Today a patient, speaking with a sense of peace and hope, reminded me of the saying, “When the student is ready, the teacher will appear”.

Mm mm.

Self care indeed.

Keep on!

While Audrey and Marlo peruse their Cheesecake Factory menus I people-watch. (I already know I’m going to have the vegan cob salad.) The place is filled. Some are sitting alone, while others are working hard on feeling connected. And once more, a weightlessness hits me.

It amazes. God loves each person in this topped off restaurant.

Even as self-absorbed as I am, a rhythm of thinking that God is all about “the fantastic me,” a Quincy Jones funk beat breaks in. Bounce. Boom. I realize that He is just as intensely absorbed with each individual.

When the weightlessness intrudes, I try to understand it, grasping. Where is the root or rock to grasp while I fall? The only way to date that I can is through our children. We love each of them, not in a quantifiable or qualifiable way—it just is. Weightless. And that’s how God loves us. It simply exists. It’s not about an amount.

I also hesitate to say that it’s qualitative, even though God’s love is relational. Qualitative implies measurability, and God’s love is immeasurable. It just is.

I hope you had a wonderful Palentines. (The term Palentine originates from the combination of the words “pal”, which is another word for friend, and “valentine”.) And if you didn’t, for whatever reason, know that you are loved.

Self-Care Tip: Know the love and value you are held in.

Keep on!

Like walking around parking lot puddles, we spend our lives trying to avoid losses and suffering. That makes intuitive sense and I’d recommend continuing to do that. Smile. However, consider the reversal processing of that.

In film development, there is this option, after the negative image has been developed. The film it is totally bleached away using an acid bleach that starts the development of the negative image. This leaves the unused silver halide untouched, but it is not fixed out, as it will later be used to form the positive image.

In mental health, I might consider this the self care we do for our biology. The stuff no one can do for us. Like the basic 6: food choices, clean air/sunlight, exercise 3-5 days a week, sleep greater than 6.5 hours a night, spiritual, and taking your medication. No one can do these for you. That is what I call being a friend to yourself. They are the most important part of avoiding those puddles in life.

Self-care tip: Doesn’t need saying again after this blurb. :) But let me know how it is going for you! Please reply. People need to hear your voice.

A woman in our community shared this with me about her grief and I thought you’d appreciate it, and even relate.

This woman lost her mom when she was 19 years old to breast cancer. Then, her only sibling had a sudden heart attack in his late 40’s. Then, shortly after, her father died in a matter of days from COVID. Her dad was alone in the hospital. This woman was minutes away and not allowed to be with him, to hold his hand while he passed. There’s other miseries that punctuate the in-between spots but we really don’t need to list them all.

As tragic as her story is, and it really really is, she’s not the only one with grief. She, unfortunately, is not specially targeted by the universe to suffer. But suffering is a lier like that. (…The meaning of LIER is one that lies, as in ambush.) It makes each of us feel like we are “special” in our suffering. And then that “being alone experience” leads us to more isolation, toward progressing danger of becoming a victim to it. We are in danger of practicing “Terminal Uniqueness.”

“Terminal uniqueness” refers to the belief that one’s experiences, feelings, or struggles are so unique and individual that no one else can truly understand or relate to them. It’s a mindset that can hinder connection and empathy with others who may be going through similar challenges. In reality, while each person is indeed unique, many share common human experiences. Recognizing this can foster a sense of connection and support. And that’s not friendly.

I’m blown away that this woman reached out when she did. That she fought the current pushing her into isolation.

Yesterday marked a sad day for me, and after attending my brother’s service last night, I penned down these reflections:

What signifies healing? Is it the capacity to discuss painful matters without tears streaming down your face or suppressing the choking sensation that seizes your breath as you attempt to stifle the cry of agony?

Today, I found myself ugly crying—recalling this day four years ago when I lost my brother as I woke up. I sobbed while being embraced by my family this morning, as we tried to share the weight of this memory. During our ritualistic journey, we laid flowers on their headstones to mark our presence, and I cried again at my family’s gravesites. Despite my efforts to smile through the tears, I continued crying while driving home, in the shower, and even now in my bed. It’s the kind of crying that causes your eyes to swell shut and your sinuses to congest, forcing you to breathe through your mouth. Physiologically, it happens as you squeeze your eyes tightly to stop the flow of tears, pushing the fluid into any available space. It’s the kind of crying where sobs cannot be silenced, your heart literally squeezes in your chest, and you become light-headed from the effort. It’s unsustainable, but grief takes you there time and time again.

