Robin Williams saw me through my developmental years. His prolific cinematic accomplishments, whit, depth of character, courage in living with and dealing with mental illness – all this configured him into my life story. Never even thought about him dying. Until he did.
Enjoy reading an excellent interview with his wife.
Here’s to Robin
“Talking about me, I sometimes feel like it is scary to know more about me. I’ve found out who I am through very difficult situations so I have an association.”
My hunch is Ericka had many times when information and experiences came to her in her life on gentler carriers than those with this kind of emotional trauma. But she didn’t notice. The coming of kindly delivered insights are easily absorbed and drop from consciousness.
“I feel I overlook those and pay more attention to the bad things.”
It’s like gratitude, a muscle that grows when deliberately developed. That is why we call it the exercise of gratitude. When we deliberately practice noticing, (flex,) recognizing, (now we apply a little fragrant oil to the lovely bulge,) one more rep, (Oh yes! Look out Venice beach!) practicing gratitude, indeed, increases self insight.
Ericka and I had this discussion in context of discussing her career. The starting point of exploring career choices brought us to look at the different paradigms that may be used to understand our identity, as well as it’s strengths and weaknesses. Poor Ericka felt that using the paradigm of “Personality Typologies” to be like inviting a bully into her living room. One that confined her, boxed her, took away her windows and doors. However the paradigm of personality typologies is just a paradigm, useful or not, with the power or lack of power that we allow it. It is not a concrete cell, that defines us. It is one more way of increasing self insight, among others.
“Footsie” by Carl D’Agostino, at, “I know I Made You Smile.”
How to Approach the Myers-Briggs:
Take Three times. Each time, read the descriptors to hone accuracy. (It’s a biased test. Taking it multiple times, as well as reading the descriptions helps eliminate the bias.)
The fourth time, the test is to be taken by someone who knows you the best in the world, answering the questions as if they were answering in your stead, with you standing by. Then read descriptors together.
This approach helps diminish the inherent test-bias in the Myers-Briggs personality test.
Example of free online test, (there are several, http://www.humanmetrics.com/cgi-win/jtypes2.asp
We don’t have have to give it more power than you are comfortable with
2. Read, Please Understand Me, vol II
-Keirsy
3. Go have fun and…
Keep on!
In the entire South wing of the LA Convention center, jammed packed with bodies, a teeming crowd was organized into sectioned exam rooms, per their needs. I’m writing to you at the tail end of “Pathways to Health” (PTH) in LA. There were some 4,000+ providers who gave their time and resources to many thousands of patients.
It was nice to work with them for many reasons. The tossing of my standard business agendas was particularly refreshing. Many would have guessed, rather, the patients made it “special.” And the patients did bless me. But all my patients bless. Each person who comes to clinic or surgery, comes as an individual. One person. They are their own story, worth hearing. Worth serving. And worth receiving a blessing from.
When I go to work, I go mainly for three reasons; to serve the needs of my patients, to make a living, and to be to true to my spiritual mission. Going to PTH left two of those in my day and the other was gone, like it slipped into a parallel universe. Removing the agenda of making a living is disruptive, almost to point of being disorienting. And that is why it stands out to me. It was experiencing what was left when it was gone, that tossed my salad.
I’ll tell you one story, …nah. Patient confidentiality and all :). There were a lot of good ones though. Keep on!
Self-care tip: Do something disruptive to your work agenda and see what is left.
Questions: What is your agenda when you go to work? What have you done to disrupt it? What did you get for yourself when you did?
Please tell us your story.
Hello! I am a newly qualified doctor working in a busy teaching hospital in the UK. I like neuroscience, old people, young people, and occasionally the people in between. When I’m not doctor…
Source: About Idgie
Hello friends. I’d like to write more to you. I’m grateful for what I am able to write though. In turn, I’m grateful for your comments. And…I’d love to hear more! But you, like I, might experience difficulties in getting the words out.
Finding “my voice” is sometimes like finding the other sock, a frustrating endeavor that the Universe conspires to obscure. Sometimes we get the best of Her, and match the pair, twinkle toes and all, only to be out, vulnerable to the spin cycle all over again.
