Living, Ready to Die

Mori-To-This-Favour-Oil-Painting

Do you ever have thoughts about wanting to die?  If so, why do you want to stay alive?  What’s worth living for?

Think of 3 things worth living for.  For me, I answer — to loose the rest of my baby weight, (my last child was born 13 years ago), God, and family.  Whatever any of our three things are, I call those “hope”.

Hope only belongs to the living.  Even when you are actively dying, hope means you are indeed still alive.  Those three things you think are worth living for now are the things you will reflect on during end of life. They are what you will use to determine whether you have lived a life worth living or not.  In all the in between moments, keep those things in front of you and then you will be ready to die if you must.

Self-care Tip: Live, ready to die.

Questions: Are you ready to live and to die? What is in that space for you?

I don’t care if California falls into the ocean and other perceptions

To all the Californians, the colored, the women, the children, the childless, the divorced, the unmarried, the impoverished, the uneducated, the honking laughers, the unclicked chicks, the benchwarmers, the undistinguished, the immigrants, the gay, the mismarked, and the misunderstood:

On a dry freezing day in Montana, while the barometer read, “2 F,” I waited for the shuttle to take me into town. My child had developed congestion in some sort of viral expression and just couldn’t breath well. The nearest pharmacy was about 10 minutes away and I thought, “I can do this.” 45 minutes till the next shuttle, so I parked myself by the door as a look-out. I let the valet men know so they could assist, something like wrangling a wild Montana horse, I supposed, to get me into the shuttle. (Not sure who the horse is in this metaphor.) I felt like I was in the team. We looked warmly at each other in between this moment and that. I thought, “They are on this.”

At exactly 1045am, when the shuttle was scheduled to come through, I approached the desk. “Have you seen it yet?” One of the men there smiled at me. It looked inclusive. Then he said, “They already came and left.”  “You’re joking,” I said. Sure that he was having a laugh with me in our conspiratorial way. Team members, you know. “No I’m not. They left about 5 minutes ago.” I was out. Suddenly I was alone and it felt cold and I thought, “My child! I’m letting her down.”

I turned away from the valet men, non team members, and reported to the front desk about it. “They left me.” Humiliating tears sprung to my eyes. Oh my word. I had survived strip down yelling sprees from attendings on the hospital wards, pimping teachers, discriminating male figures, angry patients, bird droppings on my head, and I didn’t cry.

I wonder if the front desk felt more awkward with a grown woman crying over a shuttle ride, or if I did. But within 20 minutes they had one of the security men put to task.

Security-man started right in. “Where are you from?”

Me: “California.”

Security-man: “Oh. I think Californians have something wrong with them.” Chatter chatter.

“If California fell into the ocean, I wouldn’t mind.” Chatter chatter.

“If the wall went up around California, and just left the rest of us alone, that would be fine.”

Security-man was in his second career, after having retired from working security in a prison. We commisserated on our mutual experience working in prisons. Me in psychiatry and him in security. He was happy to empathize, “Yah! I’ve seen some crazy ones! There are real wacko’s out there. People who eat their poop and stuff like that.” “You psychologists are treated rough,” and dropped the label, psychologist, several times in a knowing way.

He threw in a few more pearls. “I don’t believe in abortion.” “Californians who work, pay for all the unemployed lazy people in their state.” And then with a confident nod, “Trump is going to win the elections.”

Security-man was graciously driving me, what could have cost $40 for a private shuttle. He smiled and probably thought the whole time, “This girl gets me.” Or, “Isn’t she lucky to get a free education on the way things should be?” To him, he was engaged in friendly banter. By the time he dropped me off back at the lodge, he used my first name, saying, “Sana, people like to visit California, but living there?!” Chortle chuckle.

I didn’t cry, but wouldn’t that have been a more reasonable time to have teared up? Visceral responses can be unpredictable. The generosity, the kindness, the friendship, juxtaposed with the aggression was bewildering.

I was sputtering about all this to my home huddle when we met up for lunch and I guess wore them out a bit in a self-righteous diatribe. My wise child asked me, would you have rather taken the ride with Security-man or have paid $40 for a hired shuttle? Or have waited for the next free shuttle 1-hour later? Sheeze. Can’t an elite Californian wallow a little? Fine then. I prefered Security-man in his inconsistencies, kindnesses and cruelties. I know he is defining the world from his brain.

