Paradigms

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Growing Old

Growing old.  When do we stop looking forward to the future?  My husband, who is a Palliative Care specialist, says that even in the end stages of life, we still look forward.

Erikson‘s psychosocial crisis theory of human development says life is a balance between conflicts.  Ambivalence, two opposing forces, is something to embrace and walk with.  I don’t think Erikson ever said it in so many words, but he was largely talking about having a sense of presence in our lives.  He based most of his theory on watching kids grow and then spread the rest over adulthood like the last bit of peanut butter on the knife.  Is that what adulthood is like?

My little girl told me that she’ll never run out of love for me.  (Every now and then, after hours or days of desert-like behaviors, she’ll break open a rock and out will gush something amazingly nice like that.)  Then she looked me over and said, “You’re not old Mommy!”  I showed her my gray and my spots and my wrinkles.  Maybe I was trying to say, “How can you love me in my future?”  Love is evergreen.  I am not.

When I was a kid, my parents loaded us up for a couple weeks every year and hauled us 8 hours in a van to Brian Head ski resort in Utah.  It is where I learned that some things stay green no matter what weather they live in.  The Evergreens, tall, tall, covered in snow except for some undergarments showing through were everywhere.  Even thinking about them, I can taste

Rolo Chocolate Caramel Candies,

feel the weight of booted feet, hear Dad’s bass voice and bits of my favorite ski-story loud to be heard above the chair lift.

Evergreen’s for at least 2 weeks a year, surrounded me and my family.  I’ve heard that Brian Head has materially changed a lot since we stopped going.  I wonder about the trees.  I’m sure there are fewer.

If it is true that every stage of  life has conflicts to resolve, it makes sense to me that in age we must resolve our future with our past.  We can’t just have a past.  If we find ourselves just looking back, than we are turning a blind eye to something we are meant to be present with.  Something that brings balance and fullness to life.  Something that is an evergreen quality.

For me, it is intuitive to look at God to meet this need – future v. past.  I don’t know what it is for others.  Conflict resolution.

When the days on life’s scale are tipping backwards, and we see that there aren’t as many days left on our plate, be present.  It is an illusion.  The past does not outweigh the future.  The opposing directions of time are just fine.

Self Care Tip #71 – Be present with the past by believing in your future.  Be a friend to yourself.

Question:  Agree or Disagree?  What are your thoughts?

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Believe What You Say! It Might Make a Difference.

If you want to get passionate about something, You have to believe it.  Many people speak it, read it, plan on it, but they don’t believe it.  Do you?  Do you believe that you can actually start doing what you want to do, feeling what you want to feel, become who you want to be?

And how bout the opposite?  Too many of us quietly or loudly hold our negative patterns.  A Heathcliff with Catherine scenario in Bronte‘s Wuthering Heights – slowly bringing on our own demise.  Reminds me of the mistletoe, a parasite on it’s host but accepted and beloved nonetheless.

MIT neuroscientist Sebastian Seung gave a wonderful TED conference, “I am my connectome.”  He tells us the good news that we are more than our genes. Our memories are not “stored” in our genes.  They live amongst the neuronal connections.  He empowers us saying that because we can change our neuronal connections, we can change our behaviors and habits – which are based on neuronal memory (indian trails.)  You see, because our habits are really memories ground into the fiber of our minds, and not into the constitution of our matter, we can make different ones.

Wow!

We may not have pixie dust or elf stones, but we do have power.  We can stop, drop and roll! to that destruction in our lives.  We can be friendly with ourselves at any level of our beings – neuronal to behavioral and emotional.  Mr. Seung, that is great news!

Self Care Tip #70 – If you are going to do it, have courage and believe it!  Be a friend to yourself.

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

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Our Changing Reality

She had been gone for 3 months helping her mother transition from life to death.  However, instead of it being a melancholic experience, she felt better than she had since a time she couldn’t calendar.  Back when she had a respect for herself.  Back when she had youth, she had hope, she believed in a generous future.

I had no way of knowing what it was like for me until I left the situation.

Reality is only as real as our perspective.  She came back to a new perspective and her reality changed.  She saw an impoverished life.  She saw need to stop waiting for the better of future’s promises.  She saw disrespect when caring for her disabled daughter and emotionally abusive husband.  She hated disrespecting herself.  She felt this and she rebelled inside.  Holding back her furry with the flimsy lid of guilt-glue.  She cried.  She had just let her mother go and feeling good about letting her daughter and husband go now embarrassed and shamed her.  But there it was.  The thought she hadn’t thought before.  Reality had changed.

