Omar Reda, MD

Here in Oregon, for environmental reasons, you do not pump your own gas. When you go to a gas station, someone fills your tank for you.

The other day, I was waiting for the attendant to serve me, but he was rather busy flirting with a customer. He started grooming her by saying how much he liked her car, and then he commented on her looks. I could see how uncomfortable she was when he proceeded to insist on getting her number. He did not stop before he made sure she called his cell phone so he could save her contact information.

This is not at all uncommon. Many women get harassed while performing even the simplest of daily tasks that should be risk-free. I made it clear to the attendant that he was intrusive, his behavior was unethical, and he likely had violated her personal boundaries. He brushed me off by saying that I should take it easy. I told his supervisor that such behavior should not be condoned or tolerated, and the supervisor promised me he would talk to him.

The attendant took the woman’s reluctant agreement as a consent, not realizing that in such relationships, there is power inequality and many female customers might indeed not speak up when someone in a position of power takes advantage of their needs.

I think, morally speaking, it is an extremely low act to abuse a position of influence to exploit others. We have heard stories of teachers, doctors, and preachers taking advantage of those entrusted to their care—but as the gas station incident showed me, women are not safe anywhere they go.

It is a communal responsibility to change that. Women need to be empowered to speak up, and men need to speak up for them. It is not enough to roll your eyes or shake your head when you bear witness to such violations. Changing the status quo requires all of us to take an active stand.

In the hospital where I work, we use the acronym “CUS” to encourage staff to speak up. C stands for 

 (“I am really concerned to be observing/hearing this”); U stands for 

 (“this is making me uncomfortable”); and S stands for 

 (“I want you to immediately stop”). And, of course, no one should risk their life or safety when defending others. We have seen people die while standing up against oppression, including the 3 individuals who were stabbed inside a train here in Portland while trying to protect women from a bigot.

I see any female as my mom, wife, sister, or daughter. What I dislike for my loved ones, I dislike for all other women. I am inviting men to take responsibility, to become role models themselves, and to raise their boys to respect and protect women. This cycle needs to be broken.

Women deserve better. They deserve to feel safe inside and outside their homes, at their places of employment, in their houses of worship, and wherever they might be—including my local gas station.

 is a practicing psychiatrist with Providence Healthcare System in Portland, Oregon. He is the author of 

The Wounded Healer: The Pain and Joy of Caregiving

Articles

“Changing the status quo requires all of us to take an active stand.”

Our Women Deserve Better

On Tuesday May 24, 2022, an 18-year-old high schooler walked into Robb Elementary School in Uvalde, TX, and killed at least 14 children and 1 adult, and left many more people injured and a whole community devastated.

Grieving will take a long time, and healing from such horrific tragedies is a communal affair. When children die because of man-made violence, there are little words one can offer to console.

Working with survivors of large-scale disasters, I have founded Untangled, a model of care that aims to bear witness and break the cycles of trauma that can otherwise permanently damage us as individuals, families, and communities.

Untangled steps in with humility to fill gaps and offer support through:

1. Psychoeducation: to normalize emotions and reactions and minimize stigma

2. Training: to build capacity of the local psychosocial professionals

3. Support: to open safe spaces for the community to grieve and heal

4. Resources: that are culturally appropriate and sensitive

5. Services: to offer therapeutic clinical interventions for those who need them

We can use our anger productively, not to self-deploy without proper preparation. Good intentions alone are not enough, but organizing and collaborating to empower the survivors and celebrate the memories of those killed can help. We should also remember to care for ourselves as wounded healers, so we do not burn out while caring for others.

The cycle of human violence can be broken, but that is an effort that needs all of us to believe and invest in.

This model of care aims to bear witness and break the cycles of trauma that can otherwise permanently damage us as individuals, families, and communities.

Healing Uvalde

This is how one of my patients advocated for his peer who ended up in the seclusion room due to agitation: “Dr Reda, please try to get her out of there as soon as it is safe to do so. Seclusion is a very lonely experience.”

Due to multiple and complicated systemic issues, it is not uncommon to have a staff shortage in the acute inpatient psychiatric unit. Frontline mental health professionals—who are usually stretched too thin to start with—are expected to multitask; to carry a heavy caseload; and to navigate the culture of acute psychiatry that can, even under normal circumstances, pose an imminent threat to their safety and the safety of their patients.

Staff are humans, not machines, and they cannot be everything for everyone at all times. As a result of short staffing and burnout, when a patient’s anxiety goes unnoticed, the situation can quickly escalate into restlessness, agitation, and even full-blown violence. When things go beyond the point of verbal de-escalation, staff might see no other option than to restrain and seclude the patient to protect them from inflicting harm on themselves or on others.

A seclusion episode is commonly viewed as a bad outcome, and staff for the most part feel guilty and debrief the incident, trying to find out what went wrong and how to prevent it from happening again in the future.