Sometimes we don’t think we are being aggressive but we are. I thought to myself, “How am I being aggressive toward others?” I know I am stigma-imbued and bigoted toward others, but by definition, I won’t be able to see it. That’s how stigma works. We think we are pure minded. We think we see things clearly. We believe in “the right.” It’s not always this kind of abutment, not always this stark, but it is there. It is here.

Back in California, I am checking the tide, water sloshing up to my knees and I’m touting, “Everything is ok folks. We are good. The rest of you though….”

Now I see through a glass dimly…

The brain is vulnerable to our humanity, our health, the condition we find ourselves in at any point along life’s line of time. (Job security… Too much?) Some day, we will have a healthy brain. A healthy everything and then we will see clearly and face to face. Until then, I’m confident we will, all of us, define what we believe is true and real by the condition of the brain in our head, along with the perfect super-human protective grace of God.

For presently we see through a glass in obscurity; but then, face to face. Presently, I know in part; but then I will know fully, even as I have been fully known. 1Cor 13:12

Self-care tip: When being slammed by the hurt and twisted brains around us, contemplate our own distortions and the grace we are surrounded with despite ourselves. Then look forward with hope.

Question: How have you improved your life experience when stigma and bias hit?

Keep on!

Going to the Witch of Endor

Remember there are no dividers between God and mental health. Some patients think they have to chose; either get to go to a psychiatrist or to a pastor. Reminds me of the “seers”, like the Witch of Endor. Go to her to ask for help and you lose God’s presence in your life.

When Saul saw the Philistine army, …terror filled his heart. He inquired of the Lord, but the Lord did not answer him by dreams or Urim or prophets. Saul then said to his attendants, “Find me a woman who is a medium, so I may go and inquire of her.” 1 Samuel 28:3-25

When I was a little kid, I thought that when I would go do something bad my angel would stay behind. She couldn’t come into that bad space. Like if I went to see a bad movie, my angel would wait for me outside the theater. And with some my patients, maybe they think if they come into my office they have to leave their angel at the door.

Brent asked the question, quietly as if someone would overhear, “Will God help my depression?” 

Wow, that’s such a great question. 

So God is not a vending machine. But God is in all of “these things”. God is in the space that psychiatry and the “God-topic” occupy. He/She is in all of these things that He provides us; treatments, friends, medications, clean air, stable government, and what not. (I’ll say, “He,” because that’s traditional.) He gives Brent medication and God is a better psychiatrist than I am. He gives patient’s NAMI, (National Alliance on Mental Illness), and psychotherapists, and so many other treatment options. 

Brent replied, “I’m glad to hear you talk about this because it gives me hope. And I want to renew my faith in God and start practicing my faith and saying daily prayers to Him. So it’s good to hear you as a psychiatrist here talk about God, and God helping me heal, so that makes me feel good.”

The next question is what type of God do we believe in if it’s not this God? This God who is in this space? This God who isn’t held back? Who isn’t an either-or God? This God is a God who cares about our depression. Why would we even want a God that is otherwise?That wouldn’t be very loving.

Brent replied, “God, who could help us in every way and doesn’t … that’s … I mean, basically God should be one that doesn’t allow violence and suffering and sickness.”

But there is suffering and violence and sickness. So who’s God in all of that? 

B, “I don’t know. That’s a question I have.”

That’s the question that we need to struggle with through our suffering. Because it’s one of the purposes of our life, to find out about the love of God. Because God is … I believe that God is love, otherwise I don’t want anything to do with him. We have this job to do, find out individually who God is. Use our suffering as a tool. Such as, while we are suffering, it may be an opportunity in a way to say, “Why am I suffering? Why is there this pain when God is love?” It’s huge, right? 

The struggling with our view on God’s character is muddied by comparisons as well. sIt looks like “everybody else is fine,” like God is being a God to them but not to Me. And that’s just mean. So, based on our premise, God is love, this can’t be true.

Brent said, “I know, but that’s how I feel.”

