Month: October 2010

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Bella’s List – Tell Me Your Thoughts

 

 

“The day has been ruined!” Bella said.  Her eyes sparkled and flashed as she spoke of her injury.  Bella was not so pleased with her labor’s reward.  She was not so satisfied with being accountable for her children‘s behaviors, when they thwarted her every effort at having a good family experience.

Five pieces to Bella’s puzzle:

  1. endless new beginnings
  2. victim or what?
  3. our reward
  4. accountability in parenting
  5. all-or-none catastrophizing

 

today.msnbc.msn.com

 

There are many approaches to these provocations but I’ll tell you mine – a blend of others.  There’s a lot in Bella’s list.  Let’s take the next few days to explore them.  I’m not sure how long I’ll be interested in these topics but that’s the plan for now!

In the mean time, it would be GREAT! to hear from you.  Please tell me your thoughts on any or all of these.

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Recipe for Treating Panic Disorder, According to Me

 

shoponline2011.com

 

Recipe for Treating Panic Disorder, According to Me:

1.  If it’s taking you to the emergency room feeling like you’re going to die, or your spouse can’t peel you off with your phone calls and new needs – you have a medical illness.  Get medication.

2.  If you are afraid of being humiliated by an episode so much that you avoid public places, or if you are more fearful than not – you have a medical illness.  Get medical treatment.

3.  If you are panicking out of the blue, without something setting you off/triggers like finding your husband in bed with your dentist – this is biological.  Get a medical physician’s opinion.

4.  If you are awakening from sleep in a panic attack, when you feel like you have to get out of bed and escape and the episode lasts for about 10+ minutes before you recover yourself – this is not because you’re not trying hard enough.  Get on a serotonerigic therapy and a sleep aid(s).

5.  If you are drinking more alcohol to relax and out of fear of going to bed – get suspicious and get smart.  Medication therapy or alcohol?  It stumps me when someone says they don’t feel comfortable with taking medication that has beed studied in double-blind studies on thousands of people and reviewed and analyzed and more… but they do feel comfortable with alcohol.  That’s not friendly with yourself.

6.  If you think you are going crazy and realize your fears and suspicions don’t make sense; if you think you are possibly going psychotic over and over – you’re having a medical illness of the brain and body called panic disorder.  Get to your nearest treating physician and trust them.

 

juno.cumc.columbia.edu

 

7.  If this is you, don’t go get insight or supportive psychotherapy at least until you have been on medication therapy for 6-8 weeks.  What you are going through is not because your mom yells at you too much.  It doesn’t have to have a reason.  It is medical.  Treat it medically.  If you go to therapy too soon, you will see that you can’t give what you don’t have.  (I may have offended some people saying this.  Sorry.)

8.  If you don’t get treatment, expect that depression may likely follow soon.  Anxiety and depression are bedfellows and can’t be apart for long.

    Self-Care Tip #92 – View Panic as a medical illness.  It is.  Be a friend to yourself.

    Question:  Have you or someone you known used a similar recipe or a different one?  Please tell me your story.

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    Escape Self-Loathing

    happinessinthisworld.com

    Self-Care Tip #91 – Put the fight down and take 2 steps back.  Be a friend to yourself.

    He came in looking really good.  Chris had seen me for many years and he hasn’t always looked this way.  I said

    You look great!

    Chris shrugged and told me he had just had a long messy argument with his partner and somehow still felt alright.  In the past, after they fought and the self-loathing set in, he might have hurt himself – like using alcohol or cutting on himself to

    …just feel something different.

    I was ready to move past the story as he sounded like he was ok with it.  We talked past each other.  Me asking about his sleep, and Chris telling me clips and phrases from the argument.

    But amazingly I’m fine!  If he wanted me out today, I’d be out of there, no problem.  He just needs to say the word!

    Chris was sitting back in his chair, relaxed until then.  His hands came up and took control of his space, thrusting as he spoke.

    Being a psychiatrist, my expertise kicked in and I realized I should turn back.  Chris wasn’t ready to talk about sleep.  You see what all those years of school can do.  Not everyone knows how to pick up on such subtleties.

    Chris, maybe you aren’t so happy you argued.

    We talked more about his energy, appetite and motivation.  Then we came back to his argument.

    It’s none of his f—— business where I am during the day!  I’m not his child.  I’m his partner!  I told him…!

    And so on.  Chris still looked better than when he was in the grip of post-traumatic stress disorder symptoms, or when he was catatonic.  But he didn’t sit comfortably with himself.  And I thought, Chris has fought so hard for himself, why can’t he handle what I want to say?  And I did.  And he did.  Beautifully.  He was a brave knight on a black steed holding his wounded sides.  Life had been a battle for him, but he was making choices to fight less and live more.

    “Ok.  Yes.  You’re right.  I will next time.  That makes sense.”

    When you’re about to engage in something that in the end will make you loath yourself, choose not to.  That’s friendly to you and your other.  Say something like,

    When I was gone you felt jealous?

    Give over stage and anger and open windows and breath.  Just choose not to hurt yourself.  Winning or losing the argument, in the end, you hurt by your own choice.

    Biologically and probably spiritually Chris wouldn’t have known what to do with that years ago.  But he did now.  I saw him relax again and put his hands away.  I knew Chris had a love for Love and this clicked for him.

