Stigma

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Besmirching God with My Crazy

I’m sitting here in a volunteer medical clinic for a 60K attendee camporee. It’s humid and hot and we are seeing a lot of dehydration, amongst other things. 

As a psychiatrist, I’m humming the Hallelujah chorus as I discover how much general medicine I still remember, from gout, viral rashes, respiratory and ear infections, cuts and bruises, and so forth. The group I came with teases me that if someone comes in for a cough, two hours later they will have disclosed that they were abused as a child and be swallowing prozac.  I am ignoring this implication that I am missing “the point” by treating for psychiatric needs. Ignoring and missing, at least it’s consistent.

Our theme from this camporee week is appropriate.  We have been looking at the life of David. In these, we see a whole lot of psychiatry going on, both medical/biological, and that which has to do with volition. King Saul demonstrated a sure biological mental illness. And David pretended to be crazy – call it, “acting out.”  

God put this in the Bible for some reason(s). Question: What does this say about God’s character? I mean, we certainly don’t look up to people with acting out behavior, like David. Nor do we necessarily look up to people with mental illness like Saul, either. What does this say about who God is? Why does God put this in the Bible?

The Bible didn’t describe this as psychiatric, behavioral, acting out, or general medical.  It just told the story. These ages later, we can do more with the story. Here in time, with the knowledge that the generations have given us, we could say something psychiatric was going on. But generally, despite this knowledge, we ignore the medical condition. We still talk about them with a weighted moral perspective, as if they departed from their spiritual walk in these behaviors, rather than consider the medical condition of their brains.

David is getting a javelin thrown at him while playing the harp. Patton State Hospital for the criminally insane might have housed king Saul if he were alive today. Then, David is in front of the Philistines with King Akesh, where he “pretended to be insane; and while he was in their hands he acted like a madman, making marks on the doors of the gate and letting saliva run down his beard.” (1Sam 21.) 

Dr. Martorell, a neonatologist, told me,

“I see so many people afraid to discuss problems such as depression, anxiety, other psychiatric illnesses and even family problems or abuse.  Yes, partly due to the fact that they may be judged as not having enough faith or not taking care of their health or not following certain principles.  

Primary Care Nurse Practitioner Carrie stated, 

“God and psychiatry go hand in hand I believe, but many Christians don’t think psychiatry has anywhere to go in the church. This is sad because my mom had bipolar, but nobody could help her.  She needed the ‘extra help’. The church thinks we should be able to handle it ourselves.”

You may have seen the lock-down type who says, “Keep it in the family. Don’t tell others what goes on here. It’s none of their business.”  

Dr. Martorell said, 

Our cultural or family upbringing has a lot to do with how free we feel to discuss these issues.  In certain cultures mental health problems are simply not discussed.  If it gets brought up, the family directly or indirectly tells the affected person suffering not to discuss these outside the home, as though it were some dark secret that cannot be disclosed.

Nurse Carrie said, 

“Everyone thinks we should deal with things on our own, and we shouldn’t have to talk to people about our problems and what’s going on in our lives.”

Ironically she is describing a condition of the church of independence. Yet inherent to being a believer is the learning to depend on someone else, God. 

Nurse Carrie said, 

“Why is it with depression and such, we can’t work as a church and have medical get it done.”

Many say, ‘If you go see a psychiatrist, it’s a sign of weakness. You’re not a good Christian.’ These are the comments I’ve heard of through the years.  You should just pray, and God can take everything away.”  

When my aunt suffered colon cancer, she didn’t get medical treatment in the beginning, preferring to have herself anointed, and follow a “homeopathic” approach. Later as it progressed, she changed her mind and found it was too late. So although largely, it isn’t only in psychiatry that we misrepresent who God is, we need ask ourselves, Who is God if what we believe about this is true?

Dr. Martorell shared,

As a neonatologist, I see infants born prematurely. Their brain develops outside the womb and are simply not the same as those that develop in a dark, quiet environment listening to mother’s heart rate, free of noxious/painful stimuli inside the womb.  As much as we try to imitate a womb with our incubators we can’t provide the same care.  When these infants are followed up for years, some develop physical deficits such as cerebral palsy, blindness, the need for oxygen, and the inability to eat on their own. These physical problems are easily seen and various treatments can be provided.  They are also at greater risk for developing learning deficits, hyperactivity/inattention problems, depression, anxiety and some academic papers even suggest increased risk of schizophrenia.  The thought behind these is that billions of synapses are occurring during pregnancy and the way these synapses connect is different in premature infants.  It is also interesting to note that the brain volume preset at birth occurs during the last 4 week of pregnancy. As these children grow up they need treatment for physical problems as well as psychiatric problems they may develop.  

I realize that it is not just in our churches that we are afraid to address this issue but I see it in the families of my newborns.  So many of these moms self medicate with illicit substances in order to treat their anxiety or depression.  Our culture as a whole has neglected to look at these issues as a medical problem that needs treatment.  So many children and teens are committing suicide.  Our own “well educated” health professionals have some of the highest suicide rates and yes it is occurring in our christian institutions as well as outside.  

