The Path of More Resistance, and Brain Health

 

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!

Start Over

fabio

Muscled and gorgeous, he came in, like dessert, main course, and appetizer. Some people just carry themselves that way. It doesn’t work if they dress low, chest hair accentuated by opened buttons and glimmering chains. It doesn’t work if it’s their agenda, checking to see if you noticed, a finger hovering over the acoustic applause button. No. Attire must be intact, normal, not baptized in cologne. In fact, attire must be worn as if it is completely a non-issue. Attitude of a jack-rabbit, who never thought about his muscled legs. Those legs just hop because that’s what they do. That is the kind of attitude-ingredient to this kind of presence-recipe.

How would a mother name such a son? How could she know he would turn out this way? Greg is an essential name for this elixir to work, as essential as “Fabio” is to its destruction. Everything else may have been in place, developed over years, like a bonsai tree groomed under the tender ministration of Father Time, and caboom! “Fabio.” The bonsai becomes a paint-can-frosted Christmas tree. Greg’s mother named him ‘Greg’, in fact, because it was the dullest name she could think of, not wanting him to grow up to be anything like the sort of philandering infidel his good-for-nothing pig father “Fabio” was. Greg told me this. I didn’t come up with it. He knew it because his once beautiful mother, who worked seventy hour weeks, told him whenever he messed up, “I named you Greg! This is not supposed to happen!”

In came Greg, after three years of absentia. And it was like I had just seen him yesterday. His mother couldn’t believe that the name Greg would hold such a man, an addict. Yep. Greg hadn’t seen me for three years for a reason. There I was. Chirpy as ever.

Greg! Where you been?

Whenever a patient comes to see me, I believe in him or her. I believe. In part, because I believe in Me. I believe in my value. Wink. But I also believe in them because I believe in Love, and because I’m simply wired to. There are more reasons why we behave and feel the way we do, more than colors in your crayon box. It’s not just a moral issue, biology, or an adjustment to our human condition. Heck. His name may have even had something to do with it. “Greg,” is quite a name. But I did believe, more than I disbelieved, that he hadn’t been in to see me for reasons other than relapse. Maybe his primary doctor was filling his meds, and he was so stable he didn’t need psychiatry anymore! Yah! That’s it!

(This is inside information folks. You can’t tell anyone. My patients can’t know this about me. It could ruin my career! I don’t want them to be any more afraid of disappointing me than they already are. It’s hard enough to be honest in these places, and I do my darndest not to project my Pollyanna-agenda’s on them. They don’t deserve that. They deserve the hard-earned poker-face I screw into place when my heart gets broken. I purchased it with ten-years of my life from some magic spiders I quested in a cliff off distant shores. Bargain.)

Greg! (I said,) It’s great to see you!

Every patient wants to please their doctor. And every doctor wants to please their patient. And we all get our hearts broken at some point.

I was really glad to see Greg, after all. And he was looking good. But then I noticed he had more weather in his face, some clouds, lines, and gutters. And I noticed he wasn’t as glad. He had an aura of melancholy and self-loathing rolling off of him.

His little boy was with him, too, (Fabio. …J/K! Gotcha! Good ‘ol “cycle.”)

Greg sat there, thunder in his sorrow shaking his frame, and we reviewed his story. You may know Greg’s story. Greg may be your friend too. Or brother, husband, dad, or You. And you know the high from this addiction feels better than everything, until it doesn’t.

The best line ever spoken in this context is, “Relapse is part of Recovery.” That is from the God of Hope. That is what makes sense in every illness, like Charles Dickens is to literature, timeless and universal content, man. When Bob reaches for that doughnut, when Harriet rolls the dice at Pechenga, when Fabio uses porn rather than intimacy in a meaningful relationship, when Myrtle has to pull over on the freeway in a panic attack, this is when we ask, “Why am I alive?” and demand to start over for that answer.

I’ve asked that question fifty-plus times a week for fourteen-some years, and every time I ask it, I listen for an answer. I’m curious too. We all are, right?! It’s a marvelous question. Every time I ask, I wonder about the magic that keeps this beautiful creation in our community. I listen, because every answer is something that crescendos into the room, the words explosive, the best part of the atom.