    I can’t describe how happy I was/am.  Being a part of his journey is a great honor.

    Question:  How have you escaped self-loathing and your mean self in the heat of the moment?  Please tell me your story.

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    Don’t Forget Your Friends Chose You Too

     

     

    Ok folks.  Not much time to write tonight.  My girly girlfriend is moving out-of-state and we’re off soon on something of a Ta-Ta! date.  Why in the world do I feel rejected?!  If I were French I might think it was the language of the heart.  But I’m not French so I can’t say what they’d say.

    Friendship requires ongoing navigation through life.  You can’t ever just sit back and expect safe waters.  The close pals go far away and although they’ll always be friends, here we find ourselves, beached and sifting sand.  Finding gold is thought to be infrequent I think when sifting sand.

    Today my daughter told me her classmate’s father lost his job.  Big ouch.  She told me, “Mommy, I wish money covered the streets everywhere so no one would ever not have enough.”  She hasn’t entirely learned what gives value to the dollar.  Friendship is like that.  Valuable and uncommon.

    My friend told me once that I chose her and she chose me.  It’s awesome to be chosen!

    So I’m off to rub my coins together and be with my friend.  She is a treasure.

    Self-Care Tip #90 – Don’t forget that your friends chose you too.  Be a friend to yourself.

    Questions:  Have you noticed that you’ve been chosen too?  Please tell me your story.

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    You’ll Be Less Bored if You Do

     

    Rocky Balboa

    Image via Wikipedia

     

    Self-Care Tip #89 – Practice being real.  Exercise it!  Be a friend to yourself.

    Sara Stein MD and author of Obese From the Heart, wrote

    There’s nothing romantic or mysterious about advanced age. It’s painful and difficult for everyone, but there are good moments.

    I like that.  We could say it about a lot of other things too.  Just today in clinic for starters, Mary said she’s falling asleep during the day, but is doing less self-injury since starting topiramate.  Max has gained about 20 pounds but he is over his Staphylococcus infection and he’s sleep through the night.  Marge is crying because there is no cure for her son’s illness, but he can still be treated medically and protected against further disease progression.

    Any time someone asks me how I’m doing, I’m in a paradox.  It’s the drive I struggle with to express emotions purely and completely that can be my own Rocky (Dir: John G.Avildsen, 1977) experience or it can kick me in the back-side.  Doing what Dr. Stein so eloquently did isn’t as easy as it looks.

    “Fine,” I say.  “Things are wonderful.  Thanks for asking.”  (Snore.)

    Or, (trip,) “I’m tired and parenting is difficult, and as much as I talk about it, I can’t seem to figure out how to take care of myself.  But I’m also really good and haven’t been this happy in a long time.” (Panting holding my sides.)

    Being real without boring or tiring yourself out might take some practice.

    The “real-thing,” blogger Film Fan wrote

    Philadelphia Museum of Art, Benjamin Franklin Parkway, 26th Street, Philadelphia, Pennsylvania, USA.  The most famous location in Rocky is probably the stairs he jogs up during the ’Gonna Fly Now’ training montage. The good news is that you can re-enact the scene and jog up and down them, the bad news is that there are 68 steps… That’s quite a few if you’re jogging.

    If you ever want to get bored quick, try to be happy.  Try it.  Try to be good.  Try to ignore the monotony.  If you want to be bored, draw your house with a window and a door and a sun shining in the corner.  It’s no good for boredom when you draw in the shadows and colors.  But doing that well might not be natural for everyone.  We might need to get into a training program, like Rocky Balboa before we can be in the presence of the bad and the good of our lives without loosing our breath.

    It may take practice to be real, but you will be less bored if you do.

    Question:  How do you find being real with the good and bad of your life affects you?  Please tell me your story.

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    Lure Yourself Like a Lover

     

    Art Gallery Bangkok

    Art Joy by Marie Schem

     

    Self-Care Tip #88 – Win yourself over.  Be a friend to yourself.

    Dr. White works with mostly women in primary care medicine.  She tells me that her women so often come in tired, overextended, and they say they don’t feel good.  She wonders why they think they can run 2 full-time jobs (parenting and employment) without suffering for it.  Her counsel is to down scale.

    My patients do so much better when they are working part-time.

    Christie, a mom of 3 who works full-time, tells me tonight,

    It’s hard.

    That’s not new news but nor is it small news.  How many of us nod when on the subject of self-care.  We sagely stroke our chin yet are nowhere to be found on the list of topics of interest.  Do we even get pleasure out of taking care of ourselves?

    I think there’s a misperception here.  The hard part is not doing the 2 jobs that Dr. White’s patients work.  It is working our own person.  Maybe if we found more pleasure in caring for ourselves we would.  Maybe if we connected that caring for ourselves is the minus-1 to the starting point of caring for others.  We can get hooked.  We can.  But it won’t be the same for all of us.   Any way you turn it though, we have to make it sticky, linked to pleasure, and making sense.

    Question: Is there anything specific you can think of that contributes to self-care being a positive thing in your life?  Please tell me your story.

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    Rebel Against Your Own Intuition

    Cover of "You've Got Mail"

    Cover of Youve Got Mail

    Self-Care Tip #87 – Be a rebel towards your own intuition.

    My husband was telling me about how consumers are demanding a more human approach to industry.

