Month: January 2011

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Say, “I Can’t Control This” When You Can’t

Playing in the Sink

Image by Paul Mayne via Flickr

Self-Care Tip #169 – When there is negative chaos, remember and say, “I can’t control this.”

Carol had worked there for seven years.  The supervisor had just asked her for more hours and Carol felt almost good to be able to say she didn’t have any more to give.  Yet when Carol got the email that her job position was closing in a month, she was physically affected.  Her autonomics (“fight-or-flight” reactions) were on full alert.  If there was an attacking bear, she might have out run him.

Healthy Carol had been to enough 12-Step meetings to remember, “I can’t control this.”  She said it a few times and turned it over to her Higher Power.  She did not crave or relapse in her addiction’s disease.  Her pulse was still fast and her hands were still tingling for the next several hours but she didn’t “use.”  She went to her meeting and she pushed on.

When Carol thought about her future and the things she could do to prepare, she inevitably thought about the things she couldn’t do.  She said,

I can’t control this.

When Carol imagined what other people would think after hearing about her unemployment, she said,

I can’t control this.

In mental health we struggle with that a lot.  The emotions that grow self-loathing, the behaviors that distance us from our support and loved ones, and/or the physical changes that keep us from performing – are all confusing.  At what point do we say, “I can’t control this?”

I remember a Seinfeld joke about water faucets in  public bathrooms.  The ones that you have to hold down to keep the flow going.  I’ll spare you the misery of me trying to retell it and get to the point.  Why do they have those faucets?  It’s as if they think people will have a water party in there or take free sponge baths if they could turn the faucet on long enough actually to wash their hands.

baby elephant | playing in the water

Image by Adam Foster | Codefor via Flickr

When we say something like “I can’t control this” to the idea of emotions and behaviors, the general fear is that people will take wild liberties, – splashing emotions around and behaving like elephants after the summer Serengeti drought ends.  Mayhem will ensue and the staunch healthy-minded with dry pants will have to clean continually after us.  Not many people want to be sullied by the emotions and behaviors of others and this, “I can’t control” business is a boundary issue.  Maybe stigma is one of the ways we change out the faucet on others.

There are some very primitive characters and severely ill people who might say in fact that they cannot control all feelings and behaviors.  This is more than most of us armored with some healthy coping skills would believe or say.

“I can’t control this,” is not a free pass to vandalism, vengeance, volley-ball or any other very vexing behavior.  It is not there to hand over like a ticket to other people for their excuse, justification or condolence of our situations.  It is there for us to hold up to ourselves for the purpose of honesty, submission to our Higher Power, humility and healing.  No one can control the flow out of that.  That is free self-care.

Questions:  When have you felt like you had to explain to others your behaviors and feelings even when you didn’t have an explanation?  How did you bring it back “home” to your own self-care and get past the stigma?  Please tell me your story.

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Choose Self-Care At Your Most Elemental Level

Buchenwald-100625-14486-Schwerte-hell

Image via Wikipedia

Self-Care Tip #167 – Choose self-care at your most elemental level.

Carl, who writes blog-site, StillFugue, said after yesterday’s post on self-care being for everyone,

Sometimes depression blocks this type of self-care regardless of how good our cognitive strategies are.

Carl reminded me of Dr. Lang.  He was a physician, a father, a man of high character who never had depression in his life.  Then after a series of life stressors depression expressed itself and he, who once was the warm-fuzzy in the hospital, the man who never lost his optimism, the man who turned anyone’s bad mood around – this man came to me under a black cloud, heavy with melancholy, and raining tears.  He cried all the time.  This giant of a man cried and cried on his wife’s shoulder, and she was bewildered by him.  She told me he had done this for a month now, although the depression started about four years ago.  He kept wanting her to read to him the book of Job and cried more barely hearing the words.  He had already been through a series of well-chosen medications, but still he sank deeper.  No form of treatment kept up with the leak in his ship.  What was self-care for Dr. Lang?

Did Dr. Lang have good coping skills?  Well he wasn’t coping well now even though he knew the strategies.  He didn’t understand why he couldn’t use the coping skills.  Did he have intelligence?  Yes.  Did he have resources?  Yes.  However, none of that is what this was about.  Asking Dr. Lang to cope with his feelings is the same as asking someone blind to see.  Physically, biologically he could not.  His brain could not.  Much of his ability to choose behaviors and emotions were drowned by illness.

So again, the implied question comes to us, – “Is self-care for everyone?”

Mr. Rick C. threw this life-saver out in response to our question,

During times when chaos ensues, either internally or externally, self-care seems to become the basis on which all other positive actions are built.

Sarah McGaugh also referred to self-care as “action,”

A call to action may also be a higher calling than one’s own self….

What action did Dr. Lang do?  He cried on his wife’s shoulder and read the Bible, i.e., he leaned on the support he had built up before the hard times came.  After failing medications, he sought another opinion and other treatments.  Sure, he couldn’t get out of bed otherwise even to bathe himself, but he had made it to my office.  What did Dr. Lang do?  He got electroconvulsive therapy (ECT) and in two months, along with his medication (only one antidepressant was needed at this point), Dr. Lang was no longer crying.  In four months, he was laughing again.  In six months, he stopped ECT altogether and maintained his emotional health with his monotherapy medication.  It’s been seven years since Dr. Lang went through all that and he has not relapsed yet.

I pick out so many points that I consider self-care choices Dr. Lang made.  They changed over time for him according to his needs and abilities, but he didn’t want to die.  Even at his worst, when he could barely remember why life was so important, that wisp of hope was enough to live for.  It was a higher calling to him, higher than his own dark wants.