So, I attempt to reframe my brain, tricking my body into thinking it’s a good idea to endure this again another day. To face and even embrace what lies ahead, because those of us still here are the fortunate ones, right?

But for now, in this moment, I miss my nuclear family—the core of my memories, my childhood, the ones I call mine. I miss them from the top of my head to the tips of my toes, with every breath and heartbeat, every fiber of my being. I miss them in an abyss, a void that never diminishes. In these moments, I realize I am forever changed by their loss and acknowledge I may never find my way back because, in the center of it all, there is nothing and no one that can fill that piece of my puzzle.

Self-Care Tip: If you have your own story you’d be willing to share, please do. Be in community with your suffering.

Keep on!

• Are you irritable?
• Do you have a chronic illness?
• Does your family complain that you don’t seem like yourself?
• Is it hard to feel pleasure?

These, and more, Signal a high likelihood of a chronic untreated, low-grade depression. Your quality of life could be much higher.

Today I’m speaking for a group of all unmarried females ages 25-55. Varied educational backgrounds. The members are all Christian so I am told that they usually appreciate scriptural references, and also real life examples and practical applications.

Subclinical depression reminds me of those verses in Revelation about how/(whom) we don’t see ourselves.

14 And unto the angel of the church of the Laodiceans write; These things saith the Amen, the faithful and true witness, the beginning of the creation of God; 15 I know thy works, that thou art neither cold nor hot: I would thou wert cold or hot. 16 So then because thou art lukewarm, and neither cold nor hot, I will spue thee out of my mouth. 17 Because thou sayest, I am rich, and increased with goods, and have need of nothing; and knowest not that thou art wretched, and miserable, and poor, and blind, and naked…

Revelation 3:14-17 (KJV)

A people who are doing relatively well by the looks of it, but who are not really able to see that although this is how it seems, they actually are in a condition of suffering.

I don’t really use a lot of Bible verses in my general speach or writing because I just don’t know how to do it w/o become icky and preachy but i’m going to try. Please give me as much of a break as you can and know that yup. I hear it too. Ick. It’s not God’s fault. So there you have it.

But why would depression bring this seemingly unrelated reference to Laodicea? Because of the next verse.

18 I counsel thee to buy of me gold tried in the fire, that thou mayest be rich; and white raiment, that thou mayest be clothed, and [that] the shame of thy nakedness do not appear; and anoint thine eyes with eyesalve, that thou mayest see.

Rev 3:18 (KJV)

I don’t know if the word “insight” was even around when John the Revelator wrote this but that’s what he was talking about.

You can’t listen to your insight and intuition all the time. You have to have a healthy dollop of distrust for your own inner voice. The siren’s song of our inner self to isolate and “do it on your own”, however dulcet and powerful, are dooming.

When Marsha suffered a dramatic loss in the stock market, she became crippled by anxiety and irritability. It had the further outcome of estranging her from her spouse and friends. She spent all her clean, controlled, but lonely time, alone, like a many thorned beautiful rose in a glass vase.

Marsha and I tugged with this concept, like holding onto different ends of a rope. She did not want to start pharmacotherapy. She did not want to disrupt her flow.

Sometimes our lives are “in flow,” but it’s not a healthy flow. We are doing some healthy behaviors, such as exercising, getting our sleep, eating well. However despite this, our emotional disease progresses, unchecked by uncomfortable deliberate efforts. Sometimes we are medication adherent even, and yet our behaviors and emotions are not kind to ourselves. We remain in a condition of suffering, isolated; unable to connect to self and others. We are undertreated but we can’t see it. We think because we are going to work, taking care of things, we are “making it.”

As my beloved residency attending used to tell me,

Look who’s telling you that.

By which of course he meant, your own brain can not be the best mirror of your soul.

Compare Marsha to Madge.

“I like the way he sees me.  I have a lot of trouble seeing myself.”

