The Legacy of Mental Health: Faulty Foundations & Future Directions

/ Audry Van Houweling / Leave a comment

What I enjoy most about my job are the stories. Tales of resilience, trudging through struggle and persistence that is awe-inspiring. Tales of celebration and transformation allowing lightness to be just as present as the heaviness. To have the privilege to bear witness to the rawness of life—the vulnerability that may have never been spoken outside the walls of my office, is an opportunity I try not to take for granted. While diplomas hang on my office wall constituting some level of due diligence for my job, my most meaningful work does not come from a textbook or fancy training, but in the simple act of providing a platform for somebody to feel seen, heard, and validated.  

I have been asked many times why I have chosen this line of work. Put simply, a mental health provider is not for those who desire logic and certainty. It is a field that demands a draw to creativity, at least a bit of proclivity for drama, and a sustained fascination for what lies between point A and point B in a person’s life. What are the layers and circumstances behind action and behavior? But perhaps most of all, being a mental health provider demands an appreciation for mystery, ambiguity, and uncertainty.

Despite attempts for algorithms and treatment protocols throughout the years, the field of psychiatry and mental health has long been on shifting sand. The first edition of the Diagnostic Statistical Manual of Mental Disorders was released in 1952 and to date, there have been eight revisions published by an appointed committee of reportedly well-regarded experts tasked with establishing what has become a bit of a subjective and culturally informed bible to the mental health profession.  

The diagnoses found in what is currently the DSM-5-TR have provided a sense of clarity and validation for many and have provided targets for specific treatments, but for most of these so-called pathological conditions, there is little scientific basis constituting them as anything more than well-thought-out descriptions of generally to be expected sequelae. The DSM has attempted to universally categorize and define the vastness of human emotion, which at its essence is deeply personal, full of paradox, interconnected, and strongly intertwined with context and circumstance. Per my opinion, we have to take it all with a grain of salt.

https://www.psychiatrictimes.com/view/poor-dsm5-so-misunderstood

Alongside the subjectivity of mental health diagnoses, are widely accepted theories that depression concurrent with other mental health diagnoses constitutes an “imbalance in the brain”. This has historically referred to an imbalance or deficiency in the monoamine neurotransmitters (serotonin, dopamine, & norepinephrine). This monoamine hypothesis has served as the primary catalyst for extensive pharmaceutical campaigns promising the latest and greatest pharmaceutical agents to “restore” such imbalances. Yes, sometimes medications can be helpful and even lifesaving, but despite fancy names and multi-million-dollar ad campaigns, the extent of progress against rising rates of depression, suicide, and substance use, ought to be questioned. Extensive peer-reviewed studies have suggested that only about a third of antidepressant users will appreciate some level of improvement.

A recent extensive review conducted by University College London scientists and published in Molecular Psychiatry (July 2022) scrutinized the leading hypothesis that depression (and implicitly other mental health conditions) is a consequence of an imbalance in serotonin. In a thorough review of tens of thousands of subjects, researchers found no significant difference in serotonin levels among depressed versus healthy subjects. This shakes the foundation supporting the use of antidepressants predicated on the seemingly debunked monoamine hypothesis. With antidepressant use sharply on the rise in recent years for both adults and children, it makes one wonder how such a precarious theory became so widely accepted. And yet, I suppose that is what pharmaceutical companies do best…followed by insurance companies. While antidepressants should not be completely disregarded, the study further emphasizes the need for a holistic, contextually informed approach to mental health concerns.

The goal of emotional wellness should not be to avoid pain and sadness, but to embrace the inevitability of struggle balanced with the hope to cultivate moments of joy, gratitude, and connection. It is a quest that is undoubtedly easier for those with resources and supports and has also become difficult when up against our mainstream culture that exploits insecurities, fear tactics, time scarcity, and has cast a long shadow of existential gloom for many of us. Simultaneously, the prevailing message of mainstream mental health is that accommodations ought to be made per our discomforts perpetuating the idea that we are entitled to the path of least resistance. Our tolerance for struggle has dwindled and our resilience has faltered with it. 

Regardless of nostalgia for better times, the world has always had its dark spots. In times past, we had more distance from it all as we awaited the daily newspaper or a phone call. Now, exposure and susceptibility to vicarious trauma is only one click away and as immediate as ever. Adults and parents seeking to buffer children from danger may be unintentionally robbing opportunities for resilience-building and transferring their own anxieties. Children are less likely to drive, get a summer job, date, do chores, and communicate face-to-face. On the outside they are growing up slower, but as soon as they pick up their device, they are confronted with a slew of emotionally charged topics that overwhelm even the most emotionally mature—divisive politics, bullying, climate change, war, death, mass shootings…who wouldn’t be anxious? 

https://www.dailymail.co.uk/health/article-7653205/US-health-officials-link-childhood-trauma-adult-illness.html

Uncomfortable emotions are part of the human experience and can be just as informative as they can be problematic. Depression, anxiety, poor focus, burnout, and other common complaints these days cannot be attributed solely to an imbalance, or a subjective description written in a manual. Depression and many other mental health diagnoses remain complex, perhaps not always a “disorder”, often rooted in trauma, and may tell us more about the angst and urgency of mainstream culture than about actual pathology.

