Self-Care Doesn’t Have to Be That Big of A Fight

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Self-Care Tip #215 – Fight as little as you possibly can when reaching for your choices to self-care.

We skipped over that.  We didn’t tug on the medication-or-no-medication rope.  What a relief.  Marsha surprised me.  When we first met, she had been the one who said,

I don’t want medications but I can’t go on like this.  If I choose to start, when can I stop?

In these scenarios, it’s easy to get snagged by the temptation to educate (tug.)  There is the risk that if we don’t educate, we might miss our opportunity to engage her in treatment and get help.  However, because Marsha was willing to at least start medication, even though the duration of treatment was in question, I decided to let the medication argue its own case.  (Standing quietly by the rope.)

Not everyone is as good to me as she was.  Some patients, prodded and edgy from the anxiety, want to fight a little.  That anxiety is coiled and full of potential energy.  Feeling put off, up it springs when I say,

Let’s talk about this, if it’s alright with you, after you’re feeling better emotionally.  (Pulling on the rope now, heels three inches deep into dirt.)

Somehow, Marsha let it ride out.  Somehow, Marsha came out on the other side.  She had nearly forgotten about wanting to ever stop her medications.  She never even brought it up in fact.  I did.  I think I had to say it twice to get her to know what I was talking about.

No.  I don’t care if I have to stay on these medications the rest of my life.  I feel so much better!  I’m more myself than I ever was.

 

And there it came.  That beautiful awareness of taking care of our changing selves.  Without much in the way of hand blisters, she stepped by her own volition across the line.  Marsha was a no drama type of girl.  Just in time, I caught the temptation, my own springing up potential energy to pull on the rope when we were on the same team.

Marsha had struggled with disabling mental illness her entire life, and here in the third decade of life, she simply walked over into health.  Gracefully she left her previous self, accepted her new, assumed it was her intended baseline and that was that.  She wasn’t over the stigma, she hadn’t accepted some of the other lifestyle changes entirely but still, she was content to call her team, come what may.  What a woman.

Questions:  How has the process of getting on and staying on medications been for you?  When have you felt more yourself?  How do you define your true self when you change through life?  Please tell me your story.

Never Let Go of Hope, Even When Depressed and Anxious

Linda, Lake of the Woods Run, 15 K

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Self-Care Tip #214 – Never let go of hope, even when depressed and anxious.

Some blog-posts ago, Be Aware of Your Feelings was written and “M” asked,

What is the difference between depression and anxiety?

Anxiety and depression are like brother and sister.  They often go together.  When we think of “paradigms,” we think of an arch that might intersect with another arch.  However, when I think of the affective (or mood) spectrum intersecting with the anxiety spectrum, I see them weaving, interlaced or chasing each other.  Not a line and nothing tidy.  So understanding the difference also includes understanding their relationship.

In training, I remember presenting a patient with anxiety and depression to my psychiatry attending physician.  I hadn’t clarified the timeline of onset of symptoms.

When presenting, every resident physician knows the moment when they are found out.  The other residents on the rounding team instinctively lean back, try to take a step away even, so the lightening doesn’t singe them when it strikes.  I’m sure I smelled like fear too.

The reason the time of onset of symptoms is important, is that it tells us the primary disease process.  Knowing that, influences the speculations on patient recovery, duration of illness and our choices for treatment.  Some medications for depression can really activate anxiety and the patient might not enjoy the free-fall into hell after starting the antidepressants.  Also, there are some treatments that work better for different disease processes and such.

It’s common for someone who has suffered from depression on and off for years, but never from anxiety, to have their first panic-attack out of the blue, without trigger.  Bummer!  Then they start to roll.  Bam!  Bamm!  BAm! BAAM! BBBAm!  The panic attacks may come in spurts and then go away for a time.  The opposite is also true, starting off with anxiety, and followed by depression.

I don’t think anyone, including “M,” is asking me to talk about the differences between anxiety and depression in that depression is a state of sadness, and anxiety is a state of autonomic nervous system activation.  Rather there is the wonder of why they follow each other in course, why the are so often in each other’s company, why so many medications that treat one will treat the other, why they run in family histories and/or why they are both “so common.”  We have some ideas we use to answer but we don’t have enough objective information to explain.

Some of the good news is that these diseases are treatable.  The sooner they are treated and when treated to full recovery, the better the hope for long-term brain health is.  I have seen people feel defined by these diseases and trapped.  My job isn’t to minimize that, but rather to highlight what might bring hope.  Selling hope turns out to be one of my biggest jobs.  The same attending physician I mentioned above told me that.  He never stopped talking about hope.  Even for me.

Questions:  How do you answer “M’s” question?  How have you seen depression and anxiety move together and how have you responded to it?  What has given you hope when they did?  Or, when you saw this in someone else.  Please tell me your story.

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Does What You Live For Make Life Better For You or Worse?

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Self-Care Tip #212 – Figure out what you are living for and use it to make your life wonderful.

All of us have at least one thing in life that will undo us.  We all have something(s) that we consider worth living for.  For the most primitive to the most cultured, from the most defended to the most vulnerable, we have this (these) soft spot(s).  For me, it is my family.  Many of us might say the same, but there are others of us who have other beauties, treasures, The Pearl (as described by Steinbeck) that they would unravel over.

Because this is so scary, we might get snared up in where to go banking when we think about this.  We buy more guns, build more storehouses, fill our basement with jugs of water and like Japan, we find ourselves undone by our own preparations.

