In my home state of Oregon suicide rates have increased nearly 30 percent from 1999-2016 and suicide is now the second leading cause of death among children and young adults ages 10-24. Per Mental Health America, Oregon has the highest prevalence of mental illness in the nation.

Oregon can also claim the third worst high school graduation rate and the nation’s second highest number of unsheltered homeless persons. In many of Oregon’s rural counties, opioid prescriptions are also among the highest in the nation. There is a lot of hurt, a lot of desperation, and widespread feelings of being “stuck” in a system that allows little upward mobility.

Nearly 18 months ago I decided to make the shift to embracing functional medicine in my mental health practice. I have become convinced that functional medicine is not the latest trend, but simply common-sense medicine, I am a firm believer that functional medicine is the future of medicine.

That said, the reality is that functional medicine and frankly a lot worthwhile therapies are still a bit idealistic and inaccessible for many. Specialized labs are often not covered by insurance, supplements can be expensive, personalized nutrition approaches are not in the budget, and “stress management” may be a stretch for the many individuals existing in survival mode where relaxation, deep breathing, and self-reflection are luxuries.

And so, myself and many other healthcare providers are tasked with navigating the complexities of attempting to promote holistic, personalized care amid social realities that create immense barriers. Too many of our patients are stuck in the “fight or flight or freeze” mode where true healing becomes elusive. If we (as providers) are not careful and especially if we are being rushed into providing care for big problems, burn out can come quick.

Economic stability, physical environment, education, food, community and social supports, and access to healthcare are identified as the primary social determinants of health by the Centers for Disease Control. Many patients come my way seeking respite from understandable distress when one or more of these determinants are minimal or absent. And while counseling has often been suggested, so too has medication in many cases. The patient may be panicked, overwhelmed, depressed, hopeless, and isolated. Yes, they may meet “criteria” for a myriad of diagnoses; however, how often are we really medicating or even numbing symptoms that are not indicative of pathology, but of societal shortcomings?  I ponder the “what if’s” all the time…what if they had stable housing…enough food…a safe home? If only I had a magic wand.

Let’s go back to Psych 101 and revisit Maslow’s hierarchy of needs. Food, water, warmth, rest, security, and safety. It is in fact rare that I come across a patient that has all these basic needs met. Even in circles of affluence and privilege, there can certainly cases of unrest, insecurity, abuse, and a perception of feeling unsafe. Ultimately, when the body cannot be in a state of rest, healing is difficulty if not impossible. To expect favorable health outcomes in the context of desperation is simply irrational.

My opinions do not negate the potential value of pharmaceuticals and other mainstream therapies as tools to help regulate a person’s symptoms, but if we pretend that “the treatment” of mental illness and emotional distress is relegated to pharmaceuticals and counseling, we are being shortsighted and ignorant.

So where does this all leave us and how do we move forward? First and foremost, we cannot pretend that illness is happening in a vacuum. As a healthcare system, we know this intellectually, but in practice, as we silo care to different specialties, rush patients through appointments, and take away time for important communication, we can fail to address psycho-social, socioeconomic, and spiritual impacts. We cannot expect a pharmaceutical to solve homelessness, hunger, abuse, or poverty and we must prioritize trauma-centered care. This takes courage, radical responsibility, teamwork, and innovation. We must provide opportunities and space for discussion and emotional vulnerability in our families, schools, places of worship, and workplaces. The idea that mental health is a “personal problem” and therefore an individual burden, only increases secrecy, shame, and stigma. We must all be advocates. Your health and my health depend on it.

Thanks for listening everyone.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

Sisters & Silverton, Oregon. www.shesoarspsych.com

Its about two weeks into the New Year and rather than inspire you with a weight loss solution or exercise regimen, I want to challenge you to change your own dang mind.

In our society there is praise and admiration to be had for those who are steadfast, stay the course, and remain committed. We can get respect, kudos from our family and friends, and we may avoid the risk of nonconformity. These character attributes certainly have their merits; however, there are times when the path we choose is depleting and even destructive.

Have you ever given yourself permission to question your own path? This path has often been dictated by family, societal, and cultural expectations. This can be a path that has been ingrained for generations and in some cases, it can become difficult to differentiate between tradition versus truth. Perhaps you have identified with beliefs that may limit your personal fulfillment or your ability to express your personal gifts. Your definition of success may be rigid and formulaic leaving little room for diversion, risk, expression, or innovation. May you believe you must not ruffle feathers or rock the boat. You may feel that the repercussions of speaking up or being different outweigh the benefits. And so, you begrudgingly stay on the path.

Personally, I have long been a “box-checker” borne from the fallacy of perfectionism. I like to call myself a perfectionist in recovery and as I envision my 2019, I want to continue to question my own boundaries, labels, and “boxes” I have identified with. The boxes represent what I think I “should” do and it has been a personal challenge (and gift) to change these “shoulds” into “coulds”. Adopting this mindset, suddenly the narrow, singular trail has become a network of possibilities.

Many of us have felt it. The itch to go against the grain, try something new, and embrace a healthy dose of rebellion. Perhaps its pursuing your dream job, going back to school, moving away from your hometown, finding your own spiritual path, asserting your own political beliefs, or simply breaking from family tradition. We can tell ourselves we are too old, we don’t have the skills, we don’t have the motivation, people will be mad at us, or that whatever the itch may be, it is just a bit too crazy, ambitious, or unorthodox, and therefore, out of reach.

Most of us know what is burdening us and yet giving ourselves permission to do something about it is the challenge. Yes, some of our burdens cannot be changed and there is beauty to be found in struggle. There are times when diverting from our path could result in more harm than good. The point is that we question our allegiance to the path we have chosen. Are we simply going through the motions that we have been taught or told? Do our beliefs and values hold us back? Quoting one of my clients, in some cases, “you are not living, you are just not dying”.

 

 

This stuff gets a bit spiritual and philosophical, right? It begs the questions of what is purpose and what is meaning? Is there a right or wrong path? I am on level ground with everyone else and by no means on a pedestal, but per my assessment it seems appropriate that the path we choose inspires us to be the best human beings for ourselves and for others. Remember, these paths do not have to equate to action. You may have to keep your boring job or postpone a dream, but are you doing so on a path of pessimism or hope? Practicing gratitude, making a point to smile at others, seeing the glass half full, and simply being kind to yourself can be wholly transformative.

Ultimately, do not be afraid to question and invite curiosity to the path you have chosen. Embrace the idea of changing your mind, open up possibility, and be your own trailblazer.

Happy 2019 everyone!

With gratitude,

Audry Van Houweling, Owner & Founder, She Soars Psychiatry, LLC

Sisters & Silverton, Oregon www.shesoarspsych.com