I have a daughter. She needs me.

My dogs. Nobody loves me more than my dogs.

I want to know what it is to live without this.

I’m too scared to die.

God.

I just don’t know why.

Oops! Wait. “I just don’t know why,” isn’t good enough. Figure it. Finger it. Cradle it, and answer. What do you want to stay alive for? Because this thing! This thing is part of your recovery. Another day will come.

Greg left our appointment with options for treatment and a commitment to treatment. I’ll see him again and he’s one of the reasons I love life. Can’t wait.

Questions: Why are you alive? Please give us your answer. It will explode into the universe and someone out there needs to hear it.

Self-care Tip: Answer the question and start over. 

Run Away Before You Self-Destruct – Keep Yourself Safe

Run Away Before You Self-Destruct – Keep Yourself Safe

This is a slight remake from 7/25/10. Hugs to all.

____________________________________________

When you feel the pull to do something that isn’t good for you, turn away from it. Do something that you can stand doing at the moment that won’t make you hate yourself now or later.

In the evenings, when the kids are just in bed, the backlash of the day seems to have a few last flicks. Despite the anticipated quiet, my shoulders are tight. Dusk, when the land meets the sky, is when I feel like eating …chocolate specifically.

I purposefully don’t bring it home, except the darkest chocolate sold with over 75% cacao for this very reason. It’s so dark, it’s practically bark.

Home is my safe place and I need to know that it is as safe as possible, even from me. I used to bring treats home that were to be eaten in moderation, but I found that when the monster in me crept out. I’d board myself up in the pantry and polish it off. That would turn me to self-loathing. It was a cycle. I got tired of being my enemy and knowing what was coming next.

Now, I choose to simply go out for my chocolate. I eat what I want when I’m out, when I’m less likely to eat myself into despair. Now, when I’m home, I can pick a different fight rather than fighting the urge to closet eat. Home is a little more safe for me.

Tonight, the kids went to bed ok, but I still took my turn around the fridge and pantry, even though I knew there was nothing, absolutely nothing, I’d want to eat in my house. I am in danger now of developing something of a ritual in this rummage around the kitchen. The good thing is that when I do make the turn, it leads me to the thought of just going to my bike and riding. Tonight, after a 30 minute spin, while watching the last 1/2 of the première to Glee, I am good again. I’m thinking about the muscles in my legs and the way my body doesn’t walk as heavy as it used to and I feel good about myself. Just like that, I feel a little less self-loathing. I feel more safe.

Self Care tip #1 – Run away before you self destruct. Be a friend to yourself.

Questions: Have you found a safe place? What is keeping your home safe for you? Please tell us your story.

Gathering Friend to Yourself Blog-Post References:
Choosing Safety:
  • basics on Weight Management 2011/06/25
  • Trusting our Clinician, or Not 2011/05/17
  • Self-Care Works You, Pushes You, Tires You Out Until You Are Happily Spent On Your Friend – You 2011/04/25
  • Participate – Work as Part of A Team With Your Medical Providers 2011/04/12
  • Choosing Connections – Take The Good and Take Care of Yourself 2011/04/04
  • Check Your Read. Even When You Feel Shame, Bullied and Herded, You Are Free. 2011/03/26
  • Living Where We Feel Safe is Part of Self-Care 2011/03/20
  • Afraid of Meds 2010/09/19
  • Get in Someone’s Space 2010/09/08
  • Run Away Before You Self-Destruct – Keep Yourself Safe 2010/07/25
Self-Loathing:
  • Number One Reason For Relapse In Mental Illness 2011/04/07
  • So Many Choices, So Little Time …For Self-Care 2011/03/05
  • Say, “I Can’t Control This” When You Can’t 2011/01/31
  • Emotions: The Physical Gift We Can Name 2011/01/06
  • Escape Self-Loathing 2010/10/29
Breaking Negative Cycles:
  • Loving Me without ambivalence – Perfectionism v. Passive Surrender 2011/05/28
  • You Can’t Barter With It. Sleep. 2010/12/03
  • Regardless The Reasons Not To, Go Get Your Sleep 2010/11/22
  • Choose, Gladly, Using Resources 2010/10/13
  • Sleep Hygiene – my version 2010/08/29
  • Pay a dollar 2010/07/29

