God

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Where to trust

Sometimes, ok quite often, we feel misunderstood by others and unclear of our paths going forward. We are not alone, dear readers, in this.

This is what Taylor swift says,

“How did I go from growin’ up to breaking down?
And I wake up (Wake up) in the middle of the night
It’s like I can feel time movin’

How can a person know everything at eighteen
But nothing at twenty-two?

And will you still want me
When I’m nothing new?”

I’m thankful for her voice in this.


I am nothing new and my personal value has to be on aught else besides novelty. Nor can it safely be placed in my behaviors and emotions.

It is our life duty to discover where to put our trust. In our own capacity? In identity? Or where? We are vulnerable to our biology one could say. But we are able to trust something someone somewhere. And whether it is fortunate or unfortunate, I can’t hand you trust like a baton.

You got this though.

Sending you readers all my affection. Thank you for joining me in this life journey of being a Friend to Yourself.

Keep on!

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It is okay to be Wrong …and Fears

750+ [HQ] Fear Pictures | Download Free Images & Stock Photos on Unsplash

There was an exhale. A ripple out, like dropping eyelids, a wave on a slow shore, turning a shoulder away and the head following; this was how her disclosure soundly rolled through the room.

I failed.

I don’t care how cocky you are, everyone fears. In the brain and body, sometimes, the parasympathetic is dominant and one feels calm. Fear isn’t on the mind. Another time, the sympathetic tone rises and you think, “A bear is chasing me!” Or, “That girl is coming to talk to me!” (It can feel synonymous. Wink.) Yes, that is fear. But the kind of fear I’m talking about here is the one germane to our conscious or even before conscious awareness that we will never be enough. There will always be someone. Smarter Her beat Me in AP Calculus. Someone the boy desires… more. The things like food, shelter, clothing, the money, the votes, the power, and someone other will trump Me. This fear comes from the Amygdala, an almond in the middle of the brain that holds our sensitive selves carefully within it’s tiny shell. Others will argue that it also comes from a magical outside-of-biology-morality. A qualifier or quantifier of personal value. Plink. A widow’s mite drops in; an offering of our small or great selves.

But wait. There’s another choker, ring and leash that sparkles around our slender neck; the whole perfectionism culture. This is the psychological influence on what makes us who we are, including our constitution of fear. This is what I wish I gave better to my world, to those I am in contact with. I wish, like Pinocchio, because I believe perfectionism is dishonest and lacks moral fiber. We are made better by our failures rather than worse. And if I were a philosopher, I’d recognize the tiring loop this swings me into… It is a failure to live in shame of my failure to receive the gain that failure brings. Round and round. An ice cream truck sounds music in the distance but I have no change. I’d like to especially tell my kids with my life, my actions, my all – “It is ok to be wrong.” Wrong wrong wrong is just fine. Pause. And then also, “It is ok to not pass, to miss, to play flat notes, to sit alone, to be unchosen, to work hard and fail.”

Beatrice, a graduate of the Medical School of Manila and residency in internal medicine, and later after six years of practice, immigrated to the US of A. She had taken the USMLE Boards Step One, twice and both times, failed. She could not do the training in the states that would allow her to practice here until she passed. In the mean time, her kids back in the Philippines, needed funds to live. Beatrice worked Door-Dash, while she studied and feared.

It would have been clanging “toxic positivity” for me to chirp, chirp, “It takes a lot of failures in order to succeed.” But help me, I wanted to! And forgive me, I have with others. Ugh.

What is the balance? Because there is truth here. All successes are preceded by a large mote of failures, conscious awareness of them or not. However that doesn’t prove that successes will follow. What’s the term in logic that this is in danger of? I think it would be a blend between causal fallacies and a hasty generalization. Sometimes there is just failure. A dump in the mossy monster infested water.

Because we are good psychiatrists, we will shake it down, and dutifully approach fear here with our “bio-psycho-social” paradigm. We have the brain, including the amygdala and it’s influences. We have the psychology of perfectionism. And we have the social of Beatrice’s children’s basic needs to survive.

How do we do self care with all this? If we have enough bank, we go toward the elements, separate and whole, in this paradigm. We pluck away where our suffering calls out to us most. We go forward knowing that whatever it is we are going through, we are not alone. It is common and normal, although unique because we are, each of us, an un-duplicated wonder. We use the reminder this approach offers that things are always more than they seem to our conscious selves and if we give to it, we will weave together a greater hope, with both the good and the bad, all seated at the Thanksgiving dinner table this year.

For Beatrice, we grieve with her the difficulty in her journey. We celebrate her hopes. We encourage without losing honesty. And we give treatment for the biological expression of underlying disease that harms the way she perceives her reality. This is our privilege.

Self-Care Tip: It is okay to be wrong, wrong, wrong. Keep on!

Questions: Would you please tell us about your fear?

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God in the Space of Synthetics

Hello Friends!

I’m going to try something a little different today. I’m posting a dictation between a patient of mine and me because I think it has flow and a nucleus. (There are a few small changes made in liberty, and no identifying data.) Let me know what you think of the content.

Psychiatrist:  …And so we were talking about perfectionism, right? 

Patient:  Yes. 

Psychiatrist:  And about how you are not being kind to yourself when you expect yourself to be all healthy.

Patient:  I’m not being kind to myself when I don’t want to take this or that because I don’t do synthetics. (This is what my patient was using to describe medications.)

Psychiatrist:  I like that you used the word synthetics, because I’ve never put it in that perspective with patients, and you did that for me. 

Patient:  Well, there are non-synthetic and there are synthetic. 

There’s body recognizing things, plants, and then there are the synthetics, what the pharmaceutical companies produce. And I’m a very negative pharmaceutical company person. 

Psychiatrist:  Compare that to other inconsistencies in our life. Such as, I’m going to be all-natural, I’m only going to wear hemp.

Or take it to the point where I’m going to weave my own clothes because it’s really natural and I know exactly what’s in it. Versus saying that I’m moving forward and I’m going to take what science has offered to us. I’m wearing polyester right now. 

Or, I’m willing to take over the counter “herbs” because they don’t have the pharmaceutical stamp on it, or maybe I like that it grows out of the ground. But none of that has been governed. Aside from the “he-said-she-said evidence,” there’s often little science behind some popular over the counter remedies either. 

Let’s consider that perhaps the study data, comparing in a regulated way, one patient with another, defined synthetic agents, and then allowed my body to be its healthier self. It gave us objective data. Numbers. Sure they have their flaws and weaknesses as we learn in statistics that all does. Poke holes in it as you wish, but at least there is a degree of transparency.

Patient:  Maybe for me it’s more trust, because I feel like people are so over-medicated today. And it’s easy to write out a prescription than to really deal with the issue. 

(Me, on the sly: This view, that practitioners prescribe for reasons other than for the medical benefit of the patient, is one that I honor with humility, and stand up and listen when others voice it. Annals fill the internet search engines on it, I’m sure. I will still pick at it a little, I’m a stubborn nubby person like that.

Let us note together that the word, “easy,” in this context isn’t so kind to our person. Taking medication to treat a medical illness is often not easy. It is one of the most courageous acts in someone’s life. And this wonderful lady, who came into my scary office, was a great example of this kind of courage. She wasn’t here doing what was easy. She was giving her emotional entrails a work-over with her psychiatry venture.

This patient, whom I will name hereafter, Lady Courage, was “really dealing” with the issue, in contrast to her self-described mores. Might we suspect the insidious tendrils of “Mister Stigma” shaming her? Yet here she was… Just fabulous!)

Lady Courage: I’m more one that, “Let’s really deal with your issues, and then your mind should come around, everything should come around.” That’s how I view it, because if you don’t fix the underlying problem you’re never going to fix the problem with meds.

Psychiatrist:  Okay. But you’re willing to say there might be some inconsistencies in that right now.

Lady Courage:  Right, no, I’m not … 

Psychiatrist:  It might not be entirely false, but it might not be entirely true. 

Lady Courage:  Exactly. 

Psychiatrist:  We were saying, “I can be healthy but still have disease in my life.” 

Lady Courage:  Yes, that’s true. 

Psychiatrist:  Because I don’t have to be perfect. 

Lady Courage:  Right. And I do find that a little bit hard. But since you put it in that aspect of being, “healthy with disease,” I can see that. I probably never saw that before, because I did always separate the two, either you’re one or the other. 

Psychiatrist:  Wow. 

Lady Courage:  Yeah. 

Psychiatrist:  That’s poignant. Is that how you see God as well? 

Lady Courage:  In what aspect? Like, yeah … Well, you know what? I try to strive to walk in His ways. I haven’t always walked in His way, so I do have guilt about that, but I shouldn’t have that and I know He’s already said He’s forgotten it, He’s washed me clean. So it’s just receiving it for myself. And that just is faith. And I know then it makes me feel like I’m lacking a little faith, but I know I should be stronger. But, yeah, The Word is something that I strive to follow, and it’s hard. 

Psychiatrist:  So do you feel like God is, “either/or,” in the way He looks at you? What about the parts of you that are diseased? 

Lady Courage:  Well, no, yeah, He’s going to heal that. 

Psychiatrist:  But what if He doesn’t right now? What does that mean about who God is?