My favorite book of all time on this topic is, Bird by Bird, which you’ve probably already devoured before hearing from me. But you might be thinking about your spoken voice, rather than written voice, of course. However, knowing that these share waters, this book by Anne Lamott may still resonate.
I hope you are not frustrated or losing steam. You are important. Keep talking. Keep writing. And, Keep on.
Self-Care Tip: Keep putting yourself out there. Speak. Write. And Keep on.
Question: What helps you write, and speak, and put out into the world creatively? What helps you give of your thoughts?
There is an awkwardness, like seeing two boyfriends at the dance, when talking about medical treatment along with one’s Christian “treatment” toward health. I’ve heard in public about a Christian depression recovery program, “Daniel and Revelation will help heal your depression because for every negative statement, there is an admonition!” As a strong believer in God who is a better Psychiatrist than I am, I still feel an awkwardness with this approach. Maybe the people in these circles are guarded against the medical community disregarding the power of God. Maybe vice versa. A dear Jewish colleague of mine disclosed his regrets about developing many years ago in a culture of medicine in which he perceived he would be discriminated against if he practiced with faith. It was much stronger in the 60’s. Now it’s almost posh to say otherwise and he feels a bit robbed of experience.
In church today the man over there said, “Evil causes stress.” It’s hard for me to take that. My mind envisions a beaker over a flame burning off everything else that intersects in the differential, and nothing but evil is left, like a black stain.
Question: Christianity and Medicine, how do we go together? Please answer? It helps to be a friend to Me.
Hello Friends,
Once again, ECT is being bullied and manhandled by stigma, using fear instead of science, to steer people away from a lifesaving treatment. In this instance, they are targeting the ECT machines as an angle to keep others from having access to treatment. Science and life example clearly states the efficacy and success rates with ECT. The machines, …really?
The best way to diminish stigma is to tell others your own story.
Tell others here:
RE: FDA ECT DEVICE RECLASSIFICATION
Please post your comments to the FDA website: http://www.regulations.gov , as soon as possible.
To post comments for the proposed rule:
http://www.regulations.gov/#!submitComment;D=FDA-2014-N-1210-0001
To post comments for the draft guidance document:
http://www.regulations.gov/#!submitComment;D=FDA-2014-D-1318-0002
_____________________
A colleague, whom I tremendously respect, responded to this elequently. I wanted to share it with the world. He has so many years of practice, a deep skill set in the art of medicine, and in these short paragraphs, captured much of the beast in ECT stigma. Thank you Dr. Guerra!
Electroconvulsive therapy is a treatment for potentially fatal illnesses including major depression, bipolar disorder (manic, depressed, mixed, rapid cycling), catatonia, and schizoaffective disorder. It has a remarkable rate of success. Many patients only remain well with continuation or maintenance ECT. In more than forty years of practice, I have seen hundreds of lives saved and hundreds of my patients restored to productive lives.
ECT remains the most rapidly effective form of treatment for those who have not responded to psychotherapy and/or medication. For the acutely suicidal or catatonic patient the risk of mortality may be equal to that of a ruptured aortic aneurysm.
As we in psychiatry and medicine are trying to fight the stigmatization of the mentally ill, a few points demand attention:
Among the treatments for potentially fatal illnesses (chemotherapy, radiation, surgery), ECT has the highest rate of success with the least physical damage. In fact, while cognitive difficulties occur with ECT, they are generally short-lived and are not the result of physical damage to the brain. By contrast, treatments for other life-threatening conditions, like cancer, often leave patients permanently damaged in the service of saving lives. Treatments such as those for cancer are embarked upon (with consequent debilitating effects) even when the likelihood of remediation or cure is low. In all cases, clinical judgment and the consent of family and other stakeholders are involved before a decision to treat occurs. Such informed consent is the standard for the practice of ECT as well.
An agreement regarding the safety of ECT machines is reflected in the decision to change their classification. Restricting the clinician’s ability to apply his or her clinical skills and knowledge does not improve the safety of ECT machines. It only communicates that the safety of the ECT apparatus is of concern for some diagnostic categories by not of concern for others. Furthermore, restricting the ability of clinicians to apply treatments according to a set of guidelines does nothing the make the apparatus safer.
