This one chance

This one chance

My morning clinic had been hectic but not very interesting. I felt bad for the student who had been assigned to me – we had not seen any unusual cardiac pathology. Instead, we had heard a long litany by a patient with a recent heart attack who for the life of him could not stop smoking, and been forced to listen to a tirade by an anxious wife who was unhappy with her husband’s nursing home and wanted to take him home for end-of-life care. A large part of that visit had consisted of calming the wife, and hunting down a new oxygen canister to replace the empty one that the nursing home had forgotten to check on when they sent the patient on his way to my appointment.

I sure hoped the next case would offer something more exciting for the student. It was a new consult, an elderly man, wheeled into the office by his wife. When I asked him if he could get out of the wheelchair, he easily acquiesced though I could tell his wife was uneasy. She didn’t say anything, though – it seemed that this was the custom, defer to the husband. He tried to flop onto the exam table, steadying himself with the cane – and almost fell. The student jumped to catch him, eagerly – he was a freshman, in the beginning of his first year, and had not seen a real patient until that day, so to him, catching a patient from a fall was new. The patient grumbled that he was ok, and the wife rolled her eyes.

As we talked further, I couldn’t quite figure out why this patient had been sent to a cardiologist – he had some nonspecific complaints that I could not entirely make sense of, either because he was a bad historian by nature, or had become one after his stroke. His wife tried to supplement the history but due to her language barrier and her general reluctance to take the center stage in the storytelling she was not much help either. In the end, I decided that an objective cardiac test would help alleviate everyone’s concerns, and ordered it. I then spent another half of the visit going over heart-healthy lifestyle, and addressing other, not-heart-related safety and preventive issues that I thought were important for him, such as walking safely, getting physical therapy and doing regular exercises to prevent falling.

After the visit, I helped to wheel the patient back to the waiting room, and saw a little girl jump up from the chair and run over to take the wheelchair away from me. “Our grand-daughter”, the wife said. Oh.

I turned toward the girl: “How old are you?” She proudly extended all the fingers on one hand: “Five!” Somewhat surprised that the little girl had been left all alone in the waiting room, I nevertheless tried to make some conversation.

“So,” I offered somewhat lamely and predictably, “what do you want to be when you grow up?”

“A cop!” came a self-assured and unhesitating response.

The girl then looked at me, pondering, her brunette curly mop shaking, gold earrings glittering, and then offered somewhat less confidently, “And a doctor.” After a moment, the curls bounced again. “Yes, a cop, AND a doctor”.

I smiled. The student laughed. We said our good-byes to the patient and his wife and returned to the exam room to finish the paperwork.

As I stood at the desk, however, I found my attention wandering. I saw other little girls in my mind – myself at age five, uncertain and shy, my little niece at the same age, more confident in what she wants but not sure yet of her place in life. My feet took me back to the waiting room.

“Here,” I offered the ears of my stethoscope to the little girl who was still guiding her grandfather’s wheelchair, “Do you want to hear what your heart sounds like?”

“YESSS!” the enthusiastic reply came quickly.

“Ok, here is your heart – ‘tick-tock, tick-tock’ … and here are your lungs, ‘whoosh-whoosh’ – can you hear it?”

The curls bobbed up and down again as the girl turned to her grandmother, spell-bound: “That was my heart! Gramma, I could hear my heart!”

After I had retrieved my stethoscope from the small hands, the student and I parted the second time and went back to the exam room. While I was trying to make some teaching points about the case, the excited squeals were still very audible from the waiting room, “The doctor! My heart! It went tock-tock! I could hear it!”

The student laughed again. “And just like that, you changed this girl’s career trajectory for life,” he offered, jokingly.

Well. Probably not. But who knows? One chance is all it takes sometimes.

Maybe the little girl will become a doctor. Maybe the man with a heart attack will stop smoking. Maybe the wife of the seriously ill patient will be less distraught, knowing she can call on my help. Maybe the elderly man will not fall at home.

Maybe.

***********

I never got the name of the little girl. I don’t remember the name of her grandfather. By next week, I will not remember the name of the first-year student who spent the day observing my clinic. They will likely not remember my name. I got this one chance with all of them.

One chance. Every day, filled with one-time chances.

That is a lot of maybes.

***********

Self-care tip: Watch for one-time chances in your everyday life. It may make a change – albeit small – in your life or in someone else’s.

Question: Do you recall a time when you took a one-time chance, or missed one? Tell us your story.

 

It’s not my fault

It’s not my fault

The new on-call resident – Jonathan, I think was his name? – was trying to present another admission to me. He was visibly annoyed.

“…so, the ER calls me and says, you have a patient with chest pain, and I say, what kind of chest pain, and they say, oh, we don’t know, but the patient needs to be admitted, and then I go down and try to talk to this guy, and he is just the worst historian in the world and just stares at me, and says I don’t understand him, and…”

I cut through the never-ending sentence. “Let’s just go down and see him together, hm?”

The light was on in the ER urgent room but I couldn’t really see the patient. The gurney had its rails pulled up, and I could make out a small lump breathing heavily under the blanket. We stepped closer and I called out,“Mr Jones? We came to see you, can you come out from under the blanket?”

The top of a knitted cap made an appearance, with two dark eyes peering out from under it. “Mr Jones?” I tried again. “I hear you were having some chest pain? Are you still having any now?”

The eyes got suspicious. “Ahah,” came a noncommittal reply.

“Well, can you tell me more about it?” I persisted.

“I waited until the morning”, was a cryptic response.

“What do you mean, you waited until the morning?”

The resident interrupted. “He was actually here last night and was sent home, and he came back today morning saying he has chest pain.”