Lady Courage:  Well, He sent me here probably in hopes that you can help me to heal. He provides these avenues for us, so that we can get healed. 

(Folks! So good! Smile.)

Psychiatrist:  So you somehow think that God enters into the space of the synthetic. 

Lady Courage:  Well, yeah, I guess so, yeah. I do, okay. It’s so contradictory, but in one aspect I do take a thyroid medication that is a synthetic, but I know I have to take that and I understand it and I don’t feel it’s abusive. And I look at my blood work and I know where I’m supposed to be and how much I should be, so I feel confident. But when it comes to things like this that I’m not used to taking, and that don’t show up on labs, and it involves transforming my brain, I’m not really on board with that. 

Psychiatrist:  So when you use the word transforming my brain, I understand you’re saying that it’s making you into something different? 

Lady Courage:  It can alter your brain, yes. 

Psychiatrist:  Okay, so that’s the part I think that’s very scary for people, because they think it’s making them into somebody they’re not. But in reality the medications are there for healing who you already are. So for example, today you feel more like yourself than you did last week. 

Lady Courage:  Well, yeah, last week I was desperate and hurting and losing weight and scared. 

Psychiatrist:  And today you’re closer to who you think your healthy self is. 

Lady Courage:  I think today I’m … Yes, I’m much closer to my healthy self. 

(Q: Closer to who God is creating you to be? Closer to God’s will even?)

Psychiatrist:  In all of these scenarios, at each point we want to think, “What does this say about who God is?” If He or She, (but we will say He to simplify because it’s culturally appropriate,) is kind and loving like you mentioned, then would this belief, X, Y or Z, be true?

Self-Care Tip: Lay out our beliefs next to that standard, that premise in our life. And because we’re a lot crueler to ourselves, then we would allow other people to be, it can rescue us on occasion.

Questions: “What does this say about who God is?” Please speak out!!! …and, Keep on!

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Medication vs Drugs

I imagine some day I’ll understand why users think drugs are healthier options for them then medications.

“Doctor, I don’t think my wife will be comfortable with me adding another medication. It seems like I’m already taking so many!”

Context: Brennon is using THC “for sleep” he explains. Not recreation. It’s “medicinal.”

Boy. We are going to have to redefine what “medicinal” means in the urban dictionary vs. in the medical. 

It’s as if the masses out there are acting like it is stigma behind any opposition of THC vs. science. Folks, there may be stigma involved but it’s mostly science. THC is, 99%, not medicinal. 

My cousin is a hospice nurse and she and I were discussing this. Along the meandering conversation way, we came across, that in her field, many are taking CBD. (I know most of us think CBD is THC-free but it’s not unless it’s thoroughly governed by the FDA.) When we were in our wandering conversation about this, I imagined out loud to her, “If I were dying, I’d want to take a good trip on LSD, do a line of cocaine, and have free access to heroine. Why not?! “

My cousin politely explained that in end-of-life, most people, not apparently ignoramus blind bigots such as myself, prefer to stay alert in their last moments with their loved ones. 

That makes a lot of sense. My “free ticket” to white clouded oblivion suddenly didn’t look as appealing. I’d like that too. I’d really like to have connection with my loved ones. At any time. 

This is the effort in psychiatry as well, believe it or not. When we medicate, we are seeking to align ourselves with the patient’s agenda, toward connection and not away. Toward quality of life and not to harm. Toward hope. When we encourage to take medication, it is not to seek oblivion and isolation. Rather medication is for connection.

Brennon is not alone. Many think that medication takes us away from connection. Away from connection to ourselves by turning us into something we are not. “Doctor, I don’t want to take anything that will turn me into someone I’m not.”

Away from connection to God by taking our willingness to submit to His/Her will, away from His/Her power and toward depending on science instead, as if there is an either/or. No, there is no either-or unless we put it there. There are no dividers between science and God. He/She made them both. They are fluid to Him/Her.

Nor is taking medication taking us out of connection to our partners, nor our family who thinks medication is a cop out and whom are loaded with their own journey of self-discovery over their own self-stigma toward medication. As if taking medication makes our patients less loyal to their loved ones, thereby less connected.

It’s so layered why we think medication is worse. Even worse than mind-altering THC. Even worse, than the disabling illness, or whichever idea it may be.

Question: What is medication worse than for you?

Self-care tip: Seek connection, “even” through medical ways. Be a friend to yourself. Keep on!

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Love without connection

Delicious rocky road Baskin and Robins chocolate cake was staining Fred’s teeth bright vampire red from the frosting. It mesmerized me as we bantered. Though, not enough to completely distract from the trigger setting off my sympathetic tone. 

“So, you are writing about God and psychiatry?” (Ba-boom!)

Fred is an enormous genius, well published and internationally acclaimed. (I’ll call him, “Dr. Fred” to give some cred, because he really is all that.) He’s super kind with real attachment to his friends and the random stranger, but still intimidating as heck when he wants to grapple ideas.  I sent up a prayer that God be in this talk and not my pride in the talk. I botched up good once or twice but in the end, if nothing else, I was blessed.

In his own life journey, Dr. Fred had done his own Jacob-like wrestle with God. He was still recovering from it, I think. I respected him so much. Some of us are given the chance to wrestle and we choose not to. Fred had courage and character. He brought his all to this interest of who is God.

To clarify my starting line in this discussion, I offered up my little premises; 

  • God is, 
  • God is Love, 
  • and We Are Designed for Connection. 

He nodded. “Ok then.” I felt a little deflation in his interest because much of his personal wrestle was prior to that line/premise I drew – “God is.” Even so he rallied and engaged.

“Ok then. What if you were to say that we should bring and deliver love ourselves? In all interchanges. In all encounters. We bring love. What’s wrong with that? Do I need to have this God in that case?”

Honestly. My little corner of the world, my home, my church, my grocery store, all would be better if I/we lived this way. I am proud and blinded by it. I interpret the world and call what is real and truth as defined by my own sight and how good could that be by definition? I am not loving enough.  

The idea of bringing love is wonderful. That’s not a difficulty for me in concept. My difficulty is where it starts from and ends from. It’s a place of disconnect. A place that start autonomous from a Creator. A Maker isn’t there at the end either tying me to Him/Her. Connection. With what I understand of Dr. Fred’s perspective is that even if we were to bring love, give love, generate love, in the end, we are alone. Disconnected. It is because we are created and connect at all points that we are never alone.

I guess, inherent to the word “Love,” well it means connection to most of us. So this is a hard bridge to shimmy. It’s like water water everywhere and nothing to drink. We have this sense of goodness, kindness, call it love, in our lives, but we are still alone. I’m cringing because I don’t have it. This sounds pompous and I’m sorry. Forgive me. I’m offensive. But I don’t think God is offensive. So I’m getting it wrong. Help me?

When we run into something that doesn’t fully make sense, the problem’s not with God. It’s with us.

I am a Christian whose church doesn’t like a lot about her.

So, I was standing on stage singing songs, my service/therapy dog, Timothy, chose to lie down, belly side up one step down with his goods in full view of the saints. I think that’s when I officially lost their favor. Timothy comfortable on the raised dais, …just no. Next thing I knew, Pastor and I had the most awkward phone call of my life. Basically I learned that emotional support animals and therapy animals, no matter their licensure in these, are not legally defended to attend church.

But church is different than God. To me, it is full of people like me. Proud. Blinded by pride. Defining the world around them, what is truth, what is real, all through their senses, no matter the biopsychosocial condition of their organ; their brain. They need me as much as I need them partly because none of us can be a mirror unto ourselves. Sometimes we both get that, and it’s lovely. Other times, not so much and we fall apart. In the end, though, I remain connected. Connected because I am created. I am carefully made. I am wonderfully made. Marvelous are God’s hands that made me. My soul knows it well. Ps 139:14.

Self-care tip: Find your connection. There is Love.

Question: Tell us about connection in your life. Where is it? What is it? We need your voice.

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“Off To Sleep!” with you!

Ladies and Gentlemen! It’s time to go to sleep! Wait. Not till you read this.

PsychU, a patient education website, has invited me to present on sleep. These are their questions and how I hope to respond. Do you have any recommendations, other interests, directives? Please help me! Smile.

1.       Dr. Johnson-Quijada, in what ways is sleep important for our behavioral health?

Sleep rudders our biology ship, (if “rudders” may be used as a verb.) Our biology is the reason we have emotions and behaviors. Take out the brain and we don’t have any problems with emotions and  behaviors. So the biological health of the brain and body is where our focus should begin with when thinking about emotional and behavioral well-being.  This is not in exclusion of other import paradigms, such as the psychological or sociological influences on what make us who we are.

But let me ask you, 

Where do emotions and behaviors come from?

Now think about it and answer your true beliefs.

I was speaking with a wonderful physician the other day to whom I asked this question, (let’s call her Doctora.)

I respect Doctora for her character, personality, standard of medical practice and interpersonal beauty. She is a bulldog in the operating room. When patients need studies done that insurances won’t pay for, she tears barriers to treatment apart with vicious tools of rightness. And she cares.  She sits.  She asks.  And she cares.  She sees the person in the paper gown, each one for the person she knows them to be and the person yet unknown.

