Year: 2011

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Today on Radio in Summary

Amateur radio station with multiple receivers ...

Thank you Michele Rosenthal at HealMyPtsd.com, and to all who listened in on my first radio interview on being a FTY – Friend to Yourself.  What fun.  It was sweet and to the point.

We discussed using the marker of the new year to commit to this and see what 2012 brings differently from before.  This is freeing, as being our own friend is not selfish but rather the most selfless thing we can offer.  How it is done by starting with Me; the starting and ending point of all intentions in our life.  Knowing that we cannot give what we don’t have, that we cannot indulge the pleasures outside of ourselves such as adjustment and coping skills if we don’t have the Me to do it with (preferably a healthy me) and knowing that going where we find shame in our lives can free us up to get friendly with the rest of Me.  This knowledge helps us find the “how.”

To make being a friend to Me an easier process, leave the injustices of our lives alone, leave the sentiment of wanting happiness, of wanting what we should have gotten or been.  To make Me my own friend easier, do what any friend would do – the hard stuff.  The stuff that good-time-Jane won’t stick around for and the stuff that only Love can follow through with – do this.  That’s as easy as it will get and as hard as it will get.

We can do this.

Question:  Looking toward 2012, how would you change the direction of your intention and energy to be more of a friend to yourself?  What do you think you will experience differently if you do?  Please tell us and connect.

Thank you dear Carl d’Agostino for calling in, boosting my confidence and saying without saying it, “You are not alone.”  I’m still smiling.

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Radio Interview

For all who are interested,
I will be doing a live radio interview on PTSD this Thursday, December 29th, 7-8pm EST on 95.9 FM/106.9GM/960AM on Seaview Radio. It can be heard locally along the southeast coast of Florida or by referring to the promo page http://yourlifeaftertrauma.com/radio/guests and clicking on the yellow “listen live” button.

Details for the interview include:

The live, on-air interview will last approximately 15 minutes.
Call in via a LANDLINE (or reliable cell phone) and do NOT use the speakerphone.
Call-in number: 877.960.9960.
Call in at 7:35pm EST
We’ll be chatting about how to be a friend to yourself and why this is so important”

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Resist The Lure of Suicide

Dangerous Risk Adrenaline Suicide by Fear of F...

Image by epSos.de via Flickr

Sometimes I wonder, how come other people get to get away without having to deal with this?  Why can’t I get a break?

Heidi wasn’t talking about fair or foul fortune in life.  She was talking about suicide.  Heidi found the suicide idea alluring and promising.  She found life unfair and death a form of equalization.  She reminded me that suicide contagion is a real effect.  I didn’t know this before.  I don’t know when it became an understanding for me, but it was after medical school and definitely after residency.

So much of what I know, came to me outside of those places of learning.  So much of what I know, came from my patients and a settling effect into my specialty of practice.  I have learned, in one way of consideration, too much about suicide.  In that way, I wish I didn’t.

There are good things too, of course.  Suicide is no more moral or amoral than another act in life, it is simply (if one could use such a word with this) and most objectively the last.  I remember commenter Mike J said on December 17, 2011,

Whenever I feel suicidal I remember that I’m going to be dead a long time. As bad as the pain is, I understand but, why rush to get there?  

Life is like pizza or sex, even when it’s bad it’s kinda good.

I know.  Who wants eat bad pizza?!  Sigh.  Each to his own 😉 but you get the meaning – clever man.

Mike J has used this to inoculate himself perhaps to build suicide resistance.  He and you might be interested to know that the CDC takes the risk of “catching” suicide so seriously that they have made formal recommendations for our protection.  In reading them, we find friendly ways to protect ourselves not only from suicide, but also from the contagion of other extreme thoughts that actions such as suicide cluster in; such as self-injury, catastrophizing, all-or-none thinking, and self-flagellation.

Suicide is contagious as a learned behavior, which is part of why it is so confusing for Western Cultures to conceptualize it in any way apart from morality.  Another reason we have a hard time not moralizing suicide is that we still struggle with where emotions and behaviors come from.  (But moralizing emotions and behaviors is for another discussion.)

When I heard Heidi say those words,

Sometimes I wonder…

despite the patients I have known who’ve died by suicide, despite the knowledge gained in clinical practice and despite the diagnosis I had already reported to her insurance carrier – I had an autonomic response.  My skin erupted in goose pimples, breathing sped up and I realized I was afraid.  Despite being a psychiatrist whom our community imagines thinks of who is going to commit suicide next all the time, I am not.  I am not that jaded.  I am affected and I am still taken off guard.  “Heidi,” I thought.  “No.”

Heidi had the “benefit” of media exposure to suicides, media who was promoting suicide contagion through learned behaviors but also as activating her already infirm brain to increase in degree of illness, producing more suicide-thought symptoms.  When I weighed Heidi’s risk of hurting herself knowing her medical condition, I had thought, “Ok.  She’ll make it. We’ll do this and she’ll heal.”  But when the knowledge of news-worthy suicides spread in her, I knew her medical risks might be catalyzed and I knew enough to be afraid.  “No Heidi.”  What to do?

The CDC tells us to turn the copycat-suicide risk upside down by using the  media, which the gypsy in me really likes.  Instead of being silent and afraid, we can describe the help and support available, explain how to find persons at high risk for suicide, and tell about risk factors for suicide.

Today is Christmas and you may be wondering why I am speaking about suicide today.  It is because I’m hoping that by going toward our fears and our places of pain, that they will lose power over us.  I am hoping that on Christmas, which is for some a positive time, that we have a knowledge that Christmas is for others much less.

