PsychSIGN Magazine, Volume 2 by PsychSIGNMagazine

WELLNESS AND TECH EDITION. VOLUME 2. MAY 2022

Photo credit: Pixabay

Table of Contents 32 Interview with Dr. James Sherer Dr. James Sherer is an addiction psychiatry fellow at NYU Grossman School of Medicine/Bellevue. He is also the author of the book "Technological Addictions." Dr. Sherer enjoys video games and elaborates on a balanced and dual approach to technology and its impact on mental health.

54 Interview with Temitope Ali Temitope Ali is a third-year medical student at Rutgers New Jersey Medical School. Temitope is passionate about art and video-game design, and published a game titled "Steve's HardCore WorldTour" on Steam ®.

6 LETTER FROM THE EDITOR

32 INTERVIEW WITH DR.

7 CONTRIBUTORS

JAMES SHERER

8 EDITORS

37 LOST IN TIME

12 WHY I STOPPED WATCH-

38 PRACTICAL KINDS AND

ING THE NEWS

IMPERFECT COMMUNITIES

14 JOURNEY

43 ;

15 BOSS BATTLE

46 FRAGILE

16 THE GAMECUBE

47 A LESSON IN CULTURAL

19 OOPS I DID IT AGAIN 20 EAT YOUR PANCAKES 22 IMPOSTER 24 SURVIVOR’S GUILT 26 FOREST THERAPY 27 CALL OF THE SEA 28 GRIEF TEXTURES 30 THE IMPOSTER

HUMILITY 48 WE ARE HERE TO HELP 50 A TELEMEDICINE APPOINTMENT 52 SO CLOSE YET SO FAR 54 INTERVIEW WITH TEMITOPE ALI 67 FIND YOUR HAPPY PLACE

Letter From The Editor I am very eager to share this magazine volume with everyone, especially considering the amount of hard work and dedication that the team has put into this issue. The topic of technology and wellness is dear to my heart, having been born in the second half of the nineties. I remember the excitement I felt to receive my first game boy, to browse the web on my first personal computer, and to switch from dialPortrait credit: Keith B. Bratcher, Jr. up internet to Wi-Fi in my home. Technology has helped generate many fond memories; however, it would not be wise to ignore its shortcomings, and the way it has hurt us and our patients. I hope this volume shares the dual nature of technological advancement, and its implications on our mental health, as medical students. I want to thank the editorial team, the writers, the artists, PsychSIGN leadership, and you, the reader, for making this project a possibility. I hope you enjoy each and every piece in this volume, as much as we enjoyed putting it together. Sincerely,

Chaden Noureddine Editor in Chief

CONTRIBUTORS Contributing Writers: Temitope Ali Charisse Allen Stefanie Bennett Carter Biskup Rishab Chawla Antonia Josephine Clifford Verónica Gutiérrez del Arroyo Lebrón Nyrah Humayun Madina Jahed Darshan Kalola Faris Katkhuda Uju Madu Chaden Noureddine Chika Nwachukwu Lorelle Sun Contributing Artists: Carter Biskup Julia Siar Tasmima Tazim Sunmee Huh Emily Carroll Arman Sharbatdaran Graphic Designers: Charles Tavares Chaden Noureddine Cover Art: Kelly Huynh

MAGAZINE EDITORS CHADEN NOUREDDINE

(SHE/HER/HERS)

CHIEF EDITOR

Chaden is a graduating fourth-year medical student at Rutgers New Jersey Medical School. She immigrated from Lebanon to the United States at 17 years old. She completed a Bachelor of Arts degree at Rutgers, Newark, NJ where she majored in Biology and minored in Psychology, Chemistry, and Honors Studies. Her interest in psychiatry was kindled from an early age when she saw the adversities and stigma patients with mental illnesses had to face in the Middle East. She hopes to further her knowledge and create an impact in the fields of health equity and social justice. She is passionate about medical education, psychotherapy, and advocacy. She will be pursuing her psychiatry residency training at Icahn School of Medicine at Mount Sinai, Beth Israel, starting in July of 2022. In her free time, she enjoys drawing, painting, writing poetry, brewing coffee, over-analyzing books and films, and playing video games.

CHARLES TAVARES

(HE/HIM/HIS)

GRAPHIC DESIGNER

Charles is an artist and art educator based in Newark, New Jersey. He earned a BFA in Studio Art, with a specialization in painting and drawing, from New Jersey City University before returning for a teaching certification. He now works at Harriet Tubman Elementary and Middle School in Newark. He produces traditional and digital artwork professionally as well as personally. Other personal activities and interests include baking, woodworking, programming, electronic repair, as well as enjoying new video games, music, movies, and TV shows.

TASMIMA TAZIN

(SHE/HER/HERS)

EDITOR

Tasmima Tazin is a rising fourth-year medical student at Rutgers New Jersey Medical School. She was born in Bangladesh but has lived in New Jersey since she was four years-old. She got her Bachelor of Arts degree at New York University in Environmental Studies with a minor in Chemistry. She became interested in psychiatry after completing an inpatient psychiatry elective during third year. However, her interest in mental health started earlier on in medical school when she pioneered the Pozen Scholars program, “Therapeutic Art in Watercolors,” where she taught Zoom classes using art therapy techniques during the height of the Covid-19 pandemic. She hopes to apply for a psychiatry residency in the 2022-2023 application cycle. Her hobbies include painting, cooking, gardening, and reading.

KELLY HUYNH

EDITOR / ILLUSTRATOR

(SHE/HER/HERS)

Kelly is a rising third-year medical student at Eastern Virginia Medical School. She completed a Bachelors of Arts degree at New York University with a major in Biology. She enjoys traveling and spent semesters abroad in London and Shanghai. She first considered a career in medicine at twelve years old, and her interest in psychiatry began during her senior year of undergrad. Her interest in psychiatry comes from her personal experiences and helping those around her with mental health issues. She has particular interests in LGBTQ+ mental health, intergenerational trauma, and borderline personality disorder research. Outside of medicine, she enjoys drawing, creative writing, video editing, baking, science fiction, and exploring different grocery stores.