That was Dr. Lang’s choice.  He chose self-care at his most elemental level.  It was his response to the call of hope.

Questions:  But what about you?  What do you think?  Is self-care for everyone?  Please tell me your story.

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Self-Care is For Everyone, Regardless of Circumstance

Freedom from Want (painting)

Image via Wikipedia

Self-Care Tip #166 – To do self-care, believe that self-care is for you as it is for everyone.

How do we explain self-care to someone still in a deprived situation?  Deprived of freedoms the rest of us assume:  access to water, time, many choices, and so on.  Some time ago we talked about self-care being ours because we have freedom.  Because of democracy, we are free.  Because of those who fought and still fight for our rights, we are free.  Because of our essence, we are free.  We compared it to the Gettysburg Address of all things, and even when writing the blog-post, I was surprised that the correlation was so natural and right.

Carl, our dependable kind cynic, commented on the post Taking Care of Yourself is The Best Part of Your Treatment Cocktail:

Many I know can’t just do what they want to do.  Chained.  Chained by drudgery of work.  (You do not quit at the iron mill to become a poet, not in this economy.)  Chained by responsibility as family supporter.  Limited time and finances.  Limited by age or illness.  The best these people can do is try to find some brief periods of quality hobby or playtime.  Some have the tenacity to survive in spite of, as I did.  But facing the realities profoundly inhibit wellness, and depression deepens and immobilizes us on the worst days.

Many days I try to distill what self-care is and what it means, and it seems to change on me or grow another way just when I think I’ve got it.

…It is accountability for “Me” now and in the future.  It is not accountability for my past, for chaos or for the choices of others.

Image via Wikipedia

…It is freedom.  Personal freedom to say, “This is my body that God gave me and I will choose to take care of it.”

…It is working hard to do what is in the best interest of “Me.”  It is knowing these things may not come easily or naturally or by chance.  Self-care does not mean doing what is selfish or not in the best interest of others.

Is everyone free?  I think we’d all agree, no, in an immediate sense such as, “Freedom from want,” or freedom from mental illness.  But perhaps we might wonder together and even agree about an eternal sense of freedom that is unchanged by circumstance.

Should everyone work hard at taking care of himself regardless of circumstance?  Yes.

Is everyone accountable to himself?  I’d say it depends in which paradigm we’re talking about.

However we answer these questions, I don’t think we really have a chance at self-care for “Me” if we don’t believe it is for everyone everywhere.

Questions: What do you say?  How do you define self-care?  What about those who are limited and chained, as Carl described?

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If You Have Something Good That’s Happened, Say It

Self-Help Graphics

Image by victoriabernal via Flickr

Self-Care Tip #164 – If you have something good that’s happened to you because of your self-care, tell others about it.  Be a friend to yourself.

Have you ever heard of SparkPeople.com?  I’ve been a member for a few years and believe they are one of the most supportive networks out there for diet and lifestyle change.  Today I received this email from one of their bloggers and thought to share it with you.

From “GUITARGAL2”

Today is my one year anniversary on SparkPeople.  I have to admit this is the longest amount of time that I have ever spent focusing on me and my health.  A few things I have learned in the past year are:

1. I can lose weight be happy.

2. I can educate myself on a healthy lifestyle.

3. I have learned that when I slip up, refocus, refocus, refocus.

4. I have learned that I like being a runner.

5. I have increased confidence.

6. I like how my clothes fit.

7. I don’t need chips and dips to feel satisfied.

8. Captain Morgan is not my friend.

9. I can inspire people.

10. Having a support system makes the difference.

One year ago I wrote on my SparkPage, I can do this, and I have.

This is only one example, as described by GUITARGAL2, of what self-care has done for her, specifically through diet and lifestyle change.  All of our lists are different and powerfully inspirational to others when we share them.  It also comes back to each of us, as good things will do.  How does it comes back?  Well, I can’t try to explain that kind of magic.

Keep talking.

Question:  What list do you have for the things self-care has given to you?  Please tell us.

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Taking Care of Yourself is The Best Part of Your Treatment Cocktail.

IMAG0142

Image by schmeezla via Flickr

Self-Care Tip #163 – Taking care of yourself is the best part of your treatment cocktail.

We often talk about partial or failed treatment in medicine, in each other, in relationships.  But those are only about 40-60% of the time.  There are many people who get full treatment response to medication and self-care.  Mindy is one of them.

Mindy has seen me for about four years in clinic for her depression.  She’s never been very anxious, which is less usual as anxiety and depression tag-team so often.  Mindy’s depression had lurked in her, stepping out in the light and slipping into the shadows, for years even before she started working with me.  We seemed to hit by chance or skill the right medication cocktail that had evaded her, and she was not depressed anymore.  However, she never told me she was great.  She was “pretty good.”  She was, “doing alright.”  She was, “you know, good.”  Mindy wasn’t great.  She was good.  We spent three and a half years like that.

Then about six months ago, Mindy came in looking hot!  (I can say that because I’m a girl.)  She had lost the mom bumps around the midline, dropped padding in the hips, her hair wore a fresh coat of glossy brown, and I could tell her outfit hadn’t been worn more than twice.  Mindy was smiling and sincere when she said,

I’ve never felt better!  I had no idea what taking care of myself would do for me!

Her eyes were telling me their own conversation.  They were so expressive saying,

I can’t believe this is me!

Mindy told me in testimonial fashion, about the strangers who now noticed her.  Being noticed was an elixir and she was drinking it as often as it was served, but not in an arrogant way.  Mindy was still very human.  She wasn’t manic or grandiose.  She was doing what Gary Vaynerchuk describes in his book, Crush It!

