Stigma

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Self-Care Doesn’t Have to Be That Big of A Fight

Rajasthani women take part in tug of war game ...

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Self-Care Tip #215 – Fight as little as you possibly can when reaching for your choices to self-care.

We skipped over that.  We didn’t tug on the medication-or-no-medication rope.  What a relief.  Marsha surprised me.  When we first met, she had been the one who said,

I don’t want medications but I can’t go on like this.  If I choose to start, when can I stop?

In these scenarios, it’s easy to get snagged by the temptation to educate (tug.)  There is the risk that if we don’t educate, we might miss our opportunity to engage her in treatment and get help.  However, because Marsha was willing to at least start medication, even though the duration of treatment was in question, I decided to let the medication argue its own case.  (Standing quietly by the rope.)

Not everyone is as good to me as she was.  Some patients, prodded and edgy from the anxiety, want to fight a little.  That anxiety is coiled and full of potential energy.  Feeling put off, up it springs when I say,

Let’s talk about this, if it’s alright with you, after you’re feeling better emotionally.  (Pulling on the rope now, heels three inches deep into dirt.)

Somehow, Marsha let it ride out.  Somehow, Marsha came out on the other side.  She had nearly forgotten about wanting to ever stop her medications.  She never even brought it up in fact.  I did.  I think I had to say it twice to get her to know what I was talking about.

No.  I don’t care if I have to stay on these medications the rest of my life.  I feel so much better!  I’m more myself than I ever was.

 

And there it came.  That beautiful awareness of taking care of our changing selves.  Without much in the way of hand blisters, she stepped by her own volition across the line.  Marsha was a no drama type of girl.  Just in time, I caught the temptation, my own springing up potential energy to pull on the rope when we were on the same team.

Marsha had struggled with disabling mental illness her entire life, and here in the third decade of life, she simply walked over into health.  Gracefully she left her previous self, accepted her new, assumed it was her intended baseline and that was that.  She wasn’t over the stigma, she hadn’t accepted some of the other lifestyle changes entirely but still, she was content to call her team, come what may.  What a woman.

Questions:  How has the process of getting on and staying on medications been for you?  When have you felt more yourself?  How do you define your true self when you change through life?  Please tell me your story.

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Self-Care Is About More Than “Me”

Self-Care Tip #208 – If for no other reason, get friendly with yourself simply to survive and you’ll see what that means later.

my self care reminders

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It is not unusual to think of “selfish-care” when we hear “self-care.”  I can imagine children gripping their mother’s skirts more tightly, husbands pulling their helpmate’s hands away from this influence, church-folk sniffing over rejections to service-calls or friends personalizing the way their phone doesn’t ring as much as it used to.  This is a natural response, although it is a false perception.  Think – feeling suffocated by her penance, he’s wearing a martyr’s cross or she’s giving to us from victimhood.  Those are the times we would rather not receive the gifts of time, person or anything dripping with that kind of guilt and implied debt. This kind of service comes from someone impoverished, giving on credit.

I’ve been known to say, “We can’t give what we don’t have.”  Or as Jasmine said,

You can’t give someone a ride if you’re all out of gas!

So when is self-care selfish?  To be true to what self-care is, I’d say almost never.  However, because the question comes from such an intuitive fear in any of us, “never” can’t be an entirely fair answer.  To answer it best though, we need to turn it over and go back to trying to discover why we wanted self-care first.  What brought us here?  Jacqui said it well in yesterday’s post-comments:

Ditto about ‘self-care boot camp’. I may steal that one. You’ve given me permission to be selfish if need be. It’s all about self-preservation.

Sometimes we are reduced to self-preservation.  It has an intensity to it, a survival mode of live or die, which may be appropriate to a desperate condition in life.   Many of us know what that feels like.  So in this context, self-care is in part about survival.  Alright.  But is survival a selfish need?  Are we worth that little?  Does the life in us hold value only at that level?

rejuvenation.self.care.logo

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You hear the clomping my words are making and can follow that I answer, no.  Survival has far reaching significance.  I matter.  You matter.  We have value beyond our own selves and Me booting up to live better also ripples over those same infinite number of connections.

I am confident that if for no other reason than getting friendly with yourself simply to survive, you will still see at least some of what more that means later.  Self-care is about more than Me.

Question:  When do you think self-care is selfish?  Why do you think self-care is not?  Please tell me your story.

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Be Willing to Stick Your Toe In The Water of Self-Care – Just Start.

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Self-Care Tip #204 – Be willing to stick your toe in the water of self-care – just start.

I’m not interested in medications.

I used to really wonder why anyone would come to me and say this.  Sometimes we would both realized that they didn’t know what a psychiatrist was.  My degrees seemed transparent as they hung so quietly on the wall.

My girlfriend, who’s an Ophthalmologist, loves it when her patients homogenize her work with what optometrists do.   And it wasn’t until I read Madeleine L’Engle did I understand more of the differences between astrology and astronomy by understanding their similarities first.

For the magi, astronomy and astrology were one science, and it is probably a very sad thing that they ever became separated. That is yet another schism which looks for healing…

–Watch for the Light: Readings for Advent and Christmas.

In those cases when my patients don’t know who they came to see, I have tried to bridge the awkwardness with something to put them at ease.

Don’t run for the door.  There’s no cage.  See, the doors unlocked.  There’s no implication that you have to take medication just because you came to see a psychiatrist instead of a psychologist.

But I’m not interested in medication.

Then there are those who know who they came to see.  But they may not know the connection between behaviors, emotions and their brain health.  (Of course there are other reasons to see an MD I’m not covering here.)

I’m not interested in medication.

