Omar Reda, MD

Many psychiatrists seem to have accepted, and are content with, the narrow scope of practice imposed upon them. For myself, however, I refuse to reduce the unlimited potential of psychiatry to merely prescribing psychotropics. Medications can be quite effective, even lifesaving, but they are not the only tool we can offer our clients.

I have been reflecting on the psychosocial impact of the COVID-19 pandemic, especially on our youth, and would like to share few thoughts that might provide hope for these beautiful, little creatures.

This writing is not intended to be a naive generalization or an over-simplification; I have used an easy language here with the goal of having these tips shared with clients, especially parents and caregivers. I hope they can also help you when taking care of your family and community, and even serve your own self-care and healing.

The wounds of trauma are, for the most part, invisible. They can scar our bodies, minds, hearts, and souls. There are many hormones and chemicals involved in responding to adversity, especially protracted stress like the current pandemic. I will briefly mention 5 of those.

The hormone adrenaline (also known as epinephrine) is commonly known as the emergency hormone. It helps anticipate and prepare for threats, or activates fight or flight responses. That is helpful, and even critical short-term, but can have long-lasting negative consequences if we remain in a state of arousal, fearing an actual or a perceived threat. One way we can help children and those around us cope is to calm our mind and manage our anxiety. This can be done in many ways like meditation, mindfulness, and engaging in activities that are physically and mentally cathartic.

The hormone cortisol is commonly called the stress hormone. It helps us respond to stress, but it can also be harmful in the long run. One way to balance cortisol levels is to be kind to our bodies through mastering consistent healthy eating, sleeping, and lifestyle habits.

I want to focus now on 3 other chemicals, collectively known as the happy hormones. Dopamine (also known as the thrill hormone) is not only involved in addiction, thrill-seeking, and impulsivity, but is also a vital hormone for our emotional wellbeing. When it comes to children, we can give them a dopamine boost by simply paying attention to them. Children thrive when they feel noticed, therefore we should take every opportunity to let them know that they are seen, heard, and felt. Youth who feel safe seem to blossom, and start to believe in, and express, their beauty.

Serotonin (commonly known as the happiness hormone) is not only involved in depression, but it is also a chemical that is released when we feel valued. It is important to show appreciation to young people. When they trust in our unconditional love, they will start to believe in their own abilities, which boosts their self-esteem.

And lastly oxytocin (the love hormone) is released when children feel loved. One way to boost this hormone is to express affection towards them. Simple acts of grace and gratitude can work like magic. These can include eye contact, safe touch, smiling, kind words, and spending quality time with them.

I am a big fan and an outspoken advocate of taking care of young bodies, minds, hearts, and souls. When it comes to children, we would literally die to protect them from assaults and shield them from insults, yet many of us engage in verbal attacks and acts that verge on being abusive or neglectful towards them. I know that we are all trying our best given our circumstances, but when it comes to our loved ones, we can always do better.


To prescribe the hormones of happiness, try the Triple-A Approach:, pay attention, show appreciation, and express affection towards the people who matter most. Small moments can make all the difference.

is a practicing psychiatrist in Providence Healthcare System, Portland, OR.

Articles

One doctor gives his recommendations for attending to children’s happiness.  

Moral Duty Beyond Prescribing Medications

I have, maybe even more than my children, thoroughly enjoyed watching the Pixar Animation Studios’ film 

. Per Disney, “Soul is what makes you…YOU.” 

 is not only about finding your own passion, but also helping others find theirs.

Soul is a mysterious concept. It is more than just our heart, psyche, or spirit; it is the deepest and most intimate part of who we are. Soul is what makes us humans.

The year 2020 launched a brutal attack on our souls. The invisible scars of moral fatigue and the soul ache we are left with are constant reminders that caring comes at a cost. That is why, as a caregiver, I urge you to tend to your soul.

Find out what makes your soul sink. This can be unhealthy coping styles, unhelpful beliefs, and dysfunctional behaviors. Many caregivers act as if their feelings do not matter, as if they should ignore their needs, deny their pain, brush off their trauma, wipe away their tears, and just get up and keep going. The culture of caregiving is rampant with dark secrets, toxic stress, and silent suffering.

But that does not have to be the case. Caregiving can and should bring joy, not only pain. It brings joy when we look for and celebrate what makes our soul sing. This can include selfcare, social bonding, and engaging in deep kindness. I found family, faith, practicing gratitude, and performing acts of service to be extremely helpful in nursing my wounds and healing my compassion fatigue. One of my New Year’s resolutions is to show more appreciation to my loved ones and the things I take for granted, and to engage in activities that help people find meaning, healing, closure, and beauty.