An interesting statistic is that homes with guns in them have more suicides.  In famine, the rats eat all the grain before we can.  And poor Japan, who had the most amazing defenses against, an unheard of, three simultaneous natural disasters, is leaking cancer.

Pricilla, also, was almost undone.  She’d argued with her husband and she felt fragmented by it.  She felt herself dissolving from the emotional pain and did not even want to recover.  The argument was bad.  The construct of her world precariously balanced moment by moment immobilizing her.  If she moved, she was afraid of which way life would tilt.

Soft spots can be our greatest strengths though.  We can see them as weakening our defense against life’s cruelty, or we can see them otherwise.  When we live defensively, we miss a lot.  Pricilla, I was fortunate enough to witness, chose to go towards her pain, which was in fact going towards what made life valuable to her.  Pricilla wasn’t able to do this until her emotions (what she interpreted her reality with) became more friendly to her.  Her emotions had been awry and she had been a fearful person for a long time.  After working hard on her medical illness through self-care, including medications and other life-style changes, Pricilla became less preoccupied with her ruminating fears.

Pricilla was learning through gene therapy (i.e., medications and lifestyle changes) to use her love for her husband as a strength.  I wonder about those in Japan.  I know we have prayed for them and hurting for them and hoping.

The other day in my children’s Classical Conversations class one of the teachers prayed for the rescue and survival for the citizen’s of Japan.  I prayed for a wonderful death or dying process for those who weren’t going to live.  I don’t think either of us prayed better or braver than the other and I don’t bring this up to qualify prayers.  I say it to highlight how we were holding our soft-spots.  The individual Japanese is at the point in their life’s journey, I imagine, where the life lived till now was a preparation of sorts for how they would hold themselves during this disaster.  How did they defend themselves?  Were their soft-spots their points of vulnerability and weakness, or strength?

Questions:  What do you live for?  Is it empowering to you or does it make you scared?  Please tell me your story.

Write Your Letter To Get Self-Care Insight

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Self-Care Tip #206 – Write your letter to get what you’re looking for from self-care.  Be a friend to yourself.

So why am I so interested in self-care?

I’m not sure who said this first, but I heard it from speaker and author Peter Rollins, and it rings true.  People write letters not necessarily to communicate to others but because they needed to hear the words themselves.

For example, the smooth Paublo Neruda wrote in his poem XVII (I do not love you…) as translated by Stephen Tapscott,

…I love you without knowing how, or when, or from where.
I love you straightforwardly, without complexities or pride;
so I love you because I know no other way

than this: where I does not exist, nor you,
so close that your hand on my chest is my hand,
so close that your eyes close as I fall asleep.

You may also remember this verse from the movie Patch Adams.  I think Paublo Neruda must have really wanted connection.  And so with me, I’ve been writing my own letters of sorts – every day about self-care.  What do you think about that?

The truth is, it’s not hard to see why I’d need that.

This leads us to victims.  We’ve all seen them, and probably been them at one point or another.  Parents who blamed their kids behaviors for their feelings.  Spouses who blamed their Other for their feelings.  Physicians, nurses, accountants, judges who blamed their colleagues, who blamed their employers – “Every day there is just so much work put on me.  The system’s corrupt.”

What I realized is that I was also living like a victim.  I wasn’t taking care of myself.  No one can give what she doesn’t have.  And I didn’t think I was responsible for this.  I actually thought at some conscious and including subconscious levels that all these other things in life were reason enough to suffer like me.  Many of us think this way – stress leads to poor treatment of ourselves.  It may, or it may not.  But all we can have any control in, is our own selves.

Love Letter

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This was my ah-ha.  Self-care begins and ends with Me.  This became a passionate love-letter for me even though I’m still not above “victimhood.”

For us who were “ruined” by their circumstances, tired and loveless because someone cheated us, mad because of thoughtlessness – we were in need of Love.

 

No one is responsible for my emotions but “Me.”

Questions:  Why are you interested in self-care?  What letter have you been writing?  Please tell me your story.

Be Willing to Stick Your Toe In The Water of Self-Care – Just Start.

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Self-Care Tip #204 – Be willing to stick your toe in the water of self-care – just start.

I’m not interested in medications.

I used to really wonder why anyone would come to me and say this.  Sometimes we would both realized that they didn’t know what a psychiatrist was.  My degrees seemed transparent as they hung so quietly on the wall.

My girlfriend, who’s an Ophthalmologist, loves it when her patients homogenize her work with what optometrists do.   And it wasn’t until I read Madeleine L’Engle did I understand more of the differences between astrology and astronomy by understanding their similarities first.

For the magi, astronomy and astrology were one science, and it is probably a very sad thing that they ever became separated. That is yet another schism which looks for healing…

Watch for the Light: Readings for Advent and Christmas.

In those cases when my patients don’t know who they came to see, I have tried to bridge the awkwardness with something to put them at ease.

Don’t run for the door.  There’s no cage.  See, the doors unlocked.  There’s no implication that you have to take medication just because you came to see a psychiatrist instead of a psychologist.

But I’m not interested in medication.

Then there are those who know who they came to see.  But they may not know the connection between behaviors, emotions and their brain health.  (Of course there are other reasons to see an MD I’m not covering here.)

I’m not interested in medication.

Who wouldn’t wonder?  Now I realize an MD is good for more than just prescribing, if she wants to be.  I know.  Wild and outrageous idea, right?  So before I educate anyone on my enormous fund of knowledge or my stealth abilities to diagnose and treat, I think about what it is that this someone thought they might get from coming to see me.