Furthermore, I am hoping that we know that we and Heidi are up against our illnesses as well as media-poisons.  And most importantly, I hope that we also know that we have power.  We don’t have to be a victim and we are free to choose.  At every level, we are free.  In every paradigm, we are free.  We are free until we do not – AKA, die.

I’ll take it.  I hope Heidi and you do too.

I hope you will speak into the wind if it be windy.  I hope you will look into the flash if you must and I hope you will fight against your own destruction as long as you can choose.   I hope you know that you are free.

Questions:  How do you oppose the lure of suicide, even when you have to oppose it repetitively and against multiple forces?  Please tell us your story.

Self-Care Tip:  When others inappropriately describe suicide and when your thoughts tell you to die, be your own friend by speaking about suicide, even to yourself, with this knowledge.

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If You Want To Die, Tell Others.2011/10/17
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PTSD and Choosing Not to Be A Victim

click here to view –> Be A Friend To Yourself.

You may remember our wonderful guest post by PTSD survivor and advocate, Michele Rosenthal.

Ms. Rosenthal generously asked me to also post on her blog site. Pretty fun, huh. So here’s the link if you’d like to take a gander over.
Thank you so much Ms. Rosenthal for this opportunity to share space. Keep on folks.

To view post, click above on “Be a friend to yourself.”

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Get You Some Support Where You Are Weak

Prunus armeniaca (Apricot) branch with fruit. ...

Image via Wikipedia

If you’ve ever lived where there is dirt, not New York City or downtown Los Angeles, some place with unpaved hills and bugs, then you’ve seen how fruit grows.  Maybe not exotic fruit.  Maybe nothing from the Amazon, but you’ve seen an apple or an orange most likely, dangling from a stem, light caught in a dew dusted curve around its belly.  Maybe a pear.

You’ve seen a tree, perhaps, on a “good year.”  It was heavy, bushy in all it’s productivity and weighted down with what it was designed to do in life.  If you have lived in a place where your home didn’t require an elevator to get to, you know that fruit can be beautiful just in its waiting-ness to fall.  So beautiful, it feels personal.  The season turned as did your admiration into impatience for picking time.

If you have woken up early to the opening day where air and hour and the absence of sound work on you like a special promise, you have known what it is like to put on your creased and cracked boots, to call your happy dogs and start out into your long work.

You know that every tree has potential and every tree has limits.  You remember when you first came upon the brokenness, the fractured limbs, the long fresh splinters cutting through the morning just so.  Too soon.  “Too soon,” you think and repeat out loud to your tree, trying to explain.  Too soon, fruit still holding the branch like they are drowning.  The last clutch in death.  Oh, shame.

If you have lived where branches so full of fruit break under the weight of their life’s work, you have lived to learn that to be productive, to sustain that kind of strain, to endure, a tree and her branches need support.  You have known forever after to put two-by-fours fashioned into braces under those loads and hope the big winds don’t loose their grip.  You can’t forget the loss.  Sometimes you have even thinned the clustered fruit, maybe peaches, reluctantly pulling out one of three, two of three.  You’ve done what it takes.  Dropping them and knowing that the others will grow. Your fingers, bitten with cold and regret, move between the leaves giving yourself and the tree hope.  You give yourself and you give the tree what is needed to produce well and to live.

In those deciding moments, if you have worked with these trees, you have learned that we also break and lose what our life would put out for the world.  If we could.  If we had support.  If we were buttressed.  No one can put out for long without it.  Not Me.

And so now, we look to see where our hopes have increased.  We identify where to tend, where we habitually, that is to say, or where we have on many other occasions been known to come apart.  Oh, the loss.  The memory with the knowing fear dances like a hologram until we simply or not so simply, this time, acquire help.

Questions:  How are you working to build up support where you are weak?  How do you find support?  What have you seen come out of your life when you have?  Please tell us your story.

Self-Care Tip:  Get you some support where you are weak.  Be a friend to yourself.

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Self-Care and Joy: How You Can Use What You Love to love Yourself – By Michele Rosenthal

Self-Care and Joy: How You Can Use What You Love to love Yourself

Guest Post By Michele Rosenthal

Like any other commitment, self-care can become a chore. Whenever we force ourselves to do something the fun factor flies out the window. Yet, self-care should be one thing on our schedules that feels good! How can we turn a commitment into a pleasure? I think the key is committing to something that brings you joy. Let me explain…

Six years ago, at the age of thirty-seven, I was diagnosed with advanced osteoporosis. Putting it bluntly, my endocrinologist explained, “If you don’t immediately commit to a regimen of strength training, your bones will begin to crumble spontaneously.” You can imagine my following crash course in self-care.

Up until that point I had never thought about what I do to take care of myself. I had worked out, or not, when the spirit moved me. I meditated or not when I felt the desire for that kind of inner connection. My self-care was based on whim, not necessity.

So there I was facing the spontaneous crumbling of my bones and needing to commit to a regimen not only of strength training, but of a level of self-care I’d never previously entertained. Suddenly, self-care wasn’t some amorphous idea but an action that pertained to my very ability to walk upright. Suddenly, self-care had a purpose.

Making the commitment to self-care isn’t easy. Mood, other activities and time constraints can make it difficult to follow through. Fear, however, is a great motivator. Terrified that my bones would crumble I committed to self-care with the ferocity of a hurricane. I didn’t enjoy it but I did it. Within two years I completely reversed the osteoporosis. Since then I’ve stuck to my workout regime without a hitch.