Relying on arbitrary theories to explain emotional distress can minimize our responsibility to ourselves as we contemplate lifestyle and connection, but also to our neighbors as we contemplate policy and social reforms. Therapy and pharmaceuticals only go so far when the feelings of environmental safety and stability are frequently in jeopardy. Strengthening our collective emotional wellness demands advocacy, an acknowledgment of privilege, and innovation- a conversation we can all contribute to.

Thank you for listening, everyone.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

www.shesoarspsych.com

Sisters & Silverton, Oregon

Will You Weep for Her?

/ Audry Van Houweling / Leave a comment

Will You Weep for Her?  

Will you weep for her as she stands at a crossroads? 

Both roads sure to have risks, unknowns, twists… 

Will you weep for her as she contemplates trying to carry a secret 

A secret soon to come out of hiding as the baggy sweatshirt fails to hide the contours  

Of the unborn life blooming in her belly 

Crowds flock to weep for this unborn life, but will they weep for her?  

Will you weep for her as the story she tells becomes a mountain of shame? 

A so-called celebration turned into isolation 

She worries, prays joy will replace fear, waits… 

Will you weep for her as forced bedrest takes over her livelihood? 

As bills pile up and her body rebels 

Will you weep for her as she postpones dreams for dimes?  

You can do it all so they say…and a burden she does not wish to be 

Will you weep for her as she feigns faint smiles to onlookers? 

Wanting desperation to go undetected. 

Will you weep for her as shaky supports dwindle? 

As the once upon a time prince becomes a coward 

Abandonment all too familiar on repeat 

And she wonders, can I survive this? 

Life, liberty, & the pursuit of happiness blur into murky waters 

Will you weep for her as her body stretches overcome with primal pain 

Screaming without an anchor as she squeezes the nurses hand 

The unborn becomes born 

Pressed against her swollen chest 

A paradox of joy and fear 

Will you weep for her as she struggles through sleepless nights 

Help is fleeting and more help breaks the bank

Without a compass, a captain, or crew mates, navigation is daunting 

She sings the only lullaby sang once to her by a kind face long gone 

How do you build a family when family has never been defined?

 

Will you weep for her as she scavenges for discounts 

Welcoming kind hearts, but not wanting to be anybody’s charity case 

Diapers, formula, doctor’s visits, clothes and more clothes 

Faced with questions, dilemmas… 

How to support a child without work?  

How to support a child with work? 

Sometimes she wants to run away from it all.  

Sometimes she gets lost in darkness.  

Do you weep for her as she grasps for her worth? 

In a society failing to treasure the crown of motherhood 

Will you weep for the child as he grows 

Mother working two jobs to sustain 

Never has he known a father 

Protective of his mother, hiding his shadows… 

She doesn’t need to know 

Desperate for belonging, he strays 

Will you weep for the child turned into a man 

Who found solidarity in the streets 

They told him he was one of them 

They told him he was strong 

He writes his mother from behind steel bars 

Will you weep for her?  

A mother with the burden of a broken heart 

Will my baby boy make it? She cries. 

Don’t they remember they wept for him in my belly?  

Who weeps for him now? 

Who wipes his tears? My tears? 

She falls to her knees each night  

Praying to God that her baby be protected 

That she might have the strength to carry on 

And she does with tired eyes and bones that feel brittle 

One. Day. At. A. Time. 

Will you weep for her? 

.

This poem is dedicated to all the mothers and mothers-to-be who know the meaning of struggle and sacrifice as they navigate raising our youth in a society that offers few reassurances and safeguards. Protecting life means showing up for the unborn and already born. Mothers are the backbone of our communities. Honoring them, acknowledging their hardships, and creating policies that allow their worlds to expand rather than become smaller, are essential components to protecting the welfare, health, and livelihoods of current and future generations.

Written by Audry Van Houweling, Owner & Founder

She soars Psychiatry, LLC www.shesoarspsych.com

Sisters & Silverton, Oregon

The Problem with Unbridled Entitlement

/ Audry Van Houweling / 1 Comment

It was September 1939. My maternal grandmother was 15 when the wails of air raid sirens broadcasted throughout her home city of Warsaw, Poland. The Nazi invasion had begun. Targeted as ‘intellectuals’ by the Nazis, my great grandparents were killed in short order. My grandmother, spared for her youth, was shipped to a forced labor camp, where she later escaped, joined the underground resistance, was apprehended again, and imprisoned in Germany where she remained until the end of the War.  

Intergenerational trauma has been scientifically traced back to the womb. In-utero exposure to maternal hardship, fear, and trauma can have long lasting impacts on how a person processes and perceives stress. We may even be primed to respond to certain triggers never directly experienced, but through a sort of pre-programmed warning system passed down from our ancestors.  When the first round of bombs fell on Ukraine February 24th and the sirens wailed once again, I felt like I was standing in the shoes of my grandmother. It felt personal. I couldn’t stop thinking about her…and now the people of Ukraine. The terror. The shock. They say history repeats itself, but maybe I hope that with the passage of time and human advancement, our morality might also advance… 

We are living in a world where vicarious and secondary trauma can be experienced en masse. Once upon a time, delayed war time reports were delivered on horseback. Now real-time footage is available one click away. We can bear witness to devastation 24/7. We have a proximity to trauma that can be both intoxicating and exhausting all at the same time. Hard to look and hard to look away. Layered with all other calamities of recent times, I find myself sitting with the paradox of how to reconcile deep concern and deep longings to help alongside deep cravings for escapism. I find myself clicking through the tabs on my laptop…CNN anxiously reading up on the Russian offensive…then to taxes…then to responding to emails…then some window shopping on Zillow…then on to the best beaches in Mexico…back to an anxious bout on the news…and reluctantly, back to taxes. A lingering sort of survivor’s guilt is often in the background. Who am I to deserve such ease? 

