’t seek help. The common reasons doctors cite for not seeking treatment are fears of admission, concerns about career advancement, and stigma among their peers. To reiterate one point, these doctors are over.

I think the fault is not with the regulatory authorities or hospital administrations, but with the culture of medicine. I suspect the people who are interested in the medical profession are precisely those who have the greatest fear of death, weakness, or vulnerability. What better way to fend off these than to stuff yourself to excess with knowledge about the body and define yourself as a caregiver?

Goffman’s book predated the Civil Rights Act, the Women’s Movement, the Americans with Disabilities Act, and the Elimination of Homosexuality as a Mental Disorder in the Diagnostic and Statistical Manual of Mental Disorders. We have become more aware of some stigmata than others, which is not to say that we have removed them. It seems to me that stigmas die hard, and perhaps the stigma of people with mental illness is most persistent.

I hope that in my lifetime it will no longer be necessary to be a member of a professional group as I did in the peer supervision group. I hope doctors with mental illness will be able to seek help and share their findings without fear of condemnation or ostracism. I hope that the doctors can accept our weakness and humility as well as our knowledge and our power.

I believe it is necessary that we do this, not only because we owe it to ourselves and our colleagues, but because we owe it to our patients not to see them as a different class from ourselves. Treating until then we people with mental illness are essentially “others” – in Goffman’s vocabulary as “not entirely human” – and give them a fake smile instead of a real one.

Susan T. Mahler is a psychiatrist in her own practice and the mother of two children.

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Women’s Health

Holy Cross Women’s Health Institute Meets the Needs of Women in Taos | Health

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SPONSORED / Meeting the health needs of every member of the Taos Family is a challenge that Holy Cross Medical Center continues to work towards. The newborn members of our ward require very different care than our older fellow citizens, and parishioners of different sexes also require different types of care. Many of women’s specific health needs can be met right here in Taos at the Holy Cross Women’s Health Institute.

Women are vital to maintaining healthy families; Not only can they become pregnant and give birth, but they are often caregivers for children and other family members and thus have an overwhelming impact on the larger community in which we live. Women also tend to live longer than men and need medical assistance at many stages of life. It is therefore particularly important that women of all ages have access to high quality medical services. Such superior health services are available to the women of Taos at the Holy Cross Women’s Health Institute.

It is a rarity in these days of hospital consolidation in rural communities that specialized women’s health care – and OB / GYN services in particular – are available locally. Many rural women have to travel an hour or more to get the care they need. Hence, it is particularly noteworthy that the Holy Cross Women’s Health Institute offers the expert care of three gynecologists – Dr. Tim Moore, who has been an obstetrician in Taos since 2007, Dr. Rameet Singh, who joined the practice in 2018, and the newest addition to the medical team, Dr. Carol Kiesling – as well as the care team of the certified midwives, Naomi Hannah and Anna Hüsner.

The Holy Cross Women’s Health Institute’s health care providers strive to ensure the health of every mother in Taos, from prenatal care to pregnancy and childbirth to post-baby care such as breastfeeding advice and family doctor care.

Women’s health care doesn’t stop with pregnancy, of course, and neither do the services of the Holy Cross Women’s Health Institute. Wellness support begins in childhood with caring for adolescent girls and puberty and continues through a woman’s entire life with family planning, breast care – including Holy Cross Medical Center’s new 3D digital mammography services – and support , during and after menopause, including osteoporosis treatment.

The Holy Cross Women’s Health Institute also offers screening for healthy women to care about women’s sexual health, including cervical cancer screening, sexually transmitted infection testing and prevention, and services for other common reproductive disorders such as abnormal bleeding.

Since the health of an individual woman is inextricably linked to her environment, community health is also a focus of the Holy Cross Women’s Health Institute. They provide services to women affected by substance abuse or violence at home, and strive to improve the collective well-being of the Taos community through the health of their women.

Regardless of their age, specific health needs, or stage of life, women in our community can be confident that they will receive excellent, compassionate, and confidential care here in Taos at the Holy Cross Women’s Health Institute.

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Crews break ground on women’s health center at Providence St. Joseph campus – Orange County Register

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A four-story, 137,000 square meter health center for women and babies has laid the foundation stone on the campus of Providence St. Joseph Hospital in Orange.

