Author Archives: Dr. Felix

About Dr. Felix

Felix Torres, MD, MBA, DFAPA is the Chief of Forensic Medicine at the Texas Health and Human Services Commission’s Health and Specialty Care System’s State Hospital System. He is the Minority/Underrepresented Representative Trustee to the American Psychiatric Association (APA) Board of Trustees and the Co-Chair of the APA Board of Trustees Structural Racism Accountability Committee. Dr. Torres is a Diplomate of The American Board of Psychiatry and Neurology in Psychiatry and Forensic Psychiatry and a Distinguished Fellow of The American Psychiatric Association (APA). He is the former Vice Chair of Acute Care Services and the former Director of Electroconvulsive Therapy (ECT) Services for the Department of Psychiatry at Maimonides Medical Center in Brooklyn, NY. Dr. Torres is a Special Advisor to the American Psychiatric Association on the United Nations. In this role, he tracks issues in the United Nations relevant to the work of the APA while ensuring the inclusion of mental health in UN development goals and agendas. Dr. Torres received a Bachelor of Arts degree in Psychology, with a concentration in Behavioral Neurosciences, from Yale University. He graduated magna cum laude from Universidad Central del Caribe School of Medicine in Puerto Rico. Dr. Torres completed his general psychiatry residency and forensic psychiatry fellowship at Saint Vincent's Catholic Medical Centers in New York City. He has been certified as a provider of Electroconvulsive Therapy by Northwell Health's Zucker-Hillside Hospital. Dr. Torres also holds a Master of Business Administration degree from Johns Hopkins University Carey Business School with a double concentration in Healthcare Management and Leading Organizations. He has been inducted to the Beta Gamma Sigma International Business Honor Society. Dr. Torres is licensed in the States of Texas, New York, Florida, and California. He has served as Inpatient Unit Director at Maimonides Medical Center, Psychiatric Clinical Coordinator at NYU Langone – Brooklyn, Acute Care Psychiatry Chief and Supervisory Psychiatrist at the U.S. Department of Veterans Affairs, consulting psychiatrist for mental health clinics in the New York City area, and forensic psychiatry consultant to the Office of Court Administration of the New York State Unified Court System. Recognized as a psychiatric and forensic psychiatric expert by several courts throughout the United States, Dr. Torres has consulted and testified in hundreds of cases on mental health and addiction issues. Dr. Torres is a member of the American Psychiatric Association (APA), the American Academy of Psychiatry and the Law, the American Association for Community Psychiatry, the American Medical Association, the American Society of Hispanic Psychiatry, the Association of LGBTQ+ Psychiatrists (AGLP), the Climate Psychiatry Alliance, the Florida Medical Association, the NGO Committee on Mental Health at the United Nations, the Southern Psychiatric Association, the Texas Academy of Psychiatry, and the Texas Society of Psychiatric Physicians. Dr. Torres served as Assembly Representative from the New York County Psychiatric Society to the APA from 2012 to 2019, where he focused on issues relating to global and cultural psychiatry, addressing the delivery of psychiatric care to underserved populations, highlighting the impact of global climate change on mental health, fighting the stigma surrounding mental illness, and supporting the fourth strategic initiative of the APA: Diversity. He served as Secretary of the New York State Psychiatric Association from 2018 to 2019 until his move from New York to Texas. Dr. Torres is a former member of the APA Council on Minority Mental Health and Health Disparities (CMMH/HD), where he collaborated with the drafting of the Stress & Trauma Toolkits for Treating Hispanics and Undocumented Immigrants in a Changing Political and Social Environment. During his membership on the APA Council on Communications, he was an active member of the workgroup on social media and remained the Council on Communications’ liaison to the CMMH/HD. Dr. Torres sits on the Board of Directors of the APA Political Action Committee. Dr. Torres contributed the chapter “Help-Seeking Behavior and Access to Mental Health Care” to the book “The American Latino: Psychodynamic Perspectives on Culture and Mental Health Issues.” He has recently contributed sections on the disparate impact of global climate change on the mental health of minority populations and on global warming and criminality for a chapter on climate change and mental health in an upcoming public psychiatry book. Dr. Torres is the founder and president of New York Forensic Psychiatry Consulting, P.C. He also serves as a mental health contributor to local, national, and international media outlets. Dr. Torres speaks English, Spanish, French, and Italian.

Septiembre 11: 20 Años Después

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Para aquellos de nosotros que vivimos para presenciar ese día, es uno que estará por siempre plasmado en nuestros recuerdos.

Pregúntele a cualquier persona y te dirá exactamente qué estaba haciendo cuando todos pensamos que un avión había chocado accidentalmente con la Torre Norte del World Trade Center, donde estaba cuando el segundo avión chocó con la Torre Sur, con quién estaba cuando como vimos el Pentágono en llamas y nos enteramos de que el vuelo 93 había desaparecido sobre Shanksville, Pensilvania. Algunos de nosotros incluso podemos recordar lo que comimos esa mañana y podemos oler y hasta saborear ese desayuno cuando pensamos en tan fatídico día. Personalmente, yo me encontraba en mi clase de microbiología durante mi segundo año de la escuela de medicina. Todos nos aglomeramos para ver la cobertura noticiosa en nuestra sala de estudiantes y vimos el impacto del segundo avión.