TIM BILAL (THEY/THEM/THEIRS)

EDITOR

Tim is a graduating fourth-year medical student at Kansas City University. They completed their Bachelor of Arts at the University of Michigan with a major in Philosophy, Politics, and Economics. They are a dual degree DO/MA student and will be graduating with a Masters of Bioethics. Tim’s passion for psychiatry stems from their love for philosophy and the humanities. They are especially interested in metal health and health justice in Transgender and Gender Non-Conforming communities. They will begin their psychiatry residency training at Atrium Health Carolinas Medical Center in Charlotte, North Carolina, this summer. In their free time Tim likes to cook, explore new hiking trails, and take (a completely normal amount of) pictures of their cat being adorable.

ANTONIA CLIFFORD

(SHE/HER/HERS)

EDITOR

Antonia Clifford is a medical student at Feinberg School of Medicine. Raised in the mountains of New Mexico, she moved to Chicago to complete a BA in Sociology and an MA in Social Work at the University of Chicago. After a ten year career in HIV/AIDS and mental health research, Antonia entered medical school to apply the skillset of clinical observation, scientific inquiry, and empathetic communication to providing the highest quality medical care. For over a decade, Antonia has volunteered as a survivors of suicide advocate and support group facilitator. Her specific interests in psychiatry include ethics, telepsychiatry, and ecological impacts on mental health. She is a proud parent of three children and a big fan of decoupage.

EAMON THOMASSON

(HE/HIM/HIS)

EDITOR

Eamon is a second-year medical student at Hackensack Meridian School of Medicine. He grew up outside of Missoula, Montana and completed his B.S. in Biomedical Engineering at Columbia University. After graduation, he worked for four years in Boston, first at a tissue engineering startup, and then in clinical radiology research at Massachusetts General Hospital. While in Boston, he took an inspirational neurobiology course at Boston University, which reignited his interest in neuroscience and mental health. His passion for psychiatry stems from research experiences in the field, clinical volunteering experiences, and a deep interest in the mind. He was a co-leader for his school’s Psychiatry Interest Group from 2020-2021. His specific interests in psychiatry include addiction psychiatry, ECT and interventional psychiatry, biomarkers of mental illness, and neuropsychiatric disease. Outside of medicine, he enjoys listening to jazz and electronic music, and reading fiction.

ALLISON ZUCKERBERG

(SHE/HER/HERS)

EDITOR

Allison Zuckerberg is a third-year medical student at Hackensack Meridian School of Medicine. Born and raised in New Jersey, she first became interested in Psychiatry while working in addiction at various rehab centers in Secaucus and Newark. She pursued a degree in Biology with a specialization in Behavioral Biology at Boston University and worked as a laboratory assistant in an addiction genetics lab at the BU School of Medicine. In medical school she has led her school’s Psychiatry Interest Group and became a student representative for PsychSIGN. She has edited and contributed to PsychSIGN Magazine’s debut volume. This summer she is participating in APA’s Summer Medical Student Program and in her fourth year she is completing a community project for LGBTQ+ youth. She is planning to apply for Psychiatry residencies for the 2023-2024 cycle. She spends her free time hiking, doing yoga, and creative writing. She also enjoys traveling and wants to do more of it.

RYAN A. BEHMER HANSEN

(HE/HIM/HIS)

EDITOR

Ryan A. Behmer Hansen is a fourth-year medical student at Rutgers New Jersey Medical School. He grew up in Rochester, NY, studied engineering as an undergraduate and graduate student at Case Western Reserve University in Cleveland, OH, then moved to Newark, NJ for medical school. Ryan is committed to psychiatry because of its uniquely patient-centered and holistic ethos, as well as the significant emphasis in training placed on the psychosocial factors impacting patients’ lives. Attention to the diverse factors which shape patient outcomes aligns with the systems-level problem-solving approach taught in engineering. Outside of work, Ryan enjoys cooking and watching hockey. He lives with his wife Rosemary and their two dogs.

ELIZABETH CHERN

(SHE/HER/HERS)

EDITOR

Elizabeth is a rising fourth-year medical student at New Jersey Medical School in Newark, NJ. She was born and raised in New Jersey and has known she wanted to pursue work in the mental health field since she was in middle school. She graduated from Rutgers University, New Brunswick, with a major in psychology and a minor in biology. During her time at Rutgers, she participated in fieldwork focused on helping children cope with their family members' military service, divorce, and incarceration, and discovered a love for working with families. She is a chair of the Rutgers NJMS SFHCC Satellite Clinic branch and enjoys listening to lo-fi music while sipping tea and pondering her next case report. Other hobbies include yoga, running, rock climbing, and cooking. Elizabeth will be applying for psychiatry residency and hopes to pursue a fellowship in child and adolescent psychiatry.

WHY I STOPPED WATCHING THE NEWS By Darshan Kalola

News media today is markedly different from news media of the past. Social media enables anyone to disseminate information. Publications like Vox and Buzzfeed offer trendy, snacksized takes on a wide range of complex issues. Legacy cable news organizations fire-up the temperature of their reporting with 24/7 breaking news and political agendas. These changes are due in large part because of the advertising-based revenue model. Companies want to keep people on their platforms for as long as possible to maximize the number of ads they see. To achieve this goal, they must publish extremely compelling content. This may mean resorting to clickbait or selectively filtering stories that are the most captivating—typically those which involve fear, uncertainty, panic, tragedy, corruption, or injustice. Media outlets also turn dull stories into entertaining ones by deliberately withholding certain facts or providing information out of context. These strategies ought to be expected given that media outlets are businesses operating to earn a profit. But as consumers, we should recognize the mental health consequences of their strategies to both ourselves and our loved ones. Keeping up with “the news” in the modern world is often a harmful activity. Most people have strong emotional responses not only to other people’s suffering, but also to fear, tragedy, and injustice. Constantly being exposed to heart-breaking stories can make us feel depressed or hopeless. Studies have shown that being exposed to as little as 15 minutes of television news can decrease positive mood and increase anxiety. Furthermore, the massive scale of news today means that no one can successfully digest all of it. The rise of smartphones and social media has led to the explosion of newsworthy content since every event can now be recorded. In the past, we were ignorant of most news and rarely had footage of it. Now, in a country of 330 million and a world of 7.6 billion, at least one tragedy or injustice will be captured on video each day. We haven’t evolved to witness such pain and suffering while remaining undisturbed. To make matters worse, news companies have intensified their use of manipulative techniques amid rising competition for people's attention. CNN, for example, doesn’t compete only with Fox News. It competes with BuzzFeed, YouTube, Instagram, Twitter, TikTok—even games like Fortnite or Candy Crush. All of these products are competing for the finite resource of consumer attention, which produces a perverse race to the “bottom of the brain stem,” as Tristan Harris of The Center for Humane Technology says. Companies must adopt clickbait or sensationalism because if they don’t, someone else will. Photo credit: Berkay Ilhan

