Episodes
Profile picture of Heidi Joshi smiling to the camera. She's wearing a light blue cardigan over a black top and big hoop earrings.
The Be My Eyes Podcast
April 6, 2021

Inside the Mind of a Blind Psychologist

Blind psychologist Heidi Joshi gives advice for better mental health, finding the right therapist and her own experience navigating the medical profession.

Episode Transcript

Will Butler:

You're listening to the Be My Eyes podcast. I'm Will Butler. And today on the show, we're talking mental health. This has been a huge topic throughout the last year. May is mental health awareness month. And I've been thinking a lot about it. I go to therapy myself, I think it's one of the best things you can do no matter who you are. But I have found myself wondering, as a blind person, should I be seeing a blind therapist or someone specifically who knows about issues related to vision loss? There are some people out there who specialize in that type of thing, but it's not incredibly common.

Will Butler:

So today on the podcast, I tracked me down a real life blind psychologist, her name is Heidi Joshi. And as you would expect, she's brilliant. Heidi and I talk a lot in this episode about how to discuss your visual impairment with your therapist, maybe if they've never had a client like you before. So not only is this episode about mental health for people who are blind, who have low vision, but it's also just great advice for how to advocate for yourself with doctors in general. But before we dive in, it's April, meaning our first Be My Eyes giveaway is over. We'll be announcing the winner this week. So look out for that. But we have for you a new giveaway, drum roll please. In the month of April, we're going to be giving away an OrCam MyEye, a lightweight AI wearable that will help you in your daily life. If you've never heard of the OrCam before or want to know more, we brought in low vision optometrist, Bryan Wolynski from New York City. Bryan, thanks for coming on the show. Tell us about the OrCam. What can it do?

Bryan Wolynski:

What the OrCam does is it takes a picture and then speaks back that information. It's able to read printed text, and it's printed text off of any surface, meaning from a piece of mail, a piece of paper, a newspaper or magazine, a textbook, or even on a computer screen. It's also has facial recognition, product recognition, recognizes barcodes, money and color. So it's a multifunctional device.

Will Butler:

Very cool. And what sort of improvements do you see in people's lives when they start using it?

Bryan Wolynski:

Improvements in independence, improvements in confidence, improvements in just accessing information of the things that people didn't think were possible. And that's where I come from, in that respect being an optometrist and doing a low vision exam is that we really want to work on what an individual wants to accomplish and really accomplishing those things. And that's the greatest thing about this, is just someone being able to accomplish their goals with this technology.

Will Butler:

So how do you activate it? Do you talk to it or do you press a button?

Bryan Wolynski:

Sure. So if I just hold up a page, it'll recognize the corners of the page and it'll start reading, and that's automatic recognition. But also I can manually do it by touching a touch pad on the side of the device. So on the side of the device there's a little touch pad where I can do certain swipe commands or tapping, or if I tap once it'll take a picture. Or another way is by a pointing gesture. As far as facial recognition, barcode reading, all of that occurs seamlessly really much automatically.

Will Butler:

So is it pretty easy to set up? Like it just works out of the box?

Bryan Wolynski:

So out of the box here it works right away, and that's what's a great thing about OrCam, it does not need wifi or any other programming to work. It works on its own. And a couple of things with that that's good for is one, privacy. Two is that it's going to work anywhere you go.

Will Butler:

I love that wireless and wifiless.

Bryan Wolynski:

Yes.

Will Butler:

Well, thank you so much, Dr. Wolynski. Thanks for coming on the show, telling us about the OrCam. I can't wait to give one of these away to our listeners.

Bryan Wolynski:

Sure. I know. I heard about the contest, so that's great. That's wonderful.

Will Butler:

All right folks, so here's the deal, if you live in the United States, you can enter to win an OrCam. Go to bemyeyes.com/orcam, O-R-C-A-M, and that's how you submit your entry. If you don't live in the US and just want to find out more about OrCam, visit them on their website orcam.com or their Facebook page. And now we're going to jump in with blind psychologist, therapist, and medical professional, Heidi Joshi. Heidi, thank you so much for talking to me today.

Heidi Joshi:

Oh my gosh, it's an honor. Thanks for inviting me.

Will Butler:

We were introduced by a mutual friend, and because she and I were talking about mental health.

Heidi Joshi:

Yes.

Will Butler:

And I told her I had been going to therapy, of course, during pandemic time therapies.

Heidi Joshi:

It's all virtual, right?

Will Butler:

Virtual and bigger than ever. More important than ever.

Heidi Joshi:

I think so. Yeah.

Will Butler:

And then I said, "But I'm not sure if my therapist fully understands me. I wonder sometimes if I should have a blind therapist." That led into... she said, "Oh, I had a friend who is a psychologist who is blind." And after talking to you, I thought, "I don't think I want you to be my therapist. I think I want you on my podcast."

Heidi Joshi:

That's nice. Yeah, thank you.

Will Butler:

Because I think what you have to share is not so much clinical for an individual, but I mean the ideas and concepts that I think so many of our listeners could benefit from.

Heidi Joshi:

Oh, good. Well, I certainly am happy to try.

Will Butler:

Okay. So tell us, you're a psychologist, right Heidi?

Heidi Joshi:

Yes, that's right. So there's different, I don't want to say levels, credentials that therapists can have. In the United States at least, there's marriage and family therapists in some States, there are professional counselors, professional social workers and then psychologists. And psychologists in most States, not all, need to be doctoral level providers, and then in some States not so much. But here in California they do. Then there are psychiatrists and there are physicians. So they've been to medical school and they can prescribe psychiatric medications and some do therapy but some do not.

Will Butler:

So do you consider yourself a therapist?

Heidi Joshi:

It depends on the day and what I'm doing. I generally spend most of my day teaching physicians. So I'm on faculty here at a family medicine residency, and in most of my career has been made up of this combination of teaching physicians about mental health issues and communication skills and things like that. I also train psychologist students, and then I do see a few clients or patients or whatever you want to call that as a therapist, but not as many as I used to. I would say I probably spend maybe 10%, sometimes 20% of my week talking with folks in a therapeutic situation.

Will Butler:

So you have a small handful of clients?

Heidi Joshi:

I do right now, yeah. But it's certainly not as many as I used to. I find myself doing more teaching and administrative kinds of things now in my life.

Will Butler:

And so you work with doctors, you educate, do you consider yourself blind?

Heidi Joshi:

I do. I have pretty much no usable vision.

Will Butler:

Okay.

Heidi Joshi:

I do have some light perception, but I got to say it that depends on the days too. There are some times that if the sun's out and everything's just right, I can see more shadows and where the sidewalk and the grass might meet. But otherwise I consider myself not to have any real usable vision.

Will Butler:

Guide dog user or cane user?

Heidi Joshi:

Yes, guide dog user.

Will Butler:

Guide dog.

Heidi Joshi:

And I say this a lot. I say depends on the day all the time, because there are times when I find that using a dog is the perfect mobility aid for me, and then there are other times where I might use a cane and not use a dog. So for me, I feel like having the ability to do both has been really crucial.

Will Butler:

We have a new episode coming out about canes versus dog.

Heidi Joshi:

Oh, yes.

Will Butler:

Not versus, they're not against one another, but examining the strengths and weaknesses.