Thinking that it is true, God playing favorites, or God with limited love-supply, is one of those creepy feelings in the relationship. Something sinister. A Bogey loose wreaking havoc on our foundation.  And if this foundation is havocked, it is hard to launch. Imagine pole vaulting off of a mound at the beach. This inconsistency with our view of who God is is either about God or about us though. And that’s a stop-drop-and-roll point. A point when we realize there is an inconsistency that we shore up. 

Brent replied almost in a relieved voice, maybe a little like getting something off his chest, “It’s probably about me, not God, because He loves us all the same. So it’s probably more about me. Maybe with my sickness I don’t … 

I’m not thinking right, you know? And I perceive myself as being worse off than I actually am.”

Me, “Would it be that you have something God doesn’t want, so He doesn’t want you? 

B, “Well, I don’t think so. God loves us all. That’s my feeling.”

Me, “Okay, so it’s not that you’re so bad.”

B, “Yeah.”

Me, “Is it that God can’t quite get it right? Like, He’s just doing His darnedest but it’s not enough.”

B, “Maybe that’s it.”

That would be pretty lame, God. (I’m speaking directly here.)

Who is God? And if God is that week, again, I’m not really interested. 

Using the premise that God is love is more than Truth. It is also a self-care tool. We can use it to clarify distortions about why we are in the condition we are in. We need this premise to keep us from isolating from Love. To launch better. We need this premise to have connection in our lives.

Self-Care tip: Use the premise, God is love, whenever you can.

Question: Where are the places that the bogey is wreaking havoc in your life? 

We are not here to turn you into something bad

People often come to psychiatry afraid. Not only from what the diseases do to them but also of psychiatry itself. They think it might harm them. They think pills will change them into someone else. Will diminish them somehow. But that’s not the agenda of medical therapy. The agenda is to improve their quality of life. The intention is to allow for a greater ability to experience connection, with themselves and with others.

In our relationship with God, we often think the same thing. We think God is here to restrict us. To limit us. To suppress us with rules. But God’s agenda is to increase our quality of life. To increase our connection to self and others. To heal. To reconnect is in essence healing.

In “Patriarchs and Prophets” it explains that we are purposed here on this earth to love and be loved.

My patient, Evelyn, was telling me at one of her lowest points in life she didn’t pray. She said she didn’t know what to say to God. The pain and suffering of losing her son and then almost losing her daughter disconnected her. That’s the biological psychological and sociological paradigm in action. It was wack. God’s agenda is to bring us back to what we all want in the 1st, middle, and last place. God’s agenda is good. She/He has our back and also the bank to spend on us toward healing.

I can imagine walking into God’s office. Furniture all feng shui. There’s a diffuser in the back and some great lighting. But I’m afraid. I’m afraid of myself and my condition, but also afraid of what She/He might do to me. Somehow, I’m at yet able to understand that God is someone pretty great who wants good, and never anything bad for me and I’m willing to engage in treatment.

If God weren’t, it’s got to make us all wonder, what kind of beast are we worshiping here? Who is God? I’m thinking God is at least as kind as I think I am. Probably more. Wink.

Question: Who is God? What’s God’s intention.

Self care tip: Give it a go. There is healing bank there for you and Me.

“Off To Sleep!” with you!

Ladies and Gentlemen! It’s time to go to sleep! Wait. Not till you read this.

PsychU, a patient education website, has invited me to present on sleep. These are their questions and how I hope to respond. Do you have any recommendations, other interests, directives? Please help me! Smile.

1.       Dr. Johnson-Quijada, in what ways is sleep important for our behavioral health?

Sleep rudders our biology ship, (if “rudders” may be used as a verb.) Our biology is the reason we have emotions and behaviors. Take out the brain and we don’t have any problems with emotions and  behaviors. So the biological health of the brain and body is where our focus should begin with when thinking about emotional and behavioral well-being.  This is not in exclusion of other import paradigms, such as the psychological or sociological influences on what make us who we are.

But let me ask you, 

Where do emotions and behaviors come from?

Now think about it and answer your true beliefs.

I was speaking with a wonderful physician the other day to whom I asked this question, (let’s call her Doctora.)