(Enters Fatima:)  Fatima came in this way.

I’m not interested in medication.

Fatima wasn’t feeling good.  Her emotions were corrupting her behaviors and quality of life and she was trying to help herself, stretching her toe into the pool of science, slowly.  She had never been a person to jump in and splash.

After speaking with Fatima for some time, we were able to come up with what she felt she needed help with, what she thought might be medical, what she might be willing to try – for now that meant engaging in psychotherapy, starting omega 3’s and vit D, working on her sleep hygiene, trying to get more aerobic exercise in (like a pill) and doing a mood chart.  We decided together that she would see how this goes for her over the next two to four months.  After that, if she wasn’t doing better or better enough, we’d consider a medical intervention.  We’ll see if she’s interested in medication.  Maybe not.  She can choose when she believes she’s making the right choice.

Questions:   What helped you take the plunge into medication therapy?  What held you back?  Or in someone you know?  Please tell me your story.

Take Care of Yourself Better by Knowing What That Means.

Self-care tip #203 – Take care of yourself better by knowing what that means.

What is self-care?

Starting with the responsibility of our own persons needs, not necessarily for selfish reasons or self-less reasons – although it may be.  Self-care may also be starting with our own selves is not so simply because it is the shortest route to doing anything we want in life.  Pick something, anything.  Community service.  Parenting.  Science research.  Evangelism.  Rock-in-roll.  Name it.  Self-care gets you there more effectively and efficiently.

Self-care is not alone-care.  Self-care is a connecting force between Me and Me, Me and you, Me and all Life and Me and God.

What is self-care?

mbti, getting things done, productivity, technology

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Insight.  Insight to our needs.  Insight to our feelings.  Insight to our body function.  Insight to the needs around us and how we intersect with them.  Insight into our behaviors.

Self-care is insight into our own temperaments and pursuing the natural desires, talents, interests of our own design.
Personality Types.

Choices.  Choices to align ourselves with the constructive/positive efforts of our conscious and subconscious selves.  Choices to respond to the insight and own our role implied by the insight.  Choices to take care of our body, concretely – eat well, sleep well, exercise, drink water, take our vitamins and medications as prescribed.  Choices to Love and be Loved.  Choices to connect with others and relinquish the pride that drives our isolation.  Choices to be as healthy as possible as a gift to yourself and to those you love.

Self-care is letting go of our history.

Self-care is grabbing responsibility for now and our future.

Self-care is knowing that no one is responsible for how I feel, behave, think or function, except Me.

Question:  What is self-care for you?  Please tell me your story.

Be Aware of Your Feelings and Your Body Function When Getting Friendly With Yourself

Self-Care Tip #202 – Be aware of your feelings and your body.

symptoms and signs

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Wordsmith SuziCate commented to our post three days ago on finding depression in those of us who appear “fine.”

It can be more apparent in what is not said…. When I was depressed it was the absolute last thing I wanted to talk about. I evaded the subject, and if forced to talk it was about anything but what “I” was feeling.

Yet again, the comment completing the post.  It was on my mind and in my face somehow over these sum of days.  When I would start thinking about something else, a patient would nearly quote SuziCate and I wondered if you all have met behind my back on some other blog site with intent to trip me out.  (Grandiose delusions….)

Margo said yesterday in clinic, with hands moving, eyes wide and leaning in,

When I was really down, I just quieted down, stayed low, did my thing.  The last thing I wanted to talk about were my feelings.  I felt afraid of the Nothing that waited there.

She was talking more quietly now and her whole body receded a little.

You aren’t interested or interesting to anyone.  You don’t have anything to say.

We were both quiet for a bit.

These flattening-of-the-spirit symptoms used to be called “Pseudodementia” because they resembled dementia so much.  A muting of the mental and physical function.  A disease progression slowing the nerves and body.  We now refer to them as “Neurovegetative Symptoms.” **

When thinking about getting friendly with ourselves, we can’t forget about what we don’t say or feel emotionally.  We remember also, that the brain is connected to the rest of our body.  Brain is sick, the rest of us is sick too.  This can be a good check point once we start realizing that something is wrong either by insight or by comments from others.

It can be more apparent in what is not said….

Hear more than words.

Not all depressions are these muting processes.  Some of them are activating and agitating types leading to anger and irritability.  Those are hurtful too.

All types of depression are dangerous when left untreated.  The reason isn’t only the risk of suicide or the distance it creates from others.  The reason also includes the less familiar brain changes that it causes on the brain function.  The sooner we are able to pull out of a depression, heal and return to ourselves, the better health our brains will have the long term.  The longer a depression is left untreated, the more damage is caused to the brain’s health.

Questions:  How did you figure out you were depressed now or then? Or that someone else was depressed?  Please tell me your story.

**Neurovegetative Symptoms are the things about affective disorders that most of us don’t know about.  We think about emotions – depressed, sad, happy, angry and calm when we think about mood or anxiety.  We don’t think about the body.  We don’t think about cognition, concentration, memory and what SuziCate or Margo described so well.

It can be more apparent in what is not said….

Neurovegetative symptoms are called “neurovegetative” because they are caused by the changes in the nervous system and they limit our ability to function.

Using The Force – I Am An Emotions Jedi Diagnosing In Those Who Function “Fine”

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Self-Care Tip #200 – Use your emotions to sense the emotions around you or in your own self to detect depression.

