Daughters of Dementia – book

Introducing a lovely book written by Leslie Birkland, and Lindsey Denhof, who are sisters who felt compelled to share personal and revealing stories about their father as he fell deeper and deeper into the tragic memory robbing abyss called Dementia. The two sisters narrate their experiences born from different perspectives, but very much driven from the same heart.

dementia

 

Please enjoy and comment. Dementia is everywhere. It affects all of us. Whether we have  a parent, a spouse, a friend, or a neighbor with dementia, we are affected. Even if a community member is suffering from this, known or unknown, we are affected, although to differing degrees.

Dementia worldwide is estimated at 47 million and is projected to increase to 75 million by 2030. It is a huge economic impact – in the US, $818 billion dollars a year. People with dementia and those with family members with dementia are often discriminated against. Awareness and advocacy are needed. Dementia is a public health priority. Let us know where you stand. Thank you for reading.

Self-care tip: Everyone has a story. Tell yours.

Keep on!

False Thoughts about Getting Healthy

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Think of walking in a rainstorm. Your clothes and hair hang heavily. They provide no protection. They offer no remedy. You take a hand towel out of your bag and try to mop up your icy wet face. Wring it out and continue to wipe. 

This is like choosing to do all the psychosocial efforts in your life, but missing the biological. Until you treat the underlying illness, much of our efforts to heal are like using a hand towel to dry off in the rain storm. We think that we can get better without medication. Or, we may reject other treatment options, like ECT or TMS. We think false thoughts. 

It’s not healthy to take pills. 

I’m better than that. 

All I need is God. 

My parents would be upset, so I shouldn’t. 

If my work found out, I’d lose my job. So I shouldn’t. 

THC is better. 

Exercise is better. 

Some of these are entirely false. But some are just partly false, encased in a disconnected truth. This “rain and the hand towel” idea is not an analogy meant to minimize or bring shame to those who choose not to engage in treatment. It is not meant to talk down. Please forgive me for the crudeness and limitations. It is just meant to crack open this idea.

Yesterday, Louise commented that her physician told her taking sertraline, or Zoloft, was like taking “a vitamin for my brain”. That clicked for her! Vitamins were ok.

Question: How has your physician helped you get past not wanting to take treatment? How could your provider do better with this?

Self-care Tip: Allow healing with medical treatment for medical disease.

Get You Some of That – Medical Treatment for Medical Illness

…Continued from yesterday.

Cole_liveCole Swindell – Get Me Some Of That

Why do I feel so horrible when I start a treatment that is supposed to help?

Medication treatments for depression and anxiety, and some other brain illnesses, often worsen how you feel before you feel better. I can’t tell you how many patients have told me that if they had known this before, they never would have stopped their mediation(s).


Yesterday, our post discussed a Dr. Jones and Presley.

Presley fired Dr. Jones when after following her directive, he subsequently experienced an extreme panic attack. Dr. Jones may not have done anything wrong in her treatment recommendations. Presley was just an individual, as compared to a “number on the curve” of treatment responders. Escitalopram, the medication discussed as an example yesterday, (one medication option out of many), may have been dosed at an initial amount that Presley’s body couldn’t handle “straight out of the gait”, so to speak. But likely, if he had started at a lower dose, maybe ½ or even ¼ of the tablet, and then waited for his body to accommodate to the medication. Then Presley would have tolerated it. Presley would have tolerated slowly increasing the medication if approached, rather, piece-by-piece of a pill. I’ll even joke with patients,

I don’t care if you lick the pill. Just get on it.

When slowly titrating a medication, it allows the individual’s neurotransmitter receptors to down-regulate whilst the agent floods the receptors. If there is a neuron targeting another neuron, there’s a baseline balance in time. There is a baseline understanding between these neurons. An agreement, of sorts. “I’ll sit here and receive your messages,” (neurotransmitters, or chemical messengers such as serotonin, norepinephrine, and/or dopamine). “I’ll then carry those messages on your behalf to their intended recipients,” (such as the amygdala or hippocampus). But then this person artificially takes a higher quantity of these messengers, for example, by way of medications, and floods the system. The receivers, (or neuroreceptors), have to adjust to this to establish a new healthy baseline. 

