Month: September 2010

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Get Treatment to Move On – Addictions

Molested by his cousin, neglected by his parents, he watched his intoxicated father beat his mother.  Thinking she would die too many times, he ran away, returned in a police car over and over again, as if wanting to get away was a crime.  He came back and raped his neighbor, more than once.  He spent a lot of time trying to get sex even though he knew it was ruining him and others.  He lost interest in almost everything else.  He suffered uncontrollable impulses.

He was 18 years old when he left it all for the safety of prison.  During the next fifteen-some years he was diagnosed, treated, and kept.  But kept for what?  For eating.  He gained weight, until he needed 2 seats to sit in.  Eating became his preoccupation.  He didn’t have sex.  He had food.

He was released to a home for sexual offenders, put on a diet and lost weight.  He lost it big and fast and felt in control.  He started purging and not finishing his meals.  He thought about purging all the time.  He knew he shouldn’t do it.  His voice was changing, raspy and his throat hurt but he still purged.  He wasn’t having sex.  He wasn’t over-eating.  He was purging.

For whatever reason, no one had yet seen the pattern.  Mostly everyone saw sex offender.  Me included.  I was trying.  I was trying to treat him with empathy, trying to get past the bile that comes when I think of rape, trying to consider the courageous things this man was doing now in life.

In one of my favorite scenes from the film, Rachel Getting Married, Kim played by Anne Hathaway argues with her sister about her own chances to have a future:

Rachel: Kym, you took Ethan for granted. Okay? You were high for his life. You were not present. Okay? You were high.
Kym: [Whispering] Yes.
Rachel: And you drove him off a bridge… and now he’s dead….
Kym: Yes, I was. Yes, I was stoned out of my mind. Who do I have to be now? I mean, I could be Mother Teresa and it wouldn’t make a difference, what I did. Did I sacrifice every bit of… love I’m allowed for this life because I killed our little brother?

I thought of this and somehow through all that trying, I did. And because I could empathize, a space opened up for me to be more objective.  That’s when I saw it.  I saw the pattern.

Addictions migrate.  Someone who may have started out as a food addict, might turn to gambling, and then later to alcohol.  Someone with sex addiction, might turn to food and then later to purging.

It can be like that game I used to play at Chucky Cheese, trying to hammer down the little animals that pop out of holes.  We need to treat the disease of Addiction regardless of how it’s dressed, or else it will keep popping up.  And like Kym, if we do, although perhaps terribly wrong in some unchangeable ways, we will still have a future.  If you’d like to read more about this “kainos” (Greek word for the opportunity to be made new,) read the post New versus New.

Self Care Tip #62 – Get treatment to move on.  Be a friend to yourself.

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

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A Little Bit is Not Enough – Claim Full Health

The good news is, I just ate 3 chocolate chip cookies.  You already know the bad news.  Has nothing to do with my post.  I’m just sharing it for the sake of your own

Schadenfreude 🙂

…Onward.  Question:

Does emotional disease get worse even while on medication therapy?  Sometimes.  It does so more often when the disease process is treated but only partially treated.  Read a little more about this in this post if your interested.  A primary care physician recently told me, “I think the term ‘Partial Responder’ is a marketing gimmick to get physicians to prescribe more medications.  I don’t think it even exists.”

There’s a lot to be said about interview skills in sussing out the partial responder.  If I asked someone if they felt better, many things play into their response. Everyone’s responses are biased of course.  We don’t have sterile minds.  For example there’s the patient who wants to please their physician.  “Yes I’m better!”  i.e. “Yes you’re a good doctor!”  There are the patients who don’t want to be patients and minimize whatever they’re going through.  There is the physician who leads the interview.  “So, you’re feeling better?”  “The medication is helping?”

Partial response means that at the end of a full treatment initiation period, there is some disease remaining but a reduction of disease.  For example, in depression, I may no longer be suicidal, but I still have trouble feeling pleasure in life.  In cancer it means that there is tumor reduction of at least 30%.

Now why would a physician presumably agree that there is a partial response in cancer, but not agree that it happens in mental health?  Anyways….  (Ahem.)  When we partly respond to mental health treatment and don’t push further for full response, about 70% will relapse.  Versus maybe 25% in those who reached their pre-disease baseline emotional health through treatment.

Don’t get lost in this.  The point is, get treated and get fully treated.  Mental illness is progressive and causes changes at the cell level.  The brain is connected to the rest of our body.  The brain is human.  A bit better, is not enough.

Self Care Tip #61 – Go all the way!  Claim health.  Be a friend to yourself.

Question:  Did you find this to be true in yourself or someone you know?  Please tell me your story.

