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‚Äôs 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?

Say It Out Loud. Three Day Challenge.

Hello friends. Please join us at Friend to Yourself in a three day, “Say it Out Loud,” challenge.

Throughout the next three days, whenever you think of something you like & are grateful for about yourself, say it out loud to us.

I’ll start! ūüėČ

I like my body.

Say It Out Loud.


Celebrating Your Courage Will Connect You With Your “Me” and With Community

Veterans Day

A seriously cool veteran was cruising Old Town today on his Harley with about fifty American flags affixed in mysterious ways to his bike and person.  I cannot figure how, but those flags were not going anywhere he was not.

I had forgotten today is Veterans Day, even though my kids were all home, off from school, properly running amok. ¬†This man, in his leather skins and industrial number of stars and stripes, reminded me. ¬†As we approached each other from opposite sides of the street, I saw him nod to another biker passing him by. ¬†His nod was enough to say, “Hello. ¬†You are not alone. ¬†I am not alone. ¬†We connect by this brotherhood.” ¬†I watched him in my rearview mirror and immediately dialed my dad, of course. ¬† “Happy Verterans Day.”

Sometimes we do not wear our history as confidently as this cool vet. ¬†How messy that would be, right? ¬†Imagine a world where people used their hard-earned losses as a tool to empathize with themselves and others. ¬†Where people’s pain was used as a force to connect with their Me and with others. ¬†How tiring to receive nods, to accept judgments and applause, as it may be. ¬†Right? ¬†Company can be a burden.

This is my guess as to why not many of us speak up about what electroconvulsive therapy (ECT) has done for us.  We hear about the miracles of medication therapies from first person reports, heck, even second, third or tenth hand.  We do not hear much about the miracles of ECT.  Instead, we hear the sound of quiet or else hopeless barbarism.

I was talking with a patient, Carla, about ECT as an option for treatment, and we laughed that we are anesthetized¬†for a colonoscopy for much longer amounts of time than we would if we had ECT. ¬†They seemed like such funny things to juxtapose. ¬†The convulsion lasts around thirty seconds and you are done. ¬†There are no broken bones. ¬†No tongues bitten through. ¬†There are no chickens sacrificed on anyone’s chest. ¬†Carla had never heard about the physician-patient who had undergone thirty-six ECT treatments as a patient, whose morbid melancholia resolved and who later returned to practicing medicine in full capacity. ¬†Why would the physician tell people about his history? ¬†What kind of nods do you think he would get? ¬†What patients would be willing to go to him for medical care? ¬†Carla had not heard about the gamers, computer programmers, the nurses or anyone from the functioning productive public who had the courage to fight for themselves by choosing ECT.

My patients with whom I discuss ECT have concerns. ¬†You have concerns. ¬†Much of the world is concerned. ¬†There are reasons. ¬†ECT has improved farther than Jack Nicholson’s report on¬†One Flew Over The¬†Cuckoos¬†Nest,¬†though many of us were alive when his movie was first viewed. ¬†The distance we have come in refining the practice of ECT is out of proportion to the distance in time from when ECT was not much more than sticking your finger in a socket and getting voltage in a continuous sine wave for therapy. ¬†Is it shameful being connected to that history? ¬†Is it too soon to say, “These are the ancestors I claim?” You know what to do with shame.

There are few medical specialties that gather as many opinions as psychiatry.  Yes.  Well there are even fewer medical treatments that are found in the company of so much frothing opinions than ECT.  No wonder we are quiet.  No wonder we are concerned.

So, although we veterans of ECT perhaps have not spoken up in our community, although we may not tear up at ceremonies for what our courageous self-care has done for our country or understand how we fit in, although we may not hang flags or tattoo it into our skin, we are courageous important citizens in company.  We are heroes.  Maybe not as cool in leather, but we are where we are because of those who have come before us and for what we have carried on.  We have suffered and died and lived and we are connected.  We have community and we are not alone.

Happy Veterans Day.

Self-Care Tip – Celebrate your courage.

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 РSpeak into your dark spaces the name of your fear.  Be a friend to yourself

Question РWhat 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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Flaws You Love. Presence.

More on Life-ers.  (Those darn perdy dandelions.)

Taraxacum, seeds detail 2.jpg

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I had an interesting comment a couple of days ago on the concept of Life-ers.

If you have a weed in your garden, you pull it. ¬†If there’s something wrong in your life, you don’t fall in love with it. ¬†You get to weeding.

I can see the point of this argument as I’m sure you can. ¬†I can also see where I didn’t get my point across well, or else this argument wouldn’t as likely have been voiced this way. ¬†The person who said it isn’t stupid and neither am I. ¬†But how do we come together on this?¬† There are Life-ers that are both weeds to pull and weeds to just plain garden I reckon.

We here at, got one of the most practical life examples of a Life-er. ¬†It is both one that¬†can be¬†weeded and one that can’t. ¬†Please read¬†it¬†if you haven’t yet. ¬†Emily said in response to blog-post,¬†One Woman’s Struggle,

I related deeply to Kara‚Äôs experiences. …I have been a self-identified compulsive overeater (or binge eater) since I was a child. It has always loomed large (pun intended) in my life. I have successfully dieted and lost 30-40 pounds at a time, and then I‚Äôve gained everything back ‚ÄĒ with interest. It has been my obsession and my bete noir.