I’m told that it is bad for a counsellor to tell someone specifically what to do.  Turns out that my job includes some counseling.  I ran into a former patient today at a coffee shop.  She saw me typing on my computer and learned about this blog.

But you do meds!

Apparently sometimes I’m not that great of a counselor.  Or maybe I am if she didn’t realize I was, with her, all along.

I had to stop and say hello!  I’ve missed you!

(Whew!)

Today, I kept thinking about the way reality changes when we let our perspective get some air.

This daughter/mother/wife will never be the same woman she was before she left for 3 months.  She didn’t know.  And now she did.  She can’t stuff that knowledge.  She can’t disappear it.  She is left with a knowledge.  Is it better?  I think so.

We played with options as we talked.  A window opened in the room and a breeze came through called hope.  That was lovely to share with her and I am grateful.

Maybe when with determined labor we are trudging on in life, we might think of this.  With this memory, we could more willingly accept the urge to walk away just to see for a time.  Maybe a knowing, that we were missing, will come and change us.

Self Care Tip #67 – We might be in a different reality if we walk away.  Be a friend to yourself.

Question:  What has your own experience been?  Please tell me your story.

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There is Room In Our Wanting Selves

Having another child born, our hearts somehow open up and make more love, more space where things once seemed crowed up like hobos in a boxcar.  Our time and energy does that too.  Feeling like you can’t do another thing by 6 PM?  Feeling like watching TV on the couch is an accomplishment at that point?  I’m telling you that this changes.  Do what you want.  You may not realize it yet but you want something special.  You want something that you were designed to do.   When you discover what that is, activity becomes joyful, congruent with your inner self.  Somehow there is more room in your day.  More energy that comes with no strings attached.

My husband just came home from a tech conference.  He was told by famous Silicon Valley junkies, while sitting in an audience of other wannabe’s, “Don’t do a startup.  You’ll fail.”  It was a secondary message that returned intermittently – unless you can’t sleep at night because you need to solve a problem – if you are trying to do a startup company for any other reason than for your own sanity, you won’t make it.  These people were doing what they were doing because they felt like it was their life’s nectar.  It was their pearl of great price.  Their efforts were fueled by their own genetic design.

In medical school, I used to look around me confused by the obvious natural positive responses of other students.  I looked at myself and thought I was a fake.

I looked at them and thought, “There’s the real thing.  I wonder what it feels to be the real thing.”  I know.  Sad huh?  Ah well.  Turns out I’m a flaming extrovert.  I get energy from being with people.  Being alone takes energy from me.  Wether it happens slowly or quickly, either way eventually I have to resurface and connect with someone to re-tank.  Every day when I sat down to study, I felt alone, energy sucked out of me, the ground was going to swallow me up.  And I did it still.  Ground through my long hours long enough to make it to where I belonged.  With you in psychiatry :).

Here’s the news.  We are all “The real thing!”  Yah!  We have our own greatness.

I’m not talking about opportunity to reach that greatness.  Some of that we are given and some of that we make.  I’m just ringing our bells with the idea.  If you want to read more about this, read the blog posts on temperaments.

Question:  Are you doing what you want?  Please tell me your story.

Self Care Tip #64 – There is room in your wanting self for more.  Be a friend to yourself.

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Get Treatment to Move On – Addictions

Molested by his cousin, neglected by his parents, he watched his intoxicated father beat his mother.  Thinking she would die too many times, he ran away, returned in a police car over and over again, as if wanting to get away was a crime.  He came back and raped his neighbor, more than once.  He spent a lot of time trying to get sex even though he knew it was ruining him and others.  He lost interest in almost everything else.  He suffered uncontrollable impulses.

He was 18 years old when he left it all for the safety of prison.  During the next fifteen-some years he was diagnosed, treated, and kept.  But kept for what?  For eating.  He gained weight, until he needed 2 seats to sit in.  Eating became his preoccupation.  He didn’t have sex.  He had food.

He was released to a home for sexual offenders, put on a diet and lost weight.  He lost it big and fast and felt in control.  He started purging and not finishing his meals.  He thought about purging all the time.  He knew he shouldn’t do it.  His voice was changing, raspy and his throat hurt but he still purged.  He wasn’t having sex.  He wasn’t over-eating.  He was purging.