Who wouldn’t wonder?  Now I realize an MD is good for more than just prescribing, if she wants to be.  I know.  Wild and outrageous idea, right?  So before I educate anyone on my enormous fund of knowledge or my stealth abilities to diagnose and treat, I think about what it is that this someone thought they might get from coming to see me.

(Enters Fatima:)  Fatima came in this way.

I’m not interested in medication.

Fatima wasn’t feeling good.  Her emotions were corrupting her behaviors and quality of life and she was trying to help herself, stretching her toe into the pool of science, slowly.  She had never been a person to jump in and splash.

After speaking with Fatima for some time, we were able to come up with what she felt she needed help with, what she thought might be medical, what she might be willing to try – for now that meant engaging in psychotherapy, starting omega 3’s and vit D, working on her sleep hygiene, trying to get more aerobic exercise in (like a pill) and doing a mood chart.  We decided together that she would see how this goes for her over the next two to four months.  After that, if she wasn’t doing better or better enough, we’d consider a medical intervention.  We’ll see if she’s interested in medication.  Maybe not.  She can choose when she believes she’s making the right choice.

Questions:   What helped you take the plunge into medication therapy?  What held you back?  Or in someone you know?  Please tell me your story.

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Love – Take What is Already Yours. You Have Been Given Love.

Stef's Present with Handmade Wrapping

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Self-Care Tip #194 – Take what is already yours.  Be a friend to yourself.

Parenting, we hold the power in the relationship between us and our child/ren.  If we are emotionally maltreated by our child/ren, we parents are still the ones with the power.  What are we giving to her if we teach her that we will take the terrible words and dark emotions?  When we take the projected anger when we have the power to choose not to, what message are we giving to ourselves about ourselves?  What is the message if we say by our actions that Love demands from us to accept, to take and to be a victim to the emotional abuse?  Is that what love tells us?

It is difficult to receive maltreatment from anyone.  And because of the suffering involved, we can misinterpret the message, “This is the sacrifice that Love demands” – the sacrifice is doing what other people want before taking care of yourself.

It is difficult not to receive maltreatment as well.  Which choice is more consistent with our understanding of Love?  The words in the message might be the same, “This is the sacrifice that Love demands.”  However, the interpretation of the message, of what the sacrifice is – that meaning is different.  The sacrifice is, rather, taking care of yourself first so that you have the best of you to offer to others.

To read more on this topic, please see posts, Criticize if You Love Me, Listen to The Intention in What People Say and Stop! Before Hurting Yourself or Others.

Because we as parents hold the power in the relationship, we can feel trapped by our own power.  What a confusion for many of us.  Holding power but feeling helpless.  Holding a stick in both hands, so to speak, not seeing that we can still use our occupied hands for anything else in the mean time.

This kind of choice takes Love.  This is the kind of choice that is a work of a life-time or of a moment, but is life.  See, Let It Go and Keep Going.

We can’t teach others that we are valuable and how to treat us with Love if we don’t do it ourselves for ourselves.  When we act on Love, self-care means that we don’t accept treatment that is inconsistent with Love.  If we accept bad treatment, we are saying that self-care is accepting our lack of choices versus making the choices that are still available despite the circumstance.

FriendShip... A gift of God.

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This of course applies to any relationship.  It applies to any connection, whether it is in the work-place, marriage, if you are the child in the parent-child role, friendships – take your pick.  You can choose Love.  You can choose.  Self-care starts and ends with “Me.”

Freedom is a gift.  No matter how many times it is wrapped up and placed in our hands, if we don’t open it, use it, own it, we will never have it.  Freedom to choose has been given to us before we were born, just like our salvation.  The salvation will never be taken away.  Nor the freedom.  Both are elemental and constant.  But if we don’t pull on the ribbon, lift the lid and take – we can’t expect anything but living without what was inside.  Does the title “victim” even hold if it was our choice not to take what was already ours?

Question:  How do you claim your freedom to choose when all you perceive at the time is what has been taken away?  Please tell me your story.

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Starting With Your Own Answers to The Big Questions Leads to Reducing Stigma In Others

Alexander Ostuzhev as Quasimodo, 1925.

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Question:  How do you see the paradigm of spirituality intersecting with the paradigm of biology?

As a psychiatrist who blogs that behaviors come from the brain and not a theater script we voluntarily revise to perform, this is a good question.  As readers, and perhaps subscribers to this same belief, this is a good question.

In church, Bible study, or circle of any kind, there are fewer things that goad me more than listening to descriptions of the moral value in emotions and behaviors.  I have found myself visiting the lady’s room more often, carousing the fellowship hall-kitchen and fridge, or thrusting myself on a poor unsuspecting soul loitering by the door with my fervent uncomplimentary words.  I do this before I stand up and pull rank on the speaker.

(I know.  The words “pull rank” sound just as arrogant, and probably are, but they were said in the heat of the moment.  Please understand that the emotion behind them and including the words came from my brain.)

It wasn’t so long ago that suicides were thought to be the ultimate separation from God.  Oh wait.  That’s still happening isn’t it?  It wasn’t so long ago that anger and sadness were thought to be from separation from God.  Oh wait, they still are.  Ok.  I’ll stop.  This is childish.

The hunched figure of Notre Dame comes to me now, ringing his bell, gazing at Esmerelda – pure heaven in flesh.  He offers up his humble life force, begging to be near her despite his biology.  He is ugly.  He is different.  He is separated by his own beliefs that he is forgotten by God.  His answer to our question is his own isolation.

This pithy topic has no boundaries across the world but yet I reduce it down to Me, one apparently arrogant psychiatrist, kicking up dirt where I stand.  I realize that the best way to protect us from stigma, to help you (again arrogant me swaggers in), is to start with my answer to this marvelous question.  I have to answer it for myself.  I have to start with self-care, spiritual care, relationship care, physical care – I have to start right here with Me.

