Dr. Adam Stivala is a staff psychiatrist at Waianae Coast Comprehensive Health Center in Hawaii, as well as locum tenens psychiatrist (a temporary doctor who fills in as needed) at Hawaii State Hospital. A 2016 graduate of American University of the Caribbean School of Medicine (AUC), Dr. Stivala did his general psychiatric residency in Elizabeth, New Jersey, before completing a child and adolescent psychiatry fellowship in Honolulu. Since earning his Doctor of Medicine (MD) degree at AUC, Dr. Stivala has also served as a reservist in the United States Army Medical Corps — where service members address him as Major Stivala. Before he was a medical student, Dr. Stivala worked as a physical therapist and a teaching assistant while also volunteering in a number of ways. We reached out to Dr. Stivala to learn more about his fascinating and varied history.
Q: You have been around, we’ll say. Where did you grow up?
A: I’ve certainly been around! 😂 I grew up on a small alpaca farm near the Jersey Shore, close to New York City, so I had the luxury of beaches, farmscapes, and city nightlife. I started working on farms at age 13, and I learned the value of service, community, and hard work from a young age. I attended Syracuse University and was fortunate enough to be on the Men’s Heavyweight Crew Team and compete with other Division 1 schools across the country, as well as the Henley Royal Regatta in the United Kingdom. I started to realize the relationship between physical health and mental well-being in college and have stayed vigilant with exercise throughout my life.
Q: How does life in Hawaii compare to Sint Maarten (the island home of AUC) — or anywhere else?
A: Hawaii and Sint Maarten have a lot in common, including the laid-back island lifestyle, great beaches, and beautiful food and culture. Hawaii has an ethnically diverse but predominantly Asian and Pacific Islander population, while Sint Maarten is a mix of many people, including Dutch and French. Certainly there are differences from the mainland United States, including sourcing essentials and remoteness, but life is good in both places. Hawaii has better surfing, but Sint Maarten, for sure, has better croissants. 🙂
Q: You treat psychiatric outpatients at Waianae Coast. Was psychiatry always your specialty goal?
A: I came to AUC with an open mind, fully pursuing all specialties during my third- and fourth-year rotations. However, I found psychiatry “easy” — not from a standpoint of workload or patient care, but rather because the effort I put in seemed minimal compared to other disciplines; I was always happy to stay and learn more, even after hours. I loved the ability to hear about a patient’s life story, as well as the amount of time I was able to talk to them about their concerns and symptoms. I did expect to segue into physical medicine or physiatry with my physical therapy background, but I was, and still am, enamored with the pathology, treatment, and continuity of care in psychiatry.
Q: What are the differences between inpatient and outpatient psychiatric services?
A: Inpatient services deal with acuity of illness and psychiatric stabilization; outpatient is generally for patients who are psychiatrically stable in the community but are struggling with such common dispositions as mood changes, anxiety, relationship issues, or substance use. I prefer inpatient and emergency settings because of the variety and complexity of presentations and symptoms, but outpatient care can also be very rewarding because of the impact you can help make on a patient’s day-to-day life, as well as your scope of practice. For example, in Hawaii, because of a lack of providers, I may treat three or four children in the same family on an outpatient basis. At Hawaii State Hospital (a mental health clinic), through transitional placement programs, connection to the land and people is important for recovery, and surfing or farming taro (a Pacific Island root vegetable) may serve as therapeutic modalities.
Q: Waianae Coast has something that most hospitals do not: the Native Hawaiian Traditional Healing Center. How does Native Hawaiian healing apply to psychiatry?
A: Waianae Coast is one of the few hospitals in Hawaii to utilize such services. The Native Hawaiian Traditional Healing Center promotes traditional Native Hawaiian healing and cultural education, practices, and traditions. Primary practices include lomilomi (Hawaiian massage therapy), la‘au lapa‘au (herbal medicine), la‘au Kahea (spiritual healing), and ho‘oponopono (conflict resolution). They are designed to work in conjunction with primary and specialty clinics to foster care and continue the legacy and culture of Native Hawaiian healers.
Psychiatric care and behavioral health is holistic, meaning it is not just about taking a pill or learning a coping skill to feel better. The best treatments are multifactorial and the Hawaiian healing center incorporates these practices for optimal prognosis.
Q: What drew you to child and adolescent psychiatry?
