When you sit with patients long enough, you start picking up on patterns. Individual wellness is often connected to the collective and with our digitalized world becoming smaller, that collective is more interconnected than ever. Feelings and sentiments are more palpable and like a contagion, can spread. While we may not ourselves have experienced a particular trauma or loss, we have immediate access to those who have, creating a breeding ground for secondary anxiety, fear, sadness, anger, or division.  

Despite my training in stress reduction and self-help, I am by no means immune to my own anxieties. I prefer to sit near the exits in a theater. I scan a crowd with a healthy dose of scrutiny. I am more comfortable in the woods than in the city. I am a bit slower to trust others. After weekly commutes across the mountains and pondering “what if’s,” my SUV is probably ready for the apocalypse and definitely not kid friendly. I made my first emergency kit. I bought an escape ladder. I am intent on adding a bit more cash to the emergency fund. With so many images and stories of tragedy filling the news, my mind easily slips to a place of “what would I do?”. My imagination can sometimes feel like an intruder whipping up worst-case scenarios that periodically overpower my sense of safety. Essentially, I find myself needing to be more mindful of “walking the talk”.  

It’s a strange paradox that amid trying to avoid imagined fears, the energy, thought processes, and attempts to control an outcome, can become pretty scary and overwhelming in themselves.  

“Our anxiety does not empty tomorrow of its sorrows, but only empties today of its strengths.“
-C.H. Spurgeon

It is easy to be in a place of anticipatory anxiety, to over-prepare, to feel the need to plan and predict. To an extent, there is good reason for this. There is political unrest. The economy is not great. There have been acts of violence that challenge our comprehension. The climate is changing. To anticipate is to survive. It is part of our evolution story. And yet, defaulting to a mindset of anticipation and preparation without the balance of rest and restoration, can be costly to our health, relationships, and spirit.  

Sometimes we may not have a choice. Life will sometimes demand that we grind. Life will sometimes demand that we stay vigilant. Our sympathetic nervous system takes the wheel pumping out adrenaline and cortisol priming us for action- at least for a while. Our parasympathetic nervous system allowing us to rest, heal, and digest, gets pushed to the back of the bus. This arrangement is only meant to be temporary. Regardless, the primal alarm bells eliciting a fight, flight, freeze, or fawn response are for many of us, in overdrive. Even in the midst of relative safety, many of us are convinced that if we let our guard down, even temporarily, the risks are too high.  

In the midst of preparation and anticipation, it would benefit us to remember what we are trying to preserve. Most of us would cite safety, stability, connection, peace, gratitude, and hopefully a bit of joy. Compared to so many who are searching for such outcomes, it can feel almost indulgent or selfish to bask in such positivity. And yet, our joy and ability to hold compassion for ourselves and the greater world is the ultimate rebellion against tyranny and unrest.  

How do we cultivate joy in a world that seems to be lost in so much struggle? Smile a little more. Compliment. Dance. Sing. Be a little silly. Go on an adventure. Prioritize acts of kindness. Take a walk in nature. Practice gratitude. Take care of ourselves. It takes mindful intention. 

As we enter the holiday season, let’s remember in the midst of feeling pressure to prepare and anticipate, what it is we are working so hard for. Can we spend moments in the joy? Can we dwell for a bit in gratitude?  Can we open the door for healing and reflection? Can we be still? The welfare of the world is not just secured by military arsenals and weapon stockpiles, but so too in our insistence to not forego our compassion and kindness despite it all.

Wishing you a joyful holiday season.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

www.shesoarspsych.com

Sisters & Silverton, Oregon

Life is HARD. 

There is no way around this fact. If you are lucky enough to have resources and privilege to bypass certain stressors and outcomes, some of life’s curveballs may be dodged, but ultimately, we will all experience our own versions of grief, heartache, trauma, and pain. 

The circumstances of our world the past two years have forced many of us to become far more intimate with our emotional fragility as the triggers and vulnerability to emotional distress have been vast. More isolated with fewer coping resources, many of us have felt overwhelmed with an emotional intensity we may have not encountered before. 