    In the 1990’s the film written and directed by Nora Ephron, You’ve Got Mail, showed us how the small personal touch was muscled out of business by the book-superstore.  Today, my husband told me that the inverse is happening now because technology allows it to.  Counterintuitive to thinking, the very thing that took out the mom-and-pop store is the very thing that is bringing it back.

    Author of the blog CreatingBrains, Joana Johnson, wrote a post, “Is Barnes & Noble Changing for the Worse?”  She describes their palliative efforts to feel their way through the current changes in the book sale market.  Clearly, buyers and readers are wanting something different from the superstore ambiance again.

    Readers have written in to me about their demands for a more human approach to their own selves.  Here are 2 recent examples.

    My mother always said that it was selfish to attend to your own needs when you were a wife and mother.  I’m happy to see a Christian woman refute that so eloquently.

    I have been recovering from a complete emotional breakdown for 16 years and… the hardest thing I have had to convince myself to do for nearly 70 years now is learn to be a friend to myself.

    These women are rebels in their own way and time.  I’m not a sociologist but I see these changes influenced also by technology and information.  It’s not so easy to stay barefoot and pregnant these days even if you wanted to.  “All things bright and beautiful” beckon to us.  Nor is it quite as easy to fool ourselves into believing that we’ll be able to take care of anyone – children, work, rescue dogs – if we haven’t taken care of ourselves first.  And although we still try to all the time, we just can’t believe any more that we can give what we don’t have.  Our current upside down economy is also testimony to that.

    I wrote a blog post some time ago titled “A Woman’s Work,” that largely speaks to this as well.  Because of many contributors, including temperament and conditioning, in many of us self-care is not intuitive.  It is disruptive.  Taking care of ourselves is even a bit scandalous …but it is more humane and it is possible.

    Self-Care Tip #87 – Be a rebel towards your own intuition.  Be a friend to yourself.

    Question:  What barriers are you passing to care for yourself?  What is making it possible?  Please tell me your story.

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    Why Are You Walking The Road Alone?

    Part of humility is not isolating.  You have to be able to receive to be a friend.  Dan Allender Ph.D. calls it suffer the kindness.

    From looking at him, I didn’t guess at first that Fink was lonely, but he was.  Under-appreciated, whenever Fink thought about making new friends, he remembered that he wasn’t young any more.  All his “real” friendships were made when he hung-out for hours, had spares in the trunk so to speak.  If one relationship didn’t develop well, he still had time and possibilities that the future offers.  In this sense, Fink had been rich.  He had after all that, maybe 3 friends he considered “real.”  But over the last several years, with real jobs and families of their own, his real friends weren’t returning his calls.  Now, he thought, he may as well as not have given them his special self.  Now he was older and not so rich.  Fink kept picking at that scab, even though he knew it wasn’t so masculine to be upset about your neglected special self.

    At times we are lonely, but have trouble valuing the relationships being offered.  We see ourselves as something set apart.  This might be part of our drive to self-preserve.  Bits of neurons fighting over signals in our brain telling us that we need to dominate to propagate our genes.  Maybe.  But there is that intersection when choice crosses.

    We remember from Sebastian Seung‘s work that our memories are not stored in our genes.  That gives us something tangible to work with.

    I remember walking on the beach with a girlfriend when we were still in medical school.  I told her, “I’m tired of feeling bad about things I never had a choice in!”  It still seems wasteful to moralize things like temperament and our nature.  In fact, we’ve argued the opposite at length in previous blog posts.  Embrace that part of you and run with it! we said.

    So what do we do with Fink?  For starters, tell him that his drives are what they are.  The real question is, what’s he going to do with his genetic drives?  Do good things with that energy?  (If we can call genetic drive an energy.)  Or will he do things that aren’t so good for him.  There comes the choice.  Fink.  Suffer the kindness.  (Thanks Dan Allender!)  In the end you will be happier and healthier for it.  Even if you are half as hot as your genes tell you you are, who cares if you are walking the road alone.

    Self-Care Tip #86 – Suffer the kindess.  Be a friend to yourself.

    Question:  What has been a barrier in your life from connecting with others?  Please tell me your story.

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    Do 3 Things to Be Different

    Self-Care Tip # 85 – When you have problems, find the difference in you.

    The best thing I heard today when I was down and out was, “It’s ok to feel that.”  What a gift!  In one strike, I dumped a load of related concerns because I believed it!  I remembered saying that same thing somewhere… to someone(s) else at other times…. 😉 It is good to remember.  It is good to be reminded if we can’t.  Whatever it takes, just remember or get reminded that it is ok to feel, however we feel.  What matters is what we do with our feelings.  I owe that to my dear Dad.

    Everyone has problems.  The difference between you and someone else is what you do with your problems.

    How I miss the days of my Dad’s young healthy self.  I will always keep his essence and look for him come the new creation.  I will know him.  He will have a body that speaks his essence materially.  He will look like a warm fuzzy I’ve decided.

    It was always ok to feel any way I felt around him.  He mostly didn’t notice, so he had that going for him.  But when he did, he told me these 3 things.

    1. I wasn’t alone in having problematic feelings.
    2. They don’t have to be a problem.
    3. I have a choice of what to do with them.

    When a patient comes in with a strangle hold on feelings that have abused them, I think “Alright!”  They are making a choice.  “Let’s see what they’ll do.”