El trauma que experimentamos colectivamente el 11 de septiembre fue de una magnitud sin precedentes. Se trató de una pérdida masiva de vidas… Madres, padres, hermanos, hermanas, hijos, hijas. Pero, más allá, se trató de la pérdida de nuestra seguridad, la pérdida de algunas de nuestras libertades, la pérdida de nuestra tranquilidad y, en general, la pérdida de nuestra inocencia.

Después del 11 de septiembre, en mi entrenamiento como médico en psiquiatría y psiquiatría forense en el Centro Médico San Vincente en el Greenwich Village de la Ciudad Nueva York, le ofrecí tratamiento a sobrevivientes del WTC, familias de víctimas y socorristas. También completé evaluaciones de discapacidades psiquiátricas para el Fondo WTC de la Junta Médica del Departamento de Bomberos de la Ciudad de Nueva York. He visto toda la gama de secuelas psicológicas. Depresión, ansiedad, trastornos por uso de sustancias, trastorno de estrés postraumático. Algunas personas pudieron recuperarse con breves intervenciones terapéuticas. Otras han requerido tratamiento a largo plazo para síntomas que persisten hasta el día de hoy.

Aquellos que continúan experimentando depresión y trastorno de estrés postraumático suelen tener pensamientos perturbadores, flashbacks y pesadillas que los llevan a revivir los eventos de ese fatídico día. Pueden alejarse de los demás y padecer de una gran variedad de sentimientos encontrados: tristeza, culpa, vergüenza, miedo, e ira. Esa ira puede manifestarse de muchas formas. Podría estar dirigida a otros miembros de la familia, al gobierno, a los terroristas, e incluso a si mismos y a sus seres queridos perdidos en el 9/11. La ira puede variar desde una irritabilidad leve hasta arrebatos severos que pueden llevar a un mayor distanciamiento de amigos y familiares.

Los sobrevivientes y las familias de las víctimas pueden culpar – o desplazar su culpa – a varias personas, dependiendo de la percepción propia de su participación en los eventos que condujeron al 11 de septiembre. Pueden culpar al gobierno por no habernos protegido. Pueden desplazar de manera inapropiada la culpa hacia un grupo étnico o religioso que asemeje el perfil general de los terroristas. En el caso de las familias de las víctimas, pueden culpar a sus seres queridos perdidos por haber ido a trabajar ese día. Pueden culparse a sí mismos por no haber impedido que su ser querido fallecido en los ataques saliera por la puerta o por no retrasar su partida. De manera similar, los sobrevivientes pueden culparse a sí mismos por haber ido a trabajar ese día o por no haber hecho lo suficiente para ayudar a un compañero de trabajo a escapar. Pueden tener cierto grado de culpabilidad de sobreviviente. En general, puede haber muchas dudas de “qué hubiese pasado si” y una forma circular de pensar que complica aún más el bienestar psicológico de los sobrevivientes.

Hay un dicho que nos menciona que “El tiempo cura todas las heridas.” Esto no es totalmente correcto. A aquellas personas que se quejan de que el 11 de septiembre sucedió hace 20 años y que ya es hora de superarlo les diría que, si bien se necesita tiempo para sanar, el tiempo de por sí no es el sanador de nuestras heridas. Para algunos de nosotros, la mejoría conlleva más tiempo que para otros. Algunos de nosotros continuaremos lidiando con el peso de la pérdida que sufrimos ese día. Además, parte de esa mejoría es recordar a aquellos a quienes perdimos. Los eventos conmemorativos anuales sirven para esa mejoría para algunos, pero pueden reabrir heridas parcialmente cerradas para otros.

¡Recuerda el 11 de septiembre y Recuerda siempre cuidar de ti y de tus seres queridos!

9/11: Twenty Years Later

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For those of us who lived to experience that day, 9/11 is one that will forever be embedded in our memories.

Ask anyone and they will tell you exactly what they were doing when we all thought it was an accident that a plane had hit the North Tower of the World Trade Center, where they were when the second plane hit the South Tower, and who was with them as we saw the Pentagon on fire and found out about flight 93 going down near Shanksville, Pennsylvania. Some of us may even remember what we were eating that morning and can even smell and taste that breakfast when we think of that day. Personally, I was in my microbiology class during my second year of medical school. We all huddled to watch the news coverage in our student lounge and saw the second plane hit.

The trauma that we collectively experienced on 9/11 was unprecedented in magnitude. It was about massive loss of life… Mothers, fathers, sisters, brothers, daughters, sons. But it was also about the loss of security, the loss of some of our freedoms, the loss of trust, and, overall, the loss of our innocence.

