Megan: First off, can you introduce yourself please?

Dr. Triana: My name IS Gisela Triana and Im a psychiatrist. Ive been a psychiatrist for 36
years.

Megan: Where did you get your undergraduate degree?

Dr. Triana: I got it in San Juan, Puerto Rico. It was the Interamerican University.

Megan: And thats where you majored in biology?

Dr. Triana: Yes, thats where I majored in biology.

Megan: Where did you go to medical school?

Dr. Triana: I went to UT Health in San Antonio. So I got my medical school degree and my
residency in San Antonio at the University of Texas.

Megan: What made you want to pursue medicine?

Dr. Triana: Well that was my only interest. When I was young, I didnt want to go to school. I
never wanted to go to school. I made it through high school. Then, because of the Cuban
government, we had to leave Cuba when I was 18 so I only had a high school diploma. What I
wanted was to be married and have kids and play house. Eleven years later I decided that I
wanted to do something because I got married young, had kids young. At 40, my kids would be
grown up. I had my first child at 20, then my second at 22. I said My God when Im 40, theyre
grown and Im going to be clinging to them. My husband at the time asked me why did I want to
study medicine, and I said, Well thats the only thing I read about in magazines and things. So
I decided to go to nursing. And he said Why nursing school? Why not become a doctor? I said
Because I would have to be out of the house. I would have to be out at night. You know, the
old cultural thing. And he said So? I said, If I start this, Ill finish it. At that time it was very
hard for women to get accepted into medical school. We are talking about 1971, and I had no
undergraduate degree at that time. I was 28 and he said Yes, you can do it. So thats how it
happened. It was because I liked medicine, and that was my only interest. I wanted to know
things that were before birth and after death, and no one could really tell me about those things.
So, I settled for medicine.

Megan: Did you ever come to a point where you realized you might not want to pursue medicine,
or was that just always what you wanted once you decided?

Dr. Triana: Oh no, always. The challenge was that at 28, you start college. And I didnt even
dare say I was going for medicine because all the odds were against me. I mean to get admitted
was very difficult. To be a woman, to be older, it was very difficult. So no, I never had any
doubts. When I got interviewed for medical school, that was one of the questions that the doctor
asked me. What would you do if you were not accepted into medical school. And I told him
that I would pursue a genetic career. Genetics was the closest, it was fascinating, and this was
back in the 70s so that was ahead of my time to think of genetics, which is now in the 21st
Century, what medicine is going to be all about.

Megan: How did you choose your field of study?

Dr. Triana- My specialty? I was always fascinated by what drives humans. I was so puzzled by
the human brain, by the mind, by the behavior. By what made us function and do and be so
different. When I was 12 years old, I read a book that was called Emotional and Cerebral
Control. And I was fascinated by that book. There were a couple of books that really inspired me
to look at why humans do what they do. I was very clear on psychiatry when I started. Later on I
got a little bit lured by surgery. I love surgery. I played the piano. I sewed. I was very good with
my hands and I loved medicine. I love internal medicine and I love surgery. But at that time I
was a little older and I figured that it would be hard to stand on my feet for many, many years to
come. I was still fascinated with psychiatry, so basically those were my interests.

Megan: What does it mean to be a psychiatrist to you?

Dr. Triana: Wow, thats a good question. You know, I didnt realize it at the time, I was just
curious, but 40 years laterwhat it means to me is someone in the deepest of their sorrows, in
painthe majority of patients are depressed or losing control of the anxiety and are unable to
function, so when I meet someone, they are very much in the worst part of life. It is very difficult
because you are dealing with raw human pain, and so to see them through, and I always tell
them, whatever you go through you put to work for you, no matter how difficult it is in life. No
matter what loses and what challenges, if you have to go through it you will be better for it. And
thats something that Ive learned from my own, and having been there, it helped me understand
that there is a way out of that and that there is a light at the end of the tunnel. To see people
coming from that despair, and I often tell them that we are not only going to just get back to
where we were before, we are going to get better, because whatever we were before allowed us
to take such a dive. If we could be aware and we could understand, then we could help
tremendously not to have the faults that we sometimes inflict on ourselves from how we handle
the pain. At this time in life, to me, my patients are like my family. I have a three-generation
family by now and they all have their history and weve been together through that history. It
means that its almost like raising a child. You get them when theyre helpless, and then you see
them thrive and do better. That is as simple as I could put it.

