I’m peaking in my career

  
Supposedly, I’m peaking. And this isn’t about egg yolk and marenge pie. I’m 43 years old, have been in medical practice for fourteen years, and am looking at a canyon in 360-degrees from where I stand. That’s what the data says. I wonder if I am going to do the electric slide or how I’ll boogie through the next years of medical practice. I try to think, “This is the best moment of my life, right now,” any time self stigma and fear of mortality creeps in. (That’s not saying, “This is as good as it’s going to get!” Ha!) I want to cherish the gift of practicing medicine, for however long I am blessed with it. 

It’s a popular discussion amongst my colleagues these days, about how long a physician should practice. There’s a newer’ish respected program called, PACE, that evaluates physician competency to practice as they get old.  This is a huge shift in the culture of medicine. It’s meant to respectfully assist rather than discriminate with ageism. I try to imagine what it might feel like if I were approached and asked to take the test. 

So what does a psychiatrist rocking her best jeans have to show for herself anyway, you may ask. Well, (tapping the mike), “I’d like to first say thank you to my sponsors….” Wink.  I mean my patients! Thank you. 

…Hey! This peak is crowded! Give me some room!

Ahem. But at my “peak,” at the best of my career, I thought it would be fun to play around with, “Why?” What’s in my doctor’s bag that is so special?

  • Ask, “Why do you want to be alive?”
  • Start all work-ups with a medical work-up. 
  • Give full informed consent with the 5-Treatment Paradigms of Psychiatry
  1. chemical (medication), 
  2. psychotherapy, 
  3. hospitalization (inpatient and outpatient), 
  4. alternatives (such as acupuncture, massage, sleep hygiene, lifestyle change, etc.), 
  5. stimulation therapies (such as ECT or TMS).  There’s nothing else (that I know of 🙂 ) that anyone is going to offer you in psychiatry, no matter who’s clinic you go to. 
    • Push to full treatment response. 
    • Work toward quality of life, not cure, not perfect.  Ask again, “What makes like worth living for?” Design treatment toward those goals. 
    • Routinely and deliberately consider the flow of patient’s treatment agendas with physician treatment agendas. 
    • Mood journal. Nobody believes they were “that bad” after they feel better. Everyone wants to stop treatment when they feel better. (This is why there are so many repeat pregnancies, for example!). We all need our own voice (mood journal) to look back on and speak the truth. 
    • Fight for oxygen. If your patient has sleep apnea, don’t stop working toward treatment compliance. There are no medications that can take the place or make up for oxygen to the brain. 
    • Community. More community. 
    • The third eye – a therapist. None of us can be a mirror into ourselves. We all need someone outside of the “triangle” to speak.

    I’ll be thinking of more as I try to go to sleep tonight, but it’s bed time. I’m off! Sleep hygiene! Arg!

    Self-care Tip: Evaluate your position in your lifeline, and treasure where and who you are with deliberation. Keep on!

    Questions: Where are you in your lifeline? Are you struggling with ageism? What gives you value? Please speak! I, and the rest of us, really need your voice. 

    The Perfect Doctor – Healthy With Disease

    looking

    One of the difficulties we have in talking to psych patients is realized with the dawning truth that we are not curing anyone.  Working in those conditions of not curing, you both, patient and psychiatrist, have to come to terms with each others’ agendas.  The physician says, “(‘I’m a failure.’)  I can’t cure anything.”  Now eye contact is even tough.

    “If I don’t look them in the eye, some other emotion will surface and they’ll stop crying.”

    Rachel was crying and crying hot and hard in the emergency room.  She was unable to stop the lava flow.  It was bewildering to her.  The people around her shifted their gazes.  Those who didn’t, looked angry instead, as if to say, “Pull yourself together, Woman!”

