psychology – Ena's worlds

Take ownership of your healing

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The sickness role is a psychological concept that we give to patients to help them recognize the fact that they are NOT to blame for having an illness. Being ill is NOT something to be ashamed of, something to apologize for, and they are certainly not responsible for being sick.

Unfortunately, some people have misunderstood this concept to mean that they have no role in their healing, that “others” should be entirely responsible for their care and recovery, and they avoid taking ownership of the fact that their actions DO matter in how their healing journey will go.

So yes, none of us are responsible for having an illness AND at the same time, we absolutely DO have a responsibility to take ownership of the healing process.

A good example that I often see at the ED are patients who are coming in due to various ailments, none of which are significantly impairing or acute, because they would like a formal diagnosis or a second opinion for their condition. These ailments are often things like chronic pain, tension headaches, mood instability, ongoing relational issues, etc. Many of these conditions have already been looked at by (often multiple times) a specialist/ consultant, diagnosed, and treatments have been offered. Yet, many patients come to the ED looking for another diagnosis, a different “sick role” that they feel would explain their condition better. While it is completely understandable that an individual would want a better understanding of their condition, I am often surprised at how many of these patients believe that their recovery is entirely dependent on receiving the “correct” diagnosis and meeting the “right” specialist.

There is a huge societal role in this as well – we are often bombarded with images of patients coming to the hospital to be “taken care of”, where they are tucked into the bed and nurtured like a child, while taking a completely passive role in their recovery. This cannot be further from the truth. Best care is delivered when the patient takes an active role in and ownership of their own healing journey; when they take steps to best serve their body and mind. I wonder what changes we would see in our society if we start sending this message that patients ARE capable of and SHOULD be taking charge of their own health.

For example, someone with chronically depressed mood that have unfortunately shown poor response to conventional treatments can become angry at the health care system and the doctors for failing them, and this would be completely fair. AND, at the same time, they can take ownership of their healing process, and start actively engaging in psychotherapy, exercise regularly, set up a sleep schedule, explore their spirituality, tap into their social resources, and make a commitment everyday to heal.

One can use this for patients who have terminal illnesses as well. Palliative care is a large part of our training. It is incredible how patients with months left to live can make a commitment to do the best that they can every morning that they are alive. When they could walk, they would take a stroll around their neighborhood daily. When they couldn’t anymore, they got on a wheelchair and sat by the window every morning. When they were too unwell to be on a wheelchair, they listened to audiobooks and enriched their mind.

We can all take responsibility and ownership of our own wellness, and make a commitment. Us health professionals depend on our patients to work as a central piece of the healing journey. Without the patient’s commitment, there is only so much we can do.

As a witch and a spiritual person in general, I deeply believe that we are an active agent of change in our lives and the lives around us. Our will, actions, and energy DO have an impact in our life journey. Just like the spells we cast and the intentions we put forward, our everyday commitment and actions to heal from whatever ailment, physical or non-physical, WILL direct us towards our highest good.

Stay safe, my friends, and be well.

Manifesting success – switching from external to internal

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What is your definition of success?

Throughout my life until more recently, I used to evaluate success based on external measures, such as how much money I make, the impact factor of journals I published in, how many articles I produced in a year, etc etc. As I started achieving some of those “successes”, I started realizing quite rapidly that not all of them brought me happiness and feelings of accomplishment that I imagined they would. Even if they would bring a brief spark of joy, it would rarely last longer than a day or two. It did not contribute positively to my self-esteem either. Eventually, these “successes” just became forgettable aspects of my life that added little to my day to day joy, if at all.

The realization of WHY this was came when I was doing a guided meditation on manifesting. During this meditation exercise, the guide asks you to clearly envision what success looks like to you, and pushes you to imagine every small detail of your successful dream life. In this guided meditation, when I was only with myself, with no one to prove anything to, I realized that my vision of success was nothing like what I had defined success to be. Success was having a thriving garden, it was holding hands with my husband and watching the sunset, it was having the time to feel the breeze on my skin on a beach, it was having the luxury of booking travels with my husband, it was being in a home that gave me peace and serenity. These things of course, require some money to achieve, but by no means was money the only part of it. Fame and prestige? Well, it didn’t include those at all.

Law of attraction states that we attract things in our lives that we are in alignment with. Therefore, to manifest, we need to align ourselves with the values and outcomes we wish to attract. With my definition of success having been shifted (or perhaps realized) from what society defines as success to what I believe constitutes a successful life, now I can fine tune myself to attract what I need to achieve this dream.