Megan: What was your goal in becoming a psychiatrist?

Dr. Triana: My goal was to understand. I wanted to understand what we humans do that cannot
be understood. I guess my accomplishment that sometimes it is very hard to understand because
we are so different and there is no complete total answer. At first I was defiant. I guess Ive been
defiant all my life. In a very good way. I question; Im skeptical, but I am even skeptical of
skepticism which makes me comply and consider things, which is a good thing. At first, I heard
all these things that didnt make sense. How can the mind affect your body? How can all these
illnesses be a result of course of genetics, and the lifestyle you carry, butyou know your stress,
your fears, your passions, all of that affects your body. And at first I was like this sounds like a
little bit too far of a reach, but eventually I realized how consistent that was that we have such
an influence on who we are and who we become. Thats a little bit of that.

Megan: How do you go about diagnosing and treating your patients?

Dr. Triana: Okay, good question. When I first see a new patient, I have a general questionnaire
that is made based on all the things that we use to make different diagnoses. Whether its just
plain depression, all the symptoms of depression, sleep, eating, energy, exercise, all the simple
things of that. It also includes how we diagnose the anxiety, how we diagnose post-traumatic
stress, how we diagnose attention deficit disorder, obsessive compulsive disorderthose are
traits that we carry with us. They are not necessarily illnesses. Sometimes they are, but all of that
influences the bottom line. I have them come in one hour before I see them and they complete all
these tests so when I see them, I have a lot of information on where they are in life, childhood,
education, what they have done or not been able to do, where theyve been. That gives me a big
shot, and I get one hour to evaluate all those things and then come up with a diagnosis. We have
several criteria to come up with a diagnosis. The first one is based on the main psychiatric
disorder diagnosis, the others are made on personality disorders, temperament, and its hard on
the first try to get that one. Thats a lifetime trait, but you get an idea. Then the third one is
medical conditions. Medical conditions, like I said before, affect our functioning and
medications affect our functioning that were taking for whatever disorders we have. The fourth
and fifth criteria are the severity of the stressors that theyre going through. If theyre going
through a divorce, if theyre going through the death of a loved one, if theyre going through a
financial crisis. So that tells me what other factors externally are influential. The last one is the
level that theyre functioning. Some people are just moderately affected. They can still work;
they can still function. Some people cannot even eat or do anything. That is the basis for the
evaluation. After the interview and the examination, I have pretty much an idea of the diagnosis
and what factors are influencing the current situation and then I proceed to make a diagnosis and
to present a treatment plan.

Megan: What is a typical treatment plan like?

Dr. Triana: It varies obviously, depending on the situation. But there are two things that I tell
people are their best medicine. If theyre not sleeping, theyve got to sleep. If theyre sleeping all
the time, thats a problem too. I need to address that. That and exercise. I want my patients dead
at night, and fully alive during the day. I dont like zombies. I dont create zombies. I dont
create addicts. Usually theyre not exercising, theyre not eating, theyre not taking care of
themselves, or theyre eating themselves away and now theyre depressed because theyre
fiftyone hundred pounds overweight. We address some basics. Then we go, if there are other
things that theyre doing in their life, that gets addressed. Then ultimately it is what medications I
would propose, if any, to address the immediate issue. You cannot tell someone that cannot
sleep, you need to sleep. I address that, they go to sleep. That is my number one concern. If
theyre sleeping all the time I tell them You cannot sleep during the day. You have to walk. You
have to do something until nighttime and then you can collapse. Depression can manifest in
either one so thats very, very interesting.