I looked at Mr Jones again. It is not uncommon for patients who have no place to be, to complain about chest pain as they know it is a sure way to get admitted. This guy really did look sick, however. After some grumbling, he sat up for an exam. Clearly, he was in decompensated heart failure, and had been for a while. I motioned to Jonathan to step outside the room. “Is there anything about heart failure in the chart?” I asked him. “Yes, he has had heart failure for a while now – methamphetamines,” he added quietly under his breath, “EF, ten percent, but noncompliant with treatment, still meth positive last month though he denies using”. EF stands for ejection fraction – the normal being 60 percent – the lower it is, the weaker the heart muscle. I glanced at the monitor – heart rate at hundred and ten, blood pressure 80 systolic – he really should have been admitted last night. The ER attending had completely missed the heart failure part. I suppose Mr Jones didn’t make it easy.

I tried to get a little more information. “Mr Jones, when you say you waited until the morning, where exactly were you waiting? Did you go home?” The patient was evasive. From the bits and pieces of his broken sentences, it became obvious that he had somehow hid himself on the hospital grounds all night and come back to the emergency room when he thought the shift had changed and he would get a chance with a new physician. I decided not to press him further until he had gotten a little better.

As the day progressed, more wrinkles appeared in Mr Jones’s case. It turned out he had been diagnosed with a lung mass two years earlier and biopsies and surgical follow-up appointments had been scheduled that Mr Jones had not kept. He had not seen a health care provider other than the emergency room for at least couple of years. His heart disease was thought to be related to his drug use – initially, he had admitted heavy methamphetamine and alcohol use that he now denied. Unsurprisingly, his urine drug screen still came back positive.

****

The next day, Jonathan and I went to see our patient again. He was breathing a little better but had an expressionless look that was speaking louder than any words. I decided to press for words.

“Mr Jones, what do you know about your cancer?”

Blank eyes turned toward the wall.

“Well, they said I had one but then that’s the last I heard about it, couple of years ago.”

“Why didn’t you keep your appointments then?”

The eyes blinked rapidly. “Well, I didn’t know I was supposed to keep them, did I? They didn’t tell me what I was supposed to do…” The tail-end of the sentence ebbed away as Mr Jones was feebly trying to come up with a justification. The defense was half-hearted, as if he knew there was really nothing to say, and nothing he said changed anything anyway.

Jonathan at my side was struggling to remain silent. As a young physician, he was taught to help people, and it was frustrating to him that the help had not been accepted. Mr Jones was a veteran – all the healthcare for his cancer would have been free. Now it was too late. For Jonathan, it seemed like a failure, and what young physician likes that?

****

In the end, we were able to stabilize Mr Jones’s heart failure but his cancer was already spread to most of his body and could not be treated. He was no longer able to take care of himself, and was packed off to the nursing home for the rest of his short days.

It had been a good learning case for the residents – not because Mr Jones had presented a medical challenge – but because he had taught the limitations in our communication skills. We had never been able to engage Mr Jones in any meaningful way, and he remained as absent on the day of discharge as he had been on admission.

As an attending physician, I struggled to make sense of it to myself, so I could explain it to my residents. Was it supposed to make sense? Had we failed somehow, or was the outcome already determined before we got involved?

I tried to put myself in Mr Jones’s shoes, knowing for years that he had cancer but putting it out of his mind. Was he sorry now? Or was the current indifferent attitude merely an acceptance of his fate, knowing deep down that he would rather have chosen those carefree years again, living alone in his trailer, drinking, smoking cigarettes and weed, and allowing himself a hit of meth whenever he could spare the money? He had missed countless procedures and surgeries, doctor visits, blood draws, and lectures by the likes of me about his drug habit. Now in the end of these years, the choice was no longer his.

Remembering the vacant stare, I suspect Mr Jones may not have known himself.

****

I told Jonathan that he had done well, and that he should not give up on people. I suspect there will be time for more cynical life lessons later.

 

Self-care tip: Good intentions do not always result in good outcomes. Recognize when your help is not accepted – it is not your fault.

Question: Have you felt helpless in a face of suffering or personal struggle, and found yourself unable to help? Tell us your story.

Violence and Originality for friendship

Guest Post!

…keep reading…

Image

Learning new ideas and concepts releases Dopamine, the “feel good” neurotransmitter/messenger.  I find this theory consistent with my personal experience as I am studying for the boards.  The new concepts, when I grasp them and link them to things I already know, do seem to bring a tiny packet of fell goodness.  So, as I study, i really try to capitalize on this mechanism of feel-goodness.  Maybe I can get addicted to learning.  That would be a great addiction.  I think in some ways, I already am.

Using Dopamine in enhancing our everyday life and getting addicted on life:  Creative expressions can cause release of Dopamine – proven by both science and by our everyday observations of living our life.

Gustave Flaubert, of Madame Bovary, famously said:

Be regular and orderly in your life that you may be violent and original in your work.

To me, this fits.  I find I don’t need to lead a wild and dangerous life.  I don’t need external thrills.  I get my Dopamine from being able to be violent and original in my thoughts and ideas – Quite the thrill.  The regularity and order I try to effect gives me the time and space to be just that – violent and original.

The most cutting truths live in works where the artist is violent and original.    Flaubert, of Madame Bovary, said, “be regular and orderly in your life so that you may be violent and original in your work. “. He is fiercely unapologetic in the way he worked.  I like that.  Be violent and original in one’s work, all the while freeing one’s mind to achieve that end by being regular, mundane, and orderly in one’s life.  The creative juices that thusly pulsates in the artist’s veins more than makes up for the seemingly boring and orderly exterior.

Questions:  What role has learning played in your “feel good” self?  What helps you be violent and original in a way that is friendly to Me?  How do you channel your ferocity in the most friendly way?  How has the boredom otherwise affected your quality of life?  Please comment and tell us your story.

