Presence

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Hear, Be Heard, Believe and Speak In Your Language.

c. 1868

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Self-Care Tip #187 – Say it better by saying it in your voice.  Be a friend to yourself.

We all have our own language.  I’m not talking about Hungarian or Spanish.  I’m roughly talking about Jungian typology.  We speak and hear, we are heard and we find that we believe better with it.  But we don’t all know that and so don’t treat ourselves with enough courtesy.

For example, many of us used to think that listening to emotions was silly and that using graphs and quoting studies was smart.  (Who ever heard of smart emotions or even spiritual intelligence for that matter?!)  We used to hold our breath and hope our brains would change if we despised our own wiring enough.  As if our genes would get the hint, give up their mortgage and leave town, disgraced.

Hopefully after the paternity of the genes in question was established, and if we grew a little, we noticed that there is no better way to speak than what is our own voice.

Say it.

That was lovely.  Thank you.

We can listen to the beautiful music of Celine Dion French Album, or watch the foreign film Like Water for Chocolate (Spanish: Como agua para chocolate) without subtitles, or sing the African-American spiritual song from the 1930s, Kumbaya.  We will get a partial understanding of what is intended, what is said, what is felt.  We will know that someone is desperately in love with someone else, for example, in Como Agua Para Chocolate – but not get the full story of course unless we hear the words in the language we know.  Saying that one language is greater than another is hopefully buried with Hitler.  Our temperaments speak uniquely as well by design.  They are not qualified differently from each other.  True, they are better suited for different tasks, jobs, audiences.  But that doesn’t make one smarter or dumber than another.  Regardless of the bank account any one or many may hold, there is no difference in value between them.

If we want to say something, ….  Well all I can say is this just feels right?  You know what I mean?  😉

Question:  What has helped you discover your language best?  How has it helped you understand your connections better?  Please tell me your story.

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

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

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Self-Care #186 – Forget about fairness.

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

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

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

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

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

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

With my abuse…?  No one else will…?

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

With all the hurt I’ve received…

I was poor my whole life…

I just can’t seem to get a break!

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

I have to take care of myself.

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

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

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

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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

15th century adaptation of a T and O map. This...

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

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

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

His wife just killed herself.

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

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

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

Later in psychiatry training, my attending said,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Pain Can Be Something More and Better Than Just Pain

English: Vladimir Bystrov. 2006 Russian Premie...

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

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

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

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

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

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

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

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

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

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

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  Please tell me your story.

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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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Dad Is In The Hospital. My Reality.

Open-face helmet.

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Self-Care Tip #179 – Get inside your reality and be with Love.

When I was eight my family left me at Grandma’s farm for the summer.  There’s not much more inland to go than Iowa.  If the United States of America were a house, Iowa would be perhaps it’s cellar; full of smells, goods and it is a great place to play.  I played a lot that summer – as well as stepping in a cow-pie or two, riding tractors with Grandpa Jack cutting hay, pulling on cow tits and seeing the milk come out to shoot right into the cat’s mouth.  And I gathered eggs from pecking feisty chickens that would scare the bravest of any Coasters (those of us from the East and West.)  Grandma was no-nonsense and didn’t waste much time on coaching.

Just stick your hand in there and take the eggs.

As an eight-year-old you haven’t known real fear until you face down a mother hen in a musty unlit poop filled coup, and reach under her feathered skirts for eggs.

That summer Dad came to get me early.  I was really happy to see him.  Uncle Mel and my cousin Dougy had been in a motorcycle accident.

Dad is an orthopedic surgeon and since my summer in Iowa,  Dad has called motorcycle helmets, “brain-buckets.”  He’s seen a lot of them in emergency rooms, so he knew what his brother had looked like.  Dougy was in a hospital bed being introduced to his now forever useless arm.  I came in shy, because Dougy was so cute.  I was thinking about what he thought of me.  I know.  I did.  Despite my diva-self, despite the horror and grief, Dougy gave me a brilliant white-boy American smile.  I hid under Dad’s arm where I didn’t have to look but could still hear Dad’s voice.  I think I may have even whined.  I’m still embarrassed.

These days, unfortunately I rarely get to see Dougy, but when I do, I still want to hide under Dad’s arm as if he’d remember me there.  I wonder if he remembers Dad’s voice.

Today, Dad is in a hospital bed with a blood clot the size of a rattle-snake crawling up his leg, fighting for his right to walk, let alone live.  It is his voice, or maybe the bed, that brought Iowa back to me.