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Claim Your Brain

My mind, like rusted gears, was not moving well.  It hadn’t been really since my 1st pregnancy 8 years ago.  There are few things that dumb us down as much as pregnancy and children!   Hormone changes, lack of sleep, fluctuating from 145-200-145 pounds three times, and then the subsequent growing beloveds around me to contribute to mental dissociation.  Simple sensory overload from talking, yelling, crying, petitioning, inquiring kids factors in.  You may read more about sensory issues here.

Daily writing, like a staunch governess, found my brain under cobwebs, bug carcasses, and musty stench.  (Hello old friend!  There you are!)  This helps to explain the joy gripping my hand, like girlfriends on the playground, when I sit down to write!  The world is active to me, including rather than excluding me. My in-between moments used to hang like an old woman’s breasts.   Now much more time full of nourishing thoughts bless me.  I am in awe.

My patient came in sighing deeply.  He wasn’t better.  No, he said.  He lacked motivation and interest and connection from the world.  He felt selected out to suffer.  A dumping ground for misfortune and misunderstood.  Efforts through medication, after medication changes were like looking for love in all the wrong places.

We talked about cognitive distortions, tapping into things that used to make him happy, road-blocks in poorly designed neurological grooves – volunteering at the library or animal shelter, journaling, sharing his life story with others, exploring his spirituality.  No.  No good.  Nor could he consider psychotherapy as he’d been through too much of it already to consider it again.  And he just couldn’t get interested in groups such as through NAMI.

His brain, assaulted by stressors, disease, and disuse was growing silent.

Being a friend means yelling, fighting to reclaim your journey, finding something to connect you to your process of life.  My patient was letting squatters take his property simply by being absent.

Self Care Tip #60 – Claim your right to health.  Be a friend to yourself.

Question:  What has helped you connect with your own journey in life?  What do you think?  Please tell me your story.

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Keep it In The Relationship

She is a level-headed woman generally.  Objective by nature.  But now she asks, “What should I think?”  No longer taking birth control because she says she doesn’t need it.  They aren’t having sex.  Her husband uses porn and now openly gawks at other women walking by.  She says she doesn’t really care.

When a couple stops touching, the relationship is virtually over.  Few people revive their intimacy after too much time without sex.  Not everyone will believe this and may think it is too primitive for a true relationship of love.  But that’s the stats folks.  What to do if you physically can’t have intercourse?  Figure it out.  Must touch for intimacy.  Sounds like a bumper sticker.

Reminds me of a mighty river that suffers interference of dams and rerouting waterways.  Eventually a dry riverbed that once roiled with current and depth is left baking in the sun.  Even Paul the Apostle who never married recognized that if you aren’t physically intimate with your spouse, your nonphysical connection is also lost.

Physical intimacy is of course only one paradigm of intimacy.  And just about any one can say that, “Sex doth not a love make.”  Nor am I talking about finances, floss left in the shower, or how someone squeezes the bottle of toothpaste.  But whatever the many reasons are explaining the space on the couch, it ain’t good.  

So what did I tell her?  I certainly didn’t tell her “What she should think.”  I did review that we can’t trust our feelings.  “That’s true” she said.  “I hadn’t thought of that.”  Feelings lie all the time.

Question:  What do you think?  Agree or disagree.

Self Care Tip #59 – Keep it in the relationship.  Be a friend to yourself.

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Caught in Your Net – Thanks

Connecting more with friends since I started blogging. People I went to school with are knitted together electronically.  The world is smaller than ever.

In school, a people whom we drifted in and out of intimacy with, as kids will do, surrounded us.  Regardless of intimacy, they were generally there the next day and the next day. Familiar faces, personalities, specific laughs, and voices you could pick out in any crowd.  I’m pretty sure with many of them, I still could.

After many years without them there to see me fall off my chair, set a ball, share books, compare bra sizes, whisper, giggle – did I not miss them?  But I did.  Now however, through this technology-net, impossibly dispersed groups of people show their faces on my computer screen daily.  And regardless of degrees of intimacy, they are witnesses again when I fall down and when I stand.  I feel more alive!  Even seeing an angle of someone’s jaw line can take me back to a lawn and a tree and a bench we used to share between classes.  In almost real-time, I am laughing at their jokes, fame and foibles.  Crying with them when they lose.

Certain things are even better than they were when we were in school.  We don’t have as much time for closeting behaviors, hurts, shame.  It leaves more room for the real self to occupy.  Read more about this in the post “Sunshine.”

So to all you old (and new ;)) friends who have given me this privilege, thank you for catching me in your “net.”  Life with you is better.

Self Care Tip #58 – Connect with others to feel more alive.  Be a friend to yourself.

Question: What has helped you feel more connected?  Please tell me your story.

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Let it Make You Strong

She is young, golden, blushes easily, bright solar eyes, with graceful speech, not rushed or loud.  Like so many others, she doesn’t believe her beauty.   She came to me to get help.  Crippled by anxiety that hits out of the blue, like a hooded man grabbing her in an alley.  She feels during those times like she is dying or going crazy.  She started avoiding public places and became fearful looking over her shoulder for the next attack.  She was humiliated on all accounts by her uncontrolled emotions and thought people could see how crazy she was just by looking at her.  Branded and tortured.

