Tony Pham, MD, PhD, Psychiatrist

(June 29, 2013)  I am writing this post from a busy cafe in San Francisco, where I am currently on vacation. The city is buzzing with energy. Yesterday, was gay pride day, and the streets were clogged with people, gay and straight, mostly young, most just enjoying the street life and the loud music. The craziness, over the top costumes and antics were replaced by rather ordinary looking young people, who did not need to act up or act down, evidence of growing social acceptance and assimilation of people once marginalized.

It has been 20 years since I came to this cosmopolitan urban center as a young man, about to start my internship at the University of California, San Francisco medical center. I had been a professional student, having completed a Ph.D. in molecular biology and medical studies at Baylor college of Medicine. After driving across the West in my old Toyota Camry, accompanied by my sister Lan, we reached late in the night the apartment that I had rented on the edge of campus. The place was left rather dirty by the previous tenant, but my sister declared that it was beautiful. It was to be my home for the next 7 years.

Until I came to San Francisco, I did not truly appreciate the degree to which I had been virtually cast off to the edges of society. Growing up as an Asian in America in the 70’s and 80’s, you did not feel validated in any way. Asians occupied a small stereotyped niche in this society, much as other minorities have. Asians were considered both exotic and threatening. But here in San Francisco, I felt that I was simply one of many. There were Asian people doing manual labor, Asian people driving the bus, and Asian people doing whatever type of work. I didn’t attract any attention at all, and that was the strangest feeling.

Gradually, on many levels, I gradually began to accept myself, the ways that I am like most Americans and the ways that I am not. It happened slowly, painfully, and spontaneously. I developed a mature self-awareness. I understood who I am and who I am not.

I think that we all have to develop this insight, in order to find the fulfillment that life promises. Sometimes, like I was, one happens to be in an environment that facilitates our psychological growth. Frequently, one has to create that environment by utilizing the guidance of a psychotherapist.

My Christmas flower

I saw this spectacular hibiscus flower in my front yard December 24. Of all the things in nature, I have always been drawn to plants. In my garden, I feel tranquil and content. I don’t know why exactly. Perhaps it is an instinct that has evolved over countless millenia. For, you see, it is the plants that provide us with the nourishment and the healing medicines that we need to survive.

Because of extreme temperature shifts that we have experienced of late, my hibiscus was devoid of all leaves. Yet due to the 80 degree weather that we experienced just before Christmas, it produced this spectacular bloom, a tropical Christmas flower. Take a moment to look at it. Its symmetry, shape, and color: nothing short of perfection. It is nature’s miracle, a miracle that is easily overlooked in our rush to get through each day. In our busyness, we forget to pause, experience, breathe.

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I want to take this moment to give special thanks to all who have sent messages of sympathy, concern or advice about my sister, of whom I wrote two years ago. I have not spoken to her, but I have heard that she is safe. At the moment, she wishes no communication. It is a decision that all of us who love her have to accept.

Psychological disorders are so often misunderstood. Individuals suffering from mental disorders are often expected just to snap out of it, get back to work, and stop acting crazy. Now, we understand that mental disorders are brain disorders. It is not always important to know whether they are caused by genes, traumatic experiences, childhood abuse, use of illicit drugs, or experiences of dislocation and loss. Regardless of the cause, it is important to appreciate that the illnesses are real and brain-based.

Below is an essay from a patient of mine. In it, she describes vividly her experience with bipolar disorder.

I have bipolar disorder, which means that I cycle between suicide-slit-your-wrists-girl and cocktail-hour-party-girl. When I first was diagnosed, the doctor had linked it to a high IQ. Perhaps this illness is a payback; I don’t know what I am paying for, I just know that I have the disorder. I have cycles of depression and mania that both confound and control me, while I am helpless to do anything but to watch it unfold. I have lost friends and family and loved ones because of how this debilitation consumes me. There are times when my depression is so crippling that I feel like a dislodged flower, losing more life with each passing hour – but praying that this time when I show up to see my doctor, s/he won’t have forgotten my appointment. On the swing side, my manic episodes range from feeling like the sun can’t melt my wings to feeling like the man who is running flat-out for the train but has suddenly realized he never bought a ticket and isn’t carrying his wallet. It’s all hat and no cattle. With both of these mood disorders, I rely heavily upon my doctor – not that we always or even often agree – and on my meds. I kick and grunt about the side effects of the various drugs but I know that one day I will feel better – whether that means breaking free of my depression or finally getting some sleep after having been up for days. Over the years I have found that my inherent frustration with this disease has caused me to expect that one day my doctor will open his little black bag and actually pull forth life from it. Until then, I remain hopeful that I am not the last line.