Looking at your better future

smash

Dr. Kowalski walked into the hospital cafeteria and found me at our usual table, saying, “I hate it when I go to hug someone really sexy and my face smashes right into the mirror.” It wasn’t his joke but he always had something like this to toss at us other onlookers at the caf on our lunches.

He made me laugh and I felt like there weren’t enough of his type of friendship in my town. He was a peer in my community. He was a professional, a parent, a spouse. I enjoyed working with him and I respected so much about him.

Most of the time, with Dr. Kowalski, we talked about random stuff; hospital politics, his parents in England, God in his life, his kids’ latest antics, and the conversation rolled with content and interest. This day, after his short stent with humor, he skipped the food line, and just sat down to talk, starting in with a doozie.

My son is smoking a lot of marijuana.

Dr. Kowalski described the skeletal points of Frank’s, his son’s, journey with anxiety and then with marijuana. Now nineteen, Frank had anxiety his entire life. Paralyzing anxiety at times, and completely preoccupying at others with worries and inner tension.

Once when Frank was seven, “such a beautiful boy,” Dr. Kowalski told me, how Frank reacted when he was twenty minutes late picking Frank up from school. Most of the kids were gone already and Frank had to wait for Dr. Kowalski in the administration lobby next to the “mean secretary,” quietly in a big chair by himself, until Dr. Kowalski arrived. For three months after this, with his fluffy cheeks and round blue-blue eyes tilted up, Frank asked his dad over and over again, if he was going to pick him up from school that day. Would he pick him up and,

“Would he be on time?”

It was super hard for Dr. Kowalski to witness. Sometimes he would get impatient and snapped at Frank in response. Maybe raised his voice, or just ignored Frank’s questions. Dr. Kowalski felt a lot of guilt about this. He blamed himself in part for the persistence in Frank’s anxiety. If he had been more patient with him, if he hadn’t scared him with his voice, if he had gotten him into treatment… If he had been a better father, would Frank still have anxiety? Would Frank now be using three bowls of marijuana three days a week? Dr. Kowalski states that he would do anything to help Frank get better, and often does. Just about anything he can.

Whether Dr. Kowalski did or did not, Frank believed that anxiety led him to using marijuana.

Dr. Kowalski was the director of the adolescent psychiatry unit at our hospital. He knew that, although marijuana use often decreases the perception of anxiety at the moment, over all, in the way it affected gene expression, it exacerbated their anxiety. The disease exacerbated. So the user felt better at the moment, perhaps, but then the underlying anxiety process became worse and worse. Frank told me,

Using marijuana for anxiety is like a diabetic who takes insulin so he can eat a big cake.

But what could a father do for his son in this scenario? Being right, being correct about something, having knowledge apparently isn’t always how things, like convincing one’s son to stop using, are won. Dr. Kowalski did not know what to do.

Perhaps the guilt, perhaps the love, or for other reasons, Dr. Kowalski had spent the last several years of Frank’s marijuana-using and anxiety ridden life, trying to help Frank get into treatment. Treatment for anxiety.

When treating any biological psychiatric condition, something medical, we have to first look at anything we are doing to harm ourselves. Is there anything that is pushing us in the opposite direction of our efforts? Maybe we are drinking caffeine. That triggers anxiety. Or maybe we are using another substance that triggers, and/or worsens an underlying mental illness. With this in mind, Dr. Kowalski spent much of their discussions trying to engage Frank into preventative measures as part of his treatment recommendations. But what could a father do? Dr. Kowalski was not Frank’s treating psychiatrist. He was Frank’s dad.

Dr. Kowalski told me, with lines seemingly appearing out of no where on his usually bright and happy face, about his frustrations.

The amount of energy I am putting into helping him without results bothers me. And a lot of money to help him get better. I feel it is wasted until he puts in the effort to help himself.

I want to invest in my child! I do! But to help him get better. Not to just spin our wheels. He isn’t working to stop doing the things that actively work against this goal.