Eight years ago, out of pure desperation, I went to a Overeaters Anonymous meeting. I didn’t necessarily like it at first, but I recognized my problem as an addiction. If you hold my experience up next to an alcoholic’s, there is no difference. I struggled a long time with the program, but today I am living what OA calls an abstinent life. My definition of abstinence is three reasonable meals a day with nothing in between. I am shrinking to a healthy body weight.

I have also developed my spiritual side and my relationship with my higher power (that I get to define) is what makes it possible to eat like a normal person. My obsession has been lifted, one day at a time. Like an alcoholic, this is not something I can do on my own.  This is supported by about 25 years of data.

I am experiencing freedom I couldn‚Äôt even imagine walking in the doors of my first meeting ‚ÄĒ freedom from fat, freedom from compulsion, openness to change and growth and a life that is no longer nearly as self-centered.

Sana, you asked if it helps to think of it as an addiction ‚ÄĒ for me, it‚Äôs not an analogy; it IS an addiction. I use the Big Book for the solution. My recovery is just like that in any other program. ¬†And it‚Äôs the ONLY thing that made a difference ‚ÄĒ not just for me, but for the dozens of people I share OA with. I hope this is something health professionals will understand one day. OA is an underutilized tool, and I think that could change with better understanding and guidance.

Thank ¬†you Emily for your story. ¬†I haven’t been able to get you out of my mind.

Addictions is a weed we could more often agree is a Life-er. ¬†That isn’t to say there aren’t those of us who think that they can be weeded and be done with, but the general consensus in medicine is that they are Life-ers. ¬† However there are other Life-ers besides addictions. ¬†Recurrent major depressive disorder, treatment resistant major depressive disorder, obsessive compulsive disorder, okay – a gazillion other medical illnesses that won’t respond to weed killer or a gloved garden-grip. ¬†There are also non-medical Life-ers, such as poverty, natural or unnatural disaster, rooted social stigma and so forth. ¬†We could even use the biopsychosocial model to catalogue them if we wanted.

One of the things that intuitively sits poorly about Life-ers in our culture and communities is the helplessness that can soil it.  However, we are not implying helplessness at all.  Just as this courageous Emily described, when we take care of ourselves, when we befriend ourselves, we take accountability for where we are now.  Our yards improve neighborhoods.

For the world out there who is scared to garden with us, I have this to say.  Get over yourselves.  What we are growing is worth the space we occupy and of high value.  You may never know it, but we are and we have bank to show for it.

Questions: ¬†What is your response to those who call your Life-ers weeds to pull? ¬†What are some examples of Life-ers you’ve fallen in love with and how did you? ¬†Please tell us your story.

Demanding Freedom and Other Oxymorons That Empower Our Self-Care

Désirée Nick at "Oxymoron" in Berlin...

Désirée Nick at "Oxymoron" in Berlin, 1999

I read today on bipoblogger’s blog,

I am trying so hard to keep my head wrapped around keeping a hold on this broken heart/life balance/bipolar thing.  It’s been complicated by stupid migraine headaches.  It’s hard to make sense of things and to pay attention.

Today while I was waiting for my laundry to dry, I began writing some deep thoughts, deep like I didn’t want to deal with them. I basically wrote a page of self-help advice.  I appreciate my stubbornness.

My answer:

This sounds like a woman of courage doing it, taking accountability for where she is at, afraid maybe but pressing on to start over any time she chooses, demanding her freedom to self-care.   Demanding freedom seems like an oxymoron but this is what is called for when we feel trapped.

I will add to this “answer” that self-care often seems like an oxymoron. ¬†Such as using the brain (the same organ that is diseased) to figure out what it’s behaviors and emotions mean or everything starts and ends with Me (when we know that there was a beginning before Me) – we see the weaknesses and the conflict and we say yes. ¬†I am an oxymoron. ¬†I am good and bad. ¬†I am healthy and ill. ¬†I am growing and dying. ¬†I am flawed but perfect. ¬†I’m sure you have more.

Demanding freedom is a basic tenet of self-care.  We say that despite the limitations in our lives, in our decision-making, in our suffering or pleasures Рdespite all, I am free to do self-care.

Questions:  How have you managed to demand your freedom to self-care?  What oxymorons in your life are empowering you in your self-care?  Please tell us your story.

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


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.

Just Ordinary Bullying – The Bully and The Bullied

Physical bullying at school, as depicted in th...

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Self-Care Tip #251 – Help yourself break it down if you think you are a bully, or are bullied.

I was just bullied, folks.  I know.  Takes a certain someone to bully me but that person and the bullying materialized and I was left with my autonomics all barking, pupils dilated, and I had to break it down.  I was bullied.

Now, after some time and a good wonderful chat with my beloved, I am able to experience the pleasure of joining the popular group of bullied-adults.  It seems to be a posh crowd now who acknowledges that adults are in fact bullied Рnot only kids.

What is bullying? ¬†I’ve linked this blog-post to various web-articles that have stated this question and answered it well. ¬†The part I would like to highlight is the emotional bullying.