It is true that most patients with mental illness are not violent, and it is true that most violence is committed by individuals who are not mentally ill. However, patients in the acute psychiatric unit could resort to violence when they have acute psychosis or substance-related intoxication or withdrawal; when they feel unheard or dismissed; or when they are wrestling with intense thoughts to harm themselves and/or others.

The approach to violence is a comprehensive one. There are many tools that can be used before resorting to restrictive measures. Seclusion and restraints, however, are sometimes unavoidable or even lifesaving. The approach to this dilemma is collaborative. Staff can use tools like LUDA (listen to understand and deeply appreciate) and LATTE (listen, agree or agree to disagree, talk about the unmet need leading to the behavior, thank them for working with you through it, and empower them by equipping them with the skills needed to navigate future episodes). Some systems implement programs like “soft show of force,” “show of concern,” and “therapeutic takedown.”

The truth is your patient might end up in the seclusion room no matter how hard you try to avoid that, and seclusion could be the most appropriate action and the most therapeutic intervention. It is not always “patient first,” and it does not have to be “staff first”—we should all prioritize safety.

Safety means that we build a culture of care, so our healers stop to walk wounded, design a healing environment that focuses on early prevention rather than late intervention, fix systemic issues that place everyone at risk, and not forget the patient in the seclusion room who deserves to be debriefed and who usually shows remorse and makes amends.

We are all humans. We all make mistakes. Mistakes are opportunities to improve; they are teachable moments. And that is okay as long as we follow every rupture with a repair.

Overview of Project BETA: best practices in evaluation and treatment of agitation

What is the role of seclusion in creating a culture of care within acute inpatient psychiatric units?

In the Seclusion Room

It seems as if every time I board a plane, I have this strong urge to write. On my most recent flight to Hawaii to attend a psychiatry and addiction conference, I was quite amazed at the magnificence and mysteriousness of the Pacific Ocean. Standing in front of this majesty brought not only an overwhelming sense of serenity and inner peace, but also many thoughts and memories.

I have always been mesmerized by the power and beauty of the ocean, even before being forced to leave my home country and board a boat across the Mediterranean Sea to start a life as an asylum seeker.

Why do refugees risk their lives and the lives of their children and loved ones to embark on this very dangerous journey? I would argue that no parent would do that to their children unless they have no other choice, and unless they deem that the water is more merciful than the hearts of humans.

As we witness in heartbreak what is happening to the 

 in Ukraine, we need to understand that no one is immune when it comes to trauma, and that we need to speak up on behalf of the voiceless, no matter their background.

I also watched an impressive documentary about the struggles of the Native Americans. I witnessed in awe the many challenges this beautiful community faces every day—even today—and the leadership and resiliency of the Native women warriors.

One thing that struck a deep chord in me was how the children were taught by their elders. The focus of the schools was largely on 3 main subjects: connection with nature, human rights issues, and spirituality. I would have loved to go through this nontraditional kind of education growing up, because not only is it interactive and hands-on, but it is also done in the safety of a community. It is not only the minds of the children that the teachers are trying to empower—teachers are also trying to teach the youth how to respect their bodies, nurture their hearts, and feed their souls.

I took a similar approach when I cofounded Camp Silah (Arabic for

) with my wife. We took children of trauma on camps and retreats to connect them with nature, with one another, with a higher power, and mainly with their own selves.

 is supposed to be child-centric. It is not only about the academic rigor and how much they can memorize and regurgitate—it is also about how to make children believe in their full potential and ability to contribute, and how to cocreate with them a world that is not designed to break their wings. Children are created to soar.

I did the same in my newly published book, 

, which is about caring for caregivers. The 4 areas of focus that beautifully mirror this Native approach is to use all available resources in order for us to heal, especially to be in harmony with Mother Nature; to strengthen family ties; to look at everyone with compassion; and to tend to our souls and nurse our own wounds.

My final reflection is to encourage tourists to enjoy what the luxury destinations have to offer, but also to remember to honor the history and traditions of the local culture. The best part about my Hawaii trip was meeting with, learning from, and supporting the indigenous community.

 is a practicing psychiatrist with Providence Healthcare System in Portland, Oregon. He is the author of 

1. Camp Silah 2018 Youtube page. Accessed March 22, 2022. 

https://www.youtube.com/watch?v=PmHSmreboFM&t=206s

2. Portland Refugee Support Group. Accessed March 22, 2022. 

Caring for Syrian refugees in Portland, Oregon.

We need to heal children impacted by trauma. 

A Bird’s Eye View: Reflections on Trauma

To all my caregiver colleagues on the frontlines, risking their lives and sacrificing their comfort.

It is no secret that caring for others comes with a heavy psychosocial price tag. I can no longer remain silent or bear a false testimony while many of my coworkers are burning out and leaving the industry they once loved, numbing their soul ache through substance use and self-destruction, or ending their lives by suicide.