In the aftermath of 9/11, as a psychiatry resident and forensic psychiatry fellow at St Vincent’s Medical Center in New York City’s Greenwich Village, I treated WTC survivors, victims’ families, and first responders. I also completed evaluations of psychiatric disabilities for the NYC Fire Department Medical Board’s WTC Fund. I have seen the whole gamut of psychological sequelae. Depression, anxiety, substance use disorders, post-traumatic stress disorder (PTSD), and beyond. Some individuals were able to recover with brief therapeutic interventions. Others have required long-term treatment for persistent symptoms to this day.

Those who continue to experience depression and PTSD may have disturbing thoughts, flashbacks and nightmares that lead them to relive the events of that fateful day. They may estrange themselves from others and experience a myriad of feelings: sadness, guilt, shame, fear, and anger. That anger can manifest itself in many ways. It could be directed at other family members, the government, the terrorists, and even themselves and their lost loved ones. It could range from mild irritability to severe outbursts that can lead to further estrangement from friends and family members.

Survivors and families of victims may place — or displace – their blame at several targets, depending on their perception of their involvement in the events leading to and on 9/11. They may blame the government for not having protected us. They may inappropriately displace blame towards an ethnic or religious group that fits the general profile of the terrorists. For families of victims, they may blame their lost loved ones for having gone to work on that day or for not getting out. They may blame themselves for not having stopped their lost loved one from going out the door or for not delaying their departure. Similarly, survivors may blame themselves for having gone to work that day or for not having done enough to help a co-worker escape. They may have a degree of survivor’s guilt. Overall, there may be a lot of “what ifs” and a circular way of thinking that can further complicate the survivors’ psychological wellness.

The old adage tells us that “Time heals all wounds.” This is not entirely accurate. To those people who say 9/11 was 20 years ago and that it is time to put it behind us, I would tell them that while it does take time to heal, time itself is not a healer. For some of us, healing takes longer than for others. Some of us will continue to deal with the burden of the loss that we sustained on that day. Part of that healing process may include remembering those whom we lost. While annual commemorative events serve towards that healing for some, the same memorials may reopen partially closed wounds for others.

Remember 9/11 and Remember to take care of yourself and your loved ones!

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

Emotional Impact of the Separation of Children and Parents at the US Border

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On June 20, 2018, the American Psychiatric Association (of which I am an Assembly Member) and 17 other mental health organizations joined forces in a letter to the Departments of Justice, of Homeland Security and of Health and Human Services, urging the administration of President Donald Trump to end its policy of separation of children from their parents at the United States border.

The letter states that “children are dependent on their parents for safety and support. Any forced separation is highly stressful for children and can cause lifelong trauma, as well as an increased risk of other mental illnesses, such as depression, anxiety, and posttraumatic stress disorder (PTSD). In addition, the longer that children and parents are separated, the greater the reported symptoms of anxiety and depression for the children.”1

The separation and detention of minors is a human rights crisis

The United Nations Convention on the Rights of the Child emphasizes the importance of considering “the best interests of the child.”2 These interests include:

  • Protection against discrimination
  • Safety
  • Wellbeing
  • Health
  • Ensuring to the maximum extent possible the child’s survival and development
  • Preservation of the child’s identity
  • Family integrity
  • Protection against the separation from parents against the child’s will
  • Free expression of ideas
  • Freedom
  • Education

The separation of children from their families and their detention under inhumane and deplorable conditions are in direct opposition to all these interests.

The emotional impact of the separation

The negative effects, both physical and emotional, on the children separated from their parents may not be apparent for many years and some may be irreversible.

The short-term emotional effects include:

  • Post-traumatic stress disorder
  • Anxiety
  • Depression
  • Low self-esteem
  • Feelings of helplessness and hopelessness
  • Behavioral problems
  • Irritability
  • Sleeping problems
  • Changes in appetite
  • Loss of interest in pleasurable activities
  • Poor self-care
  • Feelings of guilt
  • Suicidal thoughts or behaviors

The long-term emotional sequelae can be reflected in:

  • Developmental delay
  • Poor psychological adjustment
  • Poor school performance
  • Regressive behavior
  • Aggression
  • Increased vulnerability to physical illness
  • Alcohol and drug use

Studies show that no matter how brief the detention, it may cause severe and long-term psychological trauma and increase the risk of mental disorders.3

Parents may also be affected due to the uncertainty of what may be happening to their child, which may manifest itself in:

  • Increase in physical and emotional problems
  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Difficulty in their relationships
  • Suicidal thoughts or behaviors

What is Attachment?

Attachment is the bond between the child and his parents, which plays a fundamental role in the social and emotional development of the child. Adequate attachment fosters feelings of security in the child. Poor attachment can make the child grow insecure, with separation anxiety, self-esteem problems, trust issues, behavioral problems, and even extreme dependence on others.

The relationship between parents and children can continue to be affected even after being reunited, which may be manifested in:

  • Attachment problems
  • Reduction in parental authority
  • Poor parent-child relationship
  • Difficulties in child rearing

How can we prevent these negative effects?

