Hello Blog-verse!

I’ve been wanting to recenter myself on what this blog is about. In brief, it is supposed to be about self-care from a biological standpoint and, from there, a branching out into the psychosocial paradigms. This means that it is a stance on what our agency is when thinking about it medically, from a physician’s point of view. That means someone who goes through full medical training, including a college degree, four years of medical school, a period of primary care training in general medicine, and then completing four years of psychiatric specialty training.

For me, this included a fellowship in “Prime Psychiatry,” which is medical psychiatry—as in psychiatry for those who are suffering primarily, at the time of the encounter with me, from a primary medical illness, such as being inpatient in the ICU for pneumonia. In this psychiatry consult scenario, the patient may be seeing me for crying jags and a work up for depression while going through the life threatening medical illness. That is a different perspective on psychiatric illness than someone whose training is different, such as from a psychology or social work background.

We look at emotions and behaviors somewhat differently because our training in understanding mental illness begins from a different starting point. Medicine first asks, “What is happening biologically?” I.e., the brain as an organ, disease processes, medications, hormones, sleep, inflammation, pain, and the countless ways the body influences the mind. That is where this blog tries to begin. But it doesn’t end there.

Psychology and social work often begin by asking, “What experiences, relationships, thoughts, and environments are shaping this person’s life?” Both perspectives are valuable, but they naturally emphasize different aspects of the same human experience. I am in danger of oversimplifying this and misrepresenting, which I apologize for.

Human beings are never just biology. We are also shaped by our relationships, beliefs, losses, trauma, purpose, and the stories we tell ourselves. Understanding ourselves well requires attention to both.

In training for psychiatry, we also cover many of the therapies taught in the various schools of counseling, and likewise, they cover neuroscience. But our pivot point in medicine is always going to be from a biological level. Nor do we spend anywhere near as much time on the many schools of thought devoted to talk therapy.

That doesn’t mean the biological explanation is always the answer. Far from it. But in psychiatry it is our nidus. From there, we broaden our view to include a person’s relationships, developmental history, coping patterns, personality, beliefs, culture, trauma, purpose, environment, and so forth. The goal is never to reduce someone to a diagnosis or a collection of neurotransmitters. Rather, it is to understand how biology and life experiences continually shape one another.

What is funny about me, and I don’t know if this is true about other psychiatrists, is that I often find myself on this blog talking most about coping issues and psychological perspectives, and I’m not sure I need to improve that. So, it makes me think I need to come clean about what I really love doing here at Friend to Yourself.

One of my agendas seems to be washing up in the tide of time and experience: trying to help others understand the role of psychiatry and detangle the social perspectives of where emotions and behaviors come from and the way those perspectives help or harm access to benefits and medical care.

So much of my practice is spent helping people understand why medication is appropriate when there is a medical illness, and why emotional and behavioral pathology may reflect illness rather than a “poor choice,” “weakness of character,” or “lack of surrender to God.”

That is an extraordinarily difficult idea.

The idea is that pathological emotions and behaviors are symptoms of an underlying disease process at the cellular level from which they arise. I.e., emotions and behaviors come from a body organ, the brain. If the place where emotions and behaviors are generated from is well, there are emotions and behaviors that are well. And vice versa.

Much like when my eyesight is bad, it means that the cells, somewhere from wherever that vision comes from in the human head, aren’t working right. They should be treated medically, such as with prescription eyeglasses—a medical prescription for a medical condition. Eyeglasses don’t heal the underlying biology, of course. They compensate for it. But we don’t moralize needing glasses; we recognize that when vision is impaired, we seek a medical solution for a medical problem.

This just isn’t easy for almost anybody to understand.

The drive to think we have control over our emotions and behaviors, i.e., our identity, is so very, very high. But emotions and behaviors start somewhere. They are birthed and formulated amongst a slurry of neurotransmitters, ions, gated channels, DNA, and so much more. From there, they take shape and grow into what we finally see in a smile, feel as an impulse, experience in tears and laughter, and even recognize as affection.

Why do we so easily believe that more hard work on “my part”—through hours of talk therapy, an exercise of prayer beads, or giving ourselves a tune-up with a wrench and hand tools—should be able to fix it? We don’t do this to someone with nearsightedness but we do it with psychiatric illness.

Many medical practitioners struggle with this. Psychiatry occupies a peculiar place in medicine because our symptoms (pathological emotions and behaviors) are experienced as our identity, much more so than in other specialties. That makes it much easier to mistake disease for personality. Other medical practitioners may inadvertently counsel patients to “work on it” in one way or another through a behavior or thought change rather than directing them to a medical treatment for a medical disease. This turns the treatment of psychiatric illness mistakenly away from medical treatment and toward volitional control, as though emotions and behaviors were under the same conscious control we have when operating a joystick or shifting the gears of a manual transmission.

It’s super unfortunate because it’s hard enough for people to understand this, let alone when their clinical providers give them inaccurate medical information.

So, this blog has become, in part, a place where I try to do just that, moving from one dial setting to another, one color on the spectrum to another, and so forth. There just are not enough voices-and-volume out there explaining this.

It is still about how to be a friend to yourself from a biological standpoint, but less directly than I thought it would be when setting out. We are doing it, but a little more circuitously, in that we have to get into and through all the reasons—the many, many reasons—we don’t understand that emotions and behaviors come from the brain, which is just as much a part of the human body as a kidney or a liver or an eyeball. To care for ourselves when we are medically ill in these ways, we need medical treatment.

To be a friend to yourself from a biological perspective, we first stop blaming ourselves for what we don’t fully control consciously: our emotions and behaviors. We grow our understanding of, and modify our actions accordingly, to the fact that the brain is an organ and is the only place from which we experience ourselves.

It is the only place from which come our perceptions of what is true, of reality, of the way we identify ourselves, and of those around us.

Even though I’ve often said emotions and behaviors come from the brain, it could be said, rather, that they come from neurotransmitters, cells, DNA, hormones, immune signaling, relationships, trauma, nutrition, and sleep, if that makes it clearer. Because they do. They all converge in brain function.

The brain is an organ, but it is also the place where we experience being human.

That acknowledges the profound influence of relationships, beliefs, faith, purpose, and culture, all of which continually affect and shape the brain, from which emotions and behaviors arise in this lovely biopsychosocial person we call “Me.”

Let us, therefore, end by saying, “this blog is about”… learning to undersand ourselves compassionately by recognizing that biolgy and lived experience continually shape one another. It doesn’t abandon biology—it explains why biology matters without reducing people to biology.

What else is this blog about? Hm. I’ll work on that. There is more that constitutes our voice here for sure. Smile.

Self-Care Tip: Treat your brain like any other organ.

Question: Have you mistaken a symptom for a personal failure? Please tell us your story! We need to hear you.