Different ways that holidays affect Mental Health

Fall is here!

In Southern California we have a glossed version of this and not the classic effect. But what we do have, includes this. Every morning when I wake up and open our bedroom door to the great outside, the fall “air” bursts in, hits my amygdala and a slurry of happy neurotransmitters perfuses throughout in a language I don’t have the best words for. I “smell”? or sense? or something, the air, and it says, “Fall is here.” So lovely and wonderful.

The problem in psychiatry, of what these changes do to our biology, come from the body rhythms. Some of us lose the sun to Jack Frost’s government. Some struggle with the time change. And the holidays have their own weighted steel tipped boots that kick up at any of us within kicking distance. Relationships struggle.

Here is a quick list of Fall simple treatment options I just thought you might like:

1.) How to Have A Stress-Reducing Conversation, from the research of Drs. John and Julie Gottman.
2.) UV lamp to help with the seasonal influence on mood and circadian rhythm, with a 10,000-lux intensity with full-spectrum light bulbs.
Also get 10-20 minutes in the morning and in evening before sunset of what sunlight you can.
3.) 10-20minutes of exercise every morning routinely, getting your heart rate up, thereby helping especially with mood, anxiety, and circadian rhythm. Of course you can do more but for many, this is a reasonable bite off of life’s apple. Consider just starting with a video from online that will even do 5min of core, and so forth.

Happy Holidays!

Keep on!

Hello Friends!

I thought you might enjoy the outline of a lecture I’m giving Tomorrow to CUSM (California University School of Medicine) 3rd year medical students. It’s one lecture intended to cover mood spectrum and anxiety spectrum disorders.

Ha!

Here’s the outline:

I want to give each of these students four years of psychiatry residency, just so they can grasp some of this. I don’t know how to get it to the community. Depression is biological. Physiological. It is dramatically under diagnosed. It is largely responsible for treatment nonadherence in any area of medicine. And it destroys our own lives.

I remember when I was a Psychiatry graduate of 6 years, when the word sounded through our community. Dr. Schultz’s, our beloved residency director, the one who had joked around with me, who had worked so hard to eliminate my imposter syndrome and who gave me a sense of being among my people, he shot himself. In our clinic’s corner bathroom, between seeing patients, he used his own gun.

I am still grieving him. He was a mentor. He was a friend.

But more than his impact on my life, he was a father of a preteen son, and was survived by many beloved family.

I’m sure you, readers, have your own stories. Maybe even against your own person. Please share them here. We need your story. Somehow, our community, our practitioners, our own medical graduates, don’t understand. Depression ruins us. And treatment can heal.

Keep on!

The trenches are not the pathology.

The stressors, the triggers, the many things that go very wrong every fraction of a second in our lives—these are not the pathology. These are normal. These are what we all have.

The pathology is being alone.

Don’t hang out in the morass of bad-alonen. Be in community. Push for that in your life. It may not come “naturally.” Community is part of self-care.

Keep on!

My reaction when I heard this was about the money. I thought, “Why not put that money toward mental health?” And I proceeded to look up related costs and details that wrapped around me like strings, making me dance. My emotions got involved. But if you know me, you’re thinking, “When aren’t they!?” Smile.

I continued to reflect and landed on, the value of our lives. How rotten does someone need to be before they should end it? How horrible should their tally of mistakes, and even volitional wrongs, quantify? And then I get caught in the eddy of political thought about law and the impact on community and so forth. And that is just not where I want to go either.

There has to be more than a bank account of talents, good deeds, beauty, popularity, and all the accoutrements that marks us. Life, your life, matters. That’s the truth of all of it. The world is better with you in it.

My patient, Ronald, came twelve years ago with a severe depression. He wasn’t interested in anything. He had 39years of successful employment in the entertainment business and used to love it. He just didn’t care. He wanted to retire and even just die. We jostled his medications and the right ones fell into place. Now he cares.