When we perceive either consciously or subconsciously that we are:

  1. Afraid
  2. Powerless
  3. Receiving implied threats (direct are obvious to us readers but the implied threats are not always as clear to us readers or others out there)
  4. Supposed to stay quite about it

Does any of this sound familiar? ¬†If it does, you ¬†might have read the blog-post, “He’s Never Hit Me.” ¬†Much is the same. ¬†I’m not able to say all that is different between emotional abuse and bullying as I don’t know of any formal scientific way of separating them. ¬†However I will propose that emotional abuse is when it is repeated and includes system issues including the victim feeling shame and deserving of that treatment. ¬†Bullying perhaps may not be repeated or it may and it might not be done to someone who is in a relationship with the bully before it happened. ¬†(This is just Me, Dr. Q saying this though. ¬†Just today in my research I have already found other sources describing it differently.)

Regardless though, what to do?!  I was bullied!

Break it down:

  1. Go to the fear.  Think about where it is coming from.
  2. Think about the power. ¬†“Why am I feeling powerless?”
  3. Clarify the threat perceived. ¬†We don’t have to do this collaboratively with the bully – who may after all, lack all ability to gain insight for whatever reason.
  4. Get it out of the closet as soon as you can. ¬†Talk about it with someone. ¬†Go to any authority who might have information to empower you. ¬†If the bullied is doing something that is wrong, we want to know! ¬†Right?! ¬†If not, we want to know that too, and be as clear about it as we can. ¬†This also helps gather an “army” around you… or you could call it support :).

Andy Becker from the Leadership Post says,

It’s not enough to say bullying is not tolerated; we need to empower ordinary adults to help stop it.

Well today, I guess I’m an ordinary person getting ordinary bullying. ¬†The bullying isn’t special. ¬†The way it affected me isn’t that special either. ¬†But I am.

Similarly, the bully isn’t being served well acting out. ¬†It’s not friendly to either of us. ¬†We are both ordinary special people who deserve better.

Questions: ¬†What has helped you when you felt bullied? ¬†…or, …What has helped you stop bullying? ¬†Please tell me your story.

Choose Back! …As Long As Life Chooses You.

A Girl On A Footbridge

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Self-Care Tip #241 – As long as life chooses you, it is your right to choose back – so do.

Although I am not a geriatric psychiatrist, I have still been given the pleasure of serving a “golden” few. ¬†What has impressed me has been their willingness to start over.

Starting over takes courage and humility whether it is¬†deliberate or not. ¬†Sometimes fear dances between the lines of all the emotions and intentions. But still, wouldn’t you agree that it takes courage and humility to negotiate fear?

(Enters Hans.)  Hans was seventy-three years old.  He had struggled with brain illness on and off he thinks since he was at least twelve.  There were big spaces of time when his disease exacerbated, and he largely suffered.  But he chose, at this age, to try again for improved brain health.

Is there a time when we start thinking, don’t keep trying to start over? ¬†Maybe in the dying process. ¬†In case you don’t know, the dying process is a specific term. ¬†It means the¬†time when a person is facing impending death.

This area of medicine is not my specialty but I imagine at some point we want to stop with that starting over process, give up, but not in a hopeless way.  In a way that says,

I can stop trying for new anything and sit in the space of what I already have in me…

…Which hopefully includes all the ingredients and interrelations of life.

But how far before that point in life do we consider starting over reasonable? ¬†I’ve heard of kids being told they’re too young to ride a bike, or cut with a knife, or understand the dinner conversation. ¬†No one bobs their head at that. ¬†But find a seventy-three year old who believes that after a lifetime of perceived failure by onlookers or themselves, who still says,

Now let’s give this another go,

…and if it hasn’t been said, it’s been thought,

give it over already! ¬†You’ve hit your seventy-times-seven chances!

It’s like they’re shopping in the teen-ware. ¬†We blink our eyes and angle our heads. ¬†Even the thought of starting over as a real option feels indiscreet.

(Enters Hans.)  Hans is seventy-three.  He is starting over.  Humbly and with courage, he pursues brain health in the face of stigma.

I think I had celebrated my six birthday when my dad asked me if I felt any different from how I felt when I was five.

Yes!  I feel older!

¬†Then he asked me how old I thought he was. ¬†When I answered some enormous number like, “twenty-two!” he asked,

Does forty-four seem old to you?  

Of course it did! ¬†But I had an intuition that if he was old, than he’d die, so I said a definitive,

NO! ¬†Daddy you’re still young! ¬†You aren’t old!

Now, almost that same age myself, I am in awe of him and the others in their golden or not so golden years (Enters Hans) who believe that as long as life chooses them, they will choose back.  It is their freedom.

Questions: ¬†When all your senses don’t sense pleasure in life, or you feel old and useless, or you feel that you’ve failed too many times, how do you choose to start over? ¬†Who has inspired you and what did they do? ¬†Please tell me your story.

Still Interested In Self-Care?

Working for Peanuts

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Self-Care Tip #131 – Start all your efforts and end all your efforts accountably with yourself.

Self-care is:

For many of us, we wonder what self-care is. ¬†Obviously being subjective, it is something unmeasured and changes between us. ¬†It doesn’t interest or make sense to many, depending on their religious biases, culture, temperament and other things. ¬†But others of us, for maybe the same reasons, find self-care to be the place from which our axis swings. ¬†We have together, here at, through the past eight-plus months, agreed on much of what self-care is and is not.