Seeking mental health support has become near trendy. Stigma has lessened and seeking counsel has generated more applause than perhaps ever before. The art of self-care is proudly featured throughout popular culture and social media platforms. Mental health professionals find themselves inundated with inquiries and waitlists are months long. While the interest in shameless self-improvement deserves an exuberant cheer, accommodating the “worried well” while also saving space for individuals in crisis is a struggle many mental health agencies and professionals are grappling with. Despite the boom of interest in mental health, the prevalence of crisis is not slowing. Studies throughout hospital systems demonstrate an overall decrease in total emergency room visits in general (this makes sense in the context of COVID), but a significant increase in the median number of total mental health emergencies. 

What is stability anyhow? 

Stability seems to be the elusive and highly sought-after goal throughout healthcare disciplines as treatment plans develop. Chart notes tracking a patient’s progress echo… 

“Patient presents as stable” 

“Patient reports overall stability” 

“Patient leaves the emergency room in stable condition” 

Stability seems to be the endgame for many health professions, but especially in regard to mental healthcare, what is “stability” anyhow? The very notion of stability is up for interpretation and rich with bias per the reporter. My version of stability may very likely differ from the next provider. While there are no true standards for what constitutes emotional stability, stability in mental healthcare is most generally noted as the absence of emotional distress. Of course, many of us are well accustomed to appearing “stable” while perhaps dealing with depths of distress internally and furthermore, what constitutes the presence or absence of emotional distress is also rich with interpretation and bias.  

Follow me if you will… 

If so-called stability is the absence of emotional distress and yet life is inevitably hard, creating inevitable emotional distress, then is the pedestal we place stability upon more predicated on avoidance than resilience? Are we haphazardly creating a mindset of emotional aversion than acceptance? There are certainly other definitions and theories of emotional stability out there, but ultimately, emotional wellness is not served by trying to run from what we cannot hide from.

Confronting Avoidance and Entitlement 

I do not seek to take away the pain of my clients, but rather to empower them to sit with the pain while developing more adaptive and constructive responses. I do not seek to make my clients “happy”, but to cultivate gratitude and lightness alongside the grief and heaviness. Do I prescribe medication? Yes. It is a cure-all? No. Is it a stepping-stone allowing clients to strengthen other aspects of resiliency? Hopefully.  

In our Westernized world rich with privilege, many of us are lucky enough to have access to primitive necessities keeping us away from the basic pursuits of survival. Internal struggles are less about where to find the next meal, but more so rife with comparison, insecurity, jealousy, purposelessness, anger, and existential fears. Underscored by the filtered and edited world of social media, we can be tricked into believing that if our lives are not rich with happiness and inspiration, we are somehow “not OK”. We are too quick to believe that such happiness is something we ought to be entitled to in our professional and personal lives, which often only enhances the discomfort felt during life’s inevitable hardships. We are a culture not so well equipped to handle pain. We are, however, very good at numbing, distracting, repressing, and avoiding what we perceive as uncomfortable feelings. I have said it before and will say it again, it is not the feelings of sadness, anxiety, loss, or shame that are problems in themselves, but often the avoidant responses that create greater suffering. 

Emotional wellness is not a destination, but a daily intentional process that demands radical responsibility. It is not something to be solved or “fixed”.  Alongside medication, treatment protocols, supplements, and lab testing, comes the willingness to acknowledge pain layer by layer, become more comfortable with discomfort, take ownership of our behaviors, and strive for more productive responses. 

Cultivating Emotional Resiliency 

Like stability, the concept of resiliency is also up for interpretation. Unlike the concept of stability however, implied within resiliency is the inevitability of hardship. At its core, resiliency acknowledges struggle and distress.  

Amid greater rhetoric around mental health and social-emotional learning, it is important not to enhance hypervigilance or skittishness around negative emotional states, but to enhance coping and responsiveness to the tough times that are part of being human. The conversation can’t stop at “its OK to not be OK”, but expanded to how can we continue to be decent and relatively healthy humans when we are not feeling “OK”? How can we better acknowledge and problem-solve so that we don’t project our distress on others? How can we create a lifestyle that enhances energy and compassion? How can we find meaning in a tough world? How can we limit distraction and numbing? How can we ask for help? 

The struggle is real y’all. There is no need for comparative suffering…it is not a competition. We have all had our dark days. Emotional distress will happen, stability is IMHO overrated, but resilience can be cultivated. In my version of resiliency, perhaps one of the greatest skills is learning to connect and ask for help. So do yourself a favor and reach out. You are not meant to ride out this rodeo called life alone. 