Ronald is now interested. Interest led him to purpose and that now gives him a greater sense of the value of his own life.

My patient, Evelyn, also in treatment for many years, has struggled more finding her treatment response. Sometimes she is “there” with her mental health, and sometimes she is not. Often she hates herself. She relives years of horrible sexual, physical, emotional abuse during the worst of it; thoughts intruding without invitation. She loses her freedom to choose her own thoughts. She wants to die then. Other times, she sees her value. It is a “life-er”, this battle for the mind and body and spirit. Today, Evelyn doesn’t want to die but still she isn’t doing well. Life has swung again and got a kidney punch in. She can barely breath.

The community at large must say, “Evelyn, you think you are ugly and rotten inside but it is a false perception” of an over-watered cactus, putrid smelling. Even so, that’s not the point. The point isn’t how good or bad we are. The point isn’t performance. There’s waaaayyy more than that which marks us for life.

400-million dollars. How many should suicide a year to justify the expense? If we could, we would pay for a net around each one of those who have lost their tether. But regardless, we must know, each of us, “No matter what condition you are in, the world is better with you in it than without you.”

Self care Tip: Step away from the edge and know you have value no matter what condition you are in.

Questions: Have you ever thought about not wanting to live? Why are you still alive?

Keep on!

Man lost 2 kids to drugs, Wife to divorce and her addictions, terribly depressed and anxious with his own morbid thoughts.
After finding the right medication treatment, he is able to grieve better because his biology is better.
Everything in his life is still the same except his biology. His biology is not. His biology is well.

That is self care.

Keep on.

Lyft rides are blowing my mind. They’re becoming the stage for some of the best dialogue of my day. Really cool people driving these rides. 

Today’s post is a bit of a hodgepodge, as conversations usually are.

My driver, call him Brandon, was a 20-something married man, who considers starting a family. We talked about using these days, before kids come to push push, to grow. Because life trajectory changes to a perpendicular when kids come and that life trajectory you are on for the many years before they come will be gone gone. Growing “now” is a privilege that changes shape after kids. 

Also start each day having a worship with your spouse before even getting out of bed. Make that a habit that will cross over, in part because it is routine. The behavior has pressed into your basal ganglia and is now automatic. Then it won’t take energy when energy has become such a guarded commodity. It can save your marriage. Parenting inevitably changes your togetherness-flow, your common ground. What was once likable about you from your “other life,” diminishes by the force of where all our energy bank ends up getting spent on. As we age out, we have to keep working on having shared experiences and interests. Kids are a distillation to what we have in common and hones our energies toward their needs. The interests of the partner can rank down. It’s not rejection. It’s accounting. Be proactive about maintaining intimacy and connection with your partner.

Brandon then shot in the dark with his next question; “What happens after you die”? This is such a wonderful topic. I go to the Bible. And without getting into a Bible-verse-battle, I’ll just give the big picture and we can do a study any time any of you like. It is a topic of huge hope and super calming. 

When we die, we sleep. Our spirit, or breath or soul as it is called, goes back to God who gave it to us and He holds it while we sleep. Then when Jesus returns, he wakes us up and everyone who is asleep in Him will greet him along with everyone who is still alive, together. There is nothing that we are doing in between death and God’s coming other than sleep. God’s character is so loving. If we were going straight to heaven, it’d be pretty tough watching the immense suffering of all our loved ones on earth that is still going on. That’d be a terrible burden. He spares us.

It’s important to note that the beliefs about the afterlife can vary widely among different religions and individuals. My beliefs are not meant to be a disregard of them. I don’t know everything! I really don’t even know a lot, when you look at this by volume. lol! And I know what I do see as truth will morph into a more complete view by God’s grace. There are so many dimensions and paradigms that my basic biology can’t grasp. And isn’t that wonderful. How boring otherwise! Eternity is a long “time” and who wants it if it is an eternity of what I see. Ultimately, beliefs about the afterlife are a deeply personal matter, and it’s up to each individual to explore and come to their own conclusions.