Megan: Do you have any advice for us in school, or even social and extracurricular activities?
Dr. Triana: Thats really important. You have to maintain your academic life, and you have to
maintain the extracurricular life because you have to preserve yourself. The demands of
undergraduates are a lot and if you have any interest in going beyond, the demands will become
much more. You really have to have a regimen. I was blessed with being a disciplinarian and
having self-discipline. You have to do what you have to do. You have to take care of yourself
physically, you have to eat healthy, you have to sleep, you have to exercise. Basic points. You
have to have a regimen. Thats not Oh I havent exercised in a month I should go walking. No.
You need in that schedule to have time for all of those in a regular, disciplined manner. Take
care of your needs. Your needs are physical, which I just mentioned, your needs are intellectual.
You have to have something that get your mind off. I have this test tomorrow I remember in
medical school, I had my third child two days before medical school started. I dont recommend
it. Dont do it, but there were times I thought if I dont eat, if I dont sleep, if I dont go to the
bathroom, if I only study from here until Friday, I cannot cover all this material. There is no way
I can cover that material. Then you learn how to.. you have to choose well what youre going to
highlight and how youre going to get through it. Then you light up a candle and you pray. And
somehow by the grace of God, you make it without flunking a year. That was totally by the grace
of God. I dont know if you believe, but for me, I couldnt have done it. A child crying at
midnight when you go to bed, and you have to get up 20 minutes later, and thats hard. So
anyway, I think that if you I had a tremendous determination, just like how I didnt want to go
to school, I had a tremendous determination to finish. Im hard-headed and stubborn, and that
comes in handy. You use that for good things, not bad things. All of our traits we can put to work
for us. Physical, you take care of it. You have to allow for some distractions, some fun,
something that youre not an undergraduate student, youre not a medical student, youre not a
biology teacher, or whatever youre going to be, for yourself. Mentally, physically, spiritually. I
dont care if you do or dont believe, I see atheists and I see everybody. We usually dont have
anything that should give us away. Thats one of the things that is expected. You dont see
pictures in a psychiatrists office of families or crosses or things like that because when I take
someone, it doesnt matter where they are. It doesnt matter about anything I believe in. it is
where they are, what they believe, what they feel, what they think it is. And I have to be in that
place with them and I dont want them to think that I cannot be in that place with them. For you,
I definitely recommend that you have to set up what your regiment is going to be that is going to
work out. For me those three criteria, physical, emotional, intellectual, and spiritual, four,
because theyre different. You have to allow for a little bit, otherwise you become just a
computer in your classes, and that is not you. Youre a compounding, integrating being, and you
need to preserve all of those. So whatever your regiment is, whatever youre doing, you need to
make sure youre nurturing every one of those aspects of yourself.

Megan: Thank you. Thats all I have for these. Do you have anything you want to add on?

Gisela: Lets talk more about biology. As far as diagnosing and the physical differences between
someone thats a recovering alcoholic or something, what in their brain makes them different
than someone who doesnt have those addictions?

Gus: Are there certain environmental factors? Other external factors that might push some
people?
Dr. Triana: Well you had to strike a good one. I can tell you what is generally believed. Again,
back to that interphase of body, mind, and soul, we used to call is a psychosocial biological
model. Many years ago, we used that word, now we dont use it anymore. What do I believe?
This is still a big conundrum. It is known that genetics is a very important factor. It is important
not just in addictions such as alcoholism and drugs, it is a factor in a lot of things. You see the
traits, and sometimes the skipped generation. Its the grandchild that comes. It applies to
everything from schizophrenia to anxiety disorders to depression, bipolar disorder, so there is
definitely a genetic component of who we are that predisposes us to be something. Now things
we know, Asians have a gene that they cannot metabolize alcohol well. You see a lot of Asians
that if they take a drink, they get red, or they get hot, or they dont drink. So I think thats very
protective, because if you cannot handle it I could never handle it and Im not Asian. What
alcohol does it not good for me. I like my head clear and in place, but thats me. Im very
protected. But it does something for some people that makes them feel good. It is legal, it is
available, so it is a little curse, because if you know something that you take, and youre not
breaking the law if you use it properly, and it makes you feel good, its very hard. Thats where
you really need to think hard of what youre doing, because thats where people become addicted
because they dont know how to function without feeling better so we have to be very careful.
The bottom line is that we dont know. I have treated alcoholics for all these years, or drug
addicts. Ive had people that have lost everything. They get back into sobriety. For 15 years they
dont touch it. They come back to life. They get a job. Theyre doing great. Something somehow,
that is not even clear, its not a big stressor, but something happens that they start drinking and
before they know it theyre back into where they cannot function without it. And before you
know it, the husband is saying shes not functioning, shes home all the time. To me, how you
can lose your life to something that you have some control ofI mean we have cancer, okay.
There are a lot of things we have no control of. But how can you put something in your mouth
that is going to make you lose everything is irrational. So when I talk to alcoholics, and I ask
them how can I understand, help me understand how this can happen. How can you turn in
everything you have earned, gained, worked for? Because their life gets destroyed. I ask them
and there is no answer. There understand what is costing them and they dont care and that goes
beyond any understanding. When youve had them cured, gone back, or when they start. To tell
you the truth at a human level, I cannot tell you this is what does it. Then you have people that
never drink again. You have children of alcoholics that will not touch a drink. For whatever
reasons, and they wont even try it. They say no. You have children of alcoholics that lose
themselves like their parents. How something can be so powerful that will totally drive any
sensible behavior or thoughtthats why the question is so hard and so difficult because to see a
life wasted for something you inflict on yourselfand you have parents of children that are well
to do and they cannot save their kids. They either give them the drugs to keep them home or they
send them away. Some of them survive or a lot of them show up dead. That is very difficult to
understand. Thats the hard part of the question that we cannot deal with.