Heidi Joshi:

When I going around, I use my dog to get to and from work. And she and I work together throughout the day. But when I'm walking around the clinic here at work, I generally use a cane because for me it's quicker, I can go from room to room, patient room to picture a primary care physician's office. We have about, I don't know, maybe 20 exam rooms here, and so I need to be going from room to room throughout the day. And with a dog it's... she doesn't know whether we're coming or going, there's no pattern to what we're doing. So I find using a cane here at work to be much quicker. But then when it's time to go to lunch or go somewhere else in the broader area, she's ready to go.

Will Butler:

So it must be fun sometimes to walk into initial meeting with a doctor, a physician, and you walk in and that you're blind and they're like, "Oh, you're the person who's going to be educating me?"

Heidi Joshi:

Well, the good news is that the physicians I work with... That happens during orientation and stuff, but I work with the same physicians that they're doing their family medicine residency, so they're here with us for three years. So they really get to know me. So I think the first week of their orientation, it's probably a little mind-blowing for them, but it's not something that we spend a lot of time talking about.

Will Butler:

Yeah.

Heidi Joshi:

I would say I don't really give them a lot of opportunities to get too into the weeds about it because I'm there to help them.

Will Butler:

Right.

Heidi Joshi:

But when it does come up, I would say almost daily when I'm walking into patient rooms, if I'm going to observe a physician and I'm one of the faculty observing their communication style with a patient, and I walk in with a cane, that can easily become a conversation if I let it. And so I will often say, I introduce myself, "I'm Dr. Joshi. I'm one of the faculty observing today," and I just leave it at that. And I find my spot in the corner of the room and do my job. And people can get thrown.

Will Butler:

Like, "How is she observing?"

Heidi Joshi:

Yeah. There can be some questions. Although...

Will Butler:

Like, "She can't see. How can she observe?"

Heidi Joshi:

Yeah, they can get a little... But oftentimes I'm very explicit about what I'm there to do. So I might say, "I'm here to observe your physician's communication style," or to answer any questions that they might have. Or sometimes I might go into a room if a patient is having a mental health crisis and the physician needs my help. And so then I go into the room as one of their providers. And in that regard, I introduce myself as one of the folks on their team.

Will Butler:

I want to ask you a lot today about the mental health of blind people and how we as blind people or people who are dealing with a vision loss can navigate the medical sphere and get the most out of it. But I think just it is interesting to hear about your background and hear about how was it getting a doctoral degree in psychology. That's very sciencey and very technical in some cases, right?

Heidi Joshi:

Yes. Some of the things definitely are. I would say that there are some classes that I took that were... I still think might have a little PTSD. Statistics, of course, was an interesting class to get through. Graduate level statistics is pretty visual, and I'm sure there are people listening today that have way more expertise on this than I do. But getting through some of those very visual courses, some of the testing classes like the psychological testing classes, were also very difficult.

Heidi Joshi:

There's a test called the Rorschach, which is an inkblot test. And basically you have to look at these inkblots as a patient or a client and tell a psychologist what you're seeing. And they're abstract for a reason to try to get at neurological issues and things like that, and other mental health things. And that was a class that I literally had to say, "Is this really going to be pertinent to me as a psychologist every day? Do I need to know how to analyze these inkblots on a regular basis? Is this going to matter?" Really, what it mattered for was passing my licensing exam and I've never faced them again. So for me, a lot of discussions about what's essential for the curriculum that I needed, and so that inkblot, I had to learn what it meant, I had to learn how to interpret the information, but I didn't have to learn how to give the test or score it. So...

Will Butler:

Yeah. It's tough to make a Rorschach accessible.

Heidi Joshi:

I still don't know how you would do it.

Will Butler:

Wow. And then did you find you were relatively accepted in the medical world or did you encounter some discrimination?

Heidi Joshi:

I've been really lucky in that regard. I work in family medicine and I find myself really drawn to family physicians in particular. I think there's just like a mission orientation kind of a social justice orientation to that particular field of physician that works for me. And if physicians and residents have been uncomfortable with me, that it hasn't been as a parent on a regular basis, but there have been times where medical staff or people in our medical buildings who work here, I could be wearing a badge, scrubs and a white lab coat and people will still think I'm a patient. And it happens probably once a week or once every other week that I-

Will Butler:

Seriously?

Heidi Joshi:

... walk in the door and it's like, "Are you lost?" Or people will ask me, "Do you need help? Are you lost?" And it's like, "No, I'm good," because I'm in a staff only place.

Will Butler:

So it's staff at the hospital asking you that?

Heidi Joshi:

Yeah. So if I'm in an employee only place, people assume that I don't belong there.

Will Butler:

Whoa. So you can literally be wearing a badge, scrubs and a lab coat?

Heidi Joshi:

Yeah, exactly. And I intentionally wear them outside of the patient care areas so that doesn't happen to me. I find myself needing to be more out there with wearing my lab coat other places in the hospital so that that doesn't happen to me as often, but it still does. People, all they see is blind person, guide dog doesn't compute, she's in a staff only area, we need to get her out of here.

Will Butler:

Yeah. I mean, it's the same reason that we feel pressure to clean our houses just so the mailman doesn't think we're a slob or whatever, you know what I mean?

Heidi Joshi:

Right. There's definitely extra pressure to... I always say, as a blind person or as a person with a disability, mediocrity or being average never really works.

Will Butler:

That hurts so bad.

Heidi Joshi:

Yeah. There's this, like it's not fair. But there's this sense that we have to be more than everybody else.

Will Butler:

Oh, that's devastating though.

Heidi Joshi:

Yeah.

Will Butler:

You're not allowed to be "normal"?

Heidi Joshi:

Right. And I think that really speaks to your initial question about mental health issues and blindness. I think to me, one of the biggest overlays or templates that happen for folks that can't see is this sense of how do I measure up to this moving target of cited worldness? It's just this ever-changing. It's not something we will ever meet. I'm never going to look like a person that can see, it's just not going to happen. I can't walk into a room and fake it. And I'm always envious of people who can, but that's not me.

Will Butler:

Yeah. They call it the hierarchy of sight, right?

Heidi Joshi:

Right.

Will Butler:

But it's like the pressure is like, as a blind person, you either have to reach for the stars and be a rockstar or you're going to be a pathetic loser.

Heidi Joshi:

Right.

Will Butler:

And we're pushed to think that there's no in between, which is not true.

Heidi Joshi:

It's not true. And it shouldn't be true. And it's a disservice, I think it's a disservice that we do to ourselves sometimes, and I think it's a disservice that others do to us. It's both. I know for me, I put a lot of pressure on myself to try to meet this moving target. And I feel like some of that has helped me to get to where I am today and some of it's hindered me. I don't feel like there's the same. I don't give myself the same freedom to be average, and that's a lot of pressure and a lot of anxiety. And I think others feel that way too.

Will Butler:

You're literally dressing up as a doctor.

Heidi Joshi:

Literally.

Will Butler:

So that you don't get discriminated against.

Heidi Joshi:

Right.

Will Butler:

The energy and time that goes into that, it's that significant, that's a resource [inaudible 00:16:22], right?

Heidi Joshi:

Yeah. And it's that discussion about microaggressions, right? There are these constant microaggressions that happen in the day that speak to, "Do I belong here? Am I somebody that has a seat at the table with other people in this room?"

Will Butler:

Well, we're going to get into PTSD and we're going to get into all this stuff about... and how it applies for us as blind people. Laying the groundwork here and establishing on background, what is it like for us as blind people to walk around? What are we mentally processing and what are we coding into our consciousness every day when we walk out the door?