In this initial time of treatment, when 1st introduced to the increased neurotransmitter-load, (ex: as released by a tablet of Escitalopram), there can be a negative response, such as panic and/or depression emotions. We call this, “initiation side effect’s.” Once the neuroreceptors get used to the new load, then the response improves. 

After accommodating to the new pharmacology, the brain is allowed to experience the blessing that comes from treatments, and heal.

Some individuals are outside of the curve and cannot tolerate the standard initial treatment dosage, like Presley was. Some are inside, and can without much difficulty. The point in treatment, though, is that the person just needs to get on it.

Get on treatment. However you do it. You have to make the treatment work for you, an individual, in your own way. The prescriptions are there to serve you. You aren’t there to serve the medications. I like to analogize Jesus’ statement,

The Sabbath is there for man, not man for the Sabbath.

Make it yours as an individual and reap the benefits; the blessings inherent there. (See Mark 2:27). 

If you don’t get on the treatment, you won’t get better. Anything less than this will be inadequate. It’s like drying water off your face with a hand towel while still walking in a rainstorm.

What is your agenda in treatment? List it. Write it out. Then, go get you some!

Outside a medical approach is like flicking water off in the context of a rainstorm. If your agenda is getting to your healthy self. Get out of the storm and get dry. Then go get it. 

You have a medical condition. Treat it with the assistance of a medical professional. 

I don’t go to a plumber to help with my electrical home repair. I don’t go to an accountant or a church counselor to treat a medical one. 

The plumber, the accountant, the church counselor are what they are. This is not minimizing their efficiency in their own fields of excellence. But why do we seek care in psychiatry from those who haven’t studied this? From those who are not experts in this? Maybe stigma keeps us away from psychiatric care. Maybe misinformation directs our search for mental health treatment elsewhere. 

Self-Care Tip: Get you some medical therapy for medical illness.

Question: What are further concerns you may have about taking medications? How would you prefer your medical providers to work with you? Please tell us your story. 

But I’m Not Someone Who Likes Taking Meds

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Presley couldn’t breath. A truck just drove through his thorax. A monster-hand was closing around his heart. He couldn’t swallow well. Was something stuck in there? Dizziness nearly dropped him, but instead of moving to sit down, like any other normal person would do, he bolted. A fire chased him. He had to escape or he would die. In the bathroom where he found himself, the mirror reflected a sweaty face and crazy eyes. Was he dying? Presley’s phone looked blurry as he dialed, 911.

Please help! I’m having a heart attack!

That was the first time this had happened. After the third visit to the emergency room over the past month, Presley was able to avoid calling 911, although still convinced he was going to die when the next episode hit. He agreed to seek counseling, where he was taught different skills to connect his mind and body, to slow his breathing down, to process, even when he was convinced he was dying.  For a time, Presley improved. It was like it never happened. He was almost able to convince himself that it wouldn’t happen again.

This turned over and over, feeling like he was going to die while losing his mind, re-engaging in counseling, thinking he was better, stopping counseling, and then another violent emotional event, thinking for sure, he would die.

It was after his second trip to the ER when he received the recommendation to schedule an evaluation with a psychiatrist. But he preferred to work through this in therapy. Presley didn’t like pills. He wasn’t someone who medicated. An olive-skinned athlete, he lived clean and didn’t believe there was much that healthy living couldn’t cure. And Presley did live clean. He ran fifty miles a week. He ate raw foods. He read his Bible.

After several months of this, his therapist, Dr. Wu, recommended he get a psychiatric evaluation. However, Dr. Wu agreed that he would continue to work with him, whatever Presley chose. (Was this the right thing for Dr Wu to do?) Presley chose, no. No psychiatrist. What would a psychiatrist do to him anyway?! He wasn’t crazy. (Except when he thought he was.)

Presley visited his primary medical physician, Dr. Belinda Jones. It had to be better than seeing a shrink!

Dr. Jones, I don’t want to take meds.

Dr. Jones, cleared him for any medical condition that might be contributing to his events. Only then was she able to convince him to try a “safe antidepressant”, escitalopram. After one pill, Presley had the worst event of his life. He’d never had any experience that was more terrifying. Presley didn’t go back to Dr. Jones, “of course.”

