Anxiety

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It is okay to be Wrong …and Fears

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There was an exhale. A ripple out, like dropping eyelids, a wave on a slow shore, turning a shoulder away and the head following; this was how her disclosure soundly rolled through the room.

I failed.

I don’t care how cocky you are, everyone fears. In the brain and body, sometimes, the parasympathetic is dominant and one feels calm. Fear isn’t on the mind. Another time, the sympathetic tone rises and you think, “A bear is chasing me!” Or, “That girl is coming to talk to me!” (It can feel synonymous. Wink.) Yes, that is fear. But the kind of fear I’m talking about here is the one germane to our conscious or even before conscious awareness that we will never be enough. There will always be someone. Smarter Her beat Me in AP Calculus. Someone the boy desires… more. The things like food, shelter, clothing, the money, the votes, the power, and someone other will trump Me. This fear comes from the Amygdala, an almond in the middle of the brain that holds our sensitive selves carefully within it’s tiny shell. Others will argue that it also comes from a magical outside-of-biology-morality. A qualifier or quantifier of personal value. Plink. A widow’s mite drops in; an offering of our small or great selves.

But wait. There’s another choker, ring and leash that sparkles around our slender neck; the whole perfectionism culture. This is the psychological influence on what makes us who we are, including our constitution of fear. This is what I wish I gave better to my world, to those I am in contact with. I wish, like Pinocchio, because I believe perfectionism is dishonest and lacks moral fiber. We are made better by our failures rather than worse. And if I were a philosopher, I’d recognize the tiring loop this swings me into… It is a failure to live in shame of my failure to receive the gain that failure brings. Round and round. An ice cream truck sounds music in the distance but I have no change. I’d like to especially tell my kids with my life, my actions, my all – “It is ok to be wrong.” Wrong wrong wrong is just fine. Pause. And then also, “It is ok to not pass, to miss, to play flat notes, to sit alone, to be unchosen, to work hard and fail.”

Beatrice, a graduate of the Medical School of Manila and residency in internal medicine, and later after six years of practice, immigrated to the US of A. She had taken the USMLE Boards Step One, twice and both times, failed. She could not do the training in the states that would allow her to practice here until she passed. In the mean time, her kids back in the Philippines, needed funds to live. Beatrice worked Door-Dash, while she studied and feared.

It would have been clanging “toxic positivity” for me to chirp, chirp, “It takes a lot of failures in order to succeed.” But help me, I wanted to! And forgive me, I have with others. Ugh.

What is the balance? Because there is truth here. All successes are preceded by a large mote of failures, conscious awareness of them or not. However that doesn’t prove that successes will follow. What’s the term in logic that this is in danger of? I think it would be a blend between causal fallacies and a hasty generalization. Sometimes there is just failure. A dump in the mossy monster infested water.

Because we are good psychiatrists, we will shake it down, and dutifully approach fear here with our “bio-psycho-social” paradigm. We have the brain, including the amygdala and it’s influences. We have the psychology of perfectionism. And we have the social of Beatrice’s children’s basic needs to survive.

How do we do self care with all this? If we have enough bank, we go toward the elements, separate and whole, in this paradigm. We pluck away where our suffering calls out to us most. We go forward knowing that whatever it is we are going through, we are not alone. It is common and normal, although unique because we are, each of us, an un-duplicated wonder. We use the reminder this approach offers that things are always more than they seem to our conscious selves and if we give to it, we will weave together a greater hope, with both the good and the bad, all seated at the Thanksgiving dinner table this year.

For Beatrice, we grieve with her the difficulty in her journey. We celebrate her hopes. We encourage without losing honesty. And we give treatment for the biological expression of underlying disease that harms the way she perceives her reality. This is our privilege.

Self-Care Tip: It is okay to be wrong, wrong, wrong. Keep on!

Questions: Would you please tell us about your fear?

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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. 

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But I’m Not Someone Who Likes Taking Meds

pill

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! 🙂

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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.”

 

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I Can’t Make Friends – Anxiety

voyagerMr. Clark stopped talking and walked to the ringing rotary phone on the wall.

We were experts, as 7th graders, in anticipating what phone calls would be about. I’m surprised we never got around to making bets. I missed my chance to be a bookie. When the phone rang, it could mean someone was in trouble and had to go to the principle’s office.

Everyone was quiet waiting to see if their name would be called. No. That wasn’t it.

It could mean there was a school announcement. It could mean there was something wrong with our bathroom plumbing! But it had never meant that a space ship had exploded. Seventh grade was not the time to grasp what this meant. If we couldn’t grasp it, if our perceptions were unable to see it, then it could not actually exist. Right?

We kids had other things we were trying to sort out. Boys and girls. Getting your period or facial hair. Zits. What Melissa said about you when you thought she was your friend. These were space occupying in our minds. There was little room for understanding that this phone call announced the end of 8 lives, a billion-plus dollars blew up, nor especially not what it meant politically! Spouses and children, watching and cheering in the bleachers live, front row and center, witnessed as their own individual loved one exploded into tiny particles.

