Depression

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Marcos and his brain illness

Man portrait

Man portrait (Photo credit: @Doug88888)

He had always been a small man with wizened lines, a moguled nose that sloped over a deep philtrum and two ears that flew like flags on the sides of his head.  Looking at Marcos has always been a study of human terrain.   For someone with so much activity and exchange with just being seen by others, it was an apparent contrast to how disconnected he remained emotionally.  Brain illness had harmed Marcos.  It was as if he had been scooped out in places.

Marcos and I had worked together for ten years in psychotropic and psychotherapeutic remedies with only partial treatment responses that curved up toward an imagined healthy baseline on currents of hope.  His improvements however, never reached where he would call himself, “well,” and too soon they drifted down despite our cumulative efforts.

About that time, I had returned from Duke University for an update in training on electroconvulsive therapy, (ECT,) and had just opened up a new outpatient ECT surgery treatment center.  When Marcos and I discussed this as a new option, (new for our living location,) he wanted it without contest.

The evidence for efficacy as compared with the side-effect profile in ECT is dramatic.  When I tell patients about it, ECT might sound too good.  However, it has been around for so long that it celebrates itself. Marcos wanted in.

It has been a year already since we started ECT together but I still remember the way he leaned back in his chair that day in my office, animated almost for a change.  His scrubber eye brows were like punctuation marks around his eyes.  “Yes.  I want it.”

Marcos has not been able to taper down ECT at this point in his treatment to less than one treatment every two weeks.  He and his wife argue for it.  We have tried many times to taper down but every time we do, his symptoms come back.  He and his wife ask me separately and together, “Why doctor?  What is the point of decreasing treatments?  I do not understand?  When they work so well and we are not having any problems from them, why are we trying to reduce them?”  So, for now, he maintains one ECT treatment every two weeks.

His wife tells me he is better than he was on their wedding day.  She has never known him to be doing this well and they both think he is closer to whatever that baseline is for brain health he has always thought he was never going to get.  More connected with her, their sex life is having a run.  More connected with their kids, everyone feels like he has become a giver and the kids grades are even getting better.  By taking, Marcos became more of a giver; taking time, courage, emotional energy, even a ride there and from ECT, Marcos took and then was able to give.

Marcos is reading everything he can get his hands on about ECT; personal biographies, scientific articles, he has become his own advocate.  He could not read before ECT.  His concentration was too poor.  Now, with improved focus and attention, he perceives his memory is better.  Marcos believes he is interesting because he is interested in himself.  He is more aware of how others see him and smiles back when he catches the looks he gets just by wearing that face.

ECT is not a cure, but it is a treatment option.  It leads to brain healing, quality of life and improved connections.

Questions:  Have you struggled with quality of life?  How do you describe quality of life?  Please tell us your story.

Self-Care Tip:  Consider changing treatment paradigms to improve brain health.

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Find Hope When You Otherwise Must Die – Depression

Jane Eyre

Image by madelinetosh via Flickr

Briggs was crying again.  His wife, who came with him to our first appointment, looked like a peeled fruit beside him.  She was undefended, giving her last layer of self without knowing what would be left.  Briggs was one case of serious depression, but his wife; she was heartbreaking.  Both of them in their own ways would not last long.

It is not unusual in a specialty clinic to work with people such as Briggs who have been around the treatment shops.  Then, finally, in Jane Eyre-style, they appear at my door in the company of death.  They have been through therapies, practitioners and churches, but disease resists treatment.  Everywhere they walk, it is as if Hades (or Neptune) were visiting.  Hope-blossoms wilt as they pass by and those of us who share space, feel like the ground is going to open up and suck us under.  It is not uncommon in specialty-care, to be told, “…I have no strength to go further.”  Like Jane Eyre, they plead, “I must die if….”  (By the way, Charlotte Bronte is the bomb.)

As the person on the other side of this exchange, I have worn down the rainbow of “specialty” options available to offer.  And what are they?

I’m going to write more about those options next, but my questions for you today are:

What has worked for you or your loved one?  Is there any treatment you think is too extreme to consider to get brain health?  Please tell me your story.

Self-Care Tip:  Find your specialty care.

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Name Your Fear To Know You Are Free

She knew the Horned King‘s secret name.

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

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

– The Book of Three by Lloyd Alexander

Science Fair Wins Ribbons

Image by OakleyOriginals via Flickr

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

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

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

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

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

There is power in a name.