A: It may sound awful, but working with adult patients can sometimes be frustrating. I found I was trying to help adults with problems or habits which could be years or decades in existence and not easily changed by a few treatment sessions or medication. With children and adolescents, you have the ability to help them early in their lives so that they may not need behavioral health services in the future. Medications are usually not the first line in child psychiatry, and it’s my role to inform kids and families of their options as well as any treatment risks or benefits. It’s also easy for me to empathize with my young patients. Like many teens, I struggled with such adolescent issues as self-image, mood swings, and feelings of worthlessness, but I never sought treatment because I thought those feelings were normal — which they should not be. Altruistically, I wanted to ease the suffering of others with lessons or examples from my own experiences.
Q: How does the treatment of children and adolescents differ from treating adults?
A: Children and adolescents are not “little humans” — a misconception that can lead to poor clinical care and even malpractice. Besides such biological processes as brain development and hormonal fluctuations, young patients also go through formative stages to become adults. Erik Erikson (a child psychoanalyst known for his theory on psychosocial development) postulated that five of the eight stages of human psychosocial development occur in childhood and adolescence. Failure to resolve any of these stages can lead to abnormal conditions later in life, which is why it’s so important to not only provide behavioral healthcare when needed to children and adolescents, but also to provide nutrition, education, and a caring, loving environment.
Q: What are some common childhood mental disorders? What are their symptoms?
A: In both inpatient and outpatient care, the most common problems stem from parent-child relational difficulties. This an antiquated diagnosis but relevant nonetheless. Symptoms include anxiety, depression, insomnia, and/or irritability. Problems arise from communication issues, addiction to cellphones or gaming, and oftentimes, an untreated pathology in a parent or guardian. I see attention-deficit/hyperactivity disorder (ADHD) being overdiagnosed by undertrained clinicians who may not take the time to listen, and unfortunately, a lot of children are placed on stimulants rather than trials of therapy or skill building. Medications can cause adverse effects and lead patients to believe that they are improving because of a pill rather than because of their own inherent resolve and work ethic. Personality disorders in children are often underdiagnosed because of the associated stigma, allowing the continued development of problems into adulthood. I also often see “bipolar disorder” misused. It’s OK to be snappy or have an attitude; just take ownership and responsibility and don’t blame it on a “disorder.” 🙂
Q: How can childhood mental disorders be prevented? How are they treated?
A: Universal preventative care for behavioral health has come a long way in the last several decades. If anything, psychiatrists, therapists, and support workers are busier now than they ever have been. This stems from the increased awareness — and decreased stigmatization — of behavioral health treatment. Despite this awareness and national- and state-level efforts, teenage suicide and other such indicators are still on the rise. Researchers postulate links to social media, a double-edged sword for both kids and adults. First-line treatment for any child or adolescent usually involves individual or family therapy, which can resolve the majority of issues or at least lessen symptoms for the patient and family. Medications can be a great asset for treatment, but so can exercise, community connection, and religion for a lot of children and families.
Q: What was your experience as a mental health professional during the COVID-19 pandemic?
A: Hawaii has six major islands, so as a fellow in the child and adolescent psychiatry program, we were already relying on telemedicine when the pandemic struck. Working from Oahu, we provided virtual services to patients on neighboring islands. Hawaii, of course, is usually filled with tourists. But Hawaii had strict COVID-19 quarantine rules, and it was surreal to see Waikiki and other tourist spots completely empty and serene on a daily basis. We were all somewhat scared in the early stages of the pandemic, but as healthcare professionals, we were all willing to do whatever we could to help — despite limited resources and information. We were physically separated, but I still built great and lasting relationships with patients, colleagues, and friends during this time.
Q: What are the biggest mental health challenges now, in 2024 — particularly for children and adolescents?
A: Social media continues to be a blessing and a bane. It provides for improved outreach, correspondence, and resources to patients and their families, but it remains a concern for parents regarding online exposure, addiction to devices, and cyberbullying. The majority of children, teens, and adults I treat have some sort of symptomatology, social media related or not. It's imprudent to blame everything on social media or to feel that the world is doomed because of it.
