Paradigms

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Self-Care Is About More Than “Me”

Self-Care Tip #208 – If for no other reason, get friendly with yourself simply to survive and you’ll see what that means later.

my self care reminders

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It is not unusual to think of “selfish-care” when we hear “self-care.”  I can imagine children gripping their mother’s skirts more tightly, husbands pulling their helpmate’s hands away from this influence, church-folk sniffing over rejections to service-calls or friends personalizing the way their phone doesn’t ring as much as it used to.  This is a natural response, although it is a false perception.  Think – feeling suffocated by her penance, he’s wearing a martyr’s cross or she’s giving to us from victimhood.  Those are the times we would rather not receive the gifts of time, person or anything dripping with that kind of guilt and implied debt. This kind of service comes from someone impoverished, giving on credit.

I’ve been known to say, “We can’t give what we don’t have.”  Or as Jasmine said,

You can’t give someone a ride if you’re all out of gas!

So when is self-care selfish?  To be true to what self-care is, I’d say almost never.  However, because the question comes from such an intuitive fear in any of us, “never” can’t be an entirely fair answer.  To answer it best though, we need to turn it over and go back to trying to discover why we wanted self-care first.  What brought us here?  Jacqui said it well in yesterday’s post-comments:

Ditto about ‘self-care boot camp’. I may steal that one. You’ve given me permission to be selfish if need be. It’s all about self-preservation.

Sometimes we are reduced to self-preservation.  It has an intensity to it, a survival mode of live or die, which may be appropriate to a desperate condition in life.   Many of us know what that feels like.  So in this context, self-care is in part about survival.  Alright.  But is survival a selfish need?  Are we worth that little?  Does the life in us hold value only at that level?

rejuvenation.self.care.logo

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You hear the clomping my words are making and can follow that I answer, no.  Survival has far reaching significance.  I matter.  You matter.  We have value beyond our own selves and Me booting up to live better also ripples over those same infinite number of connections.

I am confident that if for no other reason than getting friendly with yourself simply to survive, you will still see at least some of what more that means later.  Self-care is about more than Me.

Question:  When do you think self-care is selfish?  Why do you think self-care is not?  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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Bring Your Separate Selves Together – Personal Journey

National Museum, Czartoryski Collection

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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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Pain Doesn’t Define Life’s Potential

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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.

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

Stef's Present with Handmade Wrapping

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

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

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

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

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

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

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

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

FriendShip... A gift of God.

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

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

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

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Starting With Your Own Answers to The Big Questions Leads to Reducing Stigma In Others

Alexander Ostuzhev as Quasimodo, 1925.

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Question:  How do you see the paradigm of spirituality intersecting with the paradigm of biology?

As a psychiatrist who blogs that behaviors come from the brain and not a theater script we voluntarily revise to perform, this is a good question.  As readers, and perhaps subscribers to this same belief, this is a good question.

In church, Bible study, or circle of any kind, there are fewer things that goad me more than listening to descriptions of the moral value in emotions and behaviors.  I have found myself visiting the lady’s room more often, carousing the fellowship hall-kitchen and fridge, or thrusting myself on a poor unsuspecting soul loitering by the door with my fervent uncomplimentary words.  I do this before I stand up and pull rank on the speaker.

(I know.  The words “pull rank” sound just as arrogant, and probably are, but they were said in the heat of the moment.  Please understand that the emotion behind them and including the words came from my brain.)

It wasn’t so long ago that suicides were thought to be the ultimate separation from God.  Oh wait.  That’s still happening isn’t it?  It wasn’t so long ago that anger and sadness were thought to be from separation from God.  Oh wait, they still are.  Ok.  I’ll stop.  This is childish.

The hunched figure of Notre Dame comes to me now, ringing his bell, gazing at Esmerelda – pure heaven in flesh.  He offers up his humble life force, begging to be near her despite his biology.  He is ugly.  He is different.  He is separated by his own beliefs that he is forgotten by God.  His answer to our question is his own isolation.

