Medication

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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.

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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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What Must I Do To Be Happy?

Today, I can’t get my thoughts away from the frolic in temperament-land.

Teacher, what must I do to be happy? 

Who hasn’t asked this?  I remember Nicodemus who asked Jesus,

Teacher, what must I do to be saved? 

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I bet he was wondering, too, about happiness.

I’m not equating happiness with salvation or morality.  I am saying this might have been a parcel of his question.  Happiness is an emotion per our language and cultural definition.  And we have enjoyed our path of discovery in seeing how emotions are tools we use to interpret the world around us.  They are not universal or constant between us.

After I read,

Individualism, a stronger predictor of well-being than wealth,

in R. Fischer, PhD’s Meta-Analysis of Well-Being, I followed my thoughts toward the Jungian Typology of Temperaments.  Remember our pasture and barn people?  The Jungian Typology of Temperaments is our playground where we have a wish-basket equipped with supplies to become any variation we might choose of what our design requests.  Read the article and you might follow a similar path of thought.  Or not.

In case you’re wondering, and per Dr. Q (who is a poor statistician so take this for what it’s worth,) a meta-analysis is a study of studies.  A meta-analysis brings together a number of studies that reflect a population of people and a methodology that is as objective as we can find.  We compare them and through the tools statistics and logic offer, we make a summary conclusion.

If you are familiar with the tomatometer on RottenTomatoes.com, you already have a sense of what a meta-analysis does.  (I love rottentomatoes.com.)  There is more power in the indexed findings of many studies than in just one study.  There is also more power in a fresh tomato than a rotten one.

Questions:

  1. Do you see happiness as something that reflects your condition of spirituality and/or your condition of brain health?  Why?
  2. What do you perceive brings you happiness?  Please tell me your story.
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Safety in Connections With Others

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Marcy came in looking like a question mark.  Despite her gorgeous face and swank, she still looked uncertain.

Marcy was born into chaos.  Get this.  Her father who spent her whole childhood using drugs, alcohol and strange women, who was emotionally and mentally absent most of her life, who is possibly still using, is the one person in the whole world Marcy calls her confidante.  “He gets me.  I can really talk to him.  Even my husband doesn’t understand me like he does, you know, emotions.”

Marcy, despite years of fear, panic attacks, the survivor of abuse and neglect was clinging to her dad.

Marcy was lost in the headlights of the oncoming life.  She thought after having spent her entire life afraid, it was time to heal so she though she’d give medication therapy “a try.”

After initiating medications for Marcy’s post-traumatic stress disorder and after her panic-attacks stopped, Marcy started attending NAMI.  What a believer in NAMI she became!

They just make it easy for me to talk about myself, say things I can’t even tell my husband, and they know what I’m going through.

Listening to her talk about them was letting fresh air into our room.  Hope floated in.  Now Marci doesn’t believe that her dad is the only one in the world she can connect with at this level.  Now Marci does not feel as alone.  Why?  Because she went and got connected.  She whacked through the briar hedge of misperceptions, biases and insecurities between her and others.

Marci still thinks largely of her father, but he’s not the only one.  He has some competition to the throne which means, Marci has a better chance of being influenced by someone healthier.  Rather than attack Marci’s attachment with her Father, NAMI is giving her more to fill her heart with.

Self-Care Tip #285 – Find safety in healthy connections with others.

Questions:  When have the connections in your life saved you from warped views?  How do you think we could do better with this?  Please tell me your story.

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To Catch What People Throw At You, Give a Little or You’ll Drop It

Football: Jets-v-Eagles, Sep 2009 - 16

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Sometimes it doesn’t serve us well to follow our instincts.

When I was little, I don’t know, maybe nine, I remember one of the many times Dad tried to teach me how to throw and catch a football on our front lawn, under the huge tree that seemed to always block me. Dad had played college-ball on scholarship at Duke University where he promptly blew out his knee; one of the many orthopedic problems he’s known. However, he still had his arm and his gentle way of making me feel like he really enjoyed lopping the ball over short distances with me and my awkward hands.

Catch the ball right here, into your arm like you’d cradle a baby.

Nobody needs to try that many times before learning that footballs are hard and pointy and hurt a lot when we catch them wrong. Purposefully putting my body in front of that spinning high-speed object didn’t feel safe.

Get in there and watch it the whole way make contact with you as you catch it.

My eyes were still shut when he said that. I was trying not to cry but I was pretty sure my fingers were going to look differently when I opened them.