When Nathaniel Hawthorne wrote The Scarlet Letter, he made plain the cultural pressure to define what is apparent, seen, and interpreted.  But more importantly he made plain the ability of an individual to define themselves on their own terms regardless.  Hester Prynne wore her letter A at first by mandate and then by choice, letting it represent who she was, where she came from, and where she was going.  She wore her letter and when people tried to change its meaning to something culturally less scarlet, “A” for “Able” she made it clear that she is the one who will decide the meaning of her life’s events.  Her and God and no one else.

When anxiety hits, we are scrambling to understand why.  We think, “What could we have done that is so terrible to have brought this kind of torture on?”  As Hester Prynne began her scarlet letter days bewildered by the force of emotion behind her angry neighbors, so victims of anxiety are bewildered by the level of shame and wild fear they presume must be linked somehow to this judgment upon them.  It becomes their life’s work to determine the meaning of a life with this.

Nathaniel Hawthorne writes,

The scarlet letter was her passport into regions where other women dared not to tread. Shame, Despair, Solitude! These had been her teachers—stern and wild ones—and they had made her strong…

Suffering is a schoolhouse for the courageous.

After some months of medication therapy this twenty-something woman said

I’m not so uptight about things.  …I didn’t know my anxiety was that bad until I got out of it.”  What amazed her even more was how better the rest of her body felt.  “Even physically I feel much better.”  No more chest tightness, body aches, and shakes.

She has the rest of her life to figure out how to say what this disease means and how it plays into the way she defines herself.  She will decide I hope.  Not her family, future husband, church, or Brook Shields.  I hope she will take what it teaches her and let it make her strong.

Self Care Tip #57 – Let it make you strong.  Be a friend to yourself.

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

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Bringing Your Worst or Your Best – Family

When I go to work, I feel my spirit get up off the floor, onto its knees and then it’s feet, and then fly into skies of happiness and inner congruence.  Work is where people are respectful to others.  If not they disappear.  (i.e. They’re fired.)  They do their chores and sometimes even with pleasure.  I am less often reminded of the fine line between success and failure, and I can always find my scissors, tape and stapler.  I’m sitting at home now, letting out a dreamy sigh.  Ah.

Why do we treat strangers so well and our family not so well?  Why do we give our best where our best is valued only as much as the going rate of gold and

silver?

John Tauer, Ph.D. states that coöperation and competition are not an either or.  He tells us from 4 years of research at basketball summer camps that the effects of combining coöperation with competition (intergroup competition) is much more powerful than either one alone.   In other words, individuals competing isn’t as fun or successful as a group of people competing against another group of people (i.e. teams.)  I propose that this might be part of the play in the difference between home and out of home behaviors.

In the home, we tend to see ourselves as individuals maybe even competing against each other.  Out of the home, we ally with others whom we can work with to compete against others.  We bring our best to the playing field perhaps.

In The Swiss Family Robinson by Johann David Wyss, we see a family who is marooned, cooperating as a team against dangerous elements (intergroup competition) to survive.  They have so much fun doing it that when rescue finally comes, nothing could entice them to leave their happy treehouse.

We see other examples of this (intergroup competition) when a family member gets sick and everyone rally’s to fight the disease together.  I wonder how we can do that good stuff without having to wreck a ship or fight cancer.  I’d like to give my best to my husband and kids every day.  The fraternities, the gangs, the undying lure of neighborhood rivalries, reality TV show Survivor – all show us that this intergroup competition is pleasurable and effective.

Question:  Have you experienced this kind of success in your own home?  Please tell me your story.

Self Care Tip #57 – Bring your best to the people you love.  Be a friend to yourself.

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Criticize if You Love Me.

On the receiving end of criticism.  Different from playing football or tag, no one wants to be chased, i.e. criticized.  If given the choice, which would you choose?  Chase vs. flee?  Humans can be a bit predatory when it comes to offering up feedback.

However, what I’m talking about has nothing to do with abuse.  Verbal emotional abuse is about unequal power.  Abuse of any kind, including spoken abuse, is scary, painful and shameful.

What I’m talking about is simply criticism.  You mismanage something at work and your boss, corrects you.  After coming home from that, tired and feeling beaten up, your children are picking on each other.  Then you get them in bed and find that you forgot to write-up a report and it has to be done.  Your spouse tells you that he misses his time with you.  