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

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

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

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Flaws You Love. Presence.

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

Taraxacum, seeds detail 2.jpg

Image via Wikipedia

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 FriendtoYourself.com, 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’s 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’ve gained everything back — 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’t even imagine walking in the doors of my first meeting — 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 — for me, it’s 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’s the ONLY thing that made a difference — 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.

Self-Care Tip – If there is a weed in your life you can pull, pull it.  If you can’t, or if you do and it just keeps growing back, fall in love with it and grow a garden with those perdy dandelions.
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Are You Empowered to Start Everything and End Everything With Me?

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

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

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

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

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

Face Down w/Laundry and Gwen Stefani

Image by NCM3 via Flickr

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

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

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

Mom!  …

These questions above…;

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

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

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

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

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

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

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

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

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

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Emotions and Behaviors Will Get Better As You Heal.

Punch to the Face

Image by Ninja M. via Flickr

Don’t worry.

When you hear that, don’t you think violent thoughts?  Or how about, “Calm down?”  Got to love that.  I have visuals of my back swing.  Sure.  You might call them hallucinations.  I’ve never actually hit someone but I have pulled into ready position.

Here’s the thing though.  After all this on-and-on about taking care of ourselves, I have found myself saying things that get awfully close and I’m looking out.  Pretty soon I’m afraid I’m going to get it.  (I’ve got my eye on you!  And you!)

Here’s what happened.  Augustina was wondering what to do about her best friend.  They had quarreled and then quarreled again.

Naming someone, “best-ie” sounds pubescent but Augustina was no child.  Her best-ie had been her chosen family (as Jackie Paulson reminded us yesterday)  since she was twelve, fat and leaked.  Kids were laughing.  Future Best-ie wasn’t.  That’s the kind of girl she was.  Safe; a light in a house that she had gone toward naturally and that had not been put out by Augustina’s misty self.  Wet face, stained pants, fat neck and pimples – Future Best-ie wasn’t laughing.  And that’s about all it took.  She was her friend.

Why had Augustina and Best-ie quarrelled these thirty-some years later?  This was am apparent mystery to Augustina.  You know those kind of mysteries, when they belong to only one person while everyone else with the answer key is looking on.  It was almost like she was standing there, twelve-years-old and bewildered.  This time though, Best-ie wasn’t on her side.  Or so she thought.

Truth is, Augustina had been mean.  She was not keeping dates, she argued easily and she was more self-absorbed than the color black.  It had been months now and then they quarreled.  Augustina missed all the prodrome, the warnings, the recommendations from family, other friends and including Best-ie to get insight and help.  To Augustina, this quarrel stood alone and she was being misused and misunderstood.

So what do we do?  Do we discuss Augustina’s behavior?  Do we explain her problems?  Maybe.  But only long enough to help her join our treatment team.  Once she’s in treatment, we wait.  We for reasons of self-preservation won’t say, “Don’t worry,” but we will come close.  Why?  Because we know that many of her problems as perceived by others and herself will disappear when her brain illness heals.  Do you believe that?  Where do you think her emotions and behaviors are coming from?

See blog post, There is Less Space Between Emotions And Science.

Questions:  When have you seen maltreatment from others that feels personal to you appear without provocation?  When have you seen someone you trusted change into someone who is mean, angry, selfish and reject you when they never did before?  Did you see the opposite happen when their brain illness was treated?  Please tell me your story.

Self-Care Tip – Calm down.  (Duck!  I see you and I’m outta here!)

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

DSC03321

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

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

What do you say?

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

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

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

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

Self-Care Tip – Empower yourself by your presence.

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

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Grief Can Be Treasured At The Same Time That We Celebrate Life

Self-Care Tip #283 – Find the treasure in your grief while celebrating life.

Today is my daughter’s sixth birthday.  If ever there was a person who doubled the love she received, it is this chid.  She is all passion.  Yes, both ways, but that isn’t to judge.  Just, there is so little I can offer in words to describe her power of self.

They're asleep!

Image via Wikipedia

Tonight, we pushed two twin beds together so she and I could sleep beside each other.  Her sister slept nearby on another twin bed.  Her brother set his bed up in the closet.  (I know.)

If I wasn’t so tired, old and broke, I might be made vulnerable by times like this to having more kids.  Since that’s not going to change, these chubs are what we will stick with.  Happily.