Teracina came in initially for some sleeping pills.  She didn’t come to tell me about her personal life.  She just wanted the pills.  It’s understandable.  What a pain really to unveil on cue, like planned sex it was too impersonal to get personal.  She was in the category of people who weren’t pining for diagnosis, for a hearing ear or connection.  She wasn’t even actively thinking about those things.  Pushing them at her turned her stomach.  Foreign foods and smells to her, a girl who liked home.

Hearing what she is coming in for is the first part of anyone’s exam.

So what brought you in today?

What can I do by you?

What are your druthers?

In Teracina’s case, I got an answer of what she perceived she needed.  It’s my job to see if I can get more than that first answer, the patient’s chief complaint.  So we negotiated as we chatted.  Pills for history.  Only enough pills to get her in to her next appointment in a week when we can talk further.  She’ll come back ready to let me take a history or she won’t.

We talked a little more while I was writing out her secure-prescription for what she came in expecting to get, Zolpidem.  It turns out that her neighbor shared some with her a few weeks ago and it “worked.”

I was watching her too, while I wrote, while we talked.  She didn’t have much expression on her face and her voice lacked inflection.  She gave off this aura that the ground was about to open up and suck us both under.

This is a short-cut I learned early in my psychiatry residency training.  I also had extra credit because I was already hard-wired to listen to my internal emotional milieu.  I call myself the “Emotion’s Jedi.”  (Go ahead and laugh.  With these powers, I see right through you.)  When we are with someone and feel like the ground is going to open up and swallow us, we have a ladder-chute to diagnosis –> depression.

Depression is sneaky; an ebb out of our unsuspecting selves it takes bits of our personality away.  More often, many of us don’t know that we have been changed.  We are doing well enough at work, or school or the daily chores of a care-giver’s work-load.

I’m fine.  Nothing’s changed.

Colloquially we call this, “functional depression.”  Doing well on paper but inside fading, body changing, sleep changing, interest and motivation – changing.

No.  I never have thoughts of wanting to die.  I’m fine.

(Insert famous swooshing sound of my lightsaber.  You can add music too if you like.)

But who cares if Teracina doesn’t come back next week to see me?  I’m not fighting her.  No I’m not.  And that’s why I care.

None of us are fighting each other.  We are fighting these diseases, here to be tools to be used by each other and by ourselves for each others sake.  Flip it back again.  For our own sakes.  We fight that dark melancholy and are not worth much more than our posture if we don’t.

Question:  What has helped you to detect depression in those functioning around you?  Or yourself, when “everything was fine?”

Bring Your Separate Selves Together – Personal Journey

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Self-Care Tip #199 – Bring together what you are naturally inclined to do with what you spend your energies on.

When we do what we like to do, what is congruent with our hard-wiring, what is naturally inspiring, fatigue becomes part of our pleasure in my life.  Cliché,

Enjoy the burn,

…is common for a reason.  There are times when pain, fatigue, difficulty and hard-surfaced days are bits of what make life journey one of richness, rather than diminished.  I was reminded by Jaclyn Rae’s Blog-post today, that when we can say,

I’ve learned that I’m tired but still want to do what I do,

…we are paddling the same river our life is floating down.  When we by mental illness, misfortune, choice or neglect, don’t – we are more observant of our lives rather than participants to them.  We find being present in the process difficult.  It’s not something everyone can do in all aspects.

However, we don’t have to be defined by those particulars, choosing instead to do the hard work of processing our choices, our energy and where it comes from, our emotions and see how they weave into our constitution.  Then, some time when breathing hard, limping and spent, we will remember this and reconnect the experience with the choice and the emotion a little quicker.  We will less often separate from the water our life is traveling.  Not become observers but participate more often, more actively, more tangibly with that kernel in us that stays, our essence.  (See blog post, My Essence.)

In the marvelous work, “His Dark Materials” trilogy, Philip Pullman describes us as split persons, a body and a spirit (“demon”) that might be parted by neglect, carelessness, abuse, or other disasters.  But when it is separated, the body suffers and is disconnected from it’s life purpose, what brings pleasure and presence in the world around.  (See blog post, Soul and Body.)

There are medical illnesses that do this, as mentioned above, and in those cases, perhaps all to do is get medical care, heal, treat and get on with life.  Other times, it might be that we forgot ourselves in the midst of caring for children, a demanding job, an opinion that victim-hood defines our life possibilities or what not.  We have options.

As Jjen reminded us some days ago,

The bad doesn’t disappear but it is not a qualifier for the rest of life’s potential.

Questions:  How have you reconnected to your life journey?  Your essence?  What is constant about you in your changing self?  Please tell me your story.

So Many Choices, So Little Time …For Self-Care

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Self-Care Tip #198 – Being a friend to yourself might be saying,

No.

Our culture is brimming.  Brimming with…, well take your pick; walking the dogs, turning in a take-home test, watching The King’s Speech, writing a journal entry, making pancakes or reading Savvy – we have options.

However, today and often, options are stalkers we think difficult to restrain.  …More difficult, say than filing a restraining order against your husband.

Walter filed for divorce with his unhappy wife.  Vengefully, his wife turned around and filed a restraining order on him and just like that, he was unable to see his kid for over two months.  That was easy.  All she had to do was file it.

And when we have these many options, all we need to do is say, “Yes,” to one and to the rest,

No.

I love it when my four year-old son is rocking carelessly on my outstretched legs, flopping about, a happy-drunk bird-on-a-wire, and predictably although unintentionally falls.  Crumpled on the floor, he flicks his bangs back and says rather coolly,

I was okay, Mommy.  I was okaaaay.