Heidi Joshi:

I mean, I can imagine what it is. But in my mind, some of it depends on where you are in your journey of vision loss. That's such a multi-layered question, right?

Will Butler:

Right.

Heidi Joshi:

There's the whole concept of how long have you had your vision loss and how have you acclimated to it or adapted to it? How does your family of origin respond to your vision loss? What have been your messages over time in the world around you as a person who can't see or who has some vision loss? But all of that to me plays into the mental hassles, if you will, that we walk around with every day. And then there's the environmental pieces that we've already touched on a little bit.

Will Butler:

Right.

Heidi Joshi:

And those play a huge role in all the junk that we can carry around with us. And so I think there's the normal every day stuff that everyone in the world has, especially right now, the isolation, the self-esteem issues, and the anxiety, and the depression, and all of these pieces, and whatever sort of mental health, or chemical imbalance, or genetic components that you might have in the world, whether you can see or not. And then you add onto that, all of the things I previously mentioned about your vision loss, and it's no wonder that we all get up in the morning, right? There's this sense of, "Whew, it's a lot."

Will Butler:

And yet many of us wake up in the morning and open our eyes and don't immediately lament our vision loss, we just get up like normal and make breakfast.

Heidi Joshi:

I always say to people, "I forget that I can't see."

Will Butler:

Yeah.

Heidi Joshi:

To me it's not something I think about. It's not in the forefront of my mind until someone else puts it there.

Will Butler:

Which people want to do. Yeah, people do it all day long.

Heidi Joshi:

Yeah. I can go around my life and if I'm not working and I'm just on a weekend and especially during the pandemic, I'm not going places, so I'm home a lot with my family and the discussion of my blindness is just not there. They're more concerned about when's dinner.

Will Butler:

Yeah.

Heidi Joshi:

So I forget, it's not a thing for me until I face the world and other people bring it to my attention.

Will Butler:

I'm exploring here what are the things that mess up our minds, right? And culturally different cultures have radically different approaches to blindness, right?

Heidi Joshi:

Yes. I haven't met a culture yet that does it well. I mean, maybe you have. I don't know that I have.

Will Butler:

That is a great question. I don't know about that. There's probably some culture out there, some island nation that's got it totally figured out.

Heidi Joshi:

Maybe so, I would love to learn about that and maybe visit.

Will Butler:

And move.

Heidi Joshi:

And move someday. If it's sunny and warm, yes, exactly.

Will Butler:

And so how does that manifest the different cultural hangups that people develop?

Heidi Joshi:

Yeah. It's interesting. I live in a multicultural family and one of the things that my husband and I talk about on a regular basis is how race and culture and ethnicity intersect and overlap with disability, and visual impairment in particular. There's a lot of this similar marginalization feel, right? To what we as folks with visual impairments have, maybe not for the same reasons, but the result is similar. The result of marginalization and isms is similar to, I think, race and ethnicity and other things that happen. I don't think we often get included in the concepts of diversity. I do think there are times where it's not thought about in the same way, but that's also a part of the marginalization of it, right?

Will Butler:

It's a tremendous amount of intersectionality.

Heidi Joshi:

Yeah.

Will Butler:

And the environment is more about like, "Do you live in a city? Do you live in a rural setting?" That has a big effect on how you navigate as a blind person as well in terms of your mental health.

Heidi Joshi:

I believe it does. And I think if you are fortunate enough to be in a place where you can get to the grocery store and do your life and do your day as independently as you feel comfortable, that can help your mental health. And it doesn't have to be... Sometimes I think again we hold up this huge measurings yardstick as to what we consider success in the day. But for some of us success is like, "Oh, I finally went to the store and I didn't get lost on the way," or, "I was able to feel comfortable asking someone for assistance," or whatever it is. And that in and of itself it can feel like such a win. And any of those kinds of things, any of those wins can help lead us out of mental health issues over time. But it takes courage. You got to be willing to step out, and that's the hard part.

Will Butler:

Have you ever worked with a blind client?

Heidi Joshi:

I have, yeah. It's interesting. I was trying to decide early on in my career how much I would want to focus on having blind and visually impaired clients, or even seeing a blind therapist myself. And I was pretty intentional for better or worse about not having that be the focus of my job. I felt like, "Would there be enough people for one to have a living like that?" It wasn't necessarily my interest either, it wasn't something I wanted to spend my day with because I was really interested in medicine. But when I think about it now, I think what I look for a blind therapist in particular, like is that something I would personally look for? And I think for me, it's more about having a therapist that has an understanding of that marginalization piece of the diversity pieces of the hassles, of the privilege, and that sighted people in the world have that I don't have. And I think that takes imagination and empathy and which are not blindness in particular, right? But finding a person that gets it is golden.

Will Butler:

It sounds to me like you don't think it's necessary to have a therapist who is visually impaired or has some specialization in visual impairment when you're looking.

Heidi Joshi:

It isn't for me, it hasn't been for me. I think it's necessary to have someone who, again, gets it, and that can take some time to figure out, which is the painful part about finding a therapist, right? I always tell people it's like trying on a pair of jeans, you sometimes have to go back to the dressing room several times or just leave the store crying and kicking and screaming because you didn't find one. And sometimes finding a therapist is like that, you have to be willing to say this isn't a good fit for me. And that in and of itself can be brutal for people because they don't want to hurt anybody's feelings, they don't want to be that person, but this is about you, this is about what you need and what you want. And if you're looking for a therapist that isn't able to provide that, it's really important that you're willing to say, "Thank you so much for your time. I just don't think this is the right fit for me." And therapists know that. A good therapist is going to say, "Okay, let me help you find someone then."

Will Butler:

That's interesting. I didn't know therapists could do that, "Let me help you find another."

Heidi Joshi:

Yeah, let's think about this, "What are you looking for? Let me help you think who might be a good fit for you."

Will Butler:

We're not used to that as consumers. We can't go into trader Joe's and say like, "I'm not finding what I'm looking for." And they'll be like, "Oh, let me walk you to another grocery store."

Heidi Joshi:

I know. But you can taste things at trader Joe's, which I recently figured out, and that was life-changing for me.

Will Butler:

Really?

Heidi Joshi:

Yeah, you can ask to sample things and my life just changed when that happened.

Will Butler:

Oh my God. They'll open up a box for you?

Heidi Joshi:

Yes.

Will Butler:

Wow.

Heidi Joshi:

Isn't that awesome.

Will Butler:

Oh my gosh, that's incredible.

Heidi Joshi:

I know. I didn't know that.

Will Butler:

Wow. Okay. Well, if we got anything out of this interview, it's that you can taste things at trader Joe's.

Heidi Joshi:

I feel like that's it, right?

Will Butler:

Oh my God.

Heidi Joshi:

Just reached it.

Will Butler:

Well, okay. So blind guy walks into a therapist office.

Heidi Joshi:

Right.

Will Butler:

It sounds like the setup to a-

Heidi Joshi:

Is this a joke?

Will Butler:

... dad joke.

Heidi Joshi:

I know.

Will Butler:

But walk our listeners through how to interview your therapist, right? Because I think there's also a misconception that you're performing for them, or they're choosing you, or you don't know if... I don't know, it's like we're used to having doctors tell us what to do, but correct me if I'm wrong, but you're actually interviewing your therapist, right?