Self-Care Tip:   Be violent and original in a way that is friendly to Me

 

Dr. Chin Tang is in his last year of psychiatry residency training, on his way to Fellowship in psychopharmacology through University of California, Irvine.  He is happily married with much adored children.

Dr. Tang says he likes being my friend because in so doing, he is more “emancipated to be as weird and eccentric” as he is, by nature, meant to be.  Dr. Tang really knows how to make a girl feel great.  Thank you, Dr. Tang! 🙂  Keep on.

Remember, You Are Free, Even When You Accept Help.

Schep

In becoming a friend to yourself, we all use tools; a hoe, a shovel, a bottle of medications, friends and lots of floss.  Not all in the same moment or we might get hurt.  None of the tools we use are meant to been seen, when looked at, alone as a weapon to box us up.  They are each in turn just a tool to be used to improve our ability to be friendly with ourselves.  Don’t get paranoid.

This is important to remember, the more effective the tool becomes.  We build suspicions when things work that well, like ladders in case we need them.  But if we find ourselves miming walls that no one else can see, it really is just about Me.  The walls, the box, the perception of being defined too easily are coming from Me.

If you’ve ever heard about the biopsychosocial model, you may have experienced this sensation.  Each paradigm introduced looks more and more like brick and mortar, and you find yourself acting out the runaway-bride gig.  You are not that special, nor Me.  We are a construction of unique complexity, each of us individual and undefinable.  However, none of us are so special that we can’t use the tools.  None of us are so special that we can be captured; an exotic bird never before seen.  We are in fact too commonplace in our inability to be boxed, shut up and drawn in.    Let that twist your thoughts.

In the biopsychosocial model we use the paradigms as given to us through biology, psychology and sociology to improve our insight and what ever we hope to accomplish thereafter.  It’s a collection of tools.

When a patient comes to see me, looking for help, sometimes they apperceive the tools.  They become distorted towering constructs.  The biopsychosocial model looks like mechanisms designed to take away freedom rather than improve access to freedom.  It is a lot of unknown to be dosed with and it is a natural response.  But the biopsychosocial model is rather a collection of highly effective, (even suspiciously effective,) ways to improve brain disease.

Self-Care Tip:  Remember, you are free, even when you accept help.

Questions:  When have you perceived that you were being boxed in by the “help” coming your way?  How did you reclaim your sense freedom?  How did you manage to still get help?  Please tell us your story. 

Insight Isn’t Worth Much For Self-Care… Or Is It?

Autumn Red peach.

Image via Wikipedia

Much of self-care is about taking accountability for our choices.  Choices come in deliberately – “Oh my!  I’m old already!  It’s time to have a baby!”  Or not deliberately – “Oh my!   He’s hot!  Whoops!  I’m having a baby!”  Both choices brought a baby.  Both choices accountable by Me.

In interpersonal exchanges this is ever in debate.  From parenting to being parented, from spouses to friendship and all up and down the Mississippi river – the martyrs stake rarely collects dust.

That baby keeps her awake and she can never sleep with her husband any more or else no one gets any sleep.

That’s a lot of responsibility to put on those tiny infant shoulders.  Don’t you think?

Mom just runs my life!  I have things to do but every weekend she expects me to be by her side!

Mom may run your life but you are choosing for her to do it if that is true.

The scenes could continue on our imaginary screen, but our own are enough to keep us busy.  We don’t need others from others to get the point.  But insight only takes us so far.  Sometimes I get all grumpy and say, “Insight isn’t worth much.”  Because, we all know that we don’t choose many of our emotions.  We are learning here at FrientoYourself.com also that we don’t choose many of our behaviors.  Insight sits in us like a stone fruit.  Eat it up or don’t, eventually all we have left is a stone if we don’t have the biology to work with it.

Self-Care Tips in a stone fruit:  To take care of ourselves, to take accountability for our choices, to use our insight for more than a midmorning snack fruit – we must have the working body to turn insight into production.  One stone fruit can germinate and grow.

Question:  What relationship does insight have in your self-care?  What limitations does it have in your self-care?  please tell us your story.

Run Away Before You Self-Destruct – Keep Yourself Safe

Run Away Before You Self-Destruct – Keep Yourself Safe

This is a slight remake from 7/25/10. Hugs to all.

____________________________________________

When you feel the pull to do something that isn’t good for you, turn away from it. Do something that you can stand doing at the moment that won’t make you hate yourself now or later.

In the evenings, when the kids are just in bed, the backlash of the day seems to have a few last flicks. Despite the anticipated quiet, my shoulders are tight. Dusk, when the land meets the sky, is when I feel like eating …chocolate specifically.

I purposefully don’t bring it home, except the darkest chocolate sold with over 75% cacao for this very reason. It’s so dark, it’s practically bark.

Home is my safe place and I need to know that it is as safe as possible, even from me. I used to bring treats home that were to be eaten in moderation, but I found that when the monster in me crept out. I’d board myself up in the pantry and polish it off. That would turn me to self-loathing. It was a cycle. I got tired of being my enemy and knowing what was coming next.

Now, I choose to simply go out for my chocolate. I eat what I want when I’m out, when I’m less likely to eat myself into despair. Now, when I’m home, I can pick a different fight rather than fighting the urge to closet eat. Home is a little more safe for me.

Tonight, the kids went to bed ok, but I still took my turn around the fridge and pantry, even though I knew there was nothing, absolutely nothing, I’d want to eat in my house. I am in danger now of developing something of a ritual in this rummage around the kitchen. The good thing is that when I do make the turn, it leads me to the thought of just going to my bike and riding. Tonight, after a 30 minute spin, while watching the last 1/2 of the première to Glee, I am good again. I’m thinking about the muscles in my legs and the way my body doesn’t walk as heavy as it used to and I feel good about myself. Just like that, I feel a little less self-loathing. I feel more safe.

