Great to ground in reality. That voice in our head…
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.”
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?
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.
I’d like to introduce you to “Emotional Support Goose – Unconventional Wisdom and Support,” found on Facebook. Please check it out and let us know your thoughts – smile.
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,
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!…”)
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.
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!”
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.)
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.).
No caffeine in the second half of your day. Period. No matter how good that iced latte looks. Decaffeinated is the way to go!
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.
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!
Me: So Doctor. What do you think about the concept of God and psychiatry?
(I was speaking with a palliative care physician. We’ll label his answers as “P”, for palliative care physician.)
P: I’m not sure what you’re asking.
Me: Well some of us find it hard to think about emotions and behaviors as anything but related to moral values, right and wrong, good or bad, voluntary or involuntary, by choice. We have a hard time not thinking about them as largely spiritually related and not related to our biology.
P: God cares about our whole person, the “biopsychosocial.” That’s all part of it. It just turns out that culturally many of us mainly focus on the the psychosocial, and not the biological. We don’t think about that.
Interestingly, in the hay-day of homeopathic medical care, God told Ellen White to create an allopathic medical school; a school that taught scientific medical care. Thus, Loma Linda University was born, (then named College of Medical Evangelists). So clearly God wanted us to practice medicine also from a biological and scientific approach.
It’s hard to reach the culture though. If it’s total science or total religion, we’re still missing the whole person. The idea that emotions and behaviors come from our brain, well it’s not in our church. It’s not in our popular community either.
To me, psychiatry should not be distinguished form any medical specialty. But in the public mind, they’ll say, “Oh I’m not going to see a shrink.” They’ll see their general doctor, or pastor, but not go to the psychiatrist.
I wonder, was that problem created by the medical community separating this out or from the basic community culture?
Me: You’re first a product of your culture before you become a product of your medical training and the community of medicine, I suppose. It’s like those old adage’s about taking the person out of the “X, Y, or Z” place of birth, but never taking the “X, Y, or Z” out of the person. So as practicing physicians, pastors, therapists, or girl-friend next door, we’ll go through 30 some years of education learning otherwise, and then still believe at a visceral level that emotions and behaviors are a product of our life stressors and learned patterns, more so than the medical condition of our brain health.
Question: Do you see this in your community as well? Do you see the moralizing, qualifying, and quantifying of emotions and behaviors without considering their biological origins? Please speak!
Self-care tip: Consider what this says about who God is if this is true. What does it say about his character? In doing this as self-care, it will come back, around as a “place of safety” for what may otherwise be full of land mines.
Margarit was a lovely twenty-something, with blue-black bouncing hair above a slim pixy framed physique. She smiled easily and chattered like she was on telephone call that was about to lose reception. Her hands moved, conducting her thoughts between us. She was dressed like one of the cool girls on campus, out of my echelon, and who just might stab me in the back if I didn’t know better. But I did. She wasn’t mean. She was super sweet, like honey, and cane sugar, and mangos. Margarit was nice. But she had always wondered if she was being so nice all the time, because she was too nervous to be otherwise.
She came because she was constantly preoccupied by worries over things, “no one should be worried about”.
There had been the counsellors, therapists, and pastors consulted. Margarit and her parents had done their due diligence. With initiating each effort toward getting help for Margarit’s anxiety, they anticipated some degree of success. They thought things would get better. And sometimes they did, in degrees, and for a period of time. but the anxiety always came back. It got to the point that Margarit was put in home school, referenced her looping thoughts for everything, and was socially immobilized.
Maybe you’ve read, Gulliver’s Travels, 1726 by the Irish writer and clergyman Jonathan Swift. When Gulliver shipwrecked and washed ashore unconscious, the numerous tiny Lilliputians effectively tied him down. The rope anchors were so small, like acupuncture needles, yet Gulliver could not move. That’s what anxiety does to us. We become internally preoccupied by it and can’t think much outside of our thoughts. We are immobilized.
The anxiety Margarit had been harassed with since a child took her freedoms away. It chose for her before she even knew what she would decide. Example; friends want me to go to the mall with them. “No,” Before her thoughts could even play with the option. Maybe she wouldn’t have gone anyways. Or maybe she would have. The anxiety chose first though and she wasn’t given the chance.
By Margarit’s third visit, she had improved significantly. She was getting to know herself, she thought, for the first time. I met the parents this visit and they looked at me as a front. I supposed it had been them up against so much for so long now, that they had learned to go at the world this way, like a man plow they both held on to. They asked me why no one had ever recommended for Margarit to seek medical treatment for anxiety.
"We would have done anything asked by one of these professionals we took her to. We thought they should know what to do, but they didn't tell us to get her medical help."
In my mind, I flashed to Naaman being told by Elishah to dunk in the dirty Jordan river seven times to cure his leprosy (2Kings 5). Psychiatry is the filthy river and dunking in it is the nonsensical act of taking psychotropics based on magic and miracles. They were here reluctantly having preferred to start with clergy and therapists, beat up by inappropriate guilt, but ready now to consider that anxiety, in Margarit’s case, is a medical symptom of a biological illness.
The question of why no one had referred them toward a medical approach for their daughter’s illness is a good one, though. I asked a pastor what he thought, and he spoke of the difficulty of not being a medical specialist; not knowing when to refer people. And what of the therapists? Likewise, I guess, that they generally have been trained to approach emotions and behaviors through a psychological and sociological paradigm. And what of the parents themselves? Did they, when their daughter broke her collar bone in the 3rd grade after Christy pushed her off the swings, take her to the emergency room or to the movies for a night out? The ER. But when her daughter showed preoccupied thoughts that permeated her days, affecting her choices, small or large, affecting her sleep, and so forth, they did not think that the thoughts were related to anything medical, coming from her brain. They did not think that the thoughts were more than coping skills, or habits, or choice.
It is a condition of our humanity to want to look at thoughts and behaviors as many bits of our life control to be manipulated intentionally. As if we could. Like “The Matrix.” Or cooking a soufflé. Or driving a 1969 Chevrolet Camero. Shift already! There’s the good intentioned phrase, “Calm down.” “Take a chill pill.”
Oh good. Someone finally said it. If they didn’t I never would have thought of that. Now I am calm because I was told to be calm.
Emotions and behaviors come from the brain. Take the brain out and no matter what chaos hits, we would feel fine. Take the chaos away, and leave the brain in, we are still left with the brain, and what ever condition of health the brain is in. So if the brain is ill, it expresses itself in a way that is ill. If the brain is healthy, the emotions and behaviors are healthy. They are symptoms of a medical condition.
Question: Where do you find your sense of control comes from, considering the biological paradigm? Let’s talk folks!
Self-Care Tip: Consider the biology behind whatever it is that feel and do.