It is not selfish-care, alone-care, sacrilegious or Godless-care.  It is more than any one thing, for self-care flattens knowledge.  It is not weak but rather courageous.  It brings us to humble accountability for our lives, not erasing our history but still being free to start over any time.  Self-care is living consistent with the belief that the success of our health (emotional, physical, spiritual) begins and ends with Me.

Despite the chorus of boos, we say that we serve God and man better by taking care of ourselves first.  We attack guilt, we stand up to shame, we live as we choose despite stigma and we work harder than we ever have on perhaps the hardest job of our lives.  This is, Self-care.

Are you still interested?

Question:  How do you define self-care?  How is it played out in your life story?  Please tell us.

Where Do You Think Behavior and Emotion Come From?

Animation of an MRI brain scan, starting at th...

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Self-Care Tip #229 – See yourself as a friend by including biology in your self-perception.

In clinic, out of the clinic, here, there, if I were to pick one barrier to treatment anywhere, I’d pick the misunderstanding that behaviors and emotions come from somewhere other than the brain, and then from there, the outcropping of understanding why.

I don’t think most of us say it in so many words, but it’s intuitive. Maybe when pressed we’d say, “Where else do they (behaviors and emotions) come from?!” And then agree, the brain. But the connection that allows for self-care is missed. The connection that allows us to choose the freedom to feel good and behave well for our own sakes is lost in the shame of failing to do those very things. ¬† The stance of courage it takes to be our own friend when we don’t even want to be in our own company, takes a lot to maintain.

The marvelous @MarjieKnudsen, tweeted a reference to a wonderful post by Sarah Boesveld, How ‚Äėself-compassion‚Äô trumps ‚Äėself-esteem‚Äô. I enjoyed reading it very much as I felt it spoke to me and my generation with great perception… except! that it was without mention of biology, the brain; i.e. where behaviors and emotions come from.

In clinic, Naomi told me about her “failure” when ever she felt anxiety come on.

Why do I feel depressed when I feel the anxiety come?

I’m wondering what you think, reader, about this simply related story and the question.

I mirrored Naomi’s question,

Why do you think you feel depressed when that happens?

Today (similar to Naomi,) girl-crush, alias Rachelle Gardner, Literary Agent, wrote about feeling like a failure as well.  She asked at the end of her post the pithy questions,

What about you? How have you failed? What kind of wisdom has helped you deal with it (i.e. sense of failure)?

And I thought, how to answer? Here I am again “in the presence” of someone wonderful who in her post didn’t make it apparent that she was considering that this emotion might be a symptom of something biological. ¬† We are willing to look under every rock, be in the space of our emotion and ponder reasons why. ¬†We have the courage not to “run” even when we don’t like ourselves, but haven’t said it out loud to ourselves yet,

I might feel this way because my brain is dishing it out.   I might otherwise have not done anything to set this emotion or these behaviors in motion, other than being alive.

Girl-crush remains despite response. ¬†So readers, don’t be scared to answer what you think. ¬† If you even care, I’ll still admire the socks off you! – even if you think you are hyper every day since conception because you ate too much sugar.

Questions (In case you want me to write them again, which I’m really happy to do – anything you want so I can hear your responses): Where do you think your behaviors and emotions come from? …such as a sense of failure and/or a depressed mood? What has helped you deal with it? Please tell me your story.

Where Does Courage Come From?

I want to do that, but I have no idea where I’m going to find the courage!

This is real folks.  People think this, say this, believe this and behave accordingly.  The other day, a young woman in her forties with a rolled scroll of precious problems including joint disease, extreme morbid obesity, nicotine dependence, depression, anxiety, obstructive sleep apnea, eczema, gastroesophageal reflux disease (GERD), heart palpitations, diabetes, hyperlipidemia and polycystic ovarian disease Рthis woman told me these words.

I have no idea where I’m going to find the courage!

Where does courage come from?  Is there an odds ratio, statistics, intuition barometer or what?  Where do we find courage?  (I am remembering the dear Lion in The Wizard of Oz.)

I see courage coming from our ability to make decisions.  Being able to decide comes from many paradigms, including my favorites as broken down through the biopsychosocial model (listed in no particular order):

  • Biological – temperament (genes or personality,) mental health/brain health (the brain being the organ we use to make decisions with,) developmental (the neurodevelopment of the brain is different at different ages,)¬†things we put in our body (diet, illicit drugs, alcohol or nicotine,) medical illnesses, sleep issues, exercise, rash, ingrown toe-nail‚Ķ.
  • Psychological – self-control, coping skills, catastrophizing, negative thinking, thoughts, emotions, and behaviors….
  • Sociological – culture (including home, religion, race, gender,) stressors on our body, social support, God, interpersonal relationships (friends, marriage, kids, colleagues,) parenting, unemployment‚Ķ.

(WHEW!  Recovering my breath.)

Where do we find courage?

I drew a picture in the air for her psychological self,

17th century

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I see you 100 pounds lighter, not smoking for the past six months at least, off of six of your twelve medications, your medical problem list shortened down to two or three.  You are able to feel pleasure again.  It is a real option for you.

If you don’t, I see you growing demented, paralyzed and dying from a heart attack. ¬†I can’t say when these things will happen but they will happen if you don’t start taking care of yourself.

