I’d like to introduce you to “Emotional Support Goose – Unconventional Wisdom and Support,” found on Facebook. Please check it out and let us know your thoughts – smile.
I’d like to introduce you to “Emotional Support Goose – Unconventional Wisdom and Support,” found on Facebook. Please check it out and let us know your thoughts – smile.
Ladies and Gentlemen! It’s time to go to sleep! Wait. Not till you read this.
PsychU, a patient education website, has invited me to present on sleep. These are their questions and how I hope to respond. Do you have any recommendations, other interests, directives? Please help me! Smile.
1. Dr. Johnson-Quijada, in what ways is sleep important for our behavioral health?
Sleep rudders our biology ship, (if “rudders” may be used as a verb.) Our biology is the reason we have emotions and behaviors. Take out the brain and we don’t have any problems with emotions and behaviors. So the biological health of the brain and body is where our focus should begin with when thinking about emotional and behavioral well-being. This is not in exclusion of other import paradigms, such as the psychological or sociological influences on what make us who we are.
But let me ask you,
Now think about it and answer your true beliefs.
I was speaking with a wonderful physician the other day to whom I asked this question, (let’s call her Doctora.)
I respect Doctora for her character, personality, standard of medical practice and interpersonal beauty. She is a bulldog in the operating room. When patients need studies done that insurances won’t pay for, she tears barriers to treatment apart with vicious tools of rightness. And she cares. She sits. She asks. And she cares. She sees the person in the paper gown, each one for the person she knows them to be and the person yet unknown.
I admire Doctora greatly not only for these qualities but also because it gets personal. I, who have my own special practice of medicine, cannot do her’s.
When just a green bumbler in medical school, there was a fateful day when I shadowed another great artist of medical care into a locker room. I suited up in that blue sack they call scrubs. I put little blue sacks over my tennis shoes too.
Do you know why there are blue sacks on the surgeon’s shoes? So what is on our shoes won’t contaminate the operating room. But also so that when wet things come out of the human body and fall onto their feet, their toes won’t feel squishy. Yep. That’s what was going through my mind as I scrubbed my hands, each finger and each finger nail the ten minutes it takesto reach what is considered clean.
Surgery in progress, the color red mixed with a smell and monstrous sensual force that clobbered me to the ground. I swooned, gagged and promptly ended my surgical career.
There is nothing more irritating to a surgeon than someone who doesn’t appreciate the “fun” of “cutting.” Yes. I irritated this mentor and others too I’m afraid.
This doesn’t keep me, unfortunately, from pleasuring in telling people, “I am licensed to do surgery.” I am you know. Any Jane with a medical license can pick a scalpel up and bring back the dark ages, or contemporary, depending on who holds the license. I’m irritating to my mentors, remember. It reminds me how anyone can go online and pay to become a marriage registrar, i.e. perform a marriage ceremony for couples. My brother did that twenty years ago and has yet to perform the marriage ceremony for a willing couple. For real judges and clergy, this might be irritating too and that makes me a little happy as well.
Anywho, Doctora and I were rolling with the injustices haranguing us in the practice of medicine, both from the angle of the physician and the patient. I was pumping her up for being the cutting-wonder who she was and she was dutifully marveling at my jabber-mouth work that she would, “never be able to do in a million years.” Somehow this brought us round to how our culture avoids embracing the biological paradigm of anything inside our skull but is so willing to celebrate it for any other part of our human bodies.
Where do emotions and behaviors come from?
Doctora answered me with a frozen breath. Then after I warmed and soiled the air with a lot of jabbering and she was finally able to speak, she said,
I would just be horrified if my brain got sick!
I wondered if it was scary enough to clobber her to the ground, but I do agree. Terrifying. Don’t you think?
So sleep is important from a basic rudder-rudimentary perspective of healing, restoring, and preserving our biological identity.
If we don’t sleep well, a disease process may develop.
During sleep, we heal from injuries, both physical and mental. Our brain actually shrinks for a small period, squeezing out, like a sponge, the toxins that accumulate during the day. It becomes smaller in mass without the fluid that filled it. The toxins drain into our cerebral spinal fluid (CSF) and after a period, the brain absorbs new clean CSF and expands in size again. Without deep sleep, the brain retains the toxins it accumulated during the day and those toxins go on to damage the brain cells, summarily over time, potentially harming the brain health and leading to disease.
These treatments relating to sleeping well are often better than pharmaceuticals when it comes to processing and treating stress. When we sleep, we allow our broken neuronal connections to regenerate. We re-stock our shed with ingredients like cortisol, hormones, and neurotransmitters that are fertilizer for well-nourished thinking, kind behaviors, and stable emotions. During sleep, our memories consolidate; they find their place in the folds between our cells and root down into our rich minds.
I have seen regular, restorative sleep bring someone from a place of mental decline to no longer needing psychotropic medication. Everything works better with sleep.
2. What are some of the tools that you like to use to help people develop better sleep hygiene?
Sleep Hygiene, according to Dr. Q!
1. Bed is for
The bedroom is only for sleep and for sex. This means no food, no phone, no TV. If you are not having sex, then all you get to do here is sleep. This might be an adjustment for the entire family, if your spouse is used to clicking on the late news or your kids want you to read them stories in your bed. But your subconscious has to recognize this place as a sanctuary, and not the place to read one last chapter or check Twitter.