I had tried to rest on the couch and type, doing my self-care thing after doing Mommy-stuff with the kids for a large chunk of the day.  But telling him to stop doing that really cute thing he does was not so easy.

According to The Economic and Social Research Council,

Having older siblings is not related to children’s happiness with their family, but having younger siblings in the household is associated with lower levels of satisfaction and this effect is greater the more younger siblings present in the household.

It turns out that children feel more happiness in their homes when there are fewer younger children.  They perceive that there is less energy available for them from their parents with each born child.  And I’m here to say, there is.  With my son on the floor, flicking his hair and going,

I was okaaay…,

my middle daughter kissing my shoulder and burrowing into my arm like an ear-wig, my eldest daughter came back to ask for the sixth time if I would play jump rope with her – I remembered this study.  So true.  I don’t need more options, i.e. more children who ask and I say,

No.

With these many wonderful options, choosing Me, is not always easy.  (See post, “‘You’ Are the Best Gift.”)

Now throw in a little inappropriate guilt, some ruminating thoughts, self-loathing, bad sleep, some low motivation and energy and choosing Me becomes the hardest thing anyone has come up against.

Questions: How do you choose you when you could pick so many other great options?  How has this helped quality of life for you and others in your life?  Please tell me your story.

Pain Doesn’t Define Life’s Potential

Close-jen-grieve

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Self-Care Tip #196 – When you are hurting, remember the pain doesn’t define life’s potential.  Be a friend to yourself.

Yesterday we talked about giving and getting bad news without fear.  This was received in a spectrum of ways by you, ranging from – no way is bad news something not to be scared of, to, bad news might be something we could face knowing we might find something good in the end.  No one slammed the hammer down, dinging red at bad news equals good all around – except my dogs who don’t listen anyway and are pretty much always happy.

Jjen was brave, saying,

I would have to also agree that in some cases bad news can bring family members, or even friends together that have been estranged. This has personally happened to me. Kind of a bittersweet thing; good in result of something bad and mending a broken relationship.

“Good comes out of bad.”  Not everyone agrees and I don’t blame them.  Some bad things are better left alone to rot and stink out of our lives entirely.  It even sounds patronizing when someone is hurting to say this.  This kind of discovery should be made by the parties involved, without the rest of us holding scripted cue cards for them.

It is also something that is received easier from another who has been in, or is in their own catastrophe(s), losses, abuse or grief – say Jesus for starters.  I could hear this from Him without wanting to vomit all over the place.  He’s been there, hurt bad, and has been blessed through and by it in ways I will be learning about even after Time unhinges.

When my nine year-old adored niece suddenly died, I didn’t see that.  It’s taken almost six years to see anything good come “from” this unbelievable loss we grieve every moment.  The bad doesn’t disappear for me, but as Jjen said, it is not a qualifier for the rest of life’s potential.

Question:  What has come “from” the bad in your life – more bad or what?  Please tell us your story.

Stop! Before Hurting Yourself or Others

scream and shout

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Self-Care Tip #192 – Before hurting yourself or others, stop.

Sometimes all we can do is leave.

Not being created as a limp noodle, that’s what Brenda said.

In the moment of conflict with her daughter, she had used up the coping skills she thought of and in the end, her purse had no more gum, lip-gloss, candy-money or crayons.  She couldn’t stop the acidic emotions from taking their turn to burn.  Brenda yelled (yes she knew it wasn’t right) and then she yelled again, this time to her husband that he was on kid-duty.  She left.  The mom-van keys were the last thing left in her purse of things to do to stop the burning she was giving and receiving.

Emotional abuse is equal to or more damaging than physical or sexual abuse.  This made Brenda gulp, who could still hear her own mother screaming with bulging bubble-packing veins and eyes.  Brenda didn’t know she could say,

Let’s stop.  It hurts Mommy.

When she first had her babies, tiny with soft bones, fluffy warm sweet cakes just out of the oven, Brenda was scared.  Her pediatrician gave her baby care directives that said things like,

If you are angry and feel like you’re going to shake your baby, stop!  Call for help.

And there was a number.  Now that her kids were older, her pediatrician never gave her helpful sheets of instructions and rescue phone numbers.  Brenda drove away to stop, hoping to come back with more available to offer.

Not bad, huh?

Question:  When you can’t think of any more coping skills during a crisis, how do you stop?  In what feels like an emotional emergency, what have you seen others do that you think is useful?  Please tell me your story.

Do You Feel Pleasure? Lacking The Ability to Feel Pleasure Leads to Suffering.

Grazing in Spain

Self-Care Tip – Enjoy what you do or else find out why you don’t.

Pleasure.

I often ask patients when I am taking their mood history,

Are you able to feel pleasure?

I need to figure out how to ask this without you or anyone thinking that I want to know more about lube and feathers.  No, thank you very little.  But what I am trying to ask about is the ability to enjoy what you are doing.  It is not necessarily “joy” but at least it includes having a positive sense about you while you are progressing through something.  Being able to feel pleasure does not mean being happy at a fiesta or while doing kangaroo jumps with your child.  It does not mean changing your personality so that someone who prefers to work turns into someone who is playful, or a grazer* turns into a barn animal*.

Feeling pleasure does not mean that we achieve our fantasies.  It does not mean we are on vacation.