Heidi Joshi:

Yeah, you absolutely should. I often want to know when I tell... because I'll tell a therapist that I'm blind if I'm interviewing one. And part of my process is how do they respond to that? Is there stammering, "Oh, okay?" To me that's good information, is what do they do with my disclosure of my visual impairment? And that's true of a lot of things in my life. How people respond to my disclosure of my blindness gives me a lot of information about whether that's someone I want to spend time with.

Will Butler:

Absolutely. Yeah.

Heidi Joshi:

Or is that a store I want to frequent or... All of those things are important.

Will Butler:

Okay. So you tell them you're blind and they don't completely fall apart?

Heidi Joshi:

Yeah, they don't freak out.

Will Butler:

They could keep their cool, and maybe they're a little too cool, even they're just like, "Okay."

Heidi Joshi:

Yeah.

Will Butler:

And then they ask you another question. Then what? You want to dig a little deeper into finding out are they really going to help you become a whole person and not fixate too much on your blindness, but also you don't want them to ignore your blindness?

Heidi Joshi:

Yeah.

Will Butler:

What questions are you asking?

Heidi Joshi:

I mean, some of that you might not get in just like a phone consult. A lot of therapists will offer free phone consult before you visit them so that you can ask questions and they're going to ask you questions too. For me, I'm an unfair interviewer of therapists because I know what I'm looking for. And so I might say like, "If you're going in and you know you have some depression or anxiety, let's say, and somebody says to you, 'Well, you should get that cognitive behavioral therapy or you should get family therapy or there's all these different modes of therapy,' ask a therapist, 'Is that something that you do? What do you know about treatments for depression? Tell me a little bit about how you like to treat depression or anxiety. What insurance do you take?'" That's really important in this country especially. I think mental health coverage is hugely lacking in our country and mental health parody, which is basically like saying we give equal coverage to mental health issues as we do medical issues is a joke. It doesn't happen yet. We're not there.

Will Butler:

Yeah.

Heidi Joshi:

So finding out what are your copays going to be, do you have a deductible? All of these things are important that therapists might say you need to call your insurance to find out. So some of that is going to be some legwork on your part from a payment perspective, but that's important because you've got to feel like this is doable for you. Otherwise, you're going to cause even more mental health issues from a financial standpoint.

Will Butler:

I know for a lot of blind people transportation is an issue.

Heidi Joshi:

Absolutely.

Will Butler:

Who decides whether the sessions are virtual or in person? Is it the therapist, the client, or both?

Heidi Joshi:

I think for us as consumers, the therapist is on the hot seat for, is this going to be the right fit for them. One thing I think is hugely problematic in mental health and my colleagues is that, I call it the black hole of mental health, I don't think therapists are always very good at returning calls or getting back to folks when they call. So please, it's not personal, this is like a cultural thing. I don't even know how to tell you. I don't know why it's like this, but it can be difficult to get responses back. So you have to be pretty tenacious, hang in there with it.

Will Butler:

And I wonder if it's capitalism because if you have a full schedule-

Heidi Joshi:

Right.

Will Butler:

... maybe you're not incentivized to call back new referrals or something like that, right?

Heidi Joshi:

Yeah, it could be. The other thing is just the websites in general. How do you find a therapist? There's a website in this country called psychologytoday.com where a lot of therapists will post a bios about themselves and contact information, you can put in what your insurances and your address, and are you looking for a male or a female therapist, or all of these different parameters and come up with a list of therapists. I would say that website is fairly accessible, but there's always times when I go on there and I need to find a therapist for a client or a patient that we have, and I might need to get some assistance in doing that for them because something isn't quite reading the way I want it to. So there's that glitch as well.

Will Butler:

No wonder the accessibility level of all these sites.

Heidi Joshi:

Yeah. I wish I knew more about... I mean, I don't spend a lot of time looking for therapists, but I do think that could be a thing, is just the accessibility of getting the resources and the referrals that you need.

Will Butler:

Can you call your insurance company to find a therapist?

Heidi Joshi:

You can. I think word of mouth is a good way to go. I mean, I think that for a lot of things, especially if you know another blind person who has a therapist who that they like. Sometimes that can be nice because then you're not the first one that a therapist has ever seen. And you know it's always really interesting to be the first blind person for someone in whatever capacity that is, right? You can get over that a little bit quicker

Will Butler:

Yeah. So if you're sitting in an interview, I really... and I keep focusing in on this interview first interaction, because I think a lot of people can get stuck with someone who's not helping them because they feel too uncomfortable to-

Heidi Joshi:

Absolutely

Will Butler:

... admit that it's not a good fit, it's like a bad relationship or something. So in this first interaction where you're still getting to know each other on the first date, what would you imagine might be some red flags? What would cause you to run screaming from a therapist office in regards to your blindness if you heard them say that?

Heidi Joshi:

If they asked me how I became blind right off the bat, that would be something that I would not appreciate.

Will Butler:

You're like, "Are you a therapist or a stranger at the grocery store?"

Heidi Joshi:

In either case, I don't think it's appropriate.

Will Butler:

Exactly.

Heidi Joshi:

So I think that would be something... and it's not uncommon, right? That people ask us how we lost our vision in the first two minutes that they see us. And so if that happens, that would not be something I would want to pursue.

Will Butler:

That's a great one.

Heidi Joshi:

I also think if that's what they focus on, if there's an assumption that the reason for me to come to therapy is because I can't see, that's not for me either.

Will Butler:

What would be a giveaway that they were assuming that you're like, "Oh, this person needs help with their blindness."

Heidi Joshi:

If they just say, "Well, I've never worked with someone who's blind before and I don't think I would know what to-"

Will Butler:

Right.

Heidi Joshi:

"... ask or what the hell," I'm like, "Well, okay." That's not the point. To me, whether you've worked with someone who is blind or not, it's not like all of a sudden you're a different therapist.

Will Butler:

Right.

Heidi Joshi:

Blind people don't need you to be... they need you to have the same diagnostic skills and the same clinical skills that you would for a person who can see. You just need to have an extra set of cultural appropriateness, right? Cultural humility.

Will Butler:

So you're saying if they immediately start explaining themselves and disclosing like, "Oh, I'm not the most qualified when it comes to blindness," then you know that they're looking at you the wrong way, right?

Heidi Joshi:

Right. That's not the lens I'm looking for.

Will Butler:

Yeah. You're like, "I didn't come to you because you're a blindness specialist. I came to you because you're a therapist," right?

Heidi Joshi:

Right.

Will Butler:

Exactly.

Heidi Joshi:

Right. By the way, blindness specialist is not on the psychology today website.

Will Butler:

Really? Do you think they should be?

Heidi Joshi:

Yeah. Shocking. Not necessarily. I just think again, it's like saying, "Well, do I think I should see a physician that specializes in blind people or do I think I need a hairstylist who understands blind people?" You know what I mean? It's like, "No, I don't..." And maybe I'm oversimplifying it, which is very likely, but how do you know when somebody understands blind people? What's the measure of success there?

Will Butler:

Yeah. I know a lot of blind people who don't understand blind people.

Heidi Joshi:

Exactly. And so, for me the measure of success is not that you've known a blind person or... Because how many times do people come up to you and say, "My cousin is blind, and so I get it. I know what it's like."

Will Butler:

Or even worse, "I think I get it because my cousin is deaf."