    Psychiatrists have the advantage perhaps to these others in the lobby and receiving rooms and gurney shelves. Supposedly psychiatrists can grip and tug at the corner of the large sweater that is human behavior and say, “Emotions and behaviors come from the brain.”  They can imagine, if not entirely believing at a visceral to cognitive level, that the person they observe is responding to symptoms of what is happening biologically, at a cellular level. When they are tempted to avert their eyes, or look back impatient with the messy emotions, they can say, “This is medical.”  Impatience with emotional chaos from psychiatrist to patient, is equivalent to the ER doc saying to the trauma patient, “How dare you bleed in a public area?”

    When someone cries on the medical unit, you may hear, “Nurse! Call the psychiatrist! There’s an emotion on the ward!” Later when things are calm, I walk out and they say, “Doctor!  You’re amazing!  What did you do?”

    “Well, I bit off the head of chicken and sacrificed a goat on the patient’s chest.  Then I said, take this pill and everything will be as it should.”

    Luckily I have several chins now, and when I gesticulate, their quiver contributes to me looking very capable. As if I could cure something.  I don’t know much about art history but, The Thinker, a bronze sculpture by Auguste Rodin, is probably what that Frenchman’s psychiatrist looked like when they both came to terms with the fact that psychiatrists don’t cure anything. (Heresy.) At least he got to get nude while he did it.

    Talking to psychiatric patients can be that difficult.

    There are studies on patient satisfaction that demonstrate that patients don’t like us when they think we give them bad news.

    You see the predicament here, don’t you? So, some of the difficulty the world at large may be having with talking to psychiatric patients is that we have distorted perceptions of good and bad news. We may have difficulty with our own humanity, frailty, infirmity, and seeing it out there “without a scarf on” for decency, is a hard reminder.

    We will never be cured of so many things. All of us. And the best we can hope for…

    What is the best we can hope for?

    (We are all gluttons and all hope for many unpublishable things but please! Just humor me.)

    Say: “I hope to be healthy with disease.” There. Now we will all speak better to each other. It all starts and ends with Me.

    Questions: Have you ever had difficulty talking to a psychiatric patient? Have others had difficulty speaking with you? Why do you think that is? What could help? Please tell us your story.

    Self-Care Tip: Hope to be healthy with disease. 

    (I bet Carl D’Agostino could make an excellent cartoon with this rich irony to work with! That’s right Carl! You heard me! Maybe a blue ribbon with a hole in it?… Ah heck. I’m sticking with practicing psychiatry and leaving the toons to you!)

    Handout – How to Talk to a Psychiatric Patient.

    duck

    Finished the CME talk I did last week and thought, you might find some use for it.

    I’ve received bad press many times for not being, in so many words, legit or academic enough. Check out the comments on my ECT book on Amazon.com for examples :). Maybe this one leaning into that bosom of greatness will turn public opinion. (Sneeze.)

    …Formatting has been a real bear.

    As you go through it, please talk out. Tell me what you think. I may do it again. (That’s right. I’m not afraid to threaten. You heard me.)

    Keep on, Friends.

    How to Speak to a Psychiatric Patient

    Introduction:

    • You quack like a duck, avert your gaze, and then hold a fetal position. It’s good for core.
    • Be sure to carry your portable speakers playing zen chakra music in the background.
    • Offer cigarettes.
    • Bring a healthy white chicken to sacrifice over their chest for the exorcism.
    • Introduce yourself with an alias name. Hopefully a superhero.

    This is a fail safe method of communication to pretty much hit all the difficult misperceptions we are contending with in psychiatry – demonic possession, shame, violent tendencies, weak character, and poor moral choices.

    I’d like to give you the 1,2,3’s on how to talk to psychiatric patients. But as I researched this topic, it became apparent that this wasn’t the direction for us to go in. You have better algorithms, systems, and manuals based on research for this in your own departments. I know you have people who are specialists in the administrative side of things.

    For us today, we are going to turn rather toward the innuendos that interplay in communication between caregiver and patient.

    The is the first place for us to start, let’s just talk about it here.

    What is it like for you to talk with a psychiatric patient?