To understand what pleasure is, it helps to understand ones temperament.  It is enjoying what you do when you do your thing.  For example, if you are someone who in any given day or mood and regardless of weather or wealth would want to complete the work for the day – when you do that, are you feeling it?  Are you feeling pleasure?  Or, to contrast, if you are someone who would more often choose an unstructured and unmarked day – how is it going down for you?  Are you feeling pleasure?

Pleasure when you are doing your thing is quality of life.  If you do not feel it, life is crackers without soup.  It comes and goes dry and without anticipation.  If you do not feel pleasure, you lose your perceived connections around you and including with yourself.  Suffering is when you feel alone, even from your self.  Losing the ability to feel pleasure results in suffering.

Goodenough, PhD

Not everyone connects that emotional illness is a state of suffering – whatever one or combination of illness(es) come to us in.  Looking in at ourselves, at our Me, from the outside, we observe expressions and behaviors that we interpret from our own bank of information and intuition.  When I tell someone, what you are observing in your child, or wife or whomever is my patient at the time with mental illness – when I say,

They are really suffering,

it tugs our unconscious awareness into consciousness   We often do not actively know about this internal world where there is no pleasure.  We do not know that lacking pleasure leads to suffering.

Are you able to feel pleasure?  Do you find it harder to feel pleasure than you used to?  What things do you still enjoy? How long has it been since you last felt pleasure?

The ability to feel pleasure is a wonderful gift.

Questions:  What has helped you most in healing your suffering?  What has helped you connect again with others when illness pulls you away?  Please tell me your story.

*Reference:
Temperament definitions according to Dr. Q:
grazer = someone who comfortably wanders from idea to idea
barn animal = someone who is goal oriented and does not like things unfinished

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Just to Feel Pleasure

week-end-pleasure

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Self-Care Tip #189 – Heal for yourself, and you’ll see that also, everyone heals.

The best thing I ever did was go on antidepressants.

Bianca sat, but her whole body was talking.  She was telling me about her changing life.  She had read some of her journal from a year ago when she pounded on herself for her behaviors.  She thoroughly grieved the time with her children when they heard her scream about small things that kids do.  She told me about her sons face when she was irritable.  He showed all the waiting tension that an open child will when waiting for Mom to lose it.  She was trying to push it aside and think rather about how she now could finally enjoy them.  Bianca said,

I just had no idea before how much better life could be.

Bianca’s face became tight and she didn’t make eye-contact,

There’s no way to describe what it’s like to not enjoy your kids – My own kids! – for most of their born lives and then wake up and experience something different.  I just can’t explain what it means to now actually like being with them.  I’ve always loved them but I didn’t feel the pleasure and I hate that.  I want that time back but I can’t have it and I can’t give it to them either.

I’m so scared it will end, the pills will stop working and I’ll lose this new life.

Before her medication, Bianca worked hard at taking care of herself.  She was a check-list of responsible self-care.  Bianca thought it was important that I knew this.

  • Aerobic exercise – check!
  • Healthy diet – check!
  • Sleep hygiene – check!
  • Bianca talked about God but things got confusing for her there.  She didn’t like to think about Him being on “a list.”  He was in her life and didn’t feel He failed her even though she couldn’t feel pleasure or joy.

Still, she continued to coil up and release hard punchy words at her kids and then hate herself for it.  She had prayed so much about this and wouldn’t even mind if God had to puppet her, if that’s what it took, in order for her to treat her kids better.  She could not stop herself from being what she called,

Crazy Mommy.

But now, after she was treated, Crazy Mommy was gone.

Aside from dropping the shame, the best thing for Bianca was knowing that her kids could trust her, felt safe with her and that she felt safe with herself.  Everyone was healing subsequent to Bianca healing.

How many of you have told us a similar story.  A similar rescue.  Yet, never-the-less others of us are afraid to go there.

Question:  How are you present with others who don’t understand your rescue story?  How do you stand beside someone who needs medical help for emotional illness but won’t accept it secondary to stigma?  Please tell us your story.

Get Out Of The Company Of Comparisons. Forget About Fairness.

Tail lights, lights, rain on my windshield, co...

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Self-Care #186 – Forget about fairness.

It’s raining here; herding us.  I don’t like driving at night, but driving in the rain at night is worse.  Driving in the rain at night, with a rabid sheepdog tailgating me is still worse.  However, I do love slowing way down when I’m tailgated.  That was nice.  And seeing some family, including my folks, made it all worth it.

My kids were in on it too.  They were doling out banana smoothie and repeating a favorite theme called, “Make it fair!”  In Parenting, the frequent reminder that life will never be fair for my kids, and wondering if they’ll ever get it, gives me almost as much pleasure as being tailgated at night in the rain.

“Make it fair,” isn’t far from any of our hearts desires.  It’s easy for me to forget humility and judge my kids, but when people aren’t looking, I’m also checking to see how much I got.

I met a girl in clinic, Britt, who was also working this out for herself.  She was holding it in her hands and turning it over; a foreign object.  Britt said,

It doesn’t matter what has happened to me, I’m still responsible for taking care of myself…

She said it many ways, and the tail of her pauses kept flipping up into question marks without actually asking,

With my abuse…?  No one else will…?

I could see her with all the rest of us suffering folk, checking the fluid line in our glasses, saying

With all the hurt I’ve received…

I was poor my whole life…

I just can’t seem to get a break!

For Britt, coming to a point of owning her self-care felt like losing social support.  She had for so long sipped on her succor as a victim in the company of her received wrongs, that she felt awkward.  Britt needed to find a new group of friends.  She stood there toeing the floor,

I have to take care of myself.