  • Putting a stop to the separation of families and to the inhumane conditions in the detention centers. The separation of a parent from a child should never occur, unless there are concerns for the safety of the child at the hands of his/her parent.
  • Early detection of symptoms through mental health assessments and periodic reevaluations (especially when symptoms may arise later as the separation or detention persists).
  • Coordination of services:
      o Physical health
      o Mental health
      o Legal
      o Interpretation in the child’s primary language
  • Psychotherapy and counseling can help the children and their parents to deal with their feelings or negative thoughts, identify stressors, and strengthen coping skills. Therapy can assist in processing emotions and offer support and hope.
  • Psychiatric medications may also control symptoms of depression, anxiety, post-traumatic stress disorder, or any other mental health condition.
  • Finally, there should be no shame in seeking help, which can improve the lives of the child and his/her family.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

References:

1American Psychiatric Association. (2018, June 20). Mental health organizations urge administration to halt policy separating children and parents at U.S. border. Retrieved from https://www.psychiatry.org/newsroom/news-releases/mental-health-organizations-urge-administration-to-halt-policy-separating-children-and-parents-at-u-s-border/

2United Nations. Convention on the Rights of the Child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx/

3Linton, J.M., Griffin, M., Shapiro, A.J. (2017, March). Detention of immigrant children. American Academy of Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2017/03/09/peds.2017-0483.full.pdf

From Bruce to Caitlyn Jenner… And Why Gender Dysphoria is No Longer a Disorder

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Caitlyn Jenner’s transition is, what we would call in this day and age, “trending” in social media. But the transgender struggle has existed long before the times when it would have graced the cover of Vanity Fair. Many transgender trailblazers have come before Caitlyn: World War II era Army draftee Christine Jorgensen, former professional tennis player Renée Richards, LGBT advocate Chaz Bono, Hollywood actress Laverne Cox. We live indeed in a different world. A world more accepting about diversity, yet with deeply engrained prejudices. Let us not forget Brandon Teena.

But, What is Gender Dysphoria?

Dysphoria, from the Greek “difficult to bear,” is a sense of discomfort or distress. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5):

“Gender Dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.”1

In other words, people with gender dysphoria are not happy with the sex they were born, identify themselves as members of the other sex, and have significant distress because their sexual characteristics are in conflict with how they view, think, and feel about themselves and their gender.

Previous versions of the DSM used the terminology Gender Identity Disorder, which was included in the “Sexual and Gender Identity Disorders” chapter together with sexual dysfunctions and paraphilias. But gender identity disorder is neither a sexual dysfunction nor a paraphilia. Furthermore, DSM-5 recognizes that gender identity is not the clinical problem and shifts the focus of clinical attention to the distress experienced by the individual. The problem is not the identity but rather the mental anguish that the individual may face when dealing with the thoughts and feelings about their gender.

SEX ≠ GENDER ≠ SEXUAL ORIENTATION

Not that sexuality and gender identity are this simplistic, but let us think of sex as the anatomical characteristics we have from birth (generally speaking, vagina vs. penis, XX vs. XY chromosomes), sexual orientation as the person to whom we are sexually attracted, and gender as our internal sense of self (as male, female, neither, or both).

Gender dysphoria may begin in childhood but may also be seen later in life. It is more commonly seen in men than women, although these statistics are greatly contested. The level of distress caused by gender dysphoria places the individual at higher risk for behavioral problems, substance use, depression, anxiety, and suicide.

Gender reassignment surgery may not necessarily be the personal goal for all individuals with gender dysphoria. Regardless of the decision, it is important to seek help from an experienced mental health professional in order to deal with the distress caused by the gender incongruence, to treat any resulting or co-occurring mental health problems, and to assist the individual in the transition. While family and peer support is essential, family members may also need psychological assistance to deal with their feelings and the perceived loss of their transgender family member.

Caitlyn is not the first and certainly not the last transgender individual. While her life in the public eye will hopefully bring more attention to this important issue, we need to be mindful of the double-edge sword that comes with her fame. Living under the social microscope, with its heightened level of scrutiny, and in our ever-connected world where comments are unfiltered and, at times, intolerant and insensitive, may not only be damaging to Caitlyn’s journey but may actually hurt the transgender cause.

We have come a long way as a society and it is amazing that we are having this conversation. We must continue to educate ourselves because knowledge is not only power but it also fosters awareness, tolerance, acceptance, and respect.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

De Bruce a Caitlyn Jenner … Y Por Qué la Disforia de Género No es un Transtorno

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La transición de Caitlyn Jenner está, lo que llamaríamos hoy en día, “trending” en las redes sociales. Pero la lucha transgénero ha existido mucho antes de los días en que hubiera engalanado la portada de la revista Vanity Fair. Muchos pioneros transgénero han forjado el camino antes de Caitlyn: la soldado de la era de la Segunda Guerra Mundial Christine Jorgensen, la ex-tenista profesional Renée Richards, el activista LGBT Chaz Bono, la actriz de Hollywood Laverne Cox. De hecho, vivimos en un mundo diferente. Un mundo más tolerante de la diversidad, y aún así con profundos prejuicios. No olvidemos a Brandon Teena.

Pero, ¿Qué es la Disforia de Género?

