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Welcome Back! Taking Time Off and Coming Back Strong.
200 Plays2 years ago
Welcome Back to Season 2 of Doorknob Comments! Fara and Grant talk about taking time off and coming back strong.
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Transcript
Introduction and Doorknob Comments
00:00:01
Speaker
Hello, I'm Dr. Farah White. And I'm Dr. Grant Brenner. We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the doorknob comment. Doorknob comments are important things we all say from time to time, just as we're leaving the office, sometimes literally hand on the doorknob.
00:00:23
Speaker
Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out.
00:00:50
Speaker
Today,
Hosts' Reunion and Personal Changes
00:00:51
Speaker
Grant and I got back together after a year away from the podcast. We reflect on our time away, things going on in our lives, and look forward to this new season. We hope you enjoy it as much as we did. Hi, Farrah. Hi, Grant. It's been a little while, right? It has, like nearly a year. Yeah, it's been a little while since we last recorded.
00:01:17
Speaker
been a minute. It's been a minute. I know a bunch of people have reached out to me and said, Hey, Grant, what are you guys going to start recording again? And I said, Well, you know, Farrah's been on leave. And soon though, soon, don't worry, we're going to be back in the saddle.
00:01:36
Speaker
Yeah. How has the year been for you? What have you been up to fill people in a little bit? Well, when was the last time we recorded actually? I think it was really early in 2022 or maybe late 2021. Let's see. Let me check out our website doorknobcommons.com. No, I feel like it must have been 2021 because the baby came. Baby? Yeah. Is that why you were on leave?
00:02:04
Speaker
That is, yes, and now he's nearly a year old. You have to meet him at some point. Yeah, a lot of fun. I think, let's see, our last episode, was it with, no, it wasn't with Liz. It was... It was just us, I thought. The importance of taking breaks, right? 12, 1, 2021. So it's just been shy of a year.
00:02:32
Speaker
Oh my gosh, yeah. As we wrap up season one of Doorknob Comments, Farah and Grant discuss the importance of taking calculated breaks as an actor of self-compassion and care. Well, how's it been for you? Have you upped your self-compassion skills? It's been a great year, a busy one. You know, having a new baby in the mix always changes dynamics and
00:02:56
Speaker
it's been incredible for the most part, you know, has its expected challenges. I didn't come back to everything at the same time. I initially came back first to do some therapy and then to do med management and then like analytic training and the podcast are sort of the last pieces.
Self-Compassion and Boundaries
00:03:17
Speaker
So it's just happening this fall. It feels right. Cool. But how's the self compassion piece?
00:03:23
Speaker
Working on that, I don't think that there's a direct correlation. I feel like it's a constant evolution of just trying to be kind to myself or as kind to myself as possible as managing to balance stuff. You were mentioning that recently. You said that you sort of had some kind of fundamental change in perspective.
00:03:47
Speaker
One of my thoughts about that is, and I've seen this in my own life and I've seen this with patients and with friends and colleagues, is that when people plant a flag that they're going to be doing things differently, sometimes all hell breaks loose in their other relationships because all of a sudden they're setting different boundaries and a different framework. I didn't know that I would describe it as all hell
00:04:11
Speaker
broke loose, maybe in certain moments. But I also think that change is an inevitable part of life. Every sort of disruption to the routine, I think, is an opportunity for growth for me and also for family members. And so it's like the disruptor, right? But I don't think that's necessarily a bad thing.
00:04:35
Speaker
It's funny. Change is a part of life.