These kinds of imposed opinions have never been reduced quickly.  We can’t take care of everyone before we take care of ourselves.  We must be patient.  We have the privilege to answer thoughtfully.  It is our freedom.  It is our right.

Self-Care Tip #193 – Answer the big questions in life for yourself, deliberately, and see that a secondary benefit is that it will protect you from the prejudice of others as well as reduce their prejudice.

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Just to Feel Pleasure

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Self-Care Tip #189 – Heal for yourself, and you’ll see that also, everyone heals.

The best thing I ever did was go on antidepressants.

Bianca sat, but her whole body was talking.  She was telling me about her changing life.  She had read some of her journal from a year ago when she pounded on herself for her behaviors.  She thoroughly grieved the time with her children when they heard her scream about small things that kids do.  She told me about her sons face when she was irritable.  He showed all the waiting tension that an open child will when waiting for Mom to lose it.  She was trying to push it aside and think rather about how she now could finally enjoy them.  Bianca said,

I just had no idea before how much better life could be.

Bianca’s face became tight and she didn’t make eye-contact,

There’s no way to describe what it’s like to not enjoy your kids – My own kids! – for most of their born lives and then wake up and experience something different.  I just can’t explain what it means to now actually like being with them.  I’ve always loved them but I didn’t feel the pleasure and I hate that.  I want that time back but I can’t have it and I can’t give it to them either.

I’m so scared it will end, the pills will stop working and I’ll lose this new life.

Before her medication, Bianca worked hard at taking care of herself.  She was a check-list of responsible self-care.  Bianca thought it was important that I knew this.

  • Aerobic exercise – check!
  • Healthy diet – check!
  • Sleep hygiene – check!
  • Bianca talked about God but things got confusing for her there.  She didn’t like to think about Him being on “a list.”  He was in her life and didn’t feel He failed her even though she couldn’t feel pleasure or joy.

Still, she continued to coil up and release hard punchy words at her kids and then hate herself for it.  She had prayed so much about this and wouldn’t even mind if God had to puppet her, if that’s what it took, in order for her to treat her kids better.  She could not stop herself from being what she called,

Crazy Mommy.

But now, after she was treated, Crazy Mommy was gone.

Aside from dropping the shame, the best thing for Bianca was knowing that her kids could trust her, felt safe with her and that she felt safe with herself.  Everyone was healing subsequent to Bianca healing.

How many of you have told us a similar story.  A similar rescue.  Yet, never-the-less others of us are afraid to go there.

Question:  How are you present with others who don’t understand your rescue story?  How do you stand beside someone who needs medical help for emotional illness but won’t accept it secondary to stigma?  Please tell us your story.

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Pain Can Be Something More and Better Than Just Pain

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Self-Care Tip #181 – Look for help if your pain never becomes something more than pain.  Be a friend to yourself.

Glee is back!  I’m so glad because it makes great work-out distraction.  Good music, drama, beautiful people, and wonderful ah-ha concepts like,

Use your pain and loneliness to inspire you to make something beautiful.

Can’t remember it verbatim though and I noticed after an hour surfing the web for Mercedes quotes (and getting detoured to all sorts of other fun stuff for grazing) that whoever writes these quotes up didn’t find this one worth it.

Joni Eareckson Tada on the Larry King Show said that when she thanked God for her paralysis, she began to be productive through what paralysis offered.

It is however sometimes impossible to take what hurts and let it fuel our fires.  Sometimes it’s just a cold lump of coal.  Sometimes, we aren’t adaptable.

Luckily we aren’t sitting in a cave during the ice-age and can trust that a bear won’t come and eat us when we are wounded.  But there are other predators.  In my line of work, I could call disease process a preying force.  It takes over more and more cells, space, grey matter, consuming bits of our identity and changing our ability to cope with stress.

It’s easy for people to say, “Turn your pain into energy for creativity,” as if it were a volitional option for you like it was a choice for them.  Or we call it bits of morality; maybe a fourth of an inch on the rim of our gold crown we get in heaven.  Those of us who care about that crown look at our shoes, apologize and promise to try harder.

It is not easy to explain these apologies and inactivity to someone who has never been immobilized by mental illness.  Even those of us who have experienced it first hand have a hard time remembering the real texture of what we went through once it is passed.  Illness can be so awful that even our subconscious shudders when turned back to remember.  It is no wonder that we find it difficult to explain.

However, it doesn’t have to be this way.  If we aren’t able to adapt, aren’t elastic and sit stunned in the presence of pain, immobile to the newness that it can offer – recognize this as a flag to turn towards medical help.

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  Please tell me your story.

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The Spider Sat Down Beside Her – Mental Illness

Self-Care Tip #178 – Find your courage and answer to stigma.

The Little Miss Muffet scenario explained by D...

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Something as simple as taking pills can sabotage us.  The act of putting it in our mouths signifies all sorts of things from religion, to freedom, to personal identity and beyond; even someone who is trustworthy versus not.  Pill – take away her children.  No pill – could be president.  Pill – discredit whatever he says.  No pill – worth listening to.

Martha is a mother of four lovely girls.  Her husband is divorcing her and she wonders what he will do in the process.  She’s been depressed in the past and anxious with a history of panic attacks.  She took two years to get over them using breathing exercises and other therapies. She didn’t use medication.  I don’t need to tell you what her husband thought of meds or of her during that time.  It was a miserable time for her.

Now, during this new stressful time, she has relapsed in mood and anxiety problems and is terrified that if her husband finds out, he’ll take the kids.  Martha sees mental illness as a bullying tool for anyone to dump her over.  Little Miss Muffet is a story she often has compared to her situation.  The spider is the mental illness she feels is dangled over her to her demise.  Martha is bullied and scared away.

Taking pills makes me feel like I’m crazy!