Finding local positive role models — not social media influencers — is inherent to preventing a lot of the issues that young people face. And quality school and family time is crucial: a child or teen may see a psychiatrist or therapist once a month for a couple hours total, but they are in school with teachers half of every weekday, and the majority of a kid’s time is spent with family at home. For optimal prognosis, our work must accordingly expand from the individual patient to include school and family dynamics. At home, parental challenges include finding the optimum amount of quality time with children (not too much or too little); care dynamics involving multigenerational families; and having too little bonding time with a central figure. And limit that screen time.
I must say that I see a huge uptick in ADHD diagnoses, driven in part by uninformed Google searches. Most times, these supposed “ADHD” symptoms are instead a combination of poor self-esteem, anxiety, procrastination, or a learning disorder, and they don’t require medication. Some extra help and better practices at school or at home, however, can work wonders.
Q: Are certain mental health problems unique to Hawaii?
A: Access to resources can be a challenge in Hawaii. For example, I have seen children on neighboring islands (via telemedicine) who live in homes without running water, or homeless patients who live in encampments near the beach. We also have a large Asian population in Hawaii, and mental health is still stigmatized in certain Asian cultures. A child or teen may be willing to engage in treatment, but sometimes the parents are not. Also, many languages are spoken in Hawaii, and even the best translations may still impair clinical practice.
Q: What led you to join the Army Reserve during residency?
A: My father and grandfather were both in the Army, so I always felt a sense of fealty, but I do love our country, and respect the sacrifices made by those before me, and wanted to give back in some way. Also, they promised some pretty hefty bonuses and student loan repayment. The opportunity to serve but also do cool Army stuff was really enticing. I’m a doctor, but I’ve thrown live grenades, jumped out of helicopters, and worked alongside amazing service members. I’ve also received all-expenses-paid trips to Alaska, Texas, and the Middle East. 🙂
Q: What demands does the Army Reserve make on your time? Will you recommission after your service obligation ends next year?
A: We drill one weekend per month, which can entail physical training, educational briefs, or specific skills for medical corps soldiers. Deployment for my specialty is usually about 90 to 100 days every three to five years. I have really enjoyed being a part of the armed forces and serving my country, and I will consider continuing next year. It would be cool to be a colonel (a rank up from a major), but it was really disheartening to be away from my family and friends over this last holiday season.
Q: Who are your patients as an Army physician? How has that work differed from your civilian jobs?
A: Depending on the location, the patients can vary significantly. Some bases service all branches of the military and their dependents, or civilian employees working with the military. In the Middle East, I would see soldiers fresh from combat zones. It’s different to hear about a drone strike on U.S. troops or service members being injured on the news as compared to talking with these soldiers first hand. They would come through our post before redeployment or going back home. Sometimes the work was difficult, hearing of or seeing casualties and injuries, but you realize that not only are you a physician providing an essential service, but you are also a fellow soldier and have a duty to your comrades and country.
Q: You were a physical therapist before becoming a physician. It seems a logical if giant step, but what pushed you on to medical school?
A: I majored in finance and marketing in college, wanting a stable career and job security, and never thought I was smart enough for any healthcare profession. After I discovered physical therapy (PT), I worked at a PT clinic while taking community college classes at night. I worked in a rehabilitation hospital in Miami after PT school at the University of MiIami. I met a lot of doctors and thought, “their job looks fun, how much harder could medical school be?” Well, I would say like, five times as hard as any schooling I knew, haha! But looking back, medical school was enjoyable, and it was a privilege to be able to study medicine in this day and age with the advances in science.
I took a risk going back to school, then residency and fellowship, which took almost one-quarter of my life (at this point) to achieve. But I’ve never regretted the decision. I’m able to utilize the skills I’ve learned to positively impact the lives of my patients and their families.
Q: You volunteered at a field hospital in Haiti after the devastating 2010 earthquake. How did that experience affect you?
A: I was fresh out of physical therapy school in Miami, and our proximity to Haiti certainly made the tragedy more relevant. Project Medishare for Haiti (based in Miami) was pioneered by a colleague, Dr. Barth Green, in efforts to improve quality healthcare access for Haitians. There is a large Haitian population in Miami and I spoke a tiny bit of Haitian Creole, so I felt obligated to volunteer. The situation was dire upon arrival in Haiti, but the spirit of the people was unwavering. My only regret is that I couldn’t stay longer to help. I saw the limited impact I could make as a physical therapist, and I wanted to learn more in order to contribute on a larger scale. This was a primary reason for applying to medical school.