One Woman’s Struggle To Shed Weight, And Shame

Joana Johnson, from CreatingBrains.com, found the following story on the NPR iPhone App:
http://www.npr.org/2011/07/25/138606501/one-womans-struggle-to-shed-weight-and-shame?sc=17&f=1001

One Woman’s Struggle To Shed Weight, And Shame

by Tovia Smith

Part of an ongoing series on obesity in America.

In her 37 years, Kara Curtis has seen every dress size from 26 to 6. Looking through old photos, in her slimmer days, you see a young girl standing tall and pretty in her tiara as high school prom queen, and strong and lean in team shots of her track and swim teams.

Growing up in rural upstate New York, Curtis and her family were totally into fitness and nutrition. Her mom used to send her to school with a lunchbox packed with liverwurst on homemade whole-wheat pita, topped with sprouts grown in their kitchen cabinet. It kind of makes sense, Curtis says, that she went a bit crazy for chocolate and cheesy stuff when she was finally living out on her own. But it still took her by surprise after college when she gained nearly 100 pounds in a year.

“I remember the first time I ever heard myself called obese — it was terrible,” Curtis recalls. She was at her doctor’s for a regular check up when he started dictating notes in front of her, describing her as “an obese 22-year-old.” “I was just shocked to hear the word obese related to me.” Curtis says.

No Easy Solution

Fifteen years, countless failed diets and another 100 pounds later, “and now I’m morbidly obese,” Curtis says. “And it’s just overwhelming.”

Indeed, as one of the 70 million Americans who are obese, Curtis has watched her weight become the overriding fact of her life. It’s why she put off buying a new car, and stuck with a less-than-fulfilling job (she worried her size would limit her options.) It’s why she bought a custom-made bathrobe and porch swing and why she can’t comfortably go to the movies or get on a bike or in a boat.

“I love to kayak, but I haven’t been in years because I’m afraid my hips will get stuck,” she says.

At 300 pounds, every day is a struggle with the little things — like chafing on her inner thighs or tying her shoes — and with the biggies — like love. With bright eyes and high cheekbones, Curtis is as pretty as she is engaging and witty. And she’s into kids and family, but totally down on the idea of ever getting back into dating.

“It’s not like I can just fix myself and be done,” she says. “If you lose the weight, you’re still stuck with the stretch marks and the extra skin, and the toll you’ve taken on your body already. And I’m probably still not going to be excited about getting naked with somebody.”

She has poured all her energy and untold resources into trying to get fit. But it’s hard to stay motivated, Curtis says, when the challenge begins to look not just difficult, but impossible.

“Really, if there was an easy solution, Oprah would have bought it,” she says.

Many Factors

There is little that Curtis hasn’t tried. Making breakfast one day — a pureed concoction of hemp and rice protein, coconut milk and avocado — she recalls the gamut: macrobiotic diets, Weight Watchers, Overeaters Anonymous, acupuncture, aerobics, meditation, therapy and all kinds of exercise — from punishing pre-dawn runs to what she calls more “joyful movement.”

She starts most days with a vigorous hour-long walk, escorting a group of neighborhood toddlers to their day care. Pulling several kids piled into a big red wagon, she breaks into a sweat just minutes into the mile-long trip. Several times a week, she sweats through a rigorous dance or yoga class.

But sitting down later to a lunch of a squash soup, Curtis concedes that what she really needs is not to burn more calories but to eat less. And yet every time she tries to diet, she ends up binging.

“This is not a simple thing,” she sighs. “There are genetic components. I mean, I look just like [my] grandmother and my aunts.” Looking back, Curtis says, she has battled serious food addiction and body image issues since she was a little girl. “Clearly, there is this piece that is programmed in.”

But it’s not the only piece, Curtis says.

She’s as conflicted about what’s behind her obesity and how to deal with it as society seems to be.

