Month: January 2026

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The Leaky Illusion of Independence

A woman with curly hair covering her face with one hand while smiling slightly.

Standing in the Costco merchandise return line, I saw this lady walking out toward the exit with a cart piled high with boxes of Depends. She wasn’t that old.

I felt embarrassed.

I remembered the awkward evidence of wet pants after laughing too hard when I was pregnant. Or coughing when I was pregnant. Or basically doing anything that required any degree of bearing down when I was pregnant. She wasn’t pregnant.

The uneven balance of power between her and the rest of “the world” was announced by many boxes of Depends — the cumulative, “We don’t need Depends and she does.” In that moment, bodily control became an unspoken currency.

What does that say about me? About us?

The feeling was quieter than judgment. It was more uncomfortable than wet pants. A sudden awareness of bodies, of exposure, of who is still “contained” and who is not. Not a moral judgment, but an emotion in response to perceived loss of autonomy.

Way way way back, when I used to menstruate, I’d feel the need then too. I would hide my sanitary items going up to the teller. I’d hope hard at the people around. “Please please don’t see my period stuff!”  

Knowing people know you bleed or leak urine is embarrassing. Shame was up, eyes open, on point.

Isn’t it strange what we’re taught to hide.

We are schooled by everything. Community, commercials, the Lebanese heritage that is spliced into my DNA. Anything that signals dependency, permeability, or loss of control, is shameful. Bleeding is normal. Leaking is common. Needing products is part of being human. And yet the visibility of those needs is losing. A loss is there, of privacy, of boundaries, of dignity.

Standing there, I realized that what I felt wasn’t just that. It was vulnerability. Seeing her cart jettisoned the power-meter. It showed just how much power we quietly assign to bodily control, and how quickly that power can climb. Control, not character, had become the axis of comparison. Embarrassment wasn’t about her at all.

It was about fear.

Fear of being seen as dependent. Fear of the body betraying us in public. Fear that dignity is something you can lose simply by needing help. Unfortunately, these are not irrational fears; they are culturally reinforced and clinically familiar.

We learn early that our bodies should be discreet, quiet, sealed. That need should be invisible. That containment improves value. This belief system shows up repeatedly in clinical work — in stigma, nonadherence, and resistance to care.

What does that say about me? About us?

Maybe we are still learning how to untangle dignity from control. Or shame often masquerades as embarrassment when it’s really grief for the illusion of independence.

Question: When did needing help start to feel like losing for you?

Self-Care Tip: Notice one place this week where you hide a normal need. Then practice letting it be visible without fixing it, just to allow yourself to need something without apology.

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Why It’s Just So Hard To Take Meds

Adherence is subtle. Adherence is not the same as “compliance.” People are generally good people trying their best with what they understand and what feels right for them.

This matters, because nonadherence might not be defiance—but rather distress.

When someone doesn’t follow a treatment recommendation, it’s not generally because they don’t know they’re supposed to. Nonadherence comes from subtle reasons. “I can’t look at my bottles every day. I feel like trash for taking so many pills.” Needing medication often feels like evidence of personal failure rather than a neutral medical tool. Every time someone looks at the bottles, opens the lids, and swallows the pills, they’re fighting self-stigma. It’s hard to see yourself surrounded by pills and medication bottles.

This is where the daily work of adherence becomes invisible labor rather than willpower. It’s not one decision—it’s an argument you have with yourself over and over.

Consider using a pill box. Put the bottles away. Don’t even look at them until you have to refill the box. At least then you aren’t fighting that inner voice every day that says you are a bad person. That voice affects adherence far more than knowledge. This small tweak quiets self-judgment.

If a patient is not adherent, the patient, me, and anyone else who is part of the treatment team need to figure out why. Reframe nonadherence as a shared problem to solve, not a personal failure. People are not actually trying to sabotage themselves.

Even when teaching resident clinicians, I ask, “Whose responsibility is it if a patient is not adherent?” The confident answer is, “The patient!” Well, no—not entirely. It’s our responsibility. Ours. Us. If the patient isn’t adherent, there is a good reason why. We just haven’t figured it out yet. That’s our job: to teach, to explore, and to sell hope.

