Today I am burying my dad.
Today I am burying my dad.
Dad died and maybe it’s been about a month. I don’t remember the date. Now that I think about it, that seems like a failure. A “D” grade. How could I forget the death date? But I have been finding myself edging away from thinking about him and his death.
People talk to me about him and they say things like, “Isn’t it nice that he is resting now? He suffered for a long time.” And it is.
They say, “He really didn’t have much to live for any more. He couldn’t walk, talk, interact much.” And he didn’t.
Dad died about a month ago but Friday was the first time I said the words just so. My poor friend stuck her foot in it and I cringed for her. “How are your parents doing?!” she asked almost aglow. My parents brought that out in people. Good will and community. There was that moment when I wanted to protect her from Dad’s death and Mom’s isolation. But the knowledge grabbed me like a great wind and threw me up against it’s rocky finality. I looked her straight in the eye and responded, like I was gripping my seat in a Boeing 747 going down.
“Dad is dead.”
“He died about a month ago. And Mom is in an assisted living. She’s doing well, thanks.”
I hadn’t said those words out loud till then, to that unsuspecting kind face. Why hadn’t I? Dad is dead.
On Dad’s last night, Mom leaned over his face. (When Dad aged his bones seemed to protrude looking almost like a steering wheel, and the rest of his face sunk inward.) Mom pulled on his bones, trying to make eye contact. Dad had a hard time turning his head. She was crying. “You’ll always be my prince, Rob. You are a prince.” And Mom wasn’t glad for him to leave.
Even now, looking it up feels too tiring. Just when did Dad die? I don’t remember the date. Dad died about a month ago. And this month, has been full of work, and family, and wading through COVID-19. Dad’s ashes are sitting at the funeral home waiting to be buried whenever we are allowed to do it in person. People keep asking when the memorial is. And time is filling in the space between him and I. A foam. A retardant.
Telling my friend, saying the words, cleaned out some of the space. I had been, in general, fine over the past weeks; well cushioned and buoyed. Now, not as much. And I find that although it frightens me, and although thinking about Dad makes me feel unprotected and vulnerable to those somewhat odd congratulations on his death, contrasting with the apologies of others, although all this, the water I am in feels mostly like it is carrying me home.
This post is an interim post. I’ve not got selfcare tips to share. Just my journey. With you.
|Maintaining Your Mental Health During|
|Due to COVID-19 Public Health protocols NAMI Temecula Valley will be hosting our Mental Health Forum online.|
Wednesday May 20th 2020.
Our Guest Speaker: Dr. Johnson-Quijada
Wed, May 20, 6pm – 8pm
Description: The forum begins with sharing, and resources. Following this, every month a pre-selected guest speaker will take the podium and share their expertise with you.
All questions and answers will follow the Mental Health Forum. The forum is held monthly on the third Wednesday and is open to individuals 18 yrs. and over. DURING COVID-19 CRISIS JOIN US ONLINE.
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Some notes: Share and care will begin at 6pm, and the presentation will begin at 7pm.
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Let me tell you a story.
Once there was a young man who couldn’t negotiate the world around him well. He ostracized his peers with his behaviors. He was easily offended. He didn’t enjoy much and people could sense that, like a divining stick whenever he was around. Do you recognize him? Have you heard this story before?
Let me tell you another story of a middle-aged woman who lost her son suddenly to asthma. He was sleeping in his apartment in New York far from home. They spoke the night of his death on the phone, not knowing that it was their last conversation. This mother was awoken the following day by her son’s wife who screamed at her that her son was not breathing. This mother spent the next three years in seemingly mental silence. She felt like she turned off. She did not understand how this could have happened. She was not forgiving. She was called aloof by others. Other people did not remember her son like she did. Other people did not feel it inside of their bodies; feel it inside of their emotions; feel it inside of their spirit. Other people did not stop hearing God. Other people did not, as she did, and it left her very alone. Have you heard the story? Do you know her?
Once there was a teenager at work. Her boss pressured her to drink while on a break, and then keep drinking until she was drunk. He was her boss. She was afraid. Afraid of losing her job. Afraid of him. He forced himself on her and although intoxicated at the time, she did not blackout. She remembers over and over and over. She remembers, almost like rewatching a movie. Scenes from that day intrude during school. They intrude when she is with her parents. They intrude when she is trying to sleep. This teen avoids anything that reminds her of his stink. She avoids stores with bells that chime over the doors upon entry. She unfortunately hasn’t avoided alcohol though and that has been another form of misery to her. Do you know her? Maybe you have met.