Life Changes and Growth Cycle
00:04:38
Speaker
That reminds me of the book Being There by Jerzy Kaczynski, who is also made into a movie called Being There with Peter Sellers. And it's funny because the main character is raised in isolation from other people, like presumably adopted by a wealthy guy. But he's isolated completely from the rest of society. And he grows up in this walled
00:05:03
Speaker
sort of mansion and most of his time is spent in a garden literally and he's a sort of a simple-minded gentleman and then his benefactor dies apparently without any preparations and he wanders out into the world dressed up in this very nice suit
00:05:20
Speaker
and people don't realize his history and they assume that that he's a kind of a regular guy and he makes a lot of vague comments about life but they take it as being like profound truths uh and he becomes somewhat of a like a financial or economic guru even like ending up somehow on television and advising the president of the united states on financial matters to deal with the economy and so
00:05:48
Speaker
There's some quotes that come to mind that I have here where he's talking about the garden and he literally is talking about the garden that he grew up in. But everyone thinks he's talking about the economy and the world. And he says, growth has its season. There are spring and summer, but there are also fall and winter and then spring and summer again. As long as the roots are not severed, all is well and all be well.
00:06:17
Speaker
That is kind of like a guru speak, right? Yeah. And then there's another one, which is along the same lines. And of course, it's kind of meant to be funny, right? And satirical. In a garden, things grow. But first, they must wither.
00:06:35
Speaker
Trees have to lose their leaves in order to put forth new leaves and to grow thicker and stronger and taller. Some trees die, but fresh saplings replace them. Gardens need a lot of care, but if you love your garden, you don't mind working in it and waiting. Then in the proper season, you will surely see it flourish. You know, although it's satirical, it's also kind of profound. On that note,
00:07:02
Speaker
What's been going on with you? How does your garden grow?
00:07:05
Speaker
Yeah, it's been a busy year. I skipped the balcony gardening this year because of traveling, but I really do enjoy seeing things grow. This year for me, the family is doing well. Our kids are pre-teens and we're dealing with, I think, what are the usual kind of New York things with schools and the social environment in school is
00:07:32
Speaker
very similar to that in which I was raised. So there's all kinds of like who am I and who are my friends and what is the social pecking order like and how do we get along with people as well as the, you know, how do we get our academic needs met and
00:07:54
Speaker
Living in the city is very different, though, from the suburbs, the part of town that we live in is a lot of fun, but pretty tough. So our kids are very jaded. They've seen almost literally everything from a young age. And, you know, there are pre-teens going on, grown-ups very quickly.
Professional Updates and New Initiatives
00:08:14
Speaker
In terms of my practice has maintained,
00:08:19
Speaker
you know, mainly therapy and some medication management, working with people who are looking to get to a better place in their lives, generally long-term psychotherapy. And then a business that I had started with colleagues, Neighborhood Psychiatry, we sold that business to a larger group.
00:08:39
Speaker
And then I joined that larger group in a part-time role as chief medical officer. That new group is called The Collective Integrated Behavioral Health. But Neighborhood Psychiatry and Wellness remains the same group in the New York area. And I've had a huge amount of fun joining a new team and sort of taking it to the next level.
00:09:01
Speaker
And then throughout the pandemic, I've been doing and continuing to do not-for-profit work. And I think one of the things I'm particularly proud of that was really a collaborative effort with people from my committee in the group for the Advancement of Psychiatry, the Disaster Trauma and Global Health Committee, and Vibrant Emotional Health, where I am on the board and contribute to the Crisis Emotional Care Team.
00:09:28
Speaker
and a medical information, health information data company called Decision Point Systems.
00:09:36
Speaker
We cooked up and have realized and developed a model for disaster response and crisis response called the chronic cyclic disasters model, which takes into account some of the experiences in the pandemic of having both ongoing waves of a pandemic as a rolling disaster, as well as at the same time earthquakes and
00:10:00
Speaker
large-scale forest fires, wars, and human displacement events, on a foundation of social issues and geopolitical concerns, which are sometimes called the social determinants of health. And so we created this chronic cyclic disasters model
00:10:19
Speaker
I should mention the website. It is chroniccyclicaldisasters.info. That is chroniccyclicaldisasters.info. And having sold the practice and taken on the chief medical officer role, I'm also
00:10:37
Speaker
paying more attention to books that we had published.