Madge really had it going, as far as I was concerned.  In this one statement, she is insightful.

Juxtaposing being able to see into oneself with the self-declaration of not being able to see, is ironic.  It is lovely, like going toward anxiety to diminish its power over us.  It is complex, as are the many hues of gray.  A beautiful weed.  Great weakness.  Useful trash.  It is a pretty great irony to come to that place of wisely recognizing how little wisdom we have.

We have trouble seeing ourselves. Part of what makes it so hard to be friends is that doing that is like shaking our own hand.  When we try, we are a purse flipped inside out.  The crude insult, “Her head is stuck up her own a–!” comes to mind.

Back to our handy John the Revelator, …

18 I counsel thee to buy of me gold tried in the fire, that thou mayest be rich; and white raiment, that thou mayest be clothed, and [that] the shame of thy nakedness do not appear; and anoint thine eyes with eyesalve, that thou mayest see.

Rev 3:18 (KJV)

Everything he counsels us to buy is from outside of “Me” and in this case, the “eyesalve” is the brain-changer.

Looks who’s telling you that…

Now if you want to know more about undiagnosed untreated chronic depression, lets talk today at the meeting.

Keep on!

The intricate tapestry of sleep intertwines with various aspects of life, reflecting its impact on physical health, emotional well-being, and interpersonal relationships. Let’s weave these threads together.

Here is the outline for tonight’s NAMI meeting:

• **Understanding the Biopsychosocial Model:**
  • The importance of the biopsychosocial model in addressing sleep difficulties. By considering internal and external factors, embrace a holistic perspective.
• **Importance of Biological Perspective:**
  • The recognition of sleep as a fundamental component of our biological identity – Sleep is not merely a restful activity but a vital process that shapes our emotional and behavioral well-being.
• **Tools for Better Sleep Hygiene:**
  • Practical tips for better sleep hygiene serve as actionable tools to enhance the biological foundation of our mental health. From bedroom habits to daytime activities, these tools offer a roadmap for fostering healthy sleep.
• **Daytime Alertness and Stimulating Medications:**
  • Underline the importance of daytime alertness, emphasizing the connection between wakefulness-promoting activities and overall mental well-being. The introduction of stimulating medications provides an additional layer for those facing challenges in staying alert.
• **Personal Stories:**
  • The challenges of adopting better sleep hygiene are a human issue we all have, and our home system/culture paved the way we got here.
• **Psychiatric Vital Sign: SLEEP:**
  • Underscore its diagnostic significance. This reframing encourages a proactive approach in assessing and addressing sleep-related concerns.
• **Cultural and Emotional Complexities:**
  • There are cultural and emotional complexities tied to sleep, acknowledging that changes in sleep habits involve more than just physical adjustments. It’s a journey of self-discovery and adaptation.
• **Advocacy for Sleep:**
  • The call to fight for one’s sleep urges individuals to prioritize their well-being. This advocacy is a powerful reminder that prioritizing sleep is an act of self-love and perseverance.
• **Sacrifice for Well-Being:**
  • The essence of sacrifice for a healthier, more capable self. Prioritizing sleep is not a selfish act but an investment in personal and relational well-being.

In weaving these narratives together, the common thread is the recognition of sleep as a foundational pillar for overall health. Whether approached from a medical, psychological, or personal standpoint, the message remains clear: prioritize sleep for a richer, more vibrant life.

One of the many reasons I speak at these meetings is that it gets me thinking and writing more.  In brief, we’ll talk about, well, sleep!  (Smile.)

Keep on!

Hello “FriendtoYourself Community”!

Have you ever heard of a day hospital? In the psychiatric treatment options, the day hospital is a gem. Sometimes it is known as a “Partial Hospital Program”, or PHP. This hospitalization is called a “step down unit” as well and is classically where people go when they need more than typical outpatient care with either or both of a psychiatrist and a talk therapist, but they are not needing full inpatient care in a hospital where they stay overnight. In my community, one of our hospitals is working to develop a day hospital program.

I’ve been asked about my experience with patient’s of whom I’ve referred to psychiatric day hospitals. “They” want to know about the demographics of whom I send, why the patient’s go, and their outcomes. They have a concern that by providing day hospital care, it puts the community at risk for increasing homelessness. You can see the pavers span a distance before arriving at that conclusion but it is understandable if we walk. Fears are important. None of us are above them.