Nurse Carrie said, 

“In this kind of approach, people are saying S/He’s not a loving and forgiving God and S/He doesn’t understand us.  If you deal with psychiatry, you’re a sinner. Why can’t you get it done with God on your own. He’s not a loving God, saying this person is not allowed to take medication. The pastor’s describing a cruel God because he’s not allowing the person to get the help he needs.  Like if someone’s leg is bleeding and you refuse to give that person a band-aid. 

But, God is always loving. This can’t be true.

I don’t think the pastor has a right to tell the parishioner that.”

Maybe we just succumb to the awkwardness of it all.  Too awkward to talk about God in our community.  Too awkward to talk about psychiatry in our church. There are so many reasons we approach emotions and behaviors this way but in the church or outside of it, let’s consider the question, What does this ay about God’s character?

I was cleaning up a leg laceration about 1 1/2 inches long and 2cm deep. I placed the triple antibiotic ointment and approximated the edges with steri-strips, yet still encouraging the patient and her guardians to take her to the urgent care to get stitches. This wasn’t a sterile environment and our supplies were limited. While working on the wound of the young teen, I asked a few brief psychiatric intake questions. It turns out, no. She didn’t have anxiety, or depression, or psychosis. What do you know!? Not everyone does. But she and her guardians were super pleased to pray together before they left and I was blessed by them.  

God is a God of love and the kind of God that cares about all of it in all of us. S/He is kind and not miserly, discriminatory, or punitive in interest and connection to us.  

It sounds like from what i’m writing that psychiatry isn’t seen as a legitimate form of medicine in the church. Or maybe the church doesn’t refer to it, or support it.  

A friend from my group read this post and responded. 

“We hear a lot about emotions and behaviors in the church, and related directives. We don’t hear however about where emotions and behaviors come from. 

I hear, ‘just pray more,’ or that I am lacking in faith. The people in the church get defensive, as if they have to defend God. And that’s not it. Honestly, it’s not complimentary to me that they think I’m insulting God. They are in a way attacking my spirituality. But I know God is helping me and He’s here with me. But I’m still this way. I still feel this way.

There’s a taboo that mental health and disorders all get grouped into this one cringeworthy word, “Crazy.” We’re almost protecting God from crazy by staying away from it in the church. We forget about the sin factor. The separation between us and God. The loss of connection. The word crazy isn’t very nice. So if we say crazy and we say psychiatry and God, it’s almost like we are besmirching God.  

Self-Care tip:  Ask, and ask again, What does “this” say about the character of God? It comes back to “Me.”

Question:  Do see the Bible and your church talking about psychiatry? Where and how? What does it say about who God is? 

Keep on!

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Self-Stigma and MYTH

What is it like when people talk with you, a psychiatric patient?

How do all the areas we are contending with in stigma affecting your interaction with others? – Demonic possession, shame, violent tendencies, weak character, and poor moral choices?

We want to hear from you. Some stories please.

One patient told me that her parents were angry at her teachers when they were advised to consult with a psychiatrist for my patient’s depression. Her parents were so angry, in fact, that they removed her from her private school and enrolled her somewhere else.

I wanted to ask my patient, let’s call her Brianna, how people speak to her now that she has finally engaged in treatment, as an adult! How do her parents reconcile it? How does her church speak to her?

Briana is among many who suffer at stigma, but her best approach would be to ask how she, first speaks to herself, a psych patient. Does she have biased self talk? We need to start with “Me.”

What are the common myths? Get the myths out there.  Some of what the community says are true myths and some are not myths.

  • Time consumption.
  • Danger
  • Treatment skepticism – no recovery, there’s less hope for them
  • Punishment from God for evildoers.
  • Demonic possession
  • Danger
  • I am lessened by my affiliation with the mentally ill

The patient is sick after all. We agree. Brain illness and all that. This is Brianna’s identity; her emotions and behaviors paint what she and others see. Perhaps, Briana identifies herself as someone with depression; someone who went over her church and parents directives. That takes a chunk of courage to do. 

 

Self Care tip: Discuss and discover the self stigma we have about our mental illness.

Questions – as listed above :)!

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What are you Living for?

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“Latest Banksy Graffiti”

Why do you get out of bed every morning? To go to work? You think, “Life i is about working and then, someday I’ll die.” Are you living to go to school? Perhaps a student for life, the best is to gather and gather. A klepto of information.  Ma skzwybe you live, instead, to stay home and not leave. That can be worth it. Leaving home feels like going to one’s death for many, in fact, with anxiety.

Is what you are living for, worth “living for?” Why didn’t you kill yourself last night?m I’m not asking for “13 Reasons” or glamorizing suicide in any way, like it ois, unfortunately, being done in the media these days. I’m just asking. (Straight face. Eye contact.) Why?