    • Identifying Me in the mental health treatment paradigm.
    • Not implying that we have skills but no awareness. We are just deliberately putting the practitioner into “it.”
    • It’s a “how to,” but first we need to address our personal limitations.
    • Why do we have these limitations?

    I: Clinician/Caregiver barriers

    II: Patient barriers

    • What’s over-scored is that the problem is on the patient’s side. The patient is sick after all. We agree. Brain illness and all that.
    • Even so, what is underscored is our side. And that’s what this talk is going to be about.
    • We want to focus on our own thoughts about this. What it says about ourselves. Who am I if my identity changes with how I feel and behave? etc.
    • And then, how do we respond to that?

    III: Understand Personal Biases – Likes and dislikes

    • Figure out where we are at. What makes it difficult to talk to patients?
    • What are the common myths? Get the myths out there. 
    • Some reasons are true and not myths.
    • What are some personal biases about working with psychiatric patients?
    • (Bias means – likes and dislikes)

    IV:   Define Stigma

    1. Prejudice – Attitudes, feelings/emotions (Amygdala)

    2. Discrimination – attitudes lead to actions

    1: Prejudice

    • Weakness of character
    • Supernatural explanations. (Statistically significant association with superstitions.)
    • The word “patient” not talking about disease, perhaps, but rather about character – something of moral value.
    • Religion. (But only a few believe that spiritual leaders can play a role in treatment! People don’t relate stigma issues to biology.  i.e., It is not biology or medicine that increase the problems, but belief that the person has a personal weakness as demonstrated by their behaviors – A conflict in beliefs, or prejudice, worth exploring.) (…But where do emotions and behaviors come from? The Brain. Thinking they come from a cloud by day or a fire by night fall into the category of prejudice.)
    • Time consumption.
    • Danger
    • Treatment skepticism – no recovery, there’s less hope for them
    • Punishment from God for evildoers.
    • Demonic possession
    • I am lessened by my affiliation with the mentally ill

    What are our fears? Fears are an emotion and/or attitude…

    • Brings into play, how do we identify ourselves? …And that part of us that remains even when we are in a changing body (identity).  I call this, “Me,” with a capital “M.”
    • Think about this when we look at responses to prejudice; “discrimination.”

    Caregiver stigma – “self-stigma” comes when we internalize public attitudes and turn it onto ourselves

    • We perceive stigma from others due to those we care for.
    • Shame/Embarrassment
    • Fears of what it says about ourselves

    2. Discrimination – How we act on those prejudices.

    Example:

    • Take “Caregivers Stigma.” We can bring this into our work place as well, from what we glean in our community.
    • We avoid patients who make us feel uncomfortable.

    Who has Stigma?

    Everyone.  It is in our community, including we who serve and are involved in mental healthcare services.

    1. Patient

    2. Clinician

    Patient

    Example: Mr. Whineheart misses his medications approximately three times a week due to logistical reasons. However, we know that Mr. Whineheart has had a long history of difficulty with treatment noncompliance. As we explore further, we discover that Mr. Whineheart dislikes taking medication. It makes him feel like he is weak. Not taking his medication is Mr. Whineheart’s discriminating behaviors against himself in response to his prejudices, (emotions and attitudes of shame.)

    Clinician

    Examples:

    • Refusing care for psychiatric patients.
    • Starting with Questions:  How do we respond to challenges to our identity? When our identity’s confronted by seeing our patients with psychiatric illnesses, our patients who demonstrate changes in their emotions and behaviors since brain illness set in, we ask, what part of us remains even when we are in a changing body and mind (identity)? How do we respond?
    • If it is positive, it is not discriminatory toward ourselves. If it is negative, it is discriminatory to ourselves and inevitably to others.

    V: What are the barriers to talking with psychiatric patients?

    • The tension is when the patient and the clinician’s personal views, life stories come together.
    • Where those thoughts collide is where the tension is.
    • That’s where the barrier is.
    • Once this tension is resolved it’s easier to go into action

    VI: Why bother about Stigma?