Being right doesn’t change lives. You can have all the facts in the world and still not take the medication. What changes behavior is feeling understood and having agency. Correctness without connection is for the birds.

For example, a lot of nonadherence comes from what patients are hearing outside the office. Family members. Therapists. Friends. “You’re on too many meds.” “Meds are bad.” “Good job! You got away with taking less.” People go home, hear this, and feel like trash for needing treatment. Stigma can live in relationships, not just inside the person.

It helps to name the voice patients carry with them after they leave the office. Naming it helps it lose power.

When that happens, one option is calling the people who are talking in the patient’s ear when they’re not with the provider: a husband, a brother, a parent, a friend. If I call them on my phone, the caller ID, they’re not going to pick up. But if the patient calls them, then they pick up. Here, the voice belongs to someone specific and takes on more shape. Often these are influencers in stigma or bias around treatment. I introduce myself and ask if they have concerns. They might say they think the patient is on too many medications or that medications don’t work. That’s important to know. It may be what the patient has been absorbing and what’s been influencing their ability to adhere to treatment.

Then I say something like, “That’s important. What if we reduce dosages?” Sometimes that’s something we want to do anyway, to keep side effects low and to layer with another class of medication. Lower doses, fewer side effects, and better receptor targeting allow for more comprehensive coverage. Now we’re aligned.

Now the voice in the patient’s ear is part of the plan and has become an advocate.

Adherence isn’t about forcing people. It’s about removing the quiet barriers that make it hard to stay in care. Shame. Stigma. The feeling that something is being done to you instead of with you.

When you and yours join into the discussion early, then you get to declare for yourselves, over and over again, whether the treatment is worth it. Because it is a decision that has to be made again and again. Everyone involved feels agency. No one is victimized by treatments. In order to be my own friend, I have to be that friend even at a biological level.

That’s the work. Not just prescribing, or just taking a pill, but figuring out why someone can’t adhere.

Self-care tip: If something meant to help you feels shaming, change the ritual around it before blaming yourself for not sticking with it.

Question: What part of your self care is hardest to follow because of how it makes you feel about yourself, not because you don’t believe it helps?

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Amazing Identity

I don’t know if you are familiar with David Asscherick, teacher, speaker, and author, but this guy’s a deep sink of knowledge and is a voracious reader.

We were talking about identity, one of yours and my favorite topics here at Friend to Yourself, where we wrestle with what makes me, “Me”.

Considering that all emotions and behaviors come from my brain, and that this can change so easily depending on the health of my brain, and if we define our identity this way… well, we’ve talked about this.

Asscherick shared this amazing poem that I thought you’d love.

Who Am I? (By, Dietrich Bonhoeffer)

Who am I? They often tell me
I would step from my cell’s confinement
calmly, cheerfully, firmly,
like a country squire from his country house.

Who am I? They often tell me
I would talk to my warders
freely and friendly and clearly,
as though it were mine to command.

Who am I? They also tell me
I would bear the days of misfortune
equably, smilingly, proudly,
like one accustomed to win.

Am I then really all that which other men tell of?
Or am I only what I know of myself,
restless and longing and sick, like a bird in a cage,
struggling for breath,
as though hands were compressing my throat,
yearning for colours, for flowers,
for the voices of birds,
thirsting for words of kindness, for neighbourliness,
trembling with anger at despotisms and petty humiliation,
tossing in expectation of great events,
powerlessly trembling for friends at an infinite distance,
weary and empty at praying, at thinking, at making;
faint, and ready to say farewell to it all?

Who am I? This or the other?
Am I one person today, and tomorrow another?
Am I both at once? A hypocrite before others,
and before myself a contemptibly woebegone weakling?
Or is something within me still like a beaten army,
fleeing in disorder from victory already achieved?

Who am I?
They mock me, these lonely questions of mine.
Whoever I am, thou knowest, O God, I am thine.

…thanks for sharing this with me. Keep on!

—

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Feeling Better Is Not the Same as Being Well

An illustration of a female healthcare professional wearing scrubs, holding a clipboard and pen, with medical equipment and symbols in the background.