Suicide is increasing, this year up by ~30%. It’s sad but I’ve heard the ignorant say, “When our world is being overrun by humans, this is just one more way to improve population management.” Why anyone would say that, let alone to a psychiatrist, speaks toward the unfortunate person saying it more than anything. Even so, these are the people that contribute to our cultural stigma and sentiment, like the wrong colloid for growth. This stigma is best diminished by peer-to-peer influence. Your voice; you speaking up is the painting over the foul-language graffiti. You speaking of your own journey with suicidality or any related diseases changes the ignorance into empathic knowledge. 

We are in the mental health equivalent to the industrial revolution. Fortune. We are wealthy in mental health treatment options. Bling! Bling! It wasn’t too long ago when we were trusting depression medical therapies to crude agents bulky, and bluntly stunning our neuroreceptors. These were a big stick coming down on a flower.

Think of the cart and horse transforming into the automobile; course into sleek and refined; slowly moving and grossly impacting changes, contemporarily working rather as specific rapid responses. Now remember your parent, or mine, who never had the opportunity to receive a treatment that would work in a matter of weeks, and without turning her/him into a zombie-blimp.

A child stands there going through his own vasovagal experience, scared and confused while watching his favorite person in the whole world performing like a broken toy. The child tries to make sense and restabilize their once clarified existence. The parent goes through this at first for about six months and then somehow “gets better.” Was it the prayer that worked? Was Momma finally able to “pull through it?” Was it because the child’s behavior finally became “good enough” to please God who then condescended to make his momma better? Momma does well for another 2 years. She’s connected. She’s filled with purpose. The memory turns into something like, “Boston’s worst winter in fourteen years;” briefly print-worthy and then thankfully, not much more.

Then momma is again dark, hopeless and staying in bed whenever she can. The child, Teddy, is now a preteen of ten. This comes back, like finding another letter from his cheating dad’s girlfriend under a magazine in the back of the closet where his golf clubs are. And instead of six months, Momma’s change lasts about two years. (Can we even call it a “change” when it lasts two years?)

The amorphic improvement comes again though, like a miracle, but who can trust it. Miracles aren’t gotten in vending machines after all. I We can’t buy them with a paycheck.

Sadly, as Teddy feared, another some many months later, Momma drops again. This time she plummets rather than drops, into a drunken, more terrible condition. For longer, and the boy is now a teen. He at first appears more calloused. Yet, if questioned, he will show his grief and bewildered young self, just there behind a gentle touch, or a cluster of inquiring kind words. He loves her well. Why can’t she love him? Moms who love their kids will get up in the morning. They’ll shower and they’ll talk. They don’t write suicide notes or leave their son’s to find them half conscious when they get home from school. Not mom’s who love their kids.

Our moms, yours and mine in the seventies, didn’t have the privilege of taking treatments that worked or worked well, and rapidly. We are so blessed. How to grasp the immense difference in our Age; this Age of mental health revolution.

Now a little boy sees this change in his favorite person in the world. She is fortunate enough to receive medical treatment, and within weeks is “back to myself again.” This little family escaped years of decomposition by the ravaging damages from brain illness. 

My grandma, Elsie Louise, (isn’t that a great name!), was washing her laundry in a new machine that decreased her labor by many hours. One day, when she was daydreaming about her young handsome husband, or maybe it was the chicken she lost to the fox, when she screamed, jerking out from a terrible pain in her hand. Her fourth finger was gone. She lost it, pulled off by the twisting force of the machine’s internal grips.

Now we place our laundry in a closed lidded box we just walk away from. We don’t even think about the appendages we are allowed to retain. We don’t imagine the privilege. 

In psychiatry, it is like this. The treatments we had generations past were better than none. But, enter now into 2018, and we don’t realize how good we have it. We forgot most of the print-worthy stories back then. Not to use the treatments from this revolution, is going back to the darker ages of medicine. The treatments save lives. They bless. They make us rich in life. Bling! Bling! Look at your wealthy character. Healthy.

Why are you still alive? Whatever you answer, fight for that. Take advantage of the mental health revolution and live well.

Questions: What are some stories of those you have loved who missed out on mental health treatment? What are some stories of those who did not? Where is the difference?

Self-care tip: Speak! We need to hear you. You are painting over the foul-language graffiti of ignorance!

Keep on!

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False Thoughts about Getting Healthy

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Think of walking in a rainstorm. Your clothes and hair hang heavily. They provide no protection. They offer no remedy. You take a hand towel out of your bag and try to mop up your icy wet face. Wring it out and continue to wipe. 

This is like choosing to do all the psychosocial efforts in your life, but missing the biological. Until you treat the underlying illness, much of our efforts to heal are like using a hand towel to dry off in the rain storm. We think that we can get better without medication. Or, we may reject other treatment options, like ECT or TMS. We think false thoughts. 

It’s not healthy to take pills. 

I’m better than that. 

All I need is God. 

My parents would be upset, so I shouldn’t. 

If my work found out, I’d lose my job. So I shouldn’t. 

THC is better. 

Exercise is better. 

