Finding Our Voice

Exposure to War, Violence, Shootings, and the Impact of Migration

Dr. Virani focuses on exposure to war, violence, shootings, and the impact of migration. These migrants are forced to flee from their homes due to threats of violence and death due to cultural or religious beliefs. Just as traumatic for these individuals is the ability to adapt and be accepted in their new homes. In this episode:

• Cultural Psychiatry
• Pre-migration stressors
• Post Migration stressors
• Misdiagnosis of mental health issues in the migrant population
• Tips for diagnosing and working with refugees
• The emergence of compulsive symptoms years after trauma
• The importance to individualize each case
• Trust in leaders of the community
• Working with the religious communities to identify mental health issues

Guest: Dr. G. Eric Jarvis is an Associate Professor of Psychiatry at McGill University and Director of the Cultural Consultation Service, the First Episode Psychosis Program, and the Culture and Psychosis Working Group at the Jewish General Hospital.

Guest: Dr. Victor Pereira-Sanchez is a child, adolescent, and adult psychiatrist based in New York. He obtained his medical degree (MD) in 2014 at Universidad de Navarra, in Spain, where he also completed a clinical residency program in psychiatry in 2019 and received his Ph.D. in 2021.

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Social Exclusion and Isolation

In Eleanor Rigby, the Beatles lament about loneliness and isolation and challenge us to “look at all the lonely people”. In this episode, Dr. Virani invites Dr. Dolores Malaspina and Dr. Luca Pauselli to explore social exclusion and insolation and its effects on mental health through case studies. Join us on the first episode of a new season of Finding Our Voice covering the social determinants of mental health. In this episode:

• Jumbo, the elephant, and isolation of caged animals
• DSM-5 code 62.4
• Social isolation and exclusion during the pandemic
• Loneliness and schizophrenia study published in Psychiatric Research
• Biological pathways and the social determinants of mental health.

Guest: Dr. Dolores Malaspina is the chair of the research and education workgroup of the current Presidential taskforce on Social Determinants of Mental Health chaired by Dr. Dilip Jeste. Dr. Malaspina directs the Psychosis Program called Critical Connections at the Icahn SM Mount Sinai where she is a Professor of Psychiatry, Neuroscience, and Genetics & Genomics and the Vice-Chair for DEI. She was previously the Steckler Professor and Chairman of the NYU/Bellevue psychiatry departments, where she founded and directed a multidisciplinary program for research and training (Institute of Social and Psychiatric Initiatives- InSPIRES).

Guest: Dr. Luca Pauselli is a PGY3 in the Mount Sinai Morningside/West psychiatry residency program. Luca completed medical school and a residency in Italy.

This podcast is subject to the Terms of Use at www.psychiatry.org. The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association, its officers, trustees, or members. The content of this podcast is provided for general informational purposes only and is not intended as, and shall not be understood or construed as, medical or any other type of professional advice nor does it represent any statement of the standard of care. We strongly recommend that any listener follow the advice of physicians directly involved in their care and contact their local emergency response number for any medical emergency. The information within this podcast is provided as-is and is not guaranteed to be correct, complete, or accurate.

Indigenous Peoples

This episode focuses on the Indigenous community, Dr. Virani discusses the systemic racism issues faced by this community with two psychiatrists who have Native American heritage, Dr. Mary Hasbah Roessel, a psychiatrist at the Santa Fe Service Unit in Santa Fe Indian Hospital working in the outpatient Behavioral Health Clinic in Santa Fe, New Mexico. She is Navajo from the southwestern US. Dr. Stefanie Gillson, who is Dakota Sioux and is finishing up her 4th-year psychiatry resident at Yale University and starting her Child & Adolescent Fellowship at Yale In this episode:

• Indigenous war veterans and the treatment faced when returning from war
• PTSD and survivor’s guilt
• Tribal heritage as related to a therapeutic relationship
• Ethnic matching
• Being an indigenous psychiatrist
• The effect of white cultural norms on therapy
• Religious and spiritual assessment in the therapeutic evaluation
• DSM-5 cultural formations
• Effects of colonization policy on poor health outcomes of indigenous peoples
• Historical intergenerational trauma
• The broken promise of Indian health services
• Indigenous women’s mental health and the incidence of physical violence
• MMIWG report
• Tribal government ruling and the US government