Oftentimes, patients on initial evaluation come to me in crisis because they wait. They prefer to try anything else before seeking help, even resorting to unconventional methods. There has to be something in their life that pushes them to the point of willingness to see a psychiatrist. They come to me when it’s either see me or go to a psychiatric inpatient hospital bed. They may not qualify for a 5150, (a legal hold when someone is danger to self, danger to others, or gravely disabled – unable to provide food, shelter, or clothing for themselves). Yet although they are not disabled, at that time in their illness, I may still not be the best match for their medical care.

Outpatient clinical psychiatry is for people not in crisis. If you’re having an emergency, you should not be in my office. My outpatient clinic is not equipped to deal with emergencies, aside from being able to call law enforcement. For those in a psychiatrically fragile condition, they need more. In outpatient clinics, there are fewer allowances for this.

So, it was with Anna. Seeing a psychiatrist was the very last thing she was willing to do to get better.

People like Anna come to me at a critical juncture in their life. It’s a choice between visiting me or heading to the emergency room.

Let me introduce you to her. Anna is a 38 year-old mother of three. She’s been married for 15 years and comes from a family who survived their own depressive mother and a father who excessively drank alcohol. Her mother parented in the ’70s and ’80s when there were not many options for her. Her mother had tricyclics and MAOI‘s until Prozac came out in 1987. It was a different world of understanding mental illness and being able to treat it. Anna and her three siblings grew up with a depressed mother and an alcoholic father. Depression is contagious. So, Anna grew up with a household of depressives. Not only is it impossible to live with depressives without getting depressed, but she also had the added burden of her genetic loading written into her DNA. She was at high risk of developing depression herself.

In high school, Anna met her first and last boyfriend, Dave, and she thought he was everything; religion, hope, and fresh backed cake. They went to college together, moving in their freshman year and dropping out when she got pregnant. They had an active life before pregnancy, going out all the time and having common interests. They were best friends. It was the happiest time of her life. Then, when the babies came, life became more difficult. Dave started using drugs and alcohol, and they hadn’t had sex in eight months. They were not connected, and Anna found herself really loving her kids but not liking them. She could hardly stand listening to them cry. Their needs, as expressed through their angry voices, pulled on her viscerally. She felt like she was losing her mind.

Now, her children were irritable, and in this next generation, the contagion of Anna’s depression spread through the family. You can trace, now, three generations have suffered because the biological was never treated. The psychological and the sociological followed and also became misaligned.

When Anna first came to me, I was actually happy because she was entirely treatable and had huge resources that she hadn’t yet accessed. I knew Anna had this coming, and I was happy because she was totally treatable. My heart also broke to see something that was so treatable savage three generations.

Even so, I knew that the outpatient clinic was not the best treatment for Anna because, in outpatient clinics, the services we offer people in crisis are not the best for them. Anna was in crisis. She was having morbid thoughts that life wasn’t worth living. Her whole family had become emotionally ill in the context of the contagion of her depression. And she felt like she was losing hope. This was a higher level of care than what I could offer in the clinic.

In an outpatient clinic, I don’t generally see people more frequently than every three to six weeks. Anna needed to be seen much more frequently, especially in the short term while her medications were established and had time to take effect. She needed intensive therapy, more than what outpatient therapy could offer and intensive enough so that it could actually reroute the way her automatic thoughts traveled in her brain. She needed intensive dialectical behavioral therapy that helped when something triggered her mind, and the electrical conduction traveled across her neurons; then it actually chose a better pathway.

When a patient like Anna comes to see me, I refer them to the outpatient program, a higher level of care than what I can generally offer as an outpatient clinician. You can see the reverse of this as well. When a patient stabilizes from an inpatient psychiatric hospitalization, then they should be referred to an outpatient hospital program rather than to my clinic. This outpatient hospital program in this scenario is called a “step-down program”, one that allows them to continue the healing with intensive and close follow-up; (generally 5 days a week for 4-12 weeks). We call this a step-down program or a step-up program, depending on which direction the patient is coming from.