Ed Darling had the hardest time tracking. One thing led to another, and then another. The problem was that it wasn’t always a straight line, and there were a lot of open cliffs that flanked whichever idea or activity he diverted from before launching onto the next. For the others in proximity to him, tracking him was tiring and even perilous. Tiring in the sense that it took a lot of energy to follow and fill in gaps when Ed Darling moved between this and that. Perilous in that to be in relationship with Ed Darling would often leave you feeling alone and unheard, because Ed Darling had moved on to the next thing so fast. He couldn’t “stand” with you, interpersonally. He couldn’t be there long enough for you to communicate or complete your meaning and then actually receive what you were trying to give him in it.

In clinical settings, this kind of pattern is often not described relationally at all, but translated quickly into symptoms.

Many patients come to me like Ed Darling, and because I don’t prescribe amphetamines, I often don’t get to work with them for very long. Amphetamines are the accepted first-line therapy for what Ed Darling suffers with, Attention Deficit and Hyperactivity Disorder, or ADHD.

I felt rather thrilled to read about a study I came across published in Cell. It was like bulbs flashing in my face. I felt seen. Smile. I may not be eager to prescribe for ADHD, but I do enjoy the medical workup of why we feel the way we feel and why we behave the way we do.

Ed Darling deserved a good medical workup rather than jumping to a psychiatric diagnosis, or any diagnosis for that matter. We all do. There’s a reason that psychiatrists still have to complete college, then four years of medical school, then four years of specialty training. They need to be able to see the whole body and mind, and what medically can look like ADHD but isn’t ADHD.

Sure enough, Ed Darling had a thick neck, high palate, and a recessed chin. And sure enough, he’d been snoring loudly since he was a teen. On top of that, Ed Darling had been a football player in high school, and although he didn’t report concussions, he was a linebacker and inevitably, I’m sure he had chronic head trauma. Both untreated obstructive sleep apnea and chronic head trauma lead to changes in the frontal lobe that look symptomatically a lot like ADHD. Ed Darling was long overdue for some laboratory studies, including a sleep study.

The study published in Cell shows that the amphetamines commonly used don’t act on the brain’s attention circuitry as had been assumed, but instead target the brain’s reward and wakefulness centers. The study supports an increasing body of research looking at sleep, or the lack thereof, as a contributor to ADHD. Reading this, I found myself thinking less about attention as a moral or cognitive failure and more about what might be interfering with sustained wakefulness and frontal-lobe function in the first place.

What would have happened if I had just referred him to a provider for amphetamines? Well, he may have felt better, because amphetamines target the reward pathways of the brain, and people generally feel good on them. Ed Darling would have felt more awake, because yes, amphetamines target the wake centers of the brain. But that would throw a veil over what really may be going on. And then if those underlying disease processes weren’t diagnosed and treated, they would continue to do damage, even if Ed Darling was feeling better in the meantime. It would be like locking down your house when there was a slow water heater leak you didn’t know about.

Self-care in this scenario is more than Ed Darling doing what makes him feel better, more awake, more focused, taking stimulants. Self-care is Ed Darling working hard to get the studies done he doesn’t really want to do, and then the treatments that target the underlying illnesses. Ed Darling has to do this for himself. No one else can do this for Ed. I can partner with him. But ultimately, Ed has to fight for this. This is self-care from a biological perspective.

What Ed Darling’s story reminds us is that feeling better is not the same as being well. Medicine that sharpens focus or boosts wakefulness can be helpful, but it should never replace curiosity about the body that is asking for attention in the first place. True care, especially self-care, often looks less like a quick fix and more like patience, testing, and humility: slowing down enough to ask what else might be going on. When we honor that process, we move closer to treating people as whole human beings rather than as collections of symptoms.

Self-care tip:
If you are struggling with an emotion or behavior, consider asking not only “What helps me function better right now?” but also “What medical or biological processes might be shaping how I feel?”

Keep on!

Question to the reader:
Where in your own life might feeling better be masking something that still needs to be understood or treated?

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Today

Asking for presence today. For rest as well. Putting down the weights. Stepping out with the lightness that comes from this.

I ask for you the same. This is an amazing place to be. You are not alone!

Keep on!