When motivated by fear, sticking to a self-care schedule becomes incredibly easy. The problem comes when we don’t have that instant inspiration. When self-care offers purely emotional or spiritual benefits we’re much more likely to forgo the commitment altogether. Unless, I’ve discovered, the commitment centers around something fun.

Not long after the osteoporosis diagnosis I fell into a very deep depression. As a trauma survivor, years of trying to outrun the past finally caught up with me; I needed to do some intense emotional work. The arduous process left me feeling powerless and overwhelmed. I needed to commit to emotional self-care at a time I didn’t feel capable of committing to anything except the black hole in which I lived.

One day, as I was marveling at just how black the hole actually was, a thought occurred to me. What I really needed was to do something that would help me get in touch with the part of myself that could feel joy. What I really needed, I mused, was a way to feel something outside of the despair in which I lived. There was only one thing I thought might help me do that: dance. Throughout my life dance had always offered me a transcendent feeling of release. I decided to dance. A lot. I signed up for a dance class every single day of the week.

At first it was just sheer will that got me to class, but then a funny thing happened: After each class I felt so much better that I began looking forward to the classes. I began to look forward to the time I set aside for my self-care each day. Having fun elevated self-care from chore to respite.

The benefits were astounding. The more I danced the more I began to feel a sense of balance between the dark and light in my mind, the more I connected to the possibility of feeling better, the more I connected to myself during a time that it was much more comfortable to disconnect. Ultimately, that feeling of joy filled me with the courage I needed to do the post-trauma recovery work that had to be done.

That was all years ago. I finished the recovery work and brought myself to a place of freedom and peace. Al that dancing turned me into a really terrific dancer, too. Today, I still incorporate dance into my schedule 2-3 times a week as that connection to joy and fun fuels my creativity, bolsters my energy and connects me to a community I enjoy.

The biggest lesson I learned in all of this was how important the fun factor is in self-care. Now, any time I wish to develop some aspect of my self-care, I ask myself, “How can I make this fun?” By ensuring some form of enjoyment I strengthen my emotional buy-in to the commitment. You can do this, too. We don’t often think about how we can turn tasks into pleasurable experiences, but shifting our approach in this way can make all the difference between defaulting versus following through on a self-care regime.

Self-Care Tip – Use what you love to love yourself.

Question:  How do you get the fun factor into being your own friend?  When being friendly to yourself isn’t what feels like a good time, how do you use what you love to improve your experience?  Please tell us your story.

Michele Rosenthal is a certified professional coach and the host of Your Life After Trauma on Seaview Radio. Her post-trauma recovery memoir, Before the World Intruded: Conquering the Past and Creating the Future, will be released in 2012. To connect with Michele, visit www.yourlifeaftertrauma.com.


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The Elephant is in The Room To Help Us

English: The eye of an asian elephant at Eleph...

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How do I get him to see it?

How do we get our friends, our husbands, our wives and kids and patients to see the elephant in the room?  My patients ask me this and I ask this of myself.

I want to feel better.  I just want to get to the bottom of this!  

Will someone please just treat what is wrong and I can move on?!

There is this implication that someone is plotting against progress to derail us from appropriate therapies, treatments, walnuts and soy milk.  Why they would want to do that, no one agrees on.

When Cincy said something to this effect in clinic, a huge shade in the shape of an elephant in the room, caught my eye and it was distracting.  I smiled at the wraith and conspired with it on how it could best gain acclaim.  I tried to explain what I was seeing to Cincy, but how does one describe an apparition?  I’ve never heard anyone do it better than Edgar Allan Poe and so I know it can be done.  I’m learning.  I needed to learn from Cincy.

Teach me Cincy.  Help me learn how to speak of these things better.

I felt like I should know that already.  But we physicians don’t graduate with a certificate in introducing elephants.

Trying to do the teaching-thang in clinic or out of clinic, if we want to get anywhere, we can’t do much if we aren’t both seeing the elephant.  Talking about solutions, about treatments, motives or anything that doesn’t redirect each of us back to that specter in some way is skipping critical development.  Counterintuitive, the immediate task at hand becomes more and more simple when there are ghosts about.

He doesn’t want me to take medication because he is afraid of what his mother will say.

Start talking about Me and not about him.  How does Me factor in to deciding on medications?

Smoking is my last vice and I’m not here to talk about it.  I’m here to talk about why I’m tense all the time.

Tension happens when our blood vessels constrict.  Tension increases when our heart rate….

Well, goodness.  You don’t want this from me now on this post.  I’m just trying to talk about that darn elephant.

When things feel complicated, when conspiracies seem to be around, when we hear ourselves naming others to explain our condition, when we avoid talking about something and when we lose Me -> reduce.  Still missing it?  Get even more basic.  Soon we’ll see the shade.  The elephant is there to help us, not shame us.  He’s there to bring us back to Me where everything starts and ends.

Question:  How has the elephant in the room improved or worsened your self-care?  Please tell us your story.

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The Gift in Wanting – Water, is Taught by Thirst

Water, is taught by thirst. 
Land -- by the Oceans passed. 
Transport -- by throe 
-- Peace -- by its battles told 
-- Love, by Memorial Mold 
-- Birds, by the Snow.
-Emily Dickinson

“Some people think of the glass as half full. ...

I have been quiet here for what seems like a long time and I am happy to be talking out “loud” again.  Thank you for being, friends.