My mind is turned toward God by this girl.  I somehow arrive in the moment praying when with her, perhaps for strength and patience or for humility and gratitude.  I learn from her.

Mommy, when I’m scared I talk to Jesus.

Often in times like this, I think of my niece, dead now six years, and how her parents and we wanted what was, what was stripped.  Still grieving and still living the life with us and in us, our braided thoughts and emotions easily lose their flow.

But today I have this clarity.  My niece is gone now six years and ten days.  Today my daughter is six years old.  Today I am sleeping with my three children.  Today I know that this is precious but this is not all we want.  We want what comes after our living years.  We want to let loose to Love the grief and the life; to untangle.  Not more.  Not less.  But we want.  We want what we have, now, although still in the unknown dimension of our forever.

In psychiatry, we are alert to grief that warps the ability to engage in life.  Grief that mars the connections of survivors.  Grief that becomes pathology, brain disease and a medical condition.  This grief disables and, for example, in the case of my daughter’s birthday today, would dissolve my ability to feel pleasure.

It is difficult to gain access to treatment as many of these survivors have ill opinions about medical care.  Such as; fearing medications will mute their connection with the deceased; mute their grief, or in other words, tribute/offering to the deceased; take away the personal punishment for surviving…

Questions:

  • What do you say to these weeping lives?  How can we de-stigmatize medical care for them?
  • How have you been able to treasure your grief and the life with you and in you?
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Me! Where Emotions and Behaviors Come From

steps 15

Image by Erik - parked in Cairo these days via Flickr

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

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

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

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

Where do emotions and behaviors come from?

Me.

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

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

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

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

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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.

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When to Push – Melancholia

Edgar Degas- Melancholy

Effie came to me with many melancholic symptoms.

Melancholia is an interesting word.  It comes from the Greek word for black bile, which is where people used to think sadness came from.  The word melan is familiar to us in words we use today, such as melanin, melanocytes, or melatonin.  All of these having something to do with darkness.

Effie had been feeling dark inside, like a black cloud was hanging over her.  Effie had so many “good” reasons to feel melancholic, as if reasons were needed.  She hurt.  She had other physical problems.  She lost her employment.  She was estranged from her family.  Isolated.

I asked her what she did every day.

Just sit there sometimes.  I just sit there and think about all this stuff.

This wasn’t my first visit with Effie.  We’d worked together for years.  Some of what she was going through, along with the biology, were her psychosocial stressors and learned negative coping skills to stress.  We had been working on these together for a long time but, beyond medications and sleep, Effie had a lot of difficulty working with her directives:

  1. Medication including supplements
  2. Sleep
  3. Connection – groups, church, internet, etc…
  4. Exercise
  5. Lose forty-five pounds to decrease multiple comorbid illnesses she was suffering from.  These comorbid problems secondary to her obesity looped back and worsened her mood.  It was like a brick in her pocket taking her down to the bottom of the sea.

Effie said,

I don’t want to do anything.  I just want to be me.  It doesn’t matter if that is good for me or not.  It just matters that it is who I am now.

Thanks to our work here at FriendtoYourself.com, I felt empowered to pull out the self-care tools and share.

Effie, you need to go to groups.  You need to connect.  If your child told you that she didn’t want to take out the trash because she didn’t feel like it, what would you say?  Maybe, ‘I’m sorry you feel that way.  You still have to do your work!’  Are you going to wait until she wants to?  Do you tell her to just be herself, that it is ok?  Is that nice if you do that?  No.  It is not nice.

Effie explained that she only came to see me because I was the only one who understood her.  She didn’t want to talk to anyone else.  Of course that is flattering but I admit, however reluctantly, that I am not that good.  There are other people out there who know what she’s going through and she’s not meeting them because of her choice to isolate.

Now folks, this is not to say that when someone is depressed, that we should tell them to bucker up and get on with it.  Nor should we say that they are being childish.  We all need to be very very very careful about that.  It’s ignorant and hurtful.  In Effie’s case, however, because I knew her so well, I pushed her a little harder than I had been.  I wasn’t saying she was being childish, so much as I was telling her that she needed to do what was good for her, rather than what she wanted.

Effie wasn’t having fun either way, groups or no groups.  And although medications had helped, they hadn’t helped enough.  As we had seen each other at least once a month, if not more, for about thirty months for this most recent depressive episode, I was as clear as I could be on what had been tried and what hadn’t.  I would not do this in anyone who didn’t have this constellation of factors.  So, I pushed Effie to do something she hadn’t done yet.