Note: it’s a type of crazy she interprets as being something different from the crazy of mental illness.  For Martha, the crazy that comes with medication therapy is more sinister and discrediting than the worst experience of terror any of us have ever gone through, i.e. panic attacks.

Every day, we who take medication for emotional illness have to answer to those accusations.  We contend with the fingers pointing our way, the jeering in our memory of loved ones and the boxed presumptions we find ourselves in.

This may sound a little dramatic to some out there, although familiar.  To others, it is an understatement of what they courageously confront to take care of themselves.  Each of us must come up with our own answers and find our own courage.

Martha finally decided on medication treatment and within two days she was amazed to find that she could eat without throwing up and no longer felt anxious.  She still insisted that taking medication was only temporary but getting a pill dispenser had helped her get past some of her daily battle with stigma.  She just opened the lid and poured the pills into her palm, threw them back and swallowed without looking.  Martha found it easier not to dispense each pill each day out of each bottle.  It was also easier for her to keep this information secure in the confines of our office.  For Martha, for now, this was how she answered.

Question:  How do you answer to stigma?  How do you maintain your sense of freedom when other forces tell you that you are not free?  Please tell me your story.

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Say, “I Can’t Control This” When You Can’t

Playing in the Sink

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Self-Care Tip #169 – When there is negative chaos, remember and say, “I can’t control this.”

Carol had worked there for seven years.  The supervisor had just asked her for more hours and Carol felt almost good to be able to say she didn’t have any more to give.  Yet when Carol got the email that her job position was closing in a month, she was physically affected.  Her autonomics (“fight-or-flight” reactions) were on full alert.  If there was an attacking bear, she might have out run him.

Healthy Carol had been to enough 12-Step meetings to remember, “I can’t control this.”  She said it a few times and turned it over to her Higher Power.  She did not crave or relapse in her addiction’s disease.  Her pulse was still fast and her hands were still tingling for the next several hours but she didn’t “use.”  She went to her meeting and she pushed on.

When Carol thought about her future and the things she could do to prepare, she inevitably thought about the things she couldn’t do.  She said,

I can’t control this.

When Carol imagined what other people would think after hearing about her unemployment, she said,

I can’t control this.

In mental health we struggle with that a lot.  The emotions that grow self-loathing, the behaviors that distance us from our support and loved ones, and/or the physical changes that keep us from performing – are all confusing.  At what point do we say, “I can’t control this?”

I remember a Seinfeld joke about water faucets in  public bathrooms.  The ones that you have to hold down to keep the flow going.  I’ll spare you the misery of me trying to retell it and get to the point.  Why do they have those faucets?  It’s as if they think people will have a water party in there or take free sponge baths if they could turn the faucet on long enough actually to wash their hands.

baby elephant | playing in the water

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When we say something like “I can’t control this” to the idea of emotions and behaviors, the general fear is that people will take wild liberties, – splashing emotions around and behaving like elephants after the summer Serengeti drought ends.  Mayhem will ensue and the staunch healthy-minded with dry pants will have to clean continually after us.  Not many people want to be sullied by the emotions and behaviors of others and this, “I can’t control” business is a boundary issue.  Maybe stigma is one of the ways we change out the faucet on others.

There are some very primitive characters and severely ill people who might say in fact that they cannot control all feelings and behaviors.  This is more than most of us armored with some healthy coping skills would believe or say.

“I can’t control this,” is not a free pass to vandalism, vengeance, volley-ball or any other very vexing behavior.  It is not there to hand over like a ticket to other people for their excuse, justification or condolence of our situations.  It is there for us to hold up to ourselves for the purpose of honesty, submission to our Higher Power, humility and healing.  No one can control the flow out of that.  That is free self-care.

Questions:  When have you felt like you had to explain to others your behaviors and feelings even when you didn’t have an explanation?  How did you bring it back “home” to your own self-care and get past the stigma?  Please tell me your story.

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Who Are The Sick? From Here to The Moon.

Michael Jordan, Slamdunk Contest, Chicago, IL ...

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Self-Care Tip #162 – Know your need for self-care.

Question:  In FriendToYourself.com, am I writing to people who are sick?

I was speaking with Beth Jusino the other night, when she asked me this.  I thought I’d ask you in turn.  You readers might be interested in commenting.

What is mental illness?  Are you writing to people who are sick?

Beth is smart.  She’s heard of Major Depressive Disorder, Schizophrenia and such.  She didn’t ask me this question so I could read her the DSM IV-TR.  She was asking how far mental illness is allowed to go before it gets named.  And how about the space beyond?  Are there bits that aren’t named?  Does it drift along an arch between Crispy Health and Completely Ill?

What do you think?

One reason I like to write #mentalillness hashtags on @Twitter is because I have a theory that people who have allowed themselves to be named, who have accepted to any degree a need for help, who have released their history and claimed their future over and over again – well I have a theory about these people that explains why I write to them.

These people are more able to hear the knocking sounds of wanting.  These people are more available to grow.  These people accept the gift of health and any space between here and there where they find themselves, all the while pressing; a courageous forward effort to freedoms.  These people care about self-care and they know they are accountable for it.

I remember this,

It is not the healthy who need a doctor, but the sick.

It makes sense.  However, it isn’t as easy as calling a spade a spade, and not because I’m lacking honesty and directness.

I heard a variation of this analogy years ago and I don’t know who said it first.

If you ask me to compete in a slam dunk contest with Michael Jordan, competition would be over before it began.  I’d trip, travel, and carry my way to the net and not get air.  But move the basketball net to the moon, ask us to dunk and the competition is just as over.  The space of air between my shoes and the earth is not much different from the space between Mr. Jordan’s shoes and the earth when we are both shooting for a basketball hoop on the moon.

Maybe you get where I’m going with this.