    Because:

    • Stigma is a feature and a cause of health problems. (Both clinician and patient)
    • Belief —> action.
    • i.e., In caregivers, emotional toll can be devastating – may lead to injury or illness of caregiver

    Because It Affects:

    • How we speak to psychiatric patients. (Human Value.)
    • Choices in our clinician-patient relationship.
    • Perceived quality of work experience.
    • “Me” and QOL (Quality of Life).

    Because It Engenders:

    • Social distance. (Comes from fear. But connection is healthy for “Me.”)
    • We are robbed of opportunities (Think – Agendas, Connection, etc.)
    • Avoidance. (Comes from belief of danger.)
    • Treatment skepticism (What is “recovery” anyway?)
    • We need to ask, “What are our treatment goals?” (Agenda)
    • Frustration and anger, negative emotions.

    Responsibility:

    • There’s an unequal level of power (Us v. patients/clients) – inherently increases our responsibility toward others to overcome this.
    • What about us?
    • Identify that. Then fear can become strength. Presence. Actions of discrimination change to actions of hope.

    VII:  Agendas

    • Part of our “belief systems.”
    • Exposing agendas, leads us toward action. 
    • Just like exposing prejudice leads to actions of hope.
    • Just like starting with Me leads to actions of accountability and presence.

    1.  Traditional agendas in the medical model:

    a.  Serve altruistically.

    • Saying we don’t have an agenda is grossly dishonest.
    • Maybe we are uncomfortable speaking about agendas because it creates tension with the classic view that practicing medicine is supposed to be Altruistic.  Altruism is just another “pressure.”
    • It’s a perfectionistic model. It’s false. To ally ourselves with it is a mistake. Brings discriminatory behaviors toward ourselves, driven by prejudices of shame.

    b.   Healing

    • The paradigm that never fits for psychiatry – cure, getting rid of something bad, not joining it and integrating it. (Presence.)
    • Can’t stop disease even with appropriate treatment – Treatment agenda changes to center around QOL experience rather than cure.
    • Caregivers in long-term care are not looking for recovery in their patients.

    c.  Serve patient (Service)

    2.  Traditional agendas of business

    • $, Profit

    3.  Quality of work experience

    • Not only do we get money, we get other stuff (biopsychosocial needs).  That affects how we talk to people.

    VII:  Solutions

    1.  Start with Me. Own that we have stigma: prejudice and discrimination.

    1.  Protest
    2.  Put own selves in the way of these treatments
    3.  Rely on evidence (biomedical conceptualization or education), not ideation (prejudice, emotions, religious causation…)
    4.  Pay more attention to emotions, senses, thoughts.
    5.  Reconsider your agendas e.g., Not necessarily recovery but rather QOL
    6.  Engender a culture of expectation (ex: We expect ourselves and each other to participate…)

    2. “Contact based” solutions.

    • The impact of experience and exposure
    • Best treatment is contact with the mentally ill vs. Educational approaches, which, although are helpful, are not as effective. Nor are psychotherapeutic approaches.
    • Maybe we overemphasize education in our culture and undervalue human relationships.
    • We see this anecdotally, but also notice that nearly all interventions studied, (multiple metanalysis, etc.,) used educational interventions primarily.

    3. Education (Still important and demonstrates degree of efficacy)

    4. Collaborate

    • Involve family

    5. Collaborate

    • Involve community, Partnerships with community resources

    Conclusion

    1. Start with at Me.
    2. More contact and exposure to people with mental illness.
    3. More education.
    4. More collaboration.

    Continue reading

    Stigma and Me: Me-on-Me Crime

    who me?

    Me-on-Me Crime!

    I was doing my speed walking thing on the Balboa Beach cottage lined shore. Gorgeous, it was. Fluffy thoughts were everywhere. I was purposely passing under the low hanging docks to upscale some lower body muscles. Some string bean teens with their fishing poles moved into the water’s leisurely lipping edge ahead of me. Who wouldn’t be distracted by such poetry?