The reality is that most news is useless to most people. Unless you happen to work in politics, journalism, or some other form of public commentary, non-specific news can safely be ignored. It is not clear that news consumption provides benefits such as changing perspectives or teaching individuals to act more effectively in the world. At its best, it entertains or informs. At its worst, it frightens, enrages, or agitates. Of course, for any given person, there still exists a niche of news that will be useful. As medical students, for example, staying up to date on healthcare policy may be a good use of time. The main pushback to these arguments is that if one were to avoid news altogether, one would miss out on important current events. Or, that it is one’s civic duty to stay informed of the state of our country. Or, that one at the very least must pay attention to the unending stream of injustices around the world so as to not ignore their plight. In some ways, these concerns are valid. But they do not acknowledge that there is an infinite number of problems in the world and that individuals only have the capacity and competence to deal with a select few. Physicians can take care of patients. Electricians can fix circuit-breakers. Artists can produce music. But none of us can respond to every need in the world.

issues that matter. If aliens landed on Earth tomorrow, do you think you would not hear about it from your friends and family? Of course, you would. Passively relying on your social network is one of the best ways of getting news, because it ensures you receive only the most consequential information without a for-profit enterprise livening it up with deception and hyperbole. News is now more pervasive than ever. The unfortunate truth is that companies do not have your best interest in mind. They seek to make the world’s problems your problems so that you continue tuning into their coverage. Protect your mental health. Protect your wellness. If we each focus on solving one problem at a time, the world will become an amazing place.

Szabo, Attila & Hopkinson, Katey. (2007). Negative psychological effects of watching the news in the television: Relaxation or another intervention may be needed to buffer them! International journal of behavioral medicine. 14. 57-62. 10.1007/BF03004169. Harris, T. (2019). A New Agenda for Tech. Center for

They also do not account for the ability of our social network to inform us about

Humane Tech. Video Presentation. Available at https:// www.humanetech.com/news/newagenda

JOURNEY by Tasmima Tazim

BOSS BATTLE by Tasmima Tazim

THE GAMECUBE by Lorelle Sun

I was born in 1997, towards the tail end of the Millennial generation and at the cusp of Gen Z. My generation is one of the last few to experience a childhood free from social media and technology. I fondly remember a time when playing outside with the neighborhood kids was the norm. We would race our bikes down the street, shoot basketball in the backyard, play handball against the garage, and playfight with water guns in the cul-de-sac. It was an idyllic and privileged childhood.

Photo of me and my brother riding our bikes.

However, everything changed with the arrival of the Nintendo GameCube. In 2004, my parents bought me and my brother the much anticipated and desired GameCube for Christmas. We were obsessed with it. We spent hours playing Mario Kart, Pokemon, and Super Smash Bros. Slowly, we stopped venturing outside to play. From then on, technology would begin to consume our lives. In middle school, sometime after the release of the GameCube and a string of other video game consoles, my father brought laptops and introduced me and my brother to the internet. Soon, we were spending many hours of our day browsing the web. We watched YouTube videos after YouTube videos, with Key and Peele being our favorite. We also cre-

ated AOL Instant Messenger accounts and chatted with our friends online late into the night. We posted cringy, awkward posts on MySpace and Facebook, which to this day is a public record of my most embarrassing teenage years.

Photo of me and my brother playing our GameCube

In high school, my brother and I received our first smartphones. Before smartphones, we could only access the internet via our laptops at home. However, with the introduction of smartphones, we could access the internet anywhere. Snapchat and Instagram became the trend. We sent “snaps” to all of our friends, daily, trying hard to maintain a record-breaking “streak.” On Instagram, we captured our memories with photos, but more importantly, we flexed to others a superficial, misleading, glamorous aspect of our lives. It became harder and harder to disassociate from our phones in high school. In college, Reddit was the newest social media platform introduced to me. As a premed, I became involved with the Reddit thread “r/premed.” It was a popular, go-to resource for applying to medical school. I became obsessed with reading advice and

tidbits shared by other successful premeds. During my application cycle, I would check “r/premed” every day to see which of my fellow “redditors” were receiving interviews and acceptances from medical schools. I thought that once I got accepted to medical school, I’d stop browsing the thread and end an unhealthy obsession. However, I soon realized that it was difficult to end my dependency on social media. When I entered medical school, I became further invested in “r/medicalschool,” the Reddit thread for medical students. I also started using Tiktok, watching comedic six-second shorts one after the other. I’m ashamed to admit it, but it became very easy for me to waste an entire afternoon browsing through these social media platforms!

photo credit: Lorelle Sun

18 Photo Credit: Pexels, Mart Production

OOPS I DID IT AGAIN by Julia Siar

EAT YOUR PANCAKES by Charisse Allen

It’s Week Three and you’re feeling con(dent. You remembered to put on deodorant and you’ve mastered gene expression. You also got about six hours of sleep last night—a new record! Eat your pancakes. Clinical Skills has started. You have a write-up due tonight, but you haven’t reviewed yesterday’s lectures. You’re not quite behind, but you’re nowhere near where you anticipated. Tonight was supposed to be your night o), the time to get back to a baseline of normalcy. Alas, your best friends are now the moon and the crickets that chirp until day breaks. Eat your pancakes. Your (rst exam is in two days, and as you reffect upon what you do and don’t know, you start thinking. You’ve gone through glycolysis more times than you care to admit, and yet, you can only get as far as alpha-ketoglutarate. As you engage in practice questions, you see you’ve chosen the least-answered option despite your assurance in your choice. “How does everyone else know this but me? What am I missing?” On the ride back home, you wonder how you went from a wide-eyed hopeful, ready to change the world, to now feeling like you’re carrying the weight of it. You’re thankful you have a mask on to shield your tears. You’re not supposed to cry. You signed up for this. Eat your pancakes. Finals have arrived and you hang in the balance between advancing on with the rest of your study group or being le behind, wondering how it has come to this. They tell you to reach out for help, but you have barely been able to (nd time to shower or take a break without thinking, “I should be studying,” or “I don’t deserve a break.” You're trained to think the callous grit and perseverance that got you here is meant to sustain you, and yet everything you are tirelessly working towards appears to be a dream that seems as though it will remain just that—a far reach from any attainable reality. As much as you wish the ominous doubt would go away, you know that you’re responsible; for making the decision to forego baby showers and birthdays for review sessions and neverending standardized exams; for spending the entirety of your twenties in a classroom; for putting yourself in crippling debt that may or may not ever get repaid. You never imagined