Self Care tip #1 – Run away before you self destruct. Be a friend to yourself.

Questions: Have you found a safe place? What is keeping your home safe for you? Please tell us your story.

Gathering Friend to Yourself Blog-Post References:
Choosing Safety:
  • basics on Weight Management 2011/06/25
  • Trusting our Clinician, or Not 2011/05/17
  • Self-Care Works You, Pushes You, Tires You Out Until You Are Happily Spent On Your Friend – You 2011/04/25
  • Participate – Work as Part of A Team With Your Medical Providers 2011/04/12
  • Choosing Connections – Take The Good and Take Care of Yourself 2011/04/04
  • Check Your Read. Even When You Feel Shame, Bullied and Herded, You Are Free. 2011/03/26
  • Living Where We Feel Safe is Part of Self-Care 2011/03/20
  • Afraid of Meds 2010/09/19
  • Get in Someone’s Space 2010/09/08
  • Run Away Before You Self-Destruct – Keep Yourself Safe 2010/07/25
Self-Loathing:
  • Number One Reason For Relapse In Mental Illness 2011/04/07
  • So Many Choices, So Little Time …For Self-Care 2011/03/05
  • Say, “I Can’t Control This” When You Can’t 2011/01/31
  • Emotions: The Physical Gift We Can Name 2011/01/06
  • Escape Self-Loathing 2010/10/29
Breaking Negative Cycles:
  • Loving Me without ambivalence – Perfectionism v. Passive Surrender 2011/05/28
  • You Can’t Barter With It. Sleep. 2010/12/03
  • Regardless The Reasons Not To, Go Get Your Sleep 2010/11/22
  • Choose, Gladly, Using Resources 2010/10/13
  • Sleep Hygiene – my version 2010/08/29
  • Pay a dollar 2010/07/29

Become a Better Friend To Yourself In and With Your Culture

"Energy Crisis!" ...

Image by Toban Black via Flickr

A barrier to getting friendly with ourselves might be our culture.  The inverse of course could also be true.  ‘Takes culture to design the flavor of our homes and habits, our communities and the energy between us and them.  Think, TV in the bedroom, alcohol tasters offered to children, books or the absence of books on the floor and shelves.  Think religion and diet, family meals or take-out.  The way we deal with shame.  Culture is a gate-keeper for many of us.

We could call our culture, the way we live together at home, the balance between each family member and the flavor of emotions there.  Culture might be layered, wrapping us from one balance of energy into another into another creating our own galaxy between each point of light.  In any room, if we look we can find culture.  In any space outside, there is a flavor telling us how to maintain the balance between me and thee.

I don’t know if sociologists look at culture this way yet, but I hope they will.  With all that observing, data gathered and surmising, I hope they study how the individual can be a better friend to herself in “this” culture.  And then I hope they tell us.

Becoming an active designer of your culture is not always easy.  But it is friendly.

Questions:  How has your culture introduced you to your friend, “Me?”  How have you been able to develop a more friendly culture for Me to live in and grow in?  What’s still keeping you?  Please tell me your story.

No One is Choosing For You – Know Your Choices For Health

Yesterday we asked some pithy questions re: Why Psychiatry?  Your responses were received with gratitude and humility.  It takes courage to understand our connection with psychiatry considering ongoing stigma.  Today we’re reviewing that some and taking it one bit further.

When referred to a psychiatrist for medical care, we can feel confused.

Why is my physician sending me away?  Does this mean I’m at my last resort?  Does this mean I’m that sick?, or,

Does he think I’m crazy?  I’m not insane!, or personalizing with,

Does my physician not want to work with me?  I’m that bad of a patient?  Cast off?

Our expectations when we first see our psychiatrist are often also similarly reactive.  Maybe,

I’ll give this one chance but if she doesn’t fix whatever it is that’s going on, I’m out of here. 

I am not going to be dependent on medications!

I do not want to be made into a zombie!

Are we looking for a cure?

Also, we might be confused by the amount of time that she spent with us the first appointment as compared to our follow-up appointments.

I need to talk about my problems!  I need time!

There’s a lot to take in.

Unfortunately, when we are referred to a specialist, often our referring physician hasn’t effectively communicated as to why we are being sent there.  This is for many possible reasons, including Me not hearing him.  Many other reasons are also understandable with insight but we aren’t always given the opportunity to hear the inside story of why our physician does what he does.  That doesn’t mean we have to accept it.  But if we do, we did and it’s our choice.

Choice

Image by Scarygami via Flickr

We have choices.  Before accepting the referral, we can ask, Why?  Keep asking why until we are satisfied with our level of understanding.  Schedule a follow-up appointment with the referring physician if necessary to gain more time if we think we need it.  Sometimes, despite our physicians best efforts, we won’t understand as well as we’d like and we have to make our choice with the information we have.  We can read up on our symptoms ourselves.  I read in Twitter from @NathanBransford,

The 11th Commandment: Thou shalt not ask someone a question thy could easily Google thyself.

That’s ridiculous although I cracked up.  The World Wide Web comprehensively and including Google or any other source within that World Wide Web are not designed to practice medicine.  When we read something, we need to ask for qualifications behind the author of the print, references and so forth.  The Internet is a tool worth our attention but you decide how far you are willing to take what you read before you consult with your own physician.  I think if Doctor Seuss were alive today, he’d write a book (or many) about health care; Oh The Tools We Can Use!  (Maybe Carl and Thysleroux will do a series or a post on this?  Should be fun.  – Asking, “Why?”  Becoming our own friend.  Connection.  Going towards shame, pain, anxiety.  Growing bank – and more.)