Creative Pursuits and Podcast Plans
00:10:40
Speaker
Most especially early in 2022, I never fully marketed this book, which is called Making Your Crazy Work For You, from trauma and isolation to self-acceptance and love. And I'm looking forward to getting a proposal from a publicist and leaning in in 2023 there.
00:11:00
Speaker
Oh, cool. Well, all that is exciting stuff. And doing a ton of photography, as you know, which has become a real passion and creative pursuit for me, though I've been, you know, always been creative in the past and painted or and I've written some poetry recently, but photography has really captured my interest. You've been creative in the literal sense, you've created a human being.
00:11:24
Speaker
Yeah, but I think it's important to give your time separately to separate projects and I know photography is a great outlet for you. Maybe we can do an episode on incorporating a creative outlet. It's a great inlet for me too. Inlet and outlet, yeah. It's a good way to get to know yourself, you know, through that type of artistic creative process. Yeah.
00:11:49
Speaker
Well, what are you most excited about for for the podcast for join up comments? Like, what do you want to make sure that we talk about this season? I'm excited to get more organized. Is that a, is that a hint? Is that a thinly veiled dig at me? That was kind of harsh, but okay. Now you're going to have to edit it out that it was harsh. You had to say harsh.
00:12:18
Speaker
It was. It's playful, jeez. Okay. Forget it. Forget it. I'm done. This is our last episode. Okay, okay. No, I am joking aside. Playful rivalry aside, I'm excited to get back into the swing of it and really kind of renew and revision the podcast.
00:12:40
Speaker
And I'm excited that we were joined by a new producer this season who has a lot of experience. He set us up with cool new equipment and a new podcast recording platform. And really, you know, with a lot of things I do, and I didn't mention blogging, but I continue to blog on my Psychology Today experimentations blog. I'm about to hit 12 million views.
00:13:06
Speaker
The podcast is just another way for me to try to, you know, it sounds cliche, but kind of help make the world a better place and reach as many people as possible. Awesome. Yeah, I think for me, I'm most excited about touching on certain topics.
00:13:25
Speaker
maybe there's a way for us to incorporate some of what's trending, right? What's out there, what people are hearing about mental health or certain treatments, new medications, and if we can sort of break that down and answer some questions and maybe be a reliable source of information because there's certainly plenty of info out there.
00:13:50
Speaker
But it's also, I think, to me always a reflection of what people are thinking and feeling if they get really interested in the ideas around sort of neurodivergence or something like that.
00:14:03
Speaker
Yeah, I think that's right. We've got a number of topics on the spreadsheet, on the agenda for next year, the usual holiday things, which are always important to talk about because the holidays can be stressful. As well as I think you mentioned something really critically important is getting good information out to people. I think the statistics are that, you know, for example, on platforms like TikTok,
00:14:26
Speaker
only about 20% of the information is really credible. It's also understood that people don't quite know where to look and are a little bit hesitant about conventional wisdom, which speaks to like deep unmet needs that people have.
00:14:40
Speaker
I'll say more about that. I think you mentioned, for example, neurodivergence. I think that's an excellent example. The standard psychiatric way of thinking about that is autistic spectrum. And I think, on average, the term neurodivergence is used as a preferred alternative to autistic. And diagnostically, the most recent DSM, Diagnostic Manual for Psychiatry, dropped the term Asperger's syndrome, which was a stand-in for high-functioning autism.
00:15:10
Speaker
But that term doesn't really resonate with people. And if it doesn't necessarily resonate with people, then it doesn't do what one of the things that a diagnosis is supposed to do, which is help people get good information and make good decisions about how to live more satisfying lives.
Understanding DSM-5 and Diagnoses
00:15:30
Speaker
You mentioned the DSM. Can you say a little bit about what it is and maybe the history? Because I think it's something that's so meaningful in our work, but people probably don't even know what it is. It's certainly controversial and psychiatry is controversial to a certain extent. There's plenty of people who understand the importance of treating mental illness
00:15:56
Speaker
There are people who deny that there is such a thing as mental illness. I think this is really critical. To answer your question, the DSM stands for Diagnostic and Statistical Manual, and we're on the fifth edition. It's the DSM-5.