    Can you guess what I did? I looked up. I lost my squatting waddle.

    When someone driving on the freeway slows down to look at an accident on the shoulder, we call them “rubber-necks.” What do we call someone who walks taller, someone who loses her shorter self under a low dock when “speed walking” at approximately four-miles-an-hour?

    Me.

    This was more painful than my three cesarean-sections. Of course, there was no anesthesia when I sped into the solid, immovable wood. I loosely figured, with physics being what it is, that I received in return the equivalent to someone slamming me with a baseball bat. I was never great at physics but I remember that Force = mass * acceleration. I am not telling you how much “maaaass” was involved, so, for the disgruntled forensic’s enthusiasts out there, we just won’t know how hard I was hit back.

    As the blood was pouring down my throat, out of my mouth, down my face, and as I gargled the words, summarily “help,” to 911, I thought, “That wood was not there before, because, why would I do this to myself?!”

    How are we our own enemy? I’m learning a lot about stigma these days, in preparation for a couple CME talks coming up. Stigma is a molded and remolded term, but for our purposes, we’ll say that it can be broken down into, prejudice and discrimination.

    Prejudice refers to our attitudes, beliefs, and emotions.

    Discrimination refers to action, what we do about it, and behaviors.

    I really like this. It helps to see where “Me” plays into our own stigma behaviors toward our own selves. For example, skipping our medications on and off.  That would be, discrimination, when it is done in response to a conscious or unconscious prejudice about taking medication. Maybe taking medication induces feelings of shame or blame. Then we behave with missing pills.

    Another example of stigma, is seen in our aging “baby boomer” population. Turns out, psychiatric patients are living longer too. Social workers and other professionals are admitting more and more psychiatric patients into senior facilities, e.g., assisted living, nursing homes, home health services at home, hospice, etc., and the staff at these agencies do not know how to work with psychiatric patients.  So, the senior facilities try to send these patients to psychiatric hospitals or hospital emergency rooms, and the nursing home or senior facility won’t accept them back into their program afterwards, stating “We don’t have the staff or programming to work with psych patients.”

    Senior nursing home/assisted living facilities are realizing that they need to hire/train their staff to work with psychiatric patients in their senior years and that this is part of their growth as an organization and their commitment to providing quality care to seniors.

    The prejudice comes from feelings, such as inadequacy, on the part of those serving psychiatric patients. The discrimination is when the patients are turned away. Everyone loses.

    It’s an exciting time for senior facilities. It’s an opportunity for their staff to learn new skills and understand that with even some basic training on communication skills, therapeutic interactions, some do’s and don’ts, they CAN admit and care for psychiatric patients in these senior facilities. Everyone wins.

    The most important message in learning about stigma, is we hurt ourselves any way it turns. And why would we do that to Me?

    I still have a headache, three days later. My teeth hurt. And I’m not as pretty.

    Self-Care Tip: Break it down – What are you feeling? How are you behaving to yourself?

    Question: How have you been prejudiced and acting out toward yourself? How have you eliminated stigma toward yourself? Please tell us your story!

    Keep on!

    Media Used Educates

    media

    Me:

    Jasmine, I’m so honored to collaborate with you on this important post juxtaposing the various ways media shapes stigma and your own testimony.

    Guest Post from Jasmine:

    I love old ads, Victorian, retro, apothecaries…  not only are they works of art, but are full of the funniest jokes.

    1cigaresdejoy_custom-8b4912a13fbe70c4f74f8af5108bc2b25c35078b-s6-c30

    It would be a lot easier to laugh at the ad agencies if it wasn’t for the fact that we buy it.  These ads are proof that our health depends on our willingness to look at more than media.  Just because we read it on the internet, see a commercial on TV, it doesn’t mean it’s the right path.

    I look at my bottles of pills.  “Of course it’s safe, otherwise they wouldn’t be aloud to sell it in the grocery store”, I think to myself.  Or, “they must be okay because my doctor said so.  Somebody would have gotten in trouble for it by now, if it was bad”.