It takes a lot of love to deal with something.  Turns out, it’s much easier to let it go.  Walk away.  Examples of trying to promote criticism are the advertisements targeting parents to tell their kids not to use drugs.  It takes love to say no.  Loving yourself as well as love for someone else.  Kids who don’t get this feel neglected and confused.  Adults can also feel lost in so much impersonal space and act out just to get noticed.  Some people might call this “gamey.”  I just call it normal.  It’s a normal instinct to want the boundaries of someone who cares pressing around you.  It’s normal to feel adrift without knowing that you are worth somebody’s bother.

I say,

spare the rod and spoil the child

…at all levels.  At any age or station.  And further more, with your self-to-self included.  If you love yourself, you end up wanting to do and be better.  Coming from any direction, we can take it when we know we are loved.

The best part of Proverbs 12:24 is the second half,

but he who loves him is careful to discipline him.

So now, if given the choice, which would you choose?

Self Care Tip #56 – Bring it!  Take it!  Give it!  You are loved.  Be a friend to yourself.

Question:  Have you been criticized and known you were loved?  What’s your story?

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Bringing it Inside

“I read a lot of self-help books, but look at all the difference it’s made in my life!”  Sarcasm noted.  My friend was coming out of a dark melancholy of several years and complained that bringing something from your head into your life is hard.  Another case of trying to keep it real.

People call what we do “word play.”  Mouth flappers.  Those of us whose actions can’t keep up with our mind-matters fend off judgement like OJ Simpson. We’re guilty alright but it’s not murder folks.  Let’s get into the empty seats to applaud the performance of Good Intentions.  Good intentions come in degrees. There’s the thought, the desire, and then the levels of action that happen before and until execution.  Not all life is like playing horseshoes.  There is “win” in process too.

But my friend’s real beef was with the expectation she had that those books and their words would marinate her.  Soak her until she smelled and tasted and essentially became something new and better.  She didn’t think they did.  How does someone somehow bring what is out there inside?

If you want more about some of the biological play on this, read this post.  Basically if you are trying to grow, you are most successful working with a growing-style that is congruent with your temperament.  There are other intersecting paradigms also, including spirituality, external stressors and biology.  Bringing it inside is a balance between paradigms in life.

If I were speaking to my friend though, I’d applaud her thoughts, desires and degrees of action that have constituted her journey of Good Intentions.  I’d invite her into the stands with me and take some time to watch a replay of the parts of her life that made her glad.  That in itself opens us up to what needs to come in.  And we are more able to keep on.

Self Care Tip # 55 – Applaud.  Be a friend to yourself.

Question:  Do you ever lose yourself in processing?  Tell me your story.

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If You Are Ill

The 'Glasses Apostle' in the altarpiece of the...

Image via Wikipedia

A reader commented on yesterday’s post, “Afraid of Meds,”

My fear, I think, would be not so much the dependence—but what would happen if I did need that medicine and it suddenly became unavailable, like I couldn’t get my prescription because of a natural disaster or something like that.  …Would going off of those meds cold turkey put me at a real disadvantage?

In my late 20’s I had similar fears, only for me it was related to my eye-glasses.  Because I didn’t tolerate contact lenses, I especially had vivid fears of getting into the driver’s seat of my car without my eye-glasses anywhere to be found.  Living on loans at the time, I took out extra money and got LASIK eye surgery.  Oh the joy when I woke up one morning and could see clearly, high-definition, no glasses to grope around for, freedom!

Unfortunately in neuropsychiatry, we don’t have the privilege yet of offering many curative options like LASIK surgery for emotional illnesses.  I don’t believe it’s too far off in the future.  It wouldn’t be wild to say our children may have those options some day.  For example, embryonic stem cells may offer a cure for disorders such as depression and schizophrenia.  However, until a cure becomes as available as Prozac or even LASIK eye surgery, the reader quoted above has a reasonable fear.  Medication becoming unavailable is a disadvantage.

Now I’m not great at twisting reasoning powers, so I’ll say this as best I can.  That’s like not getting eye-glasses because we are afraid of loosing them.

So to this reader quoted above and to you I ask,

Question:  What do you think?  Treatment or no treatment?  Please tell me your story.

Self Care Tip #53 – If you are ill, get as better as you can.  Be a friend to yourself.

Related Articles From FriendtoYourself.com

  • Mental Illness Relapses When Medications Are Stopped http://bit.ly/pA4kxo
  • Number One Reason For Relapse In Mental Illness  http://bit.ly/rt1qJf
  • Are Your Meds Safe?  http://bit.ly/lh1cBh
  • Say Yes to Medication And No To Drugs  http://bit.ly/oX12i0
  • Fears of Addiction To Medications for Brain Illness http://bit.ly/oWY8i4
  • Other Fears of Medication For Brain Illness  http://bit.ly/qdHksR
  • Afraid of Meds  http://bit.ly/rjt7wY
  • Full Treatment Response Means a Better Future  http://bit.ly/ph84ZU
  • When It Is Time To Take Medication   http://bit.ly/nbIYLT
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Afraid of Meds

A colleague told me,

I want to get off my sleep meds because I don’t want to be dependent on anything.