Over the past year-and-a-half of writing and reading with you, of speaking and hearing, teaching and learning – instead of diminishing my interest, exhausting my energies and instead of completing this “task,” I am rather in process of crescendo.  This thing called, being a “friend to yourself,” apparently must continue.  It must because otherwise we would not.

Emily Dickinson knew the value of what was missing; but more so, she knew the value in the wanting of it.

Water, is taught by thirst.

I am ever aware that you and I do too.  It is this wanting that spurs in us our creative genius in this effort.  In any area of interest, in fact, whether it is this, to cultivate the caring of our own person, or to improve our eye of canvas, to swing our sword or to put pen to paper – if we do not sense potential, pleasure still to come, if we do not see beyond where we are to what might be and if we don’t want it, we will miss our selves.  We will lose our pearl to the muck that hides us.

Counter to intuition, presence is in fact enhanced by our wanting.  We clarify our point of reference to each other and to Love when we realize that we are toward something greater than ourselves.  Having that point of reference is nourishing.  It is active and it is connected.  The understanding of what we want still, have yet to obtain, rather than destabilizing or isolating us, it improves our footing and our community.  And like Emily, we give up much just to experience the exquisite process of joining our own journey.

This is what thirst has taught me.  What about you? Please tell me your story.

Self-Care Tip – Before the gift of your thirst, pursue it knowing you are blessed.  Be a friend to yourself.

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The Holidays and Lonely Me

Feeling anxious about Christmas, or whichever December holiday celebrated?  We are not alone.  We think we are.  We worry about the in-laws, parents, money, gifts for our kids, keeping the romance, abandonment, alcohol abuse, anniversary-grief of loved ones lost, and on and on.  I’m thinking now especially of our dear blogger-friend, Lisa, who is spending this first Christmas without her mom.

Lisa, we are standing with you.  We are weeping with you.  You are not alone and we value you.

In this precious sum of days, “the holidays,” going into the space that holds our fear seems almost morally wrong.  (Do we really have the responsibility we perceive we do to be “festive?”)  The smiles and joy appear to occupy any organ-cell(s), from the lowest creature to our neighbor, who doesn’t deserve more than a broken shoe in his stocking.  We think,

How can this be?  Why don’t I feel joy or care?

Even when our mind knows the true answers that we are not chosen to suffer, we are not alone and that we are safe to be in the space of our fears – even then, we don’t perceive it.  In the cold environment of our lonely selves, white breath condenses, freezes and, made heavy in winter-thought, falls to the ground before the “knowing” has a chance to reach the rest of us.

There are no universal-tips to dispense, cups of warm cocoa or four-sided tickets, except this.   Remind any part of us that can hear our friend, that is to say Me:

We weep together.  

We are present with our suffering.  This does not take sincerity away from the things we actually do still enjoy and feel pleasure with.  Inversely, feeling pleasure does not deny the grief or other negative feelings.  

We will make it past this.    

We love ourselves and see our flaws as tools to use towards furthering our efforts in self-care – potential assets.  

We claim our freedom to choose to start over at any time, to choose not to be a victim and to go where our intuitions wrongly advise us not to – our fears and shame.

We take our medication, despite stigma. 

We account to ourselves, despite what has happened in our lives.  

We keep it basic when things complicate.  We return to the home of Me whenever our view  of where we are in time films over.

Keep on my friends.  We are persons of courage and value.

Questions:  What fears complicate your holidays?  How are you friendly to yourself during this time?  Please tell us your story.

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How To Stop A Relapse Before It Starts

Australian garden orb weaver spider, after hav...

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Baby I have been here before
I know this room, I’ve walked this floor
I used to live alone before I knew you.
I’ve seen your flag on the marble arch
Love is not a victory march
It’s a cold and it’s a broken Hallelujah…

– Leonard Cohen

Relapsing in brain illness is the pits.  The prodrome, as it starts creeping into our awareness, is worse than knowing we are about to walk into a spider web with the spider and his dinner still in it.  It’s so horrible that even before the prodrome hits, imagining a relapse can trigger foreboding and anticipatory anxiety.

What will I do if I…?  

Dear God no…

Recently we did a brief series on ECT and discussed how ECT can improve brain health, signal neurogenesis and trigger healing.  This brought many of us to wonder about what causes brain damage.  It became apparent that many of us had forgotten that brain illness, in fact, damages the brain.  We still have a hard time, despite all our progressive activism and awareness, believing to the core that the brain is human, that emotions and behaviors come from the brain and that a diseased brain is what generates disease symptoms as seen in emotions and behaviors.  We still have a hard time believing that the brain responds to medication, much like the liver does.

What?!  Depression causes brain damage?

What?  

Now compound that with the spider’s cousin, Medication-For-Life, and you’ll see us doing a funny walk-hop-dance in the dark to avoid what we wish we weren’t getting into.

The wonderful bit about all this is that staying on medications, even for life, is the best way to dodge the worst of it.  Sure, even with medications, as prescribed, compliant and all that fluffy five-star behavior, we still relapse.  “Depression should be considered as a continuous rather than an episodic process,” as stated so well by French biomedical expert, Vidailhet P.   But, (this is really good news,) when we relapse, we do not drop as fast, we do not fall as low and we do not hit as hard when medication compliant.  Staying on medication is prophylactic against those miseries.  Staying on medication is protective against progressive brain disease and it’s deteriorating effects.  Staying on medication is friendly.

…Hallelujah, Hallelujah
Hallelujah, Hallelujah

–Leonard Cohen

Question:  What have you noticed that staying on your medication has done for you?  How do you manage to stay on it even when you don’t want to?  