I admire Doctora greatly not only for these qualities but also because it gets personal.  I, who have my own special practice of medicine, cannot do her’s.

When just a green bumbler in medical school, there was a fateful day when I shadowed another great artist of medical care into a locker room.  I suited up in that blue sack they call scrubs.  I put little blue sacks over my tennis shoes too.

Do you know why there are blue sacks on the surgeon’s shoes?  So what is on our shoes won’t contaminate the operating room. But also so that when wet things come out of the human body and fall onto their feet, their toes won’t feel squishy. Yep. That’s what was going through my mind as I scrubbed my hands, each finger and each finger nail the ten minutes it takesto reach what is considered clean.

Surgery in progress, the color red mixed with a smell and monstrous sensual force that clobbered me to the ground.  I swooned, gagged and promptly ended my surgical career.

There is nothing more irritating to a surgeon than someone who doesn’t appreciate the “fun” of “cutting.” Yes. I irritated this mentor and others too I’m afraid.

This doesn’t keep me, unfortunately, from pleasuring in telling people, “I am licensed to do surgery.”  I am you know.  Any Jane with a medical license can pick a scalpel up and bring back the dark ages, or contemporary, depending on who holds the license.  I’m irritating to my mentors, remember.  It reminds me how anyone can go online and pay to become a marriage registrar, i.e. perform a marriage ceremony for couples.  My brother did that twenty years ago and has yet to perform the marriage ceremony for a willing couple.  For real judges and clergy, this might be irritating too and that makes me a little happy as well.

Anywho, Doctora and I were rolling with the injustices haranguing us in the practice of medicine, both from the angle of the physician and the patient. I was pumping her up for being the cutting-wonder who she was and she was dutifully marveling at my jabber-mouth work that she would, “never be able to do in a million years.”  Somehow this brought us round to how our culture avoids embracing the biological paradigm of anything inside our skull but is so willing to celebrate it for any other part of our human bodies.

Where do emotions and behaviors come from? 

Doctora answered me with a frozen breath. Then after I warmed and soiled the air with a lot of jabbering and she was finally able to speak, she said,

I would just be horrified if my brain got sick!

I wondered if it was scary enough to clobber her to the ground, but I do agree.  Terrifying.  Don’t you think?

So sleep is important from a basic rudder-rudimentary perspective of healing, restoring, and preserving our biological identity.  

If we don’t sleep well, a disease process may develop. 

During sleep, we heal from injuries, both physical and mental. Our brain actually shrinks for a small period, squeezing out, like a sponge, the toxins that accumulate during the day. It becomes smaller in mass without the fluid that filled it. The toxins drain into our cerebral spinal fluid (CSF) and after a period, the brain absorbs new clean CSF and expands in size again. Without deep sleep, the brain retains the toxins it accumulated during the day and those toxins go on to damage the brain cells, summarily over time, potentially harming the brain health and leading to disease. 

These treatments relating to sleeping well are often better than pharmaceuticals when it comes to processing and treating stress. When we sleep, we allow our broken neuronal connections to regenerate. We re-stock our shed with ingredients like cortisol, hormones, and neurotransmitters that are fertilizer for well-nourished thinking, kind behaviors, and stable emotions. During sleep, our memories consolidate; they find their place in the folds between our cells and root down into our rich minds.

I have seen regular, restorative sleep bring someone from a place of mental decline to no longer needing psychotropic medication. Everything works better with sleep.

2.       What are some of the tools that you like to use to help people develop better sleep hygiene?

Sleep Hygiene, according to Dr. Q! 

1. Bed is for  

The bedroom is only for sleep and for sex. This means no food, no phone, no TV. If you are not having sex, then all you get to do here is sleep. This might be an adjustment for the entire family, if your spouse is used to clicking on the late news or your kids want you to read them stories in your bed. But your subconscious has to recognize this place as a sanctuary, and not the place to read one last chapter or check Twitter. 

(I have yet to have someone tell me that this improved their sex-life, but one would think!…”)

2. Naps

No naps longer than 20 minutes during the daytime. If you are tired and have the luxury of lying down during the daytime, do it! But set your alarm to wake you up in 20 minutes, and then make sure you wake up fully. You can take these “power naps” 20 times a day if you want to, as long as they are no more than 20 minutes at a time. Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture or circadian rhythm) at night.

3. Exercise

Exercise, but not before bed. Exercise during the day can help to regulate your sleep cycle by making your body tired at night, but make sure you do not crowd it against sleep initiation. Try to get 40-60 minutes of aerobic exercise, 5-7 days a week. Look at it like a pill, prescribed by a doctor. This is something you need to do not for your waistline, but for your medical and emotional health. Every day, tell yourself, “I’m exercising so that I will feel good, so that I will sleep good, and so that I can do what I want in life.”  Some say, “I’m exercising for my brain!” 

4. Lights

Keep the lights dim before bed, and turn off the screens early. Darkness releases melatonin from the pineal gland in our brains, which helps to regulate our sleep cycle. Light suppresses it. Melatonin is a cornerstone in sleep architecture. Having your face six inches from the computer or TV before you lie down doesn’t give your body much time to turn itself off. (Some people who feel they must be on the computer or TV before bed have found that wearing sunglasses for at least the last 30 minutes helps.)

5. Routine

Go to bed and get out of bed at the same time every day. Enough said there.

6. 30 Minute Get Up

If you go to bed but cannot fall asleep in 30 minutes, get up and do something else until you feel sleepy. Then go to bed and try again. Refer back to the other rules when choosing your activities (no screens, no reading in bed, etc.).

7. Caffeine

No caffeine in the second half of your day. Period. No matter how good that iced latte looks. Decaffeinated is the way to go!

8. Alcohol

Do not use alcohol to sleep. Alcohol is a depressant (will make you depressed) and also blocks deep sleep. Alcohol hits the same receptors in the brain as the benzodiazepines mentioned above. 

9. Nicotine

Do not smoke before bed or if you awaken from sleep. Nicotine is stimulating. (It also decreases blood flow to the penis, so that’s one less of only two allowable bed activities we are allowed… Bummer.)

10. Sleeping Aids

If you cannot fall asleep in 30 minutes, consider taking a sleep aid. Do not take any over-the-counter sleep aids except natural melatonin, valerian root, or chamomile. Others almost all contain diphenhydramine, which blocks your deep sleep. You may end up sleeping a longer amount of time, but you will not be getting restorative sleep. 

If you talk to a doctor about a prescription sleep aid, do not take benzodiazepines, such as diazepam (Valium,) temazepam (Restoril,) clonazepam (Klonopin,) alprazolam (Xanax,) or lorazepam (Ativan.) These also block deep sleep. Sleep aids that don’t block deep sleep and sleep architecture include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata). Trazodone (Desyrel) is also safe for sleep structure and maintenance. The newest FTY (Friend to Yourself) sleep aids are Belsomra and Silenor. Sometimes people will find that combining sleep aids, such as zolpidem with trazodone, is more effective rather than using only one agent. Some of these wash quickly out of the body, and some take a full eight hours.

11. Sleep With Me

Do not sleep with your pets or children. Pets and children are disruptive, and no one gets the rest they need. Get the sweet buddy-dog out of bed.

It is not personal. It is sleep hygiene.

I’ll insert here, that one thing that gets left out of most sleep talks, is how to be awake. 

Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.

Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.

Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.

This is where I additionally bring in the concept of a stimulating medication such as provigil. Don’t confuse this with taking caffeine. Caffeine is metabolized way too fast to be helpful in this regard. There are others one may discuss with their treatment provider.

3.       What parting words do you have for other practicing psychiatric healthcare professionals regarding this topic? How about for the consumers?

For providers and consumers alike, remember our identity is as humble as the cells from which is is generated from. Our identity is as vulnerable as those cells are. The basic needs of the body, such as sleep, lead to the most beautiful and marvelous developments that this life can bring. Without our biological health, without healthy sleep, everything in our body and what our Me connects to, is affected.

Questions for you, readers: Again, do you have any recommendations, other interests, directives?

Please help me!

(Smile.)

Keep on!

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Besmirching God with My Crazy

I’m sitting here in a volunteer medical clinic for a 60K attendee camporee. It’s humid and hot and we are seeing a lot of dehydration, amongst other things. 

As a psychiatrist, I’m humming the Hallelujah chorus as I discover how much general medicine I still remember, from gout, viral rashes, respiratory and ear infections, cuts and bruises, and so forth. The group I came with teases me that if someone comes in for a cough, two hours later they will have disclosed that they were abused as a child and be swallowing prozac.  I am ignoring this implication that I am missing “the point” by treating for psychiatric needs. Ignoring and missing, at least it’s consistent.

Our theme from this camporee week is appropriate.  We have been looking at the life of David. In these, we see a whole lot of psychiatry going on, both medical/biological, and that which has to do with volition. King Saul demonstrated a sure biological mental illness. And David pretended to be crazy – call it, “acting out.”  

God put this in the Bible for some reason(s). Question: What does this say about God’s character? I mean, we certainly don’t look up to people with acting out behavior, like David. Nor do we necessarily look up to people with mental illness like Saul, either. What does this say about who God is? Why does God put this in the Bible?