  • Officials break the ground for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, California on Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility provides access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Rendering of the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif., Tuesday, September 21, 2021. The four-story, 137,000-square-foot facility provides access to health services, benefits and resources for Orange County residents. It is currently scheduled to open in autumn 2023. (Courtesy Providence St. Joseph Hospital)

  • Sister Judith Dugan bows her head as the Reverend Kevin Vann blesses the groundbreaking ceremony for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, California on Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility will provide Orange County’s residents with access to health services, benefits and resources. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Reverend Kevin Vann prepares to help officials break ground at the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif. On Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility will provide access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Philanthropist Marsh Moeller speaks about her mother Helen Caloggero during a cornerstone ceremony for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif. On Tuesday, September 21, 2021. The four-story, 137,000-square-foot facility will be Provide Orange County’s residents with access to health services, benefits and resources. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Officials break the ground for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, California on Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility provides access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Reverend Kevin Vann prepares to help officials break ground at the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif. On Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility will provide access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

The crews began work on the new facility on Tuesday, which will occupy a space on the corner of Main Street and Stewart Drive. Orange Mayor Mark Murphy, Orange County Supervisor Donald Wagner and Bishop of Orange Rev. Kevin Vann showed their support for the new development at a ceremony on site.

The Helen Caloggero Women and Family Center – named after the mother of a major donor to the project – will streamline services to women and families, hospital officials said, bringing “mother-and-baby services currently available in nine different locations across the hospital.” one “. central location.”

The center offers a variety of women’s health resources, including pelvic health and rehabilitation services, exams for mothers and their babies, mental health services, and a pharmacy.

Part of the facility will also become a new natural birthing center “where women will receive the individual care midwives provide in a home setting,” according to a press release. Food, retail and office space are among other features of the future location.

“We are excited to offer our patients this wide range of services in a beautiful, new and convenient location as it will truly make it easier for them to access our world-class caregivers and the latest innovative technology in one place,” said Michelle Genova , Chief Nursing Officer at Providence St. Joseph Hospital, in the news release.

The center is scheduled to open in 2023. The St. Joseph Hospital Foundation is still raising $ 2.3 million for the new facility.

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Women’s Health

‘Bachelor In Paradise Couples’ Who End Up Together, Per A Matchmaker

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Lots of adorable couples have come and gone this season of Bachelor in Paradise – but which ones are staying here? From Reality Steve’s post-show spoilers to the fans’ incredible super detective skills, there are some popular theories.

But most of these guesses are missing a key factor: chemistry. After all, a couple is only as good as their food-related innuendos (if you look at you, Kenny and Mari).

Amber Kelleher-Andrews is the co-founder and CEO of Kelleher International, one of the largest matchmaking companies in the US, seemed doomed from the start.

Ready to Hear the Cold Hard Truth About Your Favorites? Amber spills it all below:

What’s so different about dating on TV?

“The hard thing about TV is that it’s all very inflated,” explains Amber WH. “The culture of this is that you shouldn’t care about anyone other than yourself and the person you want to be with.”

That would put a strain on everyone’s relationship – but Amber says it’s especially difficult for Paradise candidates because they juggle other factors that don’t come into play in real life. “Kindness is somehow swept under the rug,” she says. “And kindness is one of the most important things you look for in a relationship with someone.”

This applies to both men and women, she adds. “In terms of matchmaking, it’s a word that is used quite a lot: ‘You have to be kind.'”

This season, Amber says she “really felt for the cast” and the tricky dating situations they got into. But overall, she rates the candidates themselves as pretty good matchmakers. “They are banding together, but if I had a choice I would say, ‘Yeah, I would bring the two together. And I would definitely bring these two together,'” she said.

Maurissa Gunn and Riley Christian

Craig SjodinGetty Images

Amber’s judgment? Maurissa and Riley are a great pairing, but she’s not sure if they’re built to last. “I really thought he was so cute with Marissa,” she says. “It will break my heart to see what happens, but I really like her.

Her only red flag is Riley’s laid-back attitude. “I just feel like he’s a little more of a charmer,” says Amber. But guys like that “can turn into good guys,” she added. “I watched him like, ‘Is this his time? Will he be that guy? And he doesn’t have enough camera time to tell me. “So the jury has not yet decided on these two.