Britt will be alright.  She will be emotionally healthier and in better company very soon.  She will move past where so many of us are still gripping our goblets asking about why we didn’t get more.  She will say, without that question, self-care begins and ends with “Me.”

Britt hasn’t been able to do this without medical help.  For her, part of seeing herself as a victim to what life gave her was symptomatic of her major depressive disorder.  She was personalizing what wasn’t personal.  Not everyone will need medication.  Some of us will do well just recognizing that, “Life is not fair,” and will be able to move on.

Question:  How have you gotten out of the company of comparisons?  How has putting fairness aside been a form of self-care for you?  Please tell me your story.

It Is My Choice to Take Care of Someone, Even in The Context of Suicide

Detail of The Death of Socrates. A disciple is...

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I was a teenager I think when a woman in our church suicided.  Dad pointed out the man sitting alone.

His wife just killed herself.

Dad asked me what I thought of suicide.  Imagine.  What a compliment really for a teen, to be asked her thoughts.  Being a “Feeler,” I oozed something empathic I’m sure, but still I only remember what Dad said,

I believe God has a special way of seeing these cases.

This was at a time when culturally most of the western world saw suicide as sin.  It was quite forward for Dad to say what he did again later to the grieving man in the pew.  I did not realize at the time, but now I see that people judged him and his wife for what she did.

Later in psychiatry training, my attending said,

Suicide is the most selfish act anyone can do.  It is the ultimate punishment aimed at those who still live.

I don’t know what you think, but I couldn’t help wondering.  I still do.  I think this may be true for some and not others.  I haven’t had a chance to ask them.  They’re dead.

Suicide is terrifying to a psychiatrist.  We all tremble at the thought.  Statistically we know women attempt it more than men, but men are more “successful” when they do try.  They use methods that are generally more lethal than women.  They don’t get a chance to realize that in a month or a day they will want life again.  Or an hour.  They could have lived.

In the intensive-care unit of a hospital, “unsuccessful” suicide attempts hover in life in a space where their self-injury placed them.  The nurses are kept running between medicines, treatments, physician orders and prayers for these lives that tried to die.  Sometimes, the “chronically suicidal” become familiar patients to this critical care ward and that has it’s effect on those who have spent themselves so heroically to save them.

A nurse once told me angrily about her patient who kept coming back.

I fought for that woman’s life!  I prayed over her!  I worked all night for several nights and didn’t know if she would live until much later.  And then she was transferred out to the step-down ward (to a floor where the patients aren’t in such a life-threatening condition), and that lady probably never knew what I went through to keep her alive.

Then later, she came back, and later again, almost dead but not dead.  She kept trying to kill herself!  Finally, when she was conscious again, I just told her how it is.  ‘Listen!  I fought hard for you!  You better go out there and live!  You better figure out what it is you want and go for it.  Stop trying to die!’

This lady-patient was hurting more than herself.  Suicidal thoughts and attempts are dangerous.

There was a patient who tried to use his bed-sheets as a noose before the nurse lifted his wet body from the door frame.  In the emergency room (ER) he was examined, x-rayed and determined fit to return to the ward.  Alive.  Talking to the ER physician, I learned that the reason most people die when they hang themselves isn’t because of suffocation.  It’s because they break their neck.  Done.  No more chances to choose life.  Even an hour.  My pulse was still beating on me to the rhythm of, “He could have died!  He could have died!”  This time, no broken neck.

Regardless of our culture, we are not the judges of these people who want to die.  Regardless of our emotions, their emotions before, any previous conflicts, regardless, we cannot measure their final act by degrees or intentions.

We fight together for their lives and they may or may not know about what that does to the rest of the world.  When we don’t want to fight for them any more, we should change jobs.  It is our choice, each of us.  Whether we are fighting as professionals or as a wife, brother, friend, volunteer or the hired tutor, we fight for their lives because we choose to.  If we cannot keep it up without judging, shaming, accusing the suicidal, we need to own that and take care of ourselves first.  “Can’t give what you don’t have.”

The truth is, suicidality is hard for everyone.  It is hard in ways and in people that aren’t talked about, such as the nurses or the x-ray tech who is the first to find the cervical fracture (broken neck) on film.  It is hard for the church parishioners, the person separated by seven-degrees or the grocer.  Suicidality is hard for all of us.  We give what we choose to give and remember to say, “I can’t control that,” when we can’t.  It is our choice.

Self-Care Tip #182 – Taking care of someone is your choice, even in the context of suicide.  Be a friend to yourself.

Question:  How has suicide touched your life?  Please tell me your story.

Pain Can Be Something More and Better Than Just Pain

English: Vladimir Bystrov. 2006 Russian Premie...

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Self-Care Tip #181 – Look for help if your pain never becomes something more than pain.  Be a friend to yourself.

Glee is back!  I’m so glad because it makes great work-out distraction.  Good music, drama, beautiful people, and wonderful ah-ha concepts like,

Use your pain and loneliness to inspire you to make something beautiful.

Can’t remember it verbatim though and I noticed after an hour surfing the web for Mercedes quotes (and getting detoured to all sorts of other fun stuff for grazing) that whoever writes these quotes up didn’t find this one worth it.

Joni Eareckson Tada on the Larry King Show said that when she thanked God for her paralysis, she began to be productive through what paralysis offered.

