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I arrived at Cal State University, Long Beach (CSULB) in 2017 to become the only psychiatrist there for 39,000 students.  I work two days a week at the counseling center (CAPS) backing up the psychologists there and two days a week at the student health center (SHS) backing up the doctors, nurses, health educators, and other staff there.  In both settings the vast majority of students I see have never seen a psychiatrist before.  That’s largely by design.  If they already have some perspective on what’s going on with them and how to use medications to help or are already seeing a psychiatrist, don’t come overwhelm me. There are plenty of students who don’t know where to start.  I only see people once for a consultation to put together a picture with them (“pulling out the strands of their story from their tangled lives”) and to see if medications might be useful to them, or a few times to get them started on medications, work through the early side effects, and find the best dosage, before I send them out to the community to find another provider.  I don’t keep anyone as an ongoing patient, since I’d get overwhelmed and look just like the providers in the community if I did, prescribing as fast as I could to as many people as I could.  

I know that we live in a time when we talk about psychiatric illnesses and DSM 5 diagnoses and chemical imbalances and medication management and genetics and stabilizing brain functions, but I take a more developmental point of view:  We’re all born with whatever our strengths and weaknesses and our tendencies are, and even a blueprint for our growth and development comes with the factory packaging.  And then we’re born, and life happens.  Sometimes we’re nurtured and supported, and we blossom and grow.  Sometimes we’re traumatized, and become injured and scarred.  Sometimes we’re repressed or depleted.  Sometimes we get stuck.  I think what we call mental illnesses is usually getting stuck in our growth and development.  Maybe something in life needs to be changed to get unstuck, or maybe you need to think about things differently or work through emotions or learn some new skills and habits, or maybe medications can help get unstuck.  Hopefully then you can grow and develop again to become the person you were meant to be, and even outgrow needing the medications, because you’re not stuck anymore.  Sometimes the reason you’re stuck is the biology of your brain, but most of the time it’s a clash between who you are and what’s going on in your life. Most students do get unstuck.

As I keep working with students, I sometimes stop to write down what I’ve learned with them.  I’m posting what I write on this website as well as sharing some of it with the students I’m seeing it and the staff I’m working alongside, hopefully to help explain things I’ve figured out.  

Here’s what I’ve put together so far: 

 

Types of Anxiety and How Medications Help

If we separate out whether anxiety is in our minds or bodies or both and what’s causing it, we can figure out what to do and what medications might help.

Choosing an Antidepressant 

There are four different kinds of pills all called antidepressants that work differently and have different side effects.  Which kind might help you get unstuck?

The Next Deadly Epidemic

More and more people are taking stimulants, prescribed and unprescribed to help with ADHD and performance.  Here’s why I’m worried this could be our next deadly epidemic and what else you can do that may be more sustainable than stimulants.

Emotions in Bodies

Our emotions aren’t just in our brains.  They’re in our bodies too.  That doesn’t mean they’re not real.  We can learn to listen to our bodies to be more in touch with ourselves and more integrated emotionally.

Medications and Psychotherapy

Medications and therapy aren’t just alternatives.  Many people can benefit more by using them thoughtfully together to get the most out of both of them.

Using our Minds

This is a long article that describes how our minds are far more than just our brains, how our minds develop during our lives, can develop mental illnesses, and recover.

Thinking about Suicide​

Rates are increasing every year, not just of completed suicides, but also of thinking and planning and attempting suicide.  We need to be able to get past our fears and stigma to talk with each other about suicide and support each other.

Engagement Strategies for People Experiencing Psychosis

Psychosis is outside almost everyone’s comfort zone, even most mental health professionals, so we tend to react out of fear and avoidance, not what people need when they’re likely confused and frightened and overwhelmed too.  We can connect with people experiencing psychosis as people and help them regain self-control and recover.

Corona Virus Struggles and Strategies

At the beginning of the COVID pandemic, I created this list of common challenges and coping strategies to help people make sense of the mental struggles almost all of us have been going through and how to keep going as best we can.

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