The Bible didn’t describe this as psychiatric, behavioral, acting out, or general medical.  It just told the story. These ages later, we can do more with the story. Here in time, with the knowledge that the generations have given us, we could say something psychiatric was going on. But generally, despite this knowledge, we ignore the medical condition. We still talk about them with a weighted moral perspective, as if they departed from their spiritual walk in these behaviors, rather than consider the medical condition of their brains.

David is getting a javelin thrown at him while playing the harp. Patton State Hospital for the criminally insane might have housed king Saul if he were alive today. Then, David is in front of the Philistines with King Akesh, where he “pretended to be insane; and while he was in their hands he acted like a madman, making marks on the doors of the gate and letting saliva run down his beard.” (1Sam 21.) 

Dr. Martorell, a neonatologist, told me,

“I see so many people afraid to discuss problems such as depression, anxiety, other psychiatric illnesses and even family problems or abuse.  Yes, partly due to the fact that they may be judged as not having enough faith or not taking care of their health or not following certain principles.  

Primary Care Nurse Practitioner Carrie stated, 

“God and psychiatry go hand in hand I believe, but many Christians don’t think psychiatry has anywhere to go in the church. This is sad because my mom had bipolar, but nobody could help her.  She needed the ‘extra help’. The church thinks we should be able to handle it ourselves.”

You may have seen the lock-down type who says, “Keep it in the family. Don’t tell others what goes on here. It’s none of their business.”  

Dr. Martorell said, 

Our cultural or family upbringing has a lot to do with how free we feel to discuss these issues.  In certain cultures mental health problems are simply not discussed.  If it gets brought up, the family directly or indirectly tells the affected person suffering not to discuss these outside the home, as though it were some dark secret that cannot be disclosed.

Nurse Carrie said, 

“Everyone thinks we should deal with things on our own, and we shouldn’t have to talk to people about our problems and what’s going on in our lives.”

Ironically she is describing a condition of the church of independence. Yet inherent to being a believer is the learning to depend on someone else, God. 

Nurse Carrie said, 

“Why is it with depression and such, we can’t work as a church and have medical get it done.”

Many say, ‘If you go see a psychiatrist, it’s a sign of weakness. You’re not a good Christian.’ These are the comments I’ve heard of through the years.  You should just pray, and God can take everything away.”  

When my aunt suffered colon cancer, she didn’t get medical treatment in the beginning, preferring to have herself anointed, and follow a “homeopathic” approach. Later as it progressed, she changed her mind and found it was too late. So although largely, it isn’t only in psychiatry that we misrepresent who God is, we need ask ourselves, Who is God if what we believe about this is true?

Dr. Martorell shared,

As a neonatologist, I see infants born prematurely. Their brain develops outside the womb and are simply not the same as those that develop in a dark, quiet environment listening to mother’s heart rate, free of noxious/painful stimuli inside the womb.  As much as we try to imitate a womb with our incubators we can’t provide the same care.  When these infants are followed up for years, some develop physical deficits such as cerebral palsy, blindness, the need for oxygen, and the inability to eat on their own. These physical problems are easily seen and various treatments can be provided.  They are also at greater risk for developing learning deficits, hyperactivity/inattention problems, depression, anxiety and some academic papers even suggest increased risk of schizophrenia.  The thought behind these is that billions of synapses are occurring during pregnancy and the way these synapses connect is different in premature infants.  It is also interesting to note that the brain volume preset at birth occurs during the last 4 week of pregnancy. As these children grow up they need treatment for physical problems as well as psychiatric problems they may develop.  

I realize that it is not just in our churches that we are afraid to address this issue but I see it in the families of my newborns.  So many of these moms self medicate with illicit substances in order to treat their anxiety or depression.  Our culture as a whole has neglected to look at these issues as a medical problem that needs treatment.  So many children and teens are committing suicide.  Our own “well educated” health professionals have some of the highest suicide rates and yes it is occurring in our christian institutions as well as outside.  

Nurse Carrie said, 

“In this kind of approach, people are saying S/He’s not a loving and forgiving God and S/He doesn’t understand us.  If you deal with psychiatry, you’re a sinner. Why can’t you get it done with God on your own. He’s not a loving God, saying this person is not allowed to take medication. The pastor’s describing a cruel God because he’s not allowing the person to get the help he needs.  Like if someone’s leg is bleeding and you refuse to give that person a band-aid. 

But, God is always loving. This can’t be true.

I don’t think the pastor has a right to tell the parishioner that.”

Maybe we just succumb to the awkwardness of it all.  Too awkward to talk about God in our community.  Too awkward to talk about psychiatry in our church. There are so many reasons we approach emotions and behaviors this way but in the church or outside of it, let’s consider the question, What does this ay about God’s character?

I was cleaning up a leg laceration about 1 1/2 inches long and 2cm deep. I placed the triple antibiotic ointment and approximated the edges with steri-strips, yet still encouraging the patient and her guardians to take her to the urgent care to get stitches. This wasn’t a sterile environment and our supplies were limited. While working on the wound of the young teen, I asked a few brief psychiatric intake questions. It turns out, no. She didn’t have anxiety, or depression, or psychosis. What do you know!? Not everyone does. But she and her guardians were super pleased to pray together before they left and I was blessed by them.  

God is a God of love and the kind of God that cares about all of it in all of us. S/He is kind and not miserly, discriminatory, or punitive in interest and connection to us.  

It sounds like from what i’m writing that psychiatry isn’t seen as a legitimate form of medicine in the church. Or maybe the church doesn’t refer to it, or support it.  

A friend from my group read this post and responded. 

“We hear a lot about emotions and behaviors in the church, and related directives. We don’t hear however about where emotions and behaviors come from. 

I hear, ‘just pray more,’ or that I am lacking in faith. The people in the church get defensive, as if they have to defend God. And that’s not it. Honestly, it’s not complimentary to me that they think I’m insulting God. They are in a way attacking my spirituality. But I know God is helping me and He’s here with me. But I’m still this way. I still feel this way.

There’s a taboo that mental health and disorders all get grouped into this one cringeworthy word, “Crazy.” We’re almost protecting God from crazy by staying away from it in the church. We forget about the sin factor. The separation between us and God. The loss of connection. The word crazy isn’t very nice. So if we say crazy and we say psychiatry and God, it’s almost like we are besmirching God.  

Self-Care tip:  Ask, and ask again, What does “this” say about the character of God? It comes back to “Me.”

Question:  Do see the Bible and your church talking about psychiatry? Where and how? What does it say about who God is? 

Keep on!

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Emotions come from the brain.

Margarit was a lovely twenty-something, with blue-black bouncing hair above a slim pixy framed physique. She smiled easily and chattered like she was on telephone call that was about to lose reception. Her hands moved, conducting her thoughts between us. She was dressed like one of the cool girls on campus, out of my echelon, and who just might stab me in the back if I didn’t know better. But I did. She wasn’t mean. She was super sweet, like honey, and cane sugar, and mangos. Margarit was nice. But she had always wondered if she was being so nice all the time, because she was too nervous to be otherwise.

She came because she was constantly preoccupied by worries over things, “no one should be worried about”.

There had been the counsellors, therapists, and pastors consulted. Margarit and her parents had done their due diligence. With initiating each effort toward getting help for Margarit’s anxiety, they anticipated some degree of success. They thought things would get better. And sometimes they did, in degrees, and for a period of time. but the anxiety always came back. It got to the point that Margarit was put in home school, referenced her looping thoughts for everything, and was socially immobilized.

Maybe you’ve read, Gulliver’s Travels, 1726 by the Irish writer and clergyman Jonathan Swift. When Gulliver shipwrecked and washed ashore unconscious, the numerous tiny Lilliputians effectively tied him down. The rope anchors were so small, like acupuncture needles, yet Gulliver could not move. That’s what anxiety does to us. We become internally preoccupied by it and can’t think much outside of our thoughts. We are immobilized.

The anxiety Margarit had been harassed with since a child took her freedoms away. It chose for her before she even knew what she would decide. Example; friends want me to go to the mall with them. “No,” Before her thoughts could even play with the option. Maybe she wouldn’t have gone anyways. Or maybe she would have. The anxiety chose first though and she wasn’t given the chance.

By Margarit’s third visit, she had improved significantly. She was getting to know herself, she thought, for the first time. I met the parents this visit and they looked at me as a front. I supposed it had been them up against so much for so long now, that they had learned to go at the world this way, like a man plow they both held on to. They asked me why no one had ever recommended for Margarit to seek medical treatment for anxiety.

"We would have done anything asked by one of these professionals we took her to. We thought they should know what to do, but they didn't tell us to get her medical help."

In my mind, I flashed to Naaman being told by Elishah to dunk in the dirty Jordan river seven times to cure his leprosy (2Kings 5). Psychiatry is the filthy river and dunking in it is the nonsensical act of taking psychotropics based on magic and miracles. They were here reluctantly having preferred to start with clergy and therapists, beat up by inappropriate guilt, but ready now to consider that anxiety, in Margarit’s case, is a medical symptom of a biological illness.