Meaningful action seems distant from my small town. It is hard not to get lost in existential dread, but then I reflect on my sincere belief that global transformation starts at the dinner table. Small gestures can have big consequences. 

While there is much to be concerned about in our world, what haunts me most at the end of the day, is the prevalence of unbridled entitlement. Unbridled entitlement is often matched with a deep sense of victimhood. When mixed with power, greed, and resources, the combination of entitlement and victimhood can become…well, very ugly.  

“Power over others is weakness disguised as strength.“

-Eckhart Tolle

We can all theorize the reasons behind Putin’s heartless wrath as he disregards global condemnation, but what is clear is that he demonstrates a profound sense of victimhood, of being historically wronged, of feeling entitled to reclaim the myth of his territory regardless of the cost. Putin has equated the global projection of his victimhood with power. And unfortunately, he has one of the world’s largest militaries and nuclear arsenals to fuel his tantrum. 

Unbridled entitlement that often blinds a person from self-responsibility is not just a Putin problem, it is a societal problem. We see entitlement projected through violence, manipulation, deceit, greed, abuse, and environmental destruction. Our society makes it easy to feel persistently aggrieved. In our quick fix, dopamine driven society we have labeled negative feeling states as bad or even unwarranted- feelings to distract away, numb away, or escape from. We can raise a big fuss around temporary discomfort or rally troops when life doesn’t quite go our way. Preserving our ego can override concern for consequences. We become territorial and assume that folks should see the world through our eyes. We become rigid, angry, and more prone to division.  

And now back to the dinner table and to our local communities…What we are exemplifying for future generations has global consequences. Putin’s road to rage was not predestined, but cultivated through a series perceived aggrievances, of losses, of insecurity, failures, and a culture that did little to demand self-reflection and accountability. When we can exemplify and teach self-responsibility and compassion (the antidotes to entitlement), we do the world a favor, and we fight the foundational ills that plague Ukraine and so many places in our world. 

“Entitlement is always bad, but never as bad as when those in power cry victim.”

-Jaco Strydom

How are we teaching our youth (and ourselves) to manage negative feeling states? How are we teaching resilience in the face of discomfort? What about sustaining kindness in the face of adversity? Are we able to discern between needs and wants? How are we teaching gratitude and perspective? Can we be brave enough to demand accountability? 

The world does not owe us much at all in the end. This may sound cold but can also be liberating. To have our emotional well-being tied to the whims of others or external circumstances, takes away from our internal sense of grounding. It tethers our stability to a volatile world. It is when we can take radical responsibility that we can better identify our own internal compass, afford more grace to others, and positively redirect the remnants of intergenerational trauma in our own lives. 

So, remember as big and scary as problems may seem, please remember the ripple effects that can emanate from within the walls of our own home, one dinner conversation at a time.

Thanks for listening everyone. Sending prayers and hope to the people of Ukraine.

To help Ukraine’s refugees, please consider donating to the UN Refugee Agency for Ukraine Refugees

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

Sisters & Silverton, Oregon

A New Year’s Wish for 2022: Civility

/ Audry Van Houweling / Leave a comment

Feelings of powerlessness are insidious. While sometimes an opportunity for productive action, most often they plunge us into a state of primitive adrenaline: fight, flight, or freeze. These feelings may echo times of powerlessness from times past. They have a knack for triggering the shadows of our inner child, our greatest fears, and fortifying our defenses primed from traumas gone by. When faced with trauma, it is not simply the event itself per se that is damaging, but the surrounding feelings of powerlessness themselves leaving us feeling lost, unknowing, exposed, and shaken.  

Powerlessness has encircled the world the last two years. I could give you the (long) laundry list as to why, but I think we have all seen that list many times by now. It has left many of us looking for solutions, avenues to control, somebody to blame. The muddy waters and complexities surrounding circumstances of the past two years, have given us an unfinished narrative. How did this happen? Who is to blame? What is the best course of action? When does this end? Instead of being able to sit with a storyline that is very much “under construction”, we seek to fill the gaps with our own handywork. We create a story for ourselves that best provides a sense of safety, freedom, and control. We create our own enemies, our own protagonists, and our own plot twists. We each carry our own manuscript informed by layers of experience, culture, beliefs, opportunity, adversity, and relationships encompassing the multi-chapter, pre-COVID prologue unique to each of us. 

“Civility costs nothing and buys everything.”

Mary Worley Montagu

Evolution has taught us that when most vulnerable and powerless, we are stronger with a tribe. Our relationship to others is central to our identity and consequent behavior. Prior to the digital age (and COVID), connections to a group were solidified face-face. Emotions, sentiment, tone, and body language could be appreciated. While opportunities for face-face engagement continue to exist, our social affiliations have become far more informed by algorithmic and superficial mechanisms that pave the way for hate and extremism as the ethics of civil engagement are stripped away. Our media feeds often hijack critical thinking skills and discernment. While many of us desire decency and common courtesy, we are also being manipulated into territorialism as our fears and vulnerabilities are exploited. Powerlessness and fear can be genuine but, can also be manufactured.  