Where does courage come from?

For her biological self, I targeted the language of her¬†temperament. ¬†I remembered that we make decisions either through thought or feeling. ¬†She was a “Feeler.” ¬†I drew forth my light saber and went for the emotions.

You can do this! ¬†Think of the gift you’d be giving yourself and to those you love.

For her sociological self, I talked about everyone in the family choosing with her, including husband.  Talking about how this changes the family culture, not to smoke together, setting boundaries with her husband to care for herself and thinking about getting other support networks like starting to go to church again or calling her pastor.

Question:  Where does courage come from for you?  Please tell me your story?

Self-Care Tip РUse your biopsychosocial model, that is to say all of what makes you you, to find your courage.  Be a friend to yourself.

Love – Take What is Already Yours. You Have Been Given Love.

Stef's Present with Handmade Wrapping

Image by ex.libris via Flickr

Self-Care Tip #194 РTake what is already yours.  Be a friend to yourself.

Parenting, we hold the power in the relationship between us and our child/ren.  If we are emotionally maltreated by our child/ren, we parents are still the ones with the power.  What are we giving to her if we teach her that we will take the terrible words and dark emotions?  When we take the projected anger when we have the power to choose not to, what message are we giving to ourselves about ourselves?  What is the message if we say by our actions that Love demands from us to accept, to take and to be a victim to the emotional abuse?  Is that what love tells us?

It is difficult to receive maltreatment from anyone. ¬†And because of the suffering involved, we can misinterpret the message, “This is the sacrifice that Love demands” – the sacrifice is doing what other people want before taking care of yourself.

It is difficult not to receive maltreatment as well. ¬†Which choice is more consistent with our understanding of Love? ¬†The words in the message might be the same, “This is the sacrifice that Love demands.” ¬†However, the interpretation of the message, of what the sacrifice is – that meaning is different. ¬†The sacrifice is, rather, taking care of yourself first so that you have the best of you to offer to others.

To read more on this topic, please see posts, Criticize if You Love Me, Listen to The Intention in What People Say and Stop! Before Hurting Yourself or Others.

Because we as parents hold the power in the relationship, we can feel trapped by our own power.  What a confusion for many of us.  Holding power but feeling helpless.  Holding a stick in both hands, so to speak, not seeing that we can still use our occupied hands for anything else in the mean time.

This kind of choice takes Love.  This is the kind of choice that is a work of a life-time or of a moment, but is life.  See, Let It Go and Keep Going.

We can’t teach others that we are valuable and how to treat us with Love if we don’t do it ourselves for ourselves. ¬†When we act on Love, self-care means that we don’t accept treatment that is inconsistent with Love. ¬†If we accept bad treatment, we are saying that self-care is accepting our lack of choices versus making the choices that are still available despite the¬†circumstance.

FriendShip... A gift of God.

Image by ~FreeBirD¬ģ~ via Flickr

This of course applies to any relationship. ¬†It applies to any connection, whether it is in the work-place, marriage, if you are the child in the parent-child role, friendships – take your pick. ¬†You can choose Love. ¬†You can choose. ¬†Self-care starts and ends with “Me.”

Freedom is a gift. ¬†No matter how many times it is wrapped up and placed in our hands, if we don’t open it, use it, own it, we will never have it. ¬†Freedom to choose has been given to us before we were born, just like our salvation. ¬†The salvation will never be taken away. ¬†Nor the freedom. ¬†Both are elemental and constant. ¬†But if we don’t pull on the ribbon, lift the lid and take – we can’t expect anything but living without what was inside. ¬†Does the title “victim” even hold if it was our choice not to take what was already ours?

Question:  How do you claim your freedom to choose when all you perceive at the time is what has been taken away?  Please tell me your story.

When You Are Pushed Down, Push Back

A Push and a Shove

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Self-Care Tip #185 РWhen you are pushed down, deliberately push back with The Force in  you.  Be a friend to yourself.

So much in life pushes down on us.  I am amazed that we push back Рconsidering how awful some of it is.  After 7 years of private practice in psychiatry, I still get caught off guard by some of the particularly horrible stories I am told.  Blinking my own stinging eyes, I look in amazement at the person in front of me.  What I see is this pushing-back Force.

Last week after diagnosing PTSD in Margie, a mother of a murdered son, I could hardly believe that she still chooses life.¬† She takes care of herself despite.¬† That’s how amazing she is. ¬†And I’m her psychiatrist!¬† It‚Äôs such an honor.¬† And thinking about that straining towards life, that thread in us, all of us – I saw that it was the best description of the brilliance and power that is God.¬† True, sickness can mute our perception of this beautiful thing in us, whether it’s depression or liver disease.¬† But all of us have seen some of how hard the thrashing against that loss is.

In thinking on this amazing force, this thrashing about, this straining against the push of whatever is set at tipping us over, I named it God in us.¬† And I thought, for all the time I spend on the stuff pushing me around in bad ways, I’m going to more actively team up with the struggle to live.¬† I’m going to choose to strain and thrash about and move at that chink of space in the dark room as much as I can.¬† Hopefully I can be brave too, like that mother of a murdered son, Margie.

I can choose to ally myself, with what I want to live for.  I’m going to partner with that Force that keeps me thrashing against the push and be stronger, like you have readers.