One minute she’s sympathetic and cutting herself slack, and one breath later, she’s beating herself up.

“It’s a very schizophrenic relationship we have with obesity,” Curtis says. “I understand it as addiction, but then there’s also this other piece of me that knows that there is a lack of willingness on my part. So really, who’s to blame for that? Me!”

But another moment later, Curtis will pivot again: It can’t be all her fault, she says. Those who make and serve or sell really unhealthy food also have a role to play.

Walking through her local grocery store, she points out the junk food that lies, like a trap, right inside the front door while the healthy foods section is at the far corner of the store.

“It would be really hard to walk out of here without something with sugar on it,” she says. And once she starts, “I’m never going to eat just one cookie. And there are times recently where I’ve eaten most of a box.”

The Personal As Political

What’s brutal, Curtis says, is that your failure is out there for everyone to see and judge. So, for example, at the checkout, she says, “There will be that moment of being like ‘Oh my gosh, I have ice cream on my conveyor belt.’ Like there is that pint sitting there. And I catch someone checking me out, like I shouldn’t be doing that.”

It’s the same kind of glares she gets on an airplane. These days, Curtis says, it’s like her personal problem has become political.

“Now, it’s not just like ‘You’re fat and I feel sorry for you.’ It’s like ‘You’re fat and that’s taking a toll on my life. You’re burning more fossil fuels, you’re raising health care costs.’ It’s more vigilante. It’s more harsh.”

And that tends to be counterproductive, Curtis says. It just ends up making her feel bad — and eat more. But she’s working hard to get past it. It was a huge step for example, to go on NPR and talk about being fat. It’s taken a long time, but she’s begun to measure progress by more than just her dress size.

“I’m really proud of myself for being honest about my situation,” she says, fighting back tears. “I feel like it was gutsy to come on and say this is what I struggle with, and I want it to stop.”

It’s all part of a very uneasy paradox, Curtis says. She’s got to accept herself and her body, even as she’s desperately trying to change it.

“There were periods of time when I used to hang skinny pictures of myself up on my fridge,” she says. “But that was brutal and mean. And I don’t want to be brutal and mean to myself.”

Curtis says she had a huge breakthrough recently, when she came out of the shower and caught a reflection of herself in the glass door.

“It was the first time that I’d seen that body and not been horrified,” she says. “It was not like I don’t want this to change, but it was just about standing there and seeing the entirety of my shape — and still feel loving toward it.

Curtis actually took a picture of her reflection, and she still looks at it, almost giddy with hope, that she might finally be on the way to shedding her excess weight by shedding the shame that surrounds it. But on the other hand she adds softly, “I’m also at the highest weight I’ve ever been, so that might be complete delusion.” [Copyright 2011 National Public Radio]

Say Yes to Medication And No To Drugs

Please don’t call them drugs.

Image via Wikipedia

Today I spent eight hours in the company of many neuroscientists.  Smart folk.  People I look up to, want to emulate and learn from.  It was an honor.  We covered different stimulating topics about serving our patients, diagnosing better and the development of our field of practice.  We connected collegially, ate too much chocolate, exchanged cards and talked about each other’s families.  I hope to meet them again soon at future related conferences and continue learning from their experiences and study.

The one thing I do not like about any of these meetings however, is hearing people who know better (if they thought about it) naming our good medications “drugs.”

Drugs.  Yuck.  What do you think of when you hear that word?  I think of stigma, addiction, substance abuse, ruined families, fathers who do not come home, needle marks or powder on mirrors, low-living, illegal behavior, dealers, hepatitis and so much more – very little of which is good.  Drugs.  I cannot number how many patients I have spent oodles amount of time on talking them away from the stigma attached to medications because they thought of them as “drugs.”  Blah.  It is not anyone’s fault but we can start over when ever we want to, so let us.  It is time.

Who thinks of anything that actually improves us when thinking of drugs?  Who thinks of life-saving remedies, disease cures, hope, ability to feel pleasure again, forgotten shame, ability to hold a job, restful sleep, speaking well in public, desire to live restored or a mother who no longer wants to drown her baby?  Do you think of that when you hear drugs?