My request for you is to do the same. Practice love, mend broken hearts, speak up for the voiceless, bring people out of the shadows, listen to the suffering behind closed doors, but also make sure that you tend to your soul.

The recent Disney Pixar film has a doctor contemplating what makes us all unique, and how we can care for ourselves. 

Tend to Your Soul

There is a common saying that if the care we provide our clients is not culturally sensitive, then it is not trauma-informed.

I am a big believer in meeting our clients’ cultural needs, and in respecting and celebrating the beauty of their traditions. However, we need more than superficially pleasant interactions with individuals from diverse backgrounds, individuals who we label as “different than us” because of the way they look, talk, or practice their culture or religion.

Trauma sensitivity alone, I believe, is not enough. We need culturally responsive and effective care. I will give an example here, then expand on how to put this concept into action.

I recently walked into the inpatient unit where I work to find that my staff had called security and were about to inject or seclude a large, agitated black man. I asked if I could try to talk to him. As I listened, he asked that he only work with staff of color, asked for a menu fit for a Muslim man who only consumes halal/kosher meat, and asked if he could talk to an imam to learn how to pray again. We ended up not needing restraints or antipsychotics after all; all he needed that morning was human connection. I happen to share aspects of his cultural background, and that made him feel safe enough to open up to me.

It is not going to be possible to have non-white staff assigned to him all the time, but on this particular day that plan worked best.

There are 4 things to remember when bearing witness to individuals in distress:

1. Authenticity. Our clients will quickly discover if we genuinely care.

2. Curiosity. Show interest in them as humans, not only the labels assigned to them.

3. Flexibility. We must be ready to adjust our way of thinking, and in doing so, we can better meet their needs.

4. Humility. Maintain the attitude of a student, keen to learn from each encounter.

Psychiatry is not only a field of suffering or an industry of pain; there is also a lot of joy that we should get out of caregiving. If you are not looking for beauty in every interpersonal encounter you have with those you serve, then you have not yet touched the soul of medicine. By listening to and meeting patients’ cultural needs, we all win.

Sometimes the best medicine is understanding. 

Rx: Meeting Cultural Needs 

 interviews Omar Reda, MD, about international medical graduates (IMG) and his own personal and professional journey. In this podcast he discusses:

1. His childhood and medical training in war-torn Libya

2. The challenges facing immigrants who want to become doctors in the United States

3. How his colleagues, and the American medical establishment at large, can help IMGs realize their dreams

is a practicing psychiatrist, Providence Healthcare System, Portland, OR.

Podcasts

In their quest to become American doctors, international medical graduates face formidable obstacles. A psychiatrist from Libya explains how his colleagues can help them along the way. 

The Road Less Travelled: An Immigrant’s Story

Videos

Question and consider how people adapt, how families/communities cope, and how physicians should engage with trauma. 

Trauma Informed Care

The field of psychiatry needs to pay close attention to the long-term psychosocial impacts of trauma, not only on trauma survivors as individuals, but also on their families and communities.

Trauma that affects 1 member of a family system has the potential to fundamentally change the whole family structure. It threatens to erode the very foundation of the family unit, and family members may start to see each other as enemies. 

 has the power to make or break a family.

, out of cultural taboos and stigma, is seen as a source of shame and kept a secret, it can manifest in different ways, especially relationally, leading to a dysfunctional environment of toxic stress and silent suffering, a deadly web many families find themselves tangled in.

Early prevention is always better than late intervention because trauma can span generations. Trauma survivors can repeat the cycle and become part of the problem, or they can become part of the solution by investing in their families, normalizing the process by speaking up, and expressing emotions. To continue to choose the narrative is to choose to continue the vicious cycle and feed the fires that eventually destroy everything in their way.

Trauma that happens to children can shatter and confuse core beliefs they hold about themselves and the world. Children need to believe that the world is a safe place and that adults can be trusted to care for them. When these foundational basic needs are violated, these young beautiful creatures lose hope and start to wrestle with existential issues, doubting their own self-worth and beauty.

Psychiatrists working with traumatized populations need to establish safe spaces that serve as platforms where people can regain their voice and reclaim their narrative. Through encouraging and supporting open channels of communication and building bridges of trust, they help break the cycle for their clients, and that in turn helps bring hope in healing.

Interpersonal trauma that casts dark shadows on our beliefs about our innate goodness and shared humanity is arguably more harmful to the psyche than a largescale destruction caused by natural disasters. But the trauma story, if viewed as a learning tool, can help us become more resourceful and resilient.