Having determined that the machines are safe for some, they must be safe for all. Their use must be left to the discretion of the treating physician.
The restrictions being imposed do not seem logical to me. They tie the hands of clinicians, promote stigma, and will foster diminished access to treatment for those most desperately in need.
Frank Guerra, MD, DLFAPA, FACA
Psychiatrist/Anesthesiologist
Medical Director
The Guerra Fisher Institute
Boulder, Colorado
Clinical Professor of Psychiatry and Anesthesiology
University of Colorado School of Medicine
Past President
Colorado Psychiatric Society
Ownership of plants is an exercise. For some, their bread won’t ever rise. (Um, me.) Others, apply maschera like a windshield wiper. (Those people. Um, me.) Me, these are true, along with the exercise of owning plants, which is essentially expensive composting. They never live long.
These are different in my book than trees. I’ve got some duplicity here, I realize. Yes trees are plants but I think of them differently. More human. I classify leafy potted things as “plants.” If there were “Plant Protective Services,” (PPS), some social worker somewhere would have thick files on me. I’d never make it out of court.
But even I, plant abuser that I am, know that if you don’t water a plant it will “wilt”. Yup. Bookmark this post. Words of wisdom.
Marvelous as that pearl is, being a brain doctor and all, I can’t help but parallel that the brain will wilt without oxygen.
There is a disease called Obstructive Sleep Apnea which describes this very misery. What generally happens is the tube through which air goes from your mouth to your lungs, called the pharynx, collapses for any number of seconds, over and over throughout your sleep. Over time, the brain cells change, and diseases develop, secondary to “anoxia.”
The story goes something like this. The brain senses that there isn’t enough oxygen. As oxygen is carried on red blood cells to the brain, just like it is to any and every cell in your body, the brain interprets this as not getting enough red blood cells. As red blood cells are pumped to your brain from the heart, the brain tells your heart to “Get working! Pump harder! Pump more oxygen-carrying red blood cells. We’re wilting over here!” The heart dutifully pumps, like a champion.
What is the heart? Mostly muscle. What happens to a muscle when it gets worked is, …It gets sexy! Right? Venice-Muscle-beach type of sexy. Ding! …Um, or just muscly.
Every cell in the body, requires oxygen to live. Even muscle. Even heart muscle. So heart muscle has it’s own arteries that bring oxygen-carrying red blood cells to it’s muscle cells to live. The oxygen “perfuses” the muscle and the muscle is healthy, not like my potted plants. But when that heart muscle gets extra work-outs, like any body builder, the muscle wall of the heart grows thicker. The heart wall however was given arteries to perfuse a wall thickness less robust than that and eventually the heart wall gets too thick for it to get its own oxygen. Compost. You got it. After time enough, the heart wall will die. That thickened muscle won’t get enough oxygen, and it will die. Obstructive Sleep Apnea is a leading cause of early heart attack.
And, oh yes! there’s more! If this isn’t bad enough, boys can’t keep their erections. Wilted.
Related problems are happening everywhere in this body. Brain cells are dying. Any variety of brain diseases develop, including early dementia, depression, anxiety, and more. Day time sleepiness happens, and Boom! You’re falling asleep while driving. And you’re eating more. Yup. Good news after more good news.
When we don’t get enough oxygen at night, we don’t get enough sleep. During the day, therefore, our brain is falling asleep on and off throughout the day. Our eyes may be open, but we are actually in the early stages of sleep. Then, our subconscious tell us to eat. No respect! We can’t catch a break! That’s because food and eating release stimulating hormones and we wake up a bit more. But,… we also get more fat. The fat then pushes down harder on our poor suffering airway at night and our disease, obstructive sleep apnea, worsens! Round and round like that lovely Krispy Cream Doughnut, we go. Eating, obesity, obstructive sleep apnea, eating, more obesity, and more apnea. Burp.
Now why would the pharynx collapse? What is it’s problem, anyway?! Generally it’s because it just can’t stay open under all that weight. We’re too fat and heavy. Those poor oxygen molecules are out of luck spelunking through that tunnel.