Dependence.  Lazy, pass-the-buck, unimaginative, immoral, chemical abuser.  Maybe even doctor-shopper depending on who is speaking.  When someone says it, before we talk about medication use, biology, etc… we need to know what is behind that word.  Working with the tip of an iceberg of prejudice might sink us before navigating much treatment.  Even physicians after 25+ years of education and more of medical practice, find it hard to shed these cultural prejudices about psychotropics (medications used in psychiatry).  What does the word dependence mean to you?

To psychiatrists, substance dependence means that the body has become accustomed to something.  We don’t get as much physical or emotional boost we used to using a substance, such as to nicotine, alcohol, illicit drugs, or prescription medications.  We now need more to get the same effect we would have gotten before with less amount.  It includes physical and emotional cravings – like sweating, shaking and yearning.  A lot of time is spent to do whatever it takes to get it.  Can’t cut back.  Keep doing it even though spilling into personal and professional space.  Keep using even though aware body and mind are worse for it.

Was this a description of my “dependent” colleague?

How about abuse?  Substance abuse is when we do dangerous, mean, and/or irresponsible things when using.  Was he hitting his wife when he was under the influence of a sleep medication?  Was he taking sleep medications when he was at work because he liked how they made him feel?  Driving with them?  You get it.

This guy is no dummy.  Yet he felt guilt and shame about appropriately using a medication for a medical reason.

I was seeing a woman for the first time in my clinic.

“Doctor is this medication going to make me addicted?”

We spoke about her fears.  Turns out, she thought her medication would prejudice the world against her.  Change her personality.  Make her crave it if she ever wanted to stop.  Steal from her geriatric mother and eventually, who knows?  Panhandling?  Now how am I supposed to work with that?  How she ever got the courage to come and see me in the first place with all that on her back, must be pure grit.

So here’s the dirt.  Some medications have no dependency risks.  Some medications do.  Some people abuse any medication they can get their hands on.  There are rave parties where there is a kitty – a bowl full of whatever pills anyone in attendance donates to.  They take them out randomly and swallow to get whatever surprise awaits them.  Is one class of medication more often abused than another?  Yes.

As a prescribing physician, I have sworn to not intentionally do any harm.  As a patient, you contract with me to take your medications as prescribed and safely. We’re in this together.  We will talk about any recommendations and you will hear the risks and benefits to treatment.  You will decide.  There is no conspiracy to turn Americans into bad citizens through psychotropics.

Self Care Tip #52 – Find out where your fear is coming from.  Be a friend to yourself.

Question:  What are your fears about psychotropics?  Agree or disagree with this post?

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Take What is Yours

It doesn’t have to be that complicated.  “I only go two places.  The tattoo parlor to hang out with my buddies or the beach.”  He says he doesn’t have a cell phone or a computer.  I see him every week with his wife, doing what he can to support her as she teaches a class for my 3-year-old. He smiles and chortles and pokes with satire.  He has shown me his skin art several times and it is easy to see what these represent.  The people he loves and who love him.

In the film written and directed by Derrick Borte, “The Joneses,” we watch a pseudo-family move into a gorgeous home with intent to market their wares to the unsuspecting towns-folk.  As they are instruments in sales, they become infected with purchasing-power-fever.  As their own fantasies grow of being the perfect family unit, so does the definition of what it takes to be one.  Being happy individually as well as relationally equals easy access to riches and easy life.  The glitch is that they are not a family nor does the new this or that belong to any of them.  Like making a deal with Ursula the purple octopus-witch, they are ensnared.  It becomes a hard choice to regain the rights to their lives.  In the end, they barely escape with the understanding of what they can really claim as their own – love.

The other day when our dog was dyeing, at bedtime I was able to debrief with our daughter about her feelings.  “I know you love me Mommy but it felt like you loved Maggie more than me.  Even though I knew you loved me more, I didn’t feel it Mommy.”  For someone who can barely see around her Ego, that’s pretty amazing!  From her beautiful child-self, she told us that love is there even when we don’t feel it.

My husband was telling me his “Good News,” quite different from  rights of passage like a fraternity.  It is that God is already right here with each of us and unrelated to our performance.  We all have Love, regardless of lost opportunities, low-character, higher learning, or technology.

It’s not that complicated.

Self Care Tip #51 –  Take what is yours.  Be a friend to yourself.

Question:  Agree or disagree?  What do you think?  Please tell me your story.

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New Verses New

She died this morning.  After a day and a night of confusion, stumbling gate, and suffering, our gentle gorgeous Maggie died.  She is returning to carbon ash and giving us another reminder of what can be delivered to the living by death.