Some of these are entirely false. But some are just partly false, encased in a disconnected truth. This “rain and the hand towel” idea is not an analogy meant to minimize or bring shame to those who choose not to engage in treatment. It is not meant to talk down. Please forgive me for the crudeness and limitations. It is just meant to crack open this idea.

Yesterday, Louise commented that her physician told her taking sertraline, or Zoloft, was like taking “a vitamin for my brain”. That clicked for her! Vitamins were ok.

Question: How has your physician helped you get past not wanting to take treatment? How could your provider do better with this?

Self-care Tip: Allow healing with medical treatment for medical disease.

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Get You Some of That – Medical Treatment for Medical Illness

…Continued from yesterday.

Cole_liveCole Swindell – Get Me Some Of That

Why do I feel so horrible when I start a treatment that is supposed to help?

Medication treatments for depression and anxiety, and some other brain illnesses, often worsen how you feel before you feel better. I can’t tell you how many patients have told me that if they had known this before, they never would have stopped their mediation(s).

Yesterday, our post discussed a Dr. Jones and Presley.

Presley fired Dr. Jones when after following her directive, he subsequently experienced an extreme panic attack. Dr. Jones may not have done anything wrong in her treatment recommendations. Presley was just an individual, as compared to a “number on the curve” of treatment responders. Escitalopram, the medication discussed as an example yesterday, (one medication option out of many), may have been dosed at an initial amount that Presley’s body couldn’t handle “straight out of the gait”, so to speak. But likely, if he had started at a lower dose, maybe ½ or even ¼ of the tablet, and then waited for his body to accommodate to the medication. Then Presley would have tolerated it. Presley would have tolerated slowly increasing the medication if approached, rather, piece-by-piece of a pill. I’ll even joke with patients,

I don’t care if you lick the pill. Just get on it.

When slowly titrating a medication, it allows the individual’s neurotransmitter receptors to down-regulate whilst the agent floods the receptors. If there is a neuron targeting another neuron, there’s a baseline balance in time. There is a baseline understanding between these neurons. An agreement, of sorts. “I’ll sit here and receive your messages,” (neurotransmitters, or chemical messengers such as serotonin, norepinephrine, and/or dopamine). “I’ll then carry those messages on your behalf to their intended recipients,” (such as the amygdala or hippocampus). But then this person artificially takes a higher quantity of these messengers, for example, by way of medications, and floods the system. The receivers, (or neuroreceptors), have to adjust to this to establish a new healthy baseline. 

In this initial time of treatment, when 1st introduced to the increased neurotransmitter-load, (ex: as released by a tablet of Escitalopram), there can be a negative response, such as panic and/or depression emotions. We call this, “initiation side effect’s.” Once the neuroreceptors get used to the new load, then the response improves. 

After accommodating to the new pharmacology, the brain is allowed to experience the blessing that comes from treatments, and heal.

Some individuals are outside of the curve and cannot tolerate the standard initial treatment dosage, like Presley was. Some are inside, and can without much difficulty. The point in treatment, though, is that the person just needs to get on it.

Get on treatment. However you do it. You have to make the treatment work for you, an individual, in your own way. The prescriptions are there to serve you. You aren’t there to serve the medications. I like to analogize Jesus’ statement,

The Sabbath is there for man, not man for the Sabbath.

Make it yours as an individual and reap the benefits; the blessings inherent there. (See Mark 2:27). 

If you don’t get on the treatment, you won’t get better. Anything less than this will be inadequate. It’s like drying water off your face with a hand towel while still walking in a rainstorm.

What is your agenda in treatment? List it. Write it out. Then, go get you some!

Outside a medical approach is like flicking water off in the context of a rainstorm. If your agenda is getting to your healthy self. Get out of the storm and get dry. Then go get it. 

You have a medical condition. Treat it with the assistance of a medical professional. 

I don’t go to a plumber to help with my electrical home repair. I don’t go to an accountant or a church counselor to treat a medical one. 

The plumber, the accountant, the church counselor are what they are. This is not minimizing their efficiency in their own fields of excellence. But why do we seek care in psychiatry from those who haven’t studied this? From those who are not experts in this? Maybe stigma keeps us away from psychiatric care. Maybe misinformation directs our search for mental health treatment elsewhere. 

Self-Care Tip: Get you some medical therapy for medical illness.

Question: What are further concerns you may have about taking medications? How would you prefer your medical providers to work with you? Please tell us your story. 

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Stigma from Religion

I’m just leaning on God.

Which was her reasoning for stopping her Lexapro.

Nora’s family lashed out angrily at her. “Why are you so horrible!”

Her husband had left her for another woman from their church, a “friend” of Nora’s who used to come to their house for movie nights. He said, “You’re like poison, Nora. I’m not happy any more with you.”

Nora had now lost her job. She couldn’t focus and cried too much at work. Her supervisor told her, “You are not the same.”