There once was a boy who kept getting in trouble because he couldn’t focus. There once was an elderly man who only remembered his younger days and nothing new would stick. There once was a worry wort who couldn’t get out of her head. There once was…
There once was you. What is your story? And how do you deal?
We are currently in a quarantine. (There’s news! Smile.) And people want to know how to cope during this time of unanticipated stress.
I’d like to ask you. How have you dealt with your emotional pain so far, apart from quarantine? All these stories could have potentially isolated us in our suffering. There’s nothing quite as potentially isolating as mental illness. It destroys our ability to see ourselves. We become disconnected from self and others. We lose empathy, trapped in our own suffering. We are called “selfish” because no one can give what they don’t have. We lose our ability to chose freely, because the mental illness chooses for us. But you know that you have come up with coping skills to deal. You have brought your suffering into the space of your healthy and become more whole doing it.
These are the same coping skills to fight the tendency toward emotional isolation in quarantine.
Questions: What are your super-power coping skills you swear by? Please tell!
Self-Care tip: Fight the isolation from quarantine with the basics you already know, if you ask yourself. Keep on!
Sometimes I don’t want to respond to the, “Happy Mother’s Day’s,” as I keep feeling all the many conflicting but authentic bits of motherhood under me, like thumping behind a free willed horse I’m tied to, who’s aiming through Nottingham’s Sherwood Forest. There’s so much pressure to be the cherubic woman on Mother’s Day. Really? Heals! Whilst roped behind a horses bum!
Look! There’s Marian! She’s sagging and her right boob is slung over her shoulder. Nifty!
“Way to go Marian! You look terrific!”
See. We all lie for love.
Marian responded with a rude gesture but she was smiling. Oh, the inconsistencies women wrestle must be expressed!
There’s the number one: Being a mother is the best freaking thing of my life! I’m so glad I’m a mommy! And, thank you for making me breakfast. Yum!
Once a year.
Get away from my babies, world! You can never love them like me!
But numbers two through ninety-nine are always rudely jostling for position. Motherhood is like a stutter on repeat of, it’s really not about you!
Or wait, it is! If they fail, ie, turn into a collage of psycho-murderer blended with a throw-up fake and furry do-gooder, it’s all on me! Like getting ticketed when your kid shoplifts Snickers at Target. All time low. (I know you’re asking if that happened to me.)
One hundred stays quiet, squat and permanent: Those kids will leave you in the end. And then you are old.
But I think the reason we yell, “Happy Mother’s Day!,” to each other (and please don’t forget the apostrophe! There’s nothing that reminds us of what failures we are as mothers than bad grammer! Or is it gramm-ar?), is so that we remember, we have each other. We are really not alone.
Happy Mother’s Day, Peeps! You look great!
(Ow! Don’t throw things at me!)
And if you don’t get it, than you don’t get. Maybe read this again in ten years.
Self care tip: Stay connected. You are not alone.
Questions: Tell us about your Mother’s Day. Boys too! We want to hear you.
Visiting Mom today, we were separated by a window. Our mobiles were our speakers, like a microphone between a jail cell and her visitors. She put her hand up and splayed her fingers over the glass. Mom so wanted us to be glad visiting, not bummed by her condition, that while crying about the many things worth crying over, she pushed laughter out, and tossed her hair back and animated herself. Her act of love. Literally.
This month, my brothers, cousins and I have been closing down my parents house. We go in turns, distantly from each other, to do what our bodies can. My folks moved there, to Crown Ranch, more than fifty years ago. There’s been a lot to work through. Because of the quarantine, Mom hasn’t been allowed to participate. And so, through these two weeks since Dad died, she, and we have been saying goodbye in foreign ways. Goodbye Dad. Wave at Crown Ranch. Eyeball each of our individual idea relationship constructs, like the person with her suitcases would before moving to a different country. Awkwardly. Lumps of emotion in closed throats.
Mom was crumpled in her chair, crying. I, and my family, were on the other side of the glass.
“It’s all gone.” Mom’s voice came through the speaker phone. Her hands covered her face for a moment. We quietly sat on the other side.
I want to talk to you about loss and connection but I’m not able to do much more than tell you bits of this story. Finding connection through loss is a win though. And as we always say here at, Friend to Yourself, we are created for connection.