The question of why no one had referred them toward a medical approach for their daughter’s illness is a good one, though. I asked a pastor what he thought, and he spoke of the difficulty of not being a medical specialist; not knowing when to refer people. And what of the therapists? Likewise, I guess, that they generally have been trained to approach emotions and behaviors through a psychological and sociological paradigm. And what of the parents themselves? Did they, when their daughter broke her collar bone in the 3rd grade after Christy pushed her off the swings, take her to the emergency room or to the movies for a night out? The ER. But when her daughter showed preoccupied thoughts that permeated her days, affecting her choices, small or large, affecting her sleep, and so forth, they did not think that the thoughts were related to anything medical, coming from her brain. They did not think that the thoughts were more than coping skills, or habits, or choice.

It is a condition of our humanity to want to look at thoughts and behaviors as many bits of our life control to be manipulated intentionally. As if we could. Like “The Matrix.” Or cooking a soufflé. Or driving a 1969 Chevrolet Camero. Shift already! There’s the good intentioned phrase, “Calm down.” “Take a chill pill.”

Oh good. Someone finally said it. If they didn’t I never would have thought of that. Now I am calm because I was told to be calm.

Emotions and behaviors come from the brain. Take the brain out and no matter what chaos hits, we would feel fine. Take the chaos away, and leave the brain in, we are still left with the brain, and what ever condition of health the brain is in.  So if the brain is ill, it expresses itself in a way that is ill. If the brain is healthy, the emotions and behaviors are healthy. They are symptoms of a medical condition.

Question: Where do you find your sense of control comes from, considering the biological paradigm? Let’s talk folks!

Self-Care Tip: Consider the biology behind whatever it is that feel and do.

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Patients who see me think God has not heard them

Hi friends. This is unedited. Something unedited really doesn’t have a right to be published online. Ah well. We are all rebels here. Give me your thoughts, mark up for your edits. We need to hear from you.

People come and say, I prayed God would heal me, I did everything right, but I didn’t get better. So I finally came to you. It was my last effort. I’ll do anything. I can’t live this way.

Then we sat together and explored what was happening here.

God is a better psychiatrist then I am, but it is a miracle every time that S/He uses me to answer prayer.

See what God is doing.

I’m grateful I am given these years as I am able to grow in understanding that my job is not as much to see, what can I do. Rather, watch and participate in what God is doing.

Remember Gideon.

The Israelites from Abraham till Jesus came, wondered and wandered around, thinking about what their destiny was. When they got Saul as king, they lost vision of seeing what God can do. Then they broke up into different kingdoms and got more kings. Then they were conquered over and over and they waited to get their victory. Then Jesus came. And showed us that His kingdom was one of love. Could we say, in some ways, it was a disappointment?

I’ve been disappointed at various times of my wandering and wondering how I fit in. Now I am very slowly learning that it isn’t about me.

Do not limit what God can do. Do not squeeze God down to the confines of our own minds.

Ellen White says that we will spend all of eternity learning about the character of God. That’s a lot of content. That a lot of interest.

If we think about all the scholars of scripture; jesuit’s, ravi’s, pastors, people with photographic memories, the wisdom of Solomon, it doesn’t touch all that is waiting there in that space of eternity for us. We are just getting a toe into what will capture our attention for eternity; what will give us purpose, motivation, interest, a wanting to live and connect with self and others for a space of existence that has no parameters to time.

Self care tip: it’s more than Me

Please speak out and tell us your thoughts.

Keep on

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Get You Some of That – Medical Treatment for Medical Illness

…Continued from yesterday.

Cole_liveCole Swindell – Get Me Some Of That

Why do I feel so horrible when I start a treatment that is supposed to help?

Medication treatments for depression and anxiety, and some other brain illnesses, often worsen how you feel before you feel better. I can’t tell you how many patients have told me that if they had known this before, they never would have stopped their mediation(s).

Yesterday, our post discussed a Dr. Jones and Presley.

Presley fired Dr. Jones when after following her directive, he subsequently experienced an extreme panic attack. Dr. Jones may not have done anything wrong in her treatment recommendations. Presley was just an individual, as compared to a “number on the curve” of treatment responders. Escitalopram, the medication discussed as an example yesterday, (one medication option out of many), may have been dosed at an initial amount that Presley’s body couldn’t handle “straight out of the gait”, so to speak. But likely, if he had started at a lower dose, maybe ½ or even ¼ of the tablet, and then waited for his body to accommodate to the medication. Then Presley would have tolerated it. Presley would have tolerated slowly increasing the medication if approached, rather, piece-by-piece of a pill. I’ll even joke with patients,

I don’t care if you lick the pill. Just get on it.

When slowly titrating a medication, it allows the individual’s neurotransmitter receptors to down-regulate whilst the agent floods the receptors. If there is a neuron targeting another neuron, there’s a baseline balance in time. There is a baseline understanding between these neurons. An agreement, of sorts. “I’ll sit here and receive your messages,” (neurotransmitters, or chemical messengers such as serotonin, norepinephrine, and/or dopamine). “I’ll then carry those messages on your behalf to their intended recipients,” (such as the amygdala or hippocampus). But then this person artificially takes a higher quantity of these messengers, for example, by way of medications, and floods the system. The receivers, (or neuroreceptors), have to adjust to this to establish a new healthy baseline. 

In this initial time of treatment, when 1st introduced to the increased neurotransmitter-load, (ex: as released by a tablet of Escitalopram), there can be a negative response, such as panic and/or depression emotions. We call this, “initiation side effect’s.” Once the neuroreceptors get used to the new load, then the response improves. 

After accommodating to the new pharmacology, the brain is allowed to experience the blessing that comes from treatments, and heal.

Some individuals are outside of the curve and cannot tolerate the standard initial treatment dosage, like Presley was. Some are inside, and can without much difficulty. The point in treatment, though, is that the person just needs to get on it.

Get on treatment. However you do it. You have to make the treatment work for you, an individual, in your own way. The prescriptions are there to serve you. You aren’t there to serve the medications. I like to analogize Jesus’ statement,

The Sabbath is there for man, not man for the Sabbath.

Make it yours as an individual and reap the benefits; the blessings inherent there. (See Mark 2:27). 

If you don’t get on the treatment, you won’t get better. Anything less than this will be inadequate. It’s like drying water off your face with a hand towel while still walking in a rainstorm.

What is your agenda in treatment? List it. Write it out. Then, go get you some!

Outside a medical approach is like flicking water off in the context of a rainstorm. If your agenda is getting to your healthy self. Get out of the storm and get dry. Then go get it. 

You have a medical condition. Treat it with the assistance of a medical professional. 

I don’t go to a plumber to help with my electrical home repair. I don’t go to an accountant or a church counselor to treat a medical one. 

The plumber, the accountant, the church counselor are what they are. This is not minimizing their efficiency in their own fields of excellence. But why do we seek care in psychiatry from those who haven’t studied this? From those who are not experts in this? Maybe stigma keeps us away from psychiatric care. Maybe misinformation directs our search for mental health treatment elsewhere. 

Self-Care Tip: Get you some medical therapy for medical illness.

Question: What are further concerns you may have about taking medications? How would you prefer your medical providers to work with you? Please tell us your story. 

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The Sins of the Fathers, and Mental Health

 

“We know the Bible speaks of sins of the fathers passing to the 3rd and 4th generations while God imbues his kindness and mercy far beyond that to those who love him and keep his commandments.”

Rosa had no experience in the world of mental health, or so she thought. She had spent her formative years studying the world through the perspective of her church and interpretations of the Bible. As you know, there is a lot in both with a lot to say about emotions and behaviors. However Rosa was taught and modelled that these were moral issues and not biological. An either or, verses, part of the same thing. Could we call it sequent variants, maybe something like genetic alleles? Or maybe something better to describe this is out there, rather than an either or.

Rosa Leticia Montoya, at this point in her development, with her own overwhelming emotions and her husband’s plummet into dark moods, felt forced into considering mental health. She did not want to go there, but here in the space of losing control, not trusting herself or Carl any more, and before she was willing to say she didn’t trust God, she was doing what was a last resort. Considering that she was going crazy was the only thing this chaos could mean.

Before she completely surrendered to the idea that biology was behind this sinister change, she had to ask, “Is this because of our parents?” She had spent her life trying to untwist the bad choices her parents had made and the consequences those choices had on her life. Drugs, alcohol, and cheating were what she had grown up with. Quietly. Hiding it in the church. Rosa there, praying a lot to live well and be forgiven. Praying that bad thoughts would go away. Praying to depend on God and not on herself, as seen through her perseverating worries ever since she was a child. Worried and worried. Not speaking of the wrong Bible-breaking life her parents wore like underwear beneath nice tailored clothes. Would she ever be forgiven? Would she ever stop sinning?

So she asked me, “What do you think?”

That’s a lot to work with as a psychiatrist. So I did what most of us do. Ran to the shelter of medicine. Whew! But there is the added benefit that God created medicine, psychiatry, and all that there is in my tool bag worth working with.

Even so, there was only so long that I could avoid the topic of God and His punishments, per her perspective. It came up every visit.