    This morning my husband told me “It’s ok to feel that.”  He handed me an invitation to not isolate, to feel but not be in trouble because of it, and to choose what I would do next.

    Everyone has problems, after all.

    Self-Care Tip #85 – When you have problems, find the difference in you.  Be a friend to yourself.

    Question:  What has been the difference for you?  Do your feelings cause you problems?  Please tell me your story.

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    Self-Care is not unChristian

     

    Don’t be afraid of self-care.

    Self-care is Christian and scientific.  I have awareness of the culture that frowns on taking bad behavior out of the church and into the laboratory.

    A few days ago we talked about self-care not being selfish.  That circuitously brought up the question about how “the church” feels about this blog.

    Confusing “the church” with Christianity can be problematic.  I have confused them in the past.

    When my brother started talking evolution, I felt cold and clammy suddenly.  After my mini-panic attack, he told me about reading the entire works of Darwin and I had another mini-panic attack.  “There’s no way evolution didn’t happen.  There’s just too much evidence supporting it.”  I was confused.

    It took me a long time to realize that I didn’t have to be worried about differences between me, science and God.  Funny that my comfort level grew with this as I realized how little I knew.  In fact, my joy expanded, when I realized I would spend all eternity growing my knowledge.  That is a lot of everything that just won’t fit into any box I can think of.

    iwantthatpainting.com/Why-does-it-always-rain-on-me.html

    Now when something crashes through a pet-paradigm, I remember that it’s ok.  (Down fear!  Get down anxiety!  Heal dogs!)  I may see a different reality.  Parts of me may become changed by that knowledge, trauma, death of a dear one.  Becoming changed and different is ok.  Because God is the same.  God already knows whatever about evolution, or that the world is round.  He knows that we try to turn medical symptoms into something spiritual, like depressed mood.  He knows it and He’s still here.  He is the prototype of presence.  Now that people can look into the brain and say where feelings and behaviors come from, we can get past that and on to the next revelation.  So what if it is medicalized.  Science and spirituality are not exclusive of each other.

    So is self-care Christian or scientific?  Things aren’t that binary.  Self-care is both.

    Self-Care Tip #84 – Don’t be afraid of self-care.  Be a friend to yourself.

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    Get Gangster on Your Shame

     

    Photo by Wesker

     

    Shame.  Ah what a cloaked villain!  In this post I’m going to tell you about why shame is not an enemy you want to ignore.

    “Michael Corleone” in The Godfather Part II was not the 1st to say it, but maybe was the first to make the quote famous

    Keep your friends close and your enemies closer.

    Not many people would at first think that keeping shame close might be a good thing, but I’m here to tell you that it is.

    Meet Bill the highway patrol.  He’s been seeing me for melancholic depression.  Sometimes he feels a little better, but those times even still are not so great.  Bill has told me about where he thought his anxiety and fear came from.  His story made sense to him.  This wouldn’t be too much of a problem except that he thought about it often.  Very often.  He was running in sprints away from it.  Somehow after all the time he’d spent reluctantly in the presence of his fears, he hadn’t realized that shame was connected.  Shame of being treated the way he had been.  Shame of being misused.  He hadn’t faced his fears because he was always angled away from his thoughts of shame.

    If we don’t go where the shame is, we won’t be free from its effect on us.  Fear is a big bad bully.  Until you turn around and say stop, you’ll be running for a long time.

     

     

    We all need to be a bit “gangsta” at times.  Ignoring shame is not.  It’s not emotion-street smart.  I’m waiting for Bill to think, “What’s the worst thing that could happen?”  And sit in the feelings that come with those thoughts long enough to realize that he’s still ok.

    In obsessive compulsive disorder, there is a psychotherapy treatment called “exposure and response prevention.”  In this treatment, the person with the ego-dystonic fear exposes themselves to their fear for a progressive amount of time.  They realize that after going where the fear is over and over and materially seeing that nothing bad happens, the fear looses more and more control over them.

    This is effective in any anxiety condition, including shame.

    Self-Care Tip #83 – Get gangster on your shame.  Be a friend to yourself.

    Question:  Has shame bullied you?  Please tell me your story.

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    Your Heroic Self – Waiting For Normal

    Self-Care Tip #82 – Have courage to go for what is lovely to you in life.  Be a friend to yourself.

    Pretty, blond, about 5’6″, slender, in her 30’s, mother and wife, no funny shapes or movements but Britt still asked me, “Am I normal?”  It takes guts to ask someone that.

    I just finished this heart-squeezing book, “Waiting For Normal,” by Leslie Connor.  (Yes!  I finally read a book!  It took me 5 times as long but it was no less pleasurable.)  Connor tells us about pre-teen Addie who grew up on the waves of her bipolar mom’s chaos, salvaging bits of wreckage along the way to survive.  Addie is the life-preserver her mom uses for life.  Addie’s own buoy through it all is her hope of one day finding normalcy.  She uses all her smarts to avoid the thrust her mom’s messes force on her.  It requires her full attention.  Addie must have looked pressed for something because her Mom finally asked her

    What’s so special?  What are you chasing after?!

    Addie was fisting optimism when she answered

    I’m not chasing after anything.  I’m waiting.  Waiting for normal.

    Later Addie explains to her mom

    Normal is when you know what’s gonna happen next.  Not exactly what because probably nobody gets that.  But normal is being able to count on certain things.  Good things.  And it’s having everyone together – just because they belong that way.