, a book of 4 chapters, I offer the rule of 4, to combat this silent pandemic and the 4 deadly monsters of toxic stress, compassion fatigue, vicarious trauma, and burnout.

-Focus on self-care: tend to your body, but also your mind, heart, and soul.

-Recognize the pain and joy of interacting with clients and their families, the impact of your trauma on your loved ones, the stress caused by the system you work with, and learn to feel more comfortable sitting with your shadows, nursing your invisible wounds.

-Use nature-based, art-based, movement-based, and ritual-based activities to heal.

-As a wounded healer myself, I have found healing in 4 things: leaning on my faith, loving my family, practicing gratitude, and engaging in acts of service.

-When things are dark, when you feel desperate, when you are thinking about giving up, remember these 4 words: You are not alone. Reach out. I am here for you.

The wounded healer is a common phenomenon, not only in the health care field, but caregivers include teachers, community and faith leaders, first responders, parents, and many others. Remember that you cannot pour from an empty cup—fill your own tank so you can continue to authentically serve others.

 is a practicing psychiatrist, Providence Healthcare System, Portland, Oregon. He is the author of 

This new book encourages clinicians to take care of themselves. 

The Wounded Healer: A Token of Appreciation

 are at an elevated risk of chronic distress unless the international community intervenes quickly by demanding an immediate stop to the military assault by Russia.

War and violence create a vicious dysfunctional cycle, a deadly trap that primarily impacts the children. The 

, especially one of a protracted nature, deprives children of a much-needed time for cognitive-emotional processing and self-healing.

Before the Toils of War: Mental Health in Ukraine

What Would Dr Post Say About President Putin?

A Psychiatrist's Reflections on the Situation in Ukraine

 and areas of armed conflicts do not live normal lives. They watch their homes being demolished and see their family members, neighbors, and friends getting injured or killed. They might not have the words to express what has happened to them; instead, they share their stories through behaviors like lashing out or shutting down. They may regress in age-appropriate behaviors, have difficulty sleeping, become unable to perform activities of daily living, and/or struggle behaviorally, academically, and relationally.

We have heard of Palestinian, Syrian, Iraqi, Somali, Yemenis, and Rohingya 

; now as history repeats itself we write about Ukrainian refugees. Unfortunately, it is the nature of this beast; no one is immune to trauma. Humans can inflict pain upon each other, but they also can (and should) invest in healing. It is our moral responsibility to refuse to hate. This blazing fire must be extinguished, not fed.

The damage done by war-related trauma can never be undone. We can, however, help reduce its long-term impacts, which can span generations. When we reach within ourselves to discover our humanity, it allows us to reach out to the innocent children and remind them of their resilience and beauty. Trauma can make or break us as individuals, families, and communities.

Not all wounds are visible. We need to take proactive measures to 

—a pandemic that may be both more silent and more deadly than the global COVID-19 pandemic.

Children need to feel safe to regain their voice and make meaning out of the pain they endured.

We do not have to be therapists to be therapeutic. We all can help the children of war worldwide when we ensure that their basic needs are met, when we treat them with compassion, build culturally humble services and resources, and empower them and their caregivers. We also help when we look after our own wounds as mental health professionals through self-care.

More importantly, our highest priority as a society should be eradicating the sources of the trauma and alleviating the suffering of these children. This war is not only a psychosocial issue requiring psychosocial solutions but political ones as well. We cannot continue to place a Band-Aid on a bleeding wound. We need to stop the source of the bleeding. The vicious cycle of war and violence will end when human dignity and human rights are respected.

War is ugly. Nothing good ever comes out of war. The loudest sound you hear during wars is that of broken hearts.

May we strive for justice and compassion, and may we have some common sense to grow up and stop fighting one another, for the sake of our children and future generations.

is a psychologist at Hyde Street Community Services Inc serving the underserved population who suffers from mental illness and addiction. She also works as an adjunct faculty at the Graduate Theological Union in Berkeley and is a professor at Sofia University in Palo Alto. Dr Farajallah is a researcher at the Muslims & Mental Health Lab at Stanford University, and is researching and developing treatments tailored to the specific needs of the Muslim population for the American Psychiatric Association. She also provides training on PTSD and trauma to psychology students in the Gaza Strip. 

is practicing psychiatrist in Providence Healthcare System, Portland, OR. He has provided psychiatric and humanistic care to trauma survivors around the world.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

is an associate professor of psychiatry at Harvard Medical School and a Fellowship Site Director for Brigham and Women's Hospital. 

is a doctor working in frontline psychiatry for the National Health Service at South London and Maudsley NHS Foundation Trust in the United Kingdom.

A call to action both to support the youngest victims of war and to prevent future trauma. 