I’m happy to report that Anna went into the outpatient hospital. After nine weeks of intensive psychotherapy with weekly physician monitoring of her medication, medication adjustments, having a nurse available to her five days a week, having an individual psychotherapist assigned to her, as well as attending groups every day, I am so happy to say that Anna is back in our community. She’s back at home with her kids, and stable on medication. Her illness, her biology is healed, and now her family is starting to heal.

In fact, Anna is able to work again. She is a certified ultrasound technician, and she’s now helping to support her family. She and her husband are healing together; he is now in treatment as well for his alcoholism and no longer uses drugs to escape. And you can see how close it was for Anna to lose everything. She almost lost her family; she almost lost her capacity to be gainfully employed and contribute to her community. She almost lost her marriage; she almost lost everything that she considered worth living for. Now she has it back. It’s humbling, and now I see her in the clinic every 4 to 8 weeks depending on her needs. Sometimes we go 12 weeks because she’s stable. I always know when somebody’s stable because they really don’t want to see me that often.

And every time I see her, I really wish I could see her more often. It’s the bummer of being an outpatient psychiatrist.

Self-Care Tip: Go get medical care for emotions and behaviors that aren’t working out before they escalate. Sooner is better! And if you don’t, just go as soon as you are ready. Just get in. Keep on!

Question: Have you every gone to a day hospital? What is your opinion of having these in your community? Speak! We need to hear you.

Different ways that holidays affect Mental Health

Fall is here!

In Southern California we have a glossed version of this and not the classic effect. But what we do have, includes this. Every morning when I wake up and open our bedroom door to the great outside, the fall “air” bursts in, hits my amygdala and a slurry of happy neurotransmitters perfuses throughout in a language I don’t have the best words for. I “smell”? or sense? or something, the air, and it says, “Fall is here.” So lovely and wonderful.

The problem in psychiatry, of what these changes do to our biology, come from the body rhythms. Some of us lose the sun to Jack Frost’s government. Some struggle with the time change. And the holidays have their own weighted steel tipped boots that kick up at any of us within kicking distance. Relationships struggle.

Here is a quick list of Fall simple treatment options I just thought you might like:

1.) How to Have A Stress-Reducing Conversation, from the research of Drs. John and Julie Gottman.
2.) UV lamp to help with the seasonal influence on mood and circadian rhythm, with a 10,000-lux intensity with full-spectrum light bulbs.
Also get 10-20 minutes in the morning and in evening before sunset of what sunlight you can.
3.) 10-20minutes of exercise every morning routinely, getting your heart rate up, thereby helping especially with mood, anxiety, and circadian rhythm. Of course you can do more but for many, this is a reasonable bite off of life’s apple. Consider just starting with a video from online that will even do 5min of core, and so forth.

Happy Holidays!

Keep on!

Hello Friends!

I thought you might enjoy the outline of a lecture I’m giving Tomorrow to CUSM (California University School of Medicine) 3rd year medical students. It’s one lecture intended to cover mood spectrum and anxiety spectrum disorders.

Ha!

Here’s the outline:

I want to give each of these students four years of psychiatry residency, just so they can grasp some of this. I don’t know how to get it to the community. Depression is biological. Physiological. It is dramatically under diagnosed. It is largely responsible for treatment nonadherence in any area of medicine. And it destroys our own lives.

I remember when I was a Psychiatry graduate of 6 years, when the word sounded through our community. Dr. Schultz’s, our beloved residency director, the one who had joked around with me, who had worked so hard to eliminate my imposter syndrome and who gave me a sense of being among my people, he shot himself. In our clinic’s corner bathroom, between seeing patients, he used his own gun.

I am still grieving him. He was a mentor. He was a friend.

But more than his impact on my life, he was a father of a preteen son, and was survived by many beloved family.

I’m sure you, readers, have your own stories. Maybe even against your own person. Please share them here. We need your story. Somehow, our community, our practitioners, our own medical graduates, don’t understand. Depression ruins us. And treatment can heal.

Keep on!

The trenches are not the pathology.

The stressors, the triggers, the many things that go very wrong every fraction of a second in our lives—these are not the pathology. These are normal. These are what we all have.

The pathology is being alone.

Don’t hang out in the morass of bad-alonen. Be in community. Push for that in your life. It may not come “naturally.” Community is part of self-care.