Also, we hadn’t spent enough time on the primitive coping skills Effie was using.  What I told her this day was more directed towards getting her away from those.

Being a friend to ourselves isn’t always doing what we want.  It is being better to ourselves at least than our enemies.  I don’t know many people I would allow to speak to me, the way Effie was speaking to herself.  We talked about allying ourselves with the bits inside of us that were going in a direction to benefit, and not hurt.  Not collaborating with the parts of us that would further harm us, no.  This part we would name together out loud and drive forward to it deliberately.  We would see together what happens.

All the while, we are still continuing to work with medications and other therapies directed at Effie’s biology.  However, I believe we need to do more. When to introduce different therapies differs depending on the needs and abilities of the individual.  This is how it went for Effie.

Questions:  When have you done something you specifically didn’t want to do, but knew it was friendly to yourself?  How did it turn out and was it friendly after all?  Please tell us your story.

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Mental Illness Relapses When Medications Are Stopped

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Self-Care Tip #246 – Collaborate with your physician to change your medications.

It keeps happening.  People are stopping their medications and then getting more sick.  Recently it was Olivia.  I can always tell when she’s off medications – she personalizes things way more and she acts like a victim to many many random things.  She is irritable.

Olivia, did you stop your meds?

Olivia on medication was not a super easy-going person but she dropped much of the edge, her thoughts were clearer and she was able to see other people around her.  Today Olivia felt like her bullets were in place and about to fire.  She answered my question obliquely.

There are sooo many reasons I am better without those in me!   I used to not be able to feel God.  When I prayed, I didn’t sense His Spirit.  Besides, I’m doing fine.  There’s nothing wrong with me.  I’m happy!

The biggest bummer about getting into the scene after the medications were stopped verses before, when stopping them was just a consideration – is that the patient doesn’t see themselves clearly.  They don’t see how bad it’s gotten.  They can’t be objective largely because they are using the same organ that is ill to describe itself.  If I could have discussed it with her before she stopped her medication, she would have been in a healthier state and more able to weigh her risks and benefits of medication verses no medication.

Sometimes we do agree together, patient and physician, to stop medications and sometimes we don’t.  Doing it together is the key though.

Questions:  How do you work with someone who wants to come off their medication?  How about yourself?  Has this ever been a problem for you and if so, how did you deal with it?  Please tell me your story.

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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

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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.

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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.

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Moralizing Behaviors and Emotions

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Self-Care Tip #233 – Stop moralizing behaviors and emotions to be a real friend to yourself.

Responses to yesterday’s blog-post, I believe, revealed my point in time position in moralizing behaviors.  It is no excuse, but yesterday for reasons of my own limited perspective, personalizing behaviors, perceived judgment from myself and others, and cultural biases including some good old-fashioned well-intentioned holy roller atmosphere, I hooned in on that darned word selfish.

That word, selfish, reminds me of any class bully who hurts others but maybe not for the reasons assigned by observers.  It is more than that though.  Inherent to its own definition, morality is more than implied.  In efforts to destigmatize it, evolutionaries, such as George C. Williams, coined the term, “the selfish gene.”  We as well, in efforts to peel it off of us “self-carers” here at FriendtoYourself.com, have discussed some of the biopsychosocial reasons for behaving in ways that disregard the needs of others.  We have talked about freedom to choose and losing abilities to choose.  Because we believe in magic, or miracles, or yet unexplained science – however each of us prefers to describe the unknown – we claim some awareness that we still haven’t yet given over fair perspective, despite our intentions.

The wonderful, ever articulate, gentle writer, reader and commenter, Cindy Taylor, reminded me of this yesterday, saying simply,

I found that taking an adrenal supplement has improved my sleeping patterns greatly.

What a girl!  That one and only Cin.

Yet yesterday, somehow, I didn’t say much about those things.

Questions:  What does “selfish” mean to you?  Why and how do you extricate yourself and others from it even though they appear to be just that – selfish?  Please tell me your story.

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Number One Reason For Relapse In Mental Illness

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Self-Care Tip #230 – Remember why you feel the way you do.

Olive was doing well.

How are you doing Olive?