With the children taken to school, my husband came home to share grief with me.  He had just listened to a podcast by Rob Bell about the word “new.”  In Greek there are 2 common words used for “new.”  One connects newness to Time.  As in the young in age and old in age.  This is traditionally how our culture interprets “new.”  Another use of “new” uses the concept of renew without connecting it to time.  There is a newness in you as you are in time.  It’s a great overlap into the concept of presence.  But where my big gratitude went out to was knowing how many opportunities to being made new we have.

Some of us have the propensity to wait until we “hit bottom”  before we come looking to be made new.  I don’t mean this in any way that is judgmental.  Please see my blog posts on temperament if you want to read more about this.  If we were fortunate enough not to have picked up any self sabotaging habits, then in some ways we’ve got an easier time of it as the the years roll by.  However, few of us are, and getting crushed over and over again like recycling cans hurts a lot – us and ours.

“You can’t have it all” we are told, brewing panic after wasted opportunities.  Not having it all, missing out on more days to share with Maggie, loosing the hope of puppies some day, brought the well-timed discussion about newness straight to our grief.

We are given the opportunity to be made new any time any where regardless.  Any where from greatness to low-living, we have that choice.  When I think of Maggie, I will think of this and hopefully I will choose to be made “new” again.

A “new” heart also will I give you, and a “new” spirit will I put within you: and I will take away the stony heart out of your flesh, and I will give you an heart of flesh.

Self Care Tip #50 – Be renewed.  Be a friend to yourself.

Question:  Do you agree?  Disagree?  Please tell me your story.

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How I Feel About You

Sorry folks.  Not much of a writer today.  My dog is sick sick.  I’m distracted.  My daughter got upset.  “Mommy, you love Maggie more than you love me!”  Huh?

We’re in the middle of a garage conversion and our contractor said his 14 year old daughter wrote him a letter when he had his 3rd child.  “Dad, I know now that you have another baby you won’t be able to spend time with me any more….”

Readers, my dog is sick but that doesn’t change how I feel about you.  (Smile.)

Sleep well.

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The Good and Bad of Anxiety

In response to yesterday’s blog, a reader wrote,

I often feel my flight and fight response triggered even in situations (mostly social) that should not (theoretically) even be frightening. What do you think about that?

This is like the degrees of water temperature in our shower.  Pretty much every one falls somewhere on the spectrum of this type of anxiety.  When is it ok, and when does it become not ok?  My brother, friend, mentor, Cameron Johnson MD said in so many words

Anxiety is what makes us work hard.  If we didn’t have anxiety, we’d all be slobs.  We’d stink.  We wouldn’t get our homework done.  We wouldn’t say as many nice things.

My children still see most things in all-or-none fashion.  They would say at this point of the discussion, “Anxiety is good.”

A teenager I treat began responding to her medication.  Her mom began to complain.  “She never let this happen before!”  Her room was a mess.  She was less prompt to obey and she started voicing her opposing opinions more.  In some ways, without the anxiety, it was like her mom was getting to know her for the first time.  

This was however, better than anything this girl and her mom had hoped for.  Now the girl wasn’t throwing up, having panic attacks, avoiding just about any social experience.  She was making eye contact with me and she was able to present in class.  She told me that she can’t even think about how she felt before.  It was so bad.

It is really hard for any one who has never suffered from debilitating anxiety to realize the level of suffering and terror it causes.  Someone who may look stuck up, aloof, disinterested, quiet, bored, may in fact be at hells door.

My children might now say, “Anxiety is bad.”

And so to my reader quoted above, I’d say with my children, anxiety is good and anxiety is bad.  Come and paint the stars with me for a time.  Talk and tell me your story.  We shall in degrees of mind and manners, unwind the mysteries together.

Self Care Tip #49 – If anxiety is affecting you in a negative way, consider a medical reason.  Be a friend to yourself.

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Scare Yourself If You Must, With Caution

A patient came in depressed and anxious.  After our initial interview he disclosed that he and his girlfriend were playing around with sadomasochism and it was scaring him.  We discussed that to help him get healthy, he would need to do healthy things for himself.  Anything directly harmful or potentially life-threatening doesn’t fit in to that.  We agreed not to formally engage in therapy until he had thought this through and what he was going to do with his sex-practices.  He came back wanting treatment, and spoke like this whole S&M thing was old history.  “Oh that!  I talked it over with my girlfriend and she understands.”  Ok.

Why do we scare ourselves on purpose?  Like watching horror movies, or even movies that are more mainstream but have suicide scenes, abuse, car accidents or other freaky things.  Some are thrill-seekers through extreme sports like sky diving.  Others cut themselves or do other forms of self-injury.  This may seem like an odd bundle but they all share volitional fear experiences.  Even as do team sports like tag or football when getting happy from being chased like a rabbit from a fox.

When we scare ourselves on purpose, our bodies release a number of wonderfully feeling chemical messengers.  There is adrenaline, dopamine, cortisol and more that give us a rush, a lift.  It is positive feedback.  (Dopamine is the main pleasure molecule that all addictive drugs target as does food or even a back scratch.)