(I have yet to have someone tell me that this improved their sex-life, but one would think!…”)
No naps longer than 20 minutes during the daytime. If you are tired and have the luxury of lying down during the daytime, do it! But set your alarm to wake you up in 20 minutes, and then make sure you wake up fully. You can take these “power naps” 20 times a day if you want to, as long as they are no more than 20 minutes at a time. Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture or circadian rhythm) at night.
Exercise, but not before bed. Exercise during the day can help to regulate your sleep cycle by making your body tired at night, but make sure you do not crowd it against sleep initiation. Try to get 40-60 minutes of aerobic exercise, 5-7 days a week. Look at it like a pill, prescribed by a doctor. This is something you need to do not for your waistline, but for your medical and emotional health. Every day, tell yourself, “I’m exercising so that I will feel good, so that I will sleep good, and so that I can do what I want in life.” Some say, “I’m exercising for my brain!”
Keep the lights dim before bed, and turn off the screens early. Darkness releases melatonin from the pineal gland in our brains, which helps to regulate our sleep cycle. Light suppresses it. Melatonin is a cornerstone in sleep architecture. Having your face six inches from the computer or TV before you lie down doesn’t give your body much time to turn itself off. (Some people who feel they must be on the computer or TV before bed have found that wearing sunglasses for at least the last 30 minutes helps.)
Go to bed and get out of bed at the same time every day. Enough said there.
6. 30 Minute Get Up
If you go to bed but cannot fall asleep in 30 minutes, get up and do something else until you feel sleepy. Then go to bed and try again. Refer back to the other rules when choosing your activities (no screens, no reading in bed, etc.).
No caffeine in the second half of your day. Period. No matter how good that iced latte looks. Decaffeinated is the way to go!
Do not use alcohol to sleep. Alcohol is a depressant (will make you depressed) and also blocks deep sleep. Alcohol hits the same receptors in the brain as the benzodiazepines mentioned above.
Do not smoke before bed or if you awaken from sleep. Nicotine is stimulating. (It also decreases blood flow to the penis, so that’s one less of only two allowable bed activities we are allowed… Bummer.)
10. Sleeping Aids
If you cannot fall asleep in 30 minutes, consider taking a sleep aid. Do not take any over-the-counter sleep aids except natural melatonin, valerian root, or chamomile. Others almost all contain diphenhydramine, which blocks your deep sleep. You may end up sleeping a longer amount of time, but you will not be getting restorative sleep.
If you talk to a doctor about a prescription sleep aid, do not take benzodiazepines, such as diazepam (Valium,) temazepam (Restoril,) clonazepam (Klonopin,) alprazolam (Xanax,) or lorazepam (Ativan.) These also block deep sleep. Sleep aids that don’t block deep sleep and sleep architecture include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata). Trazodone (Desyrel) is also safe for sleep structure and maintenance. The newest FTY (Friend to Yourself) sleep aids are Belsomra and Silenor. Sometimes people will find that combining sleep aids, such as zolpidem with trazodone, is more effective rather than using only one agent. Some of these wash quickly out of the body, and some take a full eight hours.
11. Sleep With Me
Do not sleep with your pets or children. Pets and children are disruptive, and no one gets the rest they need. Get the sweet buddy-dog out of bed.
It is not personal. It is sleep hygiene.
I’ll insert here, that one thing that gets left out of most sleep talks, is how to be awake.
Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.
Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.
Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.
This is where I additionally bring in the concept of a stimulating medication such as provigil. Don’t confuse this with taking caffeine. Caffeine is metabolized way too fast to be helpful in this regard. There are others one may discuss with their treatment provider.
3. What parting words do you have for other practicing psychiatric healthcare professionals regarding this topic? How about for the consumers?
For providers and consumers alike, remember our identity is as humble as the cells from which is is generated from. Our identity is as vulnerable as those cells are. The basic needs of the body, such as sleep, lead to the most beautiful and marvelous developments that this life can bring. Without our biological health, without healthy sleep, everything in our body and what our Me connects to, is affected.
Questions for you, readers: Again, do you have any recommendations, other interests, directives?
Please help me!
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?
Me: So Doctor. What do you think about the concept of God and psychiatry?
(I was speaking with a palliative care physician. We’ll label his answers as “P”, for palliative care physician.)
P: I’m not sure what you’re asking.
Me: Well some of us find it hard to think about emotions and behaviors as anything but related to moral values, right and wrong, good or bad, voluntary or involuntary, by choice. We have a hard time not thinking about them as largely spiritually related and not related to our biology.
P: God cares about our whole person, the “biopsychosocial.” That’s all part of it. It just turns out that culturally many of us mainly focus on the the psychosocial, and not the biological. We don’t think about that.
Interestingly, in the hay-day of homeopathic medical care, God told Ellen White to create an allopathic medical school; a school that taught scientific medical care. Thus, Loma Linda University was born, (then named College of Medical Evangelists). So clearly God wanted us to practice medicine also from a biological and scientific approach.
It’s hard to reach the culture though. If it’s total science or total religion, we’re still missing the whole person. The idea that emotions and behaviors come from our brain, well it’s not in our church. It’s not in our popular community either.
To me, psychiatry should not be distinguished form any medical specialty. But in the public mind, they’ll say, “Oh I’m not going to see a shrink.” They’ll see their general doctor, or pastor, but not go to the psychiatrist.
I wonder, was that problem created by the medical community separating this out or from the basic community culture?
Me: You’re first a product of your culture before you become a product of your medical training and the community of medicine, I suppose. It’s like those old adage’s about taking the person out of the “X, Y, or Z” place of birth, but never taking the “X, Y, or Z” out of the person. So as practicing physicians, pastors, therapists, or girl-friend next door, we’ll go through 30 some years of education learning otherwise, and then still believe at a visceral level that emotions and behaviors are a product of our life stressors and learned patterns, more so than the medical condition of our brain health.