And so that brings us to today’s questions:  What choices do you perceive you have in referrals like these?  In your continuing medical care?  In your ability to collaborate with your physician?  In obtaining an understanding of your illness(es)?  Please tell me your story.

Self-Care Tip – Grow your understanding of your choices for your health and medical care.

Related Articles:

  1. Stay Connected For Your Sake and For Theirs
  2. Connecting To Others Is a Condition of Freedom
  3. Safety in Connections

She Is Worth It, But Maybe Not Because Of What You Think

Woman in satin dress holding mirror

Image by George Eastman House via Flickr

She is worth it!

Have you said that? Half crazed from this-way-that-way behaviors, your battered psyche crawls out of the smoking heap from your most recent relationship collision. There are times when this is absurd to continue. But have you ever seen those people who crawl out smiling? Sure their eyes are rolling around on their face but they are smiling. That might be you too. And there’s a reason for it. However the reason may not be what you think.

She is worth it!

I’m not disputing “her” value in this admirable exchange that takes all your energy. But what I do dust off from the good “encounter” we just spoke of is that although she may be worth it, I propose that isn’t the reason you think it is. The reason is you.
You find pleasure in it because of what it does for you. You think you are worth it, and you are.

Even the Bible says,

We love because He loved me first. 1 John 4: 19

We love because of what it does for Me. God isn’t surprised by that or looking down His nose at our motivation. It sounds like He is actually embracing it – fully consented.
Remember when we talked about inevitable selfish motives, secondary gain and the absence of altruism in us? Is that an ugly thing about us? I don’t think so. It is what it is.

Now this does not evaporate the connection, the realness of the exchange between two, the value of the bond or its quality. See blog-post, Things Will Always Be About “Me.” It does nothing else but discuss the motivation. I believe understanding our motivation to remain in a relationship is important not to devalue it or value it differently, but to help us take care of our own selves.
She is worth it. That isn’t the question.

What can go wrong in our self-friendship when we think we are motivated by reasons outside of what is in it for Me? What do you think? I think it distracts us. It’s wasted energy and we don’t have enough to waste. Getting it right, puts energy into us. Getting it wrong, takes energy away.

Yesterday we talked about wanting to connect with someone who has character pathology. Any of us can say that this is hugely energy depleting at times. If we think we are doing this for any other reason than for ourselves, we will get “burned” much more often than we might if we understand that we choose, consented, freely and for ourselves. We will wear the victim-crown and die the death of worn out do-gooders who lived to do nothing really but bemoan their special suffering existence. See blog-post, Please Don’t Say “But.”

Self-Care Tip – Do things for yourself with self-knowledge.

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.

Choice and Biology – Where Emotions and Behaviors Come From

Three Legged Race

Image via Wikipedia

I left the light on outside, waiting for my husband to come home.  He was gone, though, to a meeting and wouldn’t be back until Friday.  Some bit of automatic thought current made me flip the light switch and before I realized what I’d done, I flushed.

My husband’s eyes aren’t good and he doesn’t see well without a light.  I can.  I don’t “see” so to speak, but somehow I know where things are and can find my way in the dark.  I’m not a bobcat.  I just remember the way things look by the emotions I felt around them.  This is what was happening that night.

I flipped the switch and there he was.  Walking toward the door.  Distracted.  Fitting his key; almost home.  This was all in the moment that it took me to feel happy and then disappointed remembering he was away.

I turned the light off then because I’m not daft.  But it made me think about what sets our behaviors and emotions in motion.  In that moment, finger to the switch, up, anticipation and disappointment – in that moment, I didn’t choose what happened by the cultural definition of choice.  I responded to patterns that many choices I’d made before had laid down.  Tracks in my brain, hedged and maintained by recurring choices, along with design; my emotions and behaviors also an expression of my temperament.  These moved with each other.  But were they moving along the way we generally think of them, like a three-legged race?

Who was leading who?  Trip.  Get up!

One, two, one, two.  Step.  Step.  Step.  Step.  

And in that moment, my layers of choices were counting out with my biology, “One, two!”  There I was, participant and audience.

When we think about where emotions and behaviors come from, culturally we view them as if they are awkwardly related.  As if biology and choice are tied together at the ankles, about to trip each other up.  We call out to them, hoping somehow they might not show the public how little they know of each other’s rhythms.

But you can see the ridiculousness of this.  Choice and biology are in no way separate.  Design forbids it.  The question of where emotions and behaviors come from in itself reveals our confusion.  They come from the same place.

I can hear the concern that this eliminates free-will.  Answer …”But why?”

After these thoughts that night, I turned the light back on.  I preferred how I felt when I thought my husband might arrive soon.  I chose I guess.  What else could I do?

Questions:  What does it mean to you to fuse choice and biology in the discussion of emotions and behaviors?  How does your culture view this?  Does this affect the way you care for yourself?

Self-Care Tip #282 – Don’t deny the choice available to you to feel and behave as you wish, where that wish surfaced from and the tools you use to make them.

Stop! Don’t Stop! – Affecting Our Practice Of Medicine and Other Agendas

Self-Care Tip #281 – Be aware of how your “Stop!  Don’t stop!” behavior is interfacing with your agenda.

One of the challenges in practicing medicine is the inevitable “Stop!  Don’t stop!” petitions.

stop & go

Image by Joseph Robertson via Flickr

It’s similar in a few ways to being a shoe cobbler who receives clients that don’t want her to use leather.  Ms. Cobbler spends 40-60% of her time with clients persuading them of her capacity to use leather, the objective and subjective evidence behind the use of leather and empowering her clients to wear their leather shoes despite public opinion.

This sounds silly and is not meant to be disrespectful to patients, including myself as a patient of physicians and my own difficulties being a patient.  It is only to describe the forces we are all working with when we work together in medical care – physician and patient.