So tell me again – what is your definition of success?

Witness to suffering

As a doctor, a lot of the care that I provide has nothing to do with prescribing medications or performing procedures. Sure, they form a significant part of my training and my day to day work. However, there are also many times where all I can provide for the patients is my presence, to be a witness to their suffering and to create space for them to grieve and mourn.

This was a huge revelation to me in the earlier stages of training – recognizing that there are many things we can’t just “fix” in medicine, and that care doesn’t end with telling a patient “I am sorry, there is nothing we can do”. I never realized how difficult it is to be truly present to witness someone’s suffering until I had to do it myself. It is so easy to give into the temptation to comfort, or to give false hope or even mislead. At the beginning, I told myself that it is because I care deeply about the patients, and it was difficult for me to watch them suffer. However, the more I did this, the more I realized I was NOT helping these patients by quickly wrapping up their suffering in a neat package to replace it with something prettier – I could see how this made them feel confused and lost. Why then, was it so hard for me to change my behavior?

Problem solving engages the prefrontal cortex of our brain – the part that allows us to reason, filter and regulate our emotions. Being forced to turn away from problem solving therefore leaves us feeling exposed, out of control and yes – vulnerable. However, in turning away from problem solving, we can truly be present and focus entirely on the suffering of the individual in front of us. In psychiatry, this is called “holding space”. Having the space to grieve without feeling pressured to go into problem solving mode can be a deeply therapeutic experience that allows one to just “be” and not be judged.

Think about our daily lives – how often do we simply listen to our friends, family or significant others and be fully present to witness their experiences? As children, how many of us had the luxury of this experience when we tried to share difficult experiences with our parents?

I tried to imagine what it would feel like to have someone fully present to witness my suffering, to have an understanding of how this could help my patients. My mind shifted to when I pray or meditate at my altar. Sometimes, I am looking for answers – but more often than not, what I desire is to have the time to sit in my grief and to let it all out, and to have someone sit WITH me in my grief. The sheer presence of my goddesses and spirit guides had always comforted me in my darkest times, and this is what I could do for my patients when there is nothing else I could offer as a doctor. Simply being present in their suffering was a service I could provide in those dark moments.

Now, when I deliver bad news, I sit with them, quietly, with a tissue box in my hand. I stay present with their grief, and in doing so I hold space for them to process their suffering.

It is true that this is much harder with family and close friends – those who we consider part of ourselves and can make us feel particularly vulnerable when they share their suffering. Practice makes perfect and I am still working on it.

Sitting with your feelings

I was reading “Maybe you should talk to someone” by the brilliant Lori Gottlieb this morning just before work, my little morning ritual, when one message really struck me: it is horribly difficult to sit with one’s own feelings, even for psychotherapists. I am no psychotherapist, but as a doctor, I always ask patients to reflect on their actions, thoughts, and feelings, and encourage them to do mindfulness exercises where they try to notice their thoughts and body without judgement.

The practice of witchcraft also asks one to recognize their thoughts and feelings, so that they can be used to enhance one’s craft and power. An aware witch is a powerful witch – she who rules herself can rule the world.

Why then, is it SO HARD for me, to sit with my feelings? I spend most of my days reading, watching TV, scanning through Youtube, or scrolling through my phone when I am not working in a desperate effort to distance myself from my emotions. In a way, working is almost an escape, because focusing my attention entirely to my patients shifts me away from thinking about myself.

A common concept discussed in psychodynamic theory and in family therapy is that a child who grows up learning that their feelings are invalid, internalize this and grow up to be adults who cannot tolerate their own emotions. The act of noticing and acknowledging their internal processes become associated with deep shame, rejection, and feelings of being misunderstood such that they learn to cope with this by becoming avoidant, not just of their own emotions but of that of others as well.

The difficult part of this is that our thoughts and emotions influence our judgement and worldview whether we acknowledge them or not. Being able to sit with, notice, and acknowledge our internal processes help us realize why we see ourselves, others, and the world the way we do, and lovingly readjust if there are biases at play.