Feeling violated to a degree, used, Dr. Kowalski didn’t get it. He was giving his energy, his finances, his time, his emotion. He was giving every time Frank came to him or called in an anxiety crisis. Dr. Kowalski no longer wanted to do the “energy wastage.”

“It’ll be sad if Frank doesn’t get this idea,” Dr. Kowalski said. Frank may never choose to further work on his wellbeing, but the difference is that Dr. Kowalski decided he wouldn’t continue, with Frank, through talking therapies, and talking emotional rescue efforts, pretending they were working on something.

Dr. Kowalski wanted to tell his son,

I’m being taken advantage whether you realize you are taking advantage of me or not.

However, Dr. Kowalski was scared of stopping. He was scared of not staying on the phone for the long long conversations with Frank in crisis. He was scared of not continuing to pay for the talk therapy. He was scared of not continuing to give Frank his monthly living allowance while Frank was in college.

I asked Dr. Kowalski what the difference was between where Dr. Kowalski was now and wherever he thought it would be for him when he wasn’t being “taken advantage of?” If Frank wasn’t going to put in whatever effort Dr. Kowalski thought Frank should be doing to get better, where would that put them? Dr. Kowalski feared that this bond, yes maybe a bond somewhat founded on illness but still a bond between him and his son, would fail.

Their relationship, true, has strengthened, like an Indian trail that is treaded down daily on the forest floor from their repeatedly hashing out the anxiety. If that changed, Dr. Kowalski feared that maybe Frank would not see much reason to call Dr. Kowalski. Maybe what Frank valued in his dad was just that.

Dr. Kowalski told me that he believed there was, in reality, a sustainable bond between them. But Frank? He didn’t know what Frank would believe.

Dr. Kowalski and I rolled this story around in the air between us. After a stretch of disclosing his sincere grief, real fears, and underbelly of sorts, Dr. Kowalski decided, rather than starting with what he would stop giving and doing for Frank, he’d like to ask Frank,

What do you think your life would look like if you didn’t have this anxiety? Who would you be? Who would we be?

Dr. Kowalski said, “I’d love to find out.”

Self-care tip: Start with open-ended questions with yourself and look ahead.

Question: What is keeping you where you are and where would you be if it weren’t?

The Path of More Resistance, and Brain Health

 

The bar hummed with the energy of human emotion.  It was one of the few places Alfred could still smoke in public. He remembered the first time he was directed to a smoking area in the airport that looked like an enclosure for zoo animals, with glass walls, and positioned in the line of traffic. What in the world?! So Alfred felt unjudged at the bar, and also pumped up.

Alfred got energy from being with people – gravitated to them like a little brother follows his big sister around. If it was the bar, or the smoke break, Alfred got energy if he wasn’t alone. He absorbed every moment, marinated in it no matter how brief. The “moment” was his forever, for however long that moment would last. He was inside the color, flavor, aroma, texture, and song. He noticed. And, Alfred grazed. Amongst ideas, people, choices, and of most anything that came into his field of vision, he chewed it up in that space of time, and then moved on without guilt. Generally people didn’t hold grudges when he moved on. Alfred was just so nice!

When Alfred was in sync with his energy, senses, feelings, and perceptions, and his wife was in sync with her own, she looked at him like he was someone she was interested in. He could make her laugh and play, whereas she was never normally someone who was playful. This was nectar to Alfred’s pollinator.

Out of sync, however, Alfred’s wife called him names when they argued. He was “flakey,” or “narrow-minded.”  And Alfred, awkward with conflict, developed the habit of escaping during those times. He did not like conflict.

Alfred began to drink a lot more alcohol. After work instead of going straight home, he’d “catch a few beers with the guys”. When entertaining clients he started joining them when he offered alcoholic beverages to his clients, imbibing during work hours. His work performance started to smell sour like his alcohol.

You can see where this is going for Alfred. When he came into my office, he reported his inability to enjoy anything, increasing hopelessness, and now when he left the bar in the evening, his mood regularly plummets, a false weight in the scale of life.