    That kind of thinking gives away our power.  We are no longer responsible when we make it everyone else’s fault if something bad happens to us.  Even if the doctors and companies get sued, it is Me who will suffer the most.  There is nothing more important than our health.  How can we deal with life when we are distracted with health issues?  How will we treat people the way they deserve, when we’re not feeling well?

    The point is that what we see in popular culture isn’t there to educate us.  It is there to entertain. Or make a sale.  Or push its other entrepreneurial agenda.

    media

    I’m trying to focus on smoking because there is no way anyone could deny they hurt you in some way.  Pills are different because there is a different mindset with that, and I’m saving that for another day…  But smoking clearly isn’t healthy.  My dad was one of those people who smoked 1-3 packs a day and said that it’s a myth that people are getting lung cancer from cigarettes.  He jogged everyday and worked out… with a cigarette in his mouth.  If he was alive, I would like to ask him if he thought he would be a better athlete with more stamina if he at least didn’t smoke while working out.  I know the times are different and we know more now than we did back then… But I smoked enough cigarettes in my day to know that I would hack up a lung every morning and had a regular cough, until I quit.

    Questions:  How do we tell people what to listen to?  Not just listen to other dramatic people and what we want to hear… not kid ourselves and run away from the real solution, whatever it may be?

    -Jasmine (I’m 39, a wife, a mother and I’m cRaZy!)

     http://lakeelsinorelife.com 

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    Self-Care Tip:  Use media material for entertainment and look in better places for education and counsel.

    And Then Stigma Disappeared

    scarlet

    Discover Your Sweetness – Value, That is To Say.

    This historical post above is what I will start tonight with when we meet at NAMI.

    The blooming sense of value that comes when we pause to appreciate our imperfect selves, our abused selves, diseased, pecked at, and unrighteous selves, this we can trust more than the who believes she serves altruistically.

    I remember the Scarlet Letter by, Hawthorne, and wonderful dirtied Hester.

    But, in the lapse of the toilsome, thoughtful, and self-devoted years that made up Hester’s life, the scarlet letter ceased to be a stigma which attracted the world’s scorn and bitterness, and became a type of something to be sorrowed over, and looked upon with awe, yet with reverence too. And, …people brought all their sorrows and perplexities, and besought her counsel, as one who had herself gone through a mighty trouble. …with the dreary burden of a heart unyielded, because unvalued and unsought,—came to Hester’s cottage, demanding why they were so wretched, and what the remedy! Hester comforted and counselled them, …at some brighter period, when the world should have grown ripe for it, in Heaven’s own time, a new truth would be revealed, in order to establish the whole relation between man and woman on a surer ground of mutual happiness. 

    Once we value ourselves, much of stigma disappears.  There is a coming together of that which is “perfect” with that which is imperfect, flawed, “unvalued and unsought,” and we can see the disease in others and not demand perfection in them either.

    Everything starts and ends with Me.

    Questions:  How has stigma touched you?  How have you, do you, deal with it?  What helps you?  Please tell us your story.

    Self-Care Tip:  Let the imperfect come together with the perfect in you, to deal with stigma in others.

    The Energy in Stigma, Yours for the Taking

    unicorn

    There are nothing like lightbulb jokes in the operating room to make you plume your feathers.  The other day, my nurse “enlightened” me with them.

    How many psychiatrists does it take to change a lightbulb?  One, but the lightbulb has to be willing to change.

    How many surgeons does it take to change a lightbulb?  One, because while he holds it, the world revolves around him.

    How many nurses does it take to change a lightbulb?  If it’s during shift change, no one will touch it.

    That is as far as we got, but please share yours, especially if related to psychiatry :).

    Lightbulb jokes are common, clean, dirty, and fairly ageless. It does not take the brightest lightbulb in the room (Teehee!) to know that they are so because they capitalize on stereotypes.  Stereotypes, likewise, are widespread, and fairly ageless.  Even in something as objective as brain disease. i.e., The brain is carbon matter, a human organ, mushy grey stuff. The brain gets sick like any other part of the body, human organ, and people bits. Brain gets diseased, people behave and feel diseased.