Disforia, del griego “difícil de soportar,” es una sensación de malestar o angustia. De acuerdo con el Manual Diagnóstico y Estadístico de los Trastornos Mentales, Quinta Edición (DSM-5):

“Disforia de Género se refiere a la angustia que puede acompañar a la incongruencia entre el género expresado y el género asignado de una persona”.1

En otras palabras, las personas con disforia de género no están contentas con el sexo que nacieron, se identifican como miembros del otro sexo, y experimentan gran malestar debido a que sus características sexuales están en conflicto con la forma en que se ven, piensan y se sienten sobre sí mismos y su género.

Versiones anteriores del DSM utilizaron la terminología Trastorno de Identidad de Género, la cual fue incluida en el capítulo de “Trastornos Sexuales y de la Identidad de Género”, junto con las disfunciones sexuales y las parafilias. Pero el trastorno de identidad de género no es ni una disfunción sexual ni una parafilia. Por otra parte, el DSM-5 reconoce que la identidad de género no es el problema clínico y cambia el foco de atención clínica al malestar experimentado por el individuo. El problema no es la identidad sino la angustia mental que el individuo puede enfrentar al lidiar con los pensamientos y sentimientos acerca de su género.

SEXO ≠ GÉNERO ≠ ORIENTACIÓN SEXUAL

No es que la sexualidad y la identidad de género sean tan simplistas, pero veamos al sexo como las características anatómicas con las que nacemos (en términos generales, vagina vs. pene, cromosomas XX vs. XY), a la orientación sexual como a quien nos sentimos atraídos sexualmente, y al género como nos vemos y sentimos internamente (como varón, hembra, ninguno, o ambos).

La disforia de género puede comenzar en la niñez, pero también puede verse más tarde en el desarrollo personal. Se observa con mayor frecuencia en hombres que en mujeres, aunque estas estadísticas son muy debatidas. El nivel de angustia causado por la disforia de género aumenta el riesgo de problemas de conducta, uso de sustancias, depresión, ansiedad y suicidio.

La cirugía de reasignación de sexo no necesariamente es la meta personal para todos los individuos con disforia de género. Independientemente de su decisión, es importante buscar ayuda de un profesional de la salud mental experimentado para lidiar con la angustia causada por la incongruencia de género, para tratar cualquier problema de salud mental resultante o co-occurrente, y para ayudar a la persona en su transición. Si bien el apoyo de la familia y amigos es esencial, los miembros de la familia podrían también necesitar ayuda psicológica para lidiar con sus sentimientos y con la pérdida percibida de su familiar transgénero.

Caitlyn no es la primera y sin duda no será la última persona transgénero. Mientras que su vida en el ojo público posiblemente traerá más atención a este importante asunto, tenemos que ser conscientes del arma de doble filo que viene con su fama. Vivir bajo el microscopio social, con su mayor nivel de escrutinio, y en nuestro mundo cada vez más conectado, donde los comentarios sin filtro y, a veces, intolerantes e insensibles, podría ser perjudicial no tan sólo para el recorrido de Caitlyn pero podría afectar la causa transgénero.

Hemos avanzado grandemente como sociedad y es maravilloso que estemos teniendo esta conversación. Pero debemos continuar educándonos porque saber no es tan sólo poder sino que también fomenta conciencia, tolerancia, aceptación y respeto.

Recuerda…

Sé Inteligente. Sé Precavido. Sé Saludable. Sé Fuerte.

¡Hasta la próxima!

Dr. Félix

Death of a Doctor – Another Victim of Cyber Bullying?

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The death of Puerto Rican doctor Gloria Ortiz González is an unfortunate reminder of the power of social media, cyber bullying, the poor conditions of a public health system affecting both patients and their providers, the level of stress and the need for attention to the emotional well-being of healthcare workers, the Hippocratic Oath, and the doctrine “primum non nocere” (“first do no harm”).

Dr. Ortiz González gained notoriety and grew in infamy after a verbal altercation with patients in the emergency room waiting area of Bayamon Regional Hospital in Puerto Rico was recorded on a mobile phone and uploaded to social networks in August 2014. In the video, which clearly begins in the middle of the discussion and does not show the preceding interactions, a patient who is off camera can be heard instigating the physician to the point that she loses her composure and uses language like:

  • “And you’re ignorant, read a goddamn newspaper.”
  • “Who pays for “la reforma de la salud” [Puerto Rican Medicaid] in this country? I do with my taxes.”
  • “Damn it. I have busted myself studying me in the damn Medical Sciences Campus to have to come here and deal with you.”
  • “Bunch of ignorants.”
  • “That is why this country is a mess because what you do is listen to Daddy Yankee. Pick up a goddamn book you ignorant. Pick up a goddamn book.”

The life of Dr. Ortiz González took a huge turn after the video went viral. The doctor was suspended from duty and investigated by the Department of Health of Puerto Rico; an investigation which ceased once she resigned. Although she would later be exonerated of any wrongdoing by the Office of the Advocate for the Patient, the degree of personal harassment and devastating cyber bullying on social media were inescapable.