For whatever reason, no one had yet seen the pattern.  Mostly everyone saw sex offender.  Me included.  I was trying.  I was trying to treat him with empathy, trying to get past the bile that comes when I think of rape, trying to consider the courageous things this man was doing now in life.

In one of my favorite scenes from the film, Rachel Getting Married, Kim played by Anne Hathaway argues with her sister about her own chances to have a future:

Rachel: Kym, you took Ethan for granted. Okay? You were high for his life. You were not present. Okay? You were high.
Kym: [Whispering] Yes.
Rachel: And you drove him off a bridge… and now he’s dead….
Kym: Yes, I was. Yes, I was stoned out of my mind. Who do I have to be now? I mean, I could be Mother Teresa and it wouldn’t make a difference, what I did. Did I sacrifice every bit of… love I’m allowed for this life because I killed our little brother?

I thought of this and somehow through all that trying, I did. And because I could empathize, a space opened up for me to be more objective.  That’s when I saw it.  I saw the pattern.

Addictions migrate.  Someone who may have started out as a food addict, might turn to gambling, and then later to alcohol.  Someone with sex addiction, might turn to food and then later to purging.

It can be like that game I used to play at Chucky Cheese, trying to hammer down the little animals that pop out of holes.  We need to treat the disease of Addiction regardless of how it’s dressed, or else it will keep popping up.  And like Kym, if we do, although perhaps terribly wrong in some unchangeable ways, we will still have a future.  If you’d like to read more about this “kainos” (Greek word for the opportunity to be made new,) read the post New versus New.

Self Care Tip #62 – Get treatment to move on.  Be a friend to yourself.

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

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A Little Bit is Not Enough – Claim Full Health

The good news is, I just ate 3 chocolate chip cookies.  You already know the bad news.  Has nothing to do with my post.  I’m just sharing it for the sake of your own

Schadenfreude 🙂

…Onward.  Question:

Does emotional disease get worse even while on medication therapy?  Sometimes.  It does so more often when the disease process is treated but only partially treated.  Read a little more about this in this post if your interested.  A primary care physician recently told me, “I think the term ‘Partial Responder’ is a marketing gimmick to get physicians to prescribe more medications.  I don’t think it even exists.”

There’s a lot to be said about interview skills in sussing out the partial responder.  If I asked someone if they felt better, many things play into their response. Everyone’s responses are biased of course.  We don’t have sterile minds.  For example there’s the patient who wants to please their physician.  “Yes I’m better!”  i.e. “Yes you’re a good doctor!”  There are the patients who don’t want to be patients and minimize whatever they’re going through.  There is the physician who leads the interview.  “So, you’re feeling better?”  “The medication is helping?”

Partial response means that at the end of a full treatment initiation period, there is some disease remaining but a reduction of disease.  For example, in depression, I may no longer be suicidal, but I still have trouble feeling pleasure in life.  In cancer it means that there is tumor reduction of at least 30%.

Now why would a physician presumably agree that there is a partial response in cancer, but not agree that it happens in mental health?  Anyways….  (Ahem.)  When we partly respond to mental health treatment and don’t push further for full response, about 70% will relapse.  Versus maybe 25% in those who reached their pre-disease baseline emotional health through treatment.

Don’t get lost in this.  The point is, get treated and get fully treated.  Mental illness is progressive and causes changes at the cell level.  The brain is connected to the rest of our body.  The brain is human.  A bit better, is not enough.

Self Care Tip #61 – Go all the way!  Claim health.  Be a friend to yourself.

Question:  Did you find this to be true in yourself or someone you know?  Please tell me your story.

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Keep it In The Relationship

She is a level-headed woman generally.  Objective by nature.  But now she asks, “What should I think?”  No longer taking birth control because she says she doesn’t need it.  They aren’t having sex.  Her husband uses porn and now openly gawks at other women walking by.  She says she doesn’t really care.

When a couple stops touching, the relationship is virtually over.  Few people revive their intimacy after too much time without sex.  Not everyone will believe this and may think it is too primitive for a true relationship of love.  But that’s the stats folks.  What to do if you physically can’t have intercourse?  Figure it out.  Must touch for intimacy.  Sounds like a bumper sticker.