After our post on suicide a couple days ago, many of you responded with your own stories about how you were pushed and pushed back.  Karal said,

Like all difficult experiences we face in life, there is the possibility of growth from the ashes. ¬†It requires strength and a willingness to walk through that fire. ¬†Unfortunately for survivors of suicide (i’m referring to those left behind) we’re often chastised into feeling that our grieving, our walking through the fire is both wrong, and ¬†unnecessary. ¬†I totally disagree. ¬†Like you said, caring for people is a choice, and being a friend to yourself means making sense of, or at least peace with, what may never make sense.

Karal is allying herself with that Force to make as much sense of what will always be jumbled. ¬†I’m not going to quote all the rest of the brilliant comments. ¬†Please read them. ¬†They were amazing demonstrations of pushing back in a collaborative way with The Force that makes their lives worth living. ¬†This is active in us at times, and not deliberate at others. ¬†Being better to ourselves, we could more deliberately choose when given the push. ¬†We are not thrashing alone. ¬†Push back.

Question:  How do you deliberately choose your alliances in your life for working against what pushed you down?  How do you define that Force in you that pushes back?  Please tell me your story.

The Spider Sat Down Beside Her – Mental Illness

Self-Care Tip #178 – Find your courage and answer to stigma.

The Little Miss Muffet scenario explained by D...

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Something as simple as taking pills can sabotage us.  The act of putting it in our mouths signifies all sorts of things from religion, to freedom, to personal identity and beyond; even someone who is trustworthy versus not.  Pill Рtake away her children.  No pill Рcould be president.  Pill Рdiscredit whatever he says.  No pill Рworth listening to.

Martha is a mother of four lovely girls. ¬†Her husband is divorcing her and she wonders what he will do in the process. ¬†She’s been depressed in the past and anxious with a history of panic attacks. ¬†She took two years to get over them using breathing exercises and other therapies. She didn’t use medication. ¬†I don’t need to tell you what her husband thought of meds or of her during that time. ¬†It was a miserable time for her.

Now, during this new stressful time, she has relapsed in mood and anxiety problems and is terrified that if her husband finds out, he’ll take the kids. ¬†Martha sees mental illness as a bullying tool for anyone to dump her over. ¬†Little Miss Muffet is a story she often has compared to her situation. ¬†The spider is the mental illness she feels is dangled over her to her demise. ¬†Martha is bullied and scared away.

Taking pills makes me feel like I’m crazy!

Note: it’s a type of crazy she interprets as being something different from the crazy of mental illness. ¬†For Martha, the crazy that comes with medication therapy is more sinister and discrediting than the worst experience of terror any of us have ever gone through, i.e. panic attacks.

Every day, we who take medication for emotional illness have to answer to those accusations.  We contend with the fingers pointing our way, the jeering in our memory of loved ones and the boxed presumptions we find ourselves in.

This may sound a little dramatic to some out there, although familiar.  To others, it is an understatement of what they courageously confront to take care of themselves.  Each of us must come up with our own answers and find our own courage.

Martha finally decided on medication treatment and within two days she was amazed to find that she could eat without throwing up and no longer felt anxious.  She still insisted that taking medication was only temporary but getting a pill dispenser had helped her get past some of her daily battle with stigma.  She just opened the lid and poured the pills into her palm, threw them back and swallowed without looking.  Martha found it easier not to dispense each pill each day out of each bottle.  It was also easier for her to keep this information secure in the confines of our office.  For Martha, for now, this was how she answered.

Question:  How do you answer to stigma?  How do you maintain your sense of freedom when other forces tell you that you are not free?  Please tell me your story.

Know What You Are Fighting For – Your Right To Journey.

You Should Be Living

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Self-Care Tip #162 РKnow what you are fighting for.  Be a friend to yourself.

Bridget told me,

I felt free to do something creative without having to feel guilty about it.

She had read the blog post, “Self-Care is Freedom, is Democracy, is Because We Are Accountable.” ¬†I was just starting to think about other good places to go with that but before I got too far she hit me with,

I just hate myself!

Hearing those words is like watching squishy and partly moldy tomatoes hit the wall. ¬†It’s messy. ¬†It’s dirty. ¬†No one’s excited about dealing with it. ¬†And, there is something negative that brought it on. ¬†Readers, you’ll remember this¬†countertransference when you’re the counsellor in some other situation and think, “Darn that Quijada!”

My thoughts bumped and piled up. ¬†Stopped, until they started pulling themselves off of each other. ¬†I tried to put these disparate bits of Bridget’s narrative together. ¬†And I wasn’t alone.

I don’t get it! ¬†Why do I feel this way?

Who doesn’t have conflicting feelings about themselves? ¬†Bridget perceived and celebrated her freedom to self-care, yet was betrayed by her own, just when she was reaching for it. ¬†Is that ok?

What strikes me about Bridget is her journey. ¬†She has struggled with anxiety and depression for many years. ¬†I know with me, she’s been in treatment for five of them. ¬†During that time, she has been lovely although not perfect. ¬†She does her hair, glossy blond in large waves, trim body frame and polite like no one I’ve met. ¬†Many medications have failed her and she has taken those failures and claimed her future over again. ¬†The intense forward movement of her inner self has never been muted, even when she has had thoughts of wanting to die.