When these emotional tornadoes hit more frequently, he became paralyzed with fear that he would have them in public and be humiliated by them. Presley stopped going to work.  If it wasn’t for his rent, he’d never go back. But he had to. So finally Presley agreed to see a psychiatrist. …

To be continued

  • Sincerely, Dr. Q

Questions: What would you tell Presley? 

How would you like your physician and/or therapist to handle this, if it were you?

Why is Presley so opposed to taking medical therapies?

Please speak! We need to hear you.

Self care tip: Keep on! 🙂

Looking at your better future

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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. 

STOP! DON’T STOP! The quandary inside of us when deciding to take medication

Everyone says “Hi” to my dog, Timothy… Way more than to me. Silence.

Is it the springy fluffy hair, I wonder? They walk up, even speed, out of an unseen shadow without inhibition and rub him down. He is pleased every time, to say the least. Do I regret all the painful laser hair removal treatments I got years ago? Hm. I am half Lebanese after all and few really know how much fur I really came with.

(Curly-cue.)

Steve came looking for help. I spied him in the hallway before clinic. That’s always a little awkward for some reason. Running into someone out of context. Like we both are caught out of costume and the curtain just pulled up. (Gotcha!)

His strings pulled in, an inner tension, apparent even then. He looked susceptible to emotional or physical attack when we caught each others eye. I could see him wondering if this was “her”, his psychiatrist. What was he expecting?

When patients come in for treatment, it’s comparable to anyone acting on a realization that they’re vulnerable, asking help from a stranger. It can take immense courage.

Part of this understanding is what contributes to the awkwardness of meeting in the hallway, out of context. We are both a little undefended there.

So what would bring a person to do this to themselves? It doesn’t sound pleasant when put this way – vulnerable, asking help from a stranger.

Steve had a wife, kids, a job, a house, and a pet. Inside this bubble, Steve didn’t think he had reasons to feel the way he felt. He looked for them and felt stupid because everyone told him how good he had it. Nor did Steve see reasons to behave the way he behaved. He described his story, a rolling out of his life, like that of a hand stitched carpet. In it, we saw together that he had anxiety then, and then, and then. He had coped well mostly, until he hadn’t. Then he would spend some time falling out of circulation and incurring losses. Then he’d recover and forget. He’d forget that worse patch and redefine the lines around the man. Then again the lines would smudge, he’d get anxious and irritable beyond “control”, grapple within the darkness of the white noise, which panic brings, grapple for reasons why the anxiety came again. His identity would be so threatened, the suffering, the feedback from everyone around him would pull on him, that the lines of his person frightened him into treatment.

There Steve was. Timothy at his feet with his puffy furry head in Steve’s lap. Steve asking for help. At the same time as asking for help, he would also refuse, stating caution.

“I don’t want to change myself.

I like being the person who gets things done so well.

I like accomplishing things.” (He thought it was his anxiety that allowed him to do this.)

It reminds me of the, “Stop! Don’t stop!” that I’d tease my brothers with when we were kids.

People think that taking medication changes who they are. Understand that in order for this to be true, that would mean medication changes DNA code.

“Doesn’t it change my brain chemistry?”

Let’s say that were true, that medication changes brain chemistry. Still that isn’t changing your DNA. The DNA is what gives a person “personality,” or, what many of us say, “Who I am.”

After getting laser hair removal, I didn’t change my DNA, but I don’t have as much hair. When my kids were born, I checked, and sure enough, DNA…. They’re gorgeous! Wink. (That’s done with one heavy cluster of eyelashes around my dark Lebanese eye.)

Question: What are your fears about taking medication?

If you have taken medication, how did you see it affected your identity?  What happened to who you call, “Me?”

Please SPEAK! We need to hear you. Keep on!

Self-care tip: Self-care means taking care of yourself even at the biological level. It starts with “Me.”

 

Desperation – When to Speak

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I’m about to park in LA for the LAX protest against the immigration ban.

Last night my husband and I debated whether to come or not and were both disappointed to realize that we both wanted to be here. I mean, it’s Sunday and we don’t get a lot of down space. We have our kids who, thank goodness, still want more time with us. We have projects and exercise and self care that is on our agenda. We are moving away from a “zero percent progress” every day toward something better, right?

