There are certain phrases I use often, sometimes delivered with humor, sometimes with blunt honesty, but every one of them reflects how I live, practice, and lead. They are not motivational slogans. They are survival principles, clinical guideposts, and the backbone of my career in community mental health.
And at the center of all of them sits one core belief:
Very few people choose the jobs I’ve chosen. Three years working in corrections. More than five years on an ACT team. Nearly two decades walking directly into the suffering that most of society avoids or pretends not to see.
Even while owning and operating two psychiatric practices, South Chesapeake Psychiatry (SCP) and Transforming Minds Interventional Psychiatry (TRIP), I continue to serve on the ACT team. That work remains one of the most grounding parts of my professional life. It keeps me connected to the realities of severe mental illness, addiction, poverty, exploitation, and the daily fight for survival that many of my clients endure.
My work takes me into the most impoverished areas of my city, mile after mile, checking on clients who are homeless, severely mentally ill, often medically fragile, and frequently exploited. Some battle addictions that slowly erode their health, dignity, and relationships. Some push people away because their illness isolates them from the very connection they desperately need.
William James once wrote, “No more fiendish punishment could be devised… than that one should be turned loose in society and remain absolutely unnoticed.” He understood what I see every day: human beings are not built for invisibility. And those who are most ill are often the most unseen.
Walking among sociopaths, dealers, and people who prey on vulnerability is not romantic. Sometimes they’re the only ones who know where my client has disappeared to; sometimes they’re the danger we’re trying to protect our clients from. We have lost people to violence. We have seen lives end too early.
Add to that the moments no one prepares you for:
• The new client who casually reports taking Xanax 2 mg TID or Ativan 2 mg QID.
• The police calling unexpectedly to discuss one of your clients.
• The FBI or State Police showing up at your office asking to speak to you.
• A DEA agent leaving a message for you to call her back.
• Learning a former client died by suicide, and that you are now under investigation by the Naval Bureau of Medicine and Surgery.
These things have all happened to me. And they taught me a truth: discomfort is inevitable, so mastery comes from choosing it rather than avoiding it.
I work with optimists and idealists. I am wired a little differently. Pessimism and cynicism sharpened me, but they also forced me to adapt. So I learned another principle:
Embrace the suck.
Life does not only suck some of the time, it sucks a lot of the time. You can fight it, resent it, or deny it. Or you can embrace it. When you do, something shifts. You learn to sit in the discomfort long enough to understand it, long enough to grow from it.
But embracing the suck isn’t passive.
It demands something else:
You cannot embrace anything from a distance, not fear, not suffering, not growth, not skill. You have to lean deeply into the uncomfortable thing. When you do, you discover that discomfort is only unbearable until you decide to walk toward it.
And once you lean in long enough, something even more powerful happens:
You become comfortable being uncomfortable.
Early in my career, I had the privilege of working with three psychiatrists who shaped me in different ways.
• Elizabeth Yoder — conservative, kind, cautious, and deeply grounded.
• Paulette Tucciarone — cerebral, optimistic, thoughtful, and unafraid of confrontation.
• Amy Canuso (now Amy Arnold) — progressive, high-energy, fearless, and relentlessly challenging.
Amy told me something that changed my career: “Say yes to everything.”
At first, I didn’t understand it. But over time, I learned that saying no often comes from fear, fear of risk, fear of making the wrong call, fear of not knowing enough.
“How much time have you spent trying to block someone from admission because you were scared?” she once asked me.
That question cut deep. It forced me to confront the truth:
If I’m scared of something, it’s probably because I’m uneducated about it.
Many providers don’t prescribe benzodiazepines. Not because they academically disagree, but because they’re afraid. Afraid of addiction risk. Afraid of regulation. Afraid of consequences.
Many providers don’t give long-acting injectables. Not because they believe in alternatives, but because they’ve never been trained, never seen them used, never felt confident.
Many ask me, “Aren’t you scared in the community? In jail?” Most of that fear comes from not understanding the work, the clients, or the treatments.
So I learned: if I’m anxious about something, I educate myself until the anxiety disappears.
Knowledge breeds competency. Competency breeds confidence.
Confidence breeds action.
And action breeds comfort.
The formula is simple:
Say yes. Embrace the suck. Lean in. And eventually, comfort emerges from discomfort.
These concepts aren’t just personal, they are woven into the five pillars of South Chesapeake Psychiatry and Transforming Minds Interventional Psychiatry: Availability, Accountability, Expertise, Quality, and Excellence.
Most clinicians ask, “What if they call you in the middle of the night saying they’re suicidal?”
My answer: What if they say it in my office? I’ll do the same thing, assess, de-escalate, and help them reach a higher level of care.
Availability changes lives. A two-minute Saturday email can completely transform a therapeutic relationship. That small investment delivers a massive return, because no one else does it.
I’ve delivered medication samples to a client’s home after a prior authorization was denied. Why wouldn’t I? What’s the obstacle? What’s the cost compared to the benefit?
Accountability matters, too. When I make a mistake, I own it. I’ve forgotten follow-up appointments before, leaving clients without medications. When that happens, I apologize. Clients forgive you when you’re honest, and it strengthens the therapeutic alliance because it proves you care and you’re human.
Expertise is non-negotiable. We must be experts in what we do. That means constant learning: reading, writing, training, attending conferences, and never avoiding the hard cases.
Quality over quantity. Always. Some follow-ups take 10 minutes. Others take an hour. The client gets what they need, not what the schedule dictates.
When all of this is practiced consistently, excellence is the natural byproduct. The team performs at a higher level. Clients get better faster, with fewer side effects. They send more clients our way because they trust us.
That’s why a small practice like ours has won Coastal Virginia’s Best of two years in a row, on a volume vote, against giants with multiple providers.
We don’t win because we’re bigger.
We win because we are comfortable being uncomfortable.
James, W. (1890). The principles of psychology (Vol. 1, pp. 293–294). Henry Holt and Company.
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