This pithy topic has no boundaries across the world but yet I reduce it down to Me, one apparently arrogant psychiatrist, kicking up dirt where I stand.  I realize that the best way to protect us from stigma, to help you (again arrogant me swaggers in), is to start with my answer to this marvelous question.  I have to answer it for myself.  I have to start with self-care, spiritual care, relationship care, physical care – I have to start right here with Me.

These kinds of imposed opinions have never been reduced quickly.  We can’t take care of everyone before we take care of ourselves.  We must be patient.  We have the privilege to answer thoughtfully.  It is our freedom.  It is our right.

Self-Care Tip #193 – Answer the big questions in life for yourself, deliberately, and see that a secondary benefit is that it will protect you from the prejudice of others as well as reduce their prejudice.

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What Is Your Most Core Desire? That Is Self-Care

It's a Business Doing Pleasure

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Self-Care Tip #191 – Do what you desire to get friendly with yourself.

What is your most core desire?  I am learning more about mine.

I wonder at the improvement in my quality of life since blogging with you.  It is More than the pleasure of writing; which I do love and have missed for years.  It is More than the pleasure of being productive; a natural high for my temperament.  It is More than the self-care tips listed off that roll back; a tide of all that is sent out comes in again to wash over me and change the shape of my life.

This morning I ran into a newer friend.  We came into each other’s lives, catalyzed by the ingredient that this blog provided.  I am sure I would not previously have allowed myself the pleasure of speaking with her for long without it.  My temperament has always been a driving force that pushes me into “the barn.”  I often miss the journey for the end.  This is “The More” that has been given to me.  Connection.

Now people actually look different.  Despite years of medical education, years of psychotherapy and my years of life, I never saw people to the extent that I do now.  Each of us here for a time with our stories, our pearls to offer and each of us with our essence to share for eternity.  It is one more time for me when I am open-eyed, open-mouthed gawking at the thought of “The More” that is still coming.  Better than this.

Think of your most core desire; what you are driven toward by biology, genes and higher intelligence.  What has given you access to that?  Now think about how to go for More.  That is self-care.

Question:  Oh, you know what I’m going to ask…

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Just to Feel 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.

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When You Are Pushed Down, Push Back

A Push and a Shove

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

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

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

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

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

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

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

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

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

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Goodbyes Are A Way To Connect

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Self-Care Tip #184 – Respond to your goodbyes deliberately to be friendly to yourself.

One of the Regional Centers that I work at is closing their telemedicine clinic.  This means I’ve said goodbye to many beloved patients and their families, whom I’ve worked with since round 2003 I think.  Saying goodbye to people we respect and enjoy is not as casual as we stylin’ people make it look.

Two days ago I said goodbye to my girlfriend of around five-plus years and her family.  Moving far far away makes the flat world feel lumpy and luminous.  I now have all her leftover food and knock-offs she didn’t want to haul across the lengthening world to remind me that she is gone.

Watching parents and/or grandparents age is also an exercise in saying goodbye.  My parents have a hard time making it over to visit on week-ends for all the funerals they go to.  Their calendar sends over that whispering voice that they are growing old.  “Look,” it says.  “See me.  I am aging.  Time is connecting and taking me with it.” Even so, their essence holds its own, apart from Time.  That makes me feel more comfortable.  When that whisper gets louder I may respond differently, I can’t know until then.  But for now, this is good.

“Goodbye” is something that begs a response.  “Oh yes!  Goodbye!  See you later.”  I even say, “See you later” to people I know I have less than one percent chance of running into again.  The word calls to me and I respond.  The word implies a disconnection, but even so, beckons us to connect.  It spreads us over the space of our time shared and into the future apart.  Peanut butter and jelly, it sandwiches us up with the one who says “Goodbye” when we say back, “Until then.”