“Do what makes you happy.  Keep it simple.  Do the research.  Work hard.  Look ahead” (p 12).

Mindy said,

I used to think that what I got from life was good enough; from my husband and from the people out there.  I didn’t know I could get this by just doing what I wanted to do for myself all along.

Mindy was still taking her medication cocktail and had no plans of tapering any of them.  She thought the combination of these medications that took her out of depression, along with exercise and other self-care measures were just right.  Mindy had not forgotten her years of melancholy and sadness even though it was now four years since.

Questions:  1) What is your reaction to Mindy and the 40-60% of people who get full treatment response?  2) Do you have any questions you wish you could ask the “Mindy’s” out there?  3) Or something to say for the other 40-60% of people who don’t get full treatment response?  Please tell me your story.

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“He’s Never Hit Me.” Abuse.

Self-Care Tip #163 – Name abuse when it is there.  Be a friend to yourself.

Alexandria (Alex) was crying a lot.  She was trying to divorce her husband but he wouldn’t leave.  He wouldn’t speak.  He only yelled.  He yelled at her, alone, in front of their kids, in the morning, when he came home from work, he yelled.  And he never spoke to her any more.  It’s been weeks since they spoke.  When I asked her if she thought she was abused, she said, “No.  He’s never hit me.”

Mar de Emociones / Emotional Landscapes

What do I do?  I can’t go on like this but everything I try, he won’t listen!

There are so many things many of us would tell Alex.  But would any of it make sense if she didn’t know she had rights?  If she didn’t know what was happening to her?  If she didn’t know, this is abuse.

The “Do You?” questions, per Dr. Quijada, to ask yourself if you aren’t sure if you are abused:

Do you feel good about yourself when you are together?

Do you feel scared?

Do you feel like you have choices?

Do you have effective boundaries; observed boundaries?

Do you say, “No,” and are heard?

Do you have a balance of power?

From the outside looking in, we could answer these questions for Alex.  But anyone who is or has been abused in any way knows that from the inside, answering these questions is hard.  It was hard for Alex.

Alex missed a few beats.  She didn’t want to see herself as abused.

Identifying abuse, naming it, is a start towards the other side of things.  It is reaching the peak of a hill or mountain of life-stuff, taking the view in after the fog lifts, and knowing that things are the way they are.  This is abuse.  A tangible thing.  Not the drifting mist of fights or arguments that once stalked you, leaving you bewildered and empty-handed.  Simply naming abuse is the start of empowerment.  Name it.  Name it out loud.

“I am abused.”

Alex said,

Wow.  I didn’t know that what he is doing is abuse.  I didn’t know.

After we talked about the name of what she was suffering, she talked about what she thought she could do about it, such as:

Call 911 if she feels unsafe.

Record him.

Say the words out loud, “I am valuable and should be treated well.”

Get a restraining order.

…And other things.

Alex didn’t have a lot of extended family support, so for her, that was out.

Alex said,

I feel more empowered.  I didn’t know I could do that.

And there it was.  A dandelion growing out of the cracked cement.  Hope.  A redistribution of the unequal power.  Alex was growing a plan.

Question:  What would you tell Alex, yourself, or anyone else in her position?  How do you see words being a form of abuse or not?  Please tell me your story.

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Who Are The Sick? From Here to The Moon.

Michael Jordan, Slamdunk Contest, Chicago, IL ...

Image by cliff1066™ via Flickr

Self-Care Tip #162 – Know your need for self-care.

Question:  In FriendToYourself.com, am I writing to people who are sick?

I was speaking with Beth Jusino the other night, when she asked me this.  I thought I’d ask you in turn.  You readers might be interested in commenting.

What is mental illness?  Are you writing to people who are sick?

Beth is smart.  She’s heard of Major Depressive Disorder, Schizophrenia and such.  She didn’t ask me this question so I could read her the DSM IV-TR.  She was asking how far mental illness is allowed to go before it gets named.  And how about the space beyond?  Are there bits that aren’t named?  Does it drift along an arch between Crispy Health and Completely Ill?

What do you think?

One reason I like to write #mentalillness hashtags on @Twitter is because I have a theory that people who have allowed themselves to be named, who have accepted to any degree a need for help, who have released their history and claimed their future over and over again – well I have a theory about these people that explains why I write to them.

These people are more able to hear the knocking sounds of wanting.  These people are more available to grow.  These people accept the gift of health and any space between here and there where they find themselves, all the while pressing; a courageous forward effort to freedoms.  These people care about self-care and they know they are accountable for it.

I remember this,

It is not the healthy who need a doctor, but the sick.

It makes sense.  However, it isn’t as easy as calling a spade a spade, and not because I’m lacking honesty and directness.

I heard a variation of this analogy years ago and I don’t know who said it first.

If you ask me to compete in a slam dunk contest with Michael Jordan, competition would be over before it began.  I’d trip, travel, and carry my way to the net and not get air.  But move the basketball net to the moon, ask us to dunk and the competition is just as over.  The space of air between my shoes and the earth is not much different from the space between Mr. Jordan’s shoes and the earth when we are both shooting for a basketball hoop on the moon.

Maybe you get where I’m going with this.

What do you think?  What do you say to Beth or anyone on this?

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Know What You Are Fighting For – Your Right To Journey.

You Should Be Living

Image via Wikipedia

Self-Care Tip #162 – Know what you are fighting for.  Be a friend to yourself.

Bridget told me,

I felt free to do something creative without having to feel guilty about it.

She had read the blog post, “Self-Care is Freedom, is Democracy, is Because We Are Accountable.”  I was just starting to think about other good places to go with that but before I got too far she hit me with,

I just hate myself!