Quenn came in reminding me of this.  Quenn was a 32 year-old married mother of three, who complained of trouble swallowing, sleeping and ability to feel pleasure over the past two months.  She had struggled with this after her mother died nine years ago, but the problems went away over the following year.  However nine years-ago, Quenn was not a mother.  Nine years-ago, Quenn could shake, stay in the house with the shades down, silent or crying loudly, not eating lying in bed for days and if she wanted, nine years-ago no one would know.  This time however, Quenn told me she was desperate.

I have to get better!  This time, I’ll do anything!  But please start with something natural.  I don’t want to get addicted!  I’m someone who never does meds.”

Quenn, why are you seeing me?  

This is challenging for everyone.  Together, the physician and the patient work with this influence on their agendas.

My brothers and I used to play a game on each other when we were kids.  Maybe you did this too.

Stop!  No don’t!  Stop!  No don’t! Stop!  Don’t!  Stop! Don’t! Stop! Don’t stop! Stop! Don’t!  Don’t Stop!  Don’t Stop!

And for some reason that was hilarious to us.  I like to remember this when I’m in the office and smile despite being played by the “Stop!  Don’t stop!” behaviors and emotions.

Questions:  How about you?  How are the “Stop!  Don’t stop!” behaviors and emotions playing on your agendas?  Please tell me your story.

Summarizing What You Say About Friendship With Yourself

Friendship

Image by Rickydavid via Flickr

In Summary:

Q1:  What does being “a friend to yourself” mean?

  • self-awareness
  • Acting on that self-awareness
  • Grieving who I wished I was
  • Valuing Me

Q2:  What helps?

  • Knowing where emotions and behaviors come from
  • No self-injury or aggression to others
  • Knowing God
  • Gratitude/self-inventory
  • Support from outside of Me
  • Personal check-points in place to offensively guard again self-sabotage

Q3:  What doesn’t help?

  • Perfectionism
  • Ingratitude
  • Untreated or treatment resistant brain illness
  • Stigma
  • misdirected efforts to feel empowered (such as, preoccupied thoughts = control)
  • isolation
  • habit

Q4:  What helps despite this?

  • Self-forgiveness
  • Realism/Without catastrophizing
  • Tenacity
  • Remembering what your self-care has done
  • Presence

Q5:  What is the relationship between biology and choice when it comes to understanding where emotions and behaviors come from?

  • Biological template determines function
  • Choice is there for using that template

A Testimony of “Being A Friend To Yourself,” From Bipo Blogger

You might recognize these five questions from yesterday’s blog-post.  Thank you for your testimonies.  Is there anything more powerful than hearing someone’s personal story?  I think not!  Here is what Bipoblogger has to say.

Q1:  What does being a friend to yourself mean to you in real-time life practice?

A1:  That’s easy, but not so easy, LOL!  Being “a friend to yourself” means that I acknowledge I need to respect myself, just like I do other people.  It means not sabotaging my self, plans, job, relationships, etc.  I love myself enough to not kick myself when I am down. 

Being bipolar can be so detrimental to my being, but just like normal people, I still have the need to …allow for room and time to grieve about whatever horrible circumstances (were) caused (by) the bipolar disorder.  

…Stop every once in a while to acknowledge my accomplishments and own that.

Q2:  What helps you do this one time vs. another?

A2:  Yes, I have found that BPD is in part an anger disorder and knowing the true source of the anger can help me go forward.

I have chosen to no longer hurt myself cause when I do, and anyone else, I build up layers of hurt and it hurts to start to take the layers off when I’m ready, so why even do it? …

Also it helped me so much to learn that God doesn’t deal with me the way I deal with myself or another.  I’m not a fanatic, but I just believe in what makes sense.

Q3:  What still hinders your efforts?

A3:  Wanting to be better than I already am.  Not accepting that the balance I have is better than having less or no balance at all, …(which means various kinds of) risky behavior.

Q4:  What has pushed you past those barriers?

A4:  Really just forgiving myself for how I was affected by BPD and remembering that I am breakable and valid as a human, just like all of us.  If I keep practicing a constructive way of life, I will be okay, and that has been true for the last 3 years.

Last push.

Q5:  How do you understand the interplay between biology and choice in being “a friend to yourself?”

A5:  I was created with the choice to choose how I live my life and I do, BPD or none.  Natural inclination is to do the wrong thing because I am imperfect.  I seek power, fame, notoriety and in someway someone, including myself is gonna get hurt in the process.  …People without mental deficiencies don’t experience or don’t carry out to this degree.  So in short, biologically the deficient brain makes more extreme choices, overly withdrawn or overly outward and destructive.

Whoa, I smell smoke.  I never think that hard.  LOL.

Questions for you:  

  1. Anything you’d like to share with Bipo Blogger? 
  2. If you had a blank page for this, what would your own questions be?  What would you answer?  

I’ve heard, “It Never Hurts to Ask”

It never hurts to ask and what I learned from Honda

Honda stojan

Image via Wikipedia

 

I am a believer in Honda.  They’ve won me over with their automatic doors, convenience in just about any way they can, but mostly because of their Starbucks coffee, fresh-baked cookies and 10% discounts.  “Ten percent?,” you ask.  Well, not so easy as that.  We have to ask.  Ask nicely.

Honda has, if not taught me, reinforced my once shaky belief that if you ask for something, you’re more likely to get it.  Sounds obvious but how often we don’t.  We don’t ask.  What are the barriers?  Flip it and we wonder what helps us ask?

We bring out our biopsychosocial model again.  (Hear the whip-ahhh! as it comes out of our pocket?!)

Question:  What do you find when you break it down?