Reminds me of a mighty river that suffers interference of dams and rerouting waterways.  Eventually a dry riverbed that once roiled with current and depth is left baking in the sun.  Even Paul the Apostle who never married recognized that if you aren’t physically intimate with your spouse, your nonphysical connection is also lost.

Physical intimacy is of course only one paradigm of intimacy.  And just about any one can say that, “Sex doth not a love make.”  Nor am I talking about finances, floss left in the shower, or how someone squeezes the bottle of toothpaste.  But whatever the many reasons are explaining the space on the couch, it ain’t good.  

So what did I tell her?  I certainly didn’t tell her “What she should think.”  I did review that we can’t trust our feelings.  “That’s true” she said.  “I hadn’t thought of that.”  Feelings lie all the time.

Question:  What do you think?  Agree or disagree.

Self Care Tip #59 – Keep it in the relationship.  Be a friend to yourself.

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Criticize if You Love Me.

On the receiving end of criticism.  Different from playing football or tag, no one wants to be chased, i.e. criticized.  If given the choice, which would you choose?  Chase vs. flee?  Humans can be a bit predatory when it comes to offering up feedback.

However, what I’m talking about has nothing to do with abuse.  Verbal emotional abuse is about unequal power.  Abuse of any kind, including spoken abuse, is scary, painful and shameful.

What I’m talking about is simply criticism.  You mismanage something at work and your boss, corrects you.  After coming home from that, tired and feeling beaten up, your children are picking on each other.  Then you get them in bed and find that you forgot to write-up a report and it has to be done.  Your spouse tells you that he misses his time with you.  

It takes a lot of love to deal with something.  Turns out, it’s much easier to let it go.  Walk away.  Examples of trying to promote criticism are the advertisements targeting parents to tell their kids not to use drugs.  It takes love to say no.  Loving yourself as well as love for someone else.  Kids who don’t get this feel neglected and confused.  Adults can also feel lost in so much impersonal space and act out just to get noticed.  Some people might call this “gamey.”  I just call it normal.  It’s a normal instinct to want the boundaries of someone who cares pressing around you.  It’s normal to feel adrift without knowing that you are worth somebody’s bother.

I say,

spare the rod and spoil the child

…at all levels.  At any age or station.  And further more, with your self-to-self included.  If you love yourself, you end up wanting to do and be better.  Coming from any direction, we can take it when we know we are loved.

The best part of Proverbs 12:24 is the second half,

but he who loves him is careful to discipline him.

So now, if given the choice, which would you choose?

Self Care Tip #56 – Bring it!  Take it!  Give it!  You are loved.  Be a friend to yourself.

Question:  Have you been criticized and known you were loved?  What’s your story?

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New Verses New

She died this morning.  After a day and a night of confusion, stumbling gate, and suffering, our gentle gorgeous Maggie died.  She is returning to carbon ash and giving us another reminder of what can be delivered to the living by death.

With the children taken to school, my husband came home to share grief with me.  He had just listened to a podcast by Rob Bell about the word “new.”  In Greek there are 2 common words used for “new.”  One connects newness to Time.  As in the young in age and old in age.  This is traditionally how our culture interprets “new.”  Another use of “new” uses the concept of renew without connecting it to time.  There is a newness in you as you are in time.  It’s a great overlap into the concept of presence.  But where my big gratitude went out to was knowing how many opportunities to being made new we have.

Some of us have the propensity to wait until we “hit bottom”  before we come looking to be made new.  I don’t mean this in any way that is judgmental.  Please see my blog posts on temperament if you want to read more about this.  If we were fortunate enough not to have picked up any self sabotaging habits, then in some ways we’ve got an easier time of it as the the years roll by.  However, few of us are, and getting crushed over and over again like recycling cans hurts a lot – us and ours.

“You can’t have it all” we are told, brewing panic after wasted opportunities.  Not having it all, missing out on more days to share with Maggie, loosing the hope of puppies some day, brought the well-timed discussion about newness straight to our grief.

We are given the opportunity to be made new any time any where regardless.  Any where from greatness to low-living, we have that choice.  When I think of Maggie, I will think of this and hopefully I will choose to be made “new” again.

A “new” heart also will I give you, and a “new” spirit will I put within you: and I will take away the stony heart out of your flesh, and I will give you an heart of flesh.