Apparently, I’m a moderate. I haven’t felt the pain. I don’t have the fire. But not very long ago was the Jim Crow era, where our parents came from.  When there’s something I’m passionate about, I have to get my feet moving or I’ll miss it.

But this immigration ban is bad. This is just xenophobia and racism.  It is personal. I think of my Lebanese cousins who have been in the war and immigrated to our country with their hairy arms and scars. I think of Mom. I think of my in-laws who arrived in New York from the Philippines with $5.00 in their pocket.

What have immigrants done for America? Well. Look around. What have you done? This is who we are.


In a protest, community is strong. Unity is strong. Today, there was some prodemocracy stuff, but there was also a lot of anti-Trump-eting and name calling.

The protest felt a little like people were peaceful. They were upset. There was a lot of Trump-fest going on. But it wasn’t just that. There was a little anger with a little despair. Those guys were suffering, but it could lead somewhere.

When we start protesting a person, it becomes a zero-sum. We lose the opportunity. We didn’t waste all of the opportunity today. It was mostly a foreboding of what could happen.

When Martin Luther King marched at the Lincoln Memorial, it was very organized. They had basically shut down the city bus transport by not using them and choosing instead to walk seven miles to work, or set up car-pools, an early Uber system. They were unified in their despair. MLK had been put in jail many times for his fire. He was not moderate. When he spoke, he spoke about justice and equality, and didn’t give stage to McCarthyism. He mentioned him, but that was it. If Trump were president at the time, he would have gotten the same mention in his speeches and letters.

MLK said in his letter from Birmingham Jail, that moderates are just as evil because they are not going against what’s wrong. And that’s what’s wrong with all these things is because we are moderate.

So one of the reasons we go to these things is so that we don’t allow things to passively happen.

“Shallow understanding from people of goodwill is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.”

We have a general idea that this isn’t right. But we don’t have that despair. We are privileged. But we have a sense that this is wrong. So that’s why I move. To help me understand.

Maybe we, in this generation, have not suffered enough to stay focussed on the principles being violated here. We are America. We believe in humanity. We do not discriminate against another race. We do not believe our race is better than theirs.

The world is small. A refugee physically, manually by another human’s own hands, who is being pushed away back into the ocean from a Greek beach because the Greeks cannot feed their own countryman, affects all of us. Starvation changes one’s belief systems, I am told. These people are not moderate. They are being violated. I don’t want to be a part of who violates them. It doesn’t need to be said that I wouldn’t want to be them.

greece-refugees

Why do we march? To get our feet moving. We want to learn more. We march to help us understand.

 

Self Care Tip: Find your fire, take a stand.

Questions: What’s your story about immigration? How is this personal to you? Keep on

 

This is What America Can Give You

I told my patient today,

“You’re smart, you’re beautiful, you’re young, you’re healthy. This is what you have. Go and do it. Fight hard. You can only control yourself. Don’t wait for someone else to fight for you. This is what America can give you. The opportunity to fight hard for yourself.”

Keep on.

The Heroic Patient

imagesSorena wore a black knit scarf around a thick neck, folds between scarf and skin. She came in with reflective smooth skin and frozen brow.  After many botox injections, she increasingly found it difficult to change her expression.  People often accused her of not caring about difficult things they were disclosing, and she realized the issue was, she couldn’t move her forehead.

She had a lot of empathy and was frustrated that people didn’t understand this.

We pulled at this idea for some time, recognizing a tension unplugged for her with each injection, a relief she experienced at visceral level. She just felt like she had to get her injections, driven toward them, like a bee toward the hive.

At some level it takes courage to get through the day.  She sees the effect.  Despite the fact that she should take a break from Botox, she can’t stop and this feels frightening.  She’s freezing her face.  It’s a terrible thing to know she has to stop something she is driven to do. It’s really hard. She’s trying to get through each day.

I told Sorena, “What you do every day to deal with this is brave. It’s harder. You have so much strength. You are doing it. You are getting through.”


I’m considering starting a podcast, “The Heroic Patient.” What do you think?