    My son used to have shaggy hair with curls that flew at the world around him.  He came home the other day and told me he wanted it short.  I finally figured out that because none of the other boys in his class had longer hair, neither should he.  He showed me pictures of what his hair should look like.  The whole process was too cute.

    We are all looking for normal.

    Putting aside defining normal, for now I am content to just contemplate the largeness of the effort to find it.  The journey, the process, the coming into such a thing reveals the beauty in one’s character and essence.  It is that, rather than the “hair-cut” that makes me say, “Wow!”

    When Britt, my patient, strove towards her health and normalcy, her intent in context was lovely.  She seemed to me, in those moments we shared together, as one of the great heroes of our day.  A woman of courage.

    Self-Care Tip #82 – Have courage to go for what is lovely to you in life and appreciate the beauty in your heroic self.  Be a friend to yourself.

    Question:  Have you struggled with the question, “Am I normal?”  Please tell me your story.

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    Connect With Others to Get Friendly With Yourself

    Self-Care Tip #81 – Connect with others.  Be a friend to yourself.

    So you have bought into the famous, “You are not alone” stock.  After 2 months on psychotropics (medications for emotional illness,) you finally have an interest in people.  You are at least a little motivated and less afraid of things that move.  You don’t feel like you are the reason for original sin and more often than not, you think happiness might be more than what shopping can offer.  What is this strange and unfamiliar sensation?  And what to do with it?

    It is time to connect.  Many of us get to the point where we no longer want to hide, we don’t hate ourselves, and we don’t hate others.  We get to the place of showing our under-belly just a little to the big wide world and are shocked that the only thing we feel is the wind as everyone is rushing by!  Just when we start wanting what we spent so much time hiding from, we seem to have forgotten how to connect with others.

    It is no secret.  America is culturally impoverished.  We have little of cobblestone streets to meander down, dressed in clean clothes after a days work, checking up on neighbors and gossip.  We have few degrees of activity between full throttle and dead/no heart beat.   Come now!  How to connect in a world where our parents expected us to pay rent when we turned 18years old?

    If you find yourself in something of this situation try on one of these basic tools and see what fits.  You can’t expect them all to.  So if you strike out a few times, keep on!

    1.  Volunteer – for example, and in no particular order…

    2.  Meetup.com – an awesome site to find people interested in what you are interested in.  e.g. book clubs, skiing, small business, Italian

    3.  Support groups

    4.  Write!  Although this at first thought may appear isolating, it is not necessarily.

    • Blog!  🙂
    • Journal

    5.  Toastmasters

    There is so much more.  Please let me know your thoughts and I’ll keep adding to this list!

    Self-Care Tip #81 – Connect with others.  Be a friend to yourself.

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    Forgive to Get Friendly With Yourself

     

    Professional baseball bats are typically made ...

    Image via Wikipedia

     

    Self-Care Tip #80 – Forgive.  Be a friend to yourself.

    A reader wrote yesterday

    Always intrigued by the possible connection between empathy and forgiveness….

    Great progression of thought.  From both an anecdotal perspective and some biological considerations, David Mullen PhD and Everett L. Worthington Jr. PhD, are two of my favorites.  Other than Jesus, they have and do say it better than just about anyone.  I heard Dr. Worthington speak when still a resident-physician in psychiatry.  The story he told of his mother’s murder and how he came to forgive her murderers seared into my memory and has ever since been a reference for me in my personal life and medical practice.

    The call came on New Years Day, 1996. His brother’s voice was shaky. “I have some bad news,” he said. “Mama has been murdered.”  …Their mother had been beaten to death. Rage bubbled up in him like lava. He heard himself saying, “I’d like to have that murderer alone in a room with just a baseball bat. I’d beat his brains out.”

    Here’s where the empathy came in

    …He tried to picture the crime scene. He imagined how a pair of youths might feel as they stood in the dark street preparing to rob the house. Perhaps they had been caught at robbery previously. They would have been keyed up. The house was dark; no car was in the driveway. No one’s home, they must have thought. Perhaps one said, “They’re at a New Year’s Eve party.“ They did not know that Worthington’s mother did not drive.  …Worthington imagined their shock when her voice came from behind. “What are you doing in here?”

    “Oh, no!” one must have thought, “I’ll go to jail. She is ruining my life.” He lashed out with his crowbar, slamming his mother three times. Panicked, the youths went crazy, trashing the house, both for having their plans ruined and for the shame of having murdered.

    This is part of the process that led Dr. Worthington to forgive the murder.  You can read more in his book, The Power of Forgiving.

    There is an interplay, between choice and biology/non-choice.  It’s uncomfortable to think and talk about.  I can feel the hackles on the necks of my readers start to stand up just writing it and I humbly acknowledge my limitations in sharing this concept.  It is what I have tried to describe through many of my earlier blog posts.  This unlikely union between such polar concepts.

    Being a Christian, I have awareness of the culture that frowns on taking bad behavior out of the church and into the laboratory.  When I think of empathy and forgiveness, I see party-hoppers moving in and out of those very places irreverently perhaps in some people’s minds.

    Some other time we will broach further the idea of self-care being Christian v. scientific.

    Self-Care Tip #80 – Forgive.  Be a friend to yourself.