Today with these people and remembering all the ones I won’t get to see before my contract ends, I feel the pull to respond.  My response can be something deliberate.  It is another bit of something I get to choose.  I hope it will connect me.

Question:  How have you responded to the goodbye’s in your life?  How has it been a connecting force for you?  Please tell me your story.

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Competition as A Way To Take Care of Myself

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Self-Care Tip #183 – Compete to be a friend to yourself.

Competition is not always thought to be a friendly word.  Pictures of hair-pulling, whining, learned helplessness, failure or success come to mind.  However I’m happy to say that we can put away that old grudge and open our arms to what competition can offer.

We are sharper intellectually when we compete.  It is stimulating and good brain exercise.

We feel better when we compete.  It releases dopamine, the feel-good neurotransmitter (brain messenger.)

We are more likely to win in self-care when we include competition.  Some people call it, “Making a game out of it.”  But that is really just saying, get competitive in a friendly way.  For example, this is one of the few successful ways to get long-term success with weight loss.

We are able to connect with others easier when we compete, believe it or not.  Competition is in fact a way to get out of isolation.  Pretty cool.

Competition can increase productivity – a boost to one’s quality of life and self-esteem.

Today I was speaking with my daughter’s teacher about bits of this concept.  I am hoping that more competition is integrated into her school curriculum.  For example, her daily writing could be shared with two fellow students of like abilities and vice versa.  She would read what they wrote, coalesce the information into her own thoughts, and write her response.

She would be working on:

  1. Writing
  2. Reading
  3. Interpretive thinking
  4. Learning how to let her thoughts travel the sometimes seemingly endless road between her mind and out her fingers.
  5. Productivity
  6. Connecting with peers/socialization
  7. Personal achievement/self-esteem/confidence
  8. more….

Question:  What role has competition played in your own self-care?  Please tell me your story.

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

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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.

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Sharing Will Take You Out of Isolation

Flowers for Valentine's Day

Image by Steve Rhodes via Flickr

Self-Care Tip #180 – Sharing will take you out of isolation.  Be a friend to yourself.

If Valentine’s is about Love, today felt like Valentine’s Day to me.  Your support, my friends, came to me like bouquets of home-grown roses, lilies, daisy’s and bird-of-paradise.  You swept me up and carried me over a threshold of something I didn’t want to cross alone.  Thank you.

Carl, dear Carl, is always surprising us.  He told us yesterday about his own amazing dad and then said,

I can truly say I know how you feel.

Even though much of this feels unique to me, I know it is not.  Pain is not unique.  It is our choice to experience it alone or in community.  I choose you.  Thank you for choosing back.  Thank you for my flowers.

Mom has always been a fierce lover of flowers.  She arranges them dramatically and gives them out, believing that their beauty is enough for now.  She never worries about when she won’t have any.  I actually don’t ever remember Mom without them.  She just can’t stay away.  Either she goes where they are, or they seem to some how follow her.  Sounds like story fodder but it’s true.  She will be one of the loveliest in heaven, just because she was designed to be.  I can’t imagine all that Mom will learn on beauty through an existence disconnected from time.  I’ll know where to go when I want to gather some for you.

Mom goes to see Dad every day.  She’s usually wearing something shiny or bright or both.  Dad’s hospital room is in full bloom and there is always food for nurses or visitors.  This is how Mom does her fighting for Dad.  Through beauty.  Not bad, huh?  She washes him every day so she can spare him as many further humiliations that come with illness.  He is lotioned up; more able to receive than he ever is outside of the hospital.  In their own way, he and she give to each other like that.  I’ve seen Dad cry and Mom just push aside the tubing and get in beside him on his electric bed.  In the hospital, a lot can happen.

Tomorrow is Valentine’s Day and Dad said,

Well, I guess I’ll just have to let this one pass.

But if Valentine’s is about Love, he doesn’t have to worry too much.

Since round high school, Dad has told me that I have to sing some day at his funeral, “The Only Thing I Want Is To Be With Jesus,” By Joni Eareckson Tada.  I am sure I never will but he refuses to believe it.