Question: Do you see this in your community as well? Do you see the moralizing, qualifying, and quantifying of emotions and behaviors without considering their biological origins? Please speak!
Self-care tip: Consider what this says about who God is if this is true. What does it say about his character? In doing this as self-care, it will come back, around as a “place of safety” for what may otherwise be full of land mines.
Margarit was a lovely twenty-something, with blue-black bouncing hair above a slim pixy framed physique. She smiled easily and chattered like she was on telephone call that was about to lose reception. Her hands moved, conducting her thoughts between us. She was dressed like one of the cool girls on campus, out of my echelon, and who just might stab me in the back if I didn’t know better. But I did. She wasn’t mean. She was super sweet, like honey, and cane sugar, and mangos. Margarit was nice. But she had always wondered if she was being so nice all the time, because she was too nervous to be otherwise.
She came because she was constantly preoccupied by worries over things, “no one should be worried about”.
There had been the counsellors, therapists, and pastors consulted. Margarit and her parents had done their due diligence. With initiating each effort toward getting help for Margarit’s anxiety, they anticipated some degree of success. They thought things would get better. And sometimes they did, in degrees, and for a period of time. but the anxiety always came back. It got to the point that Margarit was put in home school, referenced her looping thoughts for everything, and was socially immobilized.
Maybe you’ve read, Gulliver’s Travels, 1726 by the Irish writer and clergyman Jonathan Swift. When Gulliver shipwrecked and washed ashore unconscious, the numerous tiny Lilliputians effectively tied him down. The rope anchors were so small, like acupuncture needles, yet Gulliver could not move. That’s what anxiety does to us. We become internally preoccupied by it and can’t think much outside of our thoughts. We are immobilized.
The anxiety Margarit had been harassed with since a child took her freedoms away. It chose for her before she even knew what she would decide. Example; friends want me to go to the mall with them. “No,” Before her thoughts could even play with the option. Maybe she wouldn’t have gone anyways. Or maybe she would have. The anxiety chose first though and she wasn’t given the chance.
By Margarit’s third visit, she had improved significantly. She was getting to know herself, she thought, for the first time. I met the parents this visit and they looked at me as a front. I supposed it had been them up against so much for so long now, that they had learned to go at the world this way, like a man plow they both held on to. They asked me why no one had ever recommended for Margarit to seek medical treatment for anxiety.
"We would have done anything asked by one of these professionals we took her to. We thought they should know what to do, but they didn't tell us to get her medical help."
In my mind, I flashed to Naaman being told by Elishah to dunk in the dirty Jordan river seven times to cure his leprosy (2Kings 5). Psychiatry is the filthy river and dunking in it is the nonsensical act of taking psychotropics based on magic and miracles. They were here reluctantly having preferred to start with clergy and therapists, beat up by inappropriate guilt, but ready now to consider that anxiety, in Margarit’s case, is a medical symptom of a biological illness.
The question of why no one had referred them toward a medical approach for their daughter’s illness is a good one, though. I asked a pastor what he thought, and he spoke of the difficulty of not being a medical specialist; not knowing when to refer people. And what of the therapists? Likewise, I guess, that they generally have been trained to approach emotions and behaviors through a psychological and sociological paradigm. And what of the parents themselves? Did they, when their daughter broke her collar bone in the 3rd grade after Christy pushed her off the swings, take her to the emergency room or to the movies for a night out? The ER. But when her daughter showed preoccupied thoughts that permeated her days, affecting her choices, small or large, affecting her sleep, and so forth, they did not think that the thoughts were related to anything medical, coming from her brain. They did not think that the thoughts were more than coping skills, or habits, or choice.
It is a condition of our humanity to want to look at thoughts and behaviors as many bits of our life control to be manipulated intentionally. As if we could. Like “The Matrix.” Or cooking a soufflé. Or driving a 1969 Chevrolet Camero. Shift already! There’s the good intentioned phrase, “Calm down.” “Take a chill pill.”
Oh good. Someone finally said it. If they didn’t I never would have thought of that. Now I am calm because I was told to be calm.
Emotions and behaviors come from the brain. Take the brain out and no matter what chaos hits, we would feel fine. Take the chaos away, and leave the brain in, we are still left with the brain, and what ever condition of health the brain is in. So if the brain is ill, it expresses itself in a way that is ill. If the brain is healthy, the emotions and behaviors are healthy. They are symptoms of a medical condition.
Question: Where do you find your sense of control comes from, considering the biological paradigm? Let’s talk folks!
Self-Care Tip: Consider the biology behind whatever it is that feel and do.
Hi friends. This is unedited. Something unedited really doesn’t have a right to be published online. Ah well. We are all rebels here. Give me your thoughts, mark up for your edits. We need to hear from you.
People come and say, I prayed God would heal me, I did everything right, but I didn’t get better. So I finally came to you. It was my last effort. I’ll do anything. I can’t live this way.
Then we sat together and explored what was happening here.
God is a better psychiatrist then I am, but it is a miracle every time that S/He uses me to answer prayer.
See what God is doing.
I’m grateful I am given these years as I am able to grow in understanding that my job is not as much to see, what can I do. Rather, watch and participate in what God is doing.
The Israelites from Abraham till Jesus came, wondered and wandered around, thinking about what their destiny was. When they got Saul as king, they lost vision of seeing what God can do. Then they broke up into different kingdoms and got more kings. Then they were conquered over and over and they waited to get their victory. Then Jesus came. And showed us that His kingdom was one of love. Could we say, in some ways, it was a disappointment?