I respect Doctora for her character, personality, standard of medical practice and interpersonal beauty. She is a bulldog in the operating room. When patients need studies done that insurances won’t pay for, she tears barriers to treatment apart with vicious tools of rightness. And she cares.  She sits.  She asks.  And she cares.  She sees the person in the paper gown, each one for the person she knows them to be and the person yet unknown.

I admire Doctora greatly not only for these qualities but also because it gets personal.  I, who have my own special practice of medicine, cannot do her’s.

When just a green bumbler in medical school, there was a fateful day when I shadowed another great artist of medical care into a locker room.  I suited up in that blue sack they call scrubs.  I put little blue sacks over my tennis shoes too.

Do you know why there are blue sacks on the surgeon’s shoes?  So what is on our shoes won’t contaminate the operating room. But also so that when wet things come out of the human body and fall onto their feet, their toes won’t feel squishy. Yep. That’s what was going through my mind as I scrubbed my hands, each finger and each finger nail the ten minutes it takesto reach what is considered clean.

Surgery in progress, the color red mixed with a smell and monstrous sensual force that clobbered me to the ground.  I swooned, gagged and promptly ended my surgical career.

There is nothing more irritating to a surgeon than someone who doesn’t appreciate the “fun” of “cutting.” Yes. I irritated this mentor and others too I’m afraid.

This doesn’t keep me, unfortunately, from pleasuring in telling people, “I am licensed to do surgery.”  I am you know.  Any Jane with a medical license can pick a scalpel up and bring back the dark ages, or contemporary, depending on who holds the license.  I’m irritating to my mentors, remember.  It reminds me how anyone can go online and pay to become a marriage registrar, i.e. perform a marriage ceremony for couples.  My brother did that twenty years ago and has yet to perform the marriage ceremony for a willing couple.  For real judges and clergy, this might be irritating too and that makes me a little happy as well.

Anywho, Doctora and I were rolling with the injustices haranguing us in the practice of medicine, both from the angle of the physician and the patient. I was pumping her up for being the cutting-wonder who she was and she was dutifully marveling at my jabber-mouth work that she would, “never be able to do in a million years.”  Somehow this brought us round to how our culture avoids embracing the biological paradigm of anything inside our skull but is so willing to celebrate it for any other part of our human bodies.

Where do emotions and behaviors come from? 

Doctora answered me with a frozen breath. Then after I warmed and soiled the air with a lot of jabbering and she was finally able to speak, she said,

I would just be horrified if my brain got sick!

I wondered if it was scary enough to clobber her to the ground, but I do agree.  Terrifying.  Don’t you think?

So sleep is important from a basic rudder-rudimentary perspective of healing, restoring, and preserving our biological identity.  

If we don’t sleep well, a disease process may develop. 

During sleep, we heal from injuries, both physical and mental. Our brain actually shrinks for a small period, squeezing out, like a sponge, the toxins that accumulate during the day. It becomes smaller in mass without the fluid that filled it. The toxins drain into our cerebral spinal fluid (CSF) and after a period, the brain absorbs new clean CSF and expands in size again. Without deep sleep, the brain retains the toxins it accumulated during the day and those toxins go on to damage the brain cells, summarily over time, potentially harming the brain health and leading to disease. 

These treatments relating to sleeping well are often better than pharmaceuticals when it comes to processing and treating stress. When we sleep, we allow our broken neuronal connections to regenerate. We re-stock our shed with ingredients like cortisol, hormones, and neurotransmitters that are fertilizer for well-nourished thinking, kind behaviors, and stable emotions. During sleep, our memories consolidate; they find their place in the folds between our cells and root down into our rich minds.

I have seen regular, restorative sleep bring someone from a place of mental decline to no longer needing psychotropic medication. Everything works better with sleep.

2.       What are some of the tools that you like to use to help people develop better sleep hygiene?

Sleep Hygiene, according to Dr. Q! 

1. Bed is for  

The bedroom is only for sleep and for sex. This means no food, no phone, no TV. If you are not having sex, then all you get to do here is sleep. This might be an adjustment for the entire family, if your spouse is used to clicking on the late news or your kids want you to read them stories in your bed. But your subconscious has to recognize this place as a sanctuary, and not the place to read one last chapter or check Twitter. 