Mom received Dad’s belongings from the nursing home last week. When we left her today, she said, “I’m going to go smell Daddy’s clothes.”
We put our hands up against hers for a moment. And we were glad. She did it.
Questions: What have you lost?
What do you remember?
Self care tip: Find your connection even through loss. You are not alone.
I used to gather rocks shiny stones precious metals and things, I thought had permanence, but now I will only go for cuttings with stems just so, bright red or pink I think on top
I like to look at hunks of wood, see the life-rings layered, a round embrace, years upon years in evidence
I like to see a cloud well formed in a frameless sky, or wispy shapes of nothing but Cyrus percolating droplets, hints rain
I once liked mountains and property, a deep footed house surrounded by trees, I once liked, permanence
now I prefer the open, unlined, spaces that cannot be so easily defined
I like to remember that I am temporary as was my father dead now, his ashes are breath behind my ear, dead like my niece some 15 years ago dying like my mother whose days blow down the sidewalk, crumpled leaves
I like to see things of beauty that are short-lived reminding me why pretend I am more than just barely, I thought barely a moment barely worth reckoning in fact nothing at all, wetted pages of Mozart or Chopin I’ll reach for them and watch them tear in my hand
I want to see a mood a whim and other changing things give me nothing that stays or I know you lie you are not any greater than Babylon nor am I
I am nothing but for who made me, else to pretend I want not, I have an old set of China from my mother’s wedding day you can finish that thought
When I was young my legs were strong my joints did not hurt my hair was thick I had potential like you I had use I had years ahead like a thick bank roll of quid and now my neck has wrinkles and I am gray and
my dad died a week ago today
I don’t want anything more than a flower than the truth that we are this this creature this creation this borrowed bit
I will holler louder come Lord Jesus come I will shake my fist it’s just temporary anyways like this
This is enough, “Carry-on,” the officer said, “nothing here to see,”
my dad died a week ago today
and even that is over please delete when you are done, no tip on self care just a poem. Keep on.
Thursday, Redlands Community Hospital was able to make an exception and allow us to spend three ultimate hours with Dad In the ICU. He was smiling and attentive. Interested and listening. He had a happy day. We told him our thoughts. Read to him your many notes of love. He especially perked up with my cousin’s report of starting to read a Bible Dad had apparently given him some time ago. That kind of thing has been his and my Mom’s life passion and I don’t think there was much of a better way to say goodnight.
Dad was getting tired. He had started to grimace. There was blood coming out if his ngtube. His pressures were rising and his heart rate was up. Dad said he was ready for his fentanyl. Then he fell asleep.
Around 2am the next morning, Friday, we are told, Dad was asleep and then he wasn’t.
This is the “time,” and he’s not suffering. We are all glad about it. But there is so much of me that still wants him here. My right-arm feels like a knife is in it. My joints hurt. I have a headache. Even in the condition he was in, I would take him if I could.
I will be waiting my whole life for him; for that fortune of being loved by him again. The ground will never be the same under my feet.
Today my Dad died.
There’s never been an Easter weekend like this for me. I’m super grateful for the many layers in our experiences. I feel like blessings surround me. Goodness and mercy follow me all the days of my life and I shall dwell in the house of the Lord forever.
Thank you for being a reader here and sharing in life with me so well. We will wait together.
Goodnight for now Dad.
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 lose 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?
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?”
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?
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.
Introducing a lovely book written byare sisters who felt compelled to share personal and revealing stories about their father as he fell deeper and deeper into the tragic memory robbing abyss called Dementia. The two sisters narrate their experiences born from different perspectives, but very much driven from the same heart.
Please enjoy and comment. Dementia is everywhere. It affects all of us. Whether we have a parent, a spouse, a friend, or a neighbor with dementia, we are affected. Even if a community member is suffering from this, known or unknown, we are affected, although to differing degrees.
Dementia worldwide is estimated at 47 million and is projected to increase to 75 million by 2030. It is a huge economic impact – in the US, $818 billion dollars a year. People with dementia and those with family members with dementia are often discriminated against. Awareness and advocacy are needed. Dementia is a public health priority. Let us know where you stand. Thank you for reading.
Self-care tip: Everyone has a story. Tell yours.