I’ve been disappointed at various times of my wandering and wondering how I fit in. Now I am very slowly learning that it isn’t about me.
Do not limit what God can do. Do not squeeze God down to the confines of our own minds.
Ellen White says that we will spend all of eternity learning about the character of God. That’s a lot of content. That a lot of interest.
If we think about all the scholars of scripture; jesuit’s, ravi’s, pastors, people with photographic memories, the wisdom of Solomon, it doesn’t touch all that is waiting there in that space of eternity for us. We are just getting a toe into what will capture our attention for eternity; what will give us purpose, motivation, interest, a wanting to live and connect with self and others for a space of existence that has no parameters to time.
Self care tip: it’s more than Me
Please speak out and tell us your thoughts.
I feel unlikable
It sounds young
It sounds like I’m fishing
But I feel unlikable and it is what it is
I can list my attributes
And do also remember
What others have said
In their own throws of comparisons
It is disconnected though
Me talking to myself
An echo in a cavern
Unlikable might be better said
And I was created for connection
I’ll never survive any pilgrimage on my own
I’m designed to say, “Me too”
But just this
Improves my sense of company
I can’t know why
Writing it out
Makes me think of you reading it
And saying something back
Selfcare Tip: Look for connection. You are not alone.
Question: What improves your connection? Will you tell us an example of a time you turned it around; went from feeling alone to then connected?
One of my strong memories of Marcy will stay, of this Halloween.
She was tired after her day at school. She had gone back to college to get her nursing degree. She was tired, like a shirt that had been over washed in hot water. She was the kind of tired that looked like the good emotions in her water bottle had been slurped down, and the refill was still in the fridge in her kitchen corner. At home. And she was still in the car.
These feelings started to increase and crescendo, and pretty soon she was tieing into memories of failure in her past. A young child who heard her parents yelling at each other in foul language. Marcy heard, “My family doesn’t love each other or me.” A kid who dressed poorly and Mom said, “Go change. You look terrible.” Marcy heard, “I’m an ugly kid.” A teen who didn’t get invited to the parties that she knew were going on. She heard in this, “I’m not likeable.” A young adult who watched her mother walk out on her father. Marcy heard, “I’ll never be someone worth committing to.” And now on halloween, with her daughter coming home from school, Marcy felt like a failure as a student and as a mother.
She told me about this, last week. We were in the quiet space of my office. Lamp light shone over the beta-fish hiding behind his splashing filter.
Marcy told me, she was wilted there, in the seat beside her daughter. Saying words in effort of trying to be understood, she spoke, and she cried. At some point, Marcy realized she thought that if she didn’t go trick-or-treating with her kids, it meant she was a let-down. She wasn’t a good mother.
Not only was she someone who gets tired too easily, she was also a flake.
Marcy threw out a few options; how to make this right for them. Then her mind opened up and processed these. She saw her inner beast let shame go. Something better in her said that she would give what she could, and discharge the rest.
Marcy, in talking it out with her daughter, made herself vulnerable to what brought her shame. In that, she let the truth surface that she was, actually, not “a piece of crap,” after all.
Building on what our living experiences are, rather than disenchanting, they are healing. The easy fantasy that comes from comparison, from fabricated idealism, and from the personalizing of it, is destructive. We can be resilient by building on real experiences. We can be present and connected both to ourselves and others.
Brene Brown speaks on wholehearted living: “It’s about the willingness to be imperfect, to be vulnerable. It’s about the courage to wake up in the morning and acknowledge that no matter what gets done and what doesn’t get done, that I’m enough, and that I’m worthy of love, belonging, and joy.”
Halloween will be a reminder to me of Marcy letting shame go, not identifying with the thin logic of her own self-inadequacies, and of getting into the living of it. That’s courage. That is brave.
Self-Care Tip: Start exploring where your shame is, and let your real experiences speak toward your belonging and self-value.
Question: In what areas of your life do you feel like you are not enough?
What has helped you discover your reality?
Please tell your story! We need to hear from you. Keep on!
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.
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 :)!
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.
All around me I hear people talking about finding your “True Self.” I hear it in podcasts, coffee shops, in magazines and even books.
What the hell was everyone talking about and if there is such thing, how does one find it?
First, apparently, it depends on who you ask. If you ask a therapist you get a vastly different answer than if you ask a spiritual guide. Honestly, even from one person to the next your answers will vary.
These are all synonyms of this mysterious phrase. After looking at countless websites, I like what the Huffington Post said in the article, “What does it mean to be your Authentic Self by Judith Johnson.” “Living in a place of profound authenticity involves being rooted in your deepest beliefs, values, and truth and living a life that is a true reflection of them. It is about being true to yourself through your thoughts, words, and actions.”
So from what I gather, the true self is something that is within us. Is it nature or nurture? Or is it something in between (the damn gray area that surrounds our lives)? I don’t have an answer for this, but from what I read and what I have experienced, it is a real thing. It’s ingrained deep in our heart and soul.
When I was younger, I was working at a camp in Ensenada for the summer. It was one of the best summers of my life and I felt that I was becoming the best version of myself. That same summer I met a girl (yes, you can roll your eyes now). I fell head over heels for her and we ended up getting married. We were together for fifteen years, and often I would look back and wondered what happened to the man I was becoming and why wasn’t I feeling any closer to being a better version of myself? I felt that I was slipping away and losing myself.