Mr. Clark walked, white-faced and perspiring, to the radio, asked for silence over the hum that had built up, and we heard. The challenger, the 8 people aboard (one of them a teacher), in 1986, was gone.

A spaceship exploding is about what anxiety feels like. That may sound extreme but it is the truth. And those who have experienced it, as if their were going to come apart, will do anything not to experience it again. This urge to avoid anxiety expresses itself in emotions and behaviors. But often, when anxiety doesn’t reach a full explosion, the afflicted individual doesn’t even know that they are sensing the urge to avoid, nor how they are responding to this avoidance. The afflicted person and those who know him get think that these medical symptoms are actually the afflicted’s personality. “It’s just the way I am.” 

You may be someone who feels inner congruence with decisions. By temperament, you like closure! But even so, against your own hard-wiring, you find that you have trouble making decisions. How you talk is driven by indecision. You’re couching what you say, being careful. Your self-esteem erodes.

Manuel had some similarities to this, but also, on top of his medical condition with avoidance symptoms, his personality was one that got energy from being alone. That doesn’t mean Manuel didn’t like people or interpersonal relationships. It just means that he got energy from being alone. And he did stay alone most of the time. When around others, the energy poured out of him like lemonade through an open spigot. However, he wanted others. Being lonely was not his goal. But there he was, more energy when alone combined with a thrumming buzz of nerves when he tried to make friends, when he tried to date, or when he was approached by someone spontaneously in public who asked the time.

Fudge! She only wanted to know the Blinking! Time! he screamed inside.

Manuel had some friends with whom he was deeply bonded to by shared experiences. But he had gone on to college and his friends had not. It was niggling in whispering thoughts that he might still be hanging out with them because they didn’t disrupt him. Because he came apart. Terror, like a spaceship exploding in the atmosphere after take-off, filled his perceptions, if he tried to hang out with anyone else! And Manuel didn’t like thinking about his friendships that way. They lost value when tattered by that persistent wind. Nor did Manuel like thinking about himself as someone who couldn’t get other friends if he wanted to. As someone who would use the faithful. Friendship by default? No. He felt shame just thinking it and he knew it’s falseness. In his most essential self, he knew he loved them for more than proximity. But he really didn’t know if he was weak. It was a possibility. And besides! What girl would want a weak man?

People with anxiety have barriers to any number of connections in life, like coming up to an energy force field we can’t see. There are interpersonal connections we might have had, but never initiated or explored because the anxiety held you in place. This is what anxiety does to us. Anxiety takes away our freedom to choose. And as the consequences and fruition play out, we live out the related losses.

Manuel came to me because, “Mom told me I better come and talk to someone.” Mom was fed-up with his isolation, hours of video games, and she had noticed that he was spending even less time with his childhood friends. 

Talking to Manuel, unearthing these patterns in his life, his insight grew a bit. But once he looked at anxiety, even with a sideways glance, which was anxiety provoking in itself, he came up against the need to decide,

Should I treat?

Deciding to treat is a decision to make between the patient, perhaps including their support system, and their treating clinician. When there isn’t a clear answer though, like a blood test that shows the vitamin D levels are low, we respond with vitamin D replacement therapy, but in these areas of diagnosis, it often feels nebulus to the patients on what to do.

When the decision doesn’t have clear form, like an undefined space, go toward the data. You may trust your clinician to know that data integrate it into all the information that goes toward deciding on treatment. Or you may choose to spend time researching and evaluating the data on your own and then go forward. Either way, if you stay with what you’ve been doing, you will remain ill and the illness will progress over time.

So either way, going with the data, either via your clinicians recommendations directly, or indirectly. Accept treatment. In fact, run toward it! You will have a much higher quality of life. And… those around you will too.

Self-care tip – Go toward the data!

Questions: What had influenced your choices in treatment or not to treat? Please tell us your story. We need your voice!

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Sweaty and Worried – Generalized Anxiety Disorder

Hank had to sing an Italian song for his tests.

His music instructor did not believe that he had been practicing two hours a day. When Hank asked his voice teacher to sign off on those hours, his voice teacher still did not believe him.  He had nothing to feel shame about.  “Then why did I?” Hank wondered.  Card in his hand, signed off, Hank resentfully kicked at the rocks covering the path back to administration.

Looking out over mostly empty hard wooden seating in the music hall, Hank slaughtered the song. Even so, it was still the best performance he had ever done.  His father was there in his stained tie and largeness.  His mother in her too many colors, smiled loudly.  She was tone deaf.  Frank’s shame followed him.  He had practiced.

Hank’s older brother dressed in silk shirts, a big gold medallion, a tuft of hair coming out of his barely suppressed neckline.  When they prayed, Hank heard these smacking noises, and thought, “Pray for my nausea,” hoping they would stop kissing.  His brother always had a girlfriend.  The girlfriend was at his recital.  There were noises.