What do you think?  What do you say to Beth or anyone on this?

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Self-Care is Freedom, is Democracy, is Because We Are Accountable

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Self-Care Tip #159 – Be accountable for and to yourself.

It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain alert.  Just when I thought I could hold out no longer, I saw him.  Big and expressive, the long form of Abraham Lincoln was there, surrounded by loud irreverent people.  My brother and I were wiping sweat out of our eyes trying to keep track of our kids.  We wanted to read the Gettysburg Address for our kids, and found ourselves screaming.  The kids could barely hear the words above the disinterested rabble around us.  Despite all this, I was choking; a weepy, sweaty, nearly anesthetized but free American.

Four score and seven years ago our fathers brought forth on this continent a new nation, conceived in liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation, so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

Just down the corner from Lincoln is a president’s list of sites to see, informers and reminders of who we are and where we came from.  However, none of them were “my Lincoln” experience.

But, in a larger sense, we can not dedicate, we can not consecrate, we can not hallow this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion…

A couple of days ago, writing the post about how stress intersects with medicine, I remembered “my Lincoln.”  It may seem like a stretch at first but take a minute.  Self-care is a way of saying, “I am free.”   In places where life is cheap, almost without value, self-care is not much of an option.  It is because of freedom that we can extricate the meddling fingers, the invasions, and be the keeper of our own private spaces however we choose to.  It is because of freedom that we can tell people that although my brain is ill and although I take medication, I am equal. Saying that is self-care.  Saying that is possible if we take that freedom to keep our own accountability for our own selves.  Accountability is not the same as blame.  Having accountability for our freedom is not the same as being at fault for what came before freedom, nor our current conditions.

—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.

If you’re not accountable to your inner self, if you’re only accountable to your actions, or you’re only accountable to what others determine and define about you, than you are not free.  You are blamed.

Accountability is such a tender privilege.  We might lose it if we forget who we are, where we came from and our rights to freedom.  Democracy is self-care.

Question:  How do you see the relationship between self-care and your freedoms?  Please tell me your story.

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Go Toward Mental Illness and Take It To The Floor

Sean and Cheryl: Drama on the dance floor

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Self-Care Tip #155 – Go toward the real issue.  Be a friend to yourself.

Little woman, she had pinched toes in her four-inch heals and wonder what her size has done for her.  Mindy was anxious.  Even though I wonder about her stressors, like possibly her height and the history she is telling me, I know something else.  Even though I wonder about her parenting and marital stressors, and about growing up in a small town but now living with giants, I don’t wonder what she thinks.  Mindy describes these giants as people with large accomplishments, things she would not try herself and that means something to her, but not what she thinks it does.  Mindy wanted to see how things went.  Apparently six months of this wasn’t long enough.

We could spend the next five years breaking all this up and apart and tossing it like a cranberry salad.  But Mindy’s anxiety is mostly not about the salad of life.  Mindy’s feelings are a bit about the stressors and a lot about her brain.

Mental illness is not a small thing.  We trim it down when we say otherwise.  The unfavored sister, Mental Illness isn’t spoken to much at the table.  Her more popular sisters, Stress and Life-Triggers, get a lot of the attention.

With some effort, people who once worked around Mental Illness like it was barely there take a chance and go straight at it, full charge, and swing that woman onto the ballroom floor.

I went for that dance with Mindy.  And she wasn’t talking about waiting and seeing how things went for long.  I told her, like I’ve told you, that how we feel and interpret our stressors comes from our brain.  I told her that mental illness gets worse if it isn’t treated and treated to as full a response as possible.

We weren’t talking about life stressors at that point.  We were talking about her medical condition.  Once treated, Mindy will continue to have life stressors.  We will hopefully also see however, that she responds to life stressors differently.

Question:  How do you make sense of the seemingly meaningfulness of how stress affects us with the seemingly less meaningful concept that we feel that way because of our brain and not because of the stress?  Please tell me your story.

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Emotions: The Physical Gift We Can Name

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Self-Care Tip #148 – Identify your emotions, navigate, and get help.

Mad.  And when Mia was angry she wanted to go eat.  Nervous.  When she was nervous she wanted to go eat.  Like a wire with a current, she couldn’t stop her thoughts from moving and moving.  Although eating soothed her in less than a shard of a second, it was also followed by self-loathing.  Self-loathing brought on more eating and then purging.

Sitting in my office, Mia said it was like she was looking at herself from the outside in and the self on the inside could hear the, “Stop!”  Demands, petitions, and begging to stop came from the other Mia, who was loosing her command-authority in a scary-fast way.

How often we hurt ourselves but blame a trigger, an emotion, a person, or an act of malice.  If only we could say, “Put the offense down and take two steps back.”  But sometimes we can’t.  It’s easy to piously say, with habits and cassocks or soutane (French for traditional priest’s attire) in place, “Don’t make decisions based on emotions.”  It’s easy to say, “Be objective, we can’t trust our emotions.”  But if emotions are what we use to interpret the world around us with, if that’s all we have, what can we do?

Emotions are ideally the color, texture, perfume, music and salt in our physical self.  Emotions are our spiritual sensory system.  Not being able to trust them is a big loss.  Being blind, deaf, anosmic (can’t smell,) unable to taste, and numb would make it really hard to interpret the world around us too.

Paul Brand, MD, coauthored with P. Yancy, “Pain:  The Gift Nobody Wants.”  This book uniquely tells Dr. Brand’s story of working with lepers in India.  Leprosy is a disease that causes a person’s nerves to stop working so they lose their sense of touch and subsequently can’t feel when they hurt themselves.  A once harmless thing like bumping a finger for example, is extremely dangerous.  Lepers can’t feel the pain, and so don’t accommodate for it and protect themselves. You can imagine that bumping a finger but not reacting to it leads to tissue damage when it is done over and over, until one day the finger falls off.