If you believe in God, at some point within your discovery of mental health, this question will come up. Rosa is not alone. Are the emotions and behaviors gone amok, such as seen in anxiety disorders and depression, secondary to moral weakness? Living with “too little” dependence on God’s power? Is it this? Or is it an “either or”, with our biology? …a matter of cellular grey matter composed of DNA-expressing pathology? And is this something evil woven into my DNA because of what parents did? Well, I’ve spent 30-some years in school and now 15+ years in practice in this space and am still trying to understand.

I’m wondering if you would help me articulate this. It’s fundamental for us in self-care. It’s not possible to be very friendly to ourselves with the dissonance.

So in our self-care question today, please answer us. What is the relationship between “the sins of the fathers” and biology? Please speak!

Self-care Tip: Pursue kindness in your belief systems toward yourself.

Thank you for speaking with us! Keep on!

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Live Imperfectly, Dad is dying, and I Have no Power.

wilted flower

Living with someone like tomorrow might be their last is much harder to do when it is actually the case.

My dad told me, after my nine-year old niece died, that a parent should never outlive their child.  When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.

When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.

My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying.  He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.

The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character.  He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.

Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?

Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.

In Life and Other Near-Death Experiences, by Camille Pagán, Libby Miller decides to live, just live, rather than die perfectly.  And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.

Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.

Question: How do you “live well?”

Keep on!

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Start Over

fabio

Muscled and gorgeous, he came in, like dessert, main course, and appetizer. Some people just carry themselves that way. It doesn’t work if they dress low, chest hair accentuated by opened buttons and glimmering chains. It doesn’t work if it’s their agenda, checking to see if you noticed, a finger hovering over the acoustic applause button. No. Attire must be intact, normal, not baptized in cologne. In fact, attire must be worn as if it is completely a non-issue. Attitude of a jack-rabbit, who never thought about his muscled legs. Those legs just hop because that’s what they do. That is the kind of attitude-ingredient to this kind of presence-recipe.

How would a mother name such a son? How could she know he would turn out this way? Greg is an essential name for this elixir to work, as essential as “Fabio” is to its destruction. Everything else may have been in place, developed over years, like a bonsai tree groomed under the tender ministration of Father Time, and caboom! “Fabio.” The bonsai becomes a paint-can-frosted Christmas tree. Greg’s mother named him ‘Greg’, in fact, because it was the dullest name she could think of, not wanting him to grow up to be anything like the sort of philandering infidel his good-for-nothing pig father “Fabio” was. Greg told me this. I didn’t come up with it. He knew it because his once beautiful mother, who worked seventy hour weeks, told him whenever he messed up, “I named you Greg! This is not supposed to happen!”

In came Greg, after three years of absentia. And it was like I had just seen him yesterday. His mother couldn’t believe that the name Greg would hold such a man, an addict. Yep. Greg hadn’t seen me for three years for a reason. There I was. Chirpy as ever.

Greg! Where you been?

Whenever a patient comes to see me, I believe in him or her. I believe. In part, because I believe in Me. I believe in my value. Wink. But I also believe in them because I believe in Love, and because I’m simply wired to. There are more reasons why we behave and feel the way we do, more than colors in your crayon box. It’s not just a moral issue, biology, or an adjustment to our human condition. Heck. His name may have even had something to do with it. “Greg,” is quite a name. But I did believe, more than I disbelieved, that he hadn’t been in to see me for reasons other than relapse. Maybe his primary doctor was filling his meds, and he was so stable he didn’t need psychiatry anymore! Yah! That’s it!

(This is inside information folks. You can’t tell anyone. My patients can’t know this about me. It could ruin my career! I don’t want them to be any more afraid of disappointing me than they already are. It’s hard enough to be honest in these places, and I do my darndest not to project my Pollyanna-agenda’s on them. They don’t deserve that. They deserve the hard-earned poker-face I screw into place when my heart gets broken. I purchased it with ten-years of my life from some magic spiders I quested in a cliff off distant shores. Bargain.)

Greg! (I said,) It’s great to see you!

Every patient wants to please their doctor. And every doctor wants to please their patient. And we all get our hearts broken at some point.

I was really glad to see Greg, after all. And he was looking good. But then I noticed he had more weather in his face, some clouds, lines, and gutters. And I noticed he wasn’t as glad. He had an aura of melancholy and self-loathing rolling off of him.

His little boy was with him, too, (Fabio. …J/K! Gotcha! Good ‘ol “cycle.”)

Greg sat there, thunder in his sorrow shaking his frame, and we reviewed his story. You may know Greg’s story. Greg may be your friend too. Or brother, husband, dad, or You. And you know the high from this addiction feels better than everything, until it doesn’t.

The best line ever spoken in this context is, “Relapse is part of Recovery.” That is from the God of Hope. That is what makes sense in every illness, like Charles Dickens is to literature, timeless and universal content, man. When Bob reaches for that doughnut, when Harriet rolls the dice at Pechenga, when Fabio uses porn rather than intimacy in a meaningful relationship, when Myrtle has to pull over on the freeway in a panic attack, this is when we ask, “Why am I alive?” and demand to start over for that answer.

I’ve asked that question fifty-plus times a week for fourteen-some years, and every time I ask it, I listen for an answer. I’m curious too. We all are, right?! It’s a marvelous question. Every time I ask, I wonder about the magic that keeps this beautiful creation in our community. I listen, because every answer is something that crescendos into the room, the words explosive, the best part of the atom.

I have a daughter. She needs me.

My dogs. Nobody loves me more than my dogs.

I want to know what it is to live without this.

I’m too scared to die.

God.

I just don’t know why.

Oops! Wait. “I just don’t know why,” isn’t good enough. Figure it. Finger it. Cradle it, and answer. What do you want to stay alive for? Because this thing! This thing is part of your recovery. Another day will come.

Greg left our appointment with options for treatment and a commitment to treatment. I’ll see him again and he’s one of the reasons I love life. Can’t wait.

Questions: Why are you alive? Please give us your answer. It will explode into the universe and someone out there needs to hear it.

Self-care Tip: Answer the question and start over. 

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Handout – How to Talk to a Psychiatric Patient.

duck

Finished the CME talk I did last week and thought, you might find some use for it.

I’ve received bad press many times for not being, in so many words, legit or academic enough. Check out the comments on my ECT book on Amazon.com for examples :). Maybe this one leaning into that bosom of greatness will turn public opinion. (Sneeze.)

…Formatting has been a real bear.

As you go through it, please talk out. Tell me what you think. I may do it again. (That’s right. I’m not afraid to threaten. You heard me.)

Keep on, Friends.

How to Speak to a Psychiatric Patient

Introduction:

  • You quack like a duck, avert your gaze, and then hold a fetal position. It’s good for core.
  • Be sure to carry your portable speakers playing zen chakra music in the background.
  • Offer cigarettes.
  • Bring a healthy white chicken to sacrifice over their chest for the exorcism.
  • Introduce yourself with an alias name. Hopefully a superhero.

This is a fail safe method of communication to pretty much hit all the difficult misperceptions we are contending with in psychiatry – demonic possession, shame, violent tendencies, weak character, and poor moral choices.

I’d like to give you the 1,2,3’s on how to talk to psychiatric patients. But as I researched this topic, it became apparent that this wasn’t the direction for us to go in. You have better algorithms, systems, and manuals based on research for this in your own departments. I know you have people who are specialists in the administrative side of things.

For us today, we are going to turn rather toward the innuendos that interplay in communication between caregiver and patient.

The is the first place for us to start, let’s just talk about it here.

What is it like for you to talk with a psychiatric patient?

  • Identifying Me in the mental health treatment paradigm.
  • Not implying that we have skills but no awareness. We are just deliberately putting the practitioner into “it.”
  • It’s a “how to,” but first we need to address our personal limitations.
  • Why do we have these limitations?

I: Clinician/Caregiver barriers

II: Patient barriers

  • What’s over-scored is that the problem is on the patient’s side. The patient is sick after all. We agree. Brain illness and all that.
  • Even so, what is underscored is our side. And that’s what this talk is going to be about.
  • We want to focus on our own thoughts about this. What it says about ourselves. Who am I if my identity changes with how I feel and behave? etc.
  • And then, how do we respond to that?

III: Understand Personal Biases – Likes and dislikes

  • Figure out where we are at. What makes it difficult to talk to patients?
  • What are the common myths? Get the myths out there. 
  • Some reasons are true and not myths.
  • What are some personal biases about working with psychiatric patients?
  • (Bias means – likes and dislikes)

IV:   Define Stigma

1. Prejudice – Attitudes, feelings/emotions (Amygdala)

2. Discrimination – attitudes lead to actions

1: Prejudice

  • Weakness of character
  • Supernatural explanations. (Statistically significant association with superstitions.)
  • The word “patient” not talking about disease, perhaps, but rather about character – something of moral value.
  • Religion. (But only a few believe that spiritual leaders can play a role in treatment! People don’t relate stigma issues to biology.  i.e., It is not biology or medicine that increase the problems, but belief that the person has a personal weakness as demonstrated by their behaviors – A conflict in beliefs, or prejudice, worth exploring.) (…But where do emotions and behaviors come from? The Brain. Thinking they come from a cloud by day or a fire by night fall into the category of prejudice.)
  • Time consumption.
  • Danger
  • Treatment skepticism – no recovery, there’s less hope for them
  • Punishment from God for evildoers.
  • Demonic possession
  • I am lessened by my affiliation with the mentally ill

What are our fears? Fears are an emotion and/or attitude…

  • Brings into play, how do we identify ourselves? …And that part of us that remains even when we are in a changing body (identity).  I call this, “Me,” with a capital “M.”
  • Think about this when we look at responses to prejudice; “discrimination.”