Self Care Tip #50 – Be renewed.  Be a friend to yourself.

Question:  Do you agree?  Disagree?  Please tell me your story.

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The Good and Bad of Anxiety

In response to yesterday’s blog, a reader wrote,

I often feel my flight and fight response triggered even in situations (mostly social) that should not (theoretically) even be frightening. What do you think about that?

This is like the degrees of water temperature in our shower.  Pretty much every one falls somewhere on the spectrum of this type of anxiety.  When is it ok, and when does it become not ok?  My brother, friend, mentor, Cameron Johnson MD said in so many words

Anxiety is what makes us work hard.  If we didn’t have anxiety, we’d all be slobs.  We’d stink.  We wouldn’t get our homework done.  We wouldn’t say as many nice things.

My children still see most things in all-or-none fashion.  They would say at this point of the discussion, “Anxiety is good.”

A teenager I treat began responding to her medication.  Her mom began to complain.  “She never let this happen before!”  Her room was a mess.  She was less prompt to obey and she started voicing her opposing opinions more.  In some ways, without the anxiety, it was like her mom was getting to know her for the first time.  

This was however, better than anything this girl and her mom had hoped for.  Now the girl wasn’t throwing up, having panic attacks, avoiding just about any social experience.  She was making eye contact with me and she was able to present in class.  She told me that she can’t even think about how she felt before.  It was so bad.

It is really hard for any one who has never suffered from debilitating anxiety to realize the level of suffering and terror it causes.  Someone who may look stuck up, aloof, disinterested, quiet, bored, may in fact be at hells door.

My children might now say, “Anxiety is bad.”

And so to my reader quoted above, I’d say with my children, anxiety is good and anxiety is bad.  Come and paint the stars with me for a time.  Talk and tell me your story.  We shall in degrees of mind and manners, unwind the mysteries together.

Self Care Tip #49 – If anxiety is affecting you in a negative way, consider a medical reason.  Be a friend to yourself.

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Look Around At The Other Reasons – Depression

Flagellants mortifying the flesh, at the time ...

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“I’ve done some bad things.”  Patient tells me she can’t sleep well, is nauseated, depressed mood, worried with perseverating thoughts about acts that shame her and ramifications, doesn’t feel as much pleasure in life, isolating, tearful and more.  I was alarmed!  What could she have done that deserved this kind of self-flagellation?  When she told me, I didn’t realize it.

I was still waiting for the rest of the story.  I got caught up in her own self-judgment and found myself sitting beside her “in court.”  Once I realized what I was doing, I was chagrined.  Here I was collaborating with her in her inappropriate guilt.  It took me too long to register that her reaction was not proportionate to the offense.  I told her I was sorry she was going through all this emotion.  She said, “It’s my own fault.”  Is it though?  We needed to start looking at additional reasons that might be influencing the way she felt.

Start looking at other paradigms when the emotional response is out of proportion to the event(s).

An analytical approach would look at unconscious reasons, such as other personal choices that conflict with a core beliefs.  Or perhaps, something like unresolved anger coming out in physical and emotional symptoms. Ask about our “closets,” peel away pretense and let your flawed self into the air.  Keep it real.

Another paradigm is medical.  Inappropriate guilt is a symptom of Major Depressive Disorder, a debilitating disease process of the brain that affects the whole person/body systems.  When distorting things out of proportion, personalizing too much, we must ask if there is a depression going on.  Ask yourself.  Ask others.  But don’t let it continue if at all possible.  Major Depressive Disorder is a progressive disease that does more damage to the brain the longer it goes untreated.  In other words, the brain is affected more over time, it is harder to treat and it is more dangerous to the person.  The average length of an episode is 2 years and the more times it returns, the more chance to have the disease process continue for life.  Treating sooner and for longer, decreases the chance of relapse.

Excellent for us are the many treatment options for this potentially devastating disease.  Even in the “lifer,” when staying on medications, the relapses are much easier to get through and shorter in duration.  The medication has a protective effect on the brain.  Prophylactic against further insult.

In the woman I told you about, there was another emotional spectrum disorder, anxiety.  Anxiety and depression are like brother and sister.  They often go together.  But for today, we’ll leave it on the symptom of inappropriate guilt and let it rest on the reminder that the brain is human, mortal, attached to our neck and not an aura.  When the brain gets sick, it shows how it is doing the only ways it can, often through emotions.