Nora decided she wasn’t going to take her medications any longer because what she needed was more faith to be well and to get her life back. Her plan for recovery from debilitating depression and paralyzing anxiety was to be more dependent on God by way of certain practices, mainly not taking her medication. Although she didn’t see her plan for recovery quite so transparently. She thought it was through prayer and sincere intention to be God’s rehabilitation appurtenant.

Nora did say she was still taking her anticholesterol medication. And so we spoke about the important related perspectives between what Nora saw to be “medical” verses “spiritual” illness.

  • First to lead into the matters, “What are you taking your Crestor for?”
  • Where does cholesterol come from in our bodies?
  • Where do emotions and behaviors come from?
  • Is there a spiritual element that has a relationship to high cholesterol?  How about to emotions and behaviors?
  • Is there a medical change that causes the disease of hypercholesterolemia? How about emotions and behaviors?
  • Why be willing to take medication for a spiritual illness of hypercholesterolemia? Wink.

Nora, it turned out, loved where this conversation took her thoughts. It was hard to encounter inconsistencies in her religious beliefs and practices. But she did because she is a woman of courage!

It got me thinking about what role our cultures, related to religion, play into our emotional health. Is there a source of stigma against getting life saving medical treatment for mental illness that we are missing simply from the religious culture we are quietly woven into through life?  Randy Travis’s song lyrics, “I hear tell the road to hell is paved with good intentions…” implies that we in religion justify the collateral damage, such as death and ruined lives by mental illness, by the belief in the greater good. I’m sure I do this too in my own unconscious way. And isn’t that what this post is all about? I want to take a big stick to this glass and shatter it! (Aggressive much? Smile.)

When I think of Nora, sometimes I can’t believe she actually is taking medication and doing so well now in her life journey. It’s a miracle.

Self-Care Tip: Explore the role religion is in your opinion toward medical treatment.

Questions: How does religion interweave into your stigmas? Or those you’ve broken through? 

Or maybe it’s the opposite. Religion has contributed to your self care and medical choices?

Please speak! We need to hear you!

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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. 

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    The Perfect Doctor – Healthy With Disease

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    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!)

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    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 →

    by

    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!

    by

    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 

    badge

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

    by

    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.

    by

    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.  

    by

    Work Hard at What You Must – Stigma

    Late... Again ?

    I was late again for my exercise group, Kaia F.I.T.  It almost kept me from going.  Being late is embarrassing!

    Being late is a misunderstood disease.  A syndrome.  I am pretty sure there is a formal diagnosis that the DSM-VI (Diagnostic and Statistical Manual of Mental Illness) will have for it.  Difficulty with being late will get its own ribbon.  I do not know.  Maybe yellow after “The Yellow Wallpaper” by Charlotte Perkins Gilman.  I will tie yellow ribbons to my hair, shoes, car, and get a yellow-ribbon pin for my shirt on behalf of myself and all those with like-affliction.  Stigma toward those of us suffering with this condition will diminish.

    (I am really hoping Becca, Rene, Alyssa, Maria and all other Kaia coaches across America are reading this so that I, and those who suffer like me, will not be further socially abused, nor get the government involved.)

    Now, in celebration of diminishing stigma of any kind all around the world, I am reposting, with gratitude:

    “Why I Wrote The Yellow Wallpaper” (Charlotte Perkins Gilman)

    Many and many a reader has asked that. When the story first came out, in the New England Magazine about 1891, a Boston physician made protest in The Transcript. Such a story ought not to be written, he said; it was enough to drive anyone mad to read it.Another physician, in Kansas I think, wrote to say that it was the best description of incipient insanity he had ever seen, and–begging my pardon–had I been there?Now the story of the story is this:

    For many years I suffered from a severe and continuous nervous breakdown tending to melancholia–and beyond. During about the third year of this trouble I went, in devout faith and some faint stir of hope, to a noted specialist in nervous diseases, the best known in the country. This wise man put me to bed and applied the rest cure, to which a still-good physique responded so promptly that he concluded there was nothing much the matter with me, and sent me home with solemn advice to “live as domestic a life as far as possible,” to “have but two hours’ intellectual life a day,” and “never to touch pen, brush, or pencil again” as long as I lived. This was in 1887.

    I went home and obeyed those directions for some three months, and came so near the borderline of utter mental ruin that I could see over.

    Then, using the remnants of intelligence that remained, and helped by a wise friend, I cast the noted specialist’s advice to the winds and went to work again–work, the normal life of every human being; work, in which is joy and growth and service, without which one is a pauper and a parasite–ultimately recovering some measure of power.

    Being naturally moved to rejoicing by this narrow escape, I wrote “The Yellow Wallpaper,” with its embellishments and additions, to carry out the ideal (I never had hallucinations or objections to my mural decorations) and sent a copy to the physician who so nearly drove me mad. He never acknowledged it.

    The little book is valued by alienists and as a good specimen of one kind of literature. It has, to my knowledge, saved one woman from a similar fate–so terrifying her family that they let her out into normal activity and she recovered.

    But the best result is this. Many years later I was told that the great specialist had admitted to friends of his that he had altered his treatment of neurasthenia since reading The Yellow Wallpaper.