Brendan Morais and Pieper James

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Craig SjodinGetty Images

The couple fans love to hate actually have more staying power than you might think. “They seem totally in love with each other,” says Amber. “But the thing is, Brendan is not only assertive, but he’s also out of control of his own emotions. And so he could implode himself.”

“He doesn’t seem to really have his own feelings,” she adds. “Something is wrong with him.” Amber says her real tip was to see how Brendan acted around Natasha. “He couldn’t even be straight with her,” she explains. “I was like, ‘Wait a minute. You’re not even able to say the words you’re thinking.'”

And the future of Brendan and Pieper? “I think he looks cute with Pieper and they have chemistry,” decides Amber.

Joe Amabile and Serena Pitt

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Let’s get one thing straight, “It’s really clear that he really, really, really likes his ex, Kendall,” says Amber. “And he’s not 100 percent honest, but that’s because he doesn’t really want to stick to Kendall.”

ICYMI, Joe, and Kendall originally split because he wanted her to move to Chicago with him, and she said no. (Fair enough.) But Amber thinks “if she had come” [on Paradise] and said, ‘Listen, I’m in love with you and I want to move to Chicago and give us a real chance,’ “then Joe would have left Serena sooner than Wells Adams can make a cocktail.

“His feelings are real for her, and he could fall in love with her again right in front of Serena,” says Amber. “I really don’t know what’s going to happen to them, I can’t tell – but he really likes them both.” Sounds like the producers focused on the wrong love triangle, if you ask me.

Kenny Braasch and Mari Pepin

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Craig SjodinGetty Images

Kenny and Mari win first place for Paradise’s cutest couple as far as Amber is concerned. Although Kenny got distracted by Demi Burnett in the first few episodes, Amber says, “He seems like a really nice guy and I think he’s probably really ready to settle down. Mari seems like a really suitable partner for him.”

Her age difference of 15 years doesn’t let her upset either: “She’s very grown up,” Amber adds. She thinks Mari is a great partner who shares her feelings with Kenny from the start. “I think there’s a chance these two might actually work,” Amber told WH.

Abigail Heringer and Noah Erb

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Craig SjodinGetty Images

“I love Abigail and Noah,” says Amber. But she really wants these two lovebirds to “have more sparks. They are something of a married couple”. Because of this lack of chemistry, she is “not sure what will happen to these two” (even if they are the butter of each other’s toast).

Becca Kufrin and Thomas Jacobs

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Craig SjodinGetty Images

At first glance, Amber says, Becca and Thomas are actually a pretty cute couple. “I think they make a lot of sense,” she explains. “I think that is Tammy [Ly] suited him strangely. “

Amber adds that Thomas and Becca go well together visually. “When I look at Thomas’ stature, his build, and then all of the women, you think, ‘Okay, it has to be Becca.’ It’s big, it’s statue-like, it’s the Bachelorette. So it makes sense. “

But in terms of relationship, this duo just isn’t built for the long haul. “She can do so much better,” says Amber. “In the end, is that really the guy you’re going to end up with?” So she won’t be surprised if the two split up: “If they get married, I still say it’s not a match until they split up and she says, ‘He cheated on me and he’s an idiot.’ And I would say, ‘There it is!’ “

Sounds like Bachelorette Katie Thurston was right when she warned the other Paradise ladies to stay away from Thomas on Us Weekly.

Tre Cooper and Tahzjuan Hawkins

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Craig SjodinGetty Images

Despite Tahzjuan’s previous affair with Tres uncle, these two actually seemed like a great couple. “It was cute,” says Amber of their brief relationship. “And he was one of my favorites.”

Amber was disappointed that Tahzjuan had dropped her association with Tre as soon as Riley arrived. She also believes the Paradise producers cut out some footage that would have made Tahzjuan’s decision more meaningful. “One night she just screamed on the beach and Tre was kind of outside. And I asked, ‘What actually happened?’ “Says Amber.

Aside from glitches and missed connections, Amber thinks Tre and Tahzjuan should try again. “The two of them should at least meet up when they get home,” she says. (Personally, I fully and completely agree!)

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