I have learned what she values, what she’s willing to let go of and what she isn’t. ¬†Her appearances matter. ¬†She is artsy and gets energy from being alone. ¬†She loves people. ¬†Her marriage is rocky. ¬†She struggles with parenting. ¬†She loves her husband and her children. ¬†Bridget’s journey is a journey of imperfection, beauty and courage.

And here she is again. ¬†Conflicted self, ill, hopeful and claiming her future. ¬†Bridget is right on her course. ¬†I wish I could help more. ¬†I wish she wasn’t still ill. ¬†But I can at least be as courageous as she is. ¬†I can hope with her. ¬†I can stand with her or walk. ¬†I know that put to the question, Bridget prefers this journey than losing the right, the¬†privilege, to journey at all. ¬†Bridget is free. ¬†Many of us are not as free as she is, who knows what she is fighting for.

Question:  What are you fighting for?  If nothing were to ever change for the better in your life, what makes your journey worth it?  Please tell me your story.

The 12 Steps To Serenity


Self-Care Tip #154 – Go towards Love.

I realize that many of us talk about the 12-Steps, we know people working the 12-Steps, we even recommend the 12-Steps but have never read them through.  So here they are.  For all of us.  A wonderful walk with and towards love.

The 12 Steps To Serenity

  • Step 1 –¬†We admitted we were powerless over our addiction – that our lives had become unmanageable
  • Step 2 –¬†Came to believe that a Power greater than ourselves could restore us to sanity
  • Step 3 –¬†Made a decision to turn our will and our lives over to the care of God as we understood God
  • Step 4 –¬†Made a searching and fearless moral inventory of ourselves
  • Step 5 –¬†Admitted to God, to ourselves and to another human being the exact nature of our wrongs
  • Step 6 –¬†Were entirely ready to have God remove all these defects of character
  • Step 7 –¬†Humbly asked God to remove our shortcomings
  • Step 8 –¬†Made a list of all persons we had harmed, and became willing to make amends to them all
  • Step 9 –¬†Made direct amends to such people wherever possible, except when to do so would injure them or others
  • Step 10 –¬†Continued to take personal inventory and when we were wrong promptly admitted it
  • Step 11 –¬†Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out
  • Step 12 –¬†Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

Question:  What do you think of these steps?  Please tell me your story.

Your Personal Fight For Emotional Freedom

Self-Care Tip #151 – Fight to be a friend to yourself.

My friend Carl, after reading yesterday’s blog-post, introduced me to this gorgeous song. ¬†I found it on YouTube connected to a slide show of our soldiers. ¬†Thank you to our courageous American troops fighting for the freedoms we enjoy and take and take and take. ¬†We know that when you fight, there are losses.

We all are soldiers of sorts, fighting in life for our own selves for so many reasons. ¬†But it’s not about the reasons or motives. ¬†God takes care of those. ¬†So regardless of why, thank you to all of you out there fighting for your own selves. ¬†You who want your own emotional freedom. ¬†The good that comes from this courageous fight ripples on the life-waves and reaches us. ¬†Thank you. ¬†We know that when you fight, there are losses.

Carl, thank you.  Your personal fight, your courage, touches all of us.  What you do is self-care, is care for us, is care.

Let There Be Peace on Earth, by Gill Vince

Let there be peace on earth
And let it begin with Me.
Let there be peace on earth
The peace that was meant to be.
With God as our father
Brothers all are we.
Let me walk with my brother
In perfect harmony.

Let peace begin with Me
Let this be the moment now.
With every step I take
Let this be my solemn vow.
To take each moment
And live each moment
With peace eternally.
Let there be peace on earth,
And let it begin with Me.

Let there be peace on earth
And let it begin with Me.
Let there be peace on earth
The peace that was meant to be.
With god as our father
Brothers all are we.
Let me walk with my brother
In perfect harmony.

Let peace begin with Me
Let this be the moment now.
With every step I take
Let this be my solemn vow.
To take each moment
And live each moment
In peace eternally.
Let there be peace on earth
And let it begin with Me.

Question:  How do you see your personal fight for emotional freedom rippling into the space of others?  Please tell me your story.

One More Honest Way To Say, It Starts and Ends With Me

Hi! I am feelin so good today. At present: joi...

Image by jessica mullen via Flickr

Self-Care Tip #150 – Be honest about why you don’t like them. ¬†Be a friend to yourself.

Today I spent with my in-laws and my own parents:  a blend of the Philippines, farm-white middle America, and Lebanese superstar.  It was tense at first but was, despite my husband’s and my paranoia (based on preformed something-or-other) nice.

When I look around at my family, I see their good features all the while remembering their not-so-good bits.¬† Depending on my state of mental health, the good is more apparent than the bad, or vice-a-versa.¬† It depends on Me.¬† When I am feeling confident, loved, and am doing what I like to do in life, their fabulous selves seem like the people who came to visit.¬† Not the ones I ‚Äúwalked out‚ÄĚ on X-number of times before.¬† I‚Äôm sure it goes both ways, even if they haven‚Äôt typed it up for the world to read.

All of us do form opinions about each other.  You, me, or any other connection do.  We all have some level of judgment about who is holding the other side of the string.