Even the world famous reggaeton singer Daddy Yankee countered in social networks and through the song “Palabras con Sentido” [“Words with Meaning”], the video of which recreates the moment when the doctor’s outburst was recorded in the waiting room. A young doctor who, in a moment of frustration, lashed out at her patients, whom she swore to treat with “warmth, sympathy and understanding.” A doctor who fell victim to persecution and cyber attacks, chasing her out of her home, affecting her mental health, and possibly contributing to her death.

Although Dr. Ortiz González’s behavior in that moment of anger was unacceptable and unprofessional, we must remember that we are all human and the burnout caused by poor working conditions in a crowded health system marred by inefficiencies, poor pay, and little appreciation, have their weight. While I do not excuse her conduct, as a medical student who walked the floors and hallways of that same regional hospital in Puerto Rico, I understand how difficult it can sometimes be to remain composed under so much pressure.

Now, we should reflect on the impact of the news of her death, the emotional footprint carved out by harassment, and the rampant use of social media to perpetuate a persecution by anonymous abusers behind a keyboard. Many people have fallen victim to this cyber hunt. Harassment, both in person and through social networks, can have lifetime effects on the victim’s personality. The power of demoralization is monumental and erodes at the victim’s self-worth. Anxiety, depression, suicides, and murders. When will it all end?

I hope the death of Dr. Gloria Ortiz González has not been in vain and makes us think twice before casting our hatred on social media, considering the irreversible damage that we may cause.

Rest in Peace, Doctora!

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

Muerte de Una Doctora – ¿Otra Víctima del “Cyber Bullying”?

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La muerte de la doctora puertorriqueña Gloria Ortiz González es un lamentable recordatorio del poder de las redes sociales, el “cyber bullying” (acoso cibernético), las pobres condiciones de un sistema de salud público afectando tanto a pacientes como a sus proveedores, el nivel de estrés y la atención al bienestar emocional de los trabajadores de la salud, el Juramento Hipocrático, y la doctrina “primum non nocere” (“lo primero es no hacer daño”).

La Doctora Ortiz González ganó notoriedad y creció en infamia después que un altercado verbal con pacientes en el área de espera de la Sala de Emergencias del Hospital Regional de Bayamón en Puerto Rico fuese grabado por una tercera persona desde un teléfono móvil y subido a las redes sociales en agosto del 2014. En el video, el cual claramente comienza ya en el medio de la discusión y no muestra las interacciones previas, se escucha fuera de cámara a una paciente instigar a la doctora hasta el punto que la misma pierde su compostura y utiliza lenguaje como:

  • “Y tú eres una ignorante, lee un maldito periódico.”
  • “¿Quiénes pagan la reforma de la salud en este país? Yo con mis ‘taxes.'”
  • “Maldita sea. Yo que me escocoto estudiando en el maldito Recinto de Ciencias Médicas pa’ venir a bregar con ustedes.”
  • “Chorro de ignorantes.”
  • “Por eso es que este país es una porquería porque ustedes lo que hacen es escuchar a Daddy Yankee. Coge un maldito libro ignorante. Coge un maldito libro.”

La vida de la Doctora Ortiz González tomó un enorme giro luego de que el video se tornara viral. La doctora fue suspendida de sus funciones e investigada por el Departamento de Salud de Puerto Rico; investigación que cesó una vez renunció a su puesto. Aunque luego fuera exonerada de toda culpa por la Oficina del Procurador del Paciente, el hostigamiento personal y el fuerte acoso en las redes sociales fueron inescapables.

Hasta el mundialmente famoso reggaetonero Daddy Yankee ripostó en las redes sociales y a través de la canción “Palabras con Sentido,” video de la cual recrea el momento en que el exabrupto de la doctora fue grabado en la sala de espera. Una joven doctora que en un momento de frustración arremetió en contra de sus pacientes, a los que juró tratar “con honor y rectitud,” y a quien la persecución personal y cibernética la llevaron a mudarse de su hogar, afectaron su salud mental, y pudieron haber contribuido a su muerte.

Aunque la conducta de la Doctora Ortiz González en ese momento de ira fue inaceptable y poco profesional, hay que recordar que todos somos humanos y el desgaste mental causado por el estrés ante las pobres condiciones laborales en un sistema de salud abarrotado de ineficiencias, escasa paga, y poca apreciación, tienen su peso. Aun así cuando no excuso el comportamiento de la doctora, como estudiante de medicina que recorrí los pisos y pasillos de ese mismo hospital regional, entiendo lo difícil que puede ser mantener la compostura ante tanta presión.

Pero ahora deberíamos reflexionar sobre el impacto de la noticia de su muerte, la huella emocional que deja el acoso, y el rampante uso de las redes sociales para perpetuar una persecución donde el abusador se mantiene en el anonimato detrás de un teclado. Muchas personas han caído víctimas de esta cacería cibernética. El acoso, tanto en persona como a través de la redes sociales, puede afectar la personalidad de la víctima de por vida. El poder de desmoralización es monumental y corroe la autovaloración de la víctima. Ansiedad, depresión, suicidios, y asesinatos. ¿Cuándo parará?