Heidi Joshi:

Right. "Do you know sign language?"

Will Butler:

Yeah. It's still crazy how often people bring up sign language.

Heidi Joshi:

I know. I have no clue of sign language, but yes, people ask me that all the time.

Will Butler:

Okay. Red flags, what about things that would make you feel sink into the chair like, "Oh, I found my person." What are we looking for?

Heidi Joshi:

Somebody that could show the fact that they understand the difficulties that living life as a person who is marginalized what that's like, and what being different from the majority is like. And then someone who has an imagination and empathy about that, who could humbly say, "You know what? I don't know that I understand what it's like specifically to be blind, but let me offer a thought for you about how I think I understand what you're saying." Like I said, there's this humility of experience, and even if I don't understand what that's like for my patient or my client, I do have an understanding of what it's like to be different, or what it's like to stand out. And I'm not going to necessarily share my experiences, but I might find a way to empathize with that difference.

Will Butler:

Right. As a therapist, you might not know what it's like to be addicted to meth, but you can still have a client who is. You might not know what it's like to have dissociative identity disorder, but you're sure can treat people who do.

Heidi Joshi:

Yeah, I don't think the yard stick should be that we should experience everything that our patients, our clients experience in order to be a good therapist to them.

Will Butler:

Yeah. I mean, it's interesting. I don't know if it's a perfect corollary, but they're talking about representation in media and film and TV and all this stuff, and there's pretty much an agreement that blind actors should have roles and be able to play blind people in movies, and that should happen more often.

Heidi Joshi:

Sure.

Will Butler:

But can a sighted person write a good blind role? I mean, that's more of like a... I think some more radical folks would say no, and I think some more traditional folks would say of course, right?

Heidi Joshi:

Yeah. It's interesting. For some reason that does feel different to me, and I'm sitting here trying to think why. I think when you're portraying a blind person in a movie, you have to have a little bit more of an intimate knowledge of the day-to-dayness of being blind, like how do you get up and walk out of a room that you've never been in before, or how do you go to a place you've never been to, or how do you navigate a crowded sidewalk. And that's not the thing. As a therapist, I don't necessarily need to have that intimate knowledge of getting from point A to point B to necessarily be a reasonable therapist to a person who can't see.

Will Butler:

So if a therapist starts asking you, "Do you grocery shop alone?"

Heidi Joshi:

Yeah.

Will Butler:

Maybe you should back away slowly. Interesting.

Heidi Joshi:

And I think there should be an assumption of competence, I think that's about everybody. But therapists need to have an assumption of competence for me to feel comfortable.

Will Butler:

Yeah. I love that, assumption of competence. That's what I'm looking for. I'm just looking for an assumption of competence. I'm repeating it so that... That's my new mantra.

Heidi Joshi:

Right. And I think we all want that in our lives, right? The people around us to assume that we're competent at whatever we're doing, and if we need assistance that we will ask.

Will Butler:

Yeah. Or if they feel the need to ask, just ask don't necessarily impose yourself, right?

Heidi Joshi:

Right. Exactly.

Will Butler:

Yeah.

Heidi Joshi:

Or people who say, "Please let me know how I can help you," or, "Is there anything I can do to make you more comfortable when you're coming to this new place?"

Will Butler:

Okay. So we've thoroughly vetted this person before therapists are exhausted, they're drinking Gatorade.

Heidi Joshi:

Right. They haven't even started with us.

Will Butler:

And assuming they don't hate us by the end of this.

Heidi Joshi:

Right.

Will Butler:

Then you start doing the work, and obviously we all know therapy is supposed to take time, right? And you build trust, right? All those. You develop a rapport, right?

Heidi Joshi:

Yeah.

Will Butler:

You're not going to be cured in four weeks of your depression.

Heidi Joshi:

You know what? I would say it depends. So research shows us that the... Do you know what the average number of sessions are that people engage in therapy?

Will Butler:

No.

Heidi Joshi:

It's one.

Will Butler:

Well, just enough to realize you don't need therapy or what?

Heidi Joshi:

I don't know, but it's one. I could probably infer a lot of reasons why I think that is, right? There's a lot of stigma still around mental health issues in general. Maybe this whole concept of like, "This isn't what I thought it was going to be." And the first session is usually like a rapport building, getting to know you kind of thing. You're spelling out why you're there. So you're not really going to get a lot out of that first session necessarily, although I believe the first session can still be a time of learning skills. But a lot of people in mental health field should take a long time to get through working through depression or anxiety or whatever is going on. I work in medicine and I work in primary care and so we have this idea that I might only see a person one time or a few times and that's it. And so I need to get as much in as I can.

Heidi Joshi:

And for me a lot about learning how to manage depression and anxiety is skill-building. It's how do I manage my thoughts, how do I work on my process for anxiety of all the ruminating things that float around in my head when I'm trying to sleep, what do I do with all that? And those are skills, it's not magic, it's not... If I could sit with you every week and never learn the skills and still have the same problem. So to me, my bias is that you have to be willing to learn the skills and have a therapist that's willing to teach them.

Will Butler:

So why do you think people are leaving? Are they being too hard on themselves or...

Heidi Joshi:

You mean why are they only doing this one visit?

Will Butler:

Yeah.

Heidi Joshi:

Again, I think that's probably multilayered. I think people... like I said, it's not maybe what they thought. It's one visit and they're like, "Well, I'm still depressed. So I'm not going to do this anymore." They don't have a realistic understanding of what the treatment plan is. I think we as therapists have to be willing to be transparent about what we're thinking about what's coming up, how are we thinking about this process looking as part of an informed consent process.

Will Butler:

What are these skills that we need to build as blind people or just as people in general?

Heidi Joshi:

I think these are people things not necessarily specific to blindness, but learning how to manage our negative thoughts, I'll give you an example and I'll use myself, and this is blindness related. I think one of the biggest barriers for me is not wanting to inconvenience people, it's this thought that I have. So if I go to the grocery store and I need to ask someone who is sighted for assistance, I'm like, "I don't want to inconvenience them," right? I mean, you could fill in the blank for all kinds of things, really the bottom line is I don't want to inconvenience anybody. And that thought, or that sort of my need to not inconvenience somebody could be a barrier to all kinds of things in my life, right? It could keep me from asking for help in the grocery store or from going to the grocery store in the first place.

Will Butler:

Yeah.

Heidi Joshi:

If I'm not even aware that my thought is, or that the thing that's there is, "Oh, I don't want to inconvenience someone," then I'm just going to spin my wheels and not go to the grocery store.

Will Butler:

Mm-hmm (affirmative).

Heidi Joshi:

Well, I think it's developing awareness first, right? Developing awareness of what the issues are comes before the skills. You have to gain some awareness of what the issues are. It's not enough to just say, "I'm not sleeping well." Well, the reason you're not sleeping well, because your mind is so busy at night and you can't settle it, therefore you need to learn skills about how to put those thoughts aside so you can sleep. I mean, that's a skill.

Will Butler:

Right.

Heidi Joshi:

It's not digging into your childhood and saying, "Well, tell me about all the repressed trauma that you have." That's the kind of therapist I am. It's not that it's a bad thing, I think some people need to do that. But for me it's also about how do we help you function today right now and moving forward.

Will Butler:

Yeah. Sometimes I get anxious on Sundays. It's a problem, but it's got a skill associated with the solution, that's what you're saying? So the work is helping you to identify?