Alfred looked at me with a degree of distrust, expecting judgment. But of course, he was also coming to me for judgment – an evaluation and diagnosis, and then to present a plan for treatment.

The treatment plan was short this day. Go to alcohol rehabilitation. Telling Alfred that there was nothing else we could do for him until he engaged in a rehab, was nerve-racking for me. (I never know how a patient will respond after similar directives like this. Sometimes they are not kind. Especially when talking about their substances or addictions, of any sort.)

Alfred stood up, a bit like a mechanical man, thanked me for his contact referrals, and left. I thought that was the last time I’d get to see him. It’s impossible not to hope for the best.

The deal with brain illness is that the treatments I am able to offer in an outpatient setting are ineffective in this context. Other stuff going into the body hits those brain receptors, turning genes on and off, like Wile E. Coyote in the back country. It would be enabling the mal-behavior if I diverted our focus onto anything else. Even so, like so many in the company of users, it is wilting not being able to offer more.

About two months later, I was completely surprised when Alfred came back sober! He told me he did just what we talked about, and rehabilitated. More surprising though, was his statement,

Thank you for refusing to treat me. You saved my life.

Alfred was still married, and yes, the marriage was still volatile. But he wasn’t plugging his ears and disconnecting from his wife with alcohol. It was a start. And Alfred still had restarts available to him.

We did end up starting psychotropic medication and psychotherapy, with which Alfred continued to heal.

I am humbled by Alfred’s courage to pursue rehab, the path of more resistance, and recognize that I should never underestimate the same courage in others when they present similarly.

Self-care tip:  Taking the path of more resistance may bring just what we are hoping for.

Question: What have you done courageously? Where has it taken you? Please tell your story!

The Sins of the Fathers, and Mental Health

 

“We know the Bible speaks of sins of the fathers passing to the 3rd and 4th generations while God imbues his kindness and mercy far beyond that to those who love him and keep his commandments.”

Rosa had no experience in the world of mental health, or so she thought. She had spent her formative years studying the world through the perspective of her church and interpretations of the Bible. As you know, there is a lot in both with a lot to say about emotions and behaviors. However Rosa was taught and modelled that these were moral issues and not biological. An either or, verses, part of the same thing. Could we call it sequent variants, maybe something like genetic alleles? Or maybe something better to describe this is out there, rather than an either or.

Rosa Leticia Montoya, at this point in her development, with her own overwhelming emotions and her husband’s plummet into dark moods, felt forced into considering mental health. She did not want to go there, but here in the space of losing control, not trusting herself or Carl any more, and before she was willing to say she didn’t trust God, she was doing what was a last resort. Considering that she was going crazy was the only thing this chaos could mean.

Before she completely surrendered to the idea that biology was behind this sinister change, she had to ask, “Is this because of our parents?” She had spent her life trying to untwist the bad choices her parents had made and the consequences those choices had on her life. Drugs, alcohol, and cheating were what she had grown up with. Quietly. Hiding it in the church. Rosa there, praying a lot to live well and be forgiven. Praying that bad thoughts would go away. Praying to depend on God and not on herself, as seen through her perseverating worries ever since she was a child. Worried and worried. Not speaking of the wrong Bible-breaking life her parents wore like underwear beneath nice tailored clothes. Would she ever be forgiven? Would she ever stop sinning?

So she asked me, “What do you think?”

That’s a lot to work with as a psychiatrist. So I did what most of us do. Ran to the shelter of medicine. Whew! But there is the added benefit that God created medicine, psychiatry, and all that there is in my tool bag worth working with.

Even so, there was only so long that I could avoid the topic of God and His punishments, per her perspective. It came up every visit.

If you believe in God, at some point within your discovery of mental health, this question will come up. Rosa is not alone. Are the emotions and behaviors gone amok, such as seen in anxiety disorders and depression, secondary to moral weakness? Living with “too little” dependence on God’s power? Is it this? Or is it an “either or”, with our biology? …a matter of cellular grey matter composed of DNA-expressing pathology? And is this something evil woven into my DNA because of what parents did? Well, I’ve spent 30-some years in school and now 15+ years in practice in this space and am still trying to understand.