I want to interview Sorena and others with heroic life journey’s for you to discovery, connect with, increase awareness of, and appreciate.

The idea is to interview a world-community patient who will tell their “story.” It enters through the physician’s office doorway and increases transparency.

Many in our world community do not have a great understanding of what a physician nor a patient do in this exchange. You may think, “Well, everyone is a patient so at some level they do.” But:

  • How many, do you think actually go into a physician’s office?
  • How many variety of physicians does any one patient see in a lifespan?
  • How many get to tell their story?
  • How many of us hear each other’s stories?
  • How many of us understand how a physician solicits the details of a story so someone is “heard?”

If a patient were to learn the ‘behind the scenes,’ thought processes, interview techniques and analysis of the physician, would that be helpful to the patient?  Would the doctor learn from this dynamic interplay, and would the interview process evolve and grow from this? How would this effect stigma of all variety? Who knows?

What do you think? Is there a need for the “Heroic Patient” Podcast? If so, what are your recommendations and opinions?

The idea is that we are designed for connection. It’s friendly, remember? 🙂

Keep on!

Self-care Tip: Get transparent to get connected! Be a friend to yourself.

Stay Awake! to sleep well

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(Whomever it is that originated this stinking hilarious picture and quote, thank you!)

The glass half empty view on sleep and age:

When you are a child, you don’t want to sleep. When you are a parent, you could if you would, and you want to, but there are the kids. When you are fortunate enough to grow old, you want to, don’t have kids, but can’t.

 

The National Sleep Foundation Recommends:

Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13) School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11) Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)

Younger adults (18-25): Sleep range is 7-9 hours (new age category) Adults (26-64): Sleep range did not change and remains 7-9 hours. Older adults (65+): Sleep range is 7-8 hours (new age category)

Should-a, could-a, would-a, right?

“The amount of sleep required by the average person is five minutes more.”

~Wilson Mizner

One thing that gets left out of most sleep books (um, did I include it in my book??) and sleep talks, is how to be awake. Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.

Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.

Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.

This is where I additionally bring in the concept of a stimulating medication such as Modafinil. Don’t confuse this with taking caffeine. Caffeine is metabolized way to fast to be helpful in this regard. There are others one may discuss with their treatment provider.

Self-care tip: Get awake, really awake, during the day to sleep well at night.

Questions:

What is your daytime energy like? Alertness, attention, and memory? Do you sleep well in relation to this?

Please tell your story. Keep on.

Bad Sleep is Not Sexy

book

I tell my patients some rough version of this:

My agenda is that you get sleep.
My agenda is not that you take your sleep meds the way I prescribe them.
Just don’t take them at a higher dose than prescribed.

When prescribed medication, sometimes my patients tell me they think, from me or from other physicians, that they need to do it exactly as prescribed. And that may be true. With most. But there are some medications, which must be specifically described by one’s prescribing provider, that may be used in the way that the patient determines is most useful. The patient needs to look, to think, to speculate, to reflect. Adjust the medication dosages, and try again.

Going forward, before I tell you how you should sleep and what to take for it, think about how your sleep is.  What are the difficulties you have with sleep?
Falling asleep?
Staying asleep?
Early morning awakenings?
Is your sleep refreshing?

Renaldo, (“Please call me Ren”), can’t fall asleep. He lays there for hours, before he finally falls asleep in the early morning hours.

In Spanish we call the early morning hours “la madrugada”. I’ve always enjoyed that word.

It’s been happening on and off for Ren over the past year, but is worsening lately. He is now afraid to go to sleep. Afraid to looking into the dark night while in the company of his thoughts. He has a feeling of dread as his evening comes around. He finds himself avoiding going to bed.

When dealing with insomnia, first we look at these personal observations. They are called “symptoms,” when they are involved in a pathology, a medical illness.

Then we look at why. Why?

To answer this we consider what regulates sleep in our body and outside of our body. These pathologies we suffer come from what is in our body and as they intersect with what stressors come to them from outside of our body.

There are so many medical illnesses that produce insomnia.
Inversely, there are so many medical illnesses that come from poor sleep.
There are also many behaviors and outside-of-our-body stimuli that affect sleep.
Hmm.  Well it’s not either/or. It is likely a tangle of these roots that make this ugly plant grow.