Dr. Brand is right.  Pain is a gift.  And so are emotions.  Including emotional pain, if serving as intended, to protect the individual and not self-destructive things such as bingeing and purging.  The purpose of this post is not to get into what binging and purging is.  That’s just an example of behaviors that might grow out of emotions gone amuck.  Emotions that we used to trust.  That use to tell us who is a friend and who is an enemy.  Emotions that used to know who’s side they were on.  Emotions that forget their own like that can be just as extremely dangerous as leprosy is to our tender fragile fingers.

The purpose of this post is to flatten the mountains of understanding between here and there.  Between understanding that emotions are as physically important as anything else, such as the spinal cord.  The purpose of this post is to furthermore say what to do about it once we can 1) identify the problem and 2) get past the stigma.  Mia did the eating and purging stuff, but she also asked for help.  3) Ask for help.

Lepers have still so few options to help their disease.  Us with emotional illness are very blessed because we do.  We have medications, psychotherapy, coping skills, miracles, and more.  We have a lot.

Question:  How do you define the space between emotions and other “real” medical illnesses such as diabetes?  How do you navigate around stigma?  How do you ask for help?  Please tell me your story.

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Leave Space in Your Beliefs to Grow

 

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Self-Care Tip #144 – Leave space in your beliefs to grow.  Be a friend to yourself.

Madeline brought her son in.  He was born male but has always allegedly believed he was female inside.  It was Madeline’s appointment with me, not her son’s.  But he came in with her and I could either listen to her concerns about her son or ask him to leave against her wishes and still hear her talk.  So I listened.

The issue was a matter of salvation.  Madeline was fighting for her son’s salvation as a mother might.  That part was lovely to watch.  I thought of God hearing her and being present with her pain and being The One behind her fierce love in the first place.

We talked a little about the biology of homosexuality.  What is transgenderism?  If God’s Word is absolute, what part does a progressive understanding of biology play in our perception of truth?

Madeline’s son asked to leave.  I thanked him for coming in and he shrugged.  His whole family abused him, Madeline said, gulping and losing form.  She had spent many years defending him even though in her heart she was terrified that her son was damned.

Some of you may have read the powerful blog-post, “My son is gay” in which a mother described her halloween experience.  Her son dressed up as Daphne from Scooby-Doo.  She and he were promptly abused. As a mother I empathized, and as a scientist, I wanted to scream things like, “You thought the world was flat too!”

But Madeline was worried not only about bullying.  She was worried about the Last Judgment.

Stigma comes from all directions.  Inside of us, our homes, our churches, our schools, our government, up, down, sideways, this way, that…  Stigma is everywhere and it is usually a painful encounter for everyone involved.  Perpetrator included.

So here’s the scoop folks.  Homosexuality is biological. We have as much choice in it as the shape of our nose.

I’ve seen kids be mean about noses.  I’m half-Lebanese and believe me, I know what big noses are.  The nose that makes you wonder how the head escaped the vaginal canal without injury.  But I’ve never heard anyone hate someone’s nose and believe that he’s going to loose his salvation for it.  I’ve never seen someone turn her back on her brother and leave him to die without the love of family around because she thought she was condoning his nose if she did.  I’ve never heard about moral judgment being attached to a culturally incorrect nose.

In my son’s church class the other day, the teacher was trying to get him and the rest of the other oppositional three-year-olds to wear angel and shepherd costumes for the song they were going to perform. Only the stage-hams garbed up.  She kept giving the rest of us parents her pleading eyes, pleading words, and pleading emotions. She was making the wrong people feel guilty.  The kids were unfazed in both compliance and emotion.  The ones who were genetically inclined to get energy from performing that way, were.  The others were not.  I could have said to my son, “Get this on!…!”  And made him feel like he was bad if he didn’t.  But attaching morality would never change where he gets energy.  That part is genetic and it won’t change despite his conditioning.

It’s a bummer that Paul’s letters were translated the ways they were in the 1950’s using the word homosexuality.  A lot of people are scared when they read it.  Fear has threatened and hurt a lot of people.  Reverend Mel White posts about this.

I don’t know if Madeline was given anything she came looking for.  I’m not always the best teacher or student myself.  But I do know that we, all of us, will continue to learn through all eternity.  We will never know enough, love enough, or be sinless and perfect enough to take over that awesome job of being Judge.  I once heard of a beautiful beloved angel who tried.

Question:  What has been attached to morality in your life that you know is not?  How have you dealt with stigma?  Please tell me your story.

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Go Toward The Pain To Get Connected

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Audrey came in looking fresh.  Better than before for sure.  She had an aura that brought to mind the moment just when tearing off wrapping paper.  It was nice to see her.

I am doing better.  I’m able to let more of the little things go, like the house doesn’t bother me as much when it’s not clean.

She was more able to do self-care with less forethought.  What did take her by surprise though, was her guilt.  She could see that it was inappropriate but insight didn’t entirely remove what shouldn’t be there.  She said these thoughts and feelings were something her husband likely never struggled with.  She didn’t think he was worried about her home doing dishes when he was at work.  However, the reverse for her was true.  She gave a coughing laugh.

I do!  I feel bad when he does the things.  It doesn’t make sense.  If he wasn’t washing dishes when I was working he’d just be watching TV.  But I still feel bad.

For her, working her job, taking her jogs, and attending Mommy groups were all in a grey category of “extras” for life.  Not necessary but bonuses she was spending their retirement on.  However, despite this, she looked the champion she was when saying,

I still am able to take care of myself.  Even though those thoughts come.

Audrey, by thinking about, talking about, and materially man-handling these thoughts, she was able to join her personal journey.  These things became connecting forces in her life.  They drew her closer to her family and not away.  Resentment dissipated and she was able to take part in her available positive emotions and thoughts.