21 photo credit: Pexel, Cottonbro

IMPOSTER by Carter Biskup

You have been following me for some time, Shame. You mockingly stand amidst the peers I compare myself to. You take notes on what I fear most. You take captive what I most desire. You manage how I see things on the little screen I always keep with me. You find ways to rest quite peacefully in my previous thoughts and I know you'll find a home for yourself in my future ones. It is past due that we officially meet. I want to show you all the resilience you've helped me build.

Here we are, Shame. Though I have to say, You are not as big as I once imagined you to be. You are not as controlling or jealous or powerful as I once thought. You are simply here, your purpose an honest one. Resisting what is here only ever leads me into depletion Therefore, I befriend you, Shame. You've helped me get this far and for that I am grateful. “I wrap my arms around you, mirroring your hold on me You are a product of me existing and I am a product of you persisting. My colleague, the honor is mine.

22 photo credit: Carter Biskup

SURVIVOR’S GUILT by Madina Jahed

Con(ict may have taken my childhood, But not my dreams and aspirations. Trials and tribulations I withstood, Sudden displacement and immigration.

A new life in America gave me hope, Education gave me a way to cope. A commitment to medicine was made, An Afghan female physician, unafraid.

To have this opportunity, lucky me, While my people clung to planes at rise, Dreaming for the chance given to me, Instead plummeting to their demise.

"Help! The Taliban are coming," they beg, Their voices echoing in my head. "You are our family, please help," they beg, Their fate fills me with dread—

Why did I survive, and you didn’t? Forgive me. Why am I still here and you aren't? Forgive me.

25 photo credit: Pexels, Cosmindo

FOREST THERAPY by Tasmima Tazim

CALL OF THE SEA by Tasmima Tazim

GRIEF TEXTURES by Antonia Josephine Clifford

Different griefs have different textures You feel them when you breathe:

The sharpness of suicide with its instant silencing of rooms The slow slipping of a family patriarch into dementia A cold and foggy feeling, followed by an empty space The quiet, private loss of a dream, watching our bloody ectoplasm floating in the toilet, the feeling of clutching porcelain tile.

But this, What do 345,311 griefs feel like? Layered together Numb At a distance Can’t touch them Masked Goodbyes Through screens Going through this together, but apart

The roundedness of this year at contrast with the tears against the fabric of time and threads of lives

Grieving relationships

Grieving milestones What is a graduation with no stage, no walk, no celebration. What is a drive-through funeral but a giant fuck you for a living? What are essential workers if we keep killing them?

And each one grating coarsely against the one underneath Until the skin is rubbed raw with grief Exposed at first in pain Gradually numb to the bite of the wind Layered scabs like tree bark Like beach sand eroding away That sand has to go somewhere Weighing heavy like refrigerated trucks, in hospital parking lots

Like the sharp ragged intake of breath Like the burning in your chest after being underwater for too long, the aluminum taste of lack of oxygen flooding our mouths, and hearts pound as the desire to breathe becoming too strong We’ve been underwater too long

photo credit: Pexels, Cottonbro

THE IMPOSTER by Chika Nwachukwu

Comparison is the enemy The future is bleak Look left, look right. It’s only me Staring blankly in the mirror White coat in hand I somehow made it; but do I really belong?

Perhaps it was a mistake Perhaps it was luck No, it can’t be by my diligence alone I am about to be a physician, yet know so little I am the imposter I am the fraud I do not belong here

Why am I here Among those who are better than me Smarter than me More experienced than me? Can others tell that I do not belong?

But I do belong here I am smart I am competent I worked so hard to be in this moment, now

Reflection in the mirror cracks a slight smile It is time to see a patient now

photo credit: Pexels, Gustavo Fring photo credit: Erkan Utu, and Tima Miroshnichenko

INTERVIEW WITH DR. JAMES SHERER interview by: Temitope Ali edited by: Elizabeth Chern, Chaden Noureddine

Welcome, Dr. Sherer! It is a true honor to be interviewing you for this article. You’re currently an addiction psychiatry fellow and possess an interesting background in technology and mental health. To start off, can you tell us a little bit about yourself? Dr. James Sherer: Sure! I’m James Sherer, an addiction psychiatry fellow at NYU Grossman School of Medicine/Bellevue. I attended medical school and completed my psychiatry residency at Rutgers New Jersey Medical School, as well. As I was in residency, I was learning about addiction and seeing patients with substance use disorders. In the back of my mind, I was always thinking about growing up with video games and being passionate about them but also realized there were times when both I and my friends overindulged. As a kid growing up in the 90s, video games were a large part of my life and a huge interest of mine. They followed me through adolescence, into young adulthood, and up until this very day. In fact, I still play them to this day. My interest in the intersection between psychiatry and technology developed as I saw how my friends and I went through periods in our lives where we were definitely too focused on playing video games. I started thinking more about writing about video games and technological addictions. As you and most people in this field will find, when you start thinking and writing about things critically, things just kind of naturally snowball. Last year a team and I came out with “Technological Addictions” which is the first textbook published by the APA to deal with this form of addiction in a comprehensive way. I was very proud of that. Since then, I've continued to work on and mull over this topic. I've written two review articles about technological addictions and Internet gaming disorder and I have additional pieces coming out this year. I recently submitted a manuscript that will be published in ”Psychiatric Clinics of North America '' and another that will be in “Current Reports”’. In May, I will be giving a workshop for the APA about Internet gaming disorder and discussing psychotherapy for addiction in general. These will be two separate items at the APA. One will be with Doctor Levounis, whom I'm very excited to talk with.