Cousin Patty was crying at Uncle Mel’s funeral.  She wouldn’t go up to the casket, just sat and cried.  I was a little bummed my cousins weren’t interested in me.  It was who I was at eight years old.

Grandma, who left me unsupervised to gather eggs from angry-chickens, cried and asked me for more kisses.

They taste like brown-sugar!  Give me some more.

Dad’s hands now have Grandma’s same wormy veins, raised over blotched ecchymosis (purple patches from leaking blood vessels into the skin); begging to be touched.

I went to see her with my brother Cam before she died.  She was delirious.  But I trusted her so.  I laid beside her in her hospital bed and looked up for a shoe she told me was stuck in the ceiling.  I thought, “There just might be one and these people don’t believe her.”  I was miffed.  Now I realize I was mostly angry because Grandma was dying.

The farm is gone and I wish I had the metal tub Grandma bathed me in outside on the lawn.  But I do have this connection in me to all she gave, the people who came from her and her showing me how to live and die.

If she was still alive and knew Dad was in this danger, she’d say, “Rob, I’m praying for you.  I Love you.”  And unlike my emotives, that would be about it.  She was from Iowa, you know.

This is my reality.  Dad is in the hospital.

Self-care includes being in our reality.  Sometimes it’s too much for one person to handle.  People need Love.  The reality of the world and of the individual is that we need Love.  We are better to ourselves and others when we can be inside our reality.

Telling you about this is my self-care.  This is part of my Love story.

Question:  What is yours?  Please tell me your story.

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Remember Love to Feel Bigger Than Your Self

A Mothers Love. The Hand of a Child.

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Self-Care Tip #175 – Remember Love.

Yesterday was my son’s birthday and today we partied over him.

How old are you?

He looks at his fingers and sees how many come up before he answers,

Four.  I’m four!

Right now, he feels really big.  He blows his lid if anyone says otherwise.  And because he’s never been above the bottom twentieth percentile on the growth curve, and because he’s four years old and the youngest of three, and because he’s so small, when he says, “I’m big!” looking serious over, yet under you with his bottle cap eyes, it’s really hard to keep straight.  But more often I do …until he loudly says,

I love you the whole day, Mommy!  The whole day!  You are my friend!

Then it’s over for me.  I can’t stay off of him.  He’s just too beautiful.  His open forwardness humbles me and I remember that it’s Love that makes us great.  It’s Love that brings us to our knees.  It’s Love, more than this stack of years, inches and knowledge that makes my son bigger than me when I forget Love.  He doesn’t.  He’s just too small to.  Four years of Love is big.

Questions:  What has helped you remember Love lately?  What has made you feel bigger than your own self?  Please tell me your story.

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Work Hard to Take Care of Yourself If You Want An Easier Time Taking Care Of Others

Self-Care Tip #174 – Work hard to take care of yourself if you want an easier time taking care of others.

My marriage has never been better.

Freedom Press (UK)

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Kirsten had good posture.  She made eye contact and she wasn’t fidgeting when she told me about the changes in her life.  I hadn’t seen her in clinic for two years and apparently in that time she had set her husband free.  She was seeing less of him than she ever had and they were both busier than any other time in their lives.  Yet their marriage was at its peak.  I felt like I was getting off the point of why she came and wondered if asking her for details was unprofessional.  I did want to know.  Lucky for me, she wanted to tell and I just let it happen, as if I was doing her a favor.

I admit, sometimes I get something out of my clinicals.  I’m not always the best therapist.  I don’t always keep things about my patient when I let myself receive, or even actively take from them.  None of us are that altruistic.  Therapy is supposed to be one place any of us can go, and know that when we go, we can expect to receive everything except the fee-for-service.  Therapy should be the closest thing to a one way street in this non-altruistic world.

To my rescue, Kirsten said,

He has been meeting with friends, exercising, eating out and working the 12-Steps twice a week.

Yes he was sober, but he was also a bunch of other stuff.  Taking care of himself, he became a better husband.  Better body, clearer mind, happier, more attentive, less angry; she could hardly stop listing.

Freedom is useless....

Taking care of himself took a lot of work but it made taking care of her a lot less work.  True, she wasn’t the center of his life, she gave up on some fantasies, she didn’t ask him for more time, but all those in the past had only grown her own point of anger and blame and not the marriage dreams she thought they would – letting them go was a good thing.  Yet, cutting him free still felt risky to her.  She came to me because she was becoming more aware of what that fear was doing.  When she was afraid, she was sabotaging herself.  Bits of herself recognized that she could feel as free as her husband did.