The only thing I want is to be with Jesus.  Just to see Him smile and say well done, what a day that’s gonna be.  I want to feel His strong and Loving arms just hold me to His side, and to be with Him, throughout eternity.  Just to be with Him is heaven enough for me.

My seven year old asked the other day,

Mommy, will Papa be alive when I have kids?

I told Dad and he laughed.  He’s an easy laugh.

That’s a really good question.  What a mind.

Dad has almost died about a zillion times and it’s easy to feel like he will live forever.  All I know is that if he keeps putting me through this, I’ll need you there to take me out of the isolation and remind me that none of us have been chosen to be alone.

Question:  How has pain been a connecting force in your life?  What has helped you share what seemed impossible at once to let outside of yourself?  Please tell me your story.

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Who Are The Sick? From Here to The Moon.

Michael Jordan, Slamdunk Contest, Chicago, IL ...

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Self-Care Tip #162 – Know your need for self-care.

Question:  In FriendToYourself.com, am I writing to people who are sick?

I was speaking with Beth Jusino the other night, when she asked me this.  I thought I’d ask you in turn.  You readers might be interested in commenting.

What is mental illness?  Are you writing to people who are sick?

Beth is smart.  She’s heard of Major Depressive Disorder, Schizophrenia and such.  She didn’t ask me this question so I could read her the DSM IV-TR.  She was asking how far mental illness is allowed to go before it gets named.  And how about the space beyond?  Are there bits that aren’t named?  Does it drift along an arch between Crispy Health and Completely Ill?

What do you think?

One reason I like to write #mentalillness hashtags on @Twitter is because I have a theory that people who have allowed themselves to be named, who have accepted to any degree a need for help, who have released their history and claimed their future over and over again – well I have a theory about these people that explains why I write to them.

These people are more able to hear the knocking sounds of wanting.  These people are more available to grow.  These people accept the gift of health and any space between here and there where they find themselves, all the while pressing; a courageous forward effort to freedoms.  These people care about self-care and they know they are accountable for it.

I remember this,

It is not the healthy who need a doctor, but the sick.

It makes sense.  However, it isn’t as easy as calling a spade a spade, and not because I’m lacking honesty and directness.

I heard a variation of this analogy years ago and I don’t know who said it first.

If you ask me to compete in a slam dunk contest with Michael Jordan, competition would be over before it began.  I’d trip, travel, and carry my way to the net and not get air.  But move the basketball net to the moon, ask us to dunk and the competition is just as over.  The space of air between my shoes and the earth is not much different from the space between Mr. Jordan’s shoes and the earth when we are both shooting for a basketball hoop on the moon.

Maybe you get where I’m going with this.

What do you think?  What do you say to Beth or anyone on this?

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Celebrate Insight, Choice, and Hope. Celebrating Can Be Self-Care.

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Self-Care Tip #161 – Celebrate your insight, your choice, and your hope to be a friend to yourself.

I realize autism has taken over my life and I’m not sure how I feel about that.

When April said this, I jumped.  The insight into her situation, the implication of her own ability to choose, the hope of what those potential choices might do for her and her children – all these leapt at me, so of course I jumped.  Startled.

April was the parent of three lovely although autistic children.  She was wiping her face.  “I never cry.  I’m usually really strong.”

And then she said those words.  Her realization.  I don’t know how much thought she had put behind them.  She certainly didn’t have much time to self-actualize.  Getting only a couple broken hours of sleep every night.  Responding to complaints from the school.  Springing towards her son every time he tried to hit himself in the head to stop him.  April was busy.  Mostly all that I had been able to do so far in our treatment together was help her kids via medication therapy.  We were clearly still working on things in that department.  She was willing to wait for us to make our slow way towards her children’s health, even though she was falling apart in the process.

Go low and slow.