Everyone was scared Hank’s brother would marry too early and maybe marry for the wrong reasons.  His dad was always like, “Wait, wait!” But with Angie, Dad was like, “Get married now!”  Angie was the best in a long line of noisy kissers.

They asked Hank to sing at their wedding.  They insisted.  His brother, his brother’s girlfriend, his parents – they spoke in harmonics all at once.  “Hank!  You sing like Sinatra! Don’t worry so much! You should sing!”

In a rented tuxedo, Hank sang.  The mike didn’t work.  Aunt Augusta told him to sing louder.  Aunt Augusta didn’t hear well, even if there was a mike.  Hank forgot his words and had to start over.  Sweat filled his shirt and he thought about the dry cleaning.

Hank has never had a girlfriend and he is almost twenty-five.  Standing in front of all those people without the song lyrics, the only words that came to him were, “I am like a sweaty doorknob.”  His brother, facing a battle of his own between his ruffled shirt and his manliness, did not help.  Hank thought, “He is probably waiting for prayer so he can start kissing.”

The second year of college, Hank got caught with pornography.  “Hank!” His mother pulled his ear, towing him while she shook the fisted magazine through the house.  He didn’t listen to her words.  He only listened to his memories asking his music instructor for his signature. Was it as bad as the wedding?  Talking to Sarah or walking across the campus greens were bad. He fingered his worries like a beaded necklace.  He worried a lot.  Worry and shame.  He wished he could have a girlfriend but thought that was a hopeless cause.  Hank was already planning on buying a new magazine before Mom had thrown that one in the garbage.

It is so easy to explain away why Hank is the way he is.  We have heard enough to say, his parents, his brother, his isolation, his treatment from teachers.  We can use these to say, “Who wouldn’t be anxious, worried, down, and isolated, when going through these experiences?”  If we did though, we might miss the generalized anxiety disorder, the medical.  Conceptualizing the medical in this way can be so difficult.  We could call it, “the un-reasons why” we feel and do what we do.  So then we don’t have to deny it.  The un-reasons why don’t have to make sense.  They are un-reasons, after all. We don’t have to deny them by our inherent need to point at the cause and effect, or explain into uselessness the reason we are this way.  We don’t have avoid eye contact just because they can’t be seen.

Hank, like so many of us, is included in the statistics that generalized anxiety disorder, or GAD, is one of the top reasons why we don’t get intimate with others.  The anxiety is distracting.  It isolates us.  It preoccupies our thoughts.  It fills us with self-doubt and develops over time, almost inevitably if not treated, into depression.

Getting by with something as subtle as GAD, or other brain illnesses such as degrees of depression, have potentially devastating effects on what occupies our life-line.  The moments that construct the overall devastation may be explained away by one injustice or another, by what are thought to be personality quirks, or simply by neglect of self. But they could be different. The moments, the otherwise same moments, could be different.  The same rude, distrustful teacher, the rejection from Sarah, the quiet mike – those moments could have been different with the same guy, different only in his brain health.  Brain health makes the sameness different.

As Nancy A. Payne, of New York University (NYU) Silver School of Social Work, wrote about treating brain illness,

“There is tremendous satisfaction gained from facilitating the transition from profound illness to equally profound recovery.”

The life-line takes courage to look at.  It takes courage to believe that the effect of our negative thoughts and distorted perceptions could indeed have that pervasively profound effect.  It takes courage to consider that medical treatment can likewise, profoundly change our quality of life.

Hank tried to take his life with a rope before we met.  I’m so glad he didn’t break his neck or die.  He is now well treated and his disease is in remission.  His life-line has changed.Bo-J0zyIEAA_Y3h

Questions:  What are you brave with?  What do you spend your courage on?  Tell us about it.  We gain so much from community and connection.  Keep on.

Self-Care Tip:  Look also at the un-reasons, at the reasons less apparent, at what isn’t seen – look  into those reasons of why we feel and do.

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To Use Tension, Or Run From it…

English: Waterfall near Lepena, Slovenia Slove...

English: Waterfall near Lepena, Slovenia Slovenščina: Slap, Lepena, Slovenija (Photo credit: Wikipedia)

A few days ago, we talked about tension being a tool for balance.  Col, in her comments, asked to expand on this.  Aside from feeling incredibly tense about it, I thought, “Ah!  All right.”

You’ve heard the term, “One’s man’s junk is another man’s treasure.”  Tension is like that.  It’s all kieshy now and pop! to meditate into oblivion, (I exaggerate,) and “medical” marijuana couldn’t be easier to get, but where do we get the opposition that provides so much of the pleasure in the calm?  Tension.

If you’ve never been quite calm yourself, imagine standing under a waterfall trying to dry off  when people say, “relax.”  (Got to love it when people say, “Calm down,” or, “Relax!”  …Ahem.)  Using tension as a tool for balance is learning to do something else in the downpour other than drying up, like take a shower or make a rainbow.