Hearing those words is like watching squishy and partly moldy tomatoes hit the wall.  It’s messy.  It’s dirty.  No one’s excited about dealing with it.  And, there is something negative that brought it on.  Readers, you’ll remember this countertransference when you’re the counsellor in some other situation and think, “Darn that Quijada!”

My thoughts bumped and piled up.  Stopped, until they started pulling themselves off of each other.  I tried to put these disparate bits of Bridget’s narrative together.  And I wasn’t alone.

I don’t get it!  Why do I feel this way?

Who doesn’t have conflicting feelings about themselves?  Bridget perceived and celebrated her freedom to self-care, yet was betrayed by her own, just when she was reaching for it.  Is that ok?

What strikes me about Bridget is her journey.  She has struggled with anxiety and depression for many years.  I know with me, she’s been in treatment for five of them.  During that time, she has been lovely although not perfect.  She does her hair, glossy blond in large waves, trim body frame and polite like no one I’ve met.  Many medications have failed her and she has taken those failures and claimed her future over again.  The intense forward movement of her inner self has never been muted, even when she has had thoughts of wanting to die.

I have learned what she values, what she’s willing to let go of and what she isn’t.  Her appearances matter.  She is artsy and gets energy from being alone.  She loves people.  Her marriage is rocky.  She struggles with parenting.  She loves her husband and her children.  Bridget’s journey is a journey of imperfection, beauty and courage.

And here she is again.  Conflicted self, ill, hopeful and claiming her future.  Bridget is right on her course.  I wish I could help more.  I wish she wasn’t still ill.  But I can at least be as courageous as she is.  I can hope with her.  I can stand with her or walk.  I know that put to the question, Bridget prefers this journey than losing the right, the privilege, to journey at all.  Bridget is free.  Many of us are not as free as she is, who knows what she is fighting for.

Question:  What are you fighting for?  If nothing were to ever change for the better in your life, what makes your journey worth it?  Please tell me your story.

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Lost But Now Found

A three-year-old labradoodle.

Image via Wikipedia

What a night.  Mr. Rick C. was right.  Sometimes I do sit home and medicate.  It is not self-medicating, though, as I have my own prescriber.  And last night I was using my self-care tools to survive:  0.25mg of alprazolam got me through the first half of the night crisis, and then 2.5mg of zolpidem got me through the rest.  Despite these helpful medications, I dreamed of Timothy and Jack in the worst of circumstances.  I was amazed at how many positions a coyote could hold my Labradoodle in his mouth.  My eyes are still swollen red cherries and my complexion is bad.

Earl and I were not connecting.  Who does when they are afraid and grieving?  I simply told him,

Sorry honey.  I’m no good.  Can’t connect.

Earl is gentle.  He responds easily to words.  He doesn’t react easily to negative emotions.  He is a wait-and-see kind of guy most of the time.  His eyes are not red this morning.  He did not medicate.  He did not make this about him.

We made forty flyers describing our Great Pyrenees Jack and Labradoodle Timothy with our phone numbers and including a lucent plea for anyone to call if they saw them.

Our three kids in the mom-van, I planned to go door-to-door and harass people – I mean ask people – if they knew anything about our dogs.  We first targeted our neighborhood mailboxes where there is a bulletin board for community announcements.  I lifted my flyer to staple in front and center position and, “Darn-it!”  My kids had broken my stapler.

Pyrenean Mountain Dog

Image via Wikipedia

While banging my stapler on the wall, I noticed another white sheet flyer.

2 White dogs found!

More tears.  I called the number and blubbered.  The woman was comforting me, suggesting more alprazolam and a good psychiatrist she knew.  Our dogs were happily frolicking in her back yard with her two German Shepherds.

Timothy and Jack are home now figuratively and literally in the dog house.  We have a dog trainer, at much expense, coming tomorrow to help us.  We will also be placing an electric wire around our fence before the rest of our neighbors cement a reactive opinion about us.  Although our dogs are important, we hope to live here a long long time and don’t want to be picketed out of the neighborhood.

Thank you so much everyone for your kindness, for your empathic responses and patience with your own Dr Q.  It was a large blessing for my fragile self last night to know you were all there.  I hope that blessing comes back to you.

Keep on!

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Celebrate Insight, Choice, and Hope. Celebrating Can Be Self-Care.

A young paper wasp queen (Polistes dominulus) ...

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Self-Care Tip #161 – Celebrate your insight, your choice, and your hope to be a friend to yourself.

I realize autism has taken over my life and I’m not sure how I feel about that.

When April said this, I jumped.  The insight into her situation, the implication of her own ability to choose, the hope of what those potential choices might do for her and her children – all these leapt at me, so of course I jumped.  Startled.

April was the parent of three lovely although autistic children.  She was wiping her face.  “I never cry.  I’m usually really strong.”

And then she said those words.  Her realization.  I don’t know how much thought she had put behind them.  She certainly didn’t have much time to self-actualize.  Getting only a couple broken hours of sleep every night.  Responding to complaints from the school.  Springing towards her son every time he tried to hit himself in the head to stop him.  April was busy.  Mostly all that I had been able to do so far in our treatment together was help her kids via medication therapy.  We were clearly still working on things in that department.  She was willing to wait for us to make our slow way towards her children’s health, even though she was falling apart in the process.

Go low and slow.

Nothing like a cowgirl psychiatrist in the saddle.  I try to keep my spurs off and make no more than one medication change at a time.  Then, when something happens, negative or positive, we know what we are looking at.  April’s children were taking their time getting to their therapeutic responses.  But at least we hadn’t done more harm than good.