With many of us triggered and primed to project our fears, we may find ourselves more skeptical, untrusting, skittish, withdrawn, and fearful of judgment. Civility seems riskier as it demands a loosening of our defenses in a time where self-preservation seems so critical. Finding a scapegoat gives us false reassurance that there is a target, a definable problem, some entity to be fixed or silenced. More than anything, finding a scapegoat allows us to bypass responsibility and escape vulnerability. 

When I see somebody overcome by anger or fear in my office, I often find myself envisioning them as a child. What happened? What informed such a reaction? What struggle is behind the emotion? We all have our dark places, our shadows. As unfair as it might be, we are not necessarily responsible for what happened to us, but inevitably most of us are responsible for how we respond to it. This is not always easy, is laced with privilege, and often cannot be done without help along the way.  

“The wound is not my fault, but the healing is my responsibility.”

Marianne Williamson

Our mind plays a lot of tricks on us. What might allow for fleeting feelings of safety or control, may not be productive and can sometimes be harmful. Having convictions can be admirable, but if we are too zealous, we back ourselves into our own corner. Rigid beliefs and behaviors lead to stagnation, the inability to grow, and lost opportunities for connection. Our world shrinks. Resourcefulness, openness, and flexibility become limited. Clutching tightly to certain labels, affiliations, and marking our territory on either side of the fence can have the allure of power. Perhaps, instead of having to choose a side of the fence, more applause should be given for those sitting on the fence thoughtfully observing either side, learning to be comfortable with ambivalence. 

As the natural transition of 2022 is upon us, my secret wish is that we can all have the courage to be introspective…to own our energy, our shadows, and our responses. When we find ourselves saddled with anger, fear, and resentment, let’s hope we can all do better at opening the door for self-compassion and reflection rather than sabotaging with projection and blame. We owe it to ourselves, we definitely owe it to our youth, and the world will thank us for it. 

Cheers to civility, cheers to kindness, cheers to responsibility. Happy New Year! 

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

Sisters & Silverton, Oregon

www.shesoarspsych.com

Prioritizing Resilience Over Stability

/ Audry Van Houweling / Leave a comment

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

I went rummaging through my garage the other day. With every intention of finding my plastic pumpkin to put on my doorstep in a half-hearted effort to appear festive, I instead came upon one of those old keepsake boxes lodged somewhere between my camping supplies and rusted paint canisters. Needless to say, I forgot about my pumpkin for the next couple hours. 

I came across a report written when I was 15. It was my then (very serious) life plan. Always a planner, the 10-page timeline composed with typical adolescent invincibility and certainty, outlined with remarkable detail how life will proceed…I played basketball for the legendary Pat Summitt at the University of Tennessee, I became a veterinarian, I decided not to marry until I was exactly 27 years old, I married a fellow vet (apparently named Kevin) who as luck would have it, was a previous Abercrombie & Fitch model…we had 3 children illustrated by cut-outs from the JC Penney catalog, we moved to Jackson Hole, Wyoming, and magically had the means to buy a multi-million-dollar equine estate on 50 acres against the Tetons. Perhaps it was Kevin’s modeling royalties? Not sure. 

Not to delve too far into my life story, but my teenage self who was very married to her idea of authenticity did not have as functional a crystal ball as she thought. Fast forwarding, I got married at 22, settled for hooping it up during late night pick-up games…mostly schooling my future husband who while quite attractive, did not hail from Abercrombie & Fitch…we did live in Wyoming for a while in a very economical however structurally questionable apartment (one of our 10 post-marriage moves), and we are for now settled in Sisters, Oregon with four-legged children only.  

All this to say that as much as we might feel we are staying allegiant to our authenticity in the moment, life has a way of surprising us.  

Stop Seeking and Just Be 

The quest for the ‘true self’ has been touted in pop culture and psychology as something the enlightened human ought to uncover. It has inspired modalities of therapy, meditations, retreats, podcasts, and God only knows how many self-help books. There is some implication that with enough introspection and self-discovery, we ought to find our ‘true self’ at the end of some rainbow and then hope to hold on to him/her forever. It is all a bit overrated in my book.

If we are getting scientific, how we feel and perceive ourselves and those around us is so multifaceted around physiology, environment, and circumstance, that one could argue that we wake up a new animal each morning. The idea of unearthing our true self and remaining in perpetual alignment is simply, not aligned with the human experience. 

A lot of anxiety comes for folks in the perceived quest for happiness. We develop benchmarks for contentment. When I lose 10 pounds…when I own a house…when I advance my career…when I fall in love. We chase ideas of “reaching our full potential”, or finding our “purpose”, and yes, the perpetual and never fully fruitful quest of finding our “true self”. Problem is that while on that quest we can lose sight of the present. Perhaps we ought to change the narrative that the true self is found in simple acknowledgement of who we are in this moment. Goals are good, but postponing contentment erases purpose altogether. 

Social Incentives 

When we make a mistake or behave in a way we regret, we may often find ourselves saying, “that was just not like me” or “that’s not who I am”. It seems that a lot of our perception of what our true self ought to be is closely aligned with concepts of reputation and social acceptance. This makes good sense in the lens of evolutionary psychology that proposes we are ultimately more protected as an individual when we can make friends and have allies. Interestingly, research has suggested that our perceived authenticity is stronger when we are more aligned with external social structures.  