This is easier to say than do, for sure.  But just simply knowing that tension isn’t the enemy is a great boon.

Question:  When have you noticed that tension is a tool for balance in your life?  Do you use tension or run from it?  Please tell us your story.

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Be a Celebrating Hero

An Asian black bear, shot after charging the &...

An Asian black bear, shot after charging the “Old Shekarry”, as illustrated in Wild sports of the world: a boy’s book of natural history and adventure (Photo credit: Wikipedia)

Potty-stench made going to the bathroom awful. Phong would wait for days rather than use a public bathroom. Just going near one left him showering for hours under scalding water and layers and layers of soap. He would work through three bars of soap at a time before he could even think about stopping. Stopping before was too horrific. If he did, before he stopped feeling dirty, than something horrible would happen, or so his thoughts shouted at him. The devil would eat his little girl.

Phong knew that was not going to happen but the thoughts were tormenting and nothing made them better. Sometimes he would rather die than see the bloody gruesome scene in his thoughts another day.

Obsessive Convulsive Disease is a bear. Getting treatment is seriously scary. The treatment not working is petrifying. And just about anything in between is fear invoking. You get the picture. Who will go up against a bear like that?

I remember in the Disney*Pixar movie, Brave, when the dad, Fergus, yells:

Mor’du! Elinor, hide!
[Elinor and Merida run off, one of Fergus’ men passes a spear to him, Fergus charges towards Mor’du (in bear form) but he snaps off Fergus’ spear, then we see Elinor and Merida escape on horseback, then Fergus holds up his sword at Mor’du and shouts]

Fergus, like the beast he fights, growls a bellow:

Come on, you!
[suddenly Mor’du lunges forward and the screen goes blank]

Eventually we learn that Fergus won but suffered the casualty of his leg. The amount of adrenaline in that time and sympathetic hyperawareness Fergus experienced is just close to the amount that Phong has daily or multiple times daily sometimes in his Exposure and response prevention (ERP) therapy and medications. In ERP, he has to choose to expose himself to this nearly incomprehensibly horrible fear, respond to it and then wait until the fear lessons. This is a bad case of, “it must get worse before it gets better.” But Phong does it. Mostly. He just does not want this to go on and like a prisoner of war, he is eating the grass under the fence line to survive. The man has courage. Can you imagine going through that kind of cortisol crisis every day?

And as mentioned, on top of that, he takes his medications. Anyone who takes medications, knows that we don’t need courage once to do it, but every day, hand to pills to mouth, we need sinew. Phong is one of my heroes.

Question: Do you know you are a hero? Any ideas, why? How do you celebrate that? Or would you if you would celebrate this? Please tell us your story.

Self-care tip: Growl a bellow at what you fight! Be a celebrated/celebrating hero.

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Feeling Afraid

Celine was made to fidget by something moving inside her.  It tooled with her body while working her over.

I’m afraid.

Rich.  We are all afraid.  Knowing it and naming it is more than many of us have the spit to do.  But not being named doesn’t make us more courageous.

I am afraid.

Celine wanted help and as her perception grew of what she was looking for, she knew.  It was fast.  Awareness appeared in progressive pictures into her own flip book.

Remember those flip books when we were kids like, Mickey Mouse tapping his foot as the pages sped by, leaning over to kiss Minnie?  Celine’s flip book showed her that she felt unappreciated at work.  She resented her authorities, lack of control and felt ashamed that she wasn’t acknowledged.  Scenes in her life gave her the illusion of movement toward more than just danger though.

Being in fear is not in itself wrong or amoral.  Sure as yams are sweet, it’s going to happen.  We all have fear.  Feeling afraid doesn’t mean that we are bad.  It doesn’t confirm the accusation or shame.  It doesn’t close on us.  It just is.  Fear.  Celine’s illusion was that she was moving toward being the wrongness, being amoral, and being especially bad.

Ironically, Celine found some comfort in this and decompressed.

The medical reasons behind fear are of all varieties and certainly important, but this post isn’t about those.  It’s about our flip books.  Lick thumb and finger and let’s see what pictures we’ve sequenced into our own illusions. We all have a book.  We all have fear.

Question:  What does looking at your flip book do for your sense of value?  Please speak.

Self-Care Tip:  Remember what makes “Me” special by being present with fear.