Where to start?

We have covered sleep hygiene a couple times. Have we made the changes in our home and personal sleep culture to groom our sleep accordingly?

Say we have. We don’t read in bed. We don’t have a TV in our room. We don’t use the bedroom except for sleep and for sex. Hey! Sleeping well is sexy! Ahem….          ….We keep the lights low. We try to go to and out of bed around the same times every day. And so forth.

If these were not attended to, a disease process may develop. It is during sleep that our body heals. None of our body rhythms heal during the day. All the neurotransmitters, chemical messengers, hormones, all of these replenish and regulate into a healthy rhythm during sleep. Also, all of our memories consolidate during sleep. That dumbing in parenting syndrome, which I’ve respectfully labelled “DIPS”, may come more from the broken nights, than by the busy busy kids.

Okay. Say we are practicing good sleep hygiene, yet continue to have poor sleep.

There is a reciprocity between symptoms and disease etiologies. In other words, a broken sleep cycle may trigger certain genes to express themselves, and vua-la! Ren is suffering from an anxiety disorder.

Or, Ren’s anxiety genes become triggered for another reason, maybe simply his age, maybe he has low testosterone, maybe he has a thyroid disease, or he snores, and his circadian rhythm, (ie, sleep cycle,) disrupts. Vua-la! Ren is suffering from a sleep disorder.

It’s like the wheels of my mom-van. I bumped the curb the other day and pinched my tire. I disregarded it, …and the orange hazard like on my dashboard. Don’t judge me.

My steering seemed to wobble over the next hour. I pulled over and sure enough. A flat. I wisely (grimace) decided I could just drive it to the repair shop, rather than get a tow. By the time I got there, my wheel was bent and my van alignment was off. There’s a reciprocity to the wellbeing along with the demise of my van’s health.

In my book, Sleep Well, I cover some of these anxiety illnesses. I don’t cover affective illnesses such as depression, or hormone imbalances, or so many other physical pathologies that are involved in generating poor sleep. They are also reciprocally important to emotional health and a quality of life.

I told Ren,

So what do you think is going on with your sleep?…

Questions:
What are your sleep symptoms?
Do they come from a pathology?
Are they triggering other pathologies?

Self-Care Tip: Sleep Well. Be a friend to yourself.

Robin Williams’ Widow Recounts His Story

Robin Williams saw me through my developmental years. His prolific cinematic accomplishments, whit, depth of character, courage in living with and dealing with mental illness – all this configured him into my life story. Never even thought about him dying. Until he did.

Enjoy reading an excellent interview with his wife.

Here’s to Robin

http://m.neurology.org/content/87/13/1308.full

Best Self-Care Ever! StepBet

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Hello Friends!

This post is a simple plug for one of the best things I’ve ever done for myself.

You have heard me talk about neural grooves and changing habits such as those that are not friendly to Me. In a post, “Pay a Dollar,” I said,

When you feel trapped by your own self, get friendly by remembering this.  You’re mistaken.  You’re talking about a brain groove, not a vampire.  It’s not hopeless.  Not much more, not much less than what it is.  A groove can be abandoned.  New paths can be made and when the stressor hits next time, you will have a longer moment to decide on which behavior to play.  You will have a choice and you will realize more often that you are not trapped by what you thought; you are not hopeless and ugly.

So how long does it take to form a habit? Or break one? To change neural grooves in the brain. Many say, twenty-one days. Others say, you have to do it every day for a year.

This game, StepBet, is designed to get us moving as a habit. I’m loving it. I invite all my patients to join me. My team. My friends! I’m not leaving you out! Smile. Check it out.

You put $40 up that says you will walk a determined number of steps every day, except one, each week for six weeks. If you miss a day, you lose your forty bucks. Some days, I start thinking, …”It’s just forty dollars…(whine – a long high pitched complaining cry.)” The money from those who don’t make it to six weeks goes into a kitty and later dispersed amongst all those who did. Yah! So fun!

Please join me, and let me know how it goes for you.

How StepBet Works

1. Get Your Goals

2. Place Your Bet

3. Step it Up!

Question: What do you do to be kind to yourself, habitually? Please tell your story!

Keep on!