The brain, is super tired after all this. All night, it’s been rudely and repeatedly awakened, gasping sounds like fog horns through the night herald the body’s cry for oxygen. Nobody can get any sleep around here, not even you. All night your brain is waking you up, even if you don’t know it, to get a deeper breath of air. You’re constantly being pulled out of a deeper sleep into a state where your pharyngeal muscles can take over again, push open, and allow yourself to breath.
Because you aren’t fully conscious when this is happening, the best way to discover this is to get a sleep study, called a polysomnogram. During this study, you have a type of electroencephalogram, where specialists study your brain activity, as well as your different levels of oxygenation, and more.
After this lovely post, it may surprise you that bucket loads of people avoid getting a sleep study, but they do. There are many barriers to getting treatment in obstructive sleep apnea, that on paper, seem tiny. Today, let’s breathily say, they’re there, they’re real, and we acknowledge them. We are just trying to understand some of the, “why?,” your psychiatrist keeps saying you need oxygen to have a healthy brain. Go figure.
Self-care tip: Everyone deserves a sleep study. Please consider.
Question: What are your barriers to getting a sleep study? What are your barrier toward getting other medical studies? Please tell us your stories. We know the barriers are real. We know the barriers are common. Please speak out!
Keep on!
Photo post by @dagostino07.
Source: “Daylight Savings Time – Oooops”
Hello Friends.
Today is my Sabbath. If you wonder, I’ll briefly explain. If you don’t, skip this :). I get the Sabbath from the Bible. The validity of the Bible as a mostly unchanged book from the original writers isn’t what I’ll comment on. But as all things, I keep the Sabbath because it has shown my selfish short lived self, (call me Blip,) that it is kind to Me. What the Sabbath is about is still my pursuit to know. My understanding influences my activities, and as my learning is plastic, my activities change over the blinking tinsy trail through space and time I traverse.
Because today is Sabbath, it is the day I choose to reengage in writing. Writing about self-care is something I unwrap with many emotions. The gift brings me here today to respond to a person who reached out a few weeks ago. I felt some inner conflict with the question from the Curious, which may have contributed to why I’ve waited to speak.
Here is an abbreviated bit of the person’s points of interest regarding electroconvulsive therapy (ECT):
- I’m concerned about the suicide epidemic in the military and veterans. I don’t understand why we are not going to ECT in many of these cases (from a scientific standpoint – I understand stigma and pharma lead to meds first).
- Are we in the military and VA missing opportunities to help people by putting ECT as the last resort?
This is how our nurse-ECT specialist responded – (Again I took liberties abbreviating, etc.):
My first exposure to ECT came during my psych rotation in nursing school at the VA in San Diego. I worked with some incredible men struggling with depression and PTSD and I witnessed some positive results during their treatments. I did notice that ECT was not widely used, and of course had much stigma attached even within the confines of the mental health unit.
A big part of my job here at our center is patient and family education… trying to break down walls, or barriers, that keep people from exploring this treatment as a valuable option. I’ve even visited local psychiatrist’s office to discuss and collaborate – many medical clinicians underutilize it as well… a last resort option for those with “treatment resistant depression/illness.”
I also handle all the insurance authorizations for patients starting ECT, and one of the biggest barriers I come across is the insurance companies asking:
‘How many medications trials has the patient done?’
There have been times that insurances will not authorize the treatments because the patient has not tried ‘enough’ medications or sought out alternate therapies. This is so very frustrating to hear. My response, ‘The patient doesn’t have the luxury of waiting another 2-3 months to try another medication…and suffer any possible side effects!’
What many people don’t understand is that depression and other affective illness is progressive, and it can happen so quickly.
The quicker a patient can have a full treatment response the better… and the success rates lie with ECT as the gold standard… 80-90% success rate.This holds true here at our center.
Patients have come out of some pretty dark places in our small corner of the world with ECT treatment. It is rewarding to watch, to help them, and their families, get their life back.
There’s a study I remember, but can’t quote without looking it up, that unless personal experience is gained in some aspect with ECT, we all will have negative beliefs about it, physicians, medical students, nurses, et al. So, knowing that psychiatry residencies don’t require ECT experience is disheartening. Who do we look to for expert opinions about psychiatric medical treatments, after all? Eventually, those psychiatry residents will become psychiatrists, in a world of underserved mental health care workers. They will become, we might suppose, prejudiced (negative beliefs not based on reason or experience,) and they will act on those beliefs (discrimination.)