This of course, doesn’t come easily at all. I realized my own tendency to avoid my feelings when a supervisor pointed out how I tend to get flustered if I don’t know something I think a patient wants of me, and how I would completely shift my behavior without even noticing that I am doing this. My supervisor asked me to sit and slow down, and notice the thoughts that arise in my head when this happens. This was an EXTREMELY difficult exercise – at the end, I identified a DEEP SENSE OF SHAME that arose when I felt that I wasn’t giving the patient what she/he wanted. Because this emotion was so difficult to tolerate, I avoided it completely, not even giving myself a second to think about it – unfortunately, this did not stop shame from influencing my behavior. Once I did notice the thought, also called “hot thought” in cognitive behavioral therapy, which in my case was “I am a failure”, I was able to lovingly tell myself: it’s okay to not know everything, you are doing the best you can. In slowing myself down and lovingly readjusting myself, I was able to be more present and authentic with my patients, which in turn made them happier.

When practicing magick, we ourselves form as much of the spell as the ingredients, incantations, and the spiritual forces that we summon to help us. When dark thoughts reside behind the spells that we cast without our knowledge, these thoughts can cause the spell to be weakened or even backfire. See the parallel here?

I still find sitting with my emotions extremely challenging, but I consider it an important part of my journey as a physician and a witch to become more self aware. I will be sure to keep you updated on that journey – wish me luck!

Anger, Compassion, and Forgiveness

It was the first one of my series of night shifts at the Emergency Department – I was excited to work in the ED again (one of my favorite places to work at) and was looking forward to having a productive and rewarding night.

Unfortunately, not quite having adjusted to the night schedule, my brain was foggy and my body was exhausted. I still tried my best to be chipper with the team and present for my patients, reminding myself of my goal to be a good team player and a healing light. Despite my efforts, I made two consecutive mistakes within the first 3 hours of my shift – both small mistakes not affecting patient care, but still quite a deviation from my usual performance. I tried to not think about it and move on, telling myself that I need to be more careful tonight as I am having an “off day”.

After suturing a patient at 3AM in the morning who had decided to do laundry in the dark in the wee hours of the morning, my staff and I had a disagreement over the type of sutures I chose to use. I decided to go with patient preference in the choice of sutures, and he wished that I had used a different suture which has evidence for causing less scarring. It was a matter of opinion and practice, and he did not hold this against me in any way. He just provided me education and made it clear what his preference would be if we were to suture another patient that night. Normally, I appreciate this kind of straight forwarded communication because it allows for a smooth shift and running of the team. That night though, I found myself getting extremely angry over this, thinking to myself “HOW DARE he decide to make an issue of this on a very busy overnight shift”.

Recognizing that my anger was completely out of proportion and irrational, I took a small break and sat in the lounge area where I could take off my mask and breathe. I went over my shift and my experience working with him so far. He was a great supervisor – he had clear communication, let me know right away what he likes and what he doesn’t like, and allowed me a good amount of independence. Why then, was I so upset with him over this small disagreement?

In situations like this, psychiatrists recommend that patients go back to the time before the argument had even started, to check in with their emotional states that may have influenced their reactions to the argument or discussion. In that moment, it became crystal clear to me that I was already very upset at MYSELF for making those small mistakes in the earlier hours of the shift. Despite my best efforts to suppress these thoughts, my mind was already on edge by disparaging thoughts targeted at myself. Specifically, I was telling myself that I was a failure and a bad doctor because I had made those mistakes.

Everybody has off days. Doctors and nurses are human, and therefore, are vulnerable to making human error. The mistakes that I made had not harmed anyone, although they did cause minor inconveniences. I took a deep breath and meditated. I looked at the sigils I wrote on my badge – protection, peace and patience. I thought of my goddesses and asked for their guidance. I then thought of what I often tell my patients – What would you have told your friend if they made these mistakes? This made it clear what the issue was. I had no compassion or patience for myself and immediately jumped into a judgmental mindset – an attitude I would have NEVER taken towards any of my colleagues. The consequent feelings of being a failure was so painful to sit with, that I had displaced my anger towards myself to my supervisor as soon as there was opportunity for such transference.

Displacement, according to Freudian principles, is one of the maladaptive defense mechanisms where one unconsciously transfers/ displaces their inner conflict, usually stemming from earlier life experiences, to a situation or a person that is not a part of that inner conflict.

I was grateful for the guidance of my goddesses for giving me the space and calm to realize that self-compassion, or lack there of, was at the root of this issue. I inwardly expressed my gratitude to my goddesses and allowed myself to feel the feelings of shame and disappointment at myself for the mistakes I had made. I then told myself “I forgive you – I forgive you for these mistakes and for being harsh on yourself. I honor that your desire for perfection came from a place of wanting to be a healing light. I embrace you and I love you”. Immediately, I felt a sense of relief come over me.