Keep on!

My reaction when I heard this was about the money. I thought, “Why not put that money toward mental health?” And I proceeded to look up related costs and details that wrapped around me like strings, making me dance. My emotions got involved. But if you know me, you’re thinking, “When aren’t they!?” Smile.

I continued to reflect and landed on, the value of our lives. How rotten does someone need to be before they should end it? How horrible should their tally of mistakes, and even volitional wrongs, quantify? And then I get caught in the eddy of political thought about law and the impact on community and so forth. And that is just not where I want to go either.

There has to be more than a bank account of talents, good deeds, beauty, popularity, and all the accoutrements that marks us. Life, your life, matters. That’s the truth of all of it. The world is better with you in it.

My patient, Ronald, came twelve years ago with a severe depression. He wasn’t interested in anything. He had 39years of successful employment in the entertainment business and used to love it. He just didn’t care. He wanted to retire and even just die. We jostled his medications and the right ones fell into place. Now he cares.

Ronald is now interested. Interest led him to purpose and that now gives him a greater sense of the value of his own life.

My patient, Evelyn, also in treatment for many years, has struggled more finding her treatment response. Sometimes she is “there” with her mental health, and sometimes she is not. Often she hates herself. She relives years of horrible sexual, physical, emotional abuse during the worst of it; thoughts intruding without invitation. She loses her freedom to choose her own thoughts. She wants to die then. Other times, she sees her value. It is a “life-er”, this battle for the mind and body and spirit. Today, Evelyn doesn’t want to die but still she isn’t doing well. Life has swung again and got a kidney punch in. She can barely breath.

The community at large must say, “Evelyn, you think you are ugly and rotten inside but it is a false perception” of an over-watered cactus, putrid smelling. Even so, that’s not the point. The point isn’t how good or bad we are. The point isn’t performance. There’s waaaayyy more than that which marks us for life.

400-million dollars. How many should suicide a year to justify the expense? If we could, we would pay for a net around each one of those who have lost their tether. But regardless, we must know, each of us, “No matter what condition you are in, the world is better with you in it than without you.”

Self care Tip: Step away from the edge and know you have value no matter what condition you are in.

Questions: Have you ever thought about not wanting to live? Why are you still alive?

Keep on!

Man lost 2 kids to drugs, Wife to divorce and her addictions, terribly depressed and anxious with his own morbid thoughts.
After finding the right medication treatment, he is able to grieve better because his biology is better.
Everything in his life is still the same except his biology. His biology is not. His biology is well.

That is self care.

Keep on.

Lyft rides are blowing my mind. They’re becoming the stage for some of the best dialogue of my day. Really cool people driving these rides. 

Today’s post is a bit of a hodgepodge, as conversations usually are.

My driver, call him Brandon, was a 20-something married man, who considers starting a family. We talked about using these days, before kids come to push push, to grow. Because life trajectory changes to a perpendicular when kids come and that life trajectory you are on for the many years before they come will be gone gone. Growing “now” is a privilege that changes shape after kids. 

Also start each day having a worship with your spouse before even getting out of bed. Make that a habit that will cross over, in part because it is routine. The behavior has pressed into your basal ganglia and is now automatic. Then it won’t take energy when energy has become such a guarded commodity. It can save your marriage. Parenting inevitably changes your togetherness-flow, your common ground. What was once likable about you from your “other life,” diminishes by the force of where all our energy bank ends up getting spent on. As we age out, we have to keep working on having shared experiences and interests. Kids are a distillation to what we have in common and hones our energies toward their needs. The interests of the partner can rank down. It’s not rejection. It’s accounting. Be proactive about maintaining intimacy and connection with your partner.

Brandon then shot in the dark with his next question; “What happens after you die”? This is such a wonderful topic. I go to the Bible. And without getting into a Bible-verse-battle, I’ll just give the big picture and we can do a study any time any of you like. It is a topic of huge hope and super calming. 

When we die, we sleep. Our spirit, or breath or soul as it is called, goes back to God who gave it to us and He holds it while we sleep. Then when Jesus returns, he wakes us up and everyone who is asleep in Him will greet him along with everyone who is still alive, together. There is nothing that we are doing in between death and God’s coming other than sleep. God’s character is so loving. If we were going straight to heaven, it’d be pretty tough watching the immense suffering of all our loved ones on earth that is still going on. That’d be a terrible burden. He spares us.