(I have yet to have someone tell me that this improved their sex-life, but one would think!…”)

2. Naps

No naps longer than 20 minutes during the daytime. If you are tired and have the luxury of lying down during the daytime, do it! But set your alarm to wake you up in 20 minutes, and then make sure you wake up fully. You can take these “power naps” 20 times a day if you want to, as long as they are no more than 20 minutes at a time. Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture or circadian rhythm) at night.

3. Exercise

Exercise, but not before bed. Exercise during the day can help to regulate your sleep cycle by making your body tired at night, but make sure you do not crowd it against sleep initiation. Try to get 40-60 minutes of aerobic exercise, 5-7 days a week. Look at it like a pill, prescribed by a doctor. This is something you need to do not for your waistline, but for your medical and emotional health. Every day, tell yourself, “I’m exercising so that I will feel good, so that I will sleep good, and so that I can do what I want in life.”  Some say, “I’m exercising for my brain!” 

4. Lights

Keep the lights dim before bed, and turn off the screens early. Darkness releases melatonin from the pineal gland in our brains, which helps to regulate our sleep cycle. Light suppresses it. Melatonin is a cornerstone in sleep architecture. Having your face six inches from the computer or TV before you lie down doesn’t give your body much time to turn itself off. (Some people who feel they must be on the computer or TV before bed have found that wearing sunglasses for at least the last 30 minutes helps.)

5. Routine

Go to bed and get out of bed at the same time every day. Enough said there.

6. 30 Minute Get Up

If you go to bed but cannot fall asleep in 30 minutes, get up and do something else until you feel sleepy. Then go to bed and try again. Refer back to the other rules when choosing your activities (no screens, no reading in bed, etc.).

7. Caffeine

No caffeine in the second half of your day. Period. No matter how good that iced latte looks. Decaffeinated is the way to go!

8. Alcohol

Do not use alcohol to sleep. Alcohol is a depressant (will make you depressed) and also blocks deep sleep. Alcohol hits the same receptors in the brain as the benzodiazepines mentioned above. 

9. Nicotine

Do not smoke before bed or if you awaken from sleep. Nicotine is stimulating. (It also decreases blood flow to the penis, so that’s one less of only two allowable bed activities we are allowed… Bummer.)

10. Sleeping Aids

If you cannot fall asleep in 30 minutes, consider taking a sleep aid. Do not take any over-the-counter sleep aids except natural melatonin, valerian root, or chamomile. Others almost all contain diphenhydramine, which blocks your deep sleep. You may end up sleeping a longer amount of time, but you will not be getting restorative sleep. 

If you talk to a doctor about a prescription sleep aid, do not take benzodiazepines, such as diazepam (Valium,) temazepam (Restoril,) clonazepam (Klonopin,) alprazolam (Xanax,) or lorazepam (Ativan.) These also block deep sleep. Sleep aids that don’t block deep sleep and sleep architecture include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata). Trazodone (Desyrel) is also safe for sleep structure and maintenance. The newest FTY (Friend to Yourself) sleep aids are Belsomra and Silenor. Sometimes people will find that combining sleep aids, such as zolpidem with trazodone, is more effective rather than using only one agent. Some of these wash quickly out of the body, and some take a full eight hours.

11. Sleep With Me

Do not sleep with your pets or children. Pets and children are disruptive, and no one gets the rest they need. Get the sweet buddy-dog out of bed.

It is not personal. It is sleep hygiene.

I’ll insert here, that one thing that gets left out of most sleep talks, is how to be awake. 

Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.

Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.

Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.

This is where I additionally bring in the concept of a stimulating medication such as provigil. Don’t confuse this with taking caffeine. Caffeine is metabolized way too fast to be helpful in this regard. There are others one may discuss with their treatment provider.

3.       What parting words do you have for other practicing psychiatric healthcare professionals regarding this topic? How about for the consumers?

For providers and consumers alike, remember our identity is as humble as the cells from which is is generated from. Our identity is as vulnerable as those cells are. The basic needs of the body, such as sleep, lead to the most beautiful and marvelous developments that this life can bring. Without our biological health, without healthy sleep, everything in our body and what our Me connects to, is affected.

Questions for you, readers: Again, do you have any recommendations, other interests, directives?

Please help me!

(Smile.)

Keep on!