I was able to return to my shift and had a great night – we helped many people and my supervisor and I made a fantastic team through a very busy ED shift. While this shift had not gone exactly as I had planned, I was grateful it happened. It was a wonderful reminder of the importance of self-compassion and forgiveness. I was also reminded that when all else fails, I will always have my spirit guides and higher self to show me the way.

Shadow Work and Projection

Lately, I have been noticing that “Shadow Work”, a concept originating from psychoanalytic theory, has been appearing more than ever in mainstream media. I often hear it in the context of Wicca, a modern religion combining witchcraft practices and psychological principles, as well as many other spiritual paths.

In psychology, the Shadow is an analytic principle that identifies the part of one self that has been split from one’s conscious identity. While it is hidden from one’s conscious mind, this Shadow forms a significant part of one’s personality and how they relate to the world. While different branches of psychoanalysis calls the Shadow by different names, they generally agree that identifying the shadow is an important part of psychotherapy as it brings into awareness one’s behavioral patterns, in particular in relationships with others, that has been hidden from their conscious mind. For example, imagine a girl who has been raised by an unpredictable mother who would swing from being verbally and physically abusive to the most loving creature in the world within a split second. A belief forms in her that adults, or authority figures in general, are dangerous and not trust worthy, and that she is not worthy of receiving unconditional love and care. This belief, this way of seeing the world is so painful for her that she represses it deep into her unconsciousness – it becomes her shadow. As an adult, she has recurring issues in her life resulting from rejection of authority figures and accepting love or care from others, particularly from those that remind her of her mother. Unconsciously, she projects her belief that authority figures cannot be trusted and that she is unworthy of love and support whenever she meets a person or a situation that triggers this shadow to reappear, lifting her away from reality and making her see the world through the veil of her shadow.

Shadow work as a Wiccan principle centers around identifying one’s shadows and bringing them into consciousness, so that one can ask for help from spirits, gods and goddesses of the highest good to integrate the shadow into one’s true self. Working through one’s shadow is thought to allow for the emergence of a more whole, and integrated self, which makes them more aligned with the Universe and their magick more powerful.

The concept of the shadow has existed far before modern psychology and Wicca. Many spiritual paths dating back thousands of years and religious teachings have identified the role of the unconscious mind in how we see the world. Many meditation practices, in particular, focuses on making room for one’s shadows to appear into the conscious mind so that they can perceive the world as it is without the cover of the shadow. In Buddhism, it is said that when Buddha was born, he looked up at the sky, down at the earth, and said “Between the earth and the sky, only I exist”. There are a number of different interpretations for this saying. My favorite one is that Buddha understood that he himself, was most responsible for how he sees and relates to the world; that he understood that only himself is the true builder of his Universe.

What can we do then, once we become aware of this shadow? Freudian psychoanalytic theory states that bringing the shadow into one’s awareness, also known as “insight” is enough of a treatment in itself to alleviate the impact of one’s unconscious influences in their psychopathology. Internal family systems talk about making space for the shadow in one’s mind by accepting it and allowing it to co-exist peacefully with the other parts of one’s identity, so that they can be integrated into a more mature and resourced part of themselves. Dialectic behavioral therapy, which incorporates a significant amount of its techniques from Zen principles, suggests that one should mindfully notice, without judgment, one’s shadows as they emerge, accept and honor them, AND at the same time, make an active effort to see the world without the influence of their shadow. In Gabrielle Berstein’s “Universe has your back”, she shares a mantra/ prayer where she beautifully demonstrates this principle of honoring one’s shadow while a making a commitment to see the world without it.

In ancient witchcraft or paganism, the influece of the Shadow or the unconscious was at times descirbed as being “posessed” by the evil spirits and energies from one’s past. For example, exorcims or banishing spells were often targeted at expelling the evil spirits hunting a person’s mind that originated from a traumatic event(s) from their past, such as war or rape, producing anxiety, depression, and even psychosis.

As a physician and a practicing witch, I find myself adopting both approaches. As you have probably already guessed, the above example of the abused and neglected girl is my own story, my own shadow. Using the psychoanalytic theory, I recognize that unconscious beliefs originating from my childhood trauma influences how I relate to others and the world. I try to keep this in mind when I find myself suddenly spiraling into fear-based decisions and judgements of others so that my world is not always covered by my shadows. I embrace my younger self and tell her, Of course you had to guard yourself from trusting authority figures, because trusting them was not SAFE. I understand and honor you, and I also recognize that we are at a safer place now where we are surrounded by wonderful mentors and have the resources to defend ourselves. I also recognize that I am still hunted by the evil spirits of my past, the spirits that hunted my mother, and hunted her mother. I ask for strength from my goddesses and higher spirits to help me see the world in its truth, and to shine light in my path to banish the evil spirits of my past. I used to struggle with consolidating magick and medicine especially with matters of the mind, seated in the brain which we understand so little about. Now, I understand that they are in fact two slightly different paths that ultimately aim to get us to one shared destination – moving us closer to peace and love.