• More podcasts by the APA including ALP Audio and The Medical Mind

LGBTQ

Before Stonewall, the gay community lived in the shadows and even after this monumental protest and other significant milestones, the LGBTQ community still faces discrimination, abuse, and aggressive behaviors in their day-to-day lives. Dr. Virani discusses the issues at the core of the mental health challenges to the LGBTQ community referencing history where applicable, with Dr. Elie Aoun and Dr. Ali Haidar, two New York-based psychiatrists. In this episode:

• Conversion therapy
• Queer expression of identity
• Dealing with cultural values in a therapeutic relationship
• Biased diagnoses due to sexual orientationg
• Doctors pathologizing based on negative implications of sexual practices
• LGBTQ identifying psychiatrists facing micro and macro aggressions from administration and patients
• Supporting LGBTQ trainees

Guest: Dr. Elie Aoun is a psychiatrist in general, addiction, and forensic practice in New York, on faculty at Columbia University, and at Central New York Psychiatric Center as the Sex Offender Management Liaison psychiatrist. He completed his general psychiatry residency at Brown University in Providence, RI, Addiction Psychiatry fellowship at UCSF in San Francisco, and Forensic Psychiatry fellowship at the Columbia University Cornell University combined program, and a fellowship in psychiatric research at Columbia University. He is the ECP Trustee at large for the APA and the immediate past Vice-Chair of the APA Council on Addiction Psychiatry. He works closely with medical students as well as psychiatric residents and fellows at Columbia University where he serves as a co-director of the sexual behavior clinic and rotation.

Guest: Dr. Ali Haidar completed his psychiatry residency at SUNY Downstate Medical Center in Brooklyn and is currently a PGY-5 Child and Adolescent Psychiatry Chief fellow at Mount Sinai in New York. His primary areas of interest include LGBTQ mental health, public psychiatry, cultural psychiatry, medical education, and global mental health particularly displacement and migration’s effect on the psyche. He is currently an APA leadership fellow and serves as ECP member of the APA Council on International Psychiatry and Global Health.

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Asian Americans

There has been a dramatic upsurge in violence against Asian Americans over the last year since the outbreak of the virus in Wuhan China. In this episode, Dr. Virani talks with Asian American and Pacific Islander Doctors about their experiences with racial trauma and cultural boundaries that have affected them and the lives of their patients. In this episode:

• The history of xenophobia against AAPIs
• DSM-5 cultural formation interview and its evolution
• Understanding the larger social context in which a patient lives
• Recommendations on how providers should respond to racist verbal assault and hate speech.
• Misdiagnosis due to lack of understanding of cultural issues
• Ethnic preference and sharing trust with patients and providers
• Cultural competence
• The CLAS Blueprint
• Cultural concepts of distress in the DSM

Guest: Peter Jongho Na, M.D., M.P.H., is an addiction psychiatry fellow at Yale University.

Guest: Francis G. Lu, M.D., is the Luke & Grace Kim Professor in Cultural Psychiatry, Emeritus, at the University of California, Davis. As a Distinguished Life Fellow of the American Psychiatric Association (APA), Dr. Lu has contributed to the areas of cultural psychiatry including the interface with religion/spirituality, psychiatric education, diversity/inclusion, mental health equity, and psychiatry/film.

Guest: Dr. Connie Chen is a PGY-2 at the San Mateo County Psychiatry Residency Training Program in San Mateo, CA. She is also Co-Chair of the San Mateo County Chinese Health Initiative, where she coordinates efforts to promote access to mental health services and reduce stigma around mental illness in local Chinese and Asian American communities. Her interests include cultural psychiatry, psychotherapy, and public psychiatry.

• Peter Na's Psychiatric News Article
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Women Psychiatrists in Academia

Diversity among women in psychiatric training programs is seldom discussed and in this episode, Dr. Virani talks with two accomplished women program directors about the challenges for women in training programs. Drs. Cama and DeJong cover issues ranging from failures of well-intentioned supervisors to pregnancy to the “imposter syndrome".