00:16:17
Speaker
it speaks to the state of diagnosis in psychiatry. And it is true that by and large, we don't have biological tests for psychiatric disorders or diseases. So we go by clusters of symptoms. So for example, if someone is diagnosed with major depressive disorder, they would have to have symptoms for at least two weeks.
00:16:39
Speaker
And there can be any one of a number of symptoms. There's a list of nine symptoms that are typical with depression, but you don't have to have all nine of them to meet criteria for a major depressive episode. And so it requires a fair amount of art to the diagnosis. However, one thing I think that
00:16:58
Speaker
The critics leave out is that every single diagnosis in the DSM-5 requires that, number one, whatever's happening is causing clinically significant dysfunction or distress, and number two, that it's not better accounted for by medical condition.
00:17:16
Speaker
For example, if someone comes in with symptoms of depression, you would also check their thyroid to make sure that they don't have low thyroid function, which can look like depression. The problem we sometimes run into is that people who are critical of psychiatry will claim that everything is a disorder. To some extent, I can understand where they're coming from because of commercial interests and drug companies, but I think
00:17:42
Speaker
good psychiatrists aren't approaching it that way. Conscientious, ethical psychiatrists understand that you have to not just have the symptoms, but it has to be causing problems of a significant nature.
00:17:56
Speaker
Yeah, I think the question that I always ask is how is this diagnosis going to either empower a patient, inform the treatment. So certainly if you are seeing someone who's complaining of symptoms of depression and it turns out that they're hypothyroid, then that would be the first step is to make sure that there are no underlying medical issues.
00:18:22
Speaker
And then I think even taking it a step further, just because we have a diagnosis of one thing or the other doesn't mean that the treatment plan is so clear. It might still mean that there are different ways to go about it. I know that both of us believe that medicine plus psychotherapy is really considered the gold standard for treatment of depression and anxiety.
00:18:50
Speaker
where I think diagnosis can be helpful is that it can sort of motivate people to get proper treatment. Yeah I think that's
00:19:00
Speaker
When done properly, that's basically self-evident, right? With any branch of medicine, coming up with a good treatment plan requires having an accurate diagnosis. One of the things that's different about psychiatry and therapy is that psychiatric diagnoses can affect a person's sense of self. So it becomes part of identity. And that can take many, many different forms. I think a good example of this is borderline personality disorder.
00:19:29
Speaker
I know tons of people, and you can see it on social media, when they get a diagnosis of Borderline Personality Disorder, they're relieved. All of a sudden, they have a way of understanding what their struggles are, and they have alternatives for treatment which can be effective. At the same time, other people think they have been mislabeled, and sometimes they have been mislabeled or misdiagnosed.
00:19:52
Speaker
Many patients with borderline personality disorder may actually have something like post-traumatic stress disorder or complex post-traumatic stress disorder, also known as CPTSD, from developmental trauma, early experiences, usually during childhood and adolescence, that shape personality and can look like borderline personality disorder in the sense of having, say, mood swings or periods of intense distress that come and go.
00:20:20
Speaker
But CPTSD is not in the DSM-5. However, it is in the ICD-11, which is the European Diagnostic Manual. And so I can understand why consumers, why the public gets really confused by this situation.
Mental Health and Social Media
00:20:37
Speaker
And maybe we can devote an episode to demystifying that.
00:20:41
Speaker
For sure. I think that what people ultimately want and what they're finding on social media are some answers. It's more accessible. It's what's out there. It's what's popping up in front of them. And I think it does take a little bit more investigation and a little bit more deep work. And there aren't the same sort of algorithms that are going to present the sort of latest psychiatric diagnostic guidelines.
00:21:10
Speaker
Well, there's been kind of an erosion of expertise, and on social media, kind of everyone can claim to be an expert. And there's a lot of misleading and dangerous information out there, offering treatments to people, often with a commercial interest, that don't have any evidence behind them at all.