Nothing like a cowgirl psychiatrist in the saddle.  I try to keep my spurs off and make no more than one medication change at a time.  Then, when something happens, negative or positive, we know what we are looking at.  April’s children were taking their time getting to their therapeutic responses.  But at least we hadn’t done more harm than good.

We had made the changes to our plan of care that we were going to make, and April was about to leave.  She had just said what she said and my mouth was open.  Unfortunately for April, I’m not consistently articulate.

Yes April!

And then she left, while I was still bouncing on the chair.

I don’t know if she’ll celebrate that marvelous epiphany.  If she does, I know her kids will benefit.  I’m confident about that.  If she does what is not intuitive, that is self-care, she will still be able to do what is intuitive.  Taking care of our kids is the most natural instinct.  Wild dragons and other mythical or natural creatures could not keep us away from it.  Now taking care of them well, however, is something that definitely is more likely to happen when we as parents are healthy, too.

For now I will celebrate this.  April has insight.  She has choice.  She has hope.

Yes April!

Question:  What has your life been about?  Where is your choice and hope?  Please tell me your story.

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Self-Care is Freedom, is Democracy, is Because We Are Accountable

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Self-Care Tip #159 – Be accountable for and to yourself.

It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain alert.  Just when I thought I could hold out no longer, I saw him.  Big and expressive, the long form of Abraham Lincoln was there, surrounded by loud irreverent people.  My brother and I were wiping sweat out of our eyes trying to keep track of our kids.  We wanted to read the Gettysburg Address for our kids, and found ourselves screaming.  The kids could barely hear the words above the disinterested rabble around us.  Despite all this, I was choking; a weepy, sweaty, nearly anesthetized but free American.

Four score and seven years ago our fathers brought forth on this continent a new nation, conceived in liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation, so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

Just down the corner from Lincoln is a president’s list of sites to see, informers and reminders of who we are and where we came from.  However, none of them were “my Lincoln” experience.

But, in a larger sense, we can not dedicate, we can not consecrate, we can not hallow this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion…

A couple of days ago, writing the post about how stress intersects with medicine, I remembered “my Lincoln.”  It may seem like a stretch at first but take a minute.  Self-care is a way of saying, “I am free.”   In places where life is cheap, almost without value, self-care is not much of an option.  It is because of freedom that we can extricate the meddling fingers, the invasions, and be the keeper of our own private spaces however we choose to.  It is because of freedom that we can tell people that although my brain is ill and although I take medication, I am equal. Saying that is self-care.  Saying that is possible if we take that freedom to keep our own accountability for our own selves.  Accountability is not the same as blame.  Having accountability for our freedom is not the same as being at fault for what came before freedom, nor our current conditions.

—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.

If you’re not accountable to your inner self, if you’re only accountable to your actions, or you’re only accountable to what others determine and define about you, than you are not free.  You are blamed.

Accountability is such a tender privilege.  We might lose it if we forget who we are, where we came from and our rights to freedom.  Democracy is self-care.

Question:  How do you see the relationship between self-care and your freedoms?  Please tell me your story.

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Blog-Jacking by Mr. Rick C. – #2 (Do I or anyone really deserve this?!)

Hello Folks.  Today Mr. Rick C. is taking this post over….

As a person with a vast amount of psychiatric experience, I have learned the importance of watching for danger signs in others and myself.  Recently, you may have noticed, our very own DQ displaying a few atypical qualities.  Let’s take a look at her last blog.  Apparently, she has now given herself the new name of Dr. Q (any body remember that show Dr. Quinn, Medicine Woman…Hamm) and began referring to herself in the third person.  Another great blogger, xcandyxcane, does this effectively but differs from our own “little bundle of identities” by acknowledging that she is speaking in such a manner.  Dr. Q aka DQ aka Dr. Quinn Medicine Woman may or may not be aware of this.