12 hours a day playing League of Legends, that is probably not enough to merit a diagnosis. However, if you are a medical student playing 12 hours a day of League of Legends [that] is certainly too much. So, it really depends on the person, their goals, what their life is like, and which lifestage they are at. Games can have a pro-social impact, but they can also pull people’s attention away from where they need to be— be it family, work, life, or even studies. This cross-over into disordered behavior really depends on the person. How does technology interact with your own mental health? Gaming for me acts as a healthy coping mechanism. I remember being a resident working through the initial stages of the pandemic in the emergency room at Hackensack Hospital before masks were even mandated. I was chief [resident] during that time and the beginning of the pandemic was extremely stressful. The very first COVID patient in New Jersey was at Hackensack and I was walking past his room!

That’s a unique background and it's amazing to see how interests in various hobbies can help to transform medicine and inform current care. I think you're a great example of that. Regarding that text, “Technological Addictions,” and the section on video game addiction and Internet gaming disorder, when do you personally see gaming crossing the line from harmless pastime to diagnosable Animal Crossing on the Nintendo Switch disorder? became an escape for myself and many other people because it acted as a social If I could answer that, succinctly, I think lifeline. To this day, I use it as I commute I would be much more successful than I from New Jersey into Manhattan, and cross am right now [chuckle]. I think the oneacross to Bellevue. Currently, I’m playing sentence answer to that is, ”it depends the new “Pokémon Legends: Arceus” game on the person”. And the goalposts are on the train on my commute and it's a nice different for every single person. If you little break. are a professional e-sport athlete spending

I will say, I studied for and passed all my boards earlier this year and I was not playing video games, then. At that point, I was using that time on the train and every spare minute that I had to study for boards, to apply for jobs, and moonlight. Now that I have these items settled, I am playing more games and I've been able to engage with them in a healthy way. Looking into society as a whole, what do you think are the positive aspects of society's current use of technology and its role in mental health? What do you think are the negative impacts of technology on society’s mental health? Technology is allowing us to provide mental health care to many people who didn't have access to it, before. One example is the virtual buprenorphine clinic that I do in the afternoon. Just a couple of years ago, the thought that you could induce someone on Suboxone without doing a physical exam and only eliciting withdrawal symptoms would have been impossible. Now, treatment can be provided by talking to patients about their usage and symptoms. Not everyone has the time or the money to come to an appointment. That's a huge change. All you have to do is watch cable TV to see a million ads about all sorts of different therapy options that are available in an app or on some sort of platform. These are definitely positive aspects. It's also positive for providers because it entails more job opportunities for us! On the other hand, social media has definitely contributed to a widening political gap in this country. There are many good documentaries about this. I feel that social media frequently lends itself to short, vapid, and insubstantial interactions. As a result, individuals often lose sight of the importance of open and rich in-person exchanges with people who may not share their same sentiments. Personally, I engage with social media often and I love it! Social media is a great way to keep up with people. So I think that's definitely a negative aspect to it and I think for those who are suffering from internet gaming disorder, sex addiction, online porn addiction, or addiction to online shopping. For people who are struggling, it's almost impossible to avoid those things these days, they're ever-present. The prevalence of technology absolutely makes it harder to abstain and can present ajor detriments. Do you think people are aware of how much technology can affect their mental health? I definitely think there needs to be more awareness. There is evidence that shows that people tend to underestimate their own use of technology. This is why something like having a screen time report on iOS is quite helpful. Other evidence shows that parents vastly underestimate how many hours their children spend playing video games. People don't really appreciate how much they're relying on technology and it's easy to downplay usage because it's an essential part of modern life, and has so many benefits. Still, I 34

think there needs to be more awareness. I think it's good that the APA and the DSM are taking these first steps by including Internet gaming disorder in the DSM as a working diagnosis that needs further research. That's a big important first step. I think it should be followed by [coming] up with some good names for cybersex addiction and online shopping disorder. We need to codify more of this so that we can comprehensively research it.

We’ve been discussing the intersection of technology with mental health and daily living. What are your thoughts on mental health apps?

A co-fellow of mine (Dr. Keriann Shalvoy) and I have co-authored a chapter about this topic. This will be coming out in a textbook on addiction published by Cornell Press. Dr. Shalvoy wrote an outstanding section on mental health apps. Again, it's hard to make a blanket statement because there On that note, on research, do you think are many applications out there. The psychiatry is equipped to keep up with short of it is, some apps work and some the rapid evolution of technology? don't. Keep in mind that even the ones that work are targeted at a person whose It's interesting because if you're talking psychopathology isn't overtly debilitating. about research, I think that this type of In truth, most people could benefit from research isn't confined solely to psychiatry. having a mental health provider, whether If you look at PubMed, the most recent it's a tele-provider or an in-person studies are about Internet gaming provider. disorder. You'll see a lot of psychiatrists publishing pieces. However, you'll [also] Despite these limitations, there is merit see many different providers such as to some of these apps. However, there pediatricians, internal medicine, doctors, are a lot of problems with these apps and and primary care doctors publishing a large one is confidentiality. I am bound as well. So, the question then becomes by HIPAA to maintain confidentiality; if psychiatry by itself can keep up with when I see a patient my EMR is HIPAA ALL of these changes. I don't know. But compliant. These apps are not held to the can medicine as a whole at least start to same standards and that's a major concern approach that? I think so. Yet despite our among other significant concerns. That best intentions, we're always going to be being said, I think they'll play an important behind the ball. These technologies come role and I'm sure some of them are useful. out faster than we're able to fully research There are a couple, for example, that were and understand them. Video games have researched by the VA. One is called “PTSD been a household staple in the United Coach” and another is called “Mindfulness States since the Atari VCS was released in Coach”. I believe those are two great apps 1977, yet Internet gaming disorder made it and they're free to use even if you're not into the DSM, for the first time, in the DSM a veteran. There's a definitive role for 5. So there is a lag time there… but you mental health apps, but I don't think that know, we get there eventually [chuckle]. they'll be doing any of the heavy lifting, at this current point!

photo credit: Pexels, Kevin Malik

Thank you for offering a nuanced and broad perspective. Your personal and professional interactions with technology echo what you said earlier about the difference between a harmless pastime and a disorder. It’s always great to hear about more patients receiving help! It’s also clear that you engage with technology in a way that enhances your ability to deal with stress and to go through life! Is there any general advice you'd give to keep technology as a positive aspect of one's life rather than a negative one? Definitely! Video games can't be the only thing you use to cope and to manage stress. This brings me to another point that I want to make. General advice would be to make sure technology is part of a healthy diet of diversions and isn't the entire diet. Something physical, something creative, something technological. Sometimes the physical and the creative can interface with technology, of course, but you want it to be kind of a slice, not the whole pie.