Psychoanalytically one might say, like Boston College professor Peter Gray, PhD

…our greatest real fear becomes, in play, our greatest joy.

When this goes wrong is when we hurt ourselves in the process.  “Look out!” is what I say.
Other examples that are more common are film, television and video games.  We now have data that supports evidence of primary emotional illness induced and driven by watching violence – such as post traumatic stress disorder.  Post traumatic stress disorder is a bummer.  It is the only primary emotional illness that has no clear genetic origin but comes after a life threatening event either experienced by yourself or observed by you.  Just don’t get it on purpose for crying out loud!

When I am hankering for a good thriller movie, I try to use this understanding to steer me.  I try to remember that I am extremely valuable.  Along with the obvious but not so obvious good advice,

…whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.

Self Care Tip #48 – Scare yourself if you must, with caution.  Be a friend to yourself.

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Celebrate Treatment and Live

Holding her breath, my niece swam the length of the pool underwater.  She popped up like an otter.  Slick, water rolling off of her like nothing in the world would bother her.  Click!  The timer showed her that she beat her record.  She was gasping but smiling like an olympian.

My niece would have liked to have added another lap before coming up for air but her body wouldn’t let her.  She needed to breath!  Have you seen the same thing happen in your spouse when they are sleeping?  They look like they are holding their breath doing laps and need to come up for air?  Gasp!  Ah!  Oxygen!  Sweet Oxygen!  Nothing like it.  This event when someone stops breathing for more than 10 seconds during sleep is called apnea.  When it happens more than 30 times in a night it is called Obstructive Sleep Apnea.  The gold standard for treatment is a machine that pushes air into the airway to keep it open – either bipap or cpap.

My patient is young, not obese, exercises regularly and looks healthy.  However, he has tested positive for Obstructive Sleep Apnea during a sleep study and has been prescribed cpap.  My patient used to wear it but frankly doesn’t feel sexy in it.  He feels like he’s wearing a jock-strap on his face.  My patient prefers to snore loudly, go silent, then gasp, over and over through his sleep rather than wear cpap.  No one had told my patient why he must wear cpap, nor did he look it up. We talked a little about his marriage and how he was happy at home.  We talked about school and how well he was performing.  Then we talked again about sleep apnea.  My patient didn’t know.  He didn’t know that he was gifting his wife with a future impotent man.  He didn’t know he was enjoying fewer an fewer functioning brain cells every day.  He didn’t know that he was gifting his children with his early death from heart attack.  He didn’t know that his anxiety might not be responding to his medications because his brain is screaming for oxygen.

Just thinking about his story made me take a deep breath and pray a prayer of gratitude for the air, oxygen, and life.  He did too.   We’ll see if he decides to use cpap or not over time.

In medicine, we can’t diagnose a primary emotional illness if someone has an ongoing medical disease that may be causing similar symptoms.  We need to be as sure as we can about where symptoms are coming from.  I liken it to a steam engine train chugging along, steam blowing out of the chimney.  The steam is what we see, but the onward movement of the train is the disease process.  Obstructive Sleep Apnea affects every cell, organ, system in our body because as it turns out, every bit of us needs oxygen to survive.  I’ve seen people after heart surgery, with no idea that they could have avoided all of that by simply using cpap.  I have been treating one woman now for 7 years for severe treatment resistant depression who is still not using cpap.

So many of the people I work with have sleep apnea.  They feel embarrassed and ashamed by it.  I’m not sure how to help them better but I’ll keep trying because their lives depend upon it.  To feel the sense of accomplishment my niece felt when she came up for air, “Ahhh!!”  Accepting treatment is that wonderful.  We could celebrate.  It’s all perspective.

Question:  Do you have any recommendations for those of us suffering and ashamed?

Self Care Tip #47 – Celebrate treatment and live.  Be a friend to yourself.

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Look Around At The Other Reasons – Depression

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“I’ve done some bad things.”  Patient tells me she can’t sleep well, is nauseated, depressed mood, worried with perseverating thoughts about acts that shame her and ramifications, doesn’t feel as much pleasure in life, isolating, tearful and more.  I was alarmed!  What could she have done that deserved this kind of self-flagellation?  When she told me, I didn’t realize it.

I was still waiting for the rest of the story.  I got caught up in her own self-judgment and found myself sitting beside her “in court.”  Once I realized what I was doing, I was chagrined.  Here I was collaborating with her in her inappropriate guilt.  It took me too long to register that her reaction was not proportionate to the offense.  I told her I was sorry she was going through all this emotion.  She said, “It’s my own fault.”  Is it though?  We needed to start looking at additional reasons that might be influencing the way she felt.

Start looking at other paradigms when the emotional response is out of proportion to the event(s).