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From a Fellow Commentor – Her Friend Suicided

Anxiety Always

Anxiety Always (Photo credit: Wikipedia)

i woke up this morning to find out that my friend shot herself last night. she texted me, said she hoped i had a good night and said goodbye. she then walked outside and shot herself in the head.  
there are so many emotions i can’t even sort them out.  i don’t know what to feel, i can’t even cry.  why haven’t I cried?  I didn’t hear her stupid text, I didn’t know… I knew she had her demons we all do, but they convinced her to end it.  it’s so finial, so F-ing stupid!!!!!
is this how it ends for us that are so f**ked up in the head?  she wasn’t on meds, would that have even helped?  I don’t know what to think sana. last month i got a phone call from my friend who lives in Fallbrook and she had been dealing with anxiety couldn’t take it anymore, said she didn’t want to feel the anxiety anymore and tried to kill herself.  she was admitted and stayed for 4 weeks.  she’s on so many meds that she’s speaks in a monotone voice.  it’s has really scared me.  
is this how it’s going to be for all of us that deal with fear, anxiety and panic? I need to go for a walk, i feel numb. i feel so pissed off and feel bad that I’m mad. 
i’m scared
didn’t know who else to share this with that would understand
Questions:  Do you?  What do you understand?  Is this how it’s going to be for all of us?  Please tell us your story.  We need to hear.
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Medications and Being Chosen by Fear

English: In 1870 he lost an arm, in 1917 he lo...

Many have been hurt by medications.  There are those life ending treatments.  There are accidents.  It doesn’t matter what remote or near number in the chance-line the side effect has to the victim or the survivors.  They happened and they happen.

If you are a survivor of something like this, if your child died or your mother almost did, if you lost your favorite thing in life – lost what you identified yourself by or if you were changed without being asked, you know what I am talking about.

How do you come back after that?  How do you endure opening your pill dispenser on Wednesday, on Thursday, every week, every day, how do you take medications when they are prescribed?

On my end as a physician, each prescription is a choice.  Each prescription carries the bit I am allowed to participate in.  Signing my name, I am saying with the informed patient, that the benefits outweigh the risks.

When you take your medications, know that you are not alone.  Know that you are doing this with numbers of other courageous people taking their medications.  Know that your physician, with the research behind this, with the high numbers of other persons generous enough to enroll themselves in those medication trials before the Federal Drug Administration (FDA) approved it.  Know that the FDA is with you and know that the benefits out weigh the risks for you.  That you decided the benefits are greater than the risks means you know what they are and you are choosing to take care of yourself.

Medication isn’t for everyone.  Medication hurts a lot of us.  Taking medication with this knowledge is still something many of us choose.

If we are not taking our medication because the fear precludes it, we can do better than that for ourselves.  We can choose not to take it without being chosen by fear.  On the flip side, we can choose to take medication without being chose by fear.  Being chosen by fear hurts us too.

Self-Care Tip:  Go into the space of where your fears are and let it lose power over you.

Questions:  How do you claim your freedom to choose when it comes to something as complicated and scary as medication?  Please tell us your story.

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PTSD and Choosing Not to Be A Victim

click here to view –> Be A Friend To Yourself.

You may remember our wonderful guest post by PTSD survivor and advocate, Michele Rosenthal.

Ms. Rosenthal generously asked me to also post on her blog site. Pretty fun, huh. So here’s the link if you’d like to take a gander over.
Thank you so much Ms. Rosenthal for this opportunity to share space. Keep on folks.

To view post, click above on “Be a friend to yourself.”

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The Elephant is in The Room To Help Us

English: The eye of an asian elephant at Eleph...

Image via Wikipedia

How do I get him to see it?

How do we get our friends, our husbands, our wives and kids and patients to see the elephant in the room?  My patients ask me this and I ask this of myself.

I want to feel better.  I just want to get to the bottom of this!  

Will someone please just treat what is wrong and I can move on?!

There is this implication that someone is plotting against progress to derail us from appropriate therapies, treatments, walnuts and soy milk.  Why they would want to do that, no one agrees on.

When Cincy said something to this effect in clinic, a huge shade in the shape of an elephant in the room, caught my eye and it was distracting.  I smiled at the wraith and conspired with it on how it could best gain acclaim.  I tried to explain what I was seeing to Cincy, but how does one describe an apparition?  I’ve never heard anyone do it better than Edgar Allan Poe and so I know it can be done.  I’m learning.  I needed to learn from Cincy.

Teach me Cincy.  Help me learn how to speak of these things better.

I felt like I should know that already.  But we physicians don’t graduate with a certificate in introducing elephants.

Trying to do the teaching-thang in clinic or out of clinic, if we want to get anywhere, we can’t do much if we aren’t both seeing the elephant.  Talking about solutions, about treatments, motives or anything that doesn’t redirect each of us back to that specter in some way is skipping critical development.  Counterintuitive, the immediate task at hand becomes more and more simple when there are ghosts about.

He doesn’t want me to take medication because he is afraid of what his mother will say.

Start talking about Me and not about him.  How does Me factor in to deciding on medications?

Smoking is my last vice and I’m not here to talk about it.  I’m here to talk about why I’m tense all the time.

Tension happens when our blood vessels constrict.  Tension increases when our heart rate….

Well, goodness.  You don’t want this from me now on this post.  I’m just trying to talk about that darn elephant.