Oh fine.  Just fine,

Olive would say.  And she was.  A sense of rightness filled her when she thought about it.  Right with the world, her garden, her work and even her kids.  She wondered that there had ever been a time when she hadn’t been.

It was almost easy for Olive to forget about why she was better.  Almost, except for her probably thirty seconds of opening the lid, dumping the contents into her hand, tossing them, all of them into her mouth.  One swallow with water and it was over.  Thirty seconds she thought.  I’m doing it for my kids.

Then came the best reason she ever needed.  And despite knowing that she had done this before and had relapsed, something about the rightness of the reason made her feel like the relapse wouldn’t be allowed.  The rightness would keep it away.  After all, she was stopping her medication for her kids.  If she didn’t have medical insurance than she would be a huge burden financially and she would die before doing that to her children.

So quietly Olive stopped.

By stopping medication, many of us have this sense of eliminating the reason we started the medication in the first place.  Take medication.  Disease continues.  Stop medication.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You’re gone.  Turn back.  You reappear.  Turn.  And just like that, you’ve been eliminated.  Even now, remembering it delights me.

Not so cute however, is the number one reason for relapse in mental illness – stopping medication.  For Olive, she turned her head, and hoped her recurrent Major Depressive Disorder would not be there when she turned back around.

How are you Olive?

(Sigh.)  Fine.  Just Fine.  (Sigh.)

But Olive wasn’t.  Even though she knew she had been better on her medications, she couldn’t see any more, how much better.  Her face tightened up, her thoughts wandered and she exploded more.  Self-loathing of course followed and she felt like her suffering was unique to her.  No-one understood her, especially her ungrateful children.  She was doing this for them, just like everything she did through her whole unappreciated life.  This was all wrong.

Is this why I worked all those years and raised them?!

Readers, you may not agree with the crystal clear logic that emboldened Olive’s heroic stopping of her medications, but it’s not the only one out there.  This being the number one reason for relapse implies that there are many that seem to make really good sense.  So forget about they specific “why” of why Olive turned, and just know that many of us do.  Many.

Question:  What has helped you stay on your medication when it seemed to make sense not to?  What do you think about people who choose to stay on medications for life?  Please tell me your story.

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Where Do You Think Behavior and Emotion Come From?

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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 ‘self-compassion’ trumps ‘self-esteem’. 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.

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Choosing Perspective

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Self-Care Tip #225 – If you can’t choose a better perspective on your own, it might be time to choose it via a medical route.

Feeling trapped?  Overextended?  Used and neglected by others?  It might be true.  But why do we get in these impossible places?

In the Wrinkle In Time by Madeleine L’Engle, towards the end of the story we find ourselves in a room with Charles and It.  Charles is trapped by It.  He has disconnected from his own thoughts and has given himself over to the control of “It.”

Charles’ sister, Meg, comes in and reminds him about Love and that changed the perspective of everything.  It reminded Charles about why he wanted to choose for himself, to have his own thoughts, to love and receive love.  And then, with that, Charles was reconnected with himself again, whole and sharing space with Love.

The changing perspective turned what seemed an impossible bondage into freedom.

When we feel disconnected from our personal journey, impossibly overextended and trapped, remembering our freedom to choose, freedom because of Love can make all the difference.  The perspective shifts.  The impossible becomes possible.  Magic.

Sometimes, choosing is thwarted by brain disease.  When we can’t extricate ourselves, when guilt plagues us, when we feel like things are about us that really aren’t, when the emotion jarring us is inappropriate to the context – we need to use that as a cue to choose to get “free” via medical help.

Questions:  When have you felt trapped?  When you did feel trapped, how did you find your freedom?  Please tell me your story.

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Self-Care Woven and Unravelled Simultaneously for Best Results

Change is good--Kente Cloth Loom

Self-Care Tip #222 – See the different parts of your self-care as independent yet dependent on each other.

One of my truest pleasures would be to teach well.  My temperament is, per Myers-Briggs, designed to be a teacher and I agree that I feel inner congruence when I’m doing just that.

…If you’re feeling your hands closing into a bracing grip, it is probably because you, like many, really don’t want to be schooled – which has happened in my less refined moments, so caution is understood.  This is not what I hope to do here.