Also, I think just keeping your values in mind as you go about your life and you engage with technology. And being introspective and asking yourself, “am I using this too much? Is this really who I am? Is this consistent with who I want to be?”. Asking those questions can be an easy first step. That said, it’s not so easy sometimes, and sometimes those questions are really hard to answer. If that resonates with you, then getting help from someone like a mental health professional can also be really beneficial. Finally, do you have any last words for the reader? Technology has already changed the face of not just mental health, but also healthcare as a whole. I think many doctors have had experience with telehealth. I believe that when the opportunity arises to garner experience in telepsychiatry, you, as a trainee, should work to seize that opportunity. Telemedicine is going to be a bigger and bigger part of your residencies and careers going forward

When I talk to medical students and residents about wellness, I always advise Thank you Dr. Sherer! I really appreciate having a physical outlet. It could be some you taking the time to answer all our type of exercise, martial arts, running, questions in an insightful manner. rowing, or whatever. You should have something like that. Next, you should really have a creative outlet, whether it's drawing, painting, or playing an instrument. Those things are really going to edify and stimulate you to carry you through. You can add games on top of that, but games should not displace those things and they certainly shouldn't displace your relationships either.

36 photo credit: Pexels, Stas Knop

LOST IN TIME "Images I Will Carry with me from my Emergency Psychiatry Rotation" by Sunmee Huh

PRACTICAL KINDS AND IMPERFECT COMMUNITIES by Rishab Chawla

A Diagnostic Predicament

“Physicians, including psychiatrists, give a lot of thought in their everyday work to answer the question of whether or not a particular patient has a disorder; they rarely give much thought to the broader issue of what constitutes a disorder.” —Dr. Robert Spitzer, 19. Last spring, I read Dr. Je(rey Lieberman’s Shrinks: An Untold Story of Psychiatry as part of my school’s psychiatry interest group. The book charts the development of psychiatry from a fringe discipline estranged from “real medicine” to now a mainstream medical specialty. Along the way, Lieberman shares numerous anecdotes to relate his life experiences to important moments in the history of the )eld.

Shrinkswas long and replete with several big names, but one that stuck with me was the late Dr. Robert Spitzer, a revolutionary )gure recognized as one of the creators of today’s widely used GAD-7 and PHQ-9 questionnaires. In short, Spitzer underwent sham treatments to try to learn more about himself, subsequently becoming a leading critic of then-contemporary psychoanalytic thought. He proceeded to develop a more objective and organized diagnostic manual and clinical interview procedure. Among the most pivotal moments in Spitzer’s career was his encounter with the protestors from the gay community who wanted homosexuality to be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). This had also become a heated issue in the psychiatric community. Spitzer became deeply invested in this issue and realized that classifying homosexuality as a mental disorder was unjusti)ed and harmful. However, this issue could not be disentangled from the question of what made something a mental disorder, in the )rst place. There was no offcial de)nition of a mental disorder neither in the DSM, nor in the psychiatric community. Inspired by passionate testimony from the gay community, Spitzer devised a de)nition of mental disorder that recognized distress and disability as central features, and an illness label was justi)ed only when the condition resulted in signi)cant distress or impairment in everyday functioning. Homosexuality was then removed as an illness in 1973, and Spitzer went on to become the chairman of the task force for the DSM-III, the edition that revolutionized psychiatry.

photo credit: Pexels, Element Digital

photo credit: Pexels, Photo-1031588

42 photo credit: Pexels, Cottonbro

; by Stefanie Bennett

“There’s been an accident,” said Mr. Lee, looking between me and his wringing hands. “What kind of accident? Is Noah in the hospital? Can I see him?” My mind racing, I fought tears as I struggled to meet Mr. Lee’s shi6ing gaze. Mrs. Lee stood somberly beside her husband, unable to 7nd the words to address me. “No. I’m afraid he’s gone,” he replied. My legs buckled and my shaking hands dropped the textbook I had been clutching. The sound of the textbook slapping the tile 8oor echoed across the tiny rental home like an earthshattering thunder. My knees hit the ground with the force of a freight train, colliding with the harsh reality that my boyfriend was dead. I let out a loud wail as my friend, Jon, gripped my shoulders, pulling me back from the steep cli1 of grief I was suddenly overlooking. Choking back the pain of his son’s sudden passing, Mr. Lee 8ed the room, as if he were running from the words that had escaped his mouth. I heard the gravel shi6 beneath the tires of the golden Ford Focus as Mr. and Mrs. Lee pulled out of the driveway and down the street. It was November 13, 2007. Noah Oliver Lee was just 20 years old. It wasn’t until several hours later that I learned he committed suicide. Jon brought me to my feet and led me outside into the cool night air. Through my swollen eyes and 8owing tears, I found what little strength I had le6 and called my friend, Ruthie. Ruthie and I met as freshmen at the University of Arizona, though at the time she was a chef at the Phoenician Hotel in Scottsdale. Sensing something was wrong, she stepped out of the bustling kitchen line to answer my call. “I’m coming to get you, Ste1,” she said. “Just hold on – I’m bringing you home,” It was a two-hour drive from the Phoenician to Noah’s house in Tucson, but Ruthie marched straight to the parking lot and began the arduous drive to collect what was le6 of me. I sat and waited in the driveway of the home once shared between Jon, Bill, and Noah, a pale yellow light spilling through the crooked window blinds to pierce the night like a beacon of mourning. Slowly, those closest to Noah trickled out onto the dimly lit street. Standing side by side, students struggling to make sense of what they just learned shared the only thing they could a1ord to o1er - their memories.