I wrestled with why. Did I fool myself that summer? Did that woman I fell in love with strip me of my manhood? What happened?
The marriage didn’t go. I decided I wanted a divorce, which happened to be one of the first real decisions I had made for myself since I met her. Pain of the failed marriage filled me, but I also felt the emergence of the boy 15 years earlier. My “true self” surface and that I didn’t have to look back in remembrance of that person. I decided that I was going to become the man I had always desired (I do not blame my ex for the hindering of this man, but blame myself. More on this in another post).
I care about the true self because I struggled for years to step on the road and begin the journey. Guilt, shame, and fear were around every corner. This trifecta left me questioning everything I did (and I still struggle with it at times). Being in that dark place is hard, and I want to help others know there is a better way. It’s not the easy way, but it’s the better way. Or as my friend, Major Lewis would say, “The hard right over the easy wrong.”
The easy answer is to be real with yourself. The hard answer is that I only know how I did and it might differ from person to person.
In my first marriage, I was a fraud and could become whomever the person I was talking to wanted me to be. I was like Julia Roberts in, “The Runaway Bride.” Depending on what guy she was with, she liked a different type of egg. Poached with one man. Scrambled with another man. I morphed myself into someone in order to be liked. Sadly this left my true self-hiding behind layers of falsehood. I pushed away those close to me in shame. My unconscious was wreaking havoc on me. I was messed up.
Be true to yourself. Look in the mirror, and know who you are. It takes time and won’t happen overnight. The first time I went to the shoe store to buy shoes after my separation I ran out in a panic because I didn’t even know what shoe I liked.
I started by giving myself permission to experiment. I would try things and then evaluate if I liked it. Slowly, month after month, year after year, I began to understand what I liked. Then I would do more of that. The small steps of trying something new and being honest with yourself will start to open your heart up to seeing deeper questions.
Self-care Tip: Take a chance on yourself. Try something new. If you hate it, great! If you loved it, great! Either way, you are opening yourself up to new opportunities and trying to ignite the flame of your true self.
Brandon Fries lives in Southern California with his lovely wife and daughter. It was through his life struggles that he found a path towards happiness.
Introducing a lovely book written byare sisters who felt compelled to share personal and revealing stories about their father as he fell deeper and deeper into the tragic memory robbing abyss called Dementia. The two sisters narrate their experiences born from different perspectives, but very much driven from the same heart.
Please enjoy and comment. Dementia is everywhere. It affects all of us. Whether we have a parent, a spouse, a friend, or a neighbor with dementia, we are affected. Even if a community member is suffering from this, known or unknown, we are affected, although to differing degrees.
Dementia worldwide is estimated at 47 million and is projected to increase to 75 million by 2030. It is a huge economic impact – in the US, $818 billion dollars a year. People with dementia and those with family members with dementia are often discriminated against. Awareness and advocacy are needed. Dementia is a public health priority. Let us know where you stand. Thank you for reading.
Self-care tip: Everyone has a story. Tell yours.
She must be in her mid-thirties, I thought. Kids – it looks like she has kids. She was well dressed, with a pleasant, kind face. Everyday Mom – a person who is easy to like, a person next door who everyone wants to be friends with.
Just right now though, she was spouting angrily, full of righteous indignation.
“And just to think that they could have easily killed him, I just could not believe it.” Her eyes were flashing. “I told them right then and there, I will never take him back to this doctor. He almost died and ended up in the intensive care for DAYS!”
The reason for the outpouring, my new patient, was sitting quietly, fondly looking on as she continued. He looked to be around eighty, which I knew was about 10 years more than his actual age. Recently diagnosed heart failure, stroke last year – this would make anyone look older.
The daughter was at the end of her rant. “So, we just decided to come straight here and find another cardiologist.” She pulled out a large binder. “Here are all his records – we want you to take over now.”
Usually I try to be understanding of my own profession and not be quick to join in the blame game. After reviewing these records, however, it was difficult not to be blunt in my judgment. Her father’s case had indeed been poorly handled – he was prescribed two medications at the same time with predictable life-threatening interactive side effects. His daughter’s diligence likely saved his life – when his mind started slipping, she had checked his blood pressure, found it extremely low, and immediately called for help.
After some painful experiences in my career, I had learned that instead of pronouncing judgment, it was best to find things to praise.
“You are quite lucky to have such a devoted daughter, sir,” I remarked. “If you are not aware, I can tell you – research shows that men with daughters live longer, so you have an edge there.”
The patient smiled. His daughter looked pleased.
As I was going through his medical records, I was relieved that this new patient had been scheduled into an hour-long slot – there was a lot to cover. Making notations in the chart, I asked follow-up questions – what other medical problems he had, what were his habits, when was he first diagnosed with heart disease. The daughter answered most of the questions – not unusual when the patient is elderly; younger people tend to have better memories.
Working through the records, I noticed a condition the daughter had not mentioned.
“So, the prostate cancer – when did you have that?” The daughter looked confused for a moment and then turned to the older man. “When was that, Dad? This must have been a long time before I met you.” They started discussing the possible dates – the patient did not have the best memory.
This snippet in the conversation caught me off guard. First I thought I had misheard the word ‘met’. Surely one would not use that word for one’s own father? Should I ask? Social history is an important part of the medical exam. Also – let’s face it – I was curious.
“That was an unusual word choice,” I started carefully. “So, I assume you are adopted then?”
“Oh no,” the woman answered cheerfully. “As biological as can be.”
The utter confusion must have shown on my face. She decided to have pity on me.
“Well, of course, I didn’t know who he was.”