Those barriers or the helps we have in other areas of our life, including with our own friend, Me.

Self-Care Tip #277 – If you want to change something, ask.  Including when it’s about yourself from yourself.

Our Conscious Self is Our Board and Paddle at Sea

Paddle away

Image by San Diego Shooter via Flickr

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

  1. Emotions Are Contagious
  2. Our own Emotional Junk 
  3. Positive Emotions and Behaviors are Contagious Too 
  4. Our Conscious Self is Our Board and Paddle at Sea (today’s post) 

Paddle boarding in the Pacific Ocean (OP) today brought me to flocks of pelicans, breaking waves and a seal who said hello.  The OP was kicked up into big swells and long-shore currents.  There was all this ocean to connect with using not much more than a paddle.  Where do the waves come from?  The moon?  The wind traveling currents of changing temperature?  And what did I have?  A paddle and a board.

Our body is about like that.  There is this huge amount of unconscious self that we are connected to but not in a direct sensory way.  Our emotions, touch, smell, hearing, taste and sight; our spiritual quotient, emotional quotient, intellectual quotients – these are a pinch of what make us who we are.  These are our summarily interpretive lens for the world.  They steer our choices and shape our understanding of reality.  They are our “paddle and board” in an ocean of biology.

Even though the things we have a direct sense of, a direct connection with and thereby implying control of is not the majority of what makes us who we are, it is such a privilege to actively engage in it.  It is what makes our life worth living.

When we think of where behaviors and emotions come from, we think of many paradigms.  But that pinch, that bit of the great enormous creation we are that we are conscious of is such a pleasure and wonder.  To not engage with it fully as we are free to do is an unqualified loss.  It is to be without board and paddle at sea.

This is not to say that we are to ignore the great majority of our biology that is otherwise who we are.  Any surfer knows better.

Self-Care Tip #270 – Do all that you can with the amount of direct awareness you are given and relish the experience.

Positive Emotions and Behaviors are Contagious Too

Chris Sacca, Google special issues

Image by dfarber via Flickr

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

  1. Emotions Are Contagious
  2. Our own Emotional Junk 
  3. Positive Emotions and Behaviors are Contagious Too (today’s post) 

What we’ve covered so far in our series is that we know emotions are contagious and we know that if we take care of our own first, we might not be as “susceptible to contagion” in turn.  Further we were left with the hope that if we do this, we might have the ability to choose to be with people we love even if they don’t do their own self-care and have that connection without personalizing what isn’t about us.  Sigh.  That is nice, isn’t it?

Yesterday, M in his usual gentle way, reminded us that contagious emotions might be effective for spreading more deliberately and more in the positive nature.

 I am encouraged and hopeful. Being peaceful can be contagious too?

Then today I read a tweet about Chris Sacca’s commencement address.

presence -> sleeping well -> breathing *ahhh* -> embracing my weird self -> presence. Thx again @sacca So good.

Well worth my time!  Sacca spoke about being a friend to yourself!  Can you believe it!?  …Ok.  He didn’t say those words or mention this blog, …or me …but he may as well have!  (Wink.)

If you listen, think and process, please tell.   I would love to hear what you get from his speech.

…Did you catch the bit about start overs?!  You know I love that.

Sometimes however, I am a real bore making this “friend to yourself” thing seem so dull and difficult.  And M and Sacca are right!  Peace and happiness are also contagious and a better effort.  To get that, Sacca tells us to do some specific things.  Did you catch them?

Question:  What did Chris Sacca say that you find useful to friendship with yourself? or others?

Self-Care #269 – Positive emotions and behaviors are also contagious and are a better effort for your friend – You.

How To Be a Friend to Yourself When Thinking About Your Bully?

I love real life John Waters freeze-frames

Image by TheeErin via Flickr

Self-Care Tip #253 – Humanize and forgive your bully.

How to be a friend to yourself when thinking about your bully?

Have you noticed that when we think about our bully, we don’t feel so good.  Just thinking about him!  Sheeze!  In our last post on bullying, Nancy said,

Wow! This one brought up WAY too much pain. I’m feeling very vulnerable and uncomfortable and hurt and stupid at the moment. 

There are jumbled emotions that flood us, such as anger, shame, helplessness, anxiety or more.  Our autonomics may even trigger, making us hypervigilant as if we were being attacked.  We are in defense mode – all the while sitting alone in a chair at our desk, in the quiet of our bed while falling asleep, or any other place of our generally hum-drum lives.  These feelings and nervous system changes come in a time and place when we are not in danger.  They come without us realizing their approach, stealth feet and skilled hands; we are in their company before we know it.

Is there no hope?  What can we do so we don’t feel victimized all over again.

Humanize

1.  Do research on the bully.  Find out about him on the internet.  See what others have said about him.

This helps us:

  1. see him as a human, mortal, without superhuman powers.
  2. feel like we are less alone in this.
  3. realize that we are not chosen, so to speak, to suffer at his hands.  He is a bully and not just around “Me.”
  4. we didn’t cause his behaviors.  He chooses his behaviors because of the same biopsychosocial paradigm that we choose ours.
  5. realize that he hasn’t chosen to do his self-care, making him more vulnerable to his own negative feelings and behaviors.

Forgive

  1. Humanizing our bully helps us move towards empathy and forgiveness.
  2. Anger debts only hurt Me and that’s not friendly to Me.

Grow our self-confidence

  1. Such as doing our own thing.
  2. Grow our own natural genius.  Work hard at it and see how it is there for us, like a friend when we are feeling pushed down.  Our friend will be standing beside us, reminding us of our value when this remembering tries to beat us down.  Our friend will be there reminding us that this negative event in our life does not define us.