When you’ve come off of it and relapsed, how was it different from when you relapsed while still maintaining your medication therapies?  Please tell us your story.

Self-Care Tip – Stay on your medication.

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Be Friendly Enough With Yourself To Acknowledge the Gift In Your Suffering

Strange Lady

Image by bending light via Flickr

Pain. There are so many of us suffering from pain that sometimes it is as if nobody escapes. Even so, in the contorting agony that pain brings, we have a very hard time thinking outside of ourselves at all. We are preoccupied with ourselves. We do not think about the others hurting or others in general at all. Pain does that – emotional and/or physical.

Penelope was preoccupied too. She had suffered and was suffering still. Peeling her thoughts away from survival during those times when, with teeth and muscles clenched, her body felt like a universe unto itself. Everyone outside of her were aliens she was able to visit occasionally. Watching her and hearing her describe how it molded her current person, I remembered the book by Paul Brand, Pain: the Gift Nobody Wants. (We mentioned this book before in our blog-post, “Emotions: The Physical Gift We Can Name.”)

When we are sick with Pain Syndrome, with symptoms seen in our emotions, behaviors and nerve language, it is hard to perceive what good can come out of bad. Saying, when we are in that ditch, that the sun is happily shining overhead is rude and boring. Especially when it is rhetoric. Change that rhetoric to insight, well that would then be worth friendly and interesting. That would be hope. There comes a degree of knowledge that hasn’t reached our sensory selves yet but sits in our intellect. We have a glimpse of the ark of the covenant, a promise, nearly prophesy in fact – we have a knowing that something good can come out of this.

This is why I thought of the work of Paul Brand, M.D. with the lepers. I thought that Penelope might want to know that there is something good that could come out of her bad if she were healthy in other ways, enough to receive it. If her senses could perceive it, her emotions, sight, hearing, touch, taste and smell could take in that information and deliver enough of it uninterrupted, what was promised to her would come true; past the pain that distracts and preoccupies.

It is as if this good that comes out of bad were like a runner in a war zone. Bombs are exploding. It is noisy even though hearing was taken out after the last gun fire. Dirt and sweat drip over eyes and into mouths and no one believes they will survive. And then the runner trips into our shelter and collapses still alive; still holding the message in his hand. Something good made it across a land in havoc and war and we know about it now.

I thought of Paul Brand, M.D., telling Penelope that her pain is her gift at that point of knowing, with that timing. Better than I could. She wouldn’t laugh angrily and give him a bad review on-line. She would hear him. “Something good is coming your way. You have hope.” In my imagination, Penelope would not hear Dr. Brand moralizing her experience – “You are good if you perceive your gift and you are bad if you don’t.” In my fantasy, Penelope would understand that this offering wasn’t intended to make her feel guilty for hurting. It was an offering of hope.

Not so easy to do, as it turns out, in real life. I am a very human psychiatrist without

much magic about me very often. But if I did…

Question: How do you give yourself hope when your senses don’t perceive it? How are you your own friend when you are preoccupied and distracted from that which is friendly? Please tell us your story.

Self-Care Tip – Be friendly enough with yourself to believe that there is something good that will come out of your bad. There is hope.

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Generic Patient Information on ECT

What is ECT? Electroconvulsive therapy (ECT) is a treatment for severe episodes of psychiatric disorders, especially major depression, mania, and some types of schizophrenia. It involves use of a brief, controlled electrical current to produce a seizure within the brain. This seizure activity is believed to bring about certain biochemical changes which may cause your symptoms to diminish or to even disappear. A series of ECT treatments, generally 6 to 12, given at a rate of 3 per week, is required to produce such a therapeutic effect; although sometimes a smaller or larger number may be necessary.

How is ECT administered? ECT is usually given three times a week, on Monday, Wednesday, and Friday mornings. It can be provided on either an inpatient or outpatient basis. You will not eat or drink after midnight the night before each treatment. Your ECT doctor will tell you what medications to take that morning. Before the treatment, a small needle is placed in a vein so that medications to put you to sleep and relax your muscles can later be given. The treatment itself is given in a special ECT Treatment Suite, where it is administered by a team of doctors and nurses with specialized training and experience. You will be brought into the Treatment Room and asked to lie down on a comfortable stretcher, after which blood pressure cuffs will be placed on your arm and ankle and a number of electrodes will be placed on your scalp, chest, and finger, so that brain waves (EEG), heart waves (ECG), and body oxygen levels can be monitored and so that the electrical stimulus can later be given after you are asleep. You will also be provided oxygen to breath by mask, and any pre-ECT medications, if indicated, will be given, followed by the anesthetic medication itself, which will put you to sleep.

Within a minute after the injection of the anesthetic medication, you will be asleep, and the medication to relax your muscles will be given. Within one to three minutes, your muscles will be relaxed. A controlled electrical stimulus, lasting a fraction of a second to eight seconds, will then be applied across the two stimulus electrodes, which will typically be placed either on both temples (bilateral ECT) or on the right temple and top of the head (unilateral ECT). As will be described later, unilateral ECT has less effect on memory than bilateral ECT. However, some reports suggest that it may not be as effective or rapid in all patients. The electrical stimulus triggers a seizure within the brain, which typically lasts around a minute. Because of the muscle relaxant drug given prior to the stimulation, very little body movement usually occurs.