Let’s get together on this and forget the word that carries so much loaded negative meaning.  It is a disservice to ourselves – physician, scientist, grocer, student, surviving family of a suicide victim, newborn baby, patient and all of us who have any connection whatsoever to disease and treatment.

Drugs.  I think of First Lady Nancy Reagan‘s famous campaign in the 80’s, “Just Say No!”  That is not what we want to say or hear when we write or receive a prescription to treat and to heal what can be healed from a debilitating disease.  Just say yes, please.

Medication.  Not drugs.  A word does matter.  A word carries emotion on it like the smell of cookies baking in the oven or the toilet that was not flushed.  A word can start a war or inspire forgiveness.  Words matter.  Words can be part of what helps us be better friends to ourselves.  Why not use them to our advantage?  Let us change our culture and decrease stigma with this simple word – “medication.”

Maybe when I am able to get together with my colleagues again, maybe next year even, we will be using the word “medication.”  Maybe it will be because of the shift in culture people like you and I can start now.

Self-Care Tip:  Please forget about the misunderstood word, “drugs,” and say yes to medication.  Be a friend to yourself.

Questions:  What do you think of when you hear “drug?”  vs. “medication?”  Is there a difference to you?  To you think it would matter to culture and your “Me” if we used “medication” to refer to prescription therapies?  If so, how?  Please tell me your story.

Related Articles:

Fears of Addiction To Medications For Brain Illness

 

Deliberately Setting Myself Up To Improve

dayspa-1

Image by samuelalove via Flickr

Self-care is about improving life, not harm.  Even though it includes doing things we don’t enjoy and sometimes hurt, it doesn’t harm us.

That’s a useful meter-stick when we wonder about something in our life.  Is this harming us?  Including people.  Do I feel better about myself when I’m with them?  Do they help me become a better person?  A better friend to myself?  Or, do they turn me toward things that harm me?

When thinking about our days activities, our choice of employment, things we put in our body, put them by this “No-Harm Meter-Stick” and see how they measure.

A deliberate check-point in my life is consistent with a deliberate goal.  …”I want to be  healthy.  Is this improving my health?”  “I want to have good self-esteem.  Does this improve my self-esteem?”  And the journey is consistent with the beginning and the end.  If the goals for the moment isn’t consistent with our big picture goals than they might not be the goals we want.  Like putting substances in our body that feel good for the moment but harm our life.  There are innumerable examples of this but you get the picture.

Questions:  What checks you when you need it?  What has been useful to remind you in this area or that to be friendly to yourself?  Please tell us your story.

Self-Care Tip – Deliberately set up feedback in your life to let you know that you are a friend to yourself.

See blog-Post:  “You” Are The Best Gift

Fears of Addiction To Medications for Brain Illness

I don’t want to get addicted!

We agree.  Who does set out to get addicted?  Is that really a starting motive for anyone?  “Ok.  I’m going to take this pill crossing my fingers that I get addicted.”  Even those of us who have suffered from addictions of illicit substances such as cocaine didn’t get into it hoping it would hook us real good.

pills galore

Image by "Boots McKenzie" via Flickr

So here are some questions for you:

  1. Do you have this concern about psychotropic (i.e. for the brain) medication?
  2. How do you see prescription medications for brain illness in comparison to illicit drugs?
  • Are they related?
  • And if so, how?
  1. Is there a difference in addictive qualities between one medication for the brain and another?
    • Is there a difference in addictive qualities between a medication for the brain and a medication for the rest of the body?
  2. Does the amount of time we stay on medication affect our risk of addiction?
    • I.e., more time, more addiction?
  3. What are other fears re: the risk of addiction with psychotropic medication that you have or think others may have?

Fears can be anxiety provoking filling us with dread and avoidance, including fears of medication addiction.  However, they can also promote a more deliberate course.  We can use our fears to get friendly with ourselves.  We can use our fears.  Fears can be a the energy we needed to do the work, to gain clarity about what we need to consider fair warning and what should be thrown out.

Self-Care Tip #284 – Use your fears as a tool to clarify what precautions are worth keeping and cleanse your stigmas otherwise.