A Conversation with Dr. Katrina Keil
Dr. Katrina Keil is an Assistant Professor of Psychological Science at Pomona College in Claremont, CA. She is also a Psychologist at Casa Colina Hospital and Centers for Healthcare in Pomona, CA.
"But if I'm working with clients, [and] he's like, okay, I went to the store, and I got overwhelmed, and I had to leave, you know. It’s like, ‘Do you want to explain to people what you need and be assertive in your communication? Or would you prefer just to be able to retreat and come back a different day when you're feeling better.’ So empowering people to feel like they have a choice so that they're not always going to have to do that educating." - Dr. Keil on empowering her patients
1. Could you talk about what you do on a day to day basis and the types of patients you work with? Are there certain patient populations that you specify in?
So currently, I'm an outpatient. Currently, because of the pandemic, all my work is through telehealth, so I'm doing therapy on the phone or via video conference with patients. I mean, a typical day would only be Fridays, because that's my only clinical day. And I would log in, join the phone call. We would talk for 45 to 50 minutes, and then I would write a note and then I would see the next person. [Before the pandemic] I would arrive at my office, they would show up, come to my office, we would have an in person session… But there are other parts of Casa Colina, where I would have also groups or meet with families or do neuropsych assessment. So that was very different from the outpatient therapy [which] is just one on one psychotherapy.
All my referrals come through our outpatient physicians, and so for the most part, I would say, people with brain injuries generally. It's often people with traumatic brain injuries, so like acquired. Also people have strokes, I could see people who have had brain tumors that's less frequent. I do work with people with spinal cord injuries, and also people with more chronic conditions like chronic pain.
All my referrals come through our outpatient physicians, and so for the most part, I would say, people with brain injuries generally. It's often people with traumatic brain injuries, so like acquired. Also people have strokes, I could see people who have had brain tumors that's less frequent. I do work with people with spinal cord injuries, and also people with more chronic conditions like chronic pain.
2. What differences have you seen in disability experience? Whart are the differences in experiences between someone who might have an acquired versus a genetic disability?
I think that's actually a pretty big part of what I treat. So if you're talking about somebody who has a traumatic brain injury, it's very sudden, so they've had their life, they have the personality, they have the things they do, whether it's job, family, whatever, then very suddenly, a lot of their abilities are taken away from them. They often have a long hospitalization, additional physical complaints, they may still have headaches, dizziness... those kinds of things. In addition to that, their identity completely changes, because now they can't return to work. Now, they might need full time supervision, they may not be able to drive, they may still be in pain, they may have sleep disorders, they may have headaches. So I think because it's acquired, partly what happens is their brain keeps thinking, they're the old person. And it takes a really long time to wrap your head around being a new person, especially when that person doesn't feel quite as competent as a person. So I can only imagine somebody who has more of a congenital disorder would have grown up with that as being as part of their life. And so they don't have the same kind of adjustment period.
3. What kind of role do you see family playing in mental health and someone's recovery or their care process?
I think families in our environment more generally have a huge role in all of our mental health, right? So everything from socio cultural, negative experiences that we have to the supportive role that families can have for sure. So when I'm working with somebody who's had a traumatic injury, or spinal cord injury or something like that, they tend to need lots of different things from their family. So they need sometimes physical care and physical caregiving, which changes the rules within the family quite a bit. They, the person, and their family may have to take over some kind of financial responsibility that they didn't have before. Then there's the emotional support, right, of going through this big change and this can be a period of depression or anxiety or something else. Then there's also the family education piece, right. So especially with a brain injury, the person may physically look the same and it can take a long time for the family to also accept that they're not necessarily the same person in terms of personality, or anger, outbursts, or sometimes violence not frequently, or apathy. It seems like suddenly, they're very lazy, and they don't want to help out or do anything, but that can actually be a function of brain injury. So it can be really important, I think, to have the family support in all kinds of ways.
4. Are there systems set up in place that also support family members as well?
Absolutely, we've had caregiver support groups at various stages. If there's not one at Casa Colina, then usually I can find one in the community for them. So ideally, like there was one that was run that was for people with TBI, but then there would be a partner group going on at the same time for the family caregivers. You can find caregiving for Parkinson's or Alzheimer's type type groups, so it tends to be more community support groups, unless that person is just individually seeking counseling.
5. How do you feel like we as a society perpetuate ableist mindset specifically with your TBI patients, where the disability may be invisible at first?