Her blog entry seemed well written, as always.  However, she did seem a bit flustered by the fact that she got a few negative little thumb things.  Let’s put this into perspective, depressed people can be negative.  It is a key symptom of being depressed.  We are here to learn how to make little thumbs up things more often.  The fact that I picked this up and she did not, while not unusual, could be an indicator that she is not functioning at her highest level.

Finally, a sure indicator that she is teetering on the brink of collapse… the use of that oh so pointed word, “shucks.”  I can only imagine the stress and pain required to push her to such an outburst.  For these reasons, and my true desire not to watch “The Doctor Formerly Known as Quijada” spiral down to a point at which she goes on and on about flooded basements, frogs and Lebanese births, (certainly was a fun week you may remember,) I have taken it upon myself to give her the day off.  If nothing else, I’ll make her sound really professional when she returns.  Let us all keep her in our thoughts as she sits comfortably in the castle (aka future sink hole) she calls a home, self-medicating while being a friend to herself.

Since I am not a real doctor, I cannot share a heart warming narrative about the one-legged blind puppy being held by the child with such a distant look in his eyes as his mother crocheted for reasons unbeknownst to the rest of the world that came into my clinic.  However, I would like to speak up about an aspect of this blog that I am truly pleased with.  (And I’m not going to try to understand what the word “paradigm” means that she keeps using.)  As I took in the fine nuggets of wisdom that are typical of this blog, I was especially pleased with the mental image when reading the description of  “Gorgeous Candy.”  Of course, any functional male reading this immediately recognizes this fine moniker.  (There is no medical term for that, I looked.)  Trust me, Q had no idea, none what so ever.

So…. as I absorb the plethora of psychiatric knowledge, I realize, I could very well be the man who could save Gorgeous Candy.  The image is clear in my mind and I know I can help.

All right, at this point, I would like to share a story about my drinking and a self-help program.  One night, after ingesting a large amount of alcohol, I decided to sit down on the couch and enjoy some television.  Interestingly, at three in the morning, there are many programs on involving various forms of “self-help” for a fee after calling and speaking with gorgeous women.  You can teach yourself to speak Icelandic in three days.  Several programs guaranteed to make you stop smoking and drinking while you do nothing.  Then – my personal favorite, the Flowbee.

The Flowbee allows you to cut your own hair with a vacuüm cleaner attachment as demonstrated by some great looking individuals.  As a result of my intoxication and the brilliant manner in which it was presented, the Flowbee sounded like an excellent idea with very few negatives.  I called just in time to be one of the lucky callers that got a discount knife set, as well.  Not so surprisingly, I was intoxicated when the Flowbee arrived.  No problem… easy enough to operate and certainly no need to watch the instructional video.  Hook it up to the Shop Vac and away I go….

Folks, you have not experienced incomprehensible demoralization until you have had a Flowbee lock onto your head with the full force of a ShopVac behind it.  At this point, as I lay on the floor trying to kick the plug out of the wall, I realized that my life was completely unmanageable and I would possibly need to go beyond the resources I had within myself.

Upon having the Flowbee removed from my head, I was fairly certain that all of my problems had been solved.  Hence, I went back to drinking.  Several years later, I would discover the twelve steps.  When I did, I was in Texas and had the fortune of becoming part of an AA group where people had no problem being honest or saying it like it is.  One of the first things that I was told, was that this is a “we” program and that if this program were to rely on “self”…. Well, based on my track record of helping myself first, I was in trouble.  Every single step talks about “we.”

Through the years, I would learn more about how important the group is to a twelve-step program.  Furthermore, the basis for AA (the first of many twelve step programs) is a movement called the Oxford Group.  This was a group that became popular around the turn of the century.  They had some basic principals that have become the basis of twelve step programs.  Key to the Oxford Group and twelve-step programs is the benefit of sharing among a group that is working this same program.  There are many tests online and other places designed to help individuals determine if they are or could be an alcoholic.  I think, for many, this test could be simplified into…. have there been times in your life that a Flowbee sounded like a great idea?