Now if they continue, these rememberings, and if these rememberings are frequent enough that we believe our quality of life is affected, we may be looking at something else.  There are other medical illnesses that can disable our abilities to cope.  In this scenario, I am thinking especially about Post-Traumatic Stress Disorder (PTSD.)

In PTSD, we relive experiences of trauma (which we perceived to have been life threatening to ourselves or observed by us in other(s).)  We may also feel hypervigilant, as if we are about to be attacked at times when our lives are not threatened.  We might have nightmares and avoid things that remind us of the trauma event as well.

PTSD is easily reactivated by other stressful situations – such as being bullied.  When we have a history of PTSD that has been quiet for a time, even years, we are more vulnerable to stressors reactivating it’s symptoms.  Then, although the said stressor may not have been a life-threatening stressor, we perceive similar feelings and neurologic changes we did when in the life-threatening situation.  Then, although the said stressor may be over and not recurring, those PTSD symptoms start happening all over again and may continue indeterminately – propagated by the disease process and not our bully event.

This might be endured and it may go away in time without treatment.  But it isn’t good for anyone while it is happening.  PTSD can improve with medical therapies.

Question:  How have you been able to humanize and forgive your bully?  Please tell me your story.

What Comes To Me From Others Is a Gift

DSC_0065

Image by krystal.pritchett via Flickr

Self-Care Tip #246 – Take care of yourself and expect that what comes from others is a gift.

Do you ever ask,

Why does drama follow me?!

It is just darn hard taking care of ourselves (including taking psychotropic medication.)  Much of the rest of the world has difficulty with it too.  Despite our best efforts to go towards what is friendly, we might decide that choosing the company of un-self-cared-for loved ones is more friendly to ourselves than cutting them off.  That is our choice.  If we want them in our lives, we are not able to just take the bits that are friendly.

Some of us are more dramatically affected by this than others.  Wonder about why that is.  I’m wondering if it has to do with our different perspectives of who will take care of us.

Feeling like someone else is going to take care of Me is a trap.  Expecting someone else to find us for love, to expect leadership, to follow without accounting for our steps, to decide without knowing we decided, thinking someone else decided for us – these are traps.

Drama-icon

Image via Wikipedia

What do we expect other people to be for us?  We will interpret the drama we encounter differently when we are our own leader.  If we take care of ourselves and if we come in a state of readiness then we can offer more of these gifts and visa versa.  Gifts are free and as free of agenda as our flawed selves can give.

We embrace our emotional self, our thinking self, our judgmental self, our sensory self, embrace and live ourselves up most fully, and we are most friendly when we do it with the freedom our lives were designed for.

Drama will always come up as long as we think that someone is worth being in our lives.  We will remember that we chose them and can choose quantity of time, the volume, the reception and the degree of connection.  We can choose freely what we will do or not do with them and live and die surrounded inside of ourselves and outside of ourselves by the connections we fought hard for.

Questions:  Why do you think drama is in your life from the perspective of self-care?  Since you’ve been more in tune to being a friend to yourself, has anything happened to the drama in your life?  Please tell me your story.

Your Pain is Not Special. It Is Normal.

Self-Care Tip #243 – See yourself as special rather than your pain and know that you will find your normal again.

What is your normal?

When we were kids, we all had a perspective of what normal was.  Let’s say it was “here.”  Let’s imagine we were lovely then, nurtured and emotionally bonded.  We struggled through peer conflicts, social anxiety and rivalry.  We wanted a bike.

Two Sisters

Image via Wikipedia

Then we got a little older.  Maybe our parents divorced.  Maybe, a sibling died.  Maybe we were abused or in an accident and damaged.  Damage changes normal.  What we never would have thought would be acceptable in our lives became acceptable.  We suffered.  We lived.  Life was indiscriminate and ignored our status.  We think there must be a mistake.

What is our normal at one point, filtered through remaining hopes, grew into regenerating fantasies, through real potential and it moved again.  We are older now and more suffering comes.

Where is our normal?  We survive our child, our own dear perfect boy, hanging from a tree.  Normal?  No dear God!  No!  And we continue to live.

Two years.  Two years are what it takes for our biology to catch up to the shock.  Two years are what it takes for us to begin to accept and realize that in this new normal we care again.  We choose it in fact.

People don’t remember his name or talk about him and we can’t remember his eyes.  We are ashamed and lose our breath from panic just trying to see them.  We want to bang our head because we know there is something wrong about feeling normal! Ever! Again! after that.  But we do.

Our normal mutates over financial ruin, abandonment and a growing healthy list of disfiguring illnesses.  We accept them and say yes please.  Live.  We want to live.  This is acceptable.  This is normal.  Our friends die.  Our memory.  We can’t find our teeth.  Our heart stops.  We die and the world finds normal.  The world chooses just like we did.

What we don’t think will ever be allowed to happen while we brush hair, clip our nails and microwave food, happens. We endure these changes.  We find normal again.

What is your normal?

My brother, Vance Johnson MD, is a physical medicine and rehabilitation specialist.  He said that during his residency, close to 100% of spinal cord injury paralysis survivors he worked with wanted to die after their injury.  Many of them would beg him to let them die.  They would cuss at him for keeping them alive.

I leaned very heavily on the studies and data during those times.  It was very hard.

Vance said that what kept him faithful to his task was knowing that close to 100% of them after two years would be glad they were kept alive.

Even the ones who were basically breathing through a straw and that’s all that moved on them; even they wanted to live.  These people found a new normal.

Where is our normal?  We will want it.  We will adapt.  Biology will catch up to our reality.

Remember that your pain is not special.  You are special.  Not your pain.  Pain is normal.

Question:  When this happened to you, how did normal find you despite the rubble?  How does this concept feel to you, that your pain is not special?  Does it make you angry or what?  Please tell me your story.