Self Care Tip #46 – Look at all the reasons influencing the way we feel.  Be a friend to yourself.

Question:  What do you think?  Agree or disagree?  What is your story?

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Do What You Were Designed to Do

Animation of the structure of a section of DNA...

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Nike made it popular.  But did we ever take it and run with it?  “Just do it!”  My girlfriend and I were having lunch together and the topic about our life’s profession came up.  She is bored in her work and would like to get into something more creative and artistic.  In an ideal world, maybe she’d think, “Just do it!” and find congruence with her inner self “just” like that.

However, taking action isn’t only about energy, interest, boredom.  But what is it?  What is it that makes one person take action and another think about it and move on?

One answer has to do with hard wiring.  Some temperaments find that thinking about it is almost as good as doing it.  Imagining what they would have done pretty much satisfies their drive.  Others find that taking action that leads to completion, decisions, just doing “It”, feels like boxes, closing in, closed doors.  They feel separation anxiety just imagining the distance growing between them and their beloved Options.  For these people, maybe the perspective of “Just do it” should be different from our cultural definition.  For them, doing it may mean doing what they do best – grazing their ideas, options, journey.  They are best at playing through life so to speak.

Western culture measures work generally by the opposite of this, although the truth is, our life’s work is what we were designed to do and be best at.  What looks like play to someone is in fact “good work” for another.  What looks like work to another, looks like something they’d rather jump over a cliff than do.

If we want to really get something done in life, we will do best taking inventory of what we bring to life with us.

I haven’t touched on other reasons why many of us do or don’t take action to completion.  Things that have to do with different pathologies.  I’ve only talked about one paradigm of hard-wiring, genetics.  This paradigm is crucial though.  It permeates all others as it is about our architecture.

Self Care Tip # 44 – Just do what you were made to do.  Be a friend to yourself.

Question – What do you think?  Have you noticed this concept at play in yourself or others?

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Something Decadently Enticing

Oh rotten orange!  I found one stinking up my pantry.  Little fruit flies netting the air above.  Green fur staining my basket below.  The fruit touching it changing colors for no reason other than proximity.

Stay healthy.  Staying healthy is one of the best things we can do for ourselves and for those we “share space” with, those we love.  It is a gift any way you look at it.

Exercise helps, including with emotional health.  Yet, how many of us do?  About 30%.  Some of us use negative self talk to get ourselves out there.  “I’m fat.”  “I’m going to have a heart attack if I don’t.”  “I won’t qualify for that insurance if I don’t.”  All of which may be true.  However, does it work for us?  Apparently 1/3 of the time.

We use the negative feedback to motivate ourselves.  But just as in children, we know it doesn’t work.

If a child lives with approval, he learns to live with himself

-Dorothy Law Nolte

Positive reinforcement is helpful in any context.  Who knows!  Maybe that rotten orange would have tried harder to stay fresh with emotional perks?!

Each of us needs to find our own positive feedback that works.  Our interests are different so it’s not universal.  However, we can be our own behavioral therapist in this.

I have found for myself that I never exercised consistently until I turned exercise into something decadently enticing.  I load up 3 large glasses of water and take them to my bike.   My bike is in an alone place.  In front of my stationary bike is our only television.  There I watch whatever I want!  I don’t allow myself to watch TV at any other time.  It is special.  Reserved for my exercise.  I can’t wait to get back to my show or movie almost every morning!

When I want to hit the streets with a walk or a jog, I listen to audio books that I only listen to when I’m exercising.

I have to set aside some persuasive treats that are now linked in my mind to exercising.  Now when I think of exercising, I am nothing but happy about it.  It is behavioral modification at it’s best.  Hopefully this is helping me and those I touch in life.

Self Care Tip #42 – Turn exercise into something decadently enticing!  Be a friend to yourself.

Question:  What positive reinforcement works for you?

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Get to Know Yourself to Be A Friend to Yourself.

On the Threshold of Eternity

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Let us put our efforts toward becoming who we can become, who we were wired to be, who we want to be, what gives us pleasure.

We can get beaten up by wanting.  Wanting to be someone who gets energy from being with people rather than from being alone.  Wanting to be someone who is a finisher rather than grazer.  Wanting to blend and lead and be chosen.