We had made the changes to our plan of care that we were going to make, and April was about to leave.  She had just said what she said and my mouth was open.  Unfortunately for April, I’m not consistently articulate.

Yes April!

And then she left, while I was still bouncing on the chair.

I don’t know if she’ll celebrate that marvelous epiphany.  If she does, I know her kids will benefit.  I’m confident about that.  If she does what is not intuitive, that is self-care, she will still be able to do what is intuitive.  Taking care of our kids is the most natural instinct.  Wild dragons and other mythical or natural creatures could not keep us away from it.  Now taking care of them well, however, is something that definitely is more likely to happen when we as parents are healthy, too.

For now I will celebrate this.  April has insight.  She has choice.  She has hope.

Yes April!

Question:  What has your life been about?  Where is your choice and hope?  Please tell me your story.

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Keep Talking

Day 349 of 365 - Self Care/Friends!

Self-Care Tip #160 – Keep talking.  Be a friend to yourself.

Lingering in the afterglow of what all of you have said in your comments over that past six months, I am distracted in the best of ways.  The comments so often complete the post.  We are a team you know.  I hope that more of you noncommenters will shuck off your shrouded lovely selves and say something to us.  Because it is not true on this blog, that casting your bread upon the water just makes soggy bread.  Nope.  You’ve all been my living examples of this.

Yesterday, Nancy wrote,

“But to associate self-care with freedom actually made me feel free today….”

I could have cried because… I just can’t say all the many reasons why she blew me away with that.  I don’t have enough fingers to point with.

Sarah,

the civil war inside of us.

Mr. Rick C. in his Blog-Jacking #2,

Folks, you have not experienced incomprehensible demoralization until you have had a Flowbee lock onto your head with the full force of a ShopVac behind it.

That one just won’t stop coming back!  The visual itself is an almost permanent gift.

Kevin Blumer keeping things light talking about stress,

I love stress I absolutely love it being busy 10 pizzas to make in 2 mins…

Some days ago, Pattyann wrote,

I think it is much easier to ask for help and receive it when we stop looking at an illness as a personal failure.

Is there any better way of saying that?

Our own articulate CarlDAugostino who shows so much interest and respect to so many of us gave me this,

I have never really heard of this “self -friendship journey” It is a wonderful concept…

Yes, you show me that I matter and that I am not alone and that it turns out, …taking care of myself has been a pretty good idea after all.  You show me that it starts (goes across a few oceans and continents) and ends with “Me.”   Thank you, all of you for that.  There are soooo many things you’ve said, (you know who you are) that have totally rocked me.   Keep talking.

Question:  What shows you that it starts and ends with you?  Please tell me your story.

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Self-Care is Freedom, is Democracy, is Because We Are Accountable

authenticsociety.com

Self-Care Tip #159 – Be accountable for and to yourself.

It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain alert.  Just when I thought I could hold out no longer, I saw him.  Big and expressive, the long form of Abraham Lincoln was there, surrounded by loud irreverent people.  My brother and I were wiping sweat out of our eyes trying to keep track of our kids.  We wanted to read the Gettysburg Address for our kids, and found ourselves screaming.  The kids could barely hear the words above the disinterested rabble around us.  Despite all this, I was choking; a weepy, sweaty, nearly anesthetized but free American.

Four score and seven years ago our fathers brought forth on this continent a new nation, conceived in liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation, so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

Just down the corner from Lincoln is a president’s list of sites to see, informers and reminders of who we are and where we came from.  However, none of them were “my Lincoln” experience.

But, in a larger sense, we can not dedicate, we can not consecrate, we can not hallow this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion…

A couple of days ago, writing the post about how stress intersects with medicine, I remembered “my Lincoln.”  It may seem like a stretch at first but take a minute.  Self-care is a way of saying, “I am free.”   In places where life is cheap, almost without value, self-care is not much of an option.  It is because of freedom that we can extricate the meddling fingers, the invasions, and be the keeper of our own private spaces however we choose to.  It is because of freedom that we can tell people that although my brain is ill and although I take medication, I am equal. Saying that is self-care.  Saying that is possible if we take that freedom to keep our own accountability for our own selves.  Accountability is not the same as blame.  Having accountability for our freedom is not the same as being at fault for what came before freedom, nor our current conditions.

—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.

If you’re not accountable to your inner self, if you’re only accountable to your actions, or you’re only accountable to what others determine and define about you, than you are not free.  You are blamed.

Accountability is such a tender privilege.  We might lose it if we forget who we are, where we came from and our rights to freedom.  Democracy is self-care.

Question:  How do you see the relationship between self-care and your freedoms?  Please tell me your story.

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Blog-Jacking by Mr. Rick C. – #2 (Do I or anyone really deserve this?!)

Hello Folks.  Today Mr. Rick C. is taking this post over….

As a person with a vast amount of psychiatric experience, I have learned the importance of watching for danger signs in others and myself.  Recently, you may have noticed, our very own DQ displaying a few atypical qualities.  Let’s take a look at her last blog.  Apparently, she has now given herself the new name of Dr. Q (any body remember that show Dr. Quinn, Medicine Woman…Hamm) and began referring to herself in the third person.  Another great blogger, xcandyxcane, does this effectively but differs from our own “little bundle of identities” by acknowledging that she is speaking in such a manner.  Dr. Q aka DQ aka Dr. Quinn Medicine Woman may or may not be aware of this.

Her blog entry seemed well written, as always.  However, she did seem a bit flustered by the fact that she got a few negative little thumb things.  Let’s put this into perspective, depressed people can be negative.  It is a key symptom of being depressed.  We are here to learn how to make little thumbs up things more often.  The fact that I picked this up and she did not, while not unusual, could be an indicator that she is not functioning at her highest level.