One might exhale under the load of it all and reroute. Why do we stay though, dig, and try to grow this poor “fig tree” with water, song, and verse? BECAUSE brain illness is a human condition that kills and destroys and denudes the beloved construct we call, Me. We continue, despite being misunderstood, because each one of us, individually and as a whole, are Loved, valued, and in the end of course, because it serves our selfish desires. Motivation to speak toward the truth about ECT treatment is as complicated as the construction of motivation in any context.
The person who started this dialogue is motivated by “the suicide epidemic in the military and veterans.”
The Curious asked why we wait so long to offer ECT, “from a scientific standpoint,” stating, “I understand stigma and pharma lead to meds first.” Let’s pull on this thread.
Some years ago during the Q&A of an expensive international well-attended ECT lecture, by those who have much more experience than I, my wobbly legs took my own curious self to the mike. I felt the years, like a bag of gold on a scale, hanging in a plate. And where I stood, my purse felt too light. But I did ask them why we continue to say this? I did even challenge, like a barking puppy, “We need to stop saying this. We need to support our community of practitioners who do offer ECT to anyone (that needs it) who wants it, at any point in their treatment. We need to stop perpetuating this tradition, that has no scientific support, to treat last.” Ruff. Ruff.
Tradition? Yes, tradition.
In medical practice, it is our standard to weigh the benefits of one treatment against the risks of that treatment. And likewise, against the available treatments otherwise known for any illness. For example, many medications may cause dry mouth. Dry mouth, leads to dry gums. Bad breath is there, sure. But do we think of root canals? When we speak about medical treatments, we consider the possible side effect’s along with the hoped for benefits.
The standard of one medical practice over time leads to traditions of medical practice. We would like to think that those traditions are based on science. But when they are not, well, here we are.
When I was a kid, I was fortunate to live in the community of FOB’s, (fresh off the boat’ers.) Our boats came from Lebanon. Among the many benefits, like belly dancing, tabouli as a staple, and high volume multi-voiced conversation, I also had to sift through noisy “traditions” not based on science.
Sana, sleep on your back so you don’t get wrinkles in your face.
Sana, pinch your nails so your fingers and nail-beds grow out thin and not flat.
Sana, drink a lot of milk because milk is good for you.
The misconception about when to offer ECT is a tradition that came from a time when many medical treatments were primitive compared to now. For context, imagine that you wanted to know if you were pregnant. You would pee into a cup, (so far so good), and your pee would be injected into a rabbit. (Wait! What!?) In 1935, Portuguese neurologist António Egas Moniz introduced lobotomies. In 1949, he was awarded the Nobel Prize for Medicine. (Clearing throat sounds rattling the air.) This is the company ECT kept.
Have you ever heard the wagging term, “Time will tell”? And it has. We can now leave rabbits perfectly unharmed in our pregnancy tests, and keep drills and saws out of the treatment options for panic attacks. But here, some 80’ish years later, we are still using electricity, a natural process in cell communication, to bring about healing. Why is it still around?
Why is it our tradition to offer ECT so late in the disease? Back in the day of the rabbit test, lobotomy, and when ECT was born, we didn’t have much control in the treatment. It was a wild foal.
The benefits not only stayed through the years, but they have improved. The risks have diminished. Dramatically. This changed the risk-to-benefit ratio, which you remember is our standard to consider in the practice of medicine. But 80-years is a long time. And since anesthesia really wasn’t developed until the 1960’s, fluoxetine was launched in the 1980’s revolutionizing the practice of psychiatry, and the recent changes in the style of practice with ECT have been made now over the last twenty-some years – our traditions have been what traditions are, practices of the old cultures.
This ends my Sabbath writing. Thank you for sharing it with me.
What is the self-care tip? To keep the Sabbath? To get ECT? To change one’s traditions? Laughing. You tell me.
Keep on!
Hello Friends,
I’m enjoying this all too fast passing time at the APA annual meeting in Toronto. What I am most enjoying is the education, the community and connection with new and old friends, and the reminder of what this is all about – you and I. In honor of us, I’m “pressing” this excellent post from our national advocators and stigma-fighters at NAMI.