Brandon asked, are you a pastor or something? Laugh. Nope. I’m a psychiatrist. I just am a psychiatrist who reads the Bible. Whoever you are. The Bible helps us walk our walk, together with each other and with God. And the only thing that lasts is love. Nothing else we gather will survive us. But He/She who holds our spirit, holds our love too until we wake up again and we will recognize who we are in relation to each other and to Him/Her. 

Self care Tip: Set up patterns in life that connect you to each other and to God. Keep on!

Question: How do you connect with the people you love when the connection frays?

Dad died and the concept, “This world is not my home”, started growing exponentially. The difficulty I’ve been running into is talking about eternity without disregarding our ongoing human experience. 

I matter. 

Human suffering matters. This includes missed opportunities. Things we wish we were. I wish I was a fabulous musician. And athlete. And I wish I could look at my wardrobe and know which clothes I should just toss out. We have eternity to grow our many facets. I’ll have a better wardrobe. We are not allowed to grow so many of these facets in this world and that’s important, but it matters that we have grown the ones we have, the ones we have fought for. It matters that we have dug in the dirt and been soiled by traumas too horrible to speak of. It matters when we summit and when we slide. 

Jesus came to the globe, gestating in womb, walked Jerusalem and Samaria, 100% human, not living as God even though He never stopped being God. He gets us. He gets the trauma and the great sensation of realizing hard earned hopes and what comes after that. And then He wove our human conscious awareness into an awakening of our eternal selves. 

This matters. 

We are more than this. “I see you. You’ve got a lot coming.” There is movement in this. There is an exercise of presence, along with the exercise of growth and hope and future. 

There is nothing lonelier than a summit without a sense of going on and toward. Listen to Freddie Mercury, 

“You can have everything in the world and still be the loneliest man. And that is the most bitter type of loneliness.” “Success has brought me world idolization and millions of pounds. But it’s prevented me from having the one thing we all need – a loving.”

A summit without connection is isolation. There is no movement. So how do we talk about this hope and future without dismissing our now? I remember my brother on his unspeakable pain of no longer living with his children, when I opened my big mouth and said something like, “I’m so glad we have a forever. A space without edges when we will not be separated. When we get to do all the things we weren’t allowed to do in this life.” And he turned to me and said, without aggression but rather immense sadness, “This feels like a threat.”

My brother was responding from humanity and I was moving right past it into a place of disconnected unrealized otherness. And whizzing past someone, like the Road Runner, can be catastrophic to them. I suppose he felt like I was dismissing his current, ongoing place in the world and indeed. That was threatening.

I see my dad watching football in the electric recliner. The Sunday paper is in his hands. He’s making unconscious glottal noises that sound like something cooking on the stove. Mom is thrumming through the house like a lawnmower, always moving. Always working. Always serving. I see my dad in the garden picking white sapote. “Get me that one over there, Sana. See. It’s still good.” And the sapote dissolves in my mouth as sweetly and as fast as this memory does. Dad has persimmons in his pockets and I’m trundling beside him, chattering and heard. He heard me.

It matters. 

And I know I will see Dad again and not be separated and that matters too. Prepping for his 82nd birthday party when his friends would come one more time to our home, Dad tells me to sing, “that song,” for his funeral. “The only Thing I want is to be with Jesus. Just to see him smile and say, ‘Well done.’” And my attention shifted from Dad here with me to Dad apart for a time, asleep in the care of Jesus. We will greet Him together and there will be no more tears and no more saying goodby. 

I never got to sing that for his funeral and I guess this is sort of an apology too. It was the worst. All I did was blubber!

Frank tells me about his son dying 10 years ago.  I asked him how to avoid inking like this, marking up one experience by talking about another. He says to ask more relational questions about his son. Get the survivor to focus on the things that they should be focusing on. I like that. It’s going toward the pain rather than away from it. So can we go toward the pain while describing our future? Frank recalls when his son died he had a pair of gloves in his briefcase he had intended to give to a lady who sold papers on the street and had cold hands all the time. “He was me but so much better in so many areas.”