Caregiver stigma – “self-stigma” comes when we internalize public attitudes and turn it onto ourselves

  • We perceive stigma from others due to those we care for.
  • Shame/Embarrassment
  • Fears of what it says about ourselves

2. Discrimination – How we act on those prejudices.

Example:

  • Take “Caregivers Stigma.” We can bring this into our work place as well, from what we glean in our community.
  • We avoid patients who make us feel uncomfortable.

Who has Stigma?

Everyone.  It is in our community, including we who serve and are involved in mental healthcare services.

1. Patient

2. Clinician

Patient

Example: Mr. Whineheart misses his medications approximately three times a week due to logistical reasons. However, we know that Mr. Whineheart has had a long history of difficulty with treatment noncompliance. As we explore further, we discover that Mr. Whineheart dislikes taking medication. It makes him feel like he is weak. Not taking his medication is Mr. Whineheart’s discriminating behaviors against himself in response to his prejudices, (emotions and attitudes of shame.)

Clinician

Examples:

  • Refusing care for psychiatric patients.
  • Starting with Questions:  How do we respond to challenges to our identity? When our identity’s confronted by seeing our patients with psychiatric illnesses, our patients who demonstrate changes in their emotions and behaviors since brain illness set in, we ask, what part of us remains even when we are in a changing body and mind (identity)? How do we respond?
  • If it is positive, it is not discriminatory toward ourselves. If it is negative, it is discriminatory to ourselves and inevitably to others.

V: What are the barriers to talking with psychiatric patients?

  • The tension is when the patient and the clinician’s personal views, life stories come together.
  • Where those thoughts collide is where the tension is.
  • That’s where the barrier is.
  • Once this tension is resolved it’s easier to go into action

VI: Why bother about Stigma?

Because:

  • Stigma is a feature and a cause of health problems. (Both clinician and patient)
  • Belief —> action.
  • i.e., In caregivers, emotional toll can be devastating – may lead to injury or illness of caregiver

Because It Affects:

  • How we speak to psychiatric patients. (Human Value.)
  • Choices in our clinician-patient relationship.
  • Perceived quality of work experience.
  • “Me” and QOL (Quality of Life).

Because It Engenders:

  • Social distance. (Comes from fear. But connection is healthy for “Me.”)
  • We are robbed of opportunities (Think – Agendas, Connection, etc.)
  • Avoidance. (Comes from belief of danger.)
  • Treatment skepticism (What is “recovery” anyway?)
  • We need to ask, “What are our treatment goals?” (Agenda)
  • Frustration and anger, negative emotions.

Responsibility:

  • There’s an unequal level of power (Us v. patients/clients) – inherently increases our responsibility toward others to overcome this.
  • What about us?
  • Identify that. Then fear can become strength. Presence. Actions of discrimination change to actions of hope.

VII:  Agendas

  • Part of our “belief systems.”
  • Exposing agendas, leads us toward action. 
  • Just like exposing prejudice leads to actions of hope.
  • Just like starting with Me leads to actions of accountability and presence.

1.  Traditional agendas in the medical model:

a.  Serve altruistically.

  • Saying we don’t have an agenda is grossly dishonest.
  • Maybe we are uncomfortable speaking about agendas because it creates tension with the classic view that practicing medicine is supposed to be Altruistic.  Altruism is just another “pressure.”
  • It’s a perfectionistic model. It’s false. To ally ourselves with it is a mistake. Brings discriminatory behaviors toward ourselves, driven by prejudices of shame.

b.   Healing

  • The paradigm that never fits for psychiatry – cure, getting rid of something bad, not joining it and integrating it. (Presence.)
  • Can’t stop disease even with appropriate treatment – Treatment agenda changes to center around QOL experience rather than cure.
  • Caregivers in long-term care are not looking for recovery in their patients.

c.  Serve patient (Service)

2.  Traditional agendas of business

  • $, Profit

3.  Quality of work experience

  • Not only do we get money, we get other stuff (biopsychosocial needs).  That affects how we talk to people.

VII:  Solutions

1.  Start with Me. Own that we have stigma: prejudice and discrimination.

  1.  Protest
  2.  Put own selves in the way of these treatments
  3.  Rely on evidence (biomedical conceptualization or education), not ideation (prejudice, emotions, religious causation…)
  4.  Pay more attention to emotions, senses, thoughts.
  5.  Reconsider your agendas e.g., Not necessarily recovery but rather QOL
  6.  Engender a culture of expectation (ex: We expect ourselves and each other to participate…)

2. “Contact based” solutions.

  • The impact of experience and exposure
  • Best treatment is contact with the mentally ill vs. Educational approaches, which, although are helpful, are not as effective. Nor are psychotherapeutic approaches.
  • Maybe we overemphasize education in our culture and undervalue human relationships.
  • We see this anecdotally, but also notice that nearly all interventions studied, (multiple metanalysis, etc.,) used educational interventions primarily.

3. Education (Still important and demonstrates degree of efficacy)

4. Collaborate

  • Involve family

5. Collaborate

  • Involve community, Partnerships with community resources

Conclusion

  1. Start with at Me.
  2. More contact and exposure to people with mental illness.
  3. More education.
  4. More collaboration.

Continue reading →

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Why do I Keep Living? – Chronically Suicidal.

trainwrecklife

Carl D’Agostino is a retired high school history teacher. His interests include woodcarving and blogging. Cartoon blog at carldagostino.wordpress.com.   Cartoons published in book, “I know I Made You Smile, Volume I.”

Marvin lived hard for years, used up his bank, his talents used up like putting a flame to his wick.  He was wired to live in the moment. Living that way, when he had gifts galore freely given, living was different than when those gifts were used, diminished, and broken. Marvin was smart enough to rationalize his way into a chronic suicidality thereafter.

What is the point of living, after all? Marvin asked this question, answered it, and asked it again, to the point that it separated itself from Time and place. It is a question that is infinite anyhow.

Sometimes Marvin, with this infinite question, this question that occupies the time of God, kings, and beggars, Marvin would sit in my office with this infinite question in his nicotine-stained and inked fingers, and he would in this bring together the infinite with the finite. I remembered that the whole point, the meaning of the infinite and finite, is increased in value by the other. Marvin, living in the moment, even now years after his coin was thus reduced, was living in the infinite.

Why do I have to keep living? I just need someone to tell me it’s going to be ok if I die.

Marvin, If you are looking for a doctor to help you die, you need to go somewhere else. I will always choose life.

(It seemed like that “FYI” was in order.)

“We” made a plan …that Marvin wasn’t entirely in agreement with. I told him he could not come back to my clinic if he wasn’t engaged in that plan.

Marvin, we are just going to do what the data tells us will work. We don’t have to feel it or even believe it. We have the data at least.

Every time I have ever seen Marvin, I took a hard look, memorized him, knowing this may be the last time. Setting boundaries with him was freaky. It felt like trying to hold broken glass. Would Marvin be back? If not, I knew I’d be hurt.

The patient-doctor relationship is unique to each patient. It is unique to each doctor. For me, in my patient-doctor relationships, if it wasn’t for the hard grip I keep on the seat of my chair, I’d have too many of my patients in a big, but likely awkward, (and my Academy tells me, “Inappropriate”) hug.

This flashed through my mind in fair warning again. I compromised, saying instead,

You matter to me, Marvin.

I think Marvin’s lip actually curled and his canines grew. And I quote,

How can you say that? I just don’t get it.

This was a moment of road’s diverging, 31 Flavors, coins in your hand in front of a mother-loaded vending machine. I could see philosophers, all over the now and then of the ages, slobbering like they were at a nudie bar.

Once, when I called 911 on behalf of a patient who needed to go into the hospital for safety, the police person looked like that, bouncey even, on her toes. I had to check her feet to see if she was actually standing on a pedestal, she sermonized my poor patient so thoroughly. I think she was even eating a candy bar as she left my office, satisfied, (without my patient, by the way. Apparently she thought her tonic words had medicinal powers.)

Marvin was fishing me. There were so many ways to lose with that question. He was hoping I’d flop around with straining gills sucking air for hours while he tugged on the hook.

I’ve done that often enough, and will do it many more times. We can count on mistakes. What took me by surprise was, this time I did not.

Well, I’d guess it has something to do with me and something to do with you.

Yup. It surprised me. The surprise brought a wave of gratitude. “Thank you God.”

And if you aren’t as surprised or grateful by that liner, I can only explain that it was right at the time. Marvin lost his handlebar lip curl. I lost my grip on the chair. Marvin’s still alive, (I know everyone’s worried about the “for now” part of that.) And our universe cares, finitely and infinitely.

To the Marvin’s of the world, the wasted, the used, and the squandered, work your programs.

To the lonely and distorted, to the ones who have tried to die, to you who don’t know why you keep living, follow what the data offers by way of direction.

