courage

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Afraid of Meds

A colleague told me,

I want to get off my sleep meds because I don’t want to be dependent on anything.

Dependence.  Lazy, pass-the-buck, unimaginative, immoral, chemical abuser.  Maybe even doctor-shopper depending on who is speaking.  When someone says it, before we talk about medication use, biology, etc… we need to know what is behind that word.  Working with the tip of an iceberg of prejudice might sink us before navigating much treatment.  Even physicians after 25+ years of education and more of medical practice, find it hard to shed these cultural prejudices about psychotropics (medications used in psychiatry).  What does the word dependence mean to you?

To psychiatrists, substance dependence means that the body has become accustomed to something.  We don’t get as much physical or emotional boost we used to using a substance, such as to nicotine, alcohol, illicit drugs, or prescription medications.  We now need more to get the same effect we would have gotten before with less amount.  It includes physical and emotional cravings – like sweating, shaking and yearning.  A lot of time is spent to do whatever it takes to get it.  Can’t cut back.  Keep doing it even though spilling into personal and professional space.  Keep using even though aware body and mind are worse for it.

Was this a description of my “dependent” colleague?

How about abuse?  Substance abuse is when we do dangerous, mean, and/or irresponsible things when using.  Was he hitting his wife when he was under the influence of a sleep medication?  Was he taking sleep medications when he was at work because he liked how they made him feel?  Driving with them?  You get it.

This guy is no dummy.  Yet he felt guilt and shame about appropriately using a medication for a medical reason.

I was seeing a woman for the first time in my clinic.

“Doctor is this medication going to make me addicted?”

We spoke about her fears.  Turns out, she thought her medication would prejudice the world against her.  Change her personality.  Make her crave it if she ever wanted to stop.  Steal from her geriatric mother and eventually, who knows?  Panhandling?  Now how am I supposed to work with that?  How she ever got the courage to come and see me in the first place with all that on her back, must be pure grit.

So here’s the dirt.  Some medications have no dependency risks.  Some medications do.  Some people abuse any medication they can get their hands on.  There are rave parties where there is a kitty – a bowl full of whatever pills anyone in attendance donates to.  They take them out randomly and swallow to get whatever surprise awaits them.  Is one class of medication more often abused than another?  Yes.

As a prescribing physician, I have sworn to not intentionally do any harm.  As a patient, you contract with me to take your medications as prescribed and safely. We’re in this together.  We will talk about any recommendations and you will hear the risks and benefits to treatment.  You will decide.  There is no conspiracy to turn Americans into bad citizens through psychotropics.

Self Care Tip #52 – Find out where your fear is coming from.  Be a friend to yourself.

Question:  What are your fears about psychotropics?  Agree or disagree with this post?

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Yell and Someone Will Hear

Today a reader responded to the blog posted on August 30, 2010, “Own It.  Our Life’s Work.”

Al-Anon, a great program. I really feel blessed to have found a 12 step program that is so gentle yet so encouraging with wonderful results for me personally.  It has taught me how to quiet my mind, live in the moment, live and let live, and let go and let God.  All principles I apply daily and the pleasure I get from living this way has enhanced all aspects of my life.  This program is not only for the loved ones of alcoholics but for anyone who has a family member suffering from addiction or if you were raised in a home with perfectionistic standards.  These standards stunt emotional growth and the results emotionally are no different than growing up in a home with addiction.  From the outside the perfectionistic home may look functional whereas the alcoholics home looks chaotic, but the emotional impact is the same.  Growing up this way may result in other acceptable addictions like workaholic, churchaholic, perfectionism, eating disorders etc… …It got me thinking about how thankful I am for Al-Anon.

She said it well.  First hand this woman of courage tells us bits of her story.  She demystified some of the suspicions about a group like Al-Anon.  She invites all of us, by her testimony, to also have courage.  To also share.  To also work on our own battered selves.  She unclosets getting treatment.  She tells us we need each other.  Al-Anon is a group meeting.  There is healing.  Healing is not a condition of stalemate.  She tells us about healing and progress.  We can choose.

In the Wizard of Oz

Tin Woodsman: Help! Help!
Scarecrow: It’s no use screaming at a time like this. Nobody will hear you. Help! Help!

Self Care Tip #37 – Yell and someone will hear you!  Be a friend to yourself.

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


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Let It Go and Keep Going

Like gripping a blade the reflex may be to grip harder.  When to let things go when it feels like we can’t…  How do we, if it is still active in our lives?.  Something negative but still going on with no end in sight?

