360° Health: When Identity Shifts - How changes in the self-affect the nervous system, mood, and meaning
Mon Feb 02 2026
FOUR TALKING POINTS
Why people can feel anxious or low even when nothing is “wrong”Many people come in saying, “My life looks fine, but I don’t feel like myself anymore.” From a psychiatric perspective, this often happens when the way someone understands themselves, their role, or what gives life meaning begins to shift. The brain and nervous system are built for predictability, so when that internal sense of self changes, distress can emerge even without an external crisis.
What the “in between” phase actually feels likeThere is often a confusing period where old motivations stop working, new ones have not formed yet, and people feel untethered. Common experiences include restlessness, emotional flatness, rumination, social withdrawal, or a quiet fear that something is wrong with them. Because most people lack language for this phase, they often interpret it as failure or illness.
How a holistic psychiatric perspective looks at this differentlyRather than focusing only on symptoms, I look at what is happening across the whole system. That includes mood, nervous system regulation, sense of identity, life context, and meaning. Sometimes medication is helpful, and sometimes it is not the primary answer. The goal is to understand what the symptoms are responding to, not just to suppress them.
What actually helps when someone is in this phaseOften the most helpful first step is not fixing or forcing decisions, but creating stability. This includes calming the nervous system, reducing pressure to have immediate answers, and helping people understand what is happening so they do not panic or overidentify with a diagnosis. With the right support, clarity tends to return over time.
SHORT BIO:
Dr. Sarah Hollander is a board-certified psychiatrist, writer, speaker, and founder of Psychiatry of Life. She focuses on how identity shifts affect the nervous system, mood, and meaning, and how psychiatric symptoms often emerge during periods of self-identity change. Her work integrates evidence-based psychiatry with a holistic, existential perspective.
Links:
website: www.psychiatryoflife.com
LinkedIn: www.linkedin.com/in/sarah-hollander-md
Substack: https://substack.com/@psychiatryoflife?utm_campaign=profile&utm_medium=profile-page
Instagram: https://www.instagram.com/psychiatryoflife/
As seen in KevinMD: https://kevinmd.com/2025/12/joy-in-medicine-a-new-culture.html
The ideas in this article evolved from an earlier podcast conversation exploring these themes: https://open.spotify.com/episode/1Bs2dxPy0LHLjyfHptdmNx
Plenty of Positivity podcast: https://www.youtube.com/watch?v=HelUqQgHhic
Support the show: http://www.cooleyfoundation.org/
See omnystudio.com/listener for privacy information.
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FOUR TALKING POINTS Why people can feel anxious or low even when nothing is “wrong”Many people come in saying, “My life looks fine, but I don’t feel like myself anymore.” From a psychiatric perspective, this often happens when the way someone understands themselves, their role, or what gives life meaning begins to shift. The brain and nervous system are built for predictability, so when that internal sense of self changes, distress can emerge even without an external crisis. What the “in between” phase actually feels likeThere is often a confusing period where old motivations stop working, new ones have not formed yet, and people feel untethered. Common experiences include restlessness, emotional flatness, rumination, social withdrawal, or a quiet fear that something is wrong with them. Because most people lack language for this phase, they often interpret it as failure or illness. How a holistic psychiatric perspective looks at this differentlyRather than focusing only on symptoms, I look at what is happening across the whole system. That includes mood, nervous system regulation, sense of identity, life context, and meaning. Sometimes medication is helpful, and sometimes it is not the primary answer. The goal is to understand what the symptoms are responding to, not just to suppress them. What actually helps when someone is in this phaseOften the most helpful first step is not fixing or forcing decisions, but creating stability. This includes calming the nervous system, reducing pressure to have immediate answers, and helping people understand what is happening so they do not panic or overidentify with a diagnosis. With the right support, clarity tends to return over time. SHORT BIO: Dr. Sarah Hollander is a board-certified psychiatrist, writer, speaker, and founder of Psychiatry of Life. She focuses on how identity shifts affect the nervous system, mood, and meaning, and how psychiatric symptoms often emerge during periods of self-identity change. Her work integrates evidence-based psychiatry with a holistic, existential perspective. Links: website: www.psychiatryoflife.com LinkedIn: www.linkedin.com/in/sarah-hollander-md Substack: https://substack.com/@psychiatryoflife?utm_campaign=profile&utm_medium=profile-page Instagram: https://www.instagram.com/psychiatryoflife/ As seen in KevinMD: https://kevinmd.com/2025/12/joy-in-medicine-a-new-culture.html The ideas in this article evolved from an earlier podcast conversation exploring these themes: https://open.spotify.com/episode/1Bs2dxPy0LHLjyfHptdmNx Plenty of Positivity podcast: https://www.youtube.com/watch?v=HelUqQgHhic Support the show: http://www.cooleyfoundation.org/ See omnystudio.com/listener for privacy information.