It is however sometimes impossible to take what hurts and let it fuel our fires.  Sometimes it’s just a cold lump of coal.  Sometimes, we aren’t adaptable.

Luckily we aren’t sitting in a cave during the ice-age and can trust that a bear won’t come and eat us when we are wounded.  But there are other predators.  In my line of work, I could call disease process a preying force.  It takes over more and more cells, space, grey matter, consuming bits of our identity and changing our ability to cope with stress.

It’s easy for people to say, “Turn your pain into energy for creativity,” as if it were a volitional option for you like it was a choice for them.  Or we call it bits of morality; maybe a fourth of an inch on the rim of our gold crown we get in heaven.  Those of us who care about that crown look at our shoes, apologize and promise to try harder.

It is not easy to explain these apologies and inactivity to someone who has never been immobilized by mental illness.  Even those of us who have experienced it first hand have a hard time remembering the real texture of what we went through once it is passed.  Illness can be so awful that even our subconscious shudders when turned back to remember.  It is no wonder that we find it difficult to explain.

However, it doesn’t have to be this way.  If we aren’t able to adapt, aren’t elastic and sit stunned in the presence of pain, immobile to the newness that it can offer – recognize this as a flag to turn towards medical help.

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  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 – take away her children.  No pill – could be president.  Pill – discredit whatever he says.  No pill – worth 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.

Waiting For Self-Care to Start

Self-Care Tip #176 – Don’t wait to start caring for your self.  

I’ll get to it when things slow down for me.

I can’t handle one more stress on top of the kids and all the people who take, take, take.

Don’t take this away!  It’s my only vice!

I don’t have time because I’m working so much.

There are so many good reasons to wait for self-care.  I don’t belittle them.  I do them too.  There’s a reason we here at FriendtoYourself.com call self-care the hardest work.  It is not for anyone who isn’t willing to go through the fire of putting themselves first.

“The fire,” you say?  Yes.  Fred taught me that.  He was down twenty pounds, working out almost every day with aerobic and anaerobic exercises, putting his ear-plugs in when sounds escalated his nerves, more motivated, interested and active.  Fred was growing again.  He said that it had been years since he’d done any of these things for himself and couldn’t believe what the world looked like when he felt so good.

Fred was sad though.  Not depressed.  No, he hadn’t been depressed for at least a year on his medication and even less so since he was taking care of himself physically.  But sad.  His wife wasn’t interested in his changes, she was disconnected emotionally, and more so every day it seemed to him as he began to change physically, emotionally and behaviorally.  His friends were growing distant.  He wasn’t interested in office politics either.  It was a simultaneous coming together of life in himself and a falling away of the life connection in his “previous life,” as he called it.  Surprisingly, the people he loved the most weren’t so happy for him.  Weren’t supportive of him.  He was sad for that.  There are never gains without losses.

This is not to forget the new relationships he was growing.  There was new life all around him and he still maintained hope for the connections he had before.  But those people who he had called his own for years were the ones who gave him all the reasons to wait for self-care.  He was way past waiting.  He was already on the other side enjoying the sun.

Question:  What have you overcome to get at your own self-care?  Is there anything your are still waiting to do?  Please tell me your story.

*Art work (assumed) courtesy of carldagostino.wordpress.com.

Tell People When You Fall

It's no laughing matter ladies... Monthly brea...

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Self-Care Tip #171 – Tell people when you fall.

Driving today, I was slowed by a driver ahead of me.  I started to get irritated, (I know, “I can’t control this“), but then I noticed the car had bumper stickers supporting breast cancer.  In less than a moment my mind grabbed memories of faces, feelings, conversations, stories and personal experiences in my memory relating to breast cancer and I suddenly felt a sense of empathy and some sadness.  It left me a bit surprised and I reminded myself I was irritated at this driver.  While trying to tease apart these seemingly opposing reactions, I realized I didn’t care much any more about the slowness.  Mainly I wondered how there was breast cancer connected and I cared.

Providentially, Erin posted today on her blog-site, Healthy, Unwealthy, and Becoming Wise,

Falling finds friends.

I remembered the driver and you readers and thought, “It sure does.  Especially when we let others know.

My Ecuadorian sister, Joana Johnson, often tells me one of the biggest contrasts she see’s between our cultures,

connection.

I spent some time in Ecuador doing some clinical work and learning more Spanish between my second and third year of medical school.  I was rarely alone, which frankly creeped me out a little.  Being westernized, I was used to a huge amount of independence and anonymity.  I wonder who I would be if I had grown up knowing someone was always involved in my life.

You might have heard the proverb asking,

If a tree falls in the forest and no one is around to hear it, does it make a sound?

Or,

Water, water everywhere and nothing to drink.

I don’t want to be surrounded but not witnessed, connected or heard.

Telling people about our “falls,” cancer, depression, assault or what not, can feel creepy too, just like I felt loosing some of my anonymity in Ecuador.  However, I now tell myself, “It’s just culture and I can grow.  And I want to.”  Culturally in the “West,” we think of telling about our falls as whining.  That’s a misperception however and a disservice to all of us.  Telling people when we fall is not whining.  The act of telling and the act of whining aren’t contiguous unless we design them to be.

This morning when I saw those bumper stickers, it brought me into the drivers life and connected us.  We are both a little less alone than we were.  These last six months for me have been about taking down boundaries in my well defended life, and I am growing into the difference.  Thank you readers and commenters for that.

Questions:  What has telling others about your “falls” done for you?  How has your culture influenced you in finding friends?  Please tell me your story.