Please, share with me your thoughts.  Why are paradigms important?  When doctors self-medicate… is there a copay?

This would make even less sense if I was drinking…. Can you imagine?

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No Matter Why, Where, or What Happens, Self-Care Starts and Ends With Me

Cover of "To Kill a Mockingbird: 50th Ann...

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Self-Care Tip #158 – No matter why, where or what happens, self-care still starts and ends with Me.

It’s no secret that I look at behavior through many paradigms.  Most of what I’ve shared on this blog is medical because I’m a physician.  That’s my specialty.  I’m not a physicist and don’t spend my posts on explaining how physics influences our behaviors – although I believe it does.  However, I don’t want you to think that I think behaviors and emotions exist within only the medical paradigm, even though that’s what you hear me talk mostly about.

According to Dr. Q, the roughly sketched breakdown of how stress intersects with medicine:

1.  Stress influences how we behave and feel. We “see” the stressors, and we see the emotional and behavioral responses, and we know their sources.  We know that emotions and behaviors are produced by a human.  Where else?  Anything magical or otherwise comes from Someone from another place.

2.  Stress influences our medical condition. Stress will awaken sleeping genes that carry the names of different diseases; cancer, major depressive disorder, schizophrenia, and so on.  Would those genes have awakened on their own without the external trigger flipping the switch?  We don’t always know.

3.  Because there are so many factors that influence the reasons a disease process demonstrates itself, we cannot say that it is causally related to the stressors.  Many people try to do this, and sometimes the disease’s labeled cause comes down to the jury’s decision.  But we don’t have to have read, “To Kill A Mockingbird” by Harper Lee to know that people’s opinions and judgments are biased.

4.  People try to find the reasons why.  This is natural and in my opinion appropriate.  However, where we look for the reasons for the feeling and behaviors is equally important.  Seeking accountability for how we feel and behave to come from outside of ourselves, to come from external reasons, to come from a source to fault is more often missing our chance to get friendly with ourselves.

“It just is,” as many say, and the 12-Steps would say “Surrender what is out of your control to your Higher Power.”  These are not inconsistent with owning that mental health begins and ends with Me.

Sure, there are the despicable situations of abuse, trauma, violence and other horrible biology changing events.  These are known to cause the one non-genetically related psychiatric disease process called post-traumatic stress disorder (PTSD.)  These are situations consistent with our previous post on not being responsible for our history but being responsible for our futures.

5.  Stress, other than in situations of PTSD, is not causal for the progression of mental illness.  Everyone has stress, but how we deal with it, how we cope makes the difference.  Even horrible events, such as losing ones wealth and the sequelae of it are not causal for the continuance of brain disease.

6.  Medications, lifestyle change, Love and various other therapies effectively influences the way genes express themselves, our biology, and our medical condition….

7.  …In so doing, medications, lifestyle change, spirituality and various other therapies effectively influence our emotions and behaviors.

Question: How has your understanding of how stress intersects with with how you feel and behave affected you?  Please tell me your story.

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Connection: It’s Medical But Still Magical

XO with Internet connection, Khairat (India)

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Self-Care Tip #157 – Don’t depend on yourself to find connection.

We are people of a greater ability to bond than our senses, emotions, intuition, reason or technology can account for.  Our connection to each other and to God supersedes our belief in connection.  In this discussion, I am looking at “connection” beyond the paradigm of our perceptions.  Although connection between me and you is all about me and you, our bond also transcends either of us.

Meet gorgeous Candy.  She refuses any medications that might change her appearance in any way, ie. increase her appetite.  She would rather freeze in a catatonic state and die thin than gain weight.  She has come to me after years of struggling with irritability, anger, depression and anxiety.  She has never seen a psychiatrist although these emotions have misshapen her relationships, crippled her parenting skills, and removed her from her community of friends and one marriage.  Her medical condition continues to threaten Candy’s connection with her own self.  It continues to threaten her connections with her now teenage children and her second marriage.  Candy tells me that she doesn’t feel anything for her husband.  When she says this, she looks at me expectantly, as if she just released a big revelation.