I’m wondering if you would help me articulate this. It’s fundamental for us in self-care. It’s not possible to be very friendly to ourselves with the dissonance.

So in our self-care question today, please answer us. What is the relationship between “the sins of the fathers” and biology? Please speak!

Self-care Tip: Pursue kindness in your belief systems toward yourself.

Thank you for speaking with us! Keep on!

My Inner Demons and I are on the Same Side – Living in the Now

“I stop fighting my inner demons. We’re on the same side now. T-shirt”

― Darynda JonesSecond Grave on the Left

 

Monday came. I was not ready to tackle the day. I lay in bed a few minutes longer while I started to dread and plan for the day’s appointments, calculating drive times, meals, and accommodate everyone else’s schedules before I had even thought to blink open my eyes.

It dawned on me at some point that I was living out a day that hadn’t even begun yet.

The anxiety of the impending tasks, or the overwhelm that comes with trying to handle everything before it arrives, you know this too? The exhaustion that eventually overtakes us makes us ridiculously absolutely not excited about our lives.

Living in the future instead of now is like sprinting ahead of our own feet, if only we could! The only task we have to do is to actually wake up.

Continue reading

Stigma from Religion

I’m just leaning on God.

Which was her reasoning for stopping her Lexapro.

Nora’s family lashed out angrily at her. “Why are you so horrible!”

Her husband had left her for another woman from their church, a “friend” of Nora’s who used to come to their house for movie nights. He said, “You’re like poison, Nora. I’m not happy any more with you.”

Nora had now lost her job. She couldn’t focus and cried too much at work. Her supervisor told her, “You are not the same.”

Nora decided she wasn’t going to take her medications any longer because what she needed was more faith to be well and to get her life back. Her plan for recovery from debilitating depression and paralyzing anxiety was to be more dependent on God by way of certain practices, mainly not taking her medication. Although she didn’t see her plan for recovery quite so transparently. She thought it was through prayer and sincere intention to be God’s rehabilitation appurtenant.

Nora did say she was still taking her anticholesterol medication. And so we spoke about the important related perspectives between what Nora saw to be “medical” verses “spiritual” illness.

  • First to lead into the matters, “What are you taking your Crestor for?”
  • Where does cholesterol come from in our bodies?
  • Where do emotions and behaviors come from?
  • Is there a spiritual element that has a relationship to high cholesterol?  How about to emotions and behaviors?
  • Is there a medical change that causes the disease of hypercholesterolemia? How about emotions and behaviors?
  • Why be willing to take medication for a spiritual illness of hypercholesterolemia? Wink.

Nora, it turned out, loved where this conversation took her thoughts. It was hard to encounter inconsistencies in her religious beliefs and practices. But she did because she is a woman of courage!

It got me thinking about what role our cultures, related to religion, play into our emotional health. Is there a source of stigma against getting life saving medical treatment for mental illness that we are missing simply from the religious culture we are quietly woven into through life?  Randy Travis’s song lyrics, “I hear tell the road to hell is paved with good intentions…” implies that we in religion justify the collateral damage, such as death and ruined lives by mental illness, by the belief in the greater good. I’m sure I do this too in my own unconscious way. And isn’t that what this post is all about? I want to take a big stick to this glass and shatter it! (Aggressive much? Smile.)

When I think of Nora, sometimes I can’t believe she actually is taking medication and doing so well now in her life journey. It’s a miracle.

Self-Care Tip: Explore the role religion is in your opinion toward medical treatment.

Questions: How does religion interweave into your stigmas? Or those you’ve broken through? 

Or maybe it’s the opposite. Religion has contributed to your self care and medical choices?

Please speak! We need to hear you!

“The devil is talking to me.”Briefly on God and Psychiatry

“The devil is talking to me.”

Her lips shaped words but her voice was like a robot. 

My gorgeous tall black thin framed model-bodied patient looked at me with a face that barely moved. Almost flat. Her eyes rarely blinked, with orbs that seemed to jump out at me when she spoke. 