It’s important to note that the beliefs about the afterlife can vary widely among different religions and individuals. My beliefs are not meant to be a disregard of them. I don’t know everything! I really don’t even know a lot, when you look at this by volume. lol! And I know what I do see as truth will morph into a more complete view by God’s grace. There are so many dimensions and paradigms that my basic biology can’t grasp. And isn’t that wonderful. How boring otherwise! Eternity is a long “time” and who wants it if it is an eternity of what I see. Ultimately, beliefs about the afterlife are a deeply personal matter, and it’s up to each individual to explore and come to their own conclusions.

Brandon asked, are you a pastor or something? Laugh. Nope. I’m a psychiatrist. I just am a psychiatrist who reads the Bible. Whoever you are. The Bible helps us walk our walk, together with each other and with God. And the only thing that lasts is love. Nothing else we gather will survive us. But He/She who holds our spirit, holds our love too until we wake up again and we will recognize who we are in relation to each other and to Him/Her. 

Self care Tip: Set up patterns in life that connect you to each other and to God. Keep on!

Question: How do you connect with the people you love when the connection frays?

Dad died and the concept, “This world is not my home”, started growing exponentially. The difficulty I’ve been running into is talking about eternity without disregarding our ongoing human experience. 

I matter. 

Human suffering matters. This includes missed opportunities. Things we wish we were. I wish I was a fabulous musician. And athlete. And I wish I could look at my wardrobe and know which clothes I should just toss out. We have eternity to grow our many facets. I’ll have a better wardrobe. We are not allowed to grow so many of these facets in this world and that’s important, but it matters that we have grown the ones we have, the ones we have fought for. It matters that we have dug in the dirt and been soiled by traumas too horrible to speak of. It matters when we summit and when we slide. 

Jesus came to the globe, gestating in womb, walked Jerusalem and Samaria, 100% human, not living as God even though He never stopped being God. He gets us. He gets the trauma and the great sensation of realizing hard earned hopes and what comes after that. And then He wove our human conscious awareness into an awakening of our eternal selves. 

This matters. 

We are more than this. “I see you. You’ve got a lot coming.” There is movement in this. There is an exercise of presence, along with the exercise of growth and hope and future. 

There is nothing lonelier than a summit without a sense of going on and toward. Listen to Freddie Mercury, 

“You can have everything in the world and still be the loneliest man. And that is the most bitter type of loneliness.” “Success has brought me world idolization and millions of pounds. But it’s prevented me from having the one thing we all need – a loving.”

A summit without connection is isolation. There is no movement. So how do we talk about this hope and future without dismissing our now? I remember my brother on his unspeakable pain of no longer living with his children, when I opened my big mouth and said something like, “I’m so glad we have a forever. A space without edges when we will not be separated. When we get to do all the things we weren’t allowed to do in this life.” And he turned to me and said, without aggression but rather immense sadness, “This feels like a threat.”

My brother was responding from humanity and I was moving right past it into a place of disconnected unrealized otherness. And whizzing past someone, like the Road Runner, can be catastrophic to them. I suppose he felt like I was dismissing his current, ongoing place in the world and indeed. That was threatening.

I see my dad watching football in the electric recliner. The Sunday paper is in his hands. He’s making unconscious glottal noises that sound like something cooking on the stove. Mom is thrumming through the house like a lawnmower, always moving. Always working. Always serving. I see my dad in the garden picking white sapote. “Get me that one over there, Sana. See. It’s still good.” And the sapote dissolves in my mouth as sweetly and as fast as this memory does. Dad has persimmons in his pockets and I’m trundling beside him, chattering and heard. He heard me.

It matters. 

And I know I will see Dad again and not be separated and that matters too. Prepping for his 82nd birthday party when his friends would come one more time to our home, Dad tells me to sing, “that song,” for his funeral. “The only Thing I want is to be with Jesus. Just to see him smile and say, ‘Well done.’” And my attention shifted from Dad here with me to Dad apart for a time, asleep in the care of Jesus. We will greet Him together and there will be no more tears and no more saying goodby. 