We owe it to our loved ones to break the cycle. Not everything we inherit is worth passing to our children, especially not our trauma story.

Post Traumatic Slave Syndrome: America's Legacy of Enduring Injury and Healing

From Generation to Generation: Healing Intergenerational Trauma Through Storytelling

Trans-generational Trauma and the Other: Dialogues across history and difference

Patients want to pass on many things to their children; trauma is not one of them. 

The Unforgiving “Gift” of Generational Trauma

Omar Reda, MD, emphasizes several points in his video on how to take care. Here are some suggestions:

-Consider all parts of your health. Dr Reda cites 4 focal points: body, heart, mind soul. Are you caring for each part of yourself, or focusing on only 1 or 2?

-Improve your family dynamic. Pay more attention and appreciation to your loved ones. Make eye contact and establish safe touch. Ensure you are spending meaningful time with your family. 

-Take breaks. When you take them, are you actually relaxing? Be sure to carve out time to truly unwind. 

is a practicing psychiatrist in Providence Healthcare System, Portland, OR. He reports no conflicts of interest concerning the subject matter of this article.

Times are hard but they are easier if we get through them together. Omar Reda, MD, provides activities and insight on ways to actively care for yourself and your family. 

How We Can Take Care of Each Other 

Not only in America, but throughout the world, difficult conversations are taking place in many homes. Behind closed doors, children are exposed at early ages to discussions about heavy topics like violence, hate, and human cruelty.

I am blessed to have three daughters. I try to create a safe and sane home for them, but I have never imagined engaging them in some of these talks, especially here in the United States, and in the 21st century.

When I moved to Portland, Oregon in 2009, I thought the city’s nickname (the Rose City) was a sign that things would be much safer and more comfortable for my family. Similarly, my wife believed that moving from the southern to the northwestern part of the country would make things easier for us as 

But shortly after arriving, a young Somali boy was accused of planning a terrorist attack in one of the city’s busiest spots, the Pioneer Square. We found ourselves working with community leaders and the Muslim youth on topics like emotional safety and well-being, how to be a proud American Muslim, strengthening family ties, and improving the relationship between the community and its neighbors and law enforcement agencies.

Fast forward to 2011, a bloody civil war started in my home country Libya. I left my small immediate family behind to care for my extended family overseas, trying to heal some of the many psychosocial wounds of that protracted conflict. I lost friends and loved ones to violence and extremism. My wife and children had to live through periods of uncertainty and high anxiety every time I boarded a plane and partook in that dangerous journey.

We thought and prayed the new decade would bring a better energy, but the year 2020 has been one of the most challenging years of all. Here in Oregon we have been struggling to breathe, literally and metaphorically. It is not only the threat of the 

 (COVID-19) to our respiratory system, but also the systemic knee of injustice on the necks of our black brothers and sisters and the wave of hate facing minorities and people of color. The mask can help with the former crisis, but unmasking is what is needed for the latter.

It became the norm to talk with kids about their identity and self-worth, about micro- and macro-aggressions, about speaking up on behalf of the voiceless, but also about how they can defend themselves when someone decides to attack them verbally or physically. After the Portland max train stabbing incident and the New Zealand mosque shooting, we spent time and energy brainstorming ways on how to stay alive and feel safe at our places of social gatherings and worship. Trauma steals precious moments and impacts the potential for beauty.

I recently participated on a panel discussion about combating hate. A young black female stated that, “at least [things] are not as bad for this generation as it was for our fellow citizens in the 1950s and 60s.” That really broke my heart. Just because hate and violence are “not as bad,” does not mean things are OK. Children should not have to settle for a dysfunctional world.

“The talk” we thought we would have with our children is about how to survive the emotional turmoil of puberty. In the black community, that talk is also about how to stay alive in America. In the Latino community, it may be about the immigration system. In the Muslim community, it may be about terrorism. Hate is horrible, and it not only makes survivors doubt their own beauty, but it also makes us miss out on each other’s beauty.

We thought COVID-19 was only going to impact our ability to breathe, but then Mr Floyd’s death reminded us of the ugly pandemic of oppression. In Oregon, the smoke of the wildfires stirs different discussions about existential themes, like our relationship with God and the meaning of life.

Is it bad that our children are growing up very quickly and having these mature conversations at a young tender age, or is that the new norm? My hope is that trauma will eventually produce a more resilient generation and a more compassionate and cohesive society, I believe that many trauma survivors become better humans not despite, but because, of their trauma stories.

This article was originally posted on September 21, 2020, and has since been updated. -Ed

With the state of the world, there are so many difficult conversations about racism, hatred, and violence that we need to have with our children. 