00:21:30
Speaker
I think don't know where to get good information necessarily or how to evaluate that information when they do find it. When I refer patients to information sources, I refer them to information sources that I know to be credible and evidence-based. Yeah. Well, maybe that's something that our listeners could benefit from as well.
00:21:50
Speaker
There's also another thing to watch out for on social media is a fair amount of subtle and not so subtle blaming the victim. So sometimes you'll see even clinically licensed people telling whoever's there to listen to them
00:22:08
Speaker
that they shouldn't take medication. And I agree, medications aren't always the right thing to do, but they're making blanket statements that medications are bad and that all you need to do is take better care of yourself, exercise, eat right, sleep well. And it is, number one, dangerous because that's certainly not always true. Some people really have depression that's hard to treat. And thankfully, some people will respond to those
00:22:34
Speaker
those tweets and say, hey, I would not be here today if it weren't for psychiatric treatment. How can you say that? It's so irresponsible as a licensed clinician to make such a sweeping statement. But the victim blaming part is, well, you wouldn't be sick if it weren't for your habits.
00:22:55
Speaker
And you see that too with medical illnesses like cancer. People say, well, if you don't want to get cancer, change your lifestyle because inflammation causes cancer and diet can fix inflammation. And that's just not true. Inflammation doesn't cause cancer and you don't get cancer because of what you've eaten by and large. And it's not your fault if you have cancer.
00:23:17
Speaker
And even if you do have a shitty diet, I think it's also probably most people, it's probably not their fault. It's sometimes really hard to get healthy food, and it's not accessible to everyone. Well, there's cultural, societal, and familial issues with that, the way we're trained.
Self-Compassion in Personal Growth
00:23:33
Speaker
I think what we can do is we can have a nuanced perspective as to what we could have influence over. And developing self-care involves developing a sense of agency and influence.
00:23:45
Speaker
while also recognizing that we can't control everything and that change can and often does take time and that it's important to have a balanced view and not an either or perspective. So yes, we do have some influence over our health through our decisions. We can become better at that decision making over time. But if we get sick, it's not somehow our fault.
00:24:10
Speaker
I like that. I think as we're sort of wrapping up for today, that is probably a good thing for us to keep in mind as we go through the rest of the season and for listeners to know that we're sort of on the team of self-compassion and understanding and not looking to sort of place blame, right? It's not our fault, but how do we sort of take responsibility
00:24:39
Speaker
for making ourselves feel better. And I think it's a good goal. I agree. I think of that as, you know, it's related to what they sometimes call executive function, really fully developing our decision making capacity. I sometimes think of that as self governance and one's relationship with oneself. From my point of view, you want to be your own best buddy. And that means accountability and compassion. Sounds good. Well, anything else?
00:25:08
Speaker
on your mind today, right? Happy holidays. You know, speaking of choices, you know, as soon as Halloween ends, literally the next day, you know, the holiday candy is on the shelf. Yeah. And I'm sure on, you know, December 26, there's going to be Valentine's Day candy. And then as soon as the Valentine's Day candy is off the shelf, it's going to be bunnies and eggs. Easter candy, which is my personal favorite. Passover candy, which is horrible.
00:25:37
Speaker
spring holiday candy. All are welcome. All right, it was great reuniting in the podcast. Congratulations on an amazing year and here's looking forward to more amazing years. Thanks for having me. Thanks Farrah.
00:26:00
Speaker
Thank
Closing Remarks and Listener Engagement
00:26:00
Speaker
you for listening to the doorknob comments podcast. We appreciate your time and hope you've gained something from joining us today. Please let us know what you think. You can email us at hello at doorknobcomments.com. Find us on Instagram at doorknobcomments on iTunes and on our website doorknobcomments.com.
00:26:18
Speaker
Let us know if there are any particular topics you'd like us to address. We'd love to hear from you. Remember, the Doorknob Comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.