Esperemos que la muerte de la Doctora Gloria Ortiz González no haya sido en vano y que nos lleve a consultar nuestra conciencia antes de derramar nuestro odio en las redes sociales, pensando en el daño irreversible que podemos causar.

Que en paz descanse, Doctora.

Recuerda…

Sé Inteligente. Sé Precavido. Sé Saludable. Sé Fuerte.

¡Hasta la próxima!

Dr. Félix

Suicide: Faces We See, Hearts We Cannot Know…1

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The recent suicide of actor Robin Williams is a tragic reminder of one of our society’s epidemics. Many have been left wondering, “How can such a talented and funny man end his life?” Robin Williams’ struggles with substance use and mental illness may have been public but, like many people around the world, his private turmoil and demons won the battle.

According to the latest data provided by the Centers for Disease Control and Prevention (CDC), suicide represented the tenth leading cause of death in the United States in 2011. If this were not alarming enough, suicide was the second leading cause of death among our teenagers and young adults (ages 15 to 34).

Recognition of warning signs, early prevention, and immediate assistance for anyone who expresses thoughts of suicide or attempts suicide are of great importance.

WHAT ARE SOME OF THE WARNING SIGNS?

Many warning signs for suicidal behavior are similar to symptoms of depression:

  • Feelings of sadness or hopelessness
  • Behavioral changes
  • Irritability
  • Anxiety
  • Trouble sleeping
  • Changes in appetite
  • Loss of interest in pleasurable or enjoyable activities
  • Poor hygiene
  • Feelings of guilt
  • Isolation from friends and family
  • Giving away or throwing out objects of personal value
  • Drug or alcohol abuse
  • Talk/verbal threats of suicide
  • Suddenly recovering from a period of depression (maybe after having decided to put an end to their suffering by ending their life)
Even in the presence of all these warning signs, it is extremely difficult to predict with certainty who will attempt suicide. We do know that the most important risk factor for the prediction of suicide is past suicidal behavior. In other words, a past suicide attempt is the best predictor of a future suicidal act.

RISK FACTORS FOR SUICIDAL BEHAVIOR:

Risk factors for suicide vary greatly from person to person depending on the severity of mental illness, personality strengths and vulnerabilities, and support system. The following list is not meant to be all-inclusive.

  • Sudden stressful life events (i.e. humiliating events, financial ruin, job loss, death of a loved one)
  • Interpersonal conflict
  • Economic problems
  • Legal problems
  • Mental illness
  • Medical problems (acute and chronic)
  • Intractable physical pain
  • Poor support system

WHAT CAN WE DO TO PREVENT SUICIDE?

It is important to recognize the above warning signs and risk factors as well as the symptoms of mental illness and alcohol/drug abuse. Early intervention is the most effective way to prevent suicide. Any statement of suicidal thoughts or suicidal behavior must be taken seriously. Anyone who expresses thoughts of suicide requires immediate medical evaluation.

WHAT ARE THE EFFECTS OF SUICIDE ON THE SURVIVORS?

The effects of suicide on friends and family can be devastating. People who lose a loved one to suicide tend to feel guilty for the death of their family member or friend, wonder what they could have done to prevent it, and may even feel rejected by others.

Suicide survivors may experience:

  • Sadness for their loss
  • Anger towards the deceased family member
  • Feelings of guilt
  • Depression
  • Anxiety
  • Posttraumatic stress disorder, especially when a witness to the suicide or finding the family member after a completed suicide
  • Suicide attempts to reconnect with their lost loved one
As the aftermath of family suicide may have long lasting effects, it is important for survivors of suicide to seek help in dealing with their loss.

HOW TO HELP?

Anyone who expresses thoughts of suicide or attempts suicide should be evaluated immediately:

  • Calling 911,
  • Taking the person (yourself) to the nearest emergency room, or
  • Looking for help from a mental health professional
Psychotherapy and counseling can help the suicidal person deal with his/her feelings or negative thoughts, identify stressors, and strengthen coping skills. Psychiatric medications may also control symptoms of depression, anxiety or any other mental health condition.

Help is also available through telephone hotlines. In the United States, the National Suicide Prevention Lifeline (1-800-273-TALK or 1-800-273-8255) is an excellent source of support. It is for people in crisis, not just when thinking about suicide. The call is free and confidential and a mental health professional will be available to listen to you and provide information about mental health services in your community.

There is no shame in seeking help and it can save your life!

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

El Suicidio: Caras Vemos, Corazones No Sabemos…

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El reciente suicidio del actor Robin Williams es un recordatorio trágico de una de las epidemias de nuestra sociedad. Muchos han quedado preguntándose, “¿Cómo puede un hombre tan talentoso y cómico terminar su propia vida?” Aunque la lucha de Robin Williams con el consumo de drogas y la enfermedad mental pudo haber sido pública, al igual que muchas otras personas alrededor del mundo, su sufrimiento y demonios internos ganaron la batalla.