It could have been different.  It had been different at other times, before medications and other positive deliberate choices in her life.  But it wasn’t now.  The could-have-beens trickled away together, the other near misses that sometimes we know about and sometimes we don’t.  There they go…

Going toward the pain in life, not averting from it, is a connecting force in our lives.

Question:  What have you been avoiding?  What has it done for you when you went toward the pain?  Please tell me your story.

Self-Care Tip #124 – Go toward the pain to feel connected.  Be a friend to yourself.

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Do The Opposite. For Your Self.

Condomaniac

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Self-Care Tip #121 – Do the opposite, do the “un,” and go where you don’t want to go.  Be a friend to yourself.

Frank, accomplished in chess, employed in a 3 digit salary job, married with children, and he heard that things were going well.  From other people.  In his opinion, Frank believed the inside life-details were more destructive than the redemption of the apparent details.  Frank listed himself off to me like a confession, but he got little relief from the exercise.  It didn’t change that he was still addicted to sex, ashamed and the addiction was changing his ability to function in the other areas of his life.  He was taking more risks and realized that if he didn’t get clean, he’d lose “everything” but the addiction.  Not wanting the addiction didn’t make it go away.

How many of us wrinkle our nose at the Frank’s out there!  How we avert.  Either side is not really good or bad.  It just is.  Frank is addicted.  And we are ignorant.  Sex addiction is in the recesses and communes of where any of us live.  And, “we” are no better than they or worse.  It just is that way.  The qualifiers are the stink that kill our connections.  The qualifiers are rotten.

One thing I love about Jesus’ earth-story is that He was always un-everything.  He was Un-segregation, un-rules, un-prejudice, un-divided, and many people thought he was un-qualified.  Wherever these things were, He went there.  I love seeing people who use Him to draw lines between their spaces.  To say, “This is because Jesus wouldn’t…”  Hmm.  Jesus wasn’t scared of mucking up in the chaos of people’s lives.  Jesus not being scared is actually the wrong way to say it.  Let’s say rather, Jesus honed in straight to the muck and chaos, drawn there because He couldn’t and didn’t want to stay away.  We are not so loving as that but who cares about motives?  I also say with confidence that Jesus/God understood biology much better than we did then, now or will.

When we can look at each other objectively, when we don’t personalize what isn’t about us, we can let go of some of what separates us.  It goes both ways.  We are afraid of Frank and what he does.  Frank is afraid of what he does and of us.  But it’s not the fear so much as it is the qualifiers that ruin us.  Bad, good, Clang!  Down go the dividers.

None of this is meant to minimize the pain that these things bring on, such as addiction.  Rather, taking away whatever is dividing us helps us be more present with the pain, with each other, and often leads to healing.  It is another opposite, another “Un,” another Jesus-move.  Doing just the opposite of what we think should be done.  Got to love that Man!

Why would any of “us” want to be connected to the addict, or to whomever is doing something hurtful, scary, negative whatever it may be?  Why?  For your self of course.  Our life is better if we are.  That is a motive I think is worth pursuing.

Question:  How has your life gotten better when you did the opposite of what you felt like doing?  Please tell me your story.

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The Great Lie.

One of the great lies of mental illness is that, “If things weren’t so stressful, I wouldn’t feel so bad.”  Look inside ourselves now and see them.  All the numbered and ranked stressors we tick off to explain how we feel and/or behave.  How about someone we love.  Do we tell them, “Of course you feel that way!  Look at all you’re going through!”

Because major depressive disorder (MDD) is mainstream enough, I’ll use it as an example.  Who, when they are down, doesn’t look for reasons why?  Say there is an additive effect of stressors such as home conflicts, financial duress, and poor sleep.  Since these events, you haven’t felt pleasure, you’ve felt sad and depressed.  You aren’t motivated or interested in your usual.  And where you normally would seek people out when you felt down, to get more energy, now you just want to be alone.  And so on.  You are able to say that you started feeling this way progressively since triggered with those stressors about 3 months-ago.  Before that you were “fine.”

Many people in your life, have told you that you are just going through a bad spell.  You have believed them but say, “Even if this is a bad spell, if it goes on much longer I think I’d rather die.”  Your best friend responds, “Anyone would be depressed if their boss was that evil!”

My answer, “No.”  Feeling down is appropriate to stress when it doesn’t disrupt your life for more than two weeks at this level.  And it is never normal to want to die.  Everyone has stress but not everyone responds to stress in the same way.  Not everyone if put under your same triggers would develop MDD.

Would you have developed this disease if you weren’t put under these stressors?  I can’t say.  We develop illnesses for many reasons.  One of the many reasons is external stress.  A hypothesis supporting this is that stressors trigger our genes for MDD much like we know cancer genes can be turned on by stress.  However, we do not have a direct correlation to the stressors as being entirely causal events.

Even if it were, none-the-less, we are left with the disease process in progress.  It is not an adjustment reaction to stress.  It is medical illness.

Feeling this way is not normal for what you are going through.  Telling yourself that it is, that is the great lie.

Self-Care Tip #118 – Don’t believe the lie if what you’re going through is affecting your function in life.  Be a friend to yourself.

Question:  What whispering lies are you struggling against?  Please tell me your story.

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Pebbles to Diamonds

 

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Self-Care Tip #117 – Notice, you got diamonds out of stones!  Be a friend to yourself.

Cindy replied to yesterday’s post (that had some discussion on functional mental illness,) “I understand Miranda’s feelings completely.  Some days it’s all I can do not to down tools and scream ‘What about ME?’”