Guest: Dr. Shireen Cama divides her time at Cambridge Health Alliance (CHA) between being the integrated child psychiatrist working as part of the CHA Child and Adolescent Mental Health Integration (CAMHI) program and the Associate Training Director for the Child & Adolescent Psychiatry Fellowship. As a member of the CAMHI team, she acts as a consultant to family medicine and pediatric providers on questions related to diagnosis and treatment of pediatric mental health and behavioral concerns.

Guest: Sandra DeJong, M.D., M.Sc., began her term as Secretary of the American Psychiatric Association at the end of the APA Annual Meeting in May 2019. Dr. DeJong is Senior Consultant to the Child and Adolescent Psychiatry Training Program at Cambridge Health Alliance where she was a training director from 2004-2018. She is an Assistant Professor of Psychiatry at Harvard Medical School and is in half-time private practice in Cambridge, MA.

International Medical Graduates IMG

Drs. Virani, Madaan, and Khan are International Medical Graduates (IMG) who come from different cultural backgrounds. Join these three as they recount personal stories of the highs and lows of being an IMG in the US. They discuss the physician and patient discrimination they faced through micro and macro aggressions and the road ahead for them and for other IMGs. Also appearing in the episode is Sarah El-Halabi.

Guest: Vishal Madaan, MD, is a tenured Associate Professor in Psychiatry and Child Psychiatry at the University of Virginia, Charlottesville. He is the founding Director for the Center for Psychopharmacology Research in Youth at UVA and serves as Training Director for the child and adolescent psychiatry fellowship program there. In the recent past, Dr. Madaan served as the Medical Director of the UVA child and family clinic, and Associate training director of the general psychiatry program at both University of Virginia and Creighton University.

• Education: Jinnah Sindh Medical University, Pakistan (MB, BS)
• Residency: Duke University; University of Washington
• Professional Interests: Childhood adversity, trauma, structural racism and its impact on the mental health of minorities, cultural psychiatry, and psychotherapy.

The Black Minority In America

Finding Our Voice continues to explore the issue of systemic racism. In this special episode released during Black History Month, we examine the effects of social determinants on the African American community in America. Dr. Virani discusses with her guests access to mental health care and the quality of care black patients encounter. Dr. Talley and Dr. Metzger cover the profound impact of the lack of homeownership upon communities of color.

Guest: Dr. Rachel Talley is a Clinical Assistant Professor of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania. She is the Director of the University of Pennsylvania's Fellowship in Community Psychiatry, a one-year post-residency training program for psychiatrists interested in management and leadership in public and community systems of care. Before joining UPenn's faculty, Dr. Talley completed an adult psychiatry residency and public psychiatry fellowship at Columbia University/New York State Psychiatric Institute. Dr. Talley is also an Early Career Representative on the Board of the American Association for Community Psychiatry.

Guest: Dr. Sarita Metzger is a PGY4 at the University of Pennsylvania. She is interested in cultural Psychiatry and devoted to furthering mental health equity for people of color and LGBTQ+ communities; after graduation, she plans to continue training in mental health advocacy and policy as a fellow in the University of Pennsylvania's Public and Community Psychiatry fellowship.

Hispanic Heritage

In this episode, Dr. Sanya Virani and her guests discuss the impact of social determinants on the Hispanic community. Listen as Dr. Esperanza Diaz and Dr. Andrea Mendiola discuss challenges their patients have faced with outcomes both positive and negative.

Guest: Esperanza Díaz M.D. provides teaching and supervision for Yale medical students, psychiatry residents, and trainees from other disciplines such as psychology, nursing, and social work. Dr. Diaz received her M.D. degree from the Javeriana University in Bogotá, Colombia. She finished her Psychiatry residency at Yale School of Medicine. She is a Board Certified Psychiatrist and Life Fellow of the American Psychiatric Association. She is a psychoanalyst. Her research concentrates on adherence to medications, development of culturally sensitive mental health services to Hispanics with persistent mental disorders, development of teaching methods of culturally sensitive care.

Guest: Andrea Mendiola Iparraguirre, MD is Assistant Professor of Psychiatry at Yale School of Medicine She completed her Psychiatry Residency at Maimonides Medical Center in Brooklyn, NY and received her MD from Universidad Peruana Cayetano Heredia in Lima, Peru