43 photo credit: Pexels, Cottonbro

45 photo credit: Pexel, Liza Summer

FRAGILE by Emily Caroll

A LESSON IN CULTURAL HUMILITY by Faris Katkhuda

“Fnu?” “Fnu?”

My call to the waiting room goes unanswered.

There were only two patients around. I decide to go with the last name that I hastily scribbled down. An elderly woman stands up with her caretaker. “Which one of you is Fnu?” I rephrase in response to a blank stare.

“Who is here to see the doctor today?”

“She is, but I am here to translate.” Introductions flow, making the most of our short walk to Exam Room 4. “Where are you two from?” I ask. Small talk as the computer starts up again. “Tibet.” Racking my brain for a conversational connection, Even as a guest to this community of over 800 languages, I feel confident in my cultural humility. A son of immigrants myself, I am armed with questions of Food Weather Language Religion. As much as the omnipresent pressure from the patient schedule permits. The EMR finally opens, And as I click on the patient file: “ALERT: FIRST NAME UNKNOWN (FNU).” Perhaps I’ve been too confident.

photo credit: Pexel, Mikhail Nilov

WE ARE HERE TO HELP by Uju Madu

Accusatory, distrustful, frustrated, restless, evasive, infatuated, with the idea that we are all out to get her. This thought, repetitive, and the only thing sure makes us the enemy, our intentions obscure. Her uncle is trying to kill her, and we are helping him. Why? She doesn’t know, but we are putting the nail in her coffin. “We are here to help you” falls on deaf ears, for all she hears is, “We are against you, take more pills.” Emphatic, unrelenting, words rushing to get out, questioning, digressing, hard to reroute. Though she enjoys the “high”, though she likes how it makes her feel, the consequences, she realizes, are undeniably real. But, she doesn’t trust that we will give her the right medication, refusing the prescription with unshakable conviction.

“We are here to help you” falls on deaf ears for all she hears is “We are going against your will.” Monotonous, disheveled, downcast, hopeless, helpless, with pain that only ends when he breathes his last, so he believes. We don’t understand, we are not the ones who have endured the abuse, the shame, the many closed doors. We are part of a system that takes and doesn’t give back, another patient, another dollar, uncaring behind a mask. “We are here to help you” falls on deaf ears. For all he hears is, “We are here to make money, another cog in the wheel.” How to build that bridge of trust between us, that vital connection, superseding the prescription? In its presence, there is opportunity for our bond to aid healing. In its absence, fracture between us plagues you unyielding. Lost in thought as I stand beside my supervising resident, as she earnestly dissents, once again telling our patient, “We are here to help.”

photo credit: Pexel, Karolina Grabowska

A TELEMEDICINE APPOINTMENT by Verónica Gutiérrez del Arroyo Lebrón

I arrive at the psychiatry pediatric clinic early lost their employment during the pandemic. that day, excited to get a glimpse of a day in Some feel the di(culty and dread of returning the clinic. Last week, I was on the psychiatry to a routine and taking time o) their already pediatrics consult service, and this week I’m disrupted schedules to go to the clinic. I ready to immerse myself in the outpatient reffect on this while having lunch. experience. I don’t have much knowledge in “I have a patient at 2:00 pm,” I hear. pediatrics psychiatry and much less in the outpatient setting, which is why I decided to I’m thrilled. At last, I’m seeing a patient! I sit rotate here. I spend the morning getting to down at the o(ce and wait, and wait, and know the clinic’s residents and faculty. They wait. The resident sits down at the computer are all very welcoming and interested in and waits, and waits, and waits. teaching, making the most of the questions Oooooh. I get it now. It is a telemedicine that I have. The hours go by fast until I appointment. We wait another ten minutes suddenly realize that we are about to have and send an email reminder to the patient. A lunch and still no patients have arrived. I y 15- ear-old boy nally connects to the online quickly ask about it. platform. “With the pandemic, we have been getting Ding. Ding. Ding. Connection established! less attendance at appointments. Many appointments are now video calls or phone At rst, we don’t see much, just a black calls,” a resident answers. screen. Something is moving. A faint face emerges from the darkness. It is the patient. “The pandemic has taken a toll on patient The resident asks him where he is and if he assistance, but we are working on reducing can position himself so we can see him better. no-shows,” says another. “I’m in my bed.” I had not thought about this, but it comes as no surprise. Covid-19 has tripped everything up, This is the only thing we can understand disrupting routines and daily lives as much amidst a symphony of mumbling. Nothing as possible. This includes children’s mental else changes. The resident continues to talk health appointments. Clinics went all-in with to him and asks him how he has been since telemedicine as an emergency measure, the last time they talked. “I’ve been ne,” is however many patients were lost because of what we gather from some more mumbling. a lack of access to technology. And now, in The resident asks him about his medications, the attempt to return to in-person visits, new which he has been taking for ADHD. struggles have risen. Some patients prefer “It’s . — ” telemedicine. Some are scared. Some don’t have the means to come in because they White screen.

51 photo credit: Pexel, Tima Miroshnichenko

SO CLOSE YET SO FAR by Arman Sharbatdaran

Brooklyn

52 Vancouver

INTERVIEW WITH TEMITOPE ALI interview by: Chaden Noureddine edited by: Ryan Behmer Hansen

In this article, we interview Temitope Ali, a rising third-year medical student at Rutgers New Jersey Medical Schoo/ (NJMS). He’s designed his own game, “Steve’s Hardcore WorldTour” which he’s worked on while matriculated in medical school, as a full-time student. In this piece, we learn about his background, his creative process, and his broader vision. Chaden: Temitope, it is such a pleasure to interview you. Would you be able to introduce yourself to our readers? Temitope: In 2014 I went to Rutgers – New Brunswick/ Piscataway for my undergraduate with a Biological Sciences Major and a Psychology minor. I graduated in 2018 and in the same year I started a Master of Biomedical Sciences at Rutgers – New Brunswick/ Piscataway. I graduated in 2019, and scribed at the emergency room of Southern Ocean Medical Center until 2020. I then started Medical School at Rutgers New Jersey Medical School in 2020, joining the class of 2024. Currently, as a second-year medical student, I am working on various studies analyzing how the internet plays a role in mental health. I am also working on a literature review regarding the mechanism of pediatric traumatic brain injury in incarceration. I am also currently part of NJMS Curricular Content medical education workgroup. In my free time, I work on creating indie videogames. What does wellness mean to you? To me, wellness means balancing one’s life so that they can continue to enjoy their career without major regret or burnout. This doesn’t necessarily mean picking up a hobby outside of that career. I have met a lot of people who find immense joy in their career, and that is wonderful! I do not think anyone can be in a state of “wellness” if their only satisfaction is through money and security. One can be well-off but eventually higher needs such as belongingness, esteem, and self-actualization must also be met. Thus, I think wellness requires allowing yourself to have time with the things you enjoy, whether that be work itself, your hobbies, your family and friends, and so on and so forth.