To be free of fear for Kirsten, she needed medical help.  Kirsten’s fear came from nowhere, out of the blue and was not only triggered by suspicions about her husband.  To be free for Kirsten’s husband required other forms of self-care.

Question:  What kind of self-care does your freedom need?  How has your hard work on your own self-care spilled over into less work to care for others?

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When You Can’t Control This, Emote Empathically

Self-Care Tip #172 – When you can’t control this, emote empathically.  Be a friend to yourself.

A couple of days ago I wrote about being transparent with ourselves and others when we are not in control of things.  (Say, “I Can’t Control This” When You Can’t.)

This road sign image is in the public domain a...

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It got mixed responses but all worth thinking about.

Jennifer responded on Facebook,

The 3 C’s help me all the time; I didn’t cause it, I can’t control it, I can’t change and or cure it!

Isn’t that wonderful?!

  1. Cause
  2. Control
  3. Change

And it’s helpful to remember that claiming these 3C’s still may not remove us from the stressor.  We are however more present with ourselves and others despite the stressor.

Another reader BeeBlu’s, brought up that famous “fine line,”

I agree that it’s healthy to have this attitude to certain things in our lives, but as you say, it is also no excuse for bad behaviour and letting emotions go into free fall at the expense of others. I think there is a very fine line between the two. bb

…And her signature, “bb,” – awesome.

A line that is thin implies insecurity, danger and something precarious that may end up all wrong.  I wonder about that line.

On one side we have the 3 C’s:  cause, control, change.  On the other side of the line we have responsibility for the boundaries of others.  I wonder if there really is a dividing line after all or if it is just bad lighting.  If there wasn’t, there would be no need to thicken the line, to defend, or to pick sides.

Emotional health makes shadowy lines disappear.  It takes someone who has emotional health to be able to say their 3 C’s and still consider the internal and external milieu of others.  It takes someone who has done their self-care and put money in the bank; someone who has reserve built up that spills over into empathy.  We can’t emote empathically so well when we aren’t emotionally healthy.  The less of that, the more real the line becomes.  The less of that, the more precarious we are.

Gaining emotional health may take medication, exercise, sunlight, granola, grandma’s kisses and all sorts of things.  Each of us has to figure it out for our own selves and just do it.

Questions:  What do you think about this business of shadows, lines, and living cautiously?  When you have been healthiest, how have you been able to embrace both the 3 C’s and emote empathically at the same time?  Please tell me your story.

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Tell People When You Fall

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

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

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

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

Falling finds friends.

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

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

connection.

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

You might have heard the proverb asking,

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

Or,

Water, water everywhere and nothing to drink.

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

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

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

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

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Say, “I Can’t Control This” When You Can’t

Playing in the Sink

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Self-Care Tip #169 – When there is negative chaos, remember and say, “I can’t control this.”

Carol had worked there for seven years.  The supervisor had just asked her for more hours and Carol felt almost good to be able to say she didn’t have any more to give.  Yet when Carol got the email that her job position was closing in a month, she was physically affected.  Her autonomics (“fight-or-flight” reactions) were on full alert.  If there was an attacking bear, she might have out run him.

Healthy Carol had been to enough 12-Step meetings to remember, “I can’t control this.”  She said it a few times and turned it over to her Higher Power.  She did not crave or relapse in her addiction’s disease.  Her pulse was still fast and her hands were still tingling for the next several hours but she didn’t “use.”  She went to her meeting and she pushed on.

When Carol thought about her future and the things she could do to prepare, she inevitably thought about the things she couldn’t do.  She said,

I can’t control this.

When Carol imagined what other people would think after hearing about her unemployment, she said,

I can’t control this.

In mental health we struggle with that a lot.  The emotions that grow self-loathing, the behaviors that distance us from our support and loved ones, and/or the physical changes that keep us from performing – are all confusing.  At what point do we say, “I can’t control this?”

I remember a Seinfeld joke about water faucets in  public bathrooms.  The ones that you have to hold down to keep the flow going.  I’ll spare you the misery of me trying to retell it and get to the point.  Why do they have those faucets?  It’s as if they think people will have a water party in there or take free sponge baths if they could turn the faucet on long enough actually to wash their hands.

baby elephant | playing in the water

Image by Adam Foster | Codefor via Flickr

When we say something like “I can’t control this” to the idea of emotions and behaviors, the general fear is that people will take wild liberties, – splashing emotions around and behaving like elephants after the summer Serengeti drought ends.  Mayhem will ensue and the staunch healthy-minded with dry pants will have to clean continually after us.  Not many people want to be sullied by the emotions and behaviors of others and this, “I can’t control” business is a boundary issue.  Maybe stigma is one of the ways we change out the faucet on others.