See, I like people more when I am doing well.  Is that so unbelievable?  Well sometimes, yes.  It is more unbelievable than we first think.  It would be more believable to say, rather, that I like people more when they are nice.  Or I like people more when they do good things.  That is easily believable.

When we have opinions about people who are less than lovely, this little epiphany is there to help:¬† We like others more when we like ourselves more.¬† Introspection is useful if we know what we‚Äôre looking for.¬† Using this handy-dandy epiphany-tool, we might be able to get inside ourselves and see that how we feel about others is about ‚ÄúMe.‚Ä̬† It feels like we don‚Äôt like someone because they are a baddy.¬† But the truth is, we aren‚Äôt feeling so good about our own selves at the time.

Inversely, we might be able to do the same for others.¬† When they behave negatively, pull out your epiphany tool.¬† (It comes in many colors.¬† Mine is pink.)¬† We can remember, ‚ÄúQuisas!¬† They don‚Äôt like themselves so much now.‚ÄĚ

What this little epiphany-tool patent banks for us is the ability to own our feelings in one more honest way.¬† Feeling good in life starts and ends with ‚ÄúMe.‚Ä̬† Isn‚Äôt that refreshing!?¬† Ah.¬† Sigh.¬† Relief.¬† At least we have a place to start and finish.¬† Me.

My mom, sweet Mom, tucked into her car about to leave today, was swelling with joy about my melting body-fat.¬† It was a little overwhelming for her, dear thing, and she reacted by throwing out her ‚Äúgift.‚ÄĚ

When you get to the size you want to be, I’m going to take you shopping!

I‚Äôm not going to get into all the history of my mom (whom I do love to no end) and me as it relates our ‚Äúcompatibility‚ÄĚ in the arena of fashion (very little of which I naturally have) nor shopping.

I said,

Mom, just take care of yourself.¬† You are the best gift I could ever want from you.‚ÄĚ

And she is.¬† This healthy part of Mom is.¬† She, that has fought so hard all these years to be healthy, is a treasure without a number.¬† I just want her.¬† And I can say that because I feel pretty good right¬†now. ¬†She’s always been a treasure, even when I didn’t appreciate her enough and wasn’t using my pink-epiphany-tool. ¬†When I think of the parts of our history that are less warm and fuzzy, I think, ‚ÄúThat‚Äôs how things go.‚Ä̬† And it rolls and ripples through to the space where angels fly. ¬†A place big enough for our good and bad parts.

It all starts and ends with Me.

Question:  When is it hard to see your own role in how you feel?  Please tell me your story.

Live And Live Despite The Ongoing Loss

Red slipper

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Self-Care Tip #141- Live and live despite the loss.  Be a friend to yourself.

The other day, my hair was barely pinned back in a knotty mass, when I arrived at clinic late with my house slippers still on. ¬†I didn’t realize this of course until I heard this flapping sound echoing behind me as I hooned down the hall. ¬†Distracted by myself, I seemed to suddenly come upon an old man. ¬†He was lovely really, wrinkled, clearly handsome in his day, shuffling my same direction, and also in his house slippers. ¬†It was less than a second when I took this all in and I suddenly felt very self-conscious. ¬†Not¬†awkward¬†for the normal reasons that I should have been, like my nappy appearance, but I’ve never really thought I was “normal.” ¬†No, I felt rude. ¬†I’m much more sensitive to rude than ugly.

Do the younger seem rude to the older? ¬†There with their supple joints, perky bodies and minds, hope, and shorter medication lists? ¬†I felt rude. ¬†Rude combined with awkward is not something most people are comfortable looking at, which is what I unfortunately offered up to this innocent man. ¬†Walking fast felt wrong. ¬†Not sure what to do, I sort of slowed, yet my tardiness to clinic didn’t let my gait relax. ¬†Giving an uncertain smile, I managed not to make eye contact when I said “Hi there,” lest the eye contact lead to further tardiness. ¬†Then off I galloped, luckily for both of us, only 3 doors down.

I didn’t spend more than a few seconds with that stranger, yet remember well what he symbolized for me. ¬†I remember him when I get grumpy about not being able to eat as much as I did 10-years ago. ¬†When I get resentful with my feet, (a size and a half HUGER since I had my first kid,) I see his lordosis (hunched back often from a collapsed spine.) ¬†I wonder how he is doing with his losses.

There’s not much romance in growing old. ¬†What is romantic is a beautiful person, who has been real with their losses and with the joys of life that are still available to them. ¬†There’s no point in my denying that I can’t have cereal and pasta every day any more. ¬†There’s no point in being angry about it. ¬†I’ll just eat slower and force, er, I mean find more pleasure out of what I do eat.

I like to think that the old man in the hall made his and makes his peace with losses and is more glad than not for his life. ¬†If so, maybe he was ok with my fast pace when he couldn’t. ¬†Maybe it makes him more comfortable in a world in which he is becoming more and more of a stranger. ¬†That is something to admire. ¬†That is something that is worthy of life’s¬†privilege.

After yesterday’s blog-post, a reader said it quite fine,

I did not know depression was progressive. ¬†That‚Äôs depressing. ¬†As is the realization that aging is progressive. ¬†…On the other hand I can say I‚Äôve had 61 more Christmas times than a new-born and perhaps that makes it worth it!

Question:  What losses are you struggling with?  How do you come to terms with your losses?  Please tell me your story.