How do you practice wellness? What are some of your favorite hobbies?

stories for them. I wasn’t really much of a writer and I wanted to give my characters life, so I chose to do that by drawing. After obtaining some tutorial books on drawing I eventually started drawing my own characters. I was very “on and off” with drawing. This was partly because my parents wanted me to focus on my education, understandably! It was also partly because I only drew when I had a burst of inspiration. In high school, I would post my creations on the internet to share. Around the end of high school, I met a friend who was into programming and he liked my stuff so we decided to make a game based on my creations.

I do quite enjoy studying medicine. But I can only do it for so long before I feel myself becoming less efficient and enjoying the process less. I like to draw, make animations, and make games. I have what I like to call my analytical battery and my creative battery. When my analytical battery feels drained through hours of studying, I like to switch to something creative. This not only includes my hobbies of drawing and game designing but also includes watching enjoyable movies and shows or reading interesting books. Funnily enough, I tend to overanalyze these things. That’s why I How did you manage to combine many sometimes think of my artistic battery as of your passions and talents into game design? my science battery, also. How did you get into video game design? I always wanted to tell interesting stories. In elementary school, I started making up scenarios of characters I liked in the media. Then I quickly started thinking about my own characters and interesting

Games are a multi-disciplinary art form. They require music, visual design, animation, sound design, and programming. I appreciate art of all forms and games are a great medium because they combine many of my artistic passions. Now, in terms of my passion for medicine

and mental health, I honestly never thought these interests would be congruent with my artistic interests. This changed around the time I was entering the second half of college and I saw the ways games could improve tangible elements of patient care such as medical adherence and medical education. There are actually evidence-based apps which use gamification to improve medication adherence. I hope to come up with applications that can help improve medicine in one way or another. What has inspired you along the way? The idea that I could make games while pursuing medicine was inspired a lot by the company Bioware, funnily enough. They were a group of doctors who ended up making a video game company. I also thought it was cool how Ken Jeong did stand-up comedy while studying and practicing medicine. These examples inspired me to keep up my hobbies during my studies. But initially, I saw my hobbies and my professional pursuit as completely separate entities. MySugr, an app which helps diabetes management through gamification, really inspired me to combine my hobbies and my professional pursuits. Reading about how video games could possibly work as therapies or educational tools has led to me openly talk about those hobbies during my medical interviews. I’ve also been fortunate to have had faculty supporting my interests along the way. I hope I can make something which will be beneficial to medicine.

How has your process evolved through time? I think this is the part where I admit I started digital art through a mouse... I did a lot of self-teaching throughout the years. The internet is a wonderful place to learn a variety of skills. By the time I started making games, I had some of the technical skills to make things look nice but I definitely needed to develop my leadership skills. As I said before, games are a multi-disciplinary art form. Many people can make games all by themselves, typically smaller independent games. However, when I started, I only really knew how

to draw and animate. Thus, I had to coordinate with other people to make my ideas come to life. Through this, I learned a lot of communication and organizational skills. This has led to things being done faster. In fact, I once participated in a competition called Ludum Dare which involved making a game in 72 hours. That was both insanely stressful and fun. How have the stressors of medical school impacted the process? How has medical school helped the process? Balancing making games with medical school pushes me to be more efficient with both. We all work with the same amount of time, and I know that making games is something I want to continue doing. So I use that as a push to make my studying very efficient. I have learned increasingly effective study strategies, giving me more time to work on my hobbies. It also drives me to stay focused when it is study time. I typically take only short breaks. Of course, it doesn’t always go as smoothly as I make it out to be. There have been times when I fall behind in a unit, and in response, I have to put all my focus into catching up. Then I use that as a lesson for how I can do better, for the next unit. I was told by some medical students before starting medical school that, “you make time for the things you care about”, and, “medical school is a marathon, not a sprint”. Those two statements have shaped how I balance myself.

Any advice for anyone reading who may have an interest in game design, but may be intimidated? There once was a time when a game could only be a couple of kilobytes. This magazine alone is more than a megabyte. As technology has progressed it has become easier to make games. A lot of the technical concerns of making games, such as memory management, are a lot less of a problem now. There are a lot of programs that make the process more streamlined, allowing you to focus on the creative aspect of the process. Plus, you don’t even have to be a professionally trained artist. A lot of independent games use simple graphics like squares and triangles. A famous example of that is the game “140”. So I encourage anyone to get started if they are interested! Any last words for our readers? I think a lot of people think that to be an artist you must go to art school. I think this is false. Art is a reflection of humankind, and humanity is extremely diverse. To think that there are only a few paths to being an artist would not be fair to the creative process of making art! Your experience is just as worthy of artistic expression as anyone else's. You never know how many people may relate to what you make. Without the creative pursuits of other doctors who have inspired me, I don’t think I would be here talking about my own experience! I look forward to seeing what everyone has to make.

FIND YOUR HAPPY PLACE by Nyrah Humayun

We woke up at sunrise, Eager to venture out into the blue ocean once again. Leaving our belongings at the seashore, we took our (rst steps into the water and Let ourselves gently )oat deeper into the ocean. It’s a New adventure each time we enter the inviting, lukewarm water. Every day brings a different collection of sea creatures and a different rhythm of waves that Soothes us as we relax and chat with each other. Serenity, it is pure serenity.

67 photo credit: Rachel Claire

Thank you for reading! Disclaimer: The views shown in this magazine do not necessarily reflect those of the magazine editors, or PsychSIGN as a whole. Please email us if you wish to participate in the next issue! For any issues or inquiries, please email

psychsignmagazine@gmail.com

photo credit: Markus Winkler