Within a few minutes after the seizure, when you are breathing well on your own, you will be moved to a nearby room, where you will wake up within 5 to 10 minutes. Because of the anesthetic drug and the effects of having had the seizure, you will temporarily feel somewhat groggy. Usually within 20-30 minutes after leaving the treatment room, you will be brought back to your room (if you are an inpatient), or, if you are an outpatient, you will go to another area of the Treatment Suite, where you will wait till you are ready to leave the hospital (typically about an hour or more).

Is ECT effective? Although there have been many advances in the treatment of mental disorders in recent years, ECT remains the most effective, fastest and/or safest treatment for some individuals, particularly when alternative treatments, usually medications, are either not effective or not safe. Your doctor will discuss with you why ECT is being recommended in your case and what alternative treatments may be available. ECT is most effective in severe clinical depression (major depressive disorder), where it has a strong beneficial effect in 50-90% of patients, depending on the case. Still, there is no guarantee that ECT, or, for that matter, any treatment will be effective. In addition, while a series of ECT (or an alternative treatment) may bring an episode of illness to an end, it will not in itself prevent another episode from occurring weeks, months, or years later. Because of this situation, you and your doctor will need to consider additional treatment to follow any ECT that your receive. Such treatment generally consists of medication, psychotherapy, and/or additional ECT (given as an outpatient at a much less frequent rate and called “maintenance ECT”).

Is ECT safe? All treatments have risks and side effects, even no treatment at all. Prior to ECT you will undergo a medical, psychiatric, and laboratory evaluation to make sure that the treatments can be administered in the safest, most effective manner possible. Your medications may also be adjusted to minimize the risk and maximize the effectiveness of the treatments. For most patients, the side effects of ECT are relatively minor. The risk of death is very rare, about 1 per 10,000 patients for typical cases, but higher in those with some types of major pre-existing medical problems. Serious complications, which are also quite rare, include temporary or permanent heart abnormalities, reactions to the medication used at the times of the treatment, injuries to muscle, bones, or other parts of the body, and greatly prolonged seizures or seizures occurring after the treatment. More common side effects involve headache, muscle soreness, nausea, confusion, and memory difficulties. Headache, muscle soreness, and nausea are usually mild and can be prevented or at least diminished by medications.

Memory problems often build up over a course of ECT, but diminish as soon as the treatments have stopped. However, because of the harmful effects that mental disorders themselves often have on memory function, some patients successfully treated with ECT actually report an improvement in memory. When memory problems occur, they vary considerably from patient to patient, but are usually greater for larger numbers of treatments or when both sides of the head are stimulated (bilateral ECT). Because of the possibility of memory loss, it is recommended that important life decisions be postponed until any major negative effects of ECT on memory have worn off (usually within a week or two following completion of the treatment course).

ECT-related memory problems can be of two types: a difficulty remembering new information, and a loss of some memories from the past, particularly the recent past, e.g., during and just prior to receiving ECT. In this regard, the ability to learn and remember new information returns to one’s usual level over a period of days to weeks after ECT. The ability to remember material from the past, i.e. prior to ECT, likewise tends to return to normal over a similar time period, except that in this case, some memories from the recent past, mainly days to months prior to the treatments, may be delayed in recovery or even permanently lost. Some patients have reported longer gaps in memory. However, patient surveys have indicated that most patients receiving ECT are not greatly disturbed by memory effects and would have ECT again if it was felt to be indicated.

Other information on ECT: Please feel free to ask your doctors or nursing staff any questions you have about ECT. A variety of types of information are available concerning this type of treatment, including videotape material. You should understand that ECT is a treatment for which you (or your representative, if applicable) must consent on a voluntary basis, and that consent for future treatments can be withdrawn at your (or your representative’s) request at any time.

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Take Care of Yourself And You Will Be Taking Care of Others – “Care-Givers”

Caregiver is a name that many of us own.  From basic parenting scenarios to families complicated with end-of-life, spinal cord injuries, congenital diseases or employees of group homes – care-givers is the generically applied term.

Is it difficult to ID care-givers that “did it right.”  Seeing them is a muscle that operates better by practicing the magical and material skills of empathy, doing rather than saying, so to speak.

By the way, I’m on hold right now with the service provider for our currently nonfunctioning internet.  The hold-music is so bad that I had to put the phone in a closed drawer to muffle it.  #selfcare.  Much better.

There are many people who have cared for me and do care for me.  You for starters have cared for and do care for me in your reading, your time, your thoughts, and comments, you are my givers of care.

I am cared for, and you know I get all fluttery when I start talking about you so I’ll stop before you throw-up.  Unless it’s too late.

There are others who gave and give care, obvious names like parents, spouse and friends. And there are many less obvious names – my dogs talking to me when I get home, the lady who came up to me in the 99-cent store and handed me $20.00 to buy treats for my kids, my psychotherapist who told me to “grow up.”  All these and more have and do care for me.

But do we call these people, (or other living creatures,) caregivers?  Is that a name for what you do for me? Not traditionally but it really is.

The differences are found between those who believe they take care of others when they don’t take care of themselves and the inverse – those who take care of themselves, and as part of that effort to be their own friend see caring for others as a natural maturation of their own needs. (Remember, agendas again.) In any other design, taking care of others when we don’t take care of ourselves is not sustainable nor congruent with our intentions.  We become the hare who lost the race to the turtle, angry and confused by our results.

stressful moments stressful moments tired caregiver stock pictures, royalty-free photos & images

I agree that this attempt to share space with the angels who so lovingly nurture and give to those who can’t give to themselves can be perceived as arrogant, ignorant and other names – creep, idiota, a– h—, pompous, fools, bigots, oblivious, uninformed, (this is fun), benighted, blind, old gum under the picnic table jerks.