Q: Marathons have been a big part of your life. Do you still run?
A: I started running regularly after college, as I wanted a simple exercise I could do almost anywhere, but back then even four miles seemed far. I ran my first marathon in New Jersey in 2007. It was painful but rewarding, and I realized I could stay in shape, eat whatever I wanted, and set long- and short-term goals with races around the world. The best year of marathons I had was my third year at AUC while in clinical rotations at Stepping Hill Hospital in Stockport, England (near Manchester). I ran eight marathons in eight months in eight different countries — and on a limited budget! It was one of the best years of my life.
I have also volunteered as a pace leader for marathons, partly because of the leadership aspect, but also because race entry as a pacer is usually complimentary. Marathons are about health, wellness, overcoming your own personal limitations, and belonging to community. They used to have beer at the finish line, too (I’m looking at you, Chicago Marathon.)
Q: It’s only been eight years since you earned your MD at AUC, but in many ways medical school must seem like a lifetime ago. Do you keep in touch with any faculty or friends from Sint Maarten?
A: I speak with my AUC classmates regularly, usually about how old we are getting to be, how much student loan debt we still have, or how fast kids are growing. Rarely do we talk about our careers, but I have provided many curbside consultations to classmates and their families, usually while they are under duress. If anything, I’m amazed at how accomplished my classmates have become, not only with careers but in their personal lives as well. Faculty and staff from my time at AUC continue to be an inspiration, from clinical pearls to their purveying their passions from their careers. Eight years is a long time, and I like to think I’m more mature, intelligent, and funnier than I was in 2016 — but it’s probably the opposite.
Q: Thinking back on when you applied to medical school, what steered you toward AUC?
A: The match rate with residency programs was enticing. I applied to three Caribbean medical schools, but AUC won out, partly because Sint Maarten had direct flights to New York City and Miami. (My family is close to NYC and I was living in Miami at the time.) It’s no secret to my classmates or professors at the time, but I was actually still working PT on weekends and during breaks in class at AUC! I would fly to Miami, make a bit of cash, then come back to school on Monday.
Really, though, I decided on AUC because of its sense of community and its welcoming faculty and staff. Living in Sint Maarten was the icing on the cake. All my colleagues from my graduating class look back on their time on the island fondly. No matter how deep in studying you were, there was something for everyone at AUC or in Sint Maarten that you could enjoy, whether it was the beaches, the food, volunteering, community, or classmates. The casino next door to AUC was pretty sweet, too.
Q: What did you enjoy most about being an AUC student in Sint Maarten?
A: AUC faculty members definitely influenced the way I practice medicine, changed the course of my career path, and they even made lectures enjoyable. Drs. Tisdall, Van der Waag, Warner, Nwosu, Berisch, to name a few, will hold a place in my heart as long as I practice medicine. I regularly use several jokes I’ve stolen from them. The staff at the Sint Maarten and Miami offices were also always prompt and friendly.
I was among several iterations of the Sint Maarten national anthem group; I would play the guitar for our trio or quartet. I tear up when I hear the anthem, which isn’t often, but it’s a gentle reminder to cherish simple moments in life.
Q: Finally, many potential and current medical students will be reading this interview. Have any words of advice for them?
A: If you have any inclination or desire to apply for and attend medical school, just do it. If you try and don’t succeed, at least you’ll know you gave it your best effort, which is better to live with than the feeling of regret from not chasing your dreams.
Thank you, Dr. Stivala, for sharing some valuable life experience with us! To learn more about mental health, visit the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), and when the calendar flips to May, see what you can do to further the cause of Mental Health Awareness Month. The CDC, too, has excellent tools and resources for anyone who may be struggling with a mental health crisis.
At AUC School of Medicine, our students have moved on to psychiatry and many other types of medical residencies. Our 2023–2024 MD graduates achieved a 98% first-time residency attainment rate*, and are now beginning their postgraduate training across 22 specialties. If a career in medicine interests you, learn more about AUC and our medical sciences curriculum, as well as the requirements for admission.
*First-time residency attainment rate is the percent of students attaining a 2024–2025 residency position out of all graduates or expected graduates in 2023–2024 who were active applicants in the 2024 NRMP match or who attained a residency position outside the NRMP match.