Depending on our routines, many of us may encounter multiple social settings within the course of our day…our work setting, our family setting, our friends setting, etc. How we show up in regard to personality, professionalism, and behavior is very likely to change a bit depending on the social setting. Does that mean we are foregoing our authenticity? Perhaps it just means we are adaptable and socially flexible humans. Kudos to us. 

While I am not advocating for being a doormat, we cannot separate the fact that our perception of identity is inextricably linked to our social and cultural landscape that will undoubtedly change overtime. Having a sense of our core values that help fortify our internal compass is important, but accepting these values may shift allows us the space to redefine meaning throughout our life. 

Finding Peace in the Dissonance 

Humans are strange creatures. If we were all strictly allegiant to authentically expressing our internal thoughts and feelings, we would all undoubtedly be locked up. We all have our shadows, our moments of scary thoughts, sometimes violent thoughts, sometimes just plain weird thoughts. While we will have our slip ups, many of us have learned through supportive social conditioning how to filter and redirect such moments. Much of the time we can play the role of a decent human without our moments of internal recklessness being found out. 

There will always be a degree of dissonance between our internal thought life and our external expressions of identity. Sometimes we can be too painfully aware of our inner insecurities, places of shame, and negative self-talk. Some of us become masters at masking our inner shadows, but nevertheless we can feel like imposters. We convince ourselves that the dissonance between the inside and the outside means we are fraudulent- not adhering to our “truth”. As we scroll through filtered, blissful images on social media we can furthermore become convinced that others have somehow figured out this game of inner and outer harmony that we are seemingly lacking. We are all fooling ourselves. 

How Can You Best Show Up Today? 

Many of us may be aware of the ways we can improve, our opportunities for growth, our goals. We may have convinced ourselves that in order to find our “truth” that such conditions need to be met. Have you ever asked yourself what happens in the meantime however? 

Forget about your true self. Let go of the quest. What about your best self—today? With everything that has culminated thus far, how can you best show up for yourself today and in this moment? How about for others? Something else may transpire tomorrow. Your best self may change. Trust that your best is simply enough. 

For now, my best self will return to the garage on the very important quest to find my adrift plastic pumpkin. 

Thanks for listening everyone.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

Sisters & Silverton, Oregon

www.shesoarspsych.com

The Myth of the “True Self”

/ Audry Van Houweling / Leave a comment

The Case for Grace…

/ Audry Van Houweling / 1 Comment

It may be my favorite word and the sound of it is indeed, sweet…grace. As I sit with clients sharing their stories of loss, grief, and trauma, my inner empath can sometimes be stretched, but more often I find myself utterly captivated by the sheer grit and resilience blooming from the struggle. And within that struggle, lies such an opportunity for amazing grace. While too often we find shame in the shadows of our lives, grace is the antidote that allows us to lean into empathy and compassion for ourselves and those around us. It has the power to transform and to heal.

We live in a society where shame, anger, greed, and judgment too often prevail over the pardon of grace.  We have been compelled to take sides reinforced by digitalized and corporatized algorithms that prey on our biases and amplify divisions. We can be convinced to forego facts for political ideologies that have the power to twist once healthy convictions to hate.  

While strides are being made amid the popularity of social-emotional learning, too many children are still being raised in homes where foundational emotions are silenced or dismissed, and mistakes are met with shame. Parents growing up in generations where emotional repression and stoicism was even more expected, may also struggle with knowing how to cultivate emotional intimacy with their partners and children. Make no mistake, grace is not a free pass for bad behavior. Grace does not bypass responsibility. And grace is a close cousin of grit. Our society has long confused grit with the repression of certain emotions such as sadness and fear as if by hiding the humanity of these emotions we are stronger. The perseverance implicit in grit demands flexibility and a keen sense of awareness and grounding as the world shifts. Grace welcomes adaptability and opens the door for understanding, which helps lay the foundation for withstanding the tough times. Conversely, emotional repression leaves little room for the spectrum of human emotion and ultimately, it is anger that too often seems to be the only safe emotional outlet. Anger tricks us into thinking it is coupled with control and power. Anger has a place, but only if prompting actions that contribute to healing, not destruction. And so, as the peaks and valleys of life inevitably happen, too many of us are ill equipped to process our multitudes of emotion leading to judgment and shame on ourselves and most certainly, the projection of such judgment on others. If we narrow the channel of acceptable emotional expression too much, we cripple ourselves from persisting amid adversity. 

Just as grace is paramount to grit, it is also central to growth. I am the first to admit I am a perfectionist “in recovery”. Like many, it is so much easier to afford leniency to others, but it takes daily intention to shake my own personal, rigid expectations. Perfectionists are running a race where the finish line keeps moving. It is a recipe for burnout. Growth sees opportunity in mistakes and shortcomings and thereby allows for risk and momentum whereas perfectionism and fear-based motivation maintains an all or nothing approach leading to stangancy.

In the aftermath of loss and social upheaval still so raw from this past year, it is understandable that many of us would be donning our emotional armor and find ourselves just a bit more defensive of our side of the fence. Grace for ourselves and others allows for the gradual loosening of this armor and makes room for vulnerability and ultimately, genuine connection. We may even find ourselves able to comingle with those on both sides of the fence. Research supports that our extent of connection is directly correlated with the extent of our resilience and wellness. So perhaps we should explore the other side of the fence or maybe better, get rid of the fence.