Finally, a sure indicator that she is teetering on the brink of collapse… the use of that oh so pointed word, “shucks.”  I can only imagine the stress and pain required to push her to such an outburst.  For these reasons, and my true desire not to watch “The Doctor Formerly Known as Quijada” spiral down to a point at which she goes on and on about flooded basements, frogs and Lebanese births, (certainly was a fun week you may remember,) I have taken it upon myself to give her the day off.  If nothing else, I’ll make her sound really professional when she returns.  Let us all keep her in our thoughts as she sits comfortably in the castle (aka future sink hole) she calls a home, self-medicating while being a friend to herself.

Since I am not a real doctor, I cannot share a heart warming narrative about the one-legged blind puppy being held by the child with such a distant look in his eyes as his mother crocheted for reasons unbeknownst to the rest of the world that came into my clinic.  However, I would like to speak up about an aspect of this blog that I am truly pleased with.  (And I’m not going to try to understand what the word “paradigm” means that she keeps using.)  As I took in the fine nuggets of wisdom that are typical of this blog, I was especially pleased with the mental image when reading the description of  “Gorgeous Candy.”  Of course, any functional male reading this immediately recognizes this fine moniker.  (There is no medical term for that, I looked.)  Trust me, Q had no idea, none what so ever.

So…. as I absorb the plethora of psychiatric knowledge, I realize, I could very well be the man who could save Gorgeous Candy.  The image is clear in my mind and I know I can help.

All right, at this point, I would like to share a story about my drinking and a self-help program.  One night, after ingesting a large amount of alcohol, I decided to sit down on the couch and enjoy some television.  Interestingly, at three in the morning, there are many programs on involving various forms of “self-help” for a fee after calling and speaking with gorgeous women.  You can teach yourself to speak Icelandic in three days.  Several programs guaranteed to make you stop smoking and drinking while you do nothing.  Then – my personal favorite, the Flowbee.

The Flowbee allows you to cut your own hair with a vacuüm cleaner attachment as demonstrated by some great looking individuals.  As a result of my intoxication and the brilliant manner in which it was presented, the Flowbee sounded like an excellent idea with very few negatives.  I called just in time to be one of the lucky callers that got a discount knife set, as well.  Not so surprisingly, I was intoxicated when the Flowbee arrived.  No problem… easy enough to operate and certainly no need to watch the instructional video.  Hook it up to the Shop Vac and away I go….

Folks, you have not experienced incomprehensible demoralization until you have had a Flowbee lock onto your head with the full force of a ShopVac behind it.  At this point, as I lay on the floor trying to kick the plug out of the wall, I realized that my life was completely unmanageable and I would possibly need to go beyond the resources I had within myself.

Upon having the Flowbee removed from my head, I was fairly certain that all of my problems had been solved.  Hence, I went back to drinking.  Several years later, I would discover the twelve steps.  When I did, I was in Texas and had the fortune of becoming part of an AA group where people had no problem being honest or saying it like it is.  One of the first things that I was told, was that this is a “we” program and that if this program were to rely on “self”…. Well, based on my track record of helping myself first, I was in trouble.  Every single step talks about “we.”

Through the years, I would learn more about how important the group is to a twelve-step program.  Furthermore, the basis for AA (the first of many twelve step programs) is a movement called the Oxford Group.  This was a group that became popular around the turn of the century.  They had some basic principals that have become the basis of twelve step programs.  Key to the Oxford Group and twelve-step programs is the benefit of sharing among a group that is working this same program.  There are many tests online and other places designed to help individuals determine if they are or could be an alcoholic.  I think, for many, this test could be simplified into…. have there been times in your life that a Flowbee sounded like a great idea?

Please, share with me your thoughts.  Why are paradigms important?  When doctors self-medicate… is there a copay?

This would make even less sense if I was drinking…. Can you imagine?

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No Matter Why, Where, or What Happens, Self-Care Starts and Ends With Me

Cover of "To Kill a Mockingbird: 50th Ann...

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Self-Care Tip #158 – No matter why, where or what happens, self-care still starts and ends with Me.

It’s no secret that I look at behavior through many paradigms.  Most of what I’ve shared on this blog is medical because I’m a physician.  That’s my specialty.  I’m not a physicist and don’t spend my posts on explaining how physics influences our behaviors – although I believe it does.  However, I don’t want you to think that I think behaviors and emotions exist within only the medical paradigm, even though that’s what you hear me talk mostly about.

According to Dr. Q, the roughly sketched breakdown of how stress intersects with medicine:

1.  Stress influences how we behave and feel. We “see” the stressors, and we see the emotional and behavioral responses, and we know their sources.  We know that emotions and behaviors are produced by a human.  Where else?  Anything magical or otherwise comes from Someone from another place.

2.  Stress influences our medical condition. Stress will awaken sleeping genes that carry the names of different diseases; cancer, major depressive disorder, schizophrenia, and so on.  Would those genes have awakened on their own without the external trigger flipping the switch?  We don’t always know.

3.  Because there are so many factors that influence the reasons a disease process demonstrates itself, we cannot say that it is causally related to the stressors.  Many people try to do this, and sometimes the disease’s labeled cause comes down to the jury’s decision.  But we don’t have to have read, “To Kill A Mockingbird” by Harper Lee to know that people’s opinions and judgments are biased.