Dr. Kowalski walked into the hospital cafeteria and found me at our usual table, saying, “I hate it when I go to hug someone really sexy and my face smashes right into the mirror.” It wasn’t his joke but he always had something like this to toss at us other onlookers at the caf on our lunches.
He made me laugh and I felt like there weren’t enough of his type of friendship in my town. He was a peer in my community. He was a professional, a parent, a spouse. I enjoyed working with him and I respected so much about him.
Most of the time, with Dr. Kowalski, we talked about random stuff; hospital politics, his parents in England, God in his life, his kids’ latest antics, and the conversation rolled with content and interest. This day, after his short stent with humor, he skipped the food line, and just sat down to talk, starting in with a doozie.
My son is smoking a lot of marijuana.
Dr. Kowalski described the skeletal points of Frank’s, his son’s, journey with anxiety and then with marijuana. Now nineteen, Frank had anxiety his entire life. Paralyzing anxiety at times, and completely preoccupying at others with worries and inner tension.
Once when Frank was seven, “such a beautiful boy,” Dr. Kowalski told me, how Frank reacted when he was twenty minutes late picking Frank up from school. Most of the kids were gone already and Frank had to wait for Dr. Kowalski in the administration lobby next to the “mean secretary,” quietly in a big chair by himself, until Dr. Kowalski arrived. For three months after this, with his fluffy cheeks and round blue-blue eyes tilted up, Frank asked his dad over and over again, if he was going to pick him up from school that day. Would he pick him up and,
“Would he be on time?”
It was super hard for Dr. Kowalski to witness. Sometimes he would get impatient and snapped at Frank in response. Maybe raised his voice, or just ignored Frank’s questions. Dr. Kowalski felt a lot of guilt about this. He blamed himself in part for the persistence in Frank’s anxiety. If he had been more patient with him, if he hadn’t scared him with his voice, if he had gotten him into treatment… If he had been a better father, would Frank still have anxiety? Would Frank now be using three bowls of marijuana three days a week? Dr. Kowalski states that he would do anything to help Frank get better, and often does. Just about anything he can.
Whether Dr. Kowalski did or did not, Frank believed that anxiety led him to using marijuana.
Dr. Kowalski was the director of the adolescent psychiatry unit at our hospital. He knew that, although marijuana use often decreases the perception of anxiety at the moment, over all, in the way it affected gene expression, it exacerbated their anxiety. The disease exacerbated. So the user felt better at the moment, perhaps, but then the underlying anxiety process became worse and worse. Frank told me,
Using marijuana for anxiety is like a diabetic who takes insulin so he can eat a big cake.
But what could a father do for his son in this scenario? Being right, being correct about something, having knowledge apparently isn’t always how things, like convincing one’s son to stop using, are won. Dr. Kowalski did not know what to do.
Perhaps the guilt, perhaps the love, or for other reasons, Dr. Kowalski had spent the last several years of Frank’s marijuana-using and anxiety ridden life, trying to help Frank get into treatment. Treatment for anxiety.
When treating any biological psychiatric condition, something medical, we have to first look at anything we are doing to harm ourselves. Is there anything that is pushing us in the opposite direction of our efforts? Maybe we are drinking caffeine. That triggers anxiety. Or maybe we are using another substance that triggers, and/or worsens an underlying mental illness. With this in mind, Dr. Kowalski spent much of their discussions trying to engage Frank into preventative measures as part of his treatment recommendations. But what could a father do? Dr. Kowalski was not Frank’s treating psychiatrist. He was Frank’s dad.
Dr. Kowalski told me, with lines seemingly appearing out of no where on his usually bright and happy face, about his frustrations.
The amount of energy I am putting into helping him without results bothers me. And a lot of money to help him get better. I feel it is wasted until he puts in the effort to help himself.
I want to invest in my child! I do! But to help him get better. Not to just spin our wheels. He isn’t working to stop doing the things that actively work against this goal.
Feeling violated to a degree, used, Dr. Kowalski didn’t get it. He was giving his energy, his finances, his time, his emotion. He was giving every time Frank came to him or called in an anxiety crisis. Dr. Kowalski no longer wanted to do the “energy wastage.”
“It’ll be sad if Frank doesn’t get this idea,” Dr. Kowalski said. Frank may never choose to further work on his wellbeing, but the difference is that Dr. Kowalski decided he wouldn’t continue, with Frank, through talking therapies, and talking emotional rescue efforts, pretending they were working on something.