Grace is not just an #instagram worthy buzz word, but a daily practice of allowing space and equanimity to our own humanity and that of others. It recognizes the dark and the light and withholds judgment and shame. This is not so easy these days when our popular culture continually glorifies greed, comparison, and division. Yet, our core humanity compels us towards connection as a mechanism of our survival. Despite understandable hesitation, there is a pull within many of us that knows better than to hold on to the exhausting toxicity prolonged anger and detachment bring. Grace is the great respite and the greatest gift. So, allow yourself to receive it, continue to generously give it, and do your part to transform the world one graceful gesture at a time. 

Thank you for listening everyone.

With gratitude,

Audry Van Houweling

Owner, She Soars Psychiatry, LLC

http://www.shesoarpsych.com

Fragility, grit, & grace…Reflections of a year gone by

/ Audry Van Houweling / Leave a comment

It has been over a year since the shut down. The virus has claimed lives and livelihoods. Yes, there has been opportunity for reflection and silver linings, but nobody has escaped some feeling of loss. Our world has changed. We have changed. Despite nostalgia for times of yesteryear, moving forward demands a sort of radical acceptance, resilience, adaptability, and a stubborn resolve to find meaning in the madness. 

Insecurity in Isolation  

It is probably true that we have all become more acquainted with our own emotional fragility. The pandemic, financial disruption, political upheaval, housing shortages, natural disasters, and extremism among other challenges have impacted near all of us with trauma either experienced directly or witnessed up close. The physiology of stress…repeated surges of cortisol and adrenaline and the familiar feelings of fight, flight, or freeze have left many of us feeling some version of wired (but tired), hypervigilant, skeptical, uncertain, and perhaps just burnt out. Our brains have been stretched and pulled as adjustments to our routine and our sense of safety have been many. While perhaps circumstantial, the shifts of the past year have meant fundamental physiological and neurobiological changes that have precipitated or amplified depression, anxiety, and burnout among other mental health concerns. Let’s just say, I thought my work was busy in 2019-2020, but 2020-2021 took it to a whole other level. 

I count myself lucky that in my job I bear witness to what’s “behind the mask” and beyond the small talk. For selfish reasons, the honesty and vulnerability I have the privilege or being part of, reminds me that my own fragile moments are amid good company. Nevertheless, as I have become more acquainted than I ever really wanted to with the virtual ways of operating and, like most everyone, have had far fewer social engagements than usual, the voids of lost face-face engagements can often be filled with insecurities. With fewer opportunities to converse, to compare, and to share, it can feel like we are standing on shaky ground. As we scan through social media, FOMO (Fear. Of. Missing. Out.)  is real as ever…how does my quarantine stack up against others? What does success look like now? How are ambitions unleashed with so much red tape? As for myself, it is the nagging ever-present voice in the background of, “am I doing enough?” What is enough? Beats me. 

The Complexities of Social Engagement 

I think I miss the dynamics of human synergy the most. People coming together for a common goal. Cheering at a sports game, swaying with strangers at a concert, sharing a meal, geeking out with like-minded professionals at packed conferences. 

Amid the pandemic, my home state of Oregon suffered devastating calamites as wildfires swallowed up whole communities and ice storms froze power, communication, and left forests and homes mangled across the Willamette Valley. And yet in the aftermath, the collective willpower and good deeds of so many was a welcome shift from division and isolation. Synergy in motion. 

Having said this, I have always enjoyed the pursuits of an introvert. Running in the woods, riding my horse through sagebrush against the mountains, road trips on back roads. Perhaps it is the rising intensity of emotional inputs the past year, or the frequent displays of division and hate, but while a part of me is wistful for the energy of humanity, every once in a while, disillusionment creeps in and I fantasize about my own version of Into the Wild.  

Thankfully, I have a job that demands daily communication with real humans- it keep my communication skills a bit more fresh. Worth noting however, is the very real social awkwardness in the aftermath of isolation, dodging strangers on sidewalks, and virtual handshakes. The prospect of socializing for some can feel…frankly, sort of weird. 

A Year for our Youth 

Gosh. Can we just take a few moments of silence for the losses our youth have had to endure? What a year.

During my adolescent years (a case study for another day), much of my motivation to be somewhat productive came from the validation I might gain from others…my peers, my family, my teachers, my coaches. The rest of my energy was spent on a healthy dose of rebellion. Like most young people, feedback was critical to my identity, my perception of myself, and the budding of my core values. Let’s just say, the forced isolation of COVID would have been a wrecking ball.  

While (some) adults may have an edge on perspective, the world stopped for so many of our youth. The proverbial ‘light at the end of the tunnel’ was hard to grasp. Self-discovery, social engagement, and a sense of forward momentum were all disrupted in big ways. Insecurities, anxiety, and depression skyrocketed while motivation sank as opportunities for validation, socialization, accomplishment, and encouragement dwindled. Furthermore, for young folks facing instability and dysfunction at home, they were without the welcome respites of school and other pre-COVID outlets.  

This has been tough stuff, but if there is anything I am hopeful about, it is the grit and compassion I see radiating from our youth on the daily. They deserve more of a voice, and we need to listen. 