    A primary care physician’s assistant, “PA,” was sharing with me the other day about how she deals with stereotypes when she approaches patients who need treatment toward brain health.

    I tell them about all the executives and professionals who get treatment ‘because the stress gets to them and they have nervous breakdowns.’  Then they don’t feel so bad about accepting treatment because they associate themselves with these successful people.

    Stereotypes can be positive, negative, or neutral.  Everyone has them.  We clinicians, patients, grocers, those who want nothing to do with medical care, and even executives and other professionals (smile) have them.  But what, in dealing with stereotypes, is friendly to Me?  It starts there.  With Me, one little, or largely valued Me.

    We stereotype ourselves and maybe that is why we stereotype others.  For example, this struggle of what to call illness of the brain is common, widespread, and fairly ageless. A Menninger Clinic blogger wrote eloquently about it recently, “Does reframing mental illnesses as brain disorders reduce stigma? by JON G. ALLEN, PHD.”  Most pithy, I thought was this,

    …we should be skeptical of the view that regarding psychological problems as brain disorders will abolish stigma. Although the disease model decreases blame, this shift comes with a cost: It increases pessimism about recovery and might also contribute to perceived dangerousness.

    I have never forgotten the Spiral Dynamics idea that in the magical level of consciousness, there is a sense of being disempowered. “Perceive dangerousness” is magical. Behind negative stereotypes, there is magical thinking.  We give over what is not to be given and take what is not to be taken.  We have fear.  We feel victimized.  We lose what is freely our own.  Disempowerment is terrifying. There is a lot more stigma out there than there is information but giving stigma and/or negative stereotypes power is our own choice.

    A fellow blogger wrote to me how he approaches it,

    Change brain illness to mental illness. Our problems really are brain illness from physical dysfunction but I can accept that my psyche is sick easier than my brain is sick.

    Stereotypes may scare us but they can also inspire.  It is up to the individual, to Me, how to respond.  As in lightbulb jokes, we who are targeted by stereotypes can take pride in them.  They are not the same as “stigma” although there is overlap when negative.  Stereotypes can be neutral or even something to be proud of.

    How many psychiatrists does it take to change a light bulb? None–the light bulb will change when it’s ready.

    How many psychiatrists does it take to change a lightbulb? None. It’s their job to help people find their way in dark places!

    There is nothing like the kind of energy in stigma and negative stereotypes to inspire us.  Such force, such Magic, these can get the punk in any of us to love who we are.

    I used to be quite turned off by the beatitudes thinking I was supposed to want to be a wimp, and couldn’t quite make myself do it.  Now I realize, being a wimp is just what it is.  The blessing is what is inherently available to Me in my “condition.”

    1 Now when he saw the crowds, he went up on a mountainside and sat down. His disciples came to him, 2 and he began to teach them, saying: 3 “Blessed are the poor in spirit, for theirs is the kingdom of heaven. 4 Blessed are those who mourn, for they will be comforted. 5 Blessed are the meek, for they will inherit the earth. 6 Blessed are those who hunger and thirst for righteousness, for they will be filled. 7 Blessed are the merciful, for they will be shown mercy. 8 Blessed are the pure in heart, for they will see God. 9 Blessed are the peacemakers, for they will be called sons of God. 10 Blessed are those who are persecuted because of righteousness, for theirs is the kingdom of heaven. 11 “Blessed are you when people insult you, persecute you and falsely say all kinds of evil against you because of me.

    Questions:  How have you been able to use stereotypes and stigma as something toward friendliness in your life?  

    What have you found is inherently blessing you from where you find the condition of life to be?

    How might you use the energy in them toward being good to yourself?  Please tell us your story.

    Self-care tip:  Use the energy available in Magic to empower you, rather than disempower.