Según los últimos datos proporcionados por los Centros para el Control y la Prevención de Enfermedades (CDC), el suicidio representó la décima causa de muerte en los Estados Unidos en 2011. Si esto no fuese lo suficientemente alarmante, para los adolescentes y adultos jóvenes, el suicidio representó la segunda causa de muerte (entre las edades de 15 a 34 años).

Es por esto que la vigilancia de las señales de alerta, la prevención, y la ayuda inmediata para alguien que expresa ideas de suicidio o intenta suicidarse son de gran importancia.

¿CUÁLES SON ALGUNAS SEÑALES DE ALERTA?

Muchas de las señales de alerta son similares a los síntomas de la depresión:

  • Sentimientos de tristeza o desesperanza
  • Cambio de comportamiento
  • Irritabilidad
  • Ansiedad o tensión
  • Problemas al dormir
  • Cambios en el apetito
  • Pérdida de interés en actividades placenteras
  • Descuido del aspecto personal
  • Sentimientos de culpa
  • Aislamiento de amigos y familiares
  • Obsequiar o deshacerse de objetos de valor personal o favoritos
  • Consumo de alcohol y drogas
  • Hablar acerca del suicidio
  • El reponerse de manera repentina luego de un período de depresión (quizás luego de haber decidido quitarse la vida para terminar con su sufrimiento)
Aunque todas las señales estén presentes, es bien difícil determinar con certeza quien va a tomar la decisión de quitarse la vida. Lo que sí sabemos es que el factor de riesgo más importante para la predicción del suicidio es el comportamiento suicida pasado. Es decir, el haber intentado suicidarse en el pasado hace que la persona sea más propensa a intentarlo en un futuro.

FACTORES DE RIESGO PARA LA CONDUCTA SUICIDA:

Los factores de riesgo para el suicidio varían enormemente de persona a persona dependiendo de la severidad de la enfermedad mental, fortalezas y vulnerabilidades en su personalidad, y su sistema de apoyo. La siguiente lista no pretende ser exhaustiva.

  • Eventos estresantes repentinos (acontecimientos humillantes, ruina económica, pérdida del empleo, muerte de un ser querido)
  • Conflicto interpersonal
  • Problemas económicos
  • Problemas legales
  • Enfermedad mental
  • Problemas médicos (agudos o crónicos)
  • Dolor físico crónico
  • Pobre sistema de apoyo

¿CÓMO PODEMOS PREVENIR EL SUICIDIO?

Es importante reconocer las señales de alerta y factores de riesgo al igual que los síntomas de enfermedades mentales y el abuso de drogas y alcohol. La intervención temprana es la manera más eficaz de prevenir el suicidio.

Siempre debemos tomar en serio cualquier declaración de pensamientos suicidas o comportamientos suicidas. Cualquier persona que exprese ideas de suicidio debe ser evaluada inmediatamente.

¿QUÉ TRAUMA PROVOCA A LA FAMILIA EL SUICIDIO DE UN SER QUERIDO?

Los efectos del suicidio en la familia o amigos pueden ser devastadores. Las personas que pierden a un ser querido por suicidio tienden a sentirse culpables por la muerte de su familiar o amigo, preguntarse que podrían haber hecho para evitarlo, o hasta sentirse rechazados por otras personas.

Los sobrevivientes del suicidio pueden experimentar una gran variedad de sentimientos:

  • Tristeza por la pérdida
  • Enojo en contra del familiar perdido
  • Sentimientos de culpa
  • Depresión
  • Ansiedad
  • Trastorno de estrés postraumático, en especial cuando presenciaron el suicido o encontraron al familiar muerto
  • Intentos de suicidio para reencontrarse con su ser querido
Las secuelas causadas por la pérdida pueden afectar al sobreviviente del suicidio por el resto de su vida, por lo cual es importante que también busque ayuda.

¿CÓMO AYUDAR?

Cualquier persona que exprese ideas de suicidio o intente suicidarse debe ser evaluada inmediatamente:

  • Llamando al 911
  • Llevándola a la sala de emergencia más cercana, o
  • Buscando ayuda con un profesional de la salud mental
La psicoterapia y consejería pueden ayudar a la persona a lidiar con sus sentimientos o pensamientos negativos, aprendiendo a identificar factores estresantes que hacen que la persona reaccione de una manera u otra, al mismo tiempo que se aprenden las destrezas para poder reaccionar de una manera positiva. Los medicamentos psiquiátricos también podrían controlar los síntomas de depresión, ansiedad y/o alguna otra condición mental.

También se podría buscar ayuda a través de líneas telefónicas de apoyo. En los Estados Unidos, la Red Nacional de Prevención del Suicidio (1-888-628-9454) es una excelente fuente de apoyo. Es para personas en crisis, no sólo si se está pensando en el suicidio. La llamada es gratuita y confidencial. Un profesional de la salud mental estará disponible para escucharte y ofrecer información acerca de servicios de salud mental en tu comunidad.

¡No hay vergüenza en pedir ayuda y podría salvar tu vida!

Recuerda…

Sé Inteligente. Sé Precavido. Sé Saludable. Sé Fuerte.

¡Hasta la próxima!

Dr. Félix