To you who may not get the same freely given gifts in this life that are now gone, you have good things coming.

We choose to live with you, than without. We choose you again. We choose, every time, what Love will bring. Keep on.

Questions: Have you ever asked yourself and/or others, “Why do I keep living?” What has your answer been? What is your answer now? For yourself. What would you tell your own Me?

Self-care tip: …I think I waxed on and off enough already with that – smile.

“I’m Making You My Business!”
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“I’m Making You My Business!”

It is pervasive.barriers

We talk about salvation as if it is an event, a diploma, a point in time, something with a frame and boundaries and a rejection of everything else about us.  Salvation is not this.  Salvation is pervasive.

Same with carrying your cross, going out into the world, and so forth.  Salvation and all these life axioms are in the divorce we are suffering, the depression, the trouble with sleep, the courage we demonstrate going into public, the fear we succumb to, the freedom we give up to anxiety – this is all about salvation.  This is what going into the world means.  It’s not one or the other.

When we say, the world will fall away, it is saying that there are no dividers any more.  If you’ve ever heard the term, the best way to get rid of an enemy is to make her a friend, this is the same idea.  God who is and who is personal takes away the dividers and makes us Her business.

God who is and who is personal is important for self care because She is all about Me.

Self-care tip:  Let the barriers go and accept the presence of Love.

Question:  Does God improve your self care?  Do you see dividers between your personal stuff and what is, who is, God?  How does that serve you, Me?

Keep on people of courage!

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There is no self-care without Love

grieving

Reggie showed up without his wife.

The wife was a short woman.  She had some practices that usually increased the space she occupied – the smell of tobacco, the size in her chair, the volume she laughed with, her large wiry curly bouffant, and her hope-filled aura. 
“Where’s your wife Reggie?” 

Reggie had sat down with his usual socially acceptable moderate expression. 

It was common for his wife to accompany him to my clinic and if she wasn’t there, it was only for purposes of work.  She prioritized him, it was clear.  However, her work was inconsistent, money was always tight, and she would most often have to travel when the opportunities arose.  Being a temp in nursing was like that.  Reggie was so proud of her and looked at her in that mix-matched role that any relationship between one person and another always is.  In Reggie’s case, sometimes she was his parent, lover, friend, enemy, caregiver, and now, what?

If you’ve been reading this blog for long, you know I love the concept of Time.  I fantasize a little about separating Time from space and yes, at some moments, think I am all that. (Wink.)  When I asked Reggie, “Where’s your wife?” I might have done it, though not pleasantly.  Something happened there that was inter-dimensional.  Because he was transformed.  His face didn’t melt or droop.  There wasn’t a process to it.  Rather he was sitting like a normal Reggie and then he was wasn’t.  Between normal and transformed, to me, reality changed.  The between was a crack that was a different reality.  A black space without Time.

Reggie cried,

“She left me. She left me.  I begged her not to, and she did.”

Reggie’s wife had done something personal.  She went and died. 

Even when Reggie stopped crying, he looked bewildered, raw and like the faucet was going to poor a lot more.  We did get to start talking a bit about how much his wife loved him.  We speculated about the love remaining after she died. 

“I wish I knew!  I wish I knew she was somewhere good and I wish I knew if she could see me.…” 

Reggie wished he could remain connected to the love. 

During our treatment together for over a decade, Reggie complied with our medical treatment in the context of that love.  Reggie honored his wife by taking care of himself.  He even lifted up his illnesses like an offering to her.  I was struck with the concern of what kind of treatment compliance Reggie would shift to if he thought he was living without love.  I was concerned that he would not value himself, including the respect he was able to show his illness without the company of his wife’s value and respect

The way that we honor those we love and those who love us, is by honoring our own selves.

It is intuitive in our nature to believe that we can’t live without love.  Where does love go when we die? 

This brings us to another premise in, “God and self-care,”  – there is no self-care without Love.

The argument psychiatry has with the concept of Love is that sensing it, knowing it, perceiving it, is all a part of our modular brain, therefore no more than grey matter.  Thus implied that it is diminished. 

Question:  Does it diminish Love for you, knowing that our perception of Love is as mapped out as that, even able to be man-handled, turned on or off by neuronal signals? 

Please tell us your thoughts.  Keep on.

Self-care Tip:  Find Love for self-care.

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Don’t Save God

saving God

A danger I don’t want to be confused by here is the temptation to save God.  I recognize I have dabbled there.  But, I am not saving God.  The agenda here is not to prove or disprove, to champion Her, or to drag any of us through the cutting edge of knowledge on dark matter. 

How much I get out of having God in psychiatry is all about me.  It’s good for me, my psyche and my self care.  I like who I am through the eyes of God, who is and who is personal.  I like what it does to me and my relationships.  This is how I see God in my life – home, biology, work, disaster, accident, gardening. 

She cannot be quantified.  If you can imagine it, God may be that and more. 

If I were a plumber, than God would be in plumbing for me.  It just so turns out that I am professionally, a psychiatrist.

Most people whom I’ve heard speak about God don’t have much that I want.  God did not employ them, from my perspective, any more than He did to me in mine.  Or the opposite is just as true.  She did.

Rob the pastor needs to do what is best for Rob. Instead, I hear Rob turfing off the disappointments in his life on God. 

Why do I do it, bring God into my self-care?  Because I want to.  Embracing that there is more knowledge than there is now in humanity, is part of Her and my relationship.

Question:  What do you want?  Why do you include or disclude God from your self-care?  Please speak!  It’s healthy for you.  It’s healthy for me.  Keep on.

Self-care Tip:  Don’t save God.  Start with Me.

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God Exists and God is Personal

God and me

As there are so many views on what “God” means, and because that’s not what we want to debate here, we have a useful premise. 

God exists.  God is personal. 

Nor is our purpose to worry over the function of religion, to roll between index and thumb the business relationship between us and God, nor to tidy up the religious wars between our nations. 

The purpose here is to discuss how to be a better friend to Me, in the context of the premise, God is and God is personal to Me. 

If God is, then He is personal.  Otherwise, there is no point to God, as far as you and I are concerned.

Question:  How do we treat ourselves well in the context that God is personal to Me?  If God exists and isn’t personal, what is the point of Him?  How does working under the premise that God is and God is personal improve the way you care for yourself?  Please speak out.  We need you.

Self-care Tip:  Accept that God is and is personal to you and keep on.

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The Modular Brain Doesn’t Need God?

I’ve been a little scared of losing God most of my professional education and practice life.  Everyone knows that no one can make it through psychiatry and still believe in God.  And those that do make it through psychiatry and still believe in God, don’t get it. Or so the opinion goes.

When I started medicine, I thought I’d most likely go into psychiatry.  I read my Bible every day. I was crushed by landslides of information I had to learn. With the equivalent of dirt in my hair, broken bones, and blood, I participated in prayer groups and Bible studies. I had to sleep eight hours a night.  If I didn’t, I couldn’t lay down knowledge and I couldn’t cope.  You may be one of those lucky persons who only need four to six hours of sleep at night to be human.  This an advantage equivalent to getting a silver silk parachute airdrop of food, medicine, and weapons in the Hunger Games.  I graduated from medical school and still had God.

Psychiatry residency opened up and I got closer to the the lions den.

What I found is that if you believe in God you are distrusted by colleagues.  If you believe in God you are distrusted by Christians because you’re a psychiatrist. And by Scientologists.

Innocents seem to be fine when they enter into psychiatry residency.  Then they come out totally changed. It disappoints Dad. Surrounded by cerebralists.  It changes the plans sponsors have made for the psychiatrists.  The psychiatrist doesn’t get invited to speak at church. The sponsors think they must have let him or her down.  And the sponsors thought the psychiatrists let them down.

Psychiatry is very high risk to the psychiatrist.  Why is it harder for them to keep God? It’s just generally not taught to utilize God in remedial processes with broken people. “And yet that is what God does best,” says my orthopedic buddy.  He says, “Psychiatry breaks down interpersonal relationships rather than include the spiritual. Unless the psychiatrist feels very comfortable with the healing and revitalizing powers of God, they don’t use it for themselves in practice.”  Is there a God-desensitization process built into their education.?

When studying where emotions and behaviors come from, God can’t be scaled.  There is no way to measure God.

We delve into human behaviors and emotions so intimately in psychiatry.  Once you realize that those things we used to moralize our life parameters with, once we realize that a perception of God is that “easily explained,” we don’t know what or who God is if not that.  Psychiatry deals with the mind and spirit and not the musculoskeletal world.  They are are right in the middle of breakdowns in that field where good bones and joints don’t make the difference.  They are right there where good behaviors and emotions are valued,  and explained in terms of grey matter.  Psychiatrist come to understand that everything is modular in the brain.  At that point, there is no need for God anymore.

Why do people lose God?  Parents blame themselves.  “I’ll never forgive myself.”  They know what they’ve lost.

Remember that song by Sting, “I hope the Russians love their children too“?  God v the Modular Brain might become a war.

My next book is going to be about God and psychiatry.  Wish me luck.  Recommendations, opinions, (no crude gestures,) and silver silk parachutes airdropped are all welcome.  Don’t hate me.  Keep on.