Some of this filters out as we age.  Aging fills our lives up with so many responsibilities that wanting to be anything more than someone who gets solid sleep hasn’t crossed our minds in a very long time.  Children get more of it right than us in this regard.  They have space to want more openly.  Our wanting muffles and cramps when we turn away from who we were genetically designed to be.

My patient came in depressed again.  Depression was familiar for him.  A psychiatrist works with a specific area of medicine.  So I get to see people after multiple medication trials before their primary physician refers them to me.  Well this patient hadn’t found lasting help from medications. He came to me with doubt.  I wish I could say we worked it out.  I can say that we are still trying.

What we are working on influences the way his genes express themselves.  We can’t change the genes but we can affect some of how and when they are activated.   We can do this by choices, such as medication therapy, sleep hygiene and exercise.  Choices are more effective when we know what and who we were wired to be.  What are our natural talents?  What are we interested in?  Feeling inner congruence when we are doing something points the way for this.

In Outliers, author Malcolm Gladwell says

“the biggest misconception about success is that we do it solely on our smarts, ambition, hustle and hard work.”

I don’t know if Mr. Gladwell recognized how closely his thoughts harmonized with Carl Jung‘s regarding temperaments.  Doing what is natural for us recruits our best through the path of least resistance – our interest, our attention, our creativity.  Rather than forced effort, drudgery and dragging feet, time looses some heaviness as we get caught up in inner and outer congruence.

Intuitively, we all surmise that when this happens, we have less stress inside and outside of us.  Ah.  What a relief.  This is what my patient is working on and when he is able to say he is doing what he wants to in life, he is less hopeless and panicked.

Self Care Tip #40 – Get to know yourself to be a friend to yourself.

Question:  What do you think?  Have you been using these tools?  Have they made a difference for you?

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Choose Your Prophesy

A woman today with a frank quick smile found out I wrote FriendtoYourself.com.  She swung open the door to her story.  People like her never bore me.  In brief, she was sad after many life losses.  Then when she made some changes in her life she got better.  “I didn’t know how bad I felt!”  (And who does?)  Now every day has activity she loves.  She gets tearful just telling me about all the gratitude that took her by surprise.

In psychiatry, the way she felt when she was sad is called an Adjustment Reaction.  An Adjustment Reaction doesn’t last long, it is in response to stress, and it goes away when the stressor is removed.

Stress is dangerous to us.  It can affect us for different amounts of time, like measuring cups.  During that time, it can affect us to different depths within ourselves, like a scuba diver exploring a coral reef.  If the sad time in this woman’s life went longer, and if she had gotten more sick, it might have become a Major Depressive Episode.  In that case, medication therapy would be appropriate.

Stress affects different intersecting paradigms that make us into who we are, like storm water over farmland.  It crosses over our biology, our genes, what is done to us in life, what we do to ourselves, what is put in our bodies, and how we cope.

Stress can pass over us like a Jewish holiday or it can stay, working, changing, reshaping, adding and taking away bits, always active and busy.  Ants in the walls of our house.  Most often we don’t know what it is doing, for how long, or where it is at work in us.  Stress mutates our cells, turns sleeping genes into loud cancer, depression, anxiety, heart attacks, dementia, old and wasted faces.

But what to do?  Do we avoid stress?  Do we end it?  Do we cure it?  All of that, of course.  My dad told me, “Everyone has problems.  The difference between you and somebody else, is what you do with your problems.”  Not the number of them.

No.  This woman’s story didn’t bore me at all.  The opposite does.

In the film directed by Adam Shankman, “Bedtime Stories,” the character played by Adam Sandler thinks choices have little effect on inevitable negative outcomes. “Life has no happy endings.”  He lives consistent with that belief, until love finds him.  A happy life story can be chosen.  His fantasies are freed to cross the boundary from imagination into the material world where love was waiting, in the shape of family and strangers.  Love showed him that his life had been a self-fulfilling prophecy.  He hadn’t even realized how unhappy he was.  (And who does?)

Self Care Tip #38 – Choose to go towards your fantasies.  Be a friend to yourself.

Question:  What do you think?  What is your story?

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Own It. Our Life’s Work.

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

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

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

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

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

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

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

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Sensory Overload

crying-baby

Image by bbaunach via Flickr

Sensory overload.  There are some neurodevelopmental disorders that cause heightened sensory awareness.  People might need to brush their arms to be desensitized to the sense of touch.  Or use a vibrating toothbrush or wear shades even with little to moderate light.  I hear most about the senses of touch and hearing from my patients who will hit their head, scratch themselves, or do other self-injurious behaviors to self soothe.