Be that as it may, please believe that we speak of caregivers without malice.  And if we are ignorant, please let our flaws inspire you to grow us as empathically as you would like us to grow you.  I know it takes a lot of love to deal with someone like us and it is much easier to walk away.

Questions:  Where do you find yourself in the care you give to others?  What helps you remember your intentions to love yourself when stigma or guilt bang you upside the head?  How do you see that caring for yourself is consistent with your goals to serve others?  Please tell us your story.

Self-Care Tip – Care for yourself and you will see yourself giving care to others.

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AfterShocks (…Smile) From our ECT Series

Reference cat

I am hoping to get a running stream of references for those interested in finding out more about ECT.  To start, some are:

  1. As relayed in our last blog post, check out Mayo Clinic
  2. Kitty Dukakis: Shock Therapy Saved My Life – ABC News on abcnews.go.com
  3. Kitty Dukakis And ECT – CBS News Video
  4. Kitty Dukakis And ECT video – CNET TV
  5. Katherine Kitty Dukakis on ECT | Psych Central
  6. Kitty Dukakis & Shock Therapy | World of Psychology
  7. Shock: The Healing Power of Electroconvulsive Therapy – Amazon …
  8. Kitty Dukakis Backs ECT for Depression : NPR
  9. Scientific Articles on Neurogenisis From ECT as described on PubMed
  10. Mortality Rate From ECT
  11. University of Maryland describes their understanding of ECT as a treatment option for Bipolar Mood Disorder and Depression
  12. Currently under research at Duke University, “Not-So-Deep Brain Stimulation:  Transcranial Magnetic Stimulation (TMS)
  13. I also really love the 1st hand words from    Here is one of her excellent statements – “No one really knows how ECT works. For the longest time everyone just said it “rebooted” the brain. Hardly scientific. What we now know is that ECT creates neurogenesis, in other words, neuron growth. And this is needed because long term depression kills brain cells and shrinks the brain. (Antidepressants also induce neurogenesis, FYI.) So ECT is able to make connections in the brain that weren’t previously there, and it makes them very, very quickly compared to any other method.”  She has done her research.
  14. Also, enjoy reading The Bipolar Badger who is going to be writing more on his experience with ECT this week (he’s promised).  The Badger says, “there is very little positive or objective is more like it out there on the interwebs. While I do not expect every post out there to be positive as not everyone has a great experience with ECT. It as important to mention positive outcomes as well.”
If you know of more, please tell us!
Be a friend to yourself.  🙂

 

 

 

 

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The Non-Dramatic Ending To Our ECT Series

Bert the Turtle

Image via Wikipedia

Not much traffic over here since drifting into electroconvulsive therapy (ECT) territory.  That’s alright.  Everything in its own time.  We got some feedback from some who didn’t find ECT helpful, some who would never be interested in ECT but not much from anyone who has found ECT helpful – and I know you are out there.  Healthy and quiet about it.  I know because I know from my patients and from the studies and statistics available.  You are there.  And you are not alone.

I was corresponding with my trusted mentor on this subject, Richard Weiner M.D., from Duke University, who has treated patients with ECT for 40+ years.  He referred us here at FriendtoYourself.com to the clean presentation by Mayo Clinic.  If you are interested in further introduction into ECT, check it out.  They have a lovely video, outline and inquiry resources.

On a slightly shifted topic, I’d like to introduce you to my friend, B.D.Erline.  This guy’s really rocking the friendship thing to yourself these days.  He’s writing and spending himself on his new, “Act-Like-You-Wanna-Live” series.  It’s brilliant.  Say hello if you’d like.

That’s all for tonight my friends.  I thank you for coming along even when topics interest you less than other days.  Keep on.

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Celebrating Your Courage Will Connect You With Your “Me” and With Community

Veterans Day

A seriously cool veteran was cruising Old Town today on his Harley with about fifty American flags affixed in mysterious ways to his bike and person.  I cannot figure how, but those flags were not going anywhere he was not.

I had forgotten today is Veterans Day, even though my kids were all home, off from school, properly running amok.  This man, in his leather skins and industrial number of stars and stripes, reminded me.  As we approached each other from opposite sides of the street, I saw him nod to another biker passing him by.  His nod was enough to say, “Hello.  You are not alone.  I am not alone.  We connect by this brotherhood.”  I watched him in my rearview mirror and immediately dialed my dad, of course.   “Happy Verterans Day.”

Sometimes we do not wear our history as confidently as this cool vet.  How messy that would be, right?  Imagine a world where people used their hard-earned losses as a tool to empathize with themselves and others.  Where people’s pain was used as a force to connect with their Me and with others.  How tiring to receive nods, to accept judgments and applause, as it may be.  Right?  Company can be a burden.

This is my guess as to why not many of us speak up about what electroconvulsive therapy (ECT) has done for us.  We hear about the miracles of medication therapies from first person reports, heck, even second, third or tenth hand.  We do not hear much about the miracles of ECT.  Instead, we hear the sound of quiet or else hopeless barbarism.