    It was not intended to drive people crazy, but to save people from being driven crazy, and it worked.

    __________________________________________________

    SOURCE: The Forerunner, October 1913.

    Awesome, huh!?

    Self-care tip:  Work hard where you must.  Stigma is as stigma does.  Keep on.

    Question:  Where is stigma attacking you?  What are doing with it?  Please tell us your story.

    by

    Allow yourself to transcend the naming of your symptoms

    French political cartoon of French cardinal Je...

    Mental illness, diseases of the mind, behavioral disorders or however our community allows it to be named, it is all inadequate.

    Mental illness, is a stale description.  It has sat in the open community air, over the many years when our awareness grew too slowly, when stigma and ignorance gave it the old cold frost-bite.  It reminds of me of the, Confessions of Georgia (Anne) Nicolson series, by the most hilarious Louise Rennison, When Georgia Anne says, “Have you gone mental?!,” in one-thousand-and-one ways.  There is just so much sniffing and eye swirling around the term.  I do not mind Georgia Anne using it at all.  It is fresh in her mouth.  It is not, however, winter green in ours.

    Dr. Thomas Insel, Director of the National Institute of Mental Health, states that these terms are “impediments to progress.”  He uses the term, brain disease, as a way to diminish barriers to scientific investigation, hopefully leading to earlier detection and treatment.

    Others, however, challenge even this term, brain disease, stating that it is premature and narrow.  The illnesses that demonstrate emotional and behavioral pathology involve more than brain and mentum.  They include the magic, the internal/external stressors, the arguments and the weather.  They include the intersecting paradigms that make us who we are, often referred to as the biopsychosocial model.  These, “Others,” argue that it is presumptuous to name pathological symptoms of emotions and behaviors with, “brain disease,” until we know what the brian does in the first place.

    Questions:  But what do you think?  Are the terms we use more impediments to progress than they are tools toward?  Do you have any recommendations?  How have these terms affected your life?  Please tell us your story.

    Self-care tip:  Allow yourself to transcend the naming of your symptoms.  

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    by

    The Elephant is in The Room To Help Us

    English: The eye of an asian elephant at Eleph...

    Image via Wikipedia

    How do I get him to see it?

    How do we get our friends, our husbands, our wives and kids and patients to see the elephant in the room?  My patients ask me this and I ask this of myself.

    I want to feel better.  I just want to get to the bottom of this!  

    Will someone please just treat what is wrong and I can move on?!

    There is this implication that someone is plotting against progress to derail us from appropriate therapies, treatments, walnuts and soy milk.  Why they would want to do that, no one agrees on.

    When Cincy said something to this effect in clinic, a huge shade in the shape of an elephant in the room, caught my eye and it was distracting.  I smiled at the wraith and conspired with it on how it could best gain acclaim.  I tried to explain what I was seeing to Cincy, but how does one describe an apparition?  I’ve never heard anyone do it better than Edgar Allan Poe and so I know it can be done.  I’m learning.  I needed to learn from Cincy.

    Teach me Cincy.  Help me learn how to speak of these things better.

    I felt like I should know that already.  But we physicians don’t graduate with a certificate in introducing elephants.

    Trying to do the teaching-thang in clinic or out of clinic, if we want to get anywhere, we can’t do much if we aren’t both seeing the elephant.  Talking about solutions, about treatments, motives or anything that doesn’t redirect each of us back to that specter in some way is skipping critical development.  Counterintuitive, the immediate task at hand becomes more and more simple when there are ghosts about.

    He doesn’t want me to take medication because he is afraid of what his mother will say.

    Start talking about Me and not about him.  How does Me factor in to deciding on medications?

    Smoking is my last vice and I’m not here to talk about it.  I’m here to talk about why I’m tense all the time.

    Tension happens when our blood vessels constrict.  Tension increases when our heart rate….

    Well, goodness.  You don’t want this from me now on this post.  I’m just trying to talk about that darn elephant.

    When things feel complicated, when conspiracies seem to be around, when we hear ourselves naming others to explain our condition, when we avoid talking about something and when we lose Me -> reduce.  Still missing it?  Get even more basic.  Soon we’ll see the shade.  The elephant is there to help us, not shame us.  He’s there to bring us back to Me where everything starts and ends.

    Question:  How has the elephant in the room improved or worsened your self-care?  Please tell us your story.

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    Celebrating Your Courage Will Connect You With Your “Me” and With Community

    Veterans Day

    A seriously cool veteran was cruising Old Town today on his Harley with about fifty American flags affixed in mysterious ways to his bike and person.  I cannot figure how, but those flags were not going anywhere he was not.

    I had forgotten today is Veterans Day, even though my kids were all home, off from school, properly running amok.  This man, in his leather skins and industrial number of stars and stripes, reminded me.  As we approached each other from opposite sides of the street, I saw him nod to another biker passing him by.  His nod was enough to say, “Hello.  You are not alone.  I am not alone.  We connect by this brotherhood.”  I watched him in my rearview mirror and immediately dialed my dad, of course.   “Happy Verterans Day.”