After yesterday’s blog-post and comments received, it shows that I have not taught as well as I implied to myself.  Implied intimacy is a danger of any familiar relationship, including with ourselves.  The beauty of you guys, is you help me say things “out loud” decreasing misunderstandings.  You guys are teaching me and I thank you.  So whatever this is we are doing, learning, schooling, teaching or whatever it is that Mr. Rick C. does – what we are doing here together is mucho-much fun.

As we unravel the rug together, we see these threads,

  • emotions and behaviors appropriate to context – yesterday we spoke about guilt
  • emotions and behaviors inappropriate to context – yesterday we spoke about guilt as a symptom of medical illness
  • the magical miraculous beyond our current understanding – before we “see face-to-face” – yesterday Carol Ann mentioned the changing power of God
  • freedom to do self-care and related choices
  • what choice yet remains when other choices are lost either by action or disease
  • (this last one I’m just putting in here to finish the pretty rainbow) – helps me get in the barn where I’m comfortable

The reason I think it’s important to see these together yet apart, as well as we can (through a glass dimly), is that too much of one or another of these, diminishes the results of our self-care intentions.  Don’t mistake this for preaching that one can get too much of God in their lives.  It just isn’t true and not in our best interest to get waylaid.

Questions:  How do you see yourself more effective in your self-care efforts and what has influenced those improvements?  In what way have certain bits of your self-care gotten “too much” attention?  Please tell me your story.

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Guilt Furiously Chasing You Is Commonly Experienced In Illnesses Of The Brain

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Self-Care Tip #221 – If you feel chased down by guilt, stop running and get friendly with yourself.

I’m so busy!  I am trying to work, raise three kids, and be a wife!  …and I’m just spread so thin!

It was new for Connie to think that where she was at in life was linked with her choices.  Somehow she intuitively felt taken along by it all, a current of life as people say, of either randomness or design.  Who could know, but it was more than her choices, she was sure, and she resented the influence on her life’s design.  Not that she had intended on taking over what was playing on her.  She just simmered in the house of cards hoping that when she got to make a play of her own, she’d make a good one and come out better for it.  In the mean time, she just had to keep moving fast.

Things would have been fine, except that over the past six months, she hadn’t been enjoying what she was living for, her kids, parenting, being a wife or her employment.  Yes, she was also  living for God but no, she wasn’t enjoying Him either.  Did she want to?  Did she feel guilty about it?

I feel guilty all the time.  It’s the guilt that gets to me.  It’s like I can’t see or feel much else.  Just when I think I’m about to get into what I’m doing, guilt comes chasing at me in a fury!  Distracting me and worrying me.  I’m on edge more and irritable from feeling defensive, and trying to get away from whatever this is.

Connie looked at me when I said,

Self-care begins and starts with “Me.”  Although we may be living for others and other things, even living for God, if we don’t take care of ourselves, our health first, our emotions and behavioral health included, we can’t give much, in the way of living, to those others.

I could see her pupils change and I got a little excited.  She was hearing something that affected her whole body and I sensed it was hope.  (See, I am an Emotions Jedi.)

We talked more about approaches she was using, prayer/meditation, exercise, grit and determination, waiting it out for better days to come and others.  Then I introduced the medical paradigm.  (You’ve heard me say it.)

Behaviors and emotions come from the brain.  We culturally think that they are volitional, under our control.  But how much can we really control of what the brain does?  Some.  But when we do the best we can with what we can control, and our behaviors and emotions are still hurting us, affecting our quality of life, damaging our relationships and connections – we need to look for biological reasons.  That’s where choice can still come into play.

She was looking and nodding.  This was at her “consideration stage” of introducing these new ideas.  I said,

I thought of telling you about this when you talked about guilt Connie because maybe your guilt is coming because of a brain illness.  It’s common in several emotional illnesses, like depression or anxiety, and in these illnesses it commonly comes in force, like you’ve described.

Her pupils had reduced to their earlier size, and her posture said she was winding down for that visit.  Whatever we discussed after that would be low yield, so we made a follow-up appointment and called it a day.

These days later, remembering Connie gets me thinking about what I would have said if she had been available to still hear more.  This bit about freedom to choose self-care, yet saying we have little to do with how our brain works can get confusing.  It might seem contradictory.  Tomorrow, I’m going to discuss it more, but for today, it would be wonderful to hear what you think.

Questions:  With behaviors and emotions coming from a material biological organ, the brain, yet knowing that we are free to choose for our self-care, what gives?  How do these ideas jive?  How have you seen it play out in your life?  Please tell me your story.

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