…. That did not make things any clearer.
“My Mom refused to tell me who my real father was – so after she died, I started looking for him. Went through as many genetic tests as I could – and I finally found him!”
There was an unmistakable triumphant note in her voice.
The patient just smiled and continued looking at her fondly.
She went on. “So, then I asked him to come visit us last year. That’s when he had the stroke. Of course he would be better off here, so I just asked him to stay and he lives with us now.”
I tried not to react. To be perfectly honest, I wasn’t sure how one would react. The commitment she described was flabbergasting… and to a father who had never been in a picture. This woman had taken a virtual stranger into her home and into her life and acted not only as a forgiving daughter but as a caregiver to an elderly man with multiple medical problems.
“Family is family,” she announced. “I am so happy I could finally be with my Dad.”
I must confess that there was a small suspicious part of me wondering if she will stick to it. The old man was not healthy and with the recent stroke needed a lot of help. After the initial euphoria of having a father wore off, would she think it too much?
On the next scheduled visit, the daughter was there, with the same updated binder. The father was looking better – the combination of optimized medications and stable home care had done wonders for his health.
On the visit after, the granddaughter had joined them. She was a bright-eyed little thing, curious about everything and intently looking at her new grandfather’s heart pumping on the ultrasound screen I was showing them. The daughter was making notes about medication changes. While I talked to the her about the home care, the granddaughter was trying to talk the grandfather into playing a game once they got home. The whole visit had an atmosphere of care and contentment.
I never asked more questions about their history. Why had the mother refused to talk about the father? What skeletons were in that family’s closet?
She probably would have told me. But it was not my place to ask. As a physician, I was happy enough that my patient had good social support.
Family is family. In this case, family that almost wasn’t.
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.
…Continued from yesterday.
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.
Presley couldn’t breath. A truck just drove through his thorax. A monster-hand was closing around his heart. He couldn’t swallow well. Was something stuck in there? Dizziness nearly dropped him, but instead of moving to sit down, like any other normal person would do, he bolted. A fire chased him. He had to escape or he would die. In the bathroom where he found himself, the mirror reflected a sweaty face and crazy eyes. Was he dying? Presley’s phone looked blurry as he dialed, 911.
Please help! I’m having a heart attack!
That was the first time this had happened. After the third visit to the emergency room over the past month, Presley was able to avoid calling 911, although still convinced he was going to die when the next episode hit. He agreed to seek counseling, where he was taught different skills to connect his mind and body, to slow his breathing down, to process, even when he was convinced he was dying. For a time, Presley improved. It was like it never happened. He was almost able to convince himself that it wouldn’t happen again.
This turned over and over, feeling like he was going to die while losing his mind, re-engaging in counseling, thinking he was better, stopping counseling, and then another violent emotional event, thinking for sure, he would die.
It was after his second trip to the ER when he received the recommendation to schedule an evaluation with a psychiatrist. But he preferred to work through this in therapy. Presley didn’t like pills. He wasn’t someone who medicated. An olive-skinned athlete, he lived clean and didn’t believe there was much that healthy living couldn’t cure. And Presley did live clean. He ran fifty miles a week. He ate raw foods. He read his Bible.
After several months of this, his therapist, Dr. Wu, recommended he get a psychiatric evaluation. However, Dr. Wu agreed that he would continue to work with him, whatever Presley chose. (Was this the right thing for Dr Wu to do?) Presley chose, no. No psychiatrist. What would a psychiatrist do to him anyway?! He wasn’t crazy. (Except when he thought he was.)
Presley visited his primary medical physician, Dr. Belinda Jones. It had to be better than seeing a shrink!
Dr. Jones, I don’t want to take meds.
Dr. Jones, cleared him for any medical condition that might be contributing to his events. Only then was she able to convince him to try a “safe antidepressant”, escitalopram. After one pill, Presley had the worst event of his life. He’d never had any experience that was more terrifying. Presley didn’t go back to Dr. Jones, “of course.”
When these emotional tornadoes hit more frequently, he became paralyzed with fear that he would have them in public and be humiliated by them. Presley stopped going to work. If it wasn’t for his rent, he’d never go back. But he had to. So finally Presley agreed to see a psychiatrist. …
To be continued
Questions: What would you tell Presley?
How would you like your physician and/or therapist to handle this, if it were you?
Why is Presley so opposed to taking medical therapies?
Please speak! We need to hear you.
Self care tip: Keep on! 🙂
Dr. Kowalski walked into the hospital cafeteria and found me at our usual table, saying, “I hate it when I go to hug someone really sexy and my face smashes right into the mirror.” It wasn’t his joke but he always had something like this to toss at us other onlookers at the caf on our lunches.
He made me laugh and I felt like there weren’t enough of his type of friendship in my town. He was a peer in my community. He was a professional, a parent, a spouse. I enjoyed working with him and I respected so much about him.
Most of the time, with Dr. Kowalski, we talked about random stuff; hospital politics, his parents in England, God in his life, his kids’ latest antics, and the conversation rolled with content and interest. This day, after his short stent with humor, he skipped the food line, and just sat down to talk, starting in with a doozie.
My son is smoking a lot of marijuana.
Dr. Kowalski described the skeletal points of Frank’s, his son’s, journey with anxiety and then with marijuana. Now nineteen, Frank had anxiety his entire life. Paralyzing anxiety at times, and completely preoccupying at others with worries and inner tension.