Rev. 21 Verses 1 to 4

He will dwell with them, and they shall be his people, and God himself will be with them; he will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning nor crying nor pain any more, for the former things have passed away.

Dad died three years ago, Good Friday. The earth has not felt the same under my feet since then and I’m glad of it. Because it is one more way that speaks, “You matter.” And I’m am able to gain movement into the weaving of our future.

Self Care Tip: Find a way to integrate our future beyond this life with the significance and value of our present experiences and relationships. You matter!

Question: How do you bring your present suffering along with hope? Speak.

I remember I was wearing my blue polyester-blend maternity outfit; a shirt that tented over my son, who was growing inside at the time, and pants that hid a band of elastic the size of Texas. I remember the kitchen florescents, whilst getting breakfast ready for my daughters. We had slept over at my parent’s home because my my mom was out of town.

Dad had been, “going through it,” during those years. He was suffering the progressive sequela of Guillain-Barre syndrome, feeling like his extremities were aflame, burning all the time, plus a long list of other stacking medical conditions. He was trying to survive the losses. These, along with their respective medication therapies, clouded his consciousness and he was not a good driver. That morning when in the kitchen getting ready for our day, Dad showed up, somehow dressed and ready to go to work as well. The business he worked for at the time provided a driver, but that day, he either wanted to drive himself or the driver wasn’t available. I remember the keys in his hand.

About ten minutes later, our neighbors called us. “Sana, I just passed some emergency response vehicles parked by a car that looked like your dad’s. I think he got in an accident.”

And I knew. I knew. Dad had crashed.

There was one road that came from my parents, leading to three more roads, that fed into the west, north, and east. Thinking I had a one in three chance of finding him, I went driving. Somehow I came upon firetrucks. They were driving loudly, and again, “I knew,” they were going to Dad. I followed them Eastward.

Dad had hit a tree and his car split in the center. He was being removed at the time from the front half. The second piece was a distance behind. I remember his face, knowing, “This is Dad,” even though I couldn’t recognize him. There was so much blood.

People had gathered, watching my dad being pulled out of his wreck. One of the officers asked me to go back to my car. It made me upset, and now that I look back, I don’t know why I wanted to get to my dad. Did I think I could save him? For some reason, even fully aware that I was trained in psychiatry, (not emergency medicine mind you,) and as a thirty-eight week pregnant beast, I think I did.

This was the second life threatening event I went through at the end of my third trimester in two of my pregnancies. The first was when my niece died. That’s another story. But in both of them, although utterly helpless, I thought I could save my family.

You know the answer to that though. You know. You know what my viscera did not. I couldn’t save anyone. My niece died, and my dad suffered more and more, chronically ill with a step-wise decline, until he also finally died two years ago.

You have survived your own life threatening events, or other sufferings, that has made you think of being a savior. We all have. And although we can’t be her or him for ourselves or others, it’s always been true. We do need a savior.

Today for, “Sabbath School”, I’m speaking on the topic, “The End of Evil.” While studying this morning, I remembered driving up to Dad. His car split in half. I was running, two hundred and three pounds of me. Holding my huge front side, I remember calling him, “Dad! Dad!” Thinking, “He’ll answer me. Call him one more time.”

And that, Folks, is what trauma looks like. Trauma from an emotional standpoint and from a physical, i.e., he just got his face bashed in, standpoint.

I’m not going to write more about trauma today, nor about needing a savior. I’m really just starting a thread.

I have to go study more. But what is your story and what do you think?

Sincerely, and Waiting to Hear From You,

Your own, Dr. Q.

Keep on!

Sometimes, we feel sideways.

Between the loss of control mental illness makes us feel and the quandary of how to go about getting better and staying better.