That is one of the lovelies that these illnesses bring to us.  In our honest moments, we can, like Cindy did, perceive our own traits that resemble them.  Perhaps, if we are lucky, that will lead to empathy, one of the great human experiences.  To be able to put yourself in the hypothetical place of someone else.  To imagine what they think and feel.  “If I were in your shoes…” and so forth.  If you’d like, read more on this at this post.

Illness is often considered a step in the dyeing process.  Others see it as part of the living process.  Of course, it is both.  We are all on level ground when it comes to having been born, coming into life, and knowing we will equally die.  Illness reminds us of our like-natured frailty and of course the opposite – resilience.  Whether seeing our own illness or someone else’s, we have this privilege of being blessed this way.

My Dad used to tell me a story (author unknown) when I was little.  It’s been a long time but I remember it this way.

Three travelers were walking when they heard a voice telling them to bend down, pick up pebbles and put them in their pockets.  The voice told them further that in the morning they would be both happy and sad.  The travelers did but not equally.  Some pockets were more full than others.  In the morning when they awoke, their stones had turned to diamonds.  Whoever gathered many stones were happy even though all of them wished they picked up more stones.  But whoever gathered few, well, they were not happy.  They still had diamonds but the comparison soured them and they finished their journey full of “what if” thoughts and not thoughts about the obvious.  They got diamonds out of stones!

We are all similar, with the opportunity to say thanks in seemingly off times, such as mental illness.

Question:  What have your “stones” turned into?  Please tell me your story.

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Who Cares What Your Diagnosis Is?

Wheelchair basketball at the 2008 Summer Paral...

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Self-Care Tip #115 – If it’s not serving you well, don’t waste your time on it.  Be a friend to yourself.

Trixie Hidalgo, advocate to end violence in America, tells me that many of the people engaging in gang crimes tell her that they are put in their life positions (poor, stereotyped, impoverished) by the people who have the power, to keep those people in power and to keep them down.  They have some credible arguments we’ve shared before in history relating to oppression such as race, color, gender, money, or status.  Are these people victims?  Sure, why not.  But is that the point here?

The victims reminded me of a clinic I was in the other day.  I was working with Marcus and his father.  The father was torn about where to go to get his disabled son, Marcus, treatment.  Marcus was disabled with both brain illnesses and severe psychosocial stressors.  Currently we found Marcus, 2 years into treatment with me, and as of yet, father and mother (divorced without amicable terms) had yet to engage in treatment with me.  They wanted to know why Marcus was the way he was.  Father pointed at Mother and Mother pointed at Father.  They blamed other things as well, the schools not providing the right services, the medications for not working, his genes, and more.  Meanwhile, Marcus is tearing up his classroom and his own life.  He is barely functional socially.  Moody and volatile.  Anxious with physical symptoms.  He was having multiple medical work-ups going successively for various physical complaints.

Before I let them go, I told his parents, “Who cares what his diagnoses are?  It’s not about the diagnosis.”  The purpose of a diagnosis is to serve the patient.  The patient doesn’t serve the diagnosis.  Right now, Marcus was serving the quest for his diagnoses.  If all they can see is that, and they miss the fact that their son isn’t functioning, he’s depressed and anxious and violent and no one can stand to be around him, Marcus is worsening continually while they go on debating – they’ve missed “IT.”

They’ve missed it.  And so have we when we waste time counting up the offenses we’ve directly or indirectly suffered.  We miss it when we increase our injury by holding ourselves responsible to our history.  I asked Marcus’ parents what the point of what they were doing for Marcus was.  I ask the victims of America, what the point is when they point to history to answer for their present condition.  If it’s not serving you well, if it’s not doing something good for you, than what are you doing with it?  Do good things for yourself.

For the victims, for Marcus, and for Marcus’ parents, 1st make sure we weren’t missing something medical that was keeping them from having life quality.  You can’t give what you don’t have.  Then move on to the psychosocial issues and spiritual and so on.  What ever we ran into that missed our point, we’d walk past it together and on to something that served us well.

If you’d like to read more on this topic, read more in “It’s Time to Grow Up” and “The Whole World Becomes Blind.”

Question:  How have you managed to move past things that weren’t serving you well?  Please tell me your story.

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Toughing It Out! …Is Not What You Think.

Mental Health of our Military

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Self-Care Tip #114 – Tough it out.  Be a friend to yourself.

Trying to tough it out is good it’s just not what most people think.

Many people think that toughing it out means staying med-free and getting through melancholy, anxiety, emotional chaos with gritted teeth.  They gather a degree of commendation from weathering out the behavioral and emotional problems until they either feel better or don’t.

This is not the kind of toughing it out that I’m calling worthy of our life efforts.  It is in fact the opposite.  Toughing it out is doing what may be socially and culturally counterintuitive.  Getting medical care sooner than later.  Not waiting to see what will happen before getting medical care if it is indicated.  Believing the medical data, the physician you trust, the knowledge that mental illness is medical, biological and often PROGRESSIVE over time.

Waiting means you are getting more ill on a cell level and at higher risk for your future and waiting is not being tough.

Toughing it out is digging into your courage bank every day to take that pill when you feel ashamed of it.  Toughing it out is fighting for your brain’s future.  Toughing it out is sacrificing what ever you need to, to give your loved ones and yourself the healthiest you possible.  Even if that means talking yourself into it, going up against your fears, ignoring prejudice, ignoring opposing recommendations from your favorite sources.

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This calls for thick skin.

Candace tells me she still intuitively can’t believe this, even though her mind tells her it is true.  She takes her medication but it still hurts a little every time.  Like she’s betraying herself.  Like she must grieve for herself.  Candace says the apparent calm, decrease in anxiety, improved relationship with her children, and the flowering hope eases her inner psychic pain.  Candace is drawing strength every day from the growing evidence of health.  Candace is tough.

Question:  What are you getting tough with in your life?  How do you do it?  Please tell me your story.

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