I never got to sing that for his funeral and I guess this is sort of an apology too. It was the worst. All I did was blubber!

Frank tells me about his son dying 10 years ago.  I asked him how to avoid inking like this, marking up one experience by talking about another. He says to ask more relational questions about his son. Get the survivor to focus on the things that they should be focusing on. I like that. It’s going toward the pain rather than away from it. So can we go toward the pain while describing our future? Frank recalls when his son died he had a pair of gloves in his briefcase he had intended to give to a lady who sold papers on the street and had cold hands all the time. “He was me but so much better in so many areas.”

Rev. 21 Verses 1 to 4

He will dwell with them, and they shall be his people, and God himself will be with them; he will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning nor crying nor pain any more, for the former things have passed away.

Dad died three years ago, Good Friday. The earth has not felt the same under my feet since then and I’m glad of it. Because it is one more way that speaks, “You matter.” And I’m am able to gain movement into the weaving of our future.

Self Care Tip: Find a way to integrate our future beyond this life with the significance and value of our present experiences and relationships. You matter!

Question: How do you bring your present suffering along with hope? Speak.

I remember I was wearing my blue polyester-blend maternity outfit; a shirt that tented over my son, who was growing inside at the time, and pants that hid a band of elastic the size of Texas. I remember the kitchen florescents, whilst getting breakfast ready for my daughters. We had slept over at my parent’s home because my my mom was out of town.

Dad had been, “going through it,” during those years. He was suffering the progressive sequela of Guillain-Barre syndrome, feeling like his extremities were aflame, burning all the time, plus a long list of other stacking medical conditions. He was trying to survive the losses. These, along with their respective medication therapies, clouded his consciousness and he was not a good driver. That morning when in the kitchen getting ready for our day, Dad showed up, somehow dressed and ready to go to work as well. The business he worked for at the time provided a driver, but that day, he either wanted to drive himself or the driver wasn’t available. I remember the keys in his hand.

About ten minutes later, our neighbors called us. “Sana, I just passed some emergency response vehicles parked by a car that looked like your dad’s. I think he got in an accident.”

And I knew. I knew. Dad had crashed.

There was one road that came from my parents, leading to three more roads, that fed into the west, north, and east. Thinking I had a one in three chance of finding him, I went driving. Somehow I came upon firetrucks. They were driving loudly, and again, “I knew,” they were going to Dad. I followed them Eastward.

Dad had hit a tree and his car split in the center. He was being removed at the time from the front half. The second piece was a distance behind. I remember his face, knowing, “This is Dad,” even though I couldn’t recognize him. There was so much blood.

People had gathered, watching my dad being pulled out of his wreck. One of the officers asked me to go back to my car. It made me upset, and now that I look back, I don’t know why I wanted to get to my dad. Did I think I could save him? For some reason, even fully aware that I was trained in psychiatry, (not emergency medicine mind you,) and as a thirty-eight week pregnant beast, I think I did.

This was the second life threatening event I went through at the end of my third trimester in two of my pregnancies. The first was when my niece died. That’s another story. But in both of them, although utterly helpless, I thought I could save my family.

You know the answer to that though. You know. You know what my viscera did not. I couldn’t save anyone. My niece died, and my dad suffered more and more, chronically ill with a step-wise decline, until he also finally died two years ago.

You have survived your own life threatening events, or other sufferings, that has made you think of being a savior. We all have. And although we can’t be her or him for ourselves or others, it’s always been true. We do need a savior.

Today for, “Sabbath School”, I’m speaking on the topic, “The End of Evil.” While studying this morning, I remembered driving up to Dad. His car split in half. I was running, two hundred and three pounds of me. Holding my huge front side, I remember calling him, “Dad! Dad!” Thinking, “He’ll answer me. Call him one more time.”

And that, Folks, is what trauma looks like. Trauma from an emotional standpoint and from a physical, i.e., he just got his face bashed in, standpoint.

I’m not going to write more about trauma today, nor about needing a savior. I’m really just starting a thread.

I have to go study more. But what is your story and what do you think?

Sincerely, and Waiting to Hear From You,

Your own, Dr. Q.

Keep on!