A woman comes to me anxious and depressed.  She looks older than her age.  She cries a lot talking about what she is ashamed of.  Staying with her emotionally abusive husband. Probably having sex with him though she didn’t want it.  Unable to leave because she didn’t have money, job, or family support.

This woman I mentioned, she is courageous.  She has tried for years to find herself again and still tries again and tries another time, times times.  She talks to her kids about it and they say she should never have married him.  She talks to her friends and they sigh and heap insults against him.  She talks to God.

She comes to me.  Why she comes when she does?  She found the courage to ask for help one more time, times times.  She takes medications.  We spend 6 months together before she starts responding to the combination therapy and each day she had the courage to wait another day times another.  Her face looks younger, slowly, like looking through an album backwards over the next weeks.  She starts talking about doing more than making it through the day.  More fits into her hopes than survival.  Like Mary Poppins‘ travel bag, she keeps pulling more out of her life than she ever thought it had space to hold.

One day about 1 1/2 years later, she came to me with a secret smile, holding her purse like a stolen cupcake.  The door closed to our room and she pulled out her dog.  She said, “I’d like you to meet my best friend in the whole world.  I just love him so much!”  She is a woman who found courage to love and be loved.

I am in awe and humbly wonder after her.

Remember again the addict who so often leads us in this example.

God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.

Serenity Prayer

We surrender when we can, when we think of it, when awareness dawns, the things we cannot control.  It might take a higher thought to “let go” of what we cannot control.  When we are able to do this, we are larger in a sense than the moment.  The recurring yucky events are seen more objectively and less personally.  We are more knowing.

It takes us back around to how we define ourself.  Our spirit.  Our essence.  This woman, she found it.  She found she was more than her circumstance.

“How do we surrender what we cannot control?” you ask.  Ask yourself.  I have my answer.  I hold my answer in my mind’s eye, like a Swiss bank account.  My most precious treasure in the care of The One,

…where neither moth nor rust does corrupt, and where thieves do not break through nor steal.

This woman, she is courageous.  She journeys without being defined by the events.

Self Care Tip #36 – If you can’t control it, let it go and keep going.  Be a friend to yourself.

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

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Own It. Our Life’s Work.

We can control what others do about as much as we can control the Democratic government.

My patient asked me if her medications were changing who she was.  After asking her more about where that came from, she disclosed that her husband was blaming her medications for the emotional distance between.  He was not blaming his daily alcohol intake nor that he see’s her as “The Patient” and not himself.  This is after she has spent years investing in herself through medications, some counseling, and regular exercise.  This woman had courage.  Yet she still bought into what her husband was telling her.

We personalize things that have very little to do with us.  Sometimes we know we’re doing it, but more often we don’t.  In this woman’s case, I had to think, how much of this was about her versus the accuser, i.e. husband.  We came to understand together that either way, true or not, the only person in her relationship she could better, is that same person she’s been attending to so well for so long.  In the end we were talking about going to CoDA, Al-Anon, or local support groups through NAMI.  She focussed on herself, excited about her opportunities to grow some more.  She wasn’t thinking so much about her husband getting passed up by his own opportunities.  Nor about the accusations.

Talking to a friend who recently shed 15 unwanted pounds, we did a celebration whoop!  She wasn’t perseverating on her husband who was smoking again. She was hurt by it, but used the energy in that emotion to motivate change in her own life.  Who knows.  Maybe her husband will grow from wanting what he see’s in her.  Courage, self-respect, inner congruence, hope, and so many more great things that come when you fight hard for your precious self.

Not taking things personally though can be much easier said than done.  If you try over and over but see that it continues to get the best of you, consider getting an opinion from someone you trust.  Get a “third-party” opinion to bounce your perspectives from.  Maybe this is something biological and medical as well. Personalization is a familiar problem in medical illnesses such as Affective Spectrum Disorders or Anxiety Spectrum Disorders.

Self Care Tip #35 – Own it.  Be a friend to yourself.

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

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An Honorable Goal

“I feel things I had no capacity to feel before!  I can’t believe how much better life is for me.”  She was 2 months into medication therapy and she felt like she was back to whom she wanted to be.  Who she thought she really was.

Before medications, she was “making it.”  Although she was irritable, easily activated by simple triggers, edgy, she was mostly not acting on it. Making it to the end of the day every day was a victory.  Now she realized that if someone told her the difference before treatment began, she would have never believed them.  She hadn’t perceived how rough things were for her.  Now that she knew, she felt joy and sadness.

Getting well is never all good.  There is the daily reminder that you need help.  Every time you take a pill, you have to argue down all the reasons not to.  Sometimes that argument doesn’t last long.  Sometimes you spend more time than any one looking at you would guess.