    Sometimes we do not wear our history as confidently as this cool vet.  How messy that would be, right?  Imagine a world where people used their hard-earned losses as a tool to empathize with themselves and others.  Where people’s pain was used as a force to connect with their Me and with others.  How tiring to receive nods, to accept judgments and applause, as it may be.  Right?  Company can be a burden.

    This is my guess as to why not many of us speak up about what electroconvulsive therapy (ECT) has done for us.  We hear about the miracles of medication therapies from first person reports, heck, even second, third or tenth hand.  We do not hear much about the miracles of ECT.  Instead, we hear the sound of quiet or else hopeless barbarism.

    I was talking with a patient, Carla, about ECT as an option for treatment, and we laughed that we are anesthetized for a colonoscopy for much longer amounts of time than we would if we had ECT.  They seemed like such funny things to juxtapose.  The convulsion lasts around thirty seconds and you are done.  There are no broken bones.  No tongues bitten through.  There are no chickens sacrificed on anyone’s chest.  Carla had never heard about the physician-patient who had undergone thirty-six ECT treatments as a patient, whose morbid melancholia resolved and who later returned to practicing medicine in full capacity.  Why would the physician tell people about his history?  What kind of nods do you think he would get?  What patients would be willing to go to him for medical care?  Carla had not heard about the gamers, computer programmers, the nurses or anyone from the functioning productive public who had the courage to fight for themselves by choosing ECT.

    My patients with whom I discuss ECT have concerns.  You have concerns.  Much of the world is concerned.  There are reasons.  ECT has improved farther than Jack Nicholson’s report on One Flew Over The Cuckoos Nest, though many of us were alive when his movie was first viewed.  The distance we have come in refining the practice of ECT is out of proportion to the distance in time from when ECT was not much more than sticking your finger in a socket and getting voltage in a continuous sine wave for therapy.  Is it shameful being connected to that history?  Is it too soon to say, “These are the ancestors I claim?” You know what to do with shame.

    There are few medical specialties that gather as many opinions as psychiatry.  Yes.  Well there are even fewer medical treatments that are found in the company of so much frothing opinions than ECT.  No wonder we are quiet.  No wonder we are concerned.

    So, although we veterans of ECT perhaps have not spoken up in our community, although we may not tear up at ceremonies for what our courageous self-care has done for our country or understand how we fit in, although we may not hang flags or tattoo it into our skin, we are courageous important citizens in company.  We are heroes.  Maybe not as cool in leather, but we are where we are because of those who have come before us and for what we have carried on.  We have suffered and died and lived and we are connected.  We have community and we are not alone.

    Happy Veterans Day.

    Self-Care Tip – Celebrate your courage.

    Questions:  How do you celebrate what others think is shameful but you know is not?  What have you found in doing so?  What has gaining your community done for your ability to celebrate?  Please tell us your story.
    Series on ECT:
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    What We Will Do For Brain Health – Looking For Heroes

    Death and the Maiden #2

    Image by CapCat Ragu via Flickr

    My dad is turning seventy-seven tomorrow folks.  He could have died a gazillion times before now, but it is the tumbling of those near-deaths into big life that teaches and recruits me.  He makes life feel like open space, warm skin, color and lyrics.  Now his spine is crumbling, his legs are weak, his lips are always moving in and out like a rabbit and he’s almost too hard of hearing to comfortably socialize with.  Still, it is the life, the interest he has, the way he doesn’t stop growing that somehow dims the many times he might have died.  Why does the one time he will die seem impossible to juxtapose against any future then?  Where will life go, if he is not there to infuse us with his humble will?  I think it may fall asleep with him but I know it will not and I cannot imagine it otherwise.

    These past few posts we have talked about “special efforts” for brain illness.  We asked, “Is there any treatment you think is too extreme to consider to get brain health?”  We have not said the reason we cannot fairly answer.

    I don’t know how life will be without Dad; we never know how life will be when our brain is bad and then more bad.  It’s hard to tell.  We can only imagine and usually our imagination will be wrong anyhow.

    Any answer to this question, “Is there treatment you think is too extreme to consider to get brain health?” is shaped by our understanding of what “extreme” means.  It changes shape and margins with the degree of brain illness.  With each turn, as our disease process exacerbates, so progresses our willingness to believe what is reasonable versus what is “extreme.”

    Many of you have told us of your own specifics in your fight for brain health.  People do heroic things and I’m thinking you and I might have a bit of a living hero in us.  In part, it is the inherent unknown in growth that testifies to life itself.

    “Is there treatment that you think is too extreme to consider to get brain health?”  I imagine my answer would be, no.  Please tell us more about yours.  Your view from your degree of extreme helps.  Keep talking.

    Self-Care Tip – Let the hero in you speak, grow you and testify to life.

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    Flaws You Love. Presence.

    More on Life-ers.  (Those darn perdy dandelions.)