Heidi Joshi:

Yeah, it's exactly. But it's coming up with awareness like, "What is it about Sundays? Is it that you know something's coming up on Monday that you're anxious about or..." So it's gaining that self-awareness first and then, "Okay, now that I know that on Sunday evenings I start feeling anxious and it's because I know I have to do something at work on Monday mornings that I don't want to do, how do I work through that?"

Will Butler:

Whereas a trauma therapist might help you identify like, "Oh, I have all this trauma around my workplace, which is why I fear going there. And Monday mornings are scary to me. And so..."

Heidi Joshi:

Yeah. Right. I have triggers and I don't want to dismiss that as important because I think for lots of folks, and especially I think blind and visually impaired folks, where trauma is often a really key part of what's going on for people, unmet or untreated trauma. Getting to these daily functional things can be more challenging because there's all this trauma junk in the way, and figuring out how to deal with that as well can be important. I just think that you don't want to lose the forest for the trees. If we spend all of our time in the past, we sometimes can feel even less functional for a while, right?

Will Butler:

Yeah. So some therapists are better at helping you address, clear out the past, and others are much more like looking right at what we're doing right now and trying to rearrange the furniture?

Heidi Joshi:

Yeah. And you had to think about what do you need, what do you want? Do you want to spend some time cleaning out the past, doing some of that important housework, so to speak, or do you want to focus on the now and the future? Those are things you can ask your therapist in that interview time. Are you somebody that tends to focus on past stuff or are you someone that is a bit more present, functional focused? And I think that's a really good question to ask a therapist.

Will Butler:

So for people's knowledge, is it possible to generally group social workers, MFTs, psychiatrist, psychologist, which of those do which of those things generally?

Heidi Joshi:

No.

Will Butler:

Okay.

Heidi Joshi:

I think it's something you're just going to have to ask because different therapists will focus on different things, and their bios will give you some of that information as well.

Will Butler:

Okay.

Heidi Joshi:

And also you can ask them what treatment modalities do they use. People who use something called cognitive behavioral therapy, which I mentioned earlier, that's a skill-based very pragmatic process. Versus someone might say I'm more trauma focused or more insight oriented, which is talk more supportive kind of talk therapy. The idea is that you're going to talk about how you feel about things to just get it out, versus family therapy, versus couples, versus... I think there's so many modalities and there's new ones coming all the time. So you're not expected to know what they are, but you can ask and then ask them to explain what it is.

Will Butler:

Stepping out of the therapy office for a moment here, I just wanted to ask you in your expertise as a psychologist and your lived experience as a blind person and just studying disability in general, I know that as blind people, we are more the same as folks who are not blind, but there are some things that are specific to our experience, right? And there are some things that we uniquely experience.

Heidi Joshi:

Mm-hmm (affirmative).

Will Butler:

I just find myself wondering about things like, "Do blind people get suicidal more than others? Or if not more than others in a particular way, is there something there?" Do we have trouble confronting our sexuality? Knowing that we're marginalized in a very particular kind of way, what are the things that are pressing on us?

Heidi Joshi:

Well, pressing is a great word. I think one of the things I think you and I chatted about before this podcast conversation was this idea of internalized depression. And I think that we, as a community of blind people, can often take on the oppression and turn it towards each other, not intentionally or consciously most of the time, but there's this sense of like that need to be as sighted as possible, right? Can often put us at a disadvantage with each other because of that internalized depression. But I do think that mental health pieces of this, the isolation that blind people can often experience, even if you're in a room, if you're in a crowd of a hundred people, it can be isolating because you don't have the visual social cues that other people have. You can't just look across the room at somebody and make eye contact and smile and think like, "Oh yeah, I know that person," or to get their attention. Unless somebody comes up to you, you're just there, or you're really intentionally trying to listen around you to see who's there.

Heidi Joshi:

We are at social disadvantages whether we want to think we are or not. And I think in those kinds of situations, that isolation factor can be very difficult for people. And the pandemic right now just exponentially makes that worse. So we have to be more intentional about how we deal with isolation than I think other people do. And I'm not sure if this is getting at what you're talking about or asking.

Will Butler:

Yeah it is.

Heidi Joshi:

I just think that that's really important, that we know that, "Hey, I'm somebody that's more likely to be isolated, whether I want to think I am or not. So what do I need to do to make sure that I'm working with that or dealing with that? Have I called anybody today? Have I reached out to anybody?" And yeah, it's hard if you're sitting there thinking, "Well, why aren't people calling me? People should call me. I'm here by myself. Why is nobody reaching out to me?" I think thinking of this as like, "I need to take my own mental health into my own hands and not wait for somebody else to do that for me. So have I made a phone call? Have I Facebook messaged a friend, have I..." It's not the same as being with people in person, but we have to be so much more intentional about how we manage isolation now.

Will Butler:

How does isolation act upon the brain?

Heidi Joshi:

I think there are going to be more and more studies about that. You think about people who are in prison in solitary confinement, right? And they don't do well, right? There's a reason that's used as a punishment or as a torture means. It is because we start to go a little crazy when we're not having social contact with people. And I think for folks that can't see, they don't even have the visual contact with people. So you have to find other ways. And now we're all wearing masks, we all sound different, muffled. We have to do a little more work on being able to hear people. We can't social distance appropriately if we do go out in public. So that can feel scary. Are we going to get yelled at, because we're not six feet apart from somebody in a line at the grocery store? So there's the regular isolation pieces. And then now we have the pandemic worries on top of that.

Heidi Joshi:

And then going to the doctor during the pandemic it's an event now, you have to screen in at the front of the building. So there's a line to do that. And then that's a whole new process that maybe if you've been to that doctor's office before everything's changed, certain entrances might be closed now because they're trying to get people funneled through one way or another. And all of a sudden what you thought you knew has changed.

Will Butler:

Well, when they put up those clear plexiglas in restaurants, I think for sighted people it's just like, "Oh, this is protection for me." But for blind people, the acoustic effect of that is like putting on a blindfold for a sighted person. You know what I mean? It's like...

Heidi Joshi:

Mind numbing. I remember the first day I had to wear a mask, because I wear a mask all day at work because I'm in healthcare, and I was so disoriented for a few days. Literally, I felt like I couldn't find my way around a place that I know very well with a mask on my face. It's just like that echolocation changed. Then I had to start wearing a shield, and a shield is like this clear plastic.

Will Butler:

It's like a welding mask, right?

Heidi Joshi:

Awning that you're wearing over your head and it covers your face. It covers your forehead basically and your eyes. And it's like, if you think about being under an awning how the sound cues sounds is very different when you're walking under an awning, as it is when you're out from underneath it. So imagine walking around your day with this awning over your head. And I literally had vertigo from trying to [crosstalk 00:50:10].

Will Butler:

Oh my gosh. I can't even thought about it. I haven't had to wear one because I haven't gone on a plane or anything, but it makes me feel panicky just to think about that.

Heidi Joshi:

I actually ended up having to switch out my shield for goggles that are more like glasses. That didn't give me that same awning effect over my ears because I would get so dizzy from the shield that I... The goggles worked so much better for me.

Will Butler:

You also mentioned change, right?

Heidi Joshi:

Yeah.

Will Butler:

Everything is changing right now.

Heidi Joshi:

Everything's changing from day to day.

Will Butler:

Yeah. And I always tell people when they are in a process of losing vision, "Listen, I can guarantee you this, being blind is not the hard part, the hard part is the change."