The justifications for medication don’t only come from ourselves.  We have others “in the know” saying how much better we are.  Or what ever their opinion is.

Some of us are entirely on our own.  Hiding our pills so we don’t have to hear it.  When something goes wrong, the pills are to blame.  It reminds me of menarche and listening to the boys saying empathic things like, “She must be on the rag!” Things said about us when we behave or feel in a way others don’t think we should, can be just as humiliating.

Is there anything that draws more public opinion than behavior?  Being your own advocate may be easier said than done.  However, difficult as it is, it has to be done.  It starts with “me.”  If I don’t fight for my own self, choose for my own self, …well, it results in so many things.

What is surprising is how things look so different once we do take action.  Sticks and stones make more sense.  We have the confidence that inevitably comes when we gave our best towards an honorable worthy goal – a healthy self.

Self Care Tip #33 – Accept help.  Be a friend to yourself.

Question: What do you think?  Agree or disagree?

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Journey

“Mumford, The screenplay by Lawrence Kasdan, describes Henry Follet, a man who is living in his fantasies.  The superior problem isn’t that he’s living in his fantasies however.  It is that he has never been a character in them.  They only included other people.  At some point he gets more connected to his own journey, which is when he started appearing in his fantasies.  Or one could say his fantasies became his reality.

Connecting to our journey is multidirectional.  It includes the folding and opening of time.  Someone asked me why I started this blog.  I told him one of the reasons is that so much of what made me who I am was shelved when I went to medical school and then had children.  Time is folding for me when I write now, connecting me here to where this writing-self was last seen then.

When avoiding crucial work, it is as if a broken person’s bits of self are walking their different directions.  There is a divorce and the kids….  What does the father do?  Five years later he is still trying to get the courage to ask them to love him again.  Relapsing negative relationships, and she found herself again with someone abusive.  Overweight, and still buying and bringing binge-foods home.

As Will Rogers said,

When you find yourself in a hole, the first thing to do is stop digging.

Lately I’ve enjoyed my journey more since I stopped breaking traffic laws.  Exhale.  Now I can relax when I’m driving and think, pray, listen to podcasts, be with myself.

Immaterial things like our hopes can both connect us and disconnect us.  When a thought like, “I wish I did…” comes, when employment is more a job than an interest, when anger flares often – look at times like this as opportunities to find your path.  I found that this yearning in me was really a portal for my fantasies to come through and join me.

Self Care Tip #29 – Take your opportunity.  Be a friend to yourself.

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Keep it Real

Smoke screens around our choices or rather lack of choices block our journey. It takes a lot of courage to look past defenses and see what we are ashamed of. Desires people call “base” or “primitive.”

Wanting to dominate sounds like someone trying to oppress the populace. However it is a core drive in people with testosterone. Wanting to purchase sounds superficial and greedy, no? Yet it is a genetic predisposition to the extroverted sensor personality type.

We waste our time being ashamed of things we never chose. Of things that in themselves aren’t shameful. And shame mixes us up. It influences our decisions. Important decisions like what to study. Who we should be friends with. When to get medical treatment. If we go where the shame is, it will

lose

lose some of its power over us. We will see more clearly what our options are.

Keeping it real improves quality of life. Our relationships are more connected, including with our own selves.

Self Care Tip #26 – Keep it real. Be a friend to yourself

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Good News

Many people see needing to take medication as bad news. But I think about what it would be like without it. Suicide, progressive deteriorating processes in the brain biology, contagious behaviors and moods spreading to those you love, inflammation…. That is bad news. I think about the not so many years ago before most of our medications existed. Before much of our understanding about the brain biology was around. Those times were hard. Misinformed people had ugly ways of looking at others with emotional illnesses. Hearing someone thump out their opinions on the pulpit about human behavior has always been a pleasure for me as well – not! Now we know that our essence isn’t dependent on our brain biology.

But here we are, in the land of milk and honey, depressed economy and all. We have a more informed public opinion (check out NAMI – awesome!), evidenced based medications, etc…. More than ever before in our history, the responsibility to take care of ourselves comes down to us as individuals. The external barriers to treatment are not what they used to be. However, what are the internal barriers? We own our choices. Our beliefs are our own. Letting yourself close off to the good news of medication – that is a tragedy.

Now is the time to fight for yourself. You are worth it. When you see the difference in your life, your perspective on good news and bad news might change a little too. Even public opinion starts with the individual.

Self Care Tip #22 – Be your own advocate. Be a friend to yourself.