Behind Closed Doors 

As a psychiatrist for over 10 years, I have had the privilege of bearing witness to a great deal of human suffering.

The current pandemic has shown us, mental health professionals, the dire consequences of human disconnection and social isolation. Humans do not do well alone. We need to bond with others, and we need to feel seen, heard, touched, and loved, not only to thrive, but also to survive.

It seems that COVID-19 has taken the mask off the tip of a huge iceberg. It has forced us to come face to face with a profound challenge. We might not be able to heal trauma, but the process of facing trauma can itself become the source of light, delight, and healing.

Many trauma survivors continue to go through the revolving door of a broken system. This is in part because many therapists are not comfortable listening to painful traumatic and graphic details.

I owe it to my clients and trauma survivors worldwide to be ready to listen when they are ready to share. I focus on these seven themes in my model, which I call Trauma Heals:

Finding safety: the focus is on fostering hope and faith

Finding a voice: building safe spaces and giving people permission to talk

Finding meaning: regaining the shattered core beliefs that the world is a safe place and others can be trusted, and realizing that they are not broken because of the trauma they endured

Finding forgiveness: unconditional self-forgiveness (making and receiving amends), knowing that they have done their best given the circumstances

Finding healing: harnessing resilience through self-care and altruism (offering grace through acts of kindness and community service)

Finding closure: mourning past relationships and redefining or reconstructing new ones

Finding beauty: integrating the trauma story, finding beauty in one’s self, family, others, humanity, and the world

My beloved mentor, professor Richard Mollica of the Harvard Program for Refugee Trauma, taught me to search for beauty in every interpersonal encounter, and my late mother left me with her last words: “if you cannot be the source of someone’s joy and delight, don’t be the source of their pain and distress.” Love does indeed heal even the most extreme of traumatic stories.

 is a Practicing Psychiatrist, Providence Healthcare System, Portland, OR. He reports no conflicts of interest concerning the subject matter of this article

While recovering from trauma, survivors have a chance to find a voice, meaning, and even beauty. 

Unmasked: Face to Face with the Trauma Story

As physicians, we are trained and expected to respond to emergencies. When our patients state that they can’t breathe we use every single medical leverage at hand to ensure that we alleviate their suffering, we take codes very seriously because they are life-threatening, so why do we so seldom respond to code black?

The suffocation of Mr George Floyd under the knee of systemic oppression is neither the first nor the last knock on the door of our conscience. The country has erupted into a wave of anger that demands justice and reform; but what can we, psychiatrists, do when we hear “code black”?

First, we need an honest self-inventory: many of us do not even “hear the announcement.” Acts of “micro” aggression are too common, frequently going unnoticed. We need to examine our implicit and explicit bias—and recognize and confront them around us when safely possible. There is nothing micro about aggression, our collective humanity diminishes with every hateful gesture we overlook; microaggressions if not challenged turn into transgressions and violence.

Where I work, when we feel uneasy about an interaction or a situation, we voice that we are concerned, uncomfortable and that the inappropriate speech or behavior needs to immediately stop (CUS), we cannot pick and choose when to pull the CUS card.

Second, we need to hold sacred spaces in our hearts for our patients and colleagues of color, we can speak up on their behalf without dominating or intruding, we should not place the burden of fighting hate and social injustice on the shoulders of its recipients. I recently came across a wonderful article about the topic that I shared with my superiors, 

How to Manage Your Team in Times of Political Trauma

 The article suggests ways to boost psychological safety.

Next, I propose that we start looking at our contribution to the problem and its solution, we need to examine the roots of “othering” in our places of work, worship, and our social circles. It is never late to do the right thing, if we find a “rupture,” we should acknowledge our part and work on repairing it. One way to do this is through educating ourselves about the history and stories of our black brothers and sisters, it is not their duty to each us about their daily struggles, but it is our responsibility to learn. For me, since the horrific death of Mr Floyd, I have been delighted at the opportunity to learn more from the beautiful black culture.

Finally, this most recent wave of anti-black hate in the midst of a 

 can take its toll on all of us, make sure you as a healer tend to your needs and nurse your wounds so you become more available to continue the “fight” for justice and basic shared human dignity, brace yourself, this is a race not a sprint.

 is a Practicing Psychiatrist, Providence Healthcare System, Portland, OR. He reports no conflicts of interest concerning the subject matter of this article.

1. Kim M. How to manage your team in times of political trauma. 

The country has erupted into a wave of anger that demands justice and reform; but what can we, psychiatrists, do when we hear “code black”?