Once when Frank was seven, “such a beautiful boy,” Dr. Kowalski told me, how Frank reacted when he was twenty minutes late picking Frank up from school. Most of the kids were gone already and Frank had to wait for Dr. Kowalski in the administration lobby next to the “mean secretary,” quietly in a big chair by himself, until Dr. Kowalski arrived. For three months after this, with his fluffy cheeks and round blue-blue eyes tilted up, Frank asked his dad over and over again, if he was going to pick him up from school that day. Would he pick him up and,
“Would he be on time?”
It was super hard for Dr. Kowalski to witness. Sometimes he would get impatient and snapped at Frank in response. Maybe raised his voice, or just ignored Frank’s questions. Dr. Kowalski felt a lot of guilt about this. He blamed himself in part for the persistence in Frank’s anxiety. If he had been more patient with him, if he hadn’t scared him with his voice, if he had gotten him into treatment… If he had been a better father, would Frank still have anxiety? Would Frank now be using three bowls of marijuana three days a week? Dr. Kowalski states that he would do anything to help Frank get better, and often does. Just about anything he can.
Whether Dr. Kowalski did or did not, Frank believed that anxiety led him to using marijuana.
Dr. Kowalski was the director of the adolescent psychiatry unit at our hospital. He knew that, although marijuana use often decreases the perception of anxiety at the moment, over all, in the way it affected gene expression, it exacerbated their anxiety. The disease exacerbated. So the user felt better at the moment, perhaps, but then the underlying anxiety process became worse and worse. Frank told me,
Using marijuana for anxiety is like a diabetic who takes insulin so he can eat a big cake.
But what could a father do for his son in this scenario? Being right, being correct about something, having knowledge apparently isn’t always how things, like convincing one’s son to stop using, are won. Dr. Kowalski did not know what to do.
Perhaps the guilt, perhaps the love, or for other reasons, Dr. Kowalski had spent the last several years of Frank’s marijuana-using and anxiety ridden life, trying to help Frank get into treatment. Treatment for anxiety.
When treating any biological psychiatric condition, something medical, we have to first look at anything we are doing to harm ourselves. Is there anything that is pushing us in the opposite direction of our efforts? Maybe we are drinking caffeine. That triggers anxiety. Or maybe we are using another substance that triggers, and/or worsens an underlying mental illness. With this in mind, Dr. Kowalski spent much of their discussions trying to engage Frank into preventative measures as part of his treatment recommendations. But what could a father do? Dr. Kowalski was not Frank’s treating psychiatrist. He was Frank’s dad.
Dr. Kowalski told me, with lines seemingly appearing out of no where on his usually bright and happy face, about his frustrations.
The amount of energy I am putting into helping him without results bothers me. And a lot of money to help him get better. I feel it is wasted until he puts in the effort to help himself.
I want to invest in my child! I do! But to help him get better. Not to just spin our wheels. He isn’t working to stop doing the things that actively work against this goal.
Feeling violated to a degree, used, Dr. Kowalski didn’t get it. He was giving his energy, his finances, his time, his emotion. He was giving every time Frank came to him or called in an anxiety crisis. Dr. Kowalski no longer wanted to do the “energy wastage.”
“It’ll be sad if Frank doesn’t get this idea,” Dr. Kowalski said. Frank may never choose to further work on his wellbeing, but the difference is that Dr. Kowalski decided he wouldn’t continue, with Frank, through talking therapies, and talking emotional rescue efforts, pretending they were working on something.
Dr. Kowalski wanted to tell his son,
I’m being taken advantage whether you realize you are taking advantage of me or not.
However, Dr. Kowalski was scared of stopping. He was scared of not staying on the phone for the long long conversations with Frank in crisis. He was scared of not continuing to pay for the talk therapy. He was scared of not continuing to give Frank his monthly living allowance while Frank was in college.
I asked Dr. Kowalski what the difference was between where Dr. Kowalski was now and wherever he thought it would be for him when he wasn’t being “taken advantage of?” If Frank wasn’t going to put in whatever effort Dr. Kowalski thought Frank should be doing to get better, where would that put them? Dr. Kowalski feared that this bond, yes maybe a bond somewhat founded on illness but still a bond between him and his son, would fail.
Their relationship, true, has strengthened, like an Indian trail that is treaded down daily on the forest floor from their repeatedly hashing out the anxiety. If that changed, Dr. Kowalski feared that maybe Frank would not see much reason to call Dr. Kowalski. Maybe what Frank valued in his dad was just that.
Dr. Kowalski told me that he believed there was, in reality, a sustainable bond between them. But Frank? He didn’t know what Frank would believe.
Dr. Kowalski and I rolled this story around in the air between us. After a stretch of disclosing his sincere grief, real fears, and underbelly of sorts, Dr. Kowalski decided, rather than starting with what he would stop giving and doing for Frank, he’d like to ask Frank,
What do you think your life would look like if you didn’t have this anxiety? Who would you be? Who would we be?
Dr. Kowalski said, “I’d love to find out.”
Self-care tip: Start with open-ended questions with yourself and look ahead.
Question: What is keeping you where you are and where would you be if it weren’t?
The bar hummed with the energy of human emotion. It was one of the few places Alfred could still smoke in public. He remembered the first time he was directed to a smoking area in the airport that looked like an enclosure for zoo animals, with glass walls, and positioned in the line of traffic. What in the world?! So Alfred felt unjudged at the bar, and also pumped up.