I don't know that I'm qualified to comment on all of it. I do know that when I work with people who have disabilities, often both traumatic brain injury and a physical, again, they may be in a wheelchair, or using a walker or things like that. That's a real challenge for them. Going out in the community can be a real source of stress for them, because they're either ignored, or people are staring at them. And again, you know, often for them, it doesn't, it doesn't mesh with their identity of themselves. So there's definitely a learning curve to how to interact with the public who doesn't understand. I think when it's invisible, it's hard in the other way, because people expect you to act, you know, normal or typical. And if you do have problems, then they're like, what's wrong with you? You know, we always say, like, ‘You look fine’... But the concept that because you look fine, everyone expects you to be able to do things that you may not be able to do. So I don't know how we think we have to train society in both, right, I think, I think head injuries and other kinds of disabilities are invisible to a lot of people, they just kind of ignore it. Environments aren't set up so that people can get through them in wheelchairs, or they're set up to be really overstimulating with lights and music and things like that, that can really affect people after head injury. And then, you know, people act like I've never seen someone in a wheelchair before right. So it's a rude awakening to how much society is not set up to be accommodating to them… it can lead to people really not going, you know, to malls or to other places where they normally would have gotten… I've also done therapy sort of in the community with people like where you go to their house, and then you take them to a store or something, and help them learn to adapt to all the challenges that they're going to have now.
6. What can we do as a community to be more accomModating and reduce the stigma against disability?
You know, I think, like with everything else that has to do with stigma, you don't want to put the burden on the people with a disability to have to educate everyone else. So it's walking this fine line between, okay, what do you want to be able to say to them on an individual basis? I have no idea how to fix society. But if I'm working with clients, he's like, okay, I went to the store, and I got overwhelmed, and I had to leave, you know. It’s like, ‘Do you want to explain to people what you need and be assertive in your communication? Or would you prefer just to be able to retreat and come back a different day when you're feeling better.’ So empowering people to feel like they have a choice so that they're not always going to have to do that educating. But then especially like, if you have a brain injury, a lot of things are harder, and our healthcare systems not great. So it can be a full time job, just trying to get your meds filled, and your appointments and all these things, so then you need other people to advocate for you. And so maybe that's where we get organizations that are… advocates, for people with disability to try to encourage change through legislation, or maybe even if you see somebody being a jerk to someone in a wheelchair, say you speak up, or if you see they're trying to get through like a crowded store, you know, maybe talk to management, like why are all these racks of clothing so close together?
7. Where do you see mental healTh and wellness playing a role along with physical health in our healthcare system?
Yeah, we've fallen down on this badly in this country… our medical care systems got its own issues, but at least there's acknowledgement that if you have a physical ailment, you should be able to see a doctor or there's some kind of insurance for you. I think mental health because it's, again, more invisible, gets a short shrift. So there's always this kind of perception that it's willpower, or it's in your head, or you can just get over it. So there's not the same kind of financial support for mental health, even though we have a Mental Health Parity Act that was passed like 12 years ago... I think it's so hard for people to find mental health practitioners, it's still hard to get those services paid for. If you are a mental health practitioner, sometimes you have to use only certain codes or certain diagnoses in order to get reimbursement, and then the insurance companies waste all kinds of your time making you jump through hoops to get reimbursed. So I think mental health is just as important as physical health, if not more, because we know, you know, about one in five Americans will have mental health issues every year... And yet, there's this stigma, we don't talk about it. People don't want to go see a psychologist, they just want a pill. The insurance gives you a hard time about paying for it. So there's this huge gap between what is needed for people to be productive and successful and happy if happiness is a goal, and what's being provided by society. A lot of that has to do with because our healthcare is so privatized. It has to do with legislation requiring insurance companies to pay out for mental health appointments and things like that, but then the rich corporations have their lobbyists to try to prevent that. People with mental health disorders tend to be disenfranchised and poor and not have deep pockets to go try to persuade Congress to pass legislation on their behalf. So I think it's an unequal system.
8. How do you feel about labels being used within clinical psychology and mental health? are they necessary?
So, professionally, we do have a need for diagnoses for multiple reasons. One is communication within the medical field. Another is research, right. So you have to be able to categorize people in some way in order to do research on that population. At the same time, I think like medically speaking, once you get a mental health diagnosis on your medical record, it's not like a broken ankle that goes away, right? It stays with you. And so I think it's a very hard balance between the fact that that label is stigmatizing and may result in worse care or people presuming that something physically wrong actually has to do with your mental health. Versus, you know, we can't just discard labels all the time. Because then I would, well, first of all, I have to put a diagnosis on my form for the insurance company to pay me, right. So I have to have a label. So you know, unless we can wipe out that whole system, and even then we would probably still need to talk. You know, people, people sometimes want that diagnosis themselves, but sometimes provides relief, it provides something for them to look up. It provides a community of people who have similar experiences for him to join. And so it's not necessarily going to be better to have new labels. I think if we could remove some of the stigma, that would be better, right? Like, I mean, no one's ashamed to be like, Oh, I have migraines, or to say, Oh, you know, I have tennis elbow. But if you have social anxiety, you're probably gonna talk about that with people. So I don't think it's the labels themselves. I think it's what society attaches what meaning society attaches to those labels.