4.  People try to find the reasons why.  This is natural and in my opinion appropriate.  However, where we look for the reasons for the feeling and behaviors is equally important.  Seeking accountability for how we feel and behave to come from outside of ourselves, to come from external reasons, to come from a source to fault is more often missing our chance to get friendly with ourselves.

“It just is,” as many say, and the 12-Steps would say “Surrender what is out of your control to your Higher Power.”  These are not inconsistent with owning that mental health begins and ends with Me.

Sure, there are the despicable situations of abuse, trauma, violence and other horrible biology changing events.  These are known to cause the one non-genetically related psychiatric disease process called post-traumatic stress disorder (PTSD.)  These are situations consistent with our previous post on not being responsible for our history but being responsible for our futures.

5.  Stress, other than in situations of PTSD, is not causal for the progression of mental illness.  Everyone has stress, but how we deal with it, how we cope makes the difference.  Even horrible events, such as losing ones wealth and the sequelae of it are not causal for the continuance of brain disease.

6.  Medications, lifestyle change, Love and various other therapies effectively influences the way genes express themselves, our biology, and our medical condition….

7.  …In so doing, medications, lifestyle change, spirituality and various other therapies effectively influence our emotions and behaviors.

Question: How has your understanding of how stress intersects with with how you feel and behave affected you?  Please tell me your story.

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Connection: It’s Medical But Still Magical

XO with Internet connection, Khairat (India)

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Self-Care Tip #157 – Don’t depend on yourself to find connection.

We are people of a greater ability to bond than our senses, emotions, intuition, reason or technology can account for.  Our connection to each other and to God supersedes our belief in connection.  In this discussion, I am looking at “connection” beyond the paradigm of our perceptions.  Although connection between me and you is all about me and you, our bond also transcends either of us.

Meet gorgeous Candy.  She refuses any medications that might change her appearance in any way, ie. increase her appetite.  She would rather freeze in a catatonic state and die thin than gain weight.  She has come to me after years of struggling with irritability, anger, depression and anxiety.  She has never seen a psychiatrist although these emotions have misshapen her relationships, crippled her parenting skills, and removed her from her community of friends and one marriage.  Her medical condition continues to threaten Candy’s connection with her own self.  It continues to threaten her connections with her now teenage children and her second marriage.  Candy tells me that she doesn’t feel anything for her husband.  When she says this, she looks at me expectantly, as if she just released a big revelation.

When people are initiating treatment, I try not to get into anything personal too much.  Although I gather their personal history, I don’t give much feedback.  I try not to discuss their desire to make sense of all their conflicting feelings.  Sometimes they ask me questions, advice, directives and that’s natural.  However, it would be misguided to answer those questions, because we can’t let our emotions guide us.  I tell them,

Let’s revisit these questions after the treatment has time to take effect and you feel more like yourself.

It’s medical but still magical.  In four to eight weeks, they often hardly remember the questions they had.  The negativity is just a haze in their past.  The resilience comes with emotional health and copes with the simple stressors that used to sever interpersonal emotional ties.

Candy was one of the lucky ones who found the magic.  She felt self-trust more than she had felt her entire life.  Feeling safe with your own self is wonderful.  Much of the population who has not been where Candy has been can’t say the kind of thank you that Candy can.  They don’t know what it means to be lost and then found in this way.  Candy has something very special.

Yet when we think of Candy’s sense of connection, we also look beyond the biology of it.  I did spend some time describing how biology can change our perception of connection, but I didn’t do it to explain how connections are formed.  I described it more to demonstrate that we cannot depend on ourselves to define connections.

Don’t stumble on the philosophies around adjustment issues and conditioning.  Connection with others exists regardless of our fortune in family, money, treatment or maltreatment, biology, and self.  We are connected because there is a force of connection created and present in all of nature, regardless.

Madeleine L’Engle, wrote in “A Stone for a Pillow,”

Perhaps what we are called to do may not seem like much, but the butterfly is a small creature to affect galaxies thousands of light years away.

Our connections are there regardless of where we are at in life.  I would even take it further to say that connections to us even survive the cutting blow from death.

Connection is an eternal truth.  It makes a difference to us just to know that, but even if we didn’t, it doesn’t change our connection.

Question:  How do you make sense of your changing perception of connections in your life?  Please tell me your story.

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I really wish I wrote this but it was Dave Barry

This red Lockheed Vega 5b was flown by Amelia ...

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There is a reason I’m writing this at 4:45 AM.  There is a reason I am taking the short road to posting, by quoting this amazing prose by D. Barry.

Ooops, excuse me!

I’m back.

You’d think after reading this that my self-care tip #156 for today is to get a colonoscopy, but it’s not.  It’s to read D. Barry if you are or if you are not.  And so, here it goes.  (I hope you are not drinking or eating, just sitting while you do this.)

Dave Barry: A journey into my colon — and yours

I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy.

A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis.  Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner.

I nodded thoughtfully, but I didn’t really hear anything he said, because my brain was shrieking, ‘HE’S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!’

I left Andy’s office with some written instructions, and a prescription for a product called ‘MoviPrep,’ which comes in a box large enough to hold a microwave oven.  I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of   America ‘s enemies.

I spent the next several days productively sitting around being nervous.

Then, on the day before my colonoscopy, I began my preparation.  In accordance with my instructions, I didn’t eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor.

Then, in the evening, I took the MoviPrep.  You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water.  (For those unfamiliar with the metric system, a liter is about 32 gallons).  Then you have to drink the whole jug.  This takes about an hour, because MoviPrep tastes – and here I am being kind – like a mixture of goat spit and urinal cleanser, with just a hint of lemon.

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, ‘a loose, watery bowel movement may result..’

This is kind of like saying that after you jump off your roof, you may experience contact with the ground..