When things feel complicated, when conspiracies seem to be around, when we hear ourselves naming others to explain our condition, when we avoid talking about something and when we lose Me -> reduce.  Still missing it?  Get even more basic.  Soon we’ll see the shade.  The elephant is there to help us, not shame us.  He’s there to bring us back to Me where everything starts and ends.

Question:  How has the elephant in the room improved or worsened your self-care?  Please tell us your story.

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Name Your Fear To Know You Are Free

She knew the Horned King‘s secret name.

His name?  … I never realized a name could be so powerful?

Yes….  Once you have courage to look upon evil, seeing it for what it is and naming it by its true name, it is powerless against you, and you can destroy it.

– The Book of Three by Lloyd Alexander

Science Fair Wins Ribbons

Image by OakleyOriginals via Flickr

Mistakes and the mist of shame thicken about us and it is hard to hope.  As if each effort of our intended labor produced Seconds and Flops we must stand in our Besties beside what we have done to get a participant appreciation ribbon tagged onto our lapel.

And somehow standing there, the layer of sweat thick under too many clothes, we remember the secret name, it comes and we whisper.  We whisper it; our last courage still enough for that.  There is a moment of surprise, as if we and whatever pressed us down didn’t know we might still live.

We can see now that we are not alone; just there, in fact you are there with your own passed over table.  I remember you working nights on it, your tired eyes, a happiness in your muscles still.  In those days.

We can see that we are special for more than injury; we hear now.  We feel concern for more and taste newness that filled the space.  The secret name.

We won’t tell you or it wouldn’t be secret any more.  But now that we remember we are free.  Now that we have the knowing, we will keep the power, thank you.

There is power in a name.

We won’t forget what came after evil and will speak more readily into dark spaces, will wait less and fear less because we have already been there.  Going toward the pain like that.  What’s the worst that can happen when you name your fear?  It takes no more than a whisper to be strong.

Self-care Tip – Speak into your dark spaces the name of your fear.  Be a friend to yourself

Question – What reminds you that you are free despite the fears that tell you otherwise?  How is freedom your truth in life even when your senses tell you otherwise?  Please tell us your story.

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Are You Empowered to Start Everything and End Everything With Me?

Yesterdays blog-post brought a few neighborly questions for us to follow-up with.

One is regarding emotions from bluebee.  Is jealousy medical?  Followed by, What part of emotion is under our control?  Indeed.

Second, Sarah quietly slipped the question under our door of how to respond to emotions and behaviors that come from brain illness.  How?  Indeed.

Third, Carl banged a little louder when asking, what keeps him in a relationship with someone who is maltreating him verses leaving?  Indeed.

There is a nice flow to these.  They are leading into the next and circle back.  Emotions and behaviors come from the brain, much which is out of our control and some of which is.  The choice to engage in the life of the ill is like any other choice.  Our own.  If it matters to us if the way the brain is working in the “other” is in their control or not, we can spend more time trying to sus that out.  I’m not sure myself when I get it good from someone mean, but it has become easier to take care of my junk rather than there’s.  For that, I will say a million thanks.  If I’m getting yelled at, I do the checks on myself – anxiety? fear? anger? fatigue? shaking? dizzy? tone of my voice? do I know what this person is yelling about? (most often it has nothing to do with Me), empathy? empowerment? You’ve told me that you are growing in similar refreshing ways.

Face Down w/Laundry and Gwen Stefani

Image by NCM3 via Flickr

I’ve seen this play out a little in my children.  My daughters and son are supposed to do the laundry every morning before they play.  I don’t know how many years now, but their arguments haven’t changed.

I’m doing this all by myself.  No one is helping me!

Mom!  He’s just laying on top of the clothes!  

Mom!  …

These questions above…;

  • where emotions and behaviors come from,
  • control over biological symptoms,
  • do I respond to others with brain illness
  • or do I walk away

These questions don’t mean much if we don’t find where our empowerment comes from.  Me.  Everything starts and ends with Me.

I’m ill for reasons I have nothing to do with, yet I will be accountable for myself and how I affect others.

I feel emotions I didn’t ask for, behaving ways that I am a spectator to rather than a whole person, yet I will do what I can to gain health.  In that, I have control.

I surrender what I don’t control to my Higher Power.  I take medication.  I exercise, guard my sleep hygiene and get regular sleep, eat responsibly, gather and engage community, attend therapy groups and/or individual, I try while at the same time I let go, I love my flaws as I love my perfections, I try to develop my natural genius, try as often as I can to pour any energies I have in that direction as I know I will heal faster, enjoy life more and be more successful at all my efforts when I do.

It reminds me of that saying, that if I have success, it is from standing on the shoulders of giant midgets.  We are all flawed.  We are all wonderful.  We are supported by others who also are full of flawed perfections.

Do I have control?  You bet.  …And no way.  Always, there are both.

Do I talk when someone is mistreating me? or mistreating themselves by neglecting their own self-care? by letting their illnesses shape their lives?  Do I walk away as that may be what my self-care demands.