Alfred got energy from being with people – gravitated to them like a little brother follows his big sister around. If it was the bar, or the smoke break, Alfred got energy if he wasn’t alone. He absorbed every moment, marinated in it no matter how brief. The “moment” was his forever, for however long that moment would last. He was inside the color, flavor, aroma, texture, and song. He noticed. And, Alfred grazed. Amongst ideas, people, choices, and of most anything that came into his field of vision, he chewed it up in that space of time, and then moved on without guilt. Generally people didn’t hold grudges when he moved on. Alfred was just so nice!
When Alfred was in sync with his energy, senses, feelings, and perceptions, and his wife was in sync with her own, she looked at him like he was someone she was interested in. He could make her laugh and play, whereas she was never normally someone who was playful. This was nectar to Alfred’s pollinator.
Out of sync, however, Alfred’s wife called him names when they argued. He was “flakey,” or “narrow-minded.” And Alfred, awkward with conflict, developed the habit of escaping during those times. He did not like conflict.
Alfred began to drink a lot more alcohol. After work instead of going straight home, he’d “catch a few beers with the guys”. When entertaining clients he started joining them when he offered alcoholic beverages to his clients, imbibing during work hours. His work performance started to smell sour like his alcohol.
You can see where this is going for Alfred. When he came into my office, he reported his inability to enjoy anything, increasing hopelessness, and now when he left the bar in the evening, his mood regularly plummets, a false weight in the scale of life.
Alfred looked at me with a degree of distrust, expecting judgment. But of course, he was also coming to me for judgment – an evaluation and diagnosis, and then to present a plan for treatment.
The treatment plan was short this day. Go to alcohol rehabilitation. Telling Alfred that there was nothing else we could do for him until he engaged in a rehab, was nerve-racking for me. (I never know how a patient will respond after similar directives like this. Sometimes they are not kind. Especially when talking about their substances or addictions, of any sort.)
Alfred stood up, a bit like a mechanical man, thanked me for his contact referrals, and left. I thought that was the last time I’d get to see him. It’s impossible not to hope for the best.
The deal with brain illness is that the treatments I am able to offer in an outpatient setting are ineffective in this context. Other stuff going into the body hits those brain receptors, turning genes on and off, like Wile E. Coyote in the back country. It would be enabling the mal-behavior if I diverted our focus onto anything else. Even so, like so many in the company of users, it is wilting not being able to offer more.
About two months later, I was completely surprised when Alfred came back sober! He told me he did just what we talked about, and rehabilitated. More surprising though, was his statement,
Thank you for refusing to treat me. You saved my life.
Alfred was still married, and yes, the marriage was still volatile. But he wasn’t plugging his ears and disconnecting from his wife with alcohol. It was a start. And Alfred still had restarts available to him.
We did end up starting psychotropic medication and psychotherapy, with which Alfred continued to heal.
I am humbled by Alfred’s courage to pursue rehab, the path of more resistance, and recognize that I should never underestimate the same courage in others when they present similarly.
Self-care tip: Taking the path of more resistance may bring just what we are hoping for.
Question: What have you done courageously? Where has it taken you? Please tell your story!
“We know the Bible speaks of sins of the fathers passing to the 3rd and 4th generations while God imbues his kindness and mercy far beyond that to those who love him and keep his commandments.”
Rosa had no experience in the world of mental health, or so she thought. She had spent her formative years studying the world through the perspective of her church and interpretations of the Bible. As you know, there is a lot in both with a lot to say about emotions and behaviors. However Rosa was taught and modelled that these were moral issues and not biological. An either or, verses, part of the same thing. Could we call it sequent variants, maybe something like genetic alleles? Or maybe something better to describe this is out there, rather than an either or.
Rosa Leticia Montoya, at this point in her development, with her own overwhelming emotions and her husband’s plummet into dark moods, felt forced into considering mental health. She did not want to go there, but here in the space of losing control, not trusting herself or Carl any more, and before she was willing to say she didn’t trust God, she was doing what was a last resort. Considering that she was going crazy was the only thing this chaos could mean.
Before she completely surrendered to the idea that biology was behind this sinister change, she had to ask, “Is this because of our parents?” She had spent her life trying to untwist the bad choices her parents had made and the consequences those choices had on her life. Drugs, alcohol, and cheating were what she had grown up with. Quietly. Hiding it in the church. Rosa there, praying a lot to live well and be forgiven. Praying that bad thoughts would go away. Praying to depend on God and not on herself, as seen through her perseverating worries ever since she was a child. Worried and worried. Not speaking of the wrong Bible-breaking life her parents wore like underwear beneath nice tailored clothes. Would she ever be forgiven? Would she ever stop sinning?
So she asked me, “What do you think?”
That’s a lot to work with as a psychiatrist. So I did what most of us do. Ran to the shelter of medicine. Whew! But there is the added benefit that God created medicine, psychiatry, and all that there is in my tool bag worth working with.
Even so, there was only so long that I could avoid the topic of God and His punishments, per her perspective. It came up every visit.
If you believe in God, at some point within your discovery of mental health, this question will come up. Rosa is not alone. Are the emotions and behaviors gone amok, such as seen in anxiety disorders and depression, secondary to moral weakness? Living with “too little” dependence on God’s power? Is it this? Or is it an “either or”, with our biology? …a matter of cellular grey matter composed of DNA-expressing pathology? And is this something evil woven into my DNA because of what parents did? Well, I’ve spent 30-some years in school and now 15+ years in practice in this space and am still trying to understand.
I’m wondering if you would help me articulate this. It’s fundamental for us in self-care. It’s not possible to be very friendly to ourselves with the dissonance.
Self-care Tip: Pursue kindness in your belief systems toward yourself.
Thank you for speaking with us! Keep on!