Dr. Kowalski wanted to tell his son,
I’m being taken advantage whether you realize you are taking advantage of me or not.
However, Dr. Kowalski was scared of stopping. He was scared of not staying on the phone for the long long conversations with Frank in crisis. He was scared of not continuing to pay for the talk therapy. He was scared of not continuing to give Frank his monthly living allowance while Frank was in college.
I asked Dr. Kowalski what the difference was between where Dr. Kowalski was now and wherever he thought it would be for him when he wasn’t being “taken advantage of?” If Frank wasn’t going to put in whatever effort Dr. Kowalski thought Frank should be doing to get better, where would that put them? Dr. Kowalski feared that this bond, yes maybe a bond somewhat founded on illness but still a bond between him and his son, would fail.
Their relationship, true, has strengthened, like an Indian trail that is treaded down daily on the forest floor from their repeatedly hashing out the anxiety. If that changed, Dr. Kowalski feared that maybe Frank would not see much reason to call Dr. Kowalski. Maybe what Frank valued in his dad was just that.
Dr. Kowalski told me that he believed there was, in reality, a sustainable bond between them. But Frank? He didn’t know what Frank would believe.
Dr. Kowalski and I rolled this story around in the air between us. After a stretch of disclosing his sincere grief, real fears, and underbelly of sorts, Dr. Kowalski decided, rather than starting with what he would stop giving and doing for Frank, he’d like to ask Frank,
What do you think your life would look like if you didn’t have this anxiety? Who would you be? Who would we be?
Dr. Kowalski said, “I’d love to find out.”
Self-care tip: Start with open-ended questions with yourself and look ahead.
Question: What is keeping you where you are and where would you be if it weren’t?
“We know the Bible speaks of sins of the fathers passing to the 3rd and 4th generations while God imbues his kindness and mercy far beyond that to those who love him and keep his commandments.”
Rosa had no experience in the world of mental health, or so she thought. She had spent her formative years studying the world through the perspective of her church and interpretations of the Bible. As you know, there is a lot in both with a lot to say about emotions and behaviors. However Rosa was taught and modelled that these were moral issues and not biological. An either or, verses, part of the same thing. Could we call it sequent variants, maybe something like genetic alleles? Or maybe something better to describe this is out there, rather than an either or.
Rosa Leticia Montoya, at this point in her development, with her own overwhelming emotions and her husband’s plummet into dark moods, felt forced into considering mental health. She did not want to go there, but here in the space of losing control, not trusting herself or Carl any more, and before she was willing to say she didn’t trust God, she was doing what was a last resort. Considering that she was going crazy was the only thing this chaos could mean.
Before she completely surrendered to the idea that biology was behind this sinister change, she had to ask, “Is this because of our parents?” She had spent her life trying to untwist the bad choices her parents had made and the consequences those choices had on her life. Drugs, alcohol, and cheating were what she had grown up with. Quietly. Hiding it in the church. Rosa there, praying a lot to live well and be forgiven. Praying that bad thoughts would go away. Praying to depend on God and not on herself, as seen through her perseverating worries ever since she was a child. Worried and worried. Not speaking of the wrong Bible-breaking life her parents wore like underwear beneath nice tailored clothes. Would she ever be forgiven? Would she ever stop sinning?
So she asked me, “What do you think?”
That’s a lot to work with as a psychiatrist. So I did what most of us do. Ran to the shelter of medicine. Whew! But there is the added benefit that God created medicine, psychiatry, and all that there is in my tool bag worth working with.
Even so, there was only so long that I could avoid the topic of God and His punishments, per her perspective. It came up every visit.
If you believe in God, at some point within your discovery of mental health, this question will come up. Rosa is not alone. Are the emotions and behaviors gone amok, such as seen in anxiety disorders and depression, secondary to moral weakness? Living with “too little” dependence on God’s power? Is it this? Or is it an “either or”, with our biology? …a matter of cellular grey matter composed of DNA-expressing pathology? And is this something evil woven into my DNA because of what parents did? Well, I’ve spent 30-some years in school and now 15+ years in practice in this space and am still trying to understand.
I’m wondering if you would help me articulate this. It’s fundamental for us in self-care. It’s not possible to be very friendly to ourselves with the dissonance.
Self-care Tip: Pursue kindness in your belief systems toward yourself.
Thank you for speaking with us! Keep on!