Manifesting and Crafting

I love crafting.

My love of crafting is one of my regular reminders that there is something magical inside of me.

Not just crafting, I love anything where I am engaged in creating something that has not existed before. I love building things out of clay, painting, western and Chinese calligraphy art, making music, and creating digital art. This translates into research as well – my favorite part about doing a research project is at the very beginning, where I am coming up with a research question and designing a particular technique or optimizing a protocol.

Most of the time, if not all, I do not have any clue as to what the final product is going to look like. I am just captivated by the joy of creation. I put my hand on the equipment, smile, and let my intuition guide my work. I know that as long as I am having fun, the outcome will ultimately be a reflection of that joy.

This is a little statue of the goddess I made. It is of course not perfect – far from it, in fact, if you want to consider the technical aspect of it. However, when I look at it, it brings a smile on my face, and I feel the joy that I felt while creating my little goddess. It is amazing how energy translates as well – when I showed my little figurine to my husband, he immediately smiled and gave her a loving pat on the head.

As witches, we co-create our destiny and the world that we live in. The Universe becomes a product of the beautiful harmony between our intentions and the spirit. Lately, I started to wonder why then, do I not approach co-creation with the joyful wonder and curiosity that I have when I am crafting. Instead, often, I find myself approaching new situations with apprehension, and at times, even outright assumption that the outcome would be horrific.

Thinking outside of magic, self-fulfilling prophecy is a well-known and studied concept in psychology. It applies to situations as well as people. If one believes that the outcome of a situation will be horrible, and therefore there is no point in trying, the lack of effort and negative behaviors that this person exhibits as a result of these beliefs will ultimately result in a bad outcome – thereby confirming this person’s “prophecy”. Another well-studied concept in psychology is Confirmation Bias. Confirmation bias is one’s tendency to look for evidence that is confirmatory to the person’s ideas/ beliefs/ opinions, adding additional evidence that the belief was correct. For example, if I approach a new rotation with the preconceived idea that it would be a bad rotation, my mind would unconsciously look for signs that it is a bad rotation, focusing on negative incidences and remembering them instead of positive experiences that also occurred with the same or even greater frequency. Overtime, these negative experiences will be much more salient and accessible in my memory than the positive ones, making me CONFIRM my BIAS that the rotation was in fact, bad.

As a witch, I believe that the Universe returns the energy that I put out. This is a Universal notion that is echoed in many different cultures – I strongly believe that ideas that resonate and persist in multiple cultures speak to the Universal truth. Therefore, if I approach a new situation with negative energies, the future that I co-create with the Universe will reflect this negative energy, ultimately leading to a negative outcome.

Crafting and co-creation are both acts of creation. I can tell myself that I approach crafting with much more joy than I do towards entering novel situations in REAL LIFE because I have complete control over what I craft while I have very little control over my reality. However, believing this is a CHOICE that I made. In crafting, I do not have control over the weather conditions that my air dry clay is exposed to while on the balcony. I have no control over the hairs falling out of my dollar store brushes, and I certainly have very little, if not ZERO control over my tempéramental computer and its constant struggle to run my lengthy codes. What is different is that in crafting and even in research, I have unconsciously made a decision that whatever is produced at the end of it is worthy of love. This allows me the freedom to approach crafting with wonderous curiosity and without fear of the outcome.

I am very well aware that many situations in real life are not enjoyable and even painful. I will not lie to myself and say that all parts of life are joyful, even if I make significant efforts to believe that they are. However, I can make the choice that no matter what, at the beginning, end, and in every step of that journey, I will love myself and trust that I am worthy of love of the Universe. Co-creation is working with the Universe to shape my reality. The product of co-creation, therefore, is my future self.

This blog therefore is a declaration to myself and you, my brothers and sisters, that I make a commitment to believe that no matter how circumstances outside of my control tear me apart, I am, even if I am in pieces, worthy of the love of the Universe. I trust that no matter what, I work with the Universe to co-create my reality where the outcome will always be of love.