Everything starts and ends with me.  There are a lot of stops along the way with other forces, but empowerment is mine.  Indeed.  That’s what I hope my kids will learn when doing the laundry.

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Don’t Run Away. You Might Fall In Love With Your Flaws.

DSC03321

Empower yourself by going towards what scares you.  Take it to the table and be with it.  Get to know it and openly share company with it.

Opal was throwing up.  She threw up more when she gained weight or felt fat.  Throwing up didn’t help her lose weight.  It was just a tool she had to deal with it all.  Opal was told often not to worry about her weight.  Told, she looked fine and not to weigh herself.  No one said openly, “Opal, you’ve gained weight and you’re going to get other illnesses because of it if it keeps going.”  They were afraid saying anything like that would make her throw up.  Hm.

What do you say?

We remember the three things that help maintain long-term weight loss.  Well one of the main reasons they work is because they help keep us present with “the problem” or “fear” or “shame” or however we name it.  Our natural instinct is to go away from fear but this is another example of when we don’t get help following our instincts.

What empowers Opal is to get tools to contend with her struggle with obesity.  It is probably a life-er for her and oh-well!  We can love our flaws better if we stop running from them and grow our skills in living with them in a friendly way.

Get empowered with whatever you are afraid of in yourself.  If you can’t do what you need to do to be in the place of that fear, it may be that you have a medical illness keeping you from coping better.  It doesn’t mean you’ve failed.  Staying with your journey, even to taking medication, even to naming brain illness in your life is so courageous.  You become one of the great ones.  Heroic.  It is so much easier to disconnect and lose our opportunity to love our flaws.

Have you ever heard someone call their life-er, “my old friend?”  Maybe it is arthritis?  Or recurring cancer?  Maybe it is brain disease.  Some day, we will also name our own, “my old friend.”  And we, with Opal, will mean it.

Self-Care Tip – Empower yourself by your presence.

Questions:  How do you do what is friendly to yourself when your instincts tell you not to?  What has that done for you?  Please tell us your story.

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Safety in Connections With Others

Nami 01

Marcy came in looking like a question mark.  Despite her gorgeous face and swank, she still looked uncertain.

Marcy was born into chaos.  Get this.  Her father who spent her whole childhood using drugs, alcohol and strange women, who was emotionally and mentally absent most of her life, who is possibly still using, is the one person in the whole world Marcy calls her confidante.  “He gets me.  I can really talk to him.  Even my husband doesn’t understand me like he does, you know, emotions.”

Marcy, despite years of fear, panic attacks, the survivor of abuse and neglect was clinging to her dad.

Marcy was lost in the headlights of the oncoming life.  She thought after having spent her entire life afraid, it was time to heal so she though she’d give medication therapy “a try.”

After initiating medications for Marcy’s post-traumatic stress disorder and after her panic-attacks stopped, Marcy started attending NAMI.  What a believer in NAMI she became!

They just make it easy for me to talk about myself, say things I can’t even tell my husband, and they know what I’m going through.

Listening to her talk about them was letting fresh air into our room.  Hope floated in.  Now Marci doesn’t believe that her dad is the only one in the world she can connect with at this level.  Now Marci does not feel as alone.  Why?  Because she went and got connected.  She whacked through the briar hedge of misperceptions, biases and insecurities between her and others.

Marci still thinks largely of her father, but he’s not the only one.  He has some competition to the throne which means, Marci has a better chance of being influenced by someone healthier.  Rather than attack Marci’s attachment with her Father, NAMI is giving her more to fill her heart with.

Self-Care Tip #285 – Find safety in healthy connections with others.

Questions:  When have the connections in your life saved you from warped views?  How do you think we could do better with this?  Please tell me your story.

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Me! Where Emotions and Behaviors Come From

steps 15

Image by Erik - parked in Cairo these days via Flickr

We are doing a narrative series on understanding where emotions and behaviors come from:

  1. Emotions Are Contagious – Emotions shared
  2. Our own Emotional Junk – Emotions hidden
  3. Positive Emotions and Behaviors are Contagious Too 
  4. Our Conscious Self is Our Board and Paddle at Sea – Small conscious self and BIG unconscious self
  5. Biopsychosocial Model – Biological, Psychological, Social selves
  6. Me!  (Today’s Post)

What we have covered so far in our series is that we know emotions are contagious.  We know that if we take care of our own first, we might not be as “susceptible” to negative “contagion” in turn and perhaps, be more available to giving and receiving positive “emotion-contagion.”  Further, we hope that if we do this, we might be able to choose to be with people we love even if they don’t do their own self-care.  We can have that connection without personalizing what isn’t about us.  Sigh.  That is nice, isn’t it?  Then …out at sea (away from our narrative for a day,) we talked about the pleasure in engaging with what bits of biology are directly available to us and the relationship we maintain with the big expanse of our unconscious biology.  Yesterday we reviewed our biopsychosocial model as a tool for further understanding where our emotions and behaviors come from.