Here came more less obvious instruction,

Let your arms and hands give a little, while you catch, closing down on the ball as you let it push you.

People throw all sorts of things at us in the space between “me and thee.” It can hurt to catch and even physically damaging. But counterintuitively, we need to catch like we are cradling a baby, get in there, and give way a little.

This isn’t always advisable but it refers to opportunities to practice presence. Not every interpersonal moment is such an opportunity. Nor will each true opportunity be received naturally or effectively. Those will improve with practice, or perhaps coaching or medical intervention.

The other day, Frida told me with some self-satisfaction about the long hoped for day when she stayed with her daughter during her daughter’s anger, rather than escaping. She gave space for her daughter to throw her pain around. Frida cradled her in her personal space long enough to receive and throw back. For Frida, what she threw back was the next effort of growth. That day we celebrated the presence she was able to offer her daughter and herself.

Now get in there Frida, let it come into you. Give way to some of the momentum or you’ll drop it, and cradle what you catch.

For Frida to do this, she owned her choice to find the presence and to do the work to gain the skill. As I am a medical physician of the brain, you might guess we worked on her illnesses. Frida stayed, received her presence in the company of her daughter – and we celebrated.

Self-Care Tip #284 – Give way to some of the momentum and cradle what you want to be present with.

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Sucking Up to the Boss May Move You Up and Keep You Healthy

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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!

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

I love real life John Waters freeze-frames

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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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Mental Illness Relapses When Medications Are Stopped

Free face of a child with eyes closed meditati...

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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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Anger – Sometimes There Doesn’t Have to Be A Reason

A metaphorical visualization of the word Anger.

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Self-Care Tip #244 – When emotions and behaviors come without being asked by you, think about the medical reasons.

She needed to keep going, Minka felt hurt and angry.  Control and failure nipped at her.  She wondered what it would take for her to recognize her own success.

Minka had a child who provoked her.  But worse for Minka, was not perceiving progress in their relationship.  Minka was bewildered by it.  But still and more so, angry.  She asked me what she needed to do to be happy and feel like what she did when life was good.  It reminded me of the man who came to Jesus and asked,

Teacher, what good thing must I do to have life forever?  (And listed off all his good deeds.)

Just as I was thinking about this, sure enough, Minka listed off her self-care efforts, angrily as if they failed to redeem her.

Turning this around in my mind, my thoughts ran over a differential – the 3 C’s, her temperament, her biology, other medical conditions, other influencing stressors and I wondered if Minka was angry in other situations as well.  (See The Biopsychosocial-How-To.)

No one really likes themselves much when they are angry.  Anger is pulled through the capillaries and passed on until it colors all of us red.  It is a confusing emotion; internally preoccupying.  Many people don’t remember chunks of their lives during which they said things and did things in anger.  It just disappeared into the white noise of the emotion.  During anger-binges, people can black-out too, much like alcohol.  Often times anger comes without invitation.  Often times, anger is not something that will leave by invitation either.

So we know already that the 3C’s apply to this kind of anger.

I didn’t cause it, I can’t control it, I can’t change and or cure it!

Minka hurriedly answered that they didn’t work for her but she had tried.  It was on her self-care list apparently.

I don’t want to blame my daughter.  I know I’m responsible for how I feel but I keep holding her responsible even though cognitively, I know she’s not.

That was pretty big.  In my opinion, she could put that on her self-care list and check it off as well.  Steller.

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Through further disclosure, I learned that Minka hadn’t enjoyed anything much lately – not only her daughter.  She was irritable, edgy, felt superior to others and then kicked herself over it.  Minka said she tolerated less and less of what life touched her.

I wrap those descriptors in the same nap-sack as anger and mood.  They are on the affective spectrum and for Minka, it wasn’t for lack of trying hard enough, for lack of being spiritual enough (it makes some of us uncomfortable to say this), or missing a puzzle piece from her psyche.  Minka was medically unable to put her anger aside and connect with her daughter.  Minka’s medical condition was isolating her not only from her daughter but most other bits of life touching her.  She was ill.  She wasn’t choosing those emotions.  Now came the job of helping Minka see that and go for help in the right direction.

Question:  What is your opinion about behaviors and emotions coming without being invited or chosen?   …without a “reason” for being there?  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?

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

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

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

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

The marvelous @MarjieKnudsen, tweeted a reference to a wonderful post by Sarah Boesveld, How ‘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

Orestes Pursued by the Furies, by John Singer ...

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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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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.

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

Project 365 June 2008 Mosaic

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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.

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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.

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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.

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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?”

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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.

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