Hearing about these people might feel like you are far removed.  However, many of the general population have some sensory issues although to a lessor degree.  These things come out when we are tired.  When we have multiple emotional stressors.  When we feel trapped or overextended.  It is linked to anxiety and so we may notice tension crawling up our skin or into our throats.  If we could escape we would.  Some people can push through this and make it until a window opens.  Some people end up reacting.

Today I found myself squinting more.  My energy was low and I yawned a lot during clinic which is rude.  My inner milieu had a lot to do with what I was bringing to the table and little to do with what was happening to me or around me.  However, there I was, a player in life.  I did my best.  And then the sound level started going up.  It felt like my skin was lifting up and contracting all at once.  Sound travels so it followed me around the house.  Before I had to put a dollar in the family money jar, I remembered my ear-plugs.  Ah.  Things went down a notch.  I could cope better.

Self soothing.  Babywise by Gary Ezzo and Dr. Robert Bucknam, the much disputed early parenting book, tells new-by’s that babies need to learn to self sooth.  Parents are advised to let their babies cry at night until they quiet down, rather than pick them up and sooth them externally.  Thus teaching  a baby that they can’t use Mom or Dad as a sleep prop.

Many of us even as adults struggle with self soothing.  Awareness of what is bothering us helps.  Getting that awareness might be a deliberate effort or it might come effortlessly.  Either way, knowing what is the trigger helps to know how to respond.  Anyone can describe a time in their life when this didn’t happen and they tried to self sooth in a way that was hurtful to themselves or someone else.

Whatever the feelings are, whatever the stressor, self soothing should be something simple, easy and fairly obvious.  Today, I was surprised at how much better I parented with ear-plugs in place!

“Mommy, why are you wearing earplugs?”…

Question:  What do you think?  Agree or disagree?

Self Care Tip #32 – Self sooth simply.  Be a friend to yourself.

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Be Aware

Cover of "The Psychology of Gratitude (Se...

Cover via Amazon

We’re sitting at the piano practicing.  She is smart, reading for a year already, beautiful in a way that scares me at times, has advantages that surround her just because.  She isn’t thinking of these things though.  She thinks about the things she is not.  She says, “I can’t do that.  I don’t know how.”  She is not thankful just now about her opportunities.

I wondered, as I was sitting at the piano, if success and gratitude are collaborators.

Gratitude should not be conceived just in terms of a particular relationship. Gratitude is a philosophical emotion. It is, in a phrase, seeing the bigger picture.  …And so viewed, being grateful for one’s whole life is not a “grateful to whom?” question so much as it is a matter of being aware of one’s whole life, being reflective in a way that most of us are not, most of the time.

-Robert Emmons and Michael McCullough, The Psychology of Gratitude

Seems like a little much to expect out of a 5 year-old?  Maybe, maybe not.  But it definitely is if her parent isn’t practicing awareness, reflection, gratitude.

We will have more success in our life’s ambitions if we practice gratitude.  This much I will do and maybe, my little girl will learn to see herself differently too.

Self Care Tip #30 – Be aware.  Be a friend to yourself.

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Do This.

A basic recipe to becoming a friend to yourself:

Before, during and after # 1-6.  Love.  Find it.  Go to it.  Be in it.

1.  Sleep well regularly

2.  Aerobic  exercise at least 5 to 7 days a week.  Try to hit 60 minutes as many days as possible.

3.  Take your supplements:  Omega 3 and vitamin D.

4.  Do what gives you energy.  This means what is congruent with your inner self.  If all stressors disappeared, along with all roadblocks, what would you want to do?  Do what ever that is as regularly as possible.  Is it playing basketball?  Is it playing with children?  Is it canvassing?

5.  More on the above.  Get creative with it.  Grow in that area.  To do this requires work.  So the 5th ingredient is to work.

6.  Reflect on yourself.  Take stock.  Are you feeling more friendly with yourself?  If not or if not enough, consider medications.

This is not a complete recipe.  I didn’t speak about diet, water, air.  Can’t live without them.  But for now, I wonder what this recipe will make for you.  Please let me know.

Self Care Tip #27 – Do this.  Be a friend to yourself.

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Good News

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

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

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

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