NAMI: National Alliance on Mental Illness | NAMI: The National Alliance on Mental Illness.
Check it out and let me know your thoughts. How does this resonate, or not, with you. We need to hear!
Be well and keep on!
Q
I worked with this amazing lady, peripherally, when I trained in ECT at Duke. She is articulate and is a leader. I’m proud of her from woman-to-woman, psychiatrist to psychiatrist, person-to-person. She is moving soon to NIMH and I bless her life journey. Our world has been blessed by her. Keep on Dr. Sarah Lisanby!
cried my eyes out.
Laughed too loud. #gratitude
watch “Danny Collins”
Question: Which character do you identify with?
Keep on.
Question: Which door would you go through and why? …Boys and Men too please.
*Thanks to my hubs who gifted me with this link.
If we’re constantly anxious about bad things that can happen we’re trapped. We have to believe you can beat “it” in terms of our strength. When bad things do happen, we have to believe we are entitled to rise above them.
Never allow yourself to hate. It will eat you up and you will lose yourself. Defense mechanism will crumble.
You cannot hate. You cannot be bored.
Do something. Create something.
Question: Do you believe you are entitled to rise above the bad? Why? Please tell us your story.
Hello Friends!
Guest post today from Leslie O’Neil, RN – she is electric! (Wink.)
Pastor Dave had always been a softy. He was the chubby boy who cared. The one helping in the kitchen when his siblings were outside and elsewhere. Taking care of his little sister after their mother diminished her with words. After seminary school, he knew he was designed for this. He was destined to care for those who had needs.
Driving down Highway 79, he pulled over for the man shambling along the sidewalk, thumb out. Dave asked,
Where ‘ya going?
This wasn’t the first time Pastor Dave has picked up stinky, filthy people. He loved serving the homeless. His church had one of the largest programs for the homeless in their county and he knew that if he weren’t employed by the church, he’d be doing it anyway. That’s how he knew he was doing what he was brilliant at and when he saw this man sitting in the passenger seat, his energy went up.
Unfortunately, after fifteen years of picking up the homeless, Pastor Dave picked up someone who was hearing persecutory command type hallucinations. Pastor Dave was taken off guard with the first fist to his face. He wasn’t expecting the second either. Raising his arms to cover himself, he took several punches to his gut. Falling down, his head broke on the car frame and then asphalt below.
It was many months later, his jaw wired shut, and wet tears rolling down a scabbed face in my office that we met. I felt scared. I didn’t know what I feared at first. Yet somehow he nailed it for me when he told me that he didn’t know how to look at the world any more.
This attack on Pastor Dave’s body was an attack on his identity, his sense of self. His belief of what he thought his very DNA had been created to do was traumatized. It was like someone who had been raised to be a baker, was never able to get into a kitchen after fifteen years of bread and pastry dough. Pastor Dave was bewildered by his visceral response to even thinking about talking to someone with possible mental illness. He felt like throwing up looking at them. He shook. And without freedom to serve others, his energy dropped and dropped and became the vapor of a memory of some other person. That guy with energy was almost like a story of a previous acquaintance.
In my research about this topic, how to talk to a psychiatric patient, I’m learning about attitudes and stigma out there toward them. It’s incredible. But there are not many who take it to the street and help us just talk to each other.
Many months later, I asked Dave his answer. He said, at this point, he had become a psychiatric patient himself and supposed it just started there. With one’s self. Too good.
Everything starts and ends with Me.
I ask with you, how do we talk to psych patients?
When we say, “Give it up, give up the stigma, get the attitude of gratitude and get out there and be kind,” are we talking about getting into a shark tank? No. We’re not encouraging people to put themselves in a place of danger. What are we saying?
Question: How do you talk to a psych patient? Please share your stories.
Self-care tip: Have a day knowing you are a person of value. Let this moment and then the next, for today, be one when you let yourself join into the great and the not so great parts of who you are, more than a spectator, more than either-or, more than healthy brain or unhealthy brain. Keep on!
Ok. So how about any funny, quirky, odd, and somehow memorable (without be aweful) stories about how people talk to psychiatric patients?
Have you observed or experienced any?
Please speak! 🙂 We need to hear you.