Gisela: Can you just enhance a little bit more on your biology background/your undergrad? Did
you always know that you wanted to do pre-med or was there any opportunity to do research? Or
did you know you didnt want to do research at all?
Dr. Triana: I had no question when I started that I was going for pre-med as unlikely.. I mean I
would be embarrassed at 28 to say Im starting college and Im going to medical school so what I
told myself was that Im going to take one trimesterI dont like to fail so I was at least mindful
that the chances are limited, I had been out of school for 11 years and your mind goes to dodo.
You dont remember anything you read. So I said Ill give it one trimester and see how I feel. I
took one trimester. And then another one. And then another one. And then I realized I had never
taken chemistry. Back then in high school I didnt do a science track, so I never had chemistry or
biology or anything. I didnt even know what an atom was, literally. I said gosh if Im going to
do this in four years I have to do my chemistry. I need two years of chemistry. So I went and I
talked to the professor and said, Can I have an A on the second trimester if I havent had
chemistry. And he said No. So I took it. And I was the highest grade in the class. But I got
myself a tutor. I did not know what the heck was going on. I probably did not know all the
information I needed to know at the end but I learned how to past those tests, and I got through
with As because it was not only passing the course. If you got into medical school, you have to
get the darn A. That was the challenge. I was always a pre-med intended pursuit, unless I
couldnt do it. I didnt do research until my residency. Some students might do, in the summer,
some internship with someone, but when you have a baby and teenagers, there is no room for a
lot of things. So I never did research until residency. We researched when people hallucinate and
theyre bilingual, did they hallucinate in their first language or second language. That was an
interesting study because supposedly the brain, and when we talk about the brain, most things are
supposed. There is a lot of hard data now, but still were soft. We dont do biopsies on the brain.
We still dont have our hands on the brain like we do most organs. So its mostly post-mortem,
but that was interesting. My thing was with people. I wanted to deal with humans. And research
is a lot of humans, but its so mechanized. And then you have the statistics and you have so
many variables that its almost like youre fighting a political fight to get approval for your
research project and then you do that and to see all these variables that make null and void the
date. that was not any of my inclinations. It was the patient contact that probably attracted me
most.

Gisela: What made you choose the biology major in comparison to something different but
common for pre-med students? Such as chemistry, or psychology, or biomedical engineering.

Dr. Triana: I think biology for me was the quickest was to get all my credits. At the time it was
90 credits for the requirement. It was a matter of numbers. I could do biology and for me it was
the easiest between physics and mathematics you could do any kind of major. You could do
language, you could do literature. Anything is going to help you. I think literature and on one
school of thought is to do some history and literature because youre going to be so flooded with
science that you will really miss not having the background and you will be amazed at how bad
some doctors misspell things sometimes so you need to cover your basics.. I did like physiology
and anatomy and all of that I took a microbiology course and that one, being OCD, and we
often say you have to be OCD to go into medicine, or if youre a CPA, if youre a pilot, because
we check and we check and we make sure. We want things the way they are. That becomes a
requisite. No big reason, just numbers.