Self-Care Tip #272 – If you are ever unsure about where your emotions and behaviors are coming from, it is always safe and true enough to say, “Me.”

Where do emotions and behaviors come from?

Me.

For example:  Me <–> Emotions Shared <–> Me <–> Emotions Hidden <–> Me <–> small conscious self and BIG unconscious self <–> Me <–> Biological, Psychological, Social selves <–> Me… round and round, starting and ending and starting with Me.

Rob and Yesenia were both breathing hard.  Rob was pale and Yesenia flushed.  Where to start?  With Me.  This is what I shared with them both.

Put your spouse down and take three steps back!  Own your own self.  Take care of your own self.  In the process, you will be able to pick each other up again and share love.

Questions:  What are you holding, carrying, using to explain where your emotions and behaviors come from?  How have you been able to put those down and hold yourself?  Please tell me your story.

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Taking Care of Our Own Emotional Junk Empowers us Not to Take Care of Theirs

Women Only - Choose your Favourite-Bangalore-n...

Image by najeebkhan2009 via Flickr

Yesterday we started a narrative series on understanding where emotions and behaviors come from:

  1. Emotions Are Contagious
  2. Our own Emotional Junk (today’s post)

Yesenia and Rob chorussed,

Yes! I am worse when Yesenia is not doing well. Who can cope around that!?

Yes! Rob is making me sicker!

Saying emotions are contagious is not the same as explaining causality or fault. It’s talking about an influence. I didn’t want Rob to misunderstand me. Saying emotions are contagious is information to use to empower us; not to make us feel like victims. It is to help disclose our own vulnerabilities, our own needs and our own quest towards healing and presence.

But how to be present with “falling knives,” as Cindy described this in yesterday’s comments?

It starts and ends with Me. So getting back to Me simplifies things and short-cuts our confusion.

It’s easier for us to be around so much charged air when we have already gone toward our own flaws, pain, emotions and anxieties. It is easier for us to not make something personal that isn’t if we have already stayed in our own nasty space for a time, did that process over and over, and each time stayed long enough to see what is there/what will happen until we realize – not much. (That was what I like to call a “super-sentence!) Taking care of our own junk helps us be available for other people when they are spilling theirs. We are less controlled by shame and fear.

This may not happen when complicated by our brain disease. Personalizing things may be inevitable if we do not get medication therapy. Being present with our own journey might not happen without medical help.

Sometimes when we are ill, we feel like we are spectators of our own life story, standing off to the side, just watching the show. With healing, we join with that living active self and can be present and whole. With healing, we don’t have to personalize someone else’s emotion-spills. With healing, we can improve our quality of life. When they don’t fight for brain health, such as taking needed medications, or whatever it is that would have been friendly for them to do – we don’t have to make it about us.

And! And if we choose to, we can be with them. We can be with the people we love! Isn’t that great?! Even when they don’t do their own self-care. Even then. Or not. But we are choosing now rather than reacting defensively.

Kaily said it yesterday like this,

Now, when I notice that my mood is starting to mimic the negative mood or negative atmosphere around me, I stop myself and realize that just because those around me are negative, stressed, uptight, etc., I have the choice and the power to stay positive and at peace within myself. Just because everyone else is jumping off the cliff doesn’t mean that I have to follow.

Self-Care Tip #268 – Taking care of our your own emotional junk helps you not try to take care of theirs.

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Emotions Are Contagious – Such as, Anxiety.

We are starting a narrative series on discussing where emotions and behaviors come from:

Anxiety bubbled, frothed and infused the air.  Yesenia could barely catch a breath.  Here’s the thing.  Yesenia is not in treatment with me.  Her husband, Rob, is.  Yet it was Yesenia who filled our space.  There was barely room for Rob and I to sit or speak with all that anxiety around.  Rob was breathing faster every moment and his face didn’t have much color.  …Where to start?

Unknown source

(What do you think? think?  think? echo echo echo…)

It was too early in our work together to expect Rob to know this, but emotions are contagious.  Anxiety is very contagious.  To say this another way we could say, the emotion of anxiety around us influences how our genes express themselves.  It is further explained by saying that my “patient” isn’t only Rob.  My patient includes the system he lives in, i.e. his home milieu, wife, kids, work and so forth.  But especially his wife.  Because of Yesenia’s untreated emotional disease, Rob’s emotional disease worsens.  The inverse is true as well and so we go round and round gaining momentum.  Like a big ball of hard packed snow gathering speed and girth as it rolls down the mountain, anxiety grows.  …Where to start?

(What do you think? think?  think? echo echo echo…)

Self-Care Tip #267 – When suffering from emotional illness, remembering that emotions are contagious (no matter who they come from) is useful to your self-care.

Questions:  How have you experienced the contagion of emotions?  or seen it play out in others?  Please tell me your story.

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