    Question:  Does any of this resonate with you?  Please tell me your story.

    by

    Be Empathic to Others to Get Friendly With Yourself

     

    Drawn by early 20th-century commercial cat ill...

    Image via Wikipedia

     

    Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

    Yesterday I wrote about considering intent and context when comparing self-care with selfishness.  That carries over to the people sharing life with those of us who have mental illness.  Do they see us as selfish?  For example, how is the spouse of the Panic Disorder going to make sense of the 40 phone-calls he gets while at work?

    Mary’s husband told me that she’s been calling him “all day,” terrified she was going to die.  Checking to see when he was coming home.  She couldn’t go to the market because people would laugh at her.  Afraid.  Afraid.  Just plain afraid.  Really, everything had become about her.  She was like a scared kid.  Frankly it was annoying.  He was in a stressful work situation with the economy slumping.  People he knew were being laid off.  The other day he had to leave in the middle of an important job to go home and reassure her.  She was sobbing in the living room.  Sure she was going crazy.  He realized that he might have to tell his boss what was going on but what was going on?!  Who had his wife turned into.

    In yesterday’s blog, we spoke about the ability to abstract v. concrete thinking.  Being able to abstract helps with empathy – connecting emotional content between people.  To put yourself in someone else’s shoes, as if you were them.  This is a critical part of relating, i.e. being in a relationship.  Many different mind illnesses affect our ability to abstract, including panic disorder.

    In Mary’s case, she was not empathic when she was anxious.  She was thinking about herself.  Understandably, if you read the part about her believing she was going to die or go crazy.  But when you’re married to her, empathizing with her gets old.  It’s not so easy when it seeps into your work life, you haven’t had sex for months, and you have to do everything that has anything to do with going outside of the home.  Some part of you knows it’s not true, but another part of you screams, “Get over it you selfish child!”

    Is Mary selfish?  Some might be able to answer even after all the phone-calls and unrecognizable behaviors, no.  Mary is not selfish.  They can do this specifically because they can abstract.  They can empathize.  They can consider the context of Mary’s disease and the intent of her behaviors.

    Not everyone does this.  Not everyone is able to let “It” be about someone else.  Not everyone doesn’t have to have “It” be about them.

    The best thing for those in relationships with someone emotionally ill, is to view the way they are behaving as biological.  When treated medically, than Mary or whoever it is in your life can do their own self-care.  But until then, staying in their lives requires maintaining an empathic view that considers intent and context.  It also means furthermore, doing your own self-care individually.

    There are over-lapping flaps to our lives.  Scales on the back of an armadillo.  Me as encased by my body.  Me, that includes the space between me and you.  Me, that includes you, because you will always be a part of me.  Self-care really involves all that by degrees.  A chain-link.

    So the question is, can empathy be chosen?  With money in the bank and wisdom, yes.

    Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

    Question:  Does any of this ring true for you?  Please tell me your story.

    by

    Intent and Context Matter

     

    A Beautiful Mind by Sylvia Nasar

    Image via Wikipedia

     

    Self-care is selfless, but doing things for yourself is not always self-care.

    A reader commented, “I believe that if I’m NOT taking care of myself and feeling joy, then that IS self-centered….”  Too eloquent.  Love it.

    Some of our confusion comes from the changing scenarios of self care.  The intent sometimes gets blurry.  The intent is hard to tease apart.  Sometimes what feels like taking care of ourselves is in fact, selfish.  For example, let’s say “hypothetically,” my husband, who is a palliative care specialist, chooses to work on twitter #hpm, play chess, or play guitar.  This is potentially positive and friendly to the self.  However, it depends on intent.  Sometimes we don’t know our own intent though.

    There is also the context of what is happening.  Let’s say we were all fighting, and then my husband goes off to read Oscar Wilde.   Is this self-care or a way of abandoning and taking himself out of the present?  Self-care puts us into the present.  Whereas selfishness takes us out.

    In another context, taking yourself out of the present is necessary to ultimately put yourself back in.  Doing this requires thought processes that can abstract and empathize (connect emotional content).

    I rely a lot on intent! (Ahem!)

    There is a mind disease called schizophrenia.  This disease is famous for hallucinations, hearing voices that other people don’t hear, seeing things that other people don’t see.  However the core symptom of schizophrenia is less famous.  It is the thought form, concrete and disconnected.

    Concrete thinking is named well, unlike many other medical conditions.  (Think diabetes!  Who would know what that has anything to do with!?)  But concrete thinking is plain, hard, and flat like my sidewalk.  For example, if I asked what does the parable mean, “A bird in the hand is worth more than two in the bush?”

    1. Concrete thinkers might say, “Birds make a mess so we don’t want a lot of them.”
    2. Further, if their thoughts are also not connected, they might say, “Birds migrate in the winter and the bush is wet.”
    3. Contrast this to connected thought that abstracts, being able to answer, “If I have an opportunity to take something good, it’s better to take it than gamble for what I might not be able to keep in the end.”

    Different emotional illnesses have trouble abstracting, but fewer have disconnected thoughts like schizophrenia.

    If you are in a relationship with someone who has trouble abstracting (traumatic brain injury) and/or connecting emotional content (ADHD for example,) you might misinterpret his or her behaviors as selfish.  Being able to empathize after all is part of most Disney fairy-tail romances.  What more do any of us want?  Right?

    Wrong.  The capacity to empathize doesn’t matter much if the intent is missing.

