March is Women’s History Month. It is a time to reflect on the many women and men who have carved pathways toward the sought after hopes of equity, respect, and opportunity. It is a time to reflect on privilege and intersectionality where systems in our society continue to favor some while sizeable gaps remain for others. It is a time to remember the women in our own lives and take inventory of sacrifice, resilience, and compassion, but also acknowledge the dark spots. It is a time for inspiration and mobilization as we seek togetherness and connection. It is a time for honesty. It is a time for accountability.

Accountability can be a controversial word. Accountability insinuates responsibility and responsibility insinuates blame, which can often lead to defensiveness. The reasons behind continued inequities for some women are complex and layered. However, amid the effects of patriarchy and discrimination also lies the subtle and more obvious ways in which we as women sabotage each other.

Women and girls have been historically socialized to lead with softness, hospitality, modesty, beauty, and maternalism. While these traits have value, the roles of assertiveness and boldness have had historically masculine connotations. As women, we may become caregivers, people-pleasers, and super-moms, but too often carry silent resentments and loneliness as speaking up, setting boundaries, and being direct can seem challenging. We may act like who we think we should be rather than who we may truly be, which can ultimately be exhausting and isolating.

Historically, women have also been too frequently in a place of dependence- often on a man. This is evident in our story books, fairy tales, media, and cultural values. This dependence has been and remains socially reinforced as a woman’s worth, financial standing, property, and welfare may be socially dictated by her marital or relationship status. Yes, this has changed in the United States (for some) although in other parts of the world it continues to be reality. Meeting social norms for some women is not simply about fitting in, but about survival. This dynamic creates competition, desperation, and disempowers a woman as her society may dismiss the value of her character, work ethic, or intellect. Women have made great strides, but for many women and girls there remains a hypervigilance of being accepted and attractive even at the expense of their welfare and aspirations.

While opportunity continues to remain staggered for women across the United States and inequities continue to be problematic, a good number of women in this country are privileged to have autonomy, free agency, access to education, financial independence, and professional opportunity. It seems these ‘privileges’ should be rights; however, they can be a luxury when compared to women on a global scale. In this place of privilege, there can still be struggle. Simply being aware of the grossly unsettling rates of abuse, assault, and mistreatment women endure creates widespread resentment, sadness, and anger.

Ultimately, many of us have been hurt, wounded, and traumatized. We have ample reason to be defensive, on-guard, and mistrusting. Many of us have faced situations where we have felt powerless and out of control. Too often this leads to self-blame, insecurity, and shame, which if not acknowledged, can be projected frequently on our female counterparts in ways that can be very ugly.

Arising from our own insecurities, we tear each other down for how we look, judge each other’s successes, shame each other’s sexuality, insult each other’s intelligence, and maintain rigid viewpoints of what constitutes a worthy woman. We gossip, backstab, serve the silent treatment, and spread rumors. We must learn to lead with accountability rather than blame and self-reflection rather than projection.

Women need to support women. There is a special resilience that binds us all. It is a strength that transcends labels, political affiliations, beliefs, occupation, relationship status, and financial standing. We must own our voice, our prejudices, our privilege, our decisions, our feelings, our actions, and our story. Jealousy, competition, and judgement only regresses our progress. So, let’s honor our history and lead with courage, togetherness, humility, openness, and yes, accountability. We still have work to do.

Thank you for listening everyone.

With gratitude,

Audry Van Houweling, Owner & Founder,

She Soars Psychiatry, LLC

www.shesoarspsych.com 

Sisters & Silverton, Oregon

Struggle does not discriminate. Grief and loss are part of the human experience. Many of us will face heartbreak, regret, and despair. It is also possible that amid all of these realities, we can simultaneously feel grateful, ‘blessed’, and perhaps just lucky.

One of the most dynamic aspects of my job is that because of universal struggle, I have the privilege to sit with clients across the cultural, socioeconomic, psychosocial, and spiritual spectrum. Each story is unique and avenues toward healing demand creativity and personalization.

While there are certainly exceptions, the small towns in which I work, Sisters and Silverton, are known as quaint, desirable, safe, and each attracts its fair share of affluence and privilege. Both communities are also largely populated by decent, hard-working, and well-meaning residents sensitive to their footprint in the community and larger world.

“I feel bad being here”, some say in reference to stepping in my office. “I feel like I am just complaining”, others say. “I am probably wasting your time…I am so grateful for my life…but I feel like I am drowning.” I do my best to gently inform each client that it is entirely possible to be both grateful and dismal at the same time. My more affluent clients, worried their trials will be perceived as petty, sometimes sheepishly tell their story as if there is a level of shame to their concerns. In truth, emotional struggle is a great equalizer. While there may be pockets of advanced treatment options available to the wealthy and money may allow for more privileged treatments for cancer, chronic disease, weight management, and aesthetic pursuits, cash cannot provide a lavish cure for depression, worry, loss, loneliness, abandonment, and heartbreak. The pain can be just as relevant and intense regardless of socioeconomic status.