Thanks for listening.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry

Sisters & Silverton, Oregon

www.shesoarspsych.com

 

Finding Roots… 

Working in functional medicine, a form of medicine that examines root causes and dedicated to a holistic vision of wellness, it is not enough to talk about nutrition, exercise, meditation, and gut health. While these factors and others have true merit, I would be negligent as practitioner to dismiss the broader forces inequity, discrimination, and socioeconomic status have upon the wellness of individuals and communities.  

Mainstream medicine continues to be driven by insurance payers and pharmaceutical companies forging a narrow path by which “healthcare” must take place. This forces healthcare institutions to play the game of profit and economic stability, which results in rushed office visits, unending paperwork, too much red tape, burnout, and patients not feeling heard. This can result in the very place that should be making you feel “well” resulting in disempowerment and even trauma. As a caveat, I do prescribe pharmaceuticals. Yes, medication can sometimes be a worthwhile tool. And yes, I often feel like I am medicating societal shortcomings rather than actual pathology. 

Navigating justice… 

In the era of COVID and the horrific circumstances of George Floyd’s murder, the realities of inequities and gross discrimination that continue in both subtle and overt ways to pollute our Constitution and cause division, have been ushered to the forefront of our national conversation. 

While I like to think I am a proponent of social justice and advocacy, in recent days, I have been convicted of the gravity of my own privilege and how it has veiled me in many ways from confronting the hardships and injustice impacting so many. My tendency  is to want to compartmentalize the hate, to escape to the luxury of denial, to tear up and express brief bouts of anger without lasting action, to voice opposition to discrimination, but rest easy in my white upper middle-class comforts. 

The wounds of our country will never heal with the thin band aids representing short lived motivations from a rally, supportive sentiments without action, and promises not upheld. Change must come with a national reckoning of our failures to uphold the Constitution, apologies married with sustained, systemic action, and the emotionally charged work of confronting our personal narratives that uphold the often quiet and subconscious, but oh so powerful schemas that allow for discrimination, inequity, and hate to exist too often without penalty. True, restorative justice has become more and more elusive. 

My best definition of justice is that it is the intersection between grace and accountability. Under this definition, justice allows grace for the complexities behind certain actions and behaviors, while also making clear how certain actions harm ourselves and others. Locking a man up in a cell without addressing roots of trauma, fractured self-worth, and missed opportunities is “justice” without grace. This breeds resentment and mistrust. In our broken criminal justice system, wealth and power have too often allowed for criminal acts to be baptized free without regard to accountability. This allows for entitlement and reinforces perceived superiority.  

Facing the realities… 

While we may reminisce about the pre-COVID days when things were “normal”, in my home state of Oregon alone, suicide had become the greatest killer among youth ages 10-24, over 500,000 residents had food insecurity, we placed #44/50 among national public school rankings, had one of the nation’s leading rates of homelessness- over 2x the national average, and despite stereotypes of progressivism, Oregon’s history has deep roots of racism that continue to haunt the present day. 

Native Americans and African Americans have the highest rates of poverty by race (25.4% and 20.8% respectively) followed by Hispanics, Whites, and Asians. The emotional stigma and burden of poverty is significant on its own. Poverty often comes with limitations to accessing quality healthcare and implement healthy behaviors. Accessing healthy food, finding reliable transportation, funding medical care, finding a safe place to exercise, taking time away from work for appointments, social and geographical isolation, and facing stereotypes and bias within the healthcare system are all potential barriers. With the time demands on mainstream medicine, healthcare providers rarely have the time to address or even acknowledge such complexities and are pushed further downstream from the driving factors of illness. It has created a flood of chronic illness and a scourge of mistrust and hopelessness. We keep throwing down sandbags when we really need to turn off the hose. 

A Collective Healing Approach…

While personalized medicine is a care model that has been popularized and has value, for us to better address upstream policies, social structures, and inequity, we must look towards a model of care that reinforces healthy communities and thereby acknowledging individual wellness is intimately intertwined with the wellness of a community.  

To untangle the roots, we must take time to come together, listen, share stories, allow for vulnerability, hold each other accountable, and support one another. Especially in mental health where privacy is understandably a mandate, we must also recognize how keeping our struggles in isolation from one another may be reinforcing stigma, stress, and fear. In some ways, a culture of too much privacy can limit the healing that can take place when we allow for connection. 