MoviPrep is a nuclear laxative. I don’t want to be too graphic, here, but, have you ever seen a space-shuttle launch?  This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt.  You spend several hours pretty much confined to the bathroom, spurting violently.  You eliminate everything.  And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.

After an action-packed evening, I finally got to sleep.

The next morning my wife drove me to the clinic. I was very nervous.  Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage.  I was thinking, ‘What if I spurt on Andy?’  How do you apologize to a friend for something like that?  Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked.

Then a nurse named Eddie put a little needle in a vein in my left hand.

Ordinarily I would have fainted, but Eddie was very good, and I was already lying down.  Eddie also told me that some people put vodka in their MoviPrep.    At first I was ticked off that I hadn’t thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode.  You would have no choice but to burn your house.

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist.  I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere.  I was seriously nervous at this point.

Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand.

There was music playing in the room, and I realized that the song was ‘Dancing Queen’ by ABBA.  I remarked to Andy that, of all the songs that could be playing during this particular procedure, ‘Dancing Queen’ had to be the least appropriate.

‘You want me to turn it up?’ said Andy, from somewhere behind me.

‘Ha ha,’ I said.  And then it was time, the moment I had been dreading for more than a decade.  If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

I have no idea.  Really.  I slept through it.  One moment, ABBA was yelling ‘Dancing Queen, feel the beat of the tambourine,’ and the next moment, I was back in the other room, waking up in a very mellow mood.

Andy was looking down at me and asking me how I felt.  I felt excellent.  I felt even more excellent when Andy told me that IT was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.

On the subject of Colonoscopies…

Colonoscopies are no joke, but these comments during the exam were quite humorous….. A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:

1. ‘Take it easy, Doc. You’re boldly going where no man has gone before!’

2. ‘Find Amelia Earhart yet?’

3. ‘Can you hear me NOW?’

4. ‘Are we there yet? Are we there yet? Are we there yet?’

5. ‘You know, in   Arkansas  , we’re now legally married.’

6. ‘Any sign of the trapped miners, Chief?’

7. ‘You put your left hand in, you take your left hand out…’

8. ‘Hey! Now I know how a Muppet feels!’

9. ‘If your hand doesn’t fit, you must quit!’

10. ‘Hey Doc, let me know if you find my dignity.’

11. ‘You used to be an executive at Enron, didn’t you?’

12. ‘God, now I know why I am not gay.’

And the best one of all:

13. ‘Could you write a note for my wife saying that my head is not up there?’

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Go Toward Mental Illness and Take It To The Floor

Sean and Cheryl: Drama on the dance floor

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Self-Care Tip #155 – Go toward the real issue.  Be a friend to yourself.

Little woman, she had pinched toes in her four-inch heals and wonder what her size has done for her.  Mindy was anxious.  Even though I wonder about her stressors, like possibly her height and the history she is telling me, I know something else.  Even though I wonder about her parenting and marital stressors, and about growing up in a small town but now living with giants, I don’t wonder what she thinks.  Mindy describes these giants as people with large accomplishments, things she would not try herself and that means something to her, but not what she thinks it does.  Mindy wanted to see how things went.  Apparently six months of this wasn’t long enough.

We could spend the next five years breaking all this up and apart and tossing it like a cranberry salad.  But Mindy’s anxiety is mostly not about the salad of life.  Mindy’s feelings are a bit about the stressors and a lot about her brain.

Mental illness is not a small thing.  We trim it down when we say otherwise.  The unfavored sister, Mental Illness isn’t spoken to much at the table.  Her more popular sisters, Stress and Life-Triggers, get a lot of the attention.

With some effort, people who once worked around Mental Illness like it was barely there take a chance and go straight at it, full charge, and swing that woman onto the ballroom floor.

I went for that dance with Mindy.  And she wasn’t talking about waiting and seeing how things went for long.  I told her, like I’ve told you, that how we feel and interpret our stressors comes from our brain.  I told her that mental illness gets worse if it isn’t treated and treated to as full a response as possible.

We weren’t talking about life stressors at that point.  We were talking about her medical condition.  Once treated, Mindy will continue to have life stressors.  We will hopefully also see however, that she responds to life stressors differently.

Question:  How do you make sense of the seemingly meaningfulness of how stress affects us with the seemingly less meaningful concept that we feel that way because of our brain and not because of the stress?  Please tell me your story.

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The 12 Steps To Serenity

Ben‑Enwonwu‑Negritu

Self-Care Tip #154 – Go towards Love.

I realize that many of us talk about the 12-Steps, we know people working the 12-Steps, we even recommend the 12-Steps but have never read them through.  So here they are.  For all of us.  A wonderful walk with and towards love.

The 12 Steps To Serenity

  • Step 1 – We admitted we were powerless over our addiction – that our lives had become unmanageable
  • Step 2 – Came to believe that a Power greater than ourselves could restore us to sanity
  • Step 3 – Made a decision to turn our will and our lives over to the care of God as we understood God
  • Step 4 – Made a searching and fearless moral inventory of ourselves
  • Step 5 – Admitted to God, to ourselves and to another human being the exact nature of our wrongs
  • Step 6 – Were entirely ready to have God remove all these defects of character
  • Step 7 – Humbly asked God to remove our shortcomings
  • Step 8 – Made a list of all persons we had harmed, and became willing to make amends to them all
  • Step 9 – Made direct amends to such people wherever possible, except when to do so would injure them or others
  • Step 10 – Continued to take personal inventory and when we were wrong promptly admitted it
  • Step 11 – Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out
  • Step 12 – Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

Question:  What do you think of these steps?  Please tell me your story.

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