    Taraxacum, seeds detail 2.jpg

    Image via Wikipedia

    I had an interesting comment a couple of days ago on the concept of Life-ers.

    If you have a weed in your garden, you pull it.  If there’s something wrong in your life, you don’t fall in love with it.  You get to weeding.

    I can see the point of this argument as I’m sure you can.  I can also see where I didn’t get my point across well, or else this argument wouldn’t as likely have been voiced this way.  The person who said it isn’t stupid and neither am I.  But how do we come together on this?  There are Life-ers that are both weeds to pull and weeds to just plain garden I reckon.

    We here at FriendtoYourself.com, got one of the most practical life examples of a Life-er.  It is both one that can be weeded and one that can’t.  Please read it if you haven’t yet.  Emily said in response to blog-post, One Woman’s Struggle,

    I related deeply to Kara’s experiences. …I have been a self-identified compulsive overeater (or binge eater) since I was a child. It has always loomed large (pun intended) in my life. I have successfully dieted and lost 30-40 pounds at a time, and then I’ve gained everything back — with interest. It has been my obsession and my bete noir.

    Eight years ago, out of pure desperation, I went to a Overeaters Anonymous meeting. I didn’t necessarily like it at first, but I recognized my problem as an addiction. If you hold my experience up next to an alcoholic’s, there is no difference. I struggled a long time with the program, but today I am living what OA calls an abstinent life. My definition of abstinence is three reasonable meals a day with nothing in between. I am shrinking to a healthy body weight.

    I have also developed my spiritual side and my relationship with my higher power (that I get to define) is what makes it possible to eat like a normal person. My obsession has been lifted, one day at a time. Like an alcoholic, this is not something I can do on my own.  This is supported by about 25 years of data.

    I am experiencing freedom I couldn’t even imagine walking in the doors of my first meeting — freedom from fat, freedom from compulsion, openness to change and growth and a life that is no longer nearly as self-centered.

    Sana, you asked if it helps to think of it as an addiction — for me, it’s not an analogy; it IS an addiction. I use the Big Book for the solution. My recovery is just like that in any other program.  And it’s the ONLY thing that made a difference — not just for me, but for the dozens of people I share OA with. I hope this is something health professionals will understand one day. OA is an underutilized tool, and I think that could change with better understanding and guidance.

    Thank  you Emily for your story.  I haven’t been able to get you out of my mind.

    Addictions is a weed we could more often agree is a Life-er.  That isn’t to say there aren’t those of us who think that they can be weeded and be done with, but the general consensus in medicine is that they are Life-ers.   However there are other Life-ers besides addictions.  Recurrent major depressive disorder, treatment resistant major depressive disorder, obsessive compulsive disorder, okay – a gazillion other medical illnesses that won’t respond to weed killer or a gloved garden-grip.  There are also non-medical Life-ers, such as poverty, natural or unnatural disaster, rooted social stigma and so forth.  We could even use the biopsychosocial model to catalogue them if we wanted.

    One of the things that intuitively sits poorly about Life-ers in our culture and communities is the helplessness that can soil it.  However, we are not implying helplessness at all.  Just as this courageous Emily described, when we take care of ourselves, when we befriend ourselves, we take accountability for where we are now.  Our yards improve neighborhoods.

    For the world out there who is scared to garden with us, I have this to say.  Get over yourselves.  What we are growing is worth the space we occupy and of high value.  You may never know it, but we are and we have bank to show for it.

    Questions:  What is your response to those who call your Life-ers weeds to pull?  What are some examples of Life-ers you’ve fallen in love with and how did you?  Please tell us your story.

    Self-Care Tip – If there is a weed in your life you can pull, pull it.  If you can’t, or if you do and it just keeps growing back, fall in love with it and grow a garden with those perdy dandelions.
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    Become a Better Friend To Yourself In and With Your Culture

    "Energy Crisis!" ...

    Image by Toban Black via Flickr

    A barrier to getting friendly with ourselves might be our culture.  The inverse of course could also be true.  ‘Takes culture to design the flavor of our homes and habits, our communities and the energy between us and them.  Think, TV in the bedroom, alcohol tasters offered to children, books or the absence of books on the floor and shelves.  Think religion and diet, family meals or take-out.  The way we deal with shame.  Culture is a gate-keeper for many of us.

    We could call our culture, the way we live together at home, the balance between each family member and the flavor of emotions there.  Culture might be layered, wrapping us from one balance of energy into another into another creating our own galaxy between each point of light.  In any room, if we look we can find culture.  In any space outside, there is a flavor telling us how to maintain the balance between me and thee.

    I don’t know if sociologists look at culture this way yet, but I hope they will.  With all that observing, data gathered and surmising, I hope they study how the individual can be a better friend to herself in “this” culture.  And then I hope they tell us.

    Becoming an active designer of your culture is not always easy.  But it is friendly.

    Questions:  How has your culture introduced you to your friend, “Me?”  How have you been able to develop a more friendly culture for Me to live in and grow in?  What’s still keeping you?  Please tell me your story.

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