Heidi Joshi:

Yeah.

Will Butler:

"It's getting used to it."

Heidi Joshi:

And feeling like, "Wait, yesterday I knew how to do this," right?

Will Butler:

Yeah.

Heidi Joshi:

Like, "I had this down," and you have this memory for it. And there's this sense of competence, this sense of like, "Okay, I've got this. I'm doing life. I'm okay. I'm independent." And then today you go and you try to do the same thing again and it's different. And all of a sudden that's gone. And that's jarring. It's not fair. It's frustrating.

Will Butler:

And the stakes are high, right?

Heidi Joshi:

Yeah.

Will Butler:

Because if you do something wrong, you might get sick.

Heidi Joshi:

You might get sick. And we touch things more in our environment, right? Like we use our hands more, we... To me, it's even more important from a public health standpoint that we wear a mask when we go out because we're touching things and we don't want to touch our face, we don't want to... I'm so much more mindful about those things in my life now. But again, I work in a doctor's office, so I see people with COVID all the time.

Will Butler:

On the flip side though, blind people are constantly being challenged. And I think one thing that we're actually very good at is adapting and being flexible.

Heidi Joshi:

Absolutely.

Will Butler:

And so in some ways we're set up to confront this pandemic because we're constantly having to switch our grocery service because the other one stopped working. Or whatever it is, right? We're used to this in some ways.

Heidi Joshi:

Totally. I think our ability to adapt is amazing. And I think it was Erik Weihenmayer, the mountain climber, the blind guy that climbed Mount Everest, who talks about the adversity advantage, which I love, it's something I think about a lot. I think that we are people who understand adversity in such a unique and important way. Our ability to adapt is important, but I also think let's not forget the perspectives and that ability that we can offer other people. We can do it for ourselves, but gosh, we've got all this knowledge about how to adapt that we can offer to the world.

Will Butler:

That's interesting.

Heidi Joshi:

And to me, mental health comes from not just how do I fix myself, but what can I give to other people.

Will Butler:

Yeah. Sometimes the best way to get out of a depressive funk is just to think about somebody else for a moment, do something.

Heidi Joshi:

Yeah. Volunteer, make a call, connect, anything.

Will Butler:

We forget as blind people that we're allowed to help other people, I think.

Heidi Joshi:

Absolutely. And I think it's vital because we don't always get messaging that we are capable of helping other people, that we have something to give. But I guess if there's anything that I would want listeners to take from this conversation, it would be that, it would be think about what you have to offer, your ability to adapt, your ability to listen, your ability to offer guidance or advice or anything like that. Whatever it is to your friends and family is vitally important.

Will Butler:

Yeah, that's huge. It really is. And the adversity advantage I think is interesting, I wrote down from our last chat, is adversity actually an advantage?

Heidi Joshi:

Yeah. I know, right? Should it be? I think it is. There's this book, Three Degrees of Separation by Malcolm Gladwell. And he wrote a few other really great books, but he talks about learning disabilities and dyslexia in particular and how there's all of these CEOs and really creative high powered people with dyslexia, and is the reason that folks get as far as they have gotten with this because of their neurological differences with dyslexia or because they've had to learn to adapt.

Will Butler:

It's a really great thing for well-known people and authors to put in their books. And I think there's a lot of truth to it, but also sometimes adversity is just adversity, right?

Heidi Joshi:

Yeah, sometimes it just sucks, right?

Will Butler:

That's also the mentality that sometimes tricks us into thinking that if we're not climbing Mount Everest, then we're just in the other group.

Heidi Joshi:

I wonder if it's all or nothing though. I wonder if it's a process. So I'll use another example from my own experience. So six years ago on Tuesday I was diagnosed with breast cancer. And I remember the very first couple of weeks of my diagnosis, the only thing I could think about was, "Oh my gosh, I'm going to die," right? Because that's a huge... Everyone who gets a diagnosis like that, their thought is like, "I'm going to die. I have cancer." It's the C word. And people who have had breast cancer would come to me during those first few weeks and say things like, "Oh, someday this is just going to be a blip on your radar," I remember someone saying that to me. Or, "Oh, I've had breast cancer and you're going to be fine." And you can't even begin to function in that reality. I was angry. I remember just thinking like, "Who are you to tell me I'm not going to die from this? How do you know? You don't know that this is not the worst thing that's ever happened to me."

Heidi Joshi:

And I didn't want to hear any of that. I wasn't ready for that. And I think we have to be really careful and knowledgeable about the fact that not everyone wants to hear that what they're going through is just, "Oh, this is just going to make you stronger." Or all of those cliches that we tell people. Sometimes you've got to be where you are and respect the fact that I'm in a position right now where my life is just torn apart and I don't know how to put it back together. And that's okay. This is just where I'm at right now. And just getting through that. But I do think that there are points in our lives where we can have a 10,000 foot view and own that part too, right? So I think that we can have both.

Will Butler:

Yeah. I'm sitting here looking at this note that I wrote. It's blown up on my screen like 4000% because it's the only way I can see it. And just is, is adversity actually an advantage? And I'm just thinking maybe advantage is the wrong word because it implies that you've got some card to play or you've got some secret power. Maybe the word is opportunity.

Heidi Joshi:

Yeah.

Will Butler:

Right? Is adversity actually an opportunity.

Heidi Joshi:

Right.

Will Butler:

Advantage is so competitive and...

Heidi Joshi:

Yeah, it can be for sure. I also think though, it can be our way into situations that we might not otherwise have a seat at the table. I have found it to be really useful. If I'm interviewing for a job and I need to sell myself, right? That's what job interviews are. Why should somebody pick a blind person over a sighted person with equal qualifications?

Will Butler:

Because you wear your doctor's outfit everywhere you go.

Heidi Joshi:

But because I have these skills that a sighted person hasn't had to necessarily work on in the same way.

Will Butler:

So someone goes, "Oh, Dr. Joshi, what skills are those?"

Heidi Joshi:

Yeah. And the things that you mentioned earlier, adaptation, the perspective on diversity and difference, and this ability to think through problems in a very different way.

Will Butler:

Yeah. And the hiring manager is like, "Oh, that board is going to be so proud of me for hiring this woman."

Heidi Joshi:

"Hey, you just meet this affirmative action quota." Yeah, but still I think if we don't own what we have to offer the world, they're not going to do it.

Will Butler:

I think it was Too $hort who said, get in where you fit in. Absolutely. We've been so disadvantaged, take the advantages that you can get.

Heidi Joshi:

Absolutely, play the cards when you need to play them.

Will Butler:

Yeah. I wonder for the final piece of this conversation, I want to have you back Heidi, because it's such a rich discussion. What about talking to doctors in general, zooming out beyond psychology therapy. You have to go to the doctor's office a lot.

Heidi Joshi:

Sure.

Will Butler:

And how does that affect us, and how do doctors talk to us? Status quo, how do doctors look at us and talk to us as we're going blind and, or just random blind person walking in?

Heidi Joshi:

I mean, for fear of overgeneralizing, I think there's this sense of, "Well, my doctor is the expert and I'm just there to do whatever they want me to do." And just like with our conversation about therapists, I would say no to that. I think that we have to be participants in our own healthcare, as well as our mental health care, which can be scary. But we're the ones that have something to lose here, right? By not doing that. And so I think it's important to be good consumers of your doctor as well. And if you feel like you're being dismissed, or you're not being heard, or you're not being listened to, then it's probably a good time to find a different doctor. Even for those of us that have to go to the County clinics and we have Medicaid insurance and we feel like, "Well, this is the only place I can go," there are plenty of other doctors in that same clinic and you need to speak up and say, "I need a different physician even if it's at this clinic." You have every right to do that.