You’re all welcome to join us tonight for NAMI (National Alliance on Mental Illness). We are discussing this. 🙂

Topic: “Medication: The Good, The Bad, The Ugly”

Time: Jan 19, 2022 06:00 PM Pacific Time (US and Canada)

Join Zoom Meeting:

https://us02web.zoom.us/j/81810597278?pwd=c0lGczZrWjhPeVNjTm5JUDJEdUhlQT09

These meetings (NAMI Temecula Valley Mental Health Speaker Series) occur on the Third Wednesday of every month, 6pm-8pm

Please download and import the following iCalendar (.ics) files to your calendar system.

Monthly: https://us02web.zoom.us/meeting/tZUldumtpzwoHdwRcEPG4eEMsua755Q6tc0Q/ics?icsToken=98tyKuGppjoqH92Ssh6PRpwcGoj4c-_xmGZBgqdKrhzAMwcHZybbJfdDZecqIY7E

Whether we see you there tonight or not, hope you are doing very well in this new year, 2022.

Keep on!
Your Own,

Dr. Q

Hello!

My name is Torie and I am a new co-host of Friend to Yourself Podcast.

Dr. Quijada and I are thrilled to be launching this podcast, and we’re so excited for you guys to see what we have planned.

Before continuing, here is some of this and that to get to know me.

I was born and raised in Southern California. I am the oldest of three girls, and studying for a psychobiology major with a minor in nutritional sciences. Mental health advocacy is my passion, especially in multicultural communities where mental health and illnesses are stigmatized, and in Eating Disorders recovery.

I absolutely love going to Padres games. But even more so, I am obsessed with my new English Bulldog, Keilani. On the weekends, you can find me and Keilani at the beach or local coffee shop. 

Both Dr. Quijada and I have been working hard to create content for our subscribers. Our podcast will focus on self-care as practiced in daily life struggles and wins, eating disorder recovery, and mental health from a biological perspective.

We’re getting some final things settled and our first episode should be out very soon! Please suggest or ask anything. We would love to hear you.

To stay updated, follow us on Instagram @friendtoyourself  & don’t forget to share with your friends and family!

Blessings, 

Torie 

On mental illness.

Generally we think about the individual/the patient. 

Generally we start with what they’re going through. 

• We don’t generally… 
• we don’t traditionally… 
• we don’t naturally
• I would say…

Our first instinct is not to think about the rest of those without. First, we think about those with mental illness. However considering statistics, the pool of persons who are not ill, is much larger to the pool of persons who are ill. 

It’s just how it goes to think of things this way. The person with the hurt comes first and last. Right?

Contrasting to this, healthy relationships ebb and flow. There is a dynamic. There is a back-and-forth. Sometimes it goes in one direction. Sometimes it goes in the other, depending on who needs what at the time. 

But when someone is ill, the needs tilt. They go more toward the person who is ill.

It’s like saying if you are in a boat on a lake you are likely trying to float. But the boat has a hole in the floor. Water is rushing in. In this boat with a hole on a lake, you with someone. There are two people. Bummer though. One of you has a broken arm. The other person has two healthy arms. Who ends up bailing more water? You guessed it. 

Even with the best intentions, the person with a broken arm is never going to be the same performer as the person with two healthy arms. 

Question. Is there culpability?

The person with two well arms is bailing water at breakneck speed. The person with only one fit arm is doing their best. Bummer though. In this story, they develop tendinitis. Bailing water slows down even more now that they have both a break in one arm and tendinitis in the other. The person with two well arms is still bailing frantically. The person with two healthy arms looks over and says…

What do they say?

Do they say, 

“Hey you! You are a dud partner. It’s your fault this boat won’t float.”?

Or, do they say,

“I am responsible if this boat sinks. I am responsible for your well-being because I have two healthy arms. It’s my job if we don’t float.”?

You see the gap. And both answers are wrong wrong wrong.

Unfortunately, most don’t say what is really going on. 