This is Talia, a 3.8 GPA college grad last year who just started her first job in marketing. She has been a Jehovas Witness for about ten years and is passionate about her God and religion. She has been attending church related meetings lately about 6-7 days a week and loves to read her Bible for hours. However, over the past six months when she reads the devil and his minions cuss loudly in a cacoffany of foul persecutory language. She is afraid all the time and has high inner tension. 

Talia cannot sleep any longer for more than a few hours at a time. She has been losing weight. She has lost her job, and is panicking, terrified to read her Bible or go to church. 

Her family says she is talking to herself, and has “crazy eyes”.  They do not know what to think. Maybe she is possessed as well as crazy. Maybe both. 

Is Talia possessed by the devil? Is Talia crazy?

I was in Los Angeles this summer with my kids, walking on Hollywood Blvd. We passed several people who were responding to internal stimuli. One extremely saddening lady was slumped against a shadowed corner sitting in her own piss leaking down the street, her shirt half open, as she spoke to various targets. My kids were afraid. We were all, frankly, sad. My kids did wonder, too, were these people possessed by the devil?

Have you ever wondered if the devil was talking to you? Or working on you? 

The question is, if you want to ask this, rather ask, “What does this say about the character of God?” Included in all the biology explanations and psychosocial intersections, we bring the magical and spiritual. If you ask about the devil, ask rather about God. What does this say about God?

Talia had been adhering to her treatments and now celebrates that she is able to read her Bible again, go to her religions meetings, and has even driven around a parking lot once with a family member in the seat beside her. She is sleeping through the night, able to enjoy life, the simple and large things like the touch of shower water or taking a walk. 

When Talia hears voices, she no longer believes the voices come from the devil but rather demonstrate that she has missed something bad inside of herself that she hasn’t yet surrendered. I asked her, “What does that tell you about God? The character of God.”

We are so quick to assign nonbiological causality to emotions, thoughts and behaviors. It turns out that when the brain gets sick, emotions, thoughts, and behaviors generally go the direction of bad, rather than “good.” Naturally we ascribe moral value to what we are culturally primed to believe has moral value – emotions, thoughts, and behaviors. The question becomes, “What does it say about who God is when we do this?”

I like to think about the character of God. It is a picker upper. When I get enmeshed in some line of thought that demonstrates a poor reflection on Gods character, I figure at some point that I’m not seeing things clearly. It’s always a relief. I don’t know it all. If it says horrible things about God’s character, than I must have some misinformation or misinterpretation. 

Others may say rather, I am misreading Gods character as good. That’s not a perspective that is friendly to me in the end. One of the reasons I reject it. 

Self care tip: Ask yourself, “What does this say about God’s character?”

Questions: Have you ever wondered if the devil was talking to you? Or working on you? 

Do you ascribe moral value to emotions, thoughts, and behaviors?

What does it say about who God is?

Dead kids and Mother’s Day 


To all the surviving mothers who celebrated this recent Mother’s Day without their children, lost to mental illness, we dedicate this post.  To the mom’s who have outlived their babies. To the mothers who have watched their boys and girls deteriorate slowly with piece meal pincing bites that brain illness has taken from them until they were gone. To the mommy’s of those who left them fast, at the end of a rope, under a car, at the point of a needle, or in the many bits of brain that a gun blows apart. 

I’m dedicating this post to the mothers who continue to live. Who remember more than the moment of their child’s death. Who celebrated on Mother’s Day the individual of her child that was more than his or her behaviors and emotions. 

This post is for the mothers who remain for us, we who need them still. We need you. Thank you for telling us your story and living with us, among us. For fighting for brain health, for freedom, we thank you. 

To the mothers who survive(d) the death of their children to mental illness, happy belated Mother’s Day. You are amazing to us. 

Today’s question is more of a request: Tell us your story please. 

Or, those of you who know these courageous women, and want to share, please do. We are listening. 

Self care tip: You tell me. How do you (they) do it?

Keep on.