Certainly, money can provide a lifestyle that may be protective against certain emotional trials and can allow for opportunities that may buffer emotional burdens, but the human experience that inevitably includes suffering cannot be avoided. Furthermore, wealth and popularity can also reinforce the need to maintain an image and reputation that limits a person’s ability to be authentic or to live their truth. This can be burdensome and quite frankly, exhausting.

We have seen celebrities, athletes, and prominent leaders and community members who appear to ‘have it all’ disclose their emotional battles or mental illness and have also felt the shock of when emotional struggle overcomes a person’s will to continue on living. We might scratch our heads in search of how or why someone so ‘successful’ could have been suffering so deeply.

Those devout to certain faith-based beliefs may also struggle within the paradox of emotional pain and simultaneous devotion to hope and redemption.  It can feel at times that the promises and comforts of  faith can fall short amid loss and despair. Seeking respite outside a congregation can even feel like a betrayal of sorts. In my humble opinion, one should be able to be ‘blessed’, devout, and seek outside help without fear of judgement.

In writing this, it is my continued hope that we would all learn to lead with compassion and kindness. We like to create labels and divisions that create a perception of how people should live and behave. When we try to have such rigidity and expectation, the world often proves us wrong. If you are experiencing struggle and pain, breathe easy, you are human. Support is priceless- we are made to lean on each other and not go through this thing called life alone.

Thank you for listening everyone.

With gratitude,

Audry Van Houweling, Owner & Founder,

She Soars Psychiatry, LLC

www.shesoarspsych.com Sisters & Silverton, Oregon

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

The holiday season can be a mixed bag of emotions. In the best case, it is filled with joy and merriment; however, feelings of grief, stress, and loneliness are also common. In either case, what makes the season most meaningful for most of us is celebrating the connections we share with those we love.

In these digitalized times, establishing and maintaining social connections that allow for face-face contact has become more challenging. It is has become the norm- especially in our younger generations that social “connection” is most commonly mediated through a device or screen and “everyone is doing it” so it creates its own unique social pressure to follow suit. While our digitalized social connections and tribes may have merit, they cannot substitute for genuine face-face human contact. Furthermore, the profiles of individuals we are “connected” to are most generally filtered and edited facades that often do not allow for authentic relationships. We too create facades for ourselves of which we may feel a pressure to live up to, which can limit our opportunities to let our guard down and display emotional vulnerability. Altogether, the loss of face-face contact can create a void of social isolation, which I believe is one of the great public health concerns of our time.

At our core we are social beings. Having a tribe or community has evolutionary roots in being central to our survival, defense, and welfare; however, amid individualism and modernism, close connections have withered for many of us.

Social integration or the frequency of which we have face-face social contact with others- from the grocery clerk to our spouse, has in fact been found to be a major social determinant of health and longevity. In reviewing over 148 studies and 308, 849 middle-age participants, researchers from Brigham Young University and University of North Carolina at Chapel Hill (2010) found that close interpersonal relationships in addition to social integration were the primary factors predicting longevity even superseding substance use, exercise, and diet.

Face to face contact has genuine neurochemical and physiological benefits that cannot be mimicked via social media, text messaging, or other forms of digitalized forms of communication. Eye contact, a good handshake, and high fives all release oxytocin otherwise known as the “bonding hormone”. Oxytocin furthermore can reduce cortisol- our primary stress hormone. Dopamine is also released, which promotes feelings of reward and pleasure. Additionally, face to face contact provides opportunities for empathy far more than via social media or texting, where you are removed from the emotional consequences of your communication. In other words, you have more reign to be a schmuck without having to bear witness to the sadness, tears, fear, or anger you may inspire.

Our digital devices have also become great distractions, and might I say, time-suckers that allow us to procrastinate and postpone confronting emotional struggle. They have also in many ways become the modern-day pacifier for children (and adults), and the preferred solution for awkwardness and conversational pauses. Basically, they have thwarted emotional resilience and the art of conversing. Our followers don’t make us happy and study after study demonstrates that the more time we spend on social media, the more susceptible we are to feelings of anxiety, loneliness, and depression. So yeah, it’s a masterful lie.

Given that social media and device addiction is in my opinion, very legitimate, we all must be a bit more intentional about giving ourselves opportunities for face-face interactions. Schedule routine coffee visits with a friend, join a club, take a class, go on date nights with your spouse, or simply surround yourself with human energy at the gym, mall, or local park. And remember, your smartphone is not your best friend.

Wishing everyone a safe and healthy holiday season. Give yourself the gift of connection, allow yourself a digital detox, and soak in the beauty of the human spirit. Happy holidays!

With gratitude,

Audry Van Houweling, PMHNP-BC

Owner & Founder She Soars Psychiatry, LLC,

Sisters & Silverton, Oregon