I was talking with a patient, Carla, about ECT as an option for treatment, and we laughed that we are anesthetized for a colonoscopy for much longer amounts of time than we would if we had ECT.  They seemed like such funny things to juxtapose.  The convulsion lasts around thirty seconds and you are done.  There are no broken bones.  No tongues bitten through.  There are no chickens sacrificed on anyone’s chest.  Carla had never heard about the physician-patient who had undergone thirty-six ECT treatments as a patient, whose morbid melancholia resolved and who later returned to practicing medicine in full capacity.  Why would the physician tell people about his history?  What kind of nods do you think he would get?  What patients would be willing to go to him for medical care?  Carla had not heard about the gamers, computer programmers, the nurses or anyone from the functioning productive public who had the courage to fight for themselves by choosing ECT.

My patients with whom I discuss ECT have concerns.  You have concerns.  Much of the world is concerned.  There are reasons.  ECT has improved farther than Jack Nicholson’s report on One Flew Over The Cuckoos Nest, though many of us were alive when his movie was first viewed.  The distance we have come in refining the practice of ECT is out of proportion to the distance in time from when ECT was not much more than sticking your finger in a socket and getting voltage in a continuous sine wave for therapy.  Is it shameful being connected to that history?  Is it too soon to say, “These are the ancestors I claim?” You know what to do with shame.

There are few medical specialties that gather as many opinions as psychiatry.  Yes.  Well there are even fewer medical treatments that are found in the company of so much frothing opinions than ECT.  No wonder we are quiet.  No wonder we are concerned.

So, although we veterans of ECT perhaps have not spoken up in our community, although we may not tear up at ceremonies for what our courageous self-care has done for our country or understand how we fit in, although we may not hang flags or tattoo it into our skin, we are courageous important citizens in company.  We are heroes.  Maybe not as cool in leather, but we are where we are because of those who have come before us and for what we have carried on.  We have suffered and died and lived and we are connected.  We have community and we are not alone.

Happy Veterans Day.

Self-Care Tip – Celebrate your courage.

Questions:  How do you celebrate what others think is shameful but you know is not?  What have you found in doing so?  What has gaining your community done for your ability to celebrate?  Please tell us your story.
Series on ECT:
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Consider the Barrier Stigma Plays in Your Ability to Take Care of Yourself

Esther... The Girl Who Became Queen DVD Cover

I am just going to come right out and say it.  I have been trying to be clever, a Queen Esther toward her King and Hamon, on behalf of the people she loved.  (Yes.  I am Queen Esther in this story.  You can play her in another one.  Maybe tomorrow.)  I have been talking about treatment options for brain health and it is just not going where I was trying to take us – ECT.

ECT, my friends.  Electroconvulsive Therapy.  Many people see this as an extreme option for the dire, filtered out treatment failures.  That is an ugly description but I believe pretty close to what we have culturally got.  Many of you have told us how you escaped receiving electrically induced convulsions.  You hid from the boogie man and lived to tell us.  (There are chemically induced convulsions but we have more control of the convulsions through electricity, so that is the standard of care.)  Others have testified that it destroyed them with a catalog of specific and nonspecific complaints.

Interestingly we have not heard from you who have received ECT.

Come out, come out wherever you are.

Stigma perhaps hides you, and we can understand why.  Stigma toward ECT is like stigma toward anything – pretty off topic and hurtful.  Although it is improved by education and empathy, it is not fun challenging it “alone.”

Tonight I am not going to talk about the pros and cons of ECT, but to say that you are not alone.  You who are in treatment or have been in treatment or are considering ECT – would you tell us what you know, personal or impersonal?  There are many of us who would benefit from your education and empathy.

(What would that do to stigma?  What would that do for us?)

It would be wonderful to hear questions any of you have, as well, and anything related to ECT that you would like to share.  Please tell us your story.

Self-Care Tip – Consider the barrier stigma plays in your willingness to receive treatment and to connect with others.

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What We Will Do For Brain Health – Looking For Heroes

Death and the Maiden #2

Image by CapCat Ragu via Flickr

My dad is turning seventy-seven tomorrow folks.  He could have died a gazillion times before now, but it is the tumbling of those near-deaths into big life that teaches and recruits me.  He makes life feel like open space, warm skin, color and lyrics.  Now his spine is crumbling, his legs are weak, his lips are always moving in and out like a rabbit and he’s almost too hard of hearing to comfortably socialize with.  Still, it is the life, the interest he has, the way he doesn’t stop growing that somehow dims the many times he might have died.  Why does the one time he will die seem impossible to juxtapose against any future then?  Where will life go, if he is not there to infuse us with his humble will?  I think it may fall asleep with him but I know it will not and I cannot imagine it otherwise.

These past few posts we have talked about “special efforts” for brain illness.  We asked, “Is there any treatment you think is too extreme to consider to get brain health?”  We have not said the reason we cannot fairly answer.

I don’t know how life will be without Dad; we never know how life will be when our brain is bad and then more bad.  It’s hard to tell.  We can only imagine and usually our imagination will be wrong anyhow.

Any answer to this question, “Is there treatment you think is too extreme to consider to get brain health?” is shaped by our understanding of what “extreme” means.  It changes shape and margins with the degree of brain illness.  With each turn, as our disease process exacerbates, so progresses our willingness to believe what is reasonable versus what is “extreme.”

Many of you have told us of your own specifics in your fight for brain health.  People do heroic things and I’m thinking you and I might have a bit of a living hero in us.  In part, it is the inherent unknown in growth that testifies to life itself.

“Is there treatment that you think is too extreme to consider to get brain health?”  I imagine my answer would be, no.  Please tell us more about yours.  Your view from your degree of extreme helps.  Keep talking.

Self-Care Tip – Let the hero in you speak, grow you and testify to life.

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