A Call for Grace 

While the world looks to slowly open its doors, many of us are a little raw around the edges. Social engagement may seem exciting and terrifying all at once. Our cups may have runneth over as our emotional capacity has been tested. For some of us, the loss and pain has come as a gush overwhelming our holding power with rapid force. For others, it has been a slow drip that suddenly we cannot contain. Traumas have been both overt and subtle. Pain and loss can deepen bitterness but can also deepen empathy. As the world continues to evolve and shift, my hope is that we can hold a bit more patience, a bit more empathy, and a bit more grace for ourselves and one another.

Be gentle. Stay open. Stay hopeful. 

With gratitude,

Audry Van Houweling

Owner & Founder, She Soars Psychiatry, LLC

www.shesoarspsych.com

https://www.facebook.com/shesoarspsych/

In Search of Ruby Red Slippers… The Intersection Between Mental Health and the Housing Crisis

/ Audry Van Houweling / Leave a comment

It’s true, Dorothy…there’s no place like home.

In 2014 my husband and I started the search for our first home in the idyllic and pastoral town of Silverton, Oregon. Like many Millennials, we had embraced nomadism hopping from one college town to the next, finishing our degrees, working when we could, and doing our best to scrape up enough savings to make homeownership a reality.  

When we arrived in Silverton in the summer of 2014 we were pampered by a weekend-long real estate tour complete with luncheons and leisurely tours from home to home as we half-way pretended to know how to scrutinize and discern our options. Historic craftsman or new build? Farmhouse or neighborly cul de sac? One story or two stories?  At the end of the weekend our realtor told us to sleep on it and take our time. We made a decision and with relative ease, we effectively moved away from the yellow brick road, tapped our ruby red slippers, and found our home. 

This all seems like a bit of a dream compared to current day realities. Dorothy’s ruby red slippers are far more elusive. Leisurely tours and long luncheons are out as the housing shortage and historically low inventory has pushed supply and demand to its brink. The task of finding a decent home is now too often laced with competition, angst, and for some, desperation. 

In my home state of Oregon, historically low inventory across the state has meant potential buyers are pressured to act fast facing sometimes daunting bidding wars, multiple rejected offers, and the reality of having to make concessions in order that their offer stands above the rest. Furthermore, as wildfires ripped through our state in 2020 and displaced thousands, an already meager housing market was crunched even more. Baby boomers looking to downsize have limited options, putting a pause to Generation X looking to “buy up”, limiting Millennials seeking to make their first home purchase, which ultimately keeps many in limbo leaning on an already sparse and inflated rental market.  

Q4 2020 Bend, Oregon Housing Market

Of course, for many, the notion of homeownership is farfetched anyhow. In an economic landscape where housing costs have far outpaced wages and nearly 40% of Americans would struggle to cover a 400.00 bill, saving for a down payment or building credit can seem beyond reach. Throughout Oregon, estimates of cost-burdened renters or homeowners (individuals or families paying upwards of 30% of household incomes) hover between 40-60 percent depending on the region. With affordable housing still woefully inadequate when matched with demand, it is not surprising that Oregon and many other states are also seeing rising rates of housing insecurity and homelessness.  

This graph shows the total active listings over the past three calendar years in the greater Portland, Oregon metropolitan area. RMLS

2020 has been (and 2021 will likely be) a time for reevaluating.  COVID, widespread financial shifts, political and social upheaval, and injustice has caused many of us to take pause and reevaluate our beliefs, relationships, work, social supports, and yes, where we call home. Some of this reevaluating has been by choice and some by sheer necessity. No longer being tied to the city office, suburbia and small-town life becomes appealing. Others are being forced to move secondary to financial hardship while break ups, divorce, death, and natural disaster have also played unique roles in the relocation boom of 2020-21.

The aftermath of the Alameda Fire in Phoenix, Oregon September 2020

These moves and shifts all have a story and come up daily in my office. Relief and hope for some, desperation and worry for others. Our health and well-being are inextricably tied to where we call home.  

From a purely mental health perspective, housing location and affordability has been demonstrated to have clear implications with behavior, self-esteem, substance abuse, exposure to crime, and access to self-care activities. Stretched to pay rent or a monthly mortgage, families may have to sacrifice quality mental healthcare or prescription costs. Multiple moves amid rising rents increase stress and lead to poorer health and education outcomes. Overcrowding in living spaces increases the risk for emotional instability and illness. Sub-standard housing increases exposure to environmental hazards such as mold, pests, lead-based paint, and structural deficits. Ultimately, a safe and affordable home provides welcome respite for individuals and families accustomed to living in perpetual survival mode. This allows for an overall reduction in mental health symptoms, less emergency visits, improved adherence to treatment recommendations, and a lower susceptibility to trauma and violence. 

The economic case for affordable housing is also noteworthy as financial stability is pertinent to individual and collective mental health. When housing is more affordable, families have more money for discretionary spending supporting local businesses. Evictions, which spark a cascade of instability are fewer. Health expenditures are reduced as health outcomes improve. Childhood poverty, limiting academic performance and opportunity, is reduced, allowing youth to pursue education and career goals that enhance the economic output of entire communities for generations to come. 