When people are initiating treatment, I try not to get into anything personal too much.  Although I gather their personal history, I don’t give much feedback.  I try not to discuss their desire to make sense of all their conflicting feelings.  Sometimes they ask me questions, advice, directives and that’s natural.  However, it would be misguided to answer those questions, because we can’t let our emotions guide us.  I tell them,

Let’s revisit these questions after the treatment has time to take effect and you feel more like yourself.

It’s medical but still magical.  In four to eight weeks, they often hardly remember the questions they had.  The negativity is just a haze in their past.  The resilience comes with emotional health and copes with the simple stressors that used to sever interpersonal emotional ties.

Candy was one of the lucky ones who found the magic.  She felt self-trust more than she had felt her entire life.  Feeling safe with your own self is wonderful.  Much of the population who has not been where Candy has been can’t say the kind of thank you that Candy can.  They don’t know what it means to be lost and then found in this way.  Candy has something very special.

Yet when we think of Candy’s sense of connection, we also look beyond the biology of it.  I did spend some time describing how biology can change our perception of connection, but I didn’t do it to explain how connections are formed.  I described it more to demonstrate that we cannot depend on ourselves to define connections.

Don’t stumble on the philosophies around adjustment issues and conditioning.  Connection with others exists regardless of our fortune in family, money, treatment or maltreatment, biology, and self.  We are connected because there is a force of connection created and present in all of nature, regardless.

Madeleine L’Engle, wrote in “A Stone for a Pillow,”

Perhaps what we are called to do may not seem like much, but the butterfly is a small creature to affect galaxies thousands of light years away.

Our connections are there regardless of where we are at in life.  I would even take it further to say that connections to us even survive the cutting blow from death.

Connection is an eternal truth.  It makes a difference to us just to know that, but even if we didn’t, it doesn’t change our connection.

Question:  How do you make sense of your changing perception of connections in your life?  Please tell me your story.

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Go Toward Mental Illness and Take It To The Floor

Sean and Cheryl: Drama on the dance floor

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Self-Care Tip #155 – Go toward the real issue.  Be a friend to yourself.

Little woman, she had pinched toes in her four-inch heals and wonder what her size has done for her.  Mindy was anxious.  Even though I wonder about her stressors, like possibly her height and the history she is telling me, I know something else.  Even though I wonder about her parenting and marital stressors, and about growing up in a small town but now living with giants, I don’t wonder what she thinks.  Mindy describes these giants as people with large accomplishments, things she would not try herself and that means something to her, but not what she thinks it does.  Mindy wanted to see how things went.  Apparently six months of this wasn’t long enough.

We could spend the next five years breaking all this up and apart and tossing it like a cranberry salad.  But Mindy’s anxiety is mostly not about the salad of life.  Mindy’s feelings are a bit about the stressors and a lot about her brain.

Mental illness is not a small thing.  We trim it down when we say otherwise.  The unfavored sister, Mental Illness isn’t spoken to much at the table.  Her more popular sisters, Stress and Life-Triggers, get a lot of the attention.

With some effort, people who once worked around Mental Illness like it was barely there take a chance and go straight at it, full charge, and swing that woman onto the ballroom floor.

I went for that dance with Mindy.  And she wasn’t talking about waiting and seeing how things went for long.  I told her, like I’ve told you, that how we feel and interpret our stressors comes from our brain.  I told her that mental illness gets worse if it isn’t treated and treated to as full a response as possible.

We weren’t talking about life stressors at that point.  We were talking about her medical condition.  Once treated, Mindy will continue to have life stressors.  We will hopefully also see however, that she responds to life stressors differently.

Question:  How do you make sense of the seemingly meaningfulness of how stress affects us with the seemingly less meaningful concept that we feel that way because of our brain and not because of the stress?  Please tell me your story.

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