For our individual and collective wellness, we must continue to mobilize, to innovate, to advocate. The mass protests and desperation of COVID is not simply what is now, but a buildup of what has been for far too long. Ultimately, as isolated as we may find ourselves these days, we continue to be interconnected. Your struggle has a ripple effect beyond yourself. Your neighbor’s struggle has a ripple effect that may impact you. True wellness will never be solved in your 15-minute doctor visit, but by the security of human-human connection.  

Wishing you wellness.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

www.shesoarspsych.com

Sisters & Silverton, Oregon

“I told myself I was tough”, she said.

“I told myself I was strong enough to stand by him”, she went on. “He has a troubled past and I understand why he might…”

She was no doubt tough. She had come into my office with her boots authentically worn from long days and dust. She placed her wide brimmed cowboy hat on the side table revealing her face with lines etched by the sun. Her long sleeve button down shirt was tucked into pressed dark denim Wranglers adorned by a silver belt buckle. She told me about her horse who had been her companion for the past fifteen years, her cow dog, and her days counting cattle and mending fence. She said she preferred solitude and despised being the subject of pity. “I have never been to anybody like you before”, she said. “It just never felt right to complain”, she continued while she shook her head and stared at the office floor.

At the time, as a bonafide ‘beginner’ in my profession, I couldn’t help feeling intimidation, respect, admiration, and curiosity all at once. She exuded an old-fashioned wisdom and grit softened by humility.

She told me about her anxiety. She told me that she could generally escape the worry amid daily demands on the ranch and with the freedom she felt on her horse’s back navigating endless acres of high desert and sage.

Inevitable aging and the toll of ranch life had forced a slow-down. She told me two much younger ranch hands were hired and the herd was downsized, which offered a reprieve, but also more moments of stillness seldom available in the past. Distractions became fewer and God help her, she was not going to get one of those “darn smartphones”. The opportunities to bury the day’s worries in hard work became scarcer.

For a long time, the story she told was not being able to overcome the tightness in her chest, the pit she felt in her gut, the lost “pep in her step”. She avoided using words like ‘sad’ and ‘afraid’ and often apologized for “bombarding me” with so many problems despite my repeated reassurance.

At times, she exuded suspicion and stubbornness when we discussed strategies and ways to cope. Nevertheless, her attendance week after week did not waiver.

One week, nearly six months into our work together, she sat down on the couch as always, put her hat on the side table as always, and then tears fell. Most always armed with stoicism and a ‘safe’ emotional distance, her tears caught me off guard. I attempted to gently inquire knowing that this was a pivotal moment…

“Can I show you something?” she said. I nodded with equal parts encouragement and concern.

She unbuttoned the cuffs on her shirt and with tears still falling rolled up her sleeves.

She held out her bare forearms discolored with visible shades of blues, reds, and purples and then stated, “there’s more”, and she slowly removed her shirt. Trying to hold back the intensity of my own emotions, I stood up from my chair, put a hand on her shoulder and could only think to say, “you are safe here”.

I scanned her upper body etched in bruises and redness- up and down her arms, the contours of her back, the base of her neck, along her ribs. Amid the damage, I couldn’t also help but notice her physical strength and stature that seemed to be in such stark contrast to the violence forcefully inscribed all over her body.

He had been described as an “old cowboy who liked whiskey”. He had been a Vietnam veteran almost certainly haunted by the trauma of war. She told me his rages would come without warning and she would become his target. Sometimes months would go by without incident. Accusations of infidelity, belittling, and name calling would escalate into punching, pushing, kicking, and hair pulling.

Afterwards there was usually an apology and sometimes a letter with promises never realized. Enduring the fear of staying was somehow lesser for her than facing the fear of pity and a future unknown. She tried her best to see her tolerance as toughness and in the lonely moments, found bits of reassurance riding out to her favorite viewpoint and taking in the beauty of the land when all else seemed so ugly.

I was the first person she told. Amid her desperation, I withheld my temptation to respond with a directive to ‘leave’ as it is almost never that simple. As she stood in my office exposed, vulnerable to the core, and overwhelmed with uncertainty, I struggled to find words. So instead, I could only say to her what was most evident to me… “I have never seen you so tough” and this I repeated week after week as we navigated the journey ahead.

This story is in honor to all the men, women, and children who have experienced or have been witness to domestic violence. 

Details of this story and names have been withheld due to confidentiality. Client consent was granted prior to publication.

Thank you for listening.

With gratitude,

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

Sisters & Silverton, Oregon, www.shesoarspsych.com