Practical interventions for increasing affordable housing are feasible. The passing of Oregon HB 2001 in 2019 paves the way for duplexes and townhouses to be constructed in lands previously zoned for single family dwellings. Subsidies and incentives for developers ought to be expanded and the red tape of infrastructure costs, building code headaches, and design standards relaxed. Employer-assisted housing programs ought to be cultivated with rental assistance or forgivable down payment loans. Safe parking areas can provide reassurances to homeless individuals living out of their cars. Low-income rental assistance and landlord mitigation funds can help minimize evictions. Regional housing counsels can help forge multi-disciplinary partnerships intimate with the needs of a particular community.

Quality mental health is far bigger than the number of therapy rooms or savvy medication prescribers. Where we call home will always be one of the most significant determinants of our individual and collective wellness. It’s going to take hard work, commitment, and creativity, but when we prioritize the health and safety of our neighbors, we make ourselves a bit safer and healthier too. 

With gratitude,

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

www.shesoarspsych.com

Sisters & Silverton, Oregon

Our Capacity for Compassion: The New Health Metric

/ Audry Van Houweling / 2 Comments

As I sit down to write this, nearly 375,00 Americans have left us from COVID-19. Many of these deaths were in isolation, away from loved ones, and the chance for processing and goodbyes interrupted by restrictions adding to the isolation of those grieving. Thousands (if not millions) more who have been impacted by the virus continue to contend with long-term and sometimes debilitating symptoms that make the motions of life seem daunting. While inexplicable, painful, and unfortunate physical and emotional calamities have always had the potential to intrude upon our lives and those we love, it seems COVID-19 has illuminated the idea that a body in relative working order is in itself, a privilege. 

As a mental health provider with a focus in functional medicine, it seems shallow if not neglectful to not talk to my clients about the value of those very basic tenants of wellness…movement, nutrition, sleep, and connection. In a functional medicine model there is no distinction between mental and physical. Your body (that yes, includes your brain) is constantly in an intimate, bidirectional, dance where a move or shift in one system can impact all others. Our emotions are driven by physiological events and can also trigger physiological events. How we treat our emotions and the story we tell ourselves about emotional experiences has a HUGE impact on our wellness from head to toe. And yet, we still live in a society skittish around confronting emotions and quick to shame or label certain emotions as weak. 

I often ask my clients to define what constitutes “health”. What constitutes a “healthy” person? From a holistic perspective and with a bias towards emotional wellness, I have seen many people check all the theoretical boxes watered down by outdated metrics and idealism, and yet be overwhelmed with despair. Top ranked in their career, hitting the gym every day, grabbing a green smoothie on their way to work, returning to their meticulously maintained home, and ending their day tuning into their 5-minute meditation before they lie in their hypoallergenic bedding and yet, peeling back the layers of emotional vulnerability is terrifying as it goes against their continuous quest for perceived control. I have found in my career that the greatest suffering comes in the running away from emotion, not the emotions themselves. As we habituate distraction, numbing, and running, the disconnect that transpires can impact our whole-body wellness, our relationships, and our spirit. 

As we enter the New Year and in the pursuit of new goals and resolutions, I want to challenge you with a definition of health that transcends the number on the scale, dietary habits, blood pressure, or cholesterol. My personal definition of health is, cultivating a lifestyle, relational landscape, and spirituality that maximizes our capacity for compassion and connection. 

Much of how society tells us to constitute health is altogether shallow.  Why are you losing that ten pounds, cutting out carbs, or dusting off that treadmill? Pursuing a goal without meaningful clarity is unsustainable. If we are honest with ourselves most of our pursuits for better health have roots in seeking connection. Some of us simply don’t like to admit that because in doing so, we are admitting vulnerability. Somewhere underneath the aesthetics of a slimmer waistline is probably the desire to be more accepted, seen, and acknowledged.  

I will not pretend to have been immune to the emotional rollercoaster of the past year. My inner empath has felt heavy and the reassurances for myself and others sometimes sparse. Nevertheless, I acknowledge the energy that I put forth has consequences both personally and professionally. And that goes for all of us. The energy I bring into sessions with clients or bring home to those I love matters. Safeguarding that energy is a daily, intentional practice that sometimes feels like an uphill battle. As I wake up in the early morning hours seeing frost on the ground or the rain pouring down, there is little motivation to put on my layers, don my headlamp, and run the handful of miles I do while dodging icy puddles and muttering resentments that I can’t be warm in the comfort of my currently closed gym (thank you for your pity). Ultimately, I run those miles because I know it makes me a more productive, pleasant person indeed more likely to be compassionate and connected. The same goes for the sleep I get at night, the foods I put in my mouth, who I spend my time with, and my spiritual practices. These lifestyle choices matter not simply because they check a box, but because they are critical to how I show up in this world and are the provisions needed for me to be a kinder human. In my view, that elevates them from mainstream recommendations to sacred and yes, a privilege. 

Our world has always had its challenges. This past year it’s been a doozy and undoubtedly, there will be more challenges ahead. It is easy to burn out and hit the metaphorical (or literal) snooze button time and again. Denial is the ultimate form of disconnect. With all the pain and loss, it is easy to harden our hearts, feel defensive, take sides, and lean into anger rather than compassion. It takes courage to confront the pain, but rather than hardening our hearts, we can seek to strengthen them. Simply put, when we can nourish our bodies, move our bodies, rest our bodies, and ground our spirit, this strength comes easier. So, here’s to hoping 2021 brings you a stronger body and stronger heart.  

Thank you for listening everyone.

With gratitude,

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

www.shesoarspsych.com

Sisters & Silverton, Oregon