There are some very primitive characters and severely ill people who might say in fact that they cannot control all feelings and behaviors.  This is more than most of us armored with some healthy coping skills would believe or say.

“I can’t control this,” is not a free pass to vandalism, vengeance, volley-ball or any other very vexing behavior.  It is not there to hand over like a ticket to other people for their excuse, justification or condolence of our situations.  It is there for us to hold up to ourselves for the purpose of honesty, submission to our Higher Power, humility and healing.  No one can control the flow out of that.  That is free self-care.

Questions:  When have you felt like you had to explain to others your behaviors and feelings even when you didn’t have an explanation?  How did you bring it back “home” to your own self-care and get past the stigma?  Please tell me your story.

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If You Have Something Good That’s Happened, Say It

Self-Help Graphics

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Self-Care Tip #164 – If you have something good that’s happened to you because of your self-care, tell others about it.  Be a friend to yourself.

Have you ever heard of SparkPeople.com?  I’ve been a member for a few years and believe they are one of the most supportive networks out there for diet and lifestyle change.  Today I received this email from one of their bloggers and thought to share it with you.

From “GUITARGAL2”

Today is my one year anniversary on SparkPeople.  I have to admit this is the longest amount of time that I have ever spent focusing on me and my health.  A few things I have learned in the past year are:

1. I can lose weight be happy.

2. I can educate myself on a healthy lifestyle.

3. I have learned that when I slip up, refocus, refocus, refocus.

4. I have learned that I like being a runner.

5. I have increased confidence.

6. I like how my clothes fit.

7. I don’t need chips and dips to feel satisfied.

8. Captain Morgan is not my friend.

9. I can inspire people.

10. Having a support system makes the difference.

One year ago I wrote on my SparkPage, I can do this, and I have.

This is only one example, as described by GUITARGAL2, of what self-care has done for her, specifically through diet and lifestyle change.  All of our lists are different and powerfully inspirational to others when we share them.  It also comes back to each of us, as good things will do.  How does it comes back?  Well, I can’t try to explain that kind of magic.

Keep talking.

Question:  What list do you have for the things self-care has given to you?  Please tell us.

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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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Know What You Are Fighting For – Your Right To Journey.

You Should Be Living

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Self-Care Tip #162 – Know what you are fighting for.  Be a friend to yourself.

Bridget told me,

I felt free to do something creative without having to feel guilty about it.

She had read the blog post, “Self-Care is Freedom, is Democracy, is Because We Are Accountable.”  I was just starting to think about other good places to go with that but before I got too far she hit me with,

I just hate myself!

Hearing those words is like watching squishy and partly moldy tomatoes hit the wall.  It’s messy.  It’s dirty.  No one’s excited about dealing with it.  And, there is something negative that brought it on.  Readers, you’ll remember this countertransference when you’re the counsellor in some other situation and think, “Darn that Quijada!”

My thoughts bumped and piled up.  Stopped, until they started pulling themselves off of each other.  I tried to put these disparate bits of Bridget’s narrative together.  And I wasn’t alone.

I don’t get it!  Why do I feel this way?

Who doesn’t have conflicting feelings about themselves?  Bridget perceived and celebrated her freedom to self-care, yet was betrayed by her own, just when she was reaching for it.  Is that ok?

What strikes me about Bridget is her journey.  She has struggled with anxiety and depression for many years.  I know with me, she’s been in treatment for five of them.  During that time, she has been lovely although not perfect.  She does her hair, glossy blond in large waves, trim body frame and polite like no one I’ve met.  Many medications have failed her and she has taken those failures and claimed her future over again.  The intense forward movement of her inner self has never been muted, even when she has had thoughts of wanting to die.

I have learned what she values, what she’s willing to let go of and what she isn’t.  Her appearances matter.  She is artsy and gets energy from being alone.  She loves people.  Her marriage is rocky.  She struggles with parenting.  She loves her husband and her children.  Bridget’s journey is a journey of imperfection, beauty and courage.

And here she is again.  Conflicted self, ill, hopeful and claiming her future.  Bridget is right on her course.  I wish I could help more.  I wish she wasn’t still ill.  But I can at least be as courageous as she is.  I can hope with her.  I can stand with her or walk.  I know that put to the question, Bridget prefers this journey than losing the right, the privilege, to journey at all.  Bridget is free.  Many of us are not as free as she is, who knows what she is fighting for.

Question:  What are you fighting for?  If nothing were to ever change for the better in your life, what makes your journey worth it?  Please tell me your story.

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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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