    Wrong.  The ability to abstract doesn’t connect if the intent to connect us is not there.  The knowledge does not matter.  It is the context.

    In the film, A Beautiful Mind, Russel Crowe plays a character that suffers from schizophrenia.  The woman who loves him, struggles to understand the way he loves her back.  His disease steals his attention.  His disease takes his time.  He seems selfish.  Their love survives when she discovers his intent in context.  He stays present in the relationship, despite all his limited capacity to relate.  Further, agreeing to the treatments of his generation, limited that they are, he is doing selfless self-care.

    At the end of the day, I’m a grateful piece of dirt who means well.  Saying that up front immediately lets you get very familiar with me.  (I could have said “grateful piece of sh–,” but that would have been selfish.  The s-bomb is just playing with the word to have fun!)  Part of why I believe in God is because I know He goes for the losers.  He goes for the piece of craps out there.  That’s what the beatitudes are about.  He pours it on. (Intent and context, baby!)  At the end of the day, we are neither angel nor beast.  We are just human to Him.

    Self-Care Tip #78 – Keep self-care selfless.  Be a friend to yourself. 😉

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

    by

    Taking Care of Yourself Is Not Selfish

    The line between self-care and self-centeredness is a thin line.  We are part of the narrative.  We are not the narrative.

    I’ve got some heat lately folks for talking about “Me” in a way that excludes the import of “You.”  How does anyone talk about the importance of the self without sounding seriously arrogant, disinterested in others, egocentric, ungrateful and rude?  Clearly it’s a learning process.  That’s something of what I’m hoping will evolve this year as we journey together.  Please let me know what you think on this subject.

    I was very excited about having a morning to myself today and had built up a storybook page turning space of time for me.  However my night went bad, and like opening the oven door too soon with the bread still rising, I just didn’t get up well.  Partly in denial that the day was already slipping away, I kept going towards my hopes.  The clock sped up and I finally got out the door with the kids buckled to where they needed to go.  And then I realized I forgot my computer and phone.  Not so easy to work without those.

    I live in the hills and although I’m not far from street lights and normal trafficked buildings, getting between me and them takes me through many blind 25 mph corners, steep hills over narrow roads.  Today I felt like I got caught in those hills.  My mom-van felt off-balance and the tight corners treated my tires cruelly.  I went back home to get my computer and back down to town finally.

    I had great intentions for today.  However, I got stuck and stuck again.  That is what it can be like when we try to treat ourselves well.  It can feel like the roads swallow us up and we just can’t get there.

    As my husband says, “That’s how it rolls!”

    Question:  How do you see self-care differently from self-centeredness?  Please tell me your story of friendship.

    Self-Care Tip #77 – Don’t get confused.  Taking care of yourself is not selfish.  Be a friend to yourself.

    by

    It Might Be Your Brain

    How are you feeling? If it’s not good, it might not be “you.” It might be your brain.

    When you don’t feel good, look at what’s happening inside.  Think about where feelings come from.  It’s hard to use your brain to think about your brain.  (Read more at “Basic but Effective.”)  But what to do?  Doctor Dolittle‘s pushmi-pullyu’s might have been able to tell us something of our missed opportunities by not having two heads and two brains.  (Unfortunately they’re extinct!)

    Feeling bad, irritable, guilty, sad, like everything is flat, nervous, emotions that are out of proportion or inappropriate to the situation or trigger?  These feelings might have nothing to do with “you” and everything to do with your brain.  At some point if you get tired of beating yourself for the holes in your purse, if you don’t understand why things feel the way they do, if you want to rest, think medical.

    Fred came in with his father, hiding himself in his shirt, in his father’s shirt, like a mouse who couldn’t find his hole.  The teacher from his special education class came in to help give history and told me about everyone’s efforts to bring him out.  Skinny, Fred preferred not to eat in front of people.  He started shaking in strange situations and climaxed into a tantrum if pushed to transition too quickly.  He was vulnerable to physical contact and avoided anyone touching him.  When he was really upset, he banged his head so hard that he had to wear a helmet.  When I asked his parents if they thought he was anxious, they said no.  No he wasn’t nervous his teacher said.  Hmm.

    I told Fred’s parents.  I restated to Fred’s teacher.  I just said back to them the story they had just told me.  I told them about Fred and asked them what they thought.  After hearing Fred’s story again, did they think Fred might be behaving this way because he was suffering on the inside?  

    We can’t give what we don’t have.  Asking Fred to come out and play so to speak, wasn’t something he had to give yet.

    After treatment takes effect, then Fred will be able to pull his head out of his shirt and he will do it without being asked to.  It doesn’t do any good for Fred or anyone else to push him to do behavioral changes if he simply can’t.  Fred is not a pushmi-pullyu.  He has no spare brain to offer when the other is ill.

    I told Fred’s father that I thought Fred was suffering inside.  Something in his father clicked.  He teared up and nodded and said “Yes!  He is suffering.”  That meant a lot to Dad.  To know that much about his son.  To know that what had confounded him for so long came from somewhere.  It had a name.  This thing might be treated.  Fred might suffer less.

    Self-Care Tip #76 – If you don’t feel good, think about your brain.  Be a friend to yourself.

    Question: Do you every feel like you expect yourself to give what you don’t have?  Please tell me your story.