Will Butler:

And that's just if you don't like the treatment they're recommending or you've got a gut feeling that they're not seeing you?

Heidi Joshi:

I think that's if you feel like you are not being talked to like a human, you're sitting in the exam room when you just feel like you're... I think a lot of us have experienced physicians that don't treat us like we're equal participants in our healthcare. They talk down to us, maybe aren't using words that we understand and they're trying to get out of the room in like two minutes, they don't even sit down when they talk to us, they're on their computer the whole time. There are basic communication skills that we should expect our physicians to have. My husband always laughs when I go in to see a doctor, he's like, "They don't even know what you're looking for." I'm the one who's like, "Okay. So they were on their computer for 15 minutes before they talked to me, and this is not going to work for me." We deserve doctors who care about what we have to say about what's going on, and we're the experts on our bodies.

Will Butler:

So for those who don't have a choice, maybe you've landed with the world expert on your rare disease or you are in a small town and can't go anywhere else, how do we take the reins? How do we talk to doctors in a way I take responsibility for the way they're talking to us to make them talk to us in the way that we need and help them get there with us?

Heidi Joshi:

I think having an idea of what you want to talk about before you go in is really useful so that you can frame the conversation, whether that's a list of questions or just an idea of like, "Okay, I know I need to talk about my diabetes today," but what specifically is it about your diabetes that you're not going to feel like it's going to be a successful visit if you don't leave without that question answer.

Will Butler:

Yeah.

Heidi Joshi:

So be real specific about what you're looking for in that visit.

Will Butler:

Make a list. I like that.

Heidi Joshi:

I think also just knowing that doctors are under a real time constraint when they see us. So literally they have 20 minutes with you. And how do you want to use that time? Do you really want to use that time telling stories about your grandmother's Christmas cookies or do you want to use that time talking about your diabetes? And it sounds really like I'm being a little bit harsh with that, but I think oftentimes people don't realize doctors don't want to be under the time constraints that they're under, that's a misnomer, that the healthcare system has production requirements of doctors that they see a certain amount of patients every day or they can lose their jobs. But they would love to spend an hour with us, I think most doctors would feel more satisfied with that, but that isn't the reality that they're working in right now. So how do we help them with that? And I think one of the ways is to come in with our agendas.

Will Butler:

And make the decision together.

Heidi Joshi:

Absolutely. And co-create a plan. I asked doctors all the time, "So what are you thinking about this? Okay, so these are my lab results, what are you thinking?" I know my question is, where's your head at?

Will Butler:

And they might recommend something that's not appropriate for you, but they don't know it's not appropriate for you. They don't know what your lifestyle is like, they don't know what you do when you leave the office.

Heidi Joshi:

Right. And I think ultimately it's important to have some transparent thoughts around what are the options that you're mulling over in your head right now.

Will Butler:

Like the difference between, "Oh, you could do this immunotherapy that is a tongue dropper that takes every day, or you can do these shots set every week."

Heidi Joshi:

Right. And I'm really clear with my doctors. I'm a terrible medication taker. I tell them immediately, "You should know that I'm not reliable with taking pills. It's not that I want to be difficult. I just know that's not me. And so if there's another way for us to get the same result, I'm all for it. But just know that I'm really rotten at this."

Will Butler:

And sometimes doctors will respond to that. They'll be like, "Oh, there's totally another..."

Heidi Joshi:

Absolutely. And if they don't, they're probably not the right doctor for me because I really want a doctor that knows this is not my forte, taking medications like a pill, especially a pill, is not for me. So if there's an injection, if there's something like a once or whatever that you can do instead, then do that for me because I'm not reliable, and you should know that... Think of how much time that saves. Then we don't have to go back and forth, and they're not saying like, "Why aren't you taking that pill?" "Well, Oh, I just..." I don't want to tell them that I'm not reliable, what I want to... But I think ultimately if something's not going to work for you and you know you're not going to do it anyway, then don't waste anybody's time and let them know that. Like, "You know what? This goal that we've set together, that I'm going to take this new blood pressure medicine, I'm too scared of the side effects of this. I don't know that I'm going to take it."

Will Butler:

It might ultimately save you money too. I mean, sometimes doctors get on autopilot and they recommend something you don't really need at all.

Heidi Joshi:

Absolutely. Or they may have another medication that has less side effects that they could do instead, or side effects that you can live with.

Will Butler:

You told me some stories when we first met about your kid at the dentist.

Heidi Joshi:

Oh, yeah. So one of my kiddos is she's seven and she's got a lot of baby teeth still, and the dentist wanted to do a filling. She had a cavity in one of her baby teeth. And I was like, "Why are we filling a tooth that's going to come out? Help me understand." It would be very easy for me to just go in and say, "Okay, yes, I guess they want to fill this tooth." And I could be scratching my head and not ask the question and pay a bunch of money for a cavity to get filled when this tooth is coming out. Then the dentist said, "Well, actually if you want, I can just put a sealer on this tooth so that it doesn't have as many grooves in it, because this tooth won't come out until she's around 10." And I was like, "Okay, yeah, let's do that." I'd rather do that than fill a tooth that doesn't need to be... But if I didn't ask that question, then we could be off to the races with cavity fillings on baby teeth.

Will Butler:

Those are expensive.

Heidi Joshi:

And more importantly even, it's not necessary.

Will Butler:

Yeah. And I think that's a good of a metaphor as any for other things people assume that we need as blind people.

Heidi Joshi:

Yeah.

Will Butler:

And we have to follow our own compass, right?

Heidi Joshi:

Right. Absolutely. Trust our instincts and ask questions if we don't know.

Will Butler:

Well, I wonder if you had to sum it all up in a headline, if you were on the front page of the newspaper-

Heidi Joshi:

Oh, gosh.

Will Butler:

... what would you want people to know about blindness as a lifestyle, as a phenomenon?

Heidi Joshi:

As a lifestyle.

Will Butler:

Everything we've talked about today.

Heidi Joshi:

Oh my gosh. Wow.

Will Butler:

What's the big message?

Heidi Joshi:

That's a great question. I think I would say it's not something we choose, but we're going to be okay, if that makes sense.

Will Butler:

Right.

Heidi Joshi:

Even if it's not the path that we've chosen, that there are wonderful guides and people to help us along the way, and we're not alone in it, and ultimately we're going to be okay. We're going to find our way.

Will Butler:

Yeah. Absolutely. I wish someone had told me that when I was 19.

Heidi Joshi:

Yeah.

Will Butler:

But hey, I'm glad we're here today and I can't thank you enough for coming to talk with me.

Heidi Joshi:

Thanks for asking me, I really appreciate it.

Will Butler:

Yeah, absolutely. Let's be in touch and continue to brainstorm ways to improve everybody's lives.

Heidi Joshi:

I love that. Thanks for doing this.

Will Butler:

Thanks for listening to the Be My Eyes podcast everybody. Go try and win that OrCam, bemyeyes.com/orcam. If you've got ideas for podcasts, email me at podcast@bemyeyes.com.