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Successful People

“Successful people expand their dreams to move them forward, others shrink their dreams to justify where they are.”
—Sam Meers

How do you see yourself? To be truthful, any of us will find ourselves in a straddle. Which side we think we’re leaning towards will depend on emotional confidence at the time and our perception will flux accordingly. Getting yelled at by a respected mentor may make you see yourself as stalemate, but that doesn’t make it truth.

If we stayed on the exact course of our current, what do we imagine our lives will look like in 5 years? There are bits of tack and turn we influence. No matter the level of abuse suffered, individuals have a sense of their own person. Their separateness. Their choice is there held fast on the buoy of their human right.

While shrinking some dreams to justify condition, the mere courage to persist in life is a form of expansion. You might not agree with this. We all have people we scorn. But this isn’t a matter of opinion. Without expansion, we die, even the grossest of us. There are more obviously lovely examples of expansion, of going towards what is congruent with your inner self, of doing what gives you energy. When someone is in flow, aren’t we all drawn to them? When someone is not, it can be hard to make eye contact, even with yourself.

When getting friendly with yourself, give your straddle a nod of courtesy. Counter intuitive at times, this in fact promotes self-respect. The more we trust the ebb and flow down our river of dreams, the more a part of our own journey we can be.

However, if you can’t look yourself in the eye, if despite setting your jaw and keeping a strangle grip on life you still feel like the ground is sucking you under, think about a medical reason. You always have a choice.

I really liked what Mr. Meers said, but I’ll say it differently for our purposes:
Successful people expand their dreams to move them forward even while they shrink their dreams to justify where they are.

Self Care Tip # 21 – Be a success by joining your journey. Be a friend to yourself.

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My Essence – A Matter of Love

Betrayal?

Connecting that behaviors are linked to brain health is often confusing. The distance traveled to reach that point may have been long. It may have involved experiences painful to themselves and their loved ones.

For example, they may have lost a job because they couldn’t get out of bed in the morning. A divorce might have come after changing into someone irritable and angry. A trucker might no longer be able to drive on the freeway because of panic. But once they connect that this change in personality relates to a change in their brain health, how do they feel about that?

Some people feel relief. That they didn’t personally fail. That they aren’t a bad Christian. That it wasn’t because they didn’t try hard enough to “feel good,” to stop itching, to get up and do something with their life, to quit gambling, etc… Maybe they feel for a moment that judgment can be suspended for them.

However there is a group of people, maybe overlapping these, who feel betrayed. Betrayed by their very essence. The question of, if they can’t trust themselves, what is real in life at all? They struggle with the shame of betraying their own person. “Who am I if I’m not…?” and the questions roll on. It must be a question for all of us with changing bodies, Who are you if your mind gets sick?

There is the temporal line of thought, that if your brain changes, your memories, your personality, than you change. Your human form is different. Like getting your arm cut off, you have to grieve and grow a new picture of how you see yourself. A changing person through the span of life. This is in fact healthy adaptation.

There is also a thread in this weave of believing that our essence isn’t wholly related to our changing bodies. That somehow when the various curtains of life fall and open and the final curtain comes around, that this bit remains. I don’t think you can believe this unless you believe in a Love which is stronger than death.

Love is stronger than the death of my neurons, my dendritic connections, stronger than the death of my mind.

The adaptability needed for this life is a no-brainer. We can’t survive if we don’t. It takes courage to adapt when your person is changing. It takes courage when you are loosing yourself. Such courage, like someone in war or flight or determined movement that others could only imagine.

But how you define your essence also matters. I see it as a related step, but also apart from these excellent coping skills. I see it as a matter of Love. It’s win-win when Love weaves through you.

Self Care Tip #16 – Choose Love. Be a friend to yourself.

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Courage to take medication

So when is a psychiatrist going to get around to talking about medications already? Nobody really wants to take medications. But it turns out in this world that our brains are just as human as the rest of our bodies. When they get sick, what does it look like? Behaviors and emotions. Our brains are not hovering over us like a supernatural aura. When our brains get sick, our behaviors are in the fist of control about as much as our liver function is.

The people I see in clinic are some of the most courageous people I know. We find each other at an amazing time when they are aware of their plight, that of being disconnected from their journey. They are humble people, willing to consider that behavior is more than something the “will” or “force of character” can control. They use as many healthy means they can to get healthy. They believe that you can’t give what you don’t have, even to yourself.

Counterintuitive to culture and prejudice, taking medication is an act of courage.

Self Care Tip #11 – When your emotions and behaviors are messing you up, think of the many modalities to getting healthy, including meds. Be a friend to yourself.

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