An analytical approach would look at unconscious reasons, such as other personal choices that conflict with a core beliefs.  Or perhaps, something like unresolved anger coming out in physical and emotional symptoms. Ask about our “closets,” peel away pretense and let your flawed self into the air.  Keep it real.

Another paradigm is medical.  Inappropriate guilt is a symptom of Major Depressive Disorder, a debilitating disease process of the brain that affects the whole person/body systems.  When distorting things out of proportion, personalizing too much, we must ask if there is a depression going on.  Ask yourself.  Ask others.  But don’t let it continue if at all possible.  Major Depressive Disorder is a progressive disease that does more damage to the brain the longer it goes untreated.  In other words, the brain is affected more over time, it is harder to treat and it is more dangerous to the person.  The average length of an episode is 2 years and the more times it returns, the more chance to have the disease process continue for life.  Treating sooner and for longer, decreases the chance of relapse.

Excellent for us are the many treatment options for this potentially devastating disease.  Even in the “lifer,” when staying on medications, the relapses are much easier to get through and shorter in duration.  The medication has a protective effect on the brain.  Prophylactic against further insult.

In the woman I told you about, there was another emotional spectrum disorder, anxiety.  Anxiety and depression are like brother and sister.  They often go together.  But for today, we’ll leave it on the symptom of inappropriate guilt and let it rest on the reminder that the brain is human, mortal, attached to our neck and not an aura.  When the brain gets sick, it shows how it is doing the only ways it can, often through emotions.

Self Care Tip #46 – Look at all the reasons influencing the way we feel.  Be a friend to yourself.

Question:  What do you think?  Agree or disagree?  What is your story?

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Your flawed self

My niece is sitting beside me and I can barely keep my hands off of her 5 month self.  I am eating a blueberry scone slowly.  She, with her tummy-full of breast milk, is watching every bite, a faint smile on her pink face.  I’m a little afraid she’s learning to eat carbohydrates from me and I want to tell her that I can’t remember the last time I ate one of these.  I start eating faster and turn away so I don’t imprint this on her supple myelinating neurons.

We closet eat, closet smoke, closet shop, closet sex, closet what we want to protect others from but what we independently are strong enough to handle …or not.  There is a term called “self-sabotaging behavior.”  Reducing this, we find that the process of closeting is in fact the handle on the door to that mal-behavior.  Keeping it real is the same as saying get it out of the closet.

My mentor and brother, Cameron Johnson used to say, “Go where the pain or fear is and it will lose control over you.”  People who work the 12-Steps call this “Rigorous Honesty.”  It is a pealing away of all pretense with yourself.

Avoiding rigorous honesty turns into self-sabotage.  We end up cutting ourselves down at the knees.  Anxiety uses fear to make us hide.  In cases that include emotional illness, of course medication will help our work toward honesty.

It is not about whether we hide our bad sides or not – we do.  It is about trying to keep it real.  The only thing to be ashamed about, if we must, is not trying.

So to my niece, I give her my flawed self and when the time(s) come, I will accept hers as well.

Self Care Tip #45 – Show the world your flawed self.  Be a friend to yourself.

Question:  How have you experienced the freedom that comes from going toward the fear?  Please tell us your story.

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Do What You Were Designed to Do

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Nike made it popular.  But did we ever take it and run with it?  “Just do it!”  My girlfriend and I were having lunch together and the topic about our life’s profession came up.  She is bored in her work and would like to get into something more creative and artistic.  In an ideal world, maybe she’d think, “Just do it!” and find congruence with her inner self “just” like that.

However, taking action isn’t only about energy, interest, boredom.  But what is it?  What is it that makes one person take action and another think about it and move on?

One answer has to do with hard wiring.  Some temperaments find that thinking about it is almost as good as doing it.  Imagining what they would have done pretty much satisfies their drive.  Others find that taking action that leads to completion, decisions, just doing “It”, feels like boxes, closing in, closed doors.  They feel separation anxiety just imagining the distance growing between them and their beloved Options.  For these people, maybe the perspective of “Just do it” should be different from our cultural definition.  For them, doing it may mean doing what they do best – grazing their ideas, options, journey.  They are best at playing through life so to speak.

Western culture measures work generally by the opposite of this, although the truth is, our life’s work is what we were designed to do and be best at.  What looks like play to someone is in fact “good work” for another.  What looks like work to another, looks like something they’d rather jump over a cliff than do.

If we want to really get something done in life, we will do best taking inventory of what we bring to life with us.

I haven’t touched on other reasons why many of us do or don’t take action to completion.  Things that have to do with different pathologies.  I’ve only talked about one paradigm of hard-wiring, genetics.  This paradigm is crucial though.  It permeates all others as it is about our architecture.

Self Care Tip # 44 – Just do what you were made to do.  Be a friend to yourself.

Question – What do you think?  Have you noticed this concept at play in yourself or others?