“No. There is no culpability. There is no fault. It just is what it is.”

Have you ever felt like it’s your fault? On either side of this equation. Caregiver or patient, there is blame we do to ourselves. Being joined, as a spouse, a parent, a child, a friend… with someone who is ill, even illnesses of the mind, puts you in a position of care-giving. 

What is it like to be a caregiver?

You may be saying, “Dr. Q. Are you a dummy?! It’s a tiring thankless job that I do because,” …there are so many reasons. Love. Finances. Religion. Guilt. So so many reasons we become, and stay, caregivers.

Dr. David Kessler, grief researcher, explains that in the grieving process we often fall out of intimacy with others because we are judging how the other person grieves. This took me by surprise. I didn’t realize that in our pain we judge. As pathological as it is, this is a process of self-preservation. Fists up, we are just trying to survive. 

“They are not grieving the right way.” 

“They are getting over it too soon.” 

“They are already forgetting.” …and so forth.

In a care-giving relationship, we get into the same trap. We judge ourselves and others in how we give and receive care. 

No one ever feels quite so lonely as when they are “right” and looking down at others. The other, even being one’s own tired crumbling self. Being at the “top” is a windy cold summit. The pedestal of “correctness” is paper mache. Care-giving easily encargos judgment, even judging yourself. And is isolating. I’ve never felt so alone as when standing in judgement.

Being a caregiver is, well, …giving!  There is a need.  We respond to the need.  We give.  There is also a taking from what is given. When we talk about this, some of us hear the tap, tap of a bookkeeper balancing ins-and-outs.  Tap, tap, take, take. “Keep it fair!” Or, “Keep it right!” There is judgment. Are you giving enough? Are you giving right?

How to pull away from the Judge Judy role:

Understand first that the illness is there just because it is. It’s no fault of anyone. No culpability. These illnesses are, at the most primitive perspective, because of our human condition. We suffer. It is what it is.

These illnesses come because we are human. It is what it is.

These come from biology we didn’t choose. It is what it is.

They come, perhaps, from bad choices, like illicit substance use, texting and driving, or ring boxing and collecting a series of traumatic brain injuries. Bad choices that, although have a degree of selfish beginnings, still come down to the human condition. They happen. Humans make bad choices. It is what it is.

My patient was struggling with her own sense of guilt. “I just feel responsible,” she said. “I’m his mother.” She couldn’t let him “hang in the wing, out to dry.” Rescue after rescue.

And that’s ok, right? It’s ok if that’s what you want to do. Rescue away, I say! But do you loath that about yourself?

While bailing water, take stock. It is your own choice. Think of your reasons why. Own them. Celebrate them rather than judge yourself. You are doing what you want to do. 

At FriendtoYourself, we say, “Everything starts and ends with me.” There is freedom in that. It is putting the judgment down and claiming your life. It is digging in your own dirt for your own worms and feasting. It is spending your energy where it will make a difference. With, “Me.” This is the only person I can account for. This is all I can have any control over, (as little as that is considering biology!) but it is what we have. 

And from this accountability, from this place of freedom, comes connection. Both to yourself and to others. The caregivers-martyr-death is lonely lonely, like a howl sounding that no one ever captures. A caregiver who repositions themself, adjusts and tweeks their lens, to say, “I choose…” 

What? What do you choose? Do you continue to give and bail water? Do you walk, or swim as it were? No judgment here. You are doing the best for others still when you do either of these. Sometimes you are still giving love when you swim away. Sometimes staying and bailing water is worse. It’s worse no matter what your choice is when you choose and perform from a place of judgment on yourself and on others. 

If this is off from your care-giving experience, forgive me and speak. Tell what you are going through. We need to hear.

Self-care tip: It is what it is. Find forgiveness for yourself in your human condition. 

Questions: What is your care-giving experience like? Do you judge? Do you feel lonely? What has helped you gain self care during it all?

Keep on!!!!