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    Choose, Gladly, Using Resources

    Being a friend to yourself includes choosing, being glad that you can, and using resources to make your choice a good one.

    Mrs. Smith told me with a barely noticeable arch in her back that she was still planning on God healing her daughter.  I don’t know if Mrs. Smith thought about how her daughter felt about that.  Was Kristy personalizing her illness?  Did she think God rejected her?  The problem of her continued illness must show something more than a physical flaw in her perhaps.

    Will we know it when we are healed?  Until then, what to do?

    Years ago, I met Fran.  She was pulling her hair out.  Her annoyed husband disrespected her for it.  Fran kept willing herself to stop.  She said,

    I’m doing it less now I think.

    The good news for Fran is that she responded well to fluoxetine.  Her anxiety decreased and she almost stopped pulling out her hair.  She’d wear her growing bristles pressed down with bobby-pins and hide it with her long hair.  As her hair grew longer, she had fewer bobby-pins and I knew she was taking her medication.  There were other problems between Fran and her medications.  Taking medication shamed her.  And, she blamed her fluoxetine for her weight gain and rash on her face.  She felt uglier than ever in her husband’s eyes.

    I don’t pull hair any more.

    Fran stopped her fluoxetine and half her head went bald.  She did not lose weight and she still had a rash on her face.  Fran went back on her fluoxetine and she has cycled on and off of it this way over the years we’ve worked together.  Somehow despite all our time together, Fran does not believe me when I tell her that when she is better symptomatically, she is not healed.  Fran does not grasp that her behaviors come from something at a genetic level.  We can treat her, influencing the way her genes express themselves, but in her case, not cure her.

    We are a team.  She and I, and sometimes her husband, and sometimes her sister.  I give her medications when she thinks she needs it.  I don’t leave her when she doesn’t.  Either way, we keep trying.  It is very hard for Fran to know that she has not been healed.

    I don’t have many clear examples of treatment-to-cure in psychiatry.  The statistics vary between diseases as to their rates of recurrence.  The brain being human, we can yell at the serpent for our insanity.  However, in the end, here we are.  As Billy Joel says in his great ’70’s hit song “My Life”

    Either way it’s okay to wake up with yourself.

    The opportunity to choose our own answers, to decide what to do about it, and believing if we are sick or not sick  – is all our own.  These can be hard decisions but until we lose capacity to choose, we own them.  Decision making capacity of course is a medical decision.  But competency is a legal decision made in a court of law.  Having the right to choose is a beautiful privilege.  This does not mean to ignore counsel, evidence, data.  On the contrary.  That would not be a friendly thing to do to yourself.

    Self Care Tip # 75 – Choose well and be glad you can.  Be a friend to yourself.

    Question:  What do you think?  Agree or disagree.

    by

    You Are Ink + Water

    THE SUCCESS OF OUR HEALTH – EMOTIONAL, PHYSICAL, SPIRITUAL – BEGINS AND ENDS WITH “ME.”

    Being responsible for what we do now is not the same as being responsible for what has happened to us or is happening to us.

    How to tell someone who suffered abuse that they are responsible for themselves?  How to tell a child of an OCD mom, that his adult self, is responsible for his emotional health?  How about someone living in poverty?  How about a victim of natural disaster?

    …A parent whose child died before they did?

    My dad tells me, no parent should live longer than their own child.  In 1993, in Mogadishu, Somalia, the US state department sent him to find a hospital that was usable as a service, not in anticipation of war.  There were essentially no hospitals.  Stripped, robbed of wood used to burn, hocked copper wiring, and a spirit of “every one for himself” sat in place of hospital supplies.  Dad had met with some tribe elders to try to conciliate, but without effect.  Before he knew it, it was war.

    There was one hospital he found with 2 operating theaters and some recovery beds.  He joined the French nurses who were still there.  Working around the clock, he was Mogadishu’s only surgeon for that first week.  He walked out to a mile of bodies spread outside the hospital.  He chose who would be taken in to the operating room versus who would not and what that meant.  There was no anesthesia for hundreds of amputations.  Life expired without many theatrics.  Three weeks later, and after other surgeons had come, they evacuated him.  He came back to manicured bushes, telephone wires, paved roads.

    After surviving the Vietnam war, 40 plus years of medical practice, and participating in treatment for many people who have died over many years, it is Somalia‘a open album that stays in Dad’s thoughts.  He sees the faces of parents shrouding their children.  He tells me as if I’d forget, “I can’t say enough about how I loved the people!”

    Although Dad shared these traumas, he must claim his health.  The grieving parents likewise.  This is not to say, “Get over it.”

    There is so much bad stuff affecting us, that it makes it easy to not take responsibility for our own selves.  But, the success of our health – emotional, physical, spiritual – begins and ends with “Me.”

    Don’t give up or get over or go at “It” alone.  Buying in to being a friend to yourself, does not mean giving up on your other friends, including God, family, your beliefs, your assistance.  It does not mean erasing your history.  It does not mean starting over.  It means joining all these things.  It means being ink in the water, everywhere in your story.

    So, here you are.  (Clang, cling, Chicka-Chicka Boom Boom!)  Can you still hear yourself?  You must!  I must!  Our health begins and ends with “Me.”

    Self-Care Tip #74 – Be your story.  Be a friend to yourself.

    Question:  Have you done this?  Do you relate?  Please tell me your thoughts.

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