anxiety

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When You Can’t Control This, Emote Empathically

Self-Care Tip #172 – When you can’t control this, emote empathically.  Be a friend to yourself.

A couple of days ago I wrote about being transparent with ourselves and others when we are not in control of things.  (Say, “I Can’t Control This” When You Can’t.)

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It got mixed responses but all worth thinking about.

Jennifer responded on Facebook,

The 3 C’s help me all the time; I didn’t cause it, I can’t control it, I can’t change and or cure it!

Isn’t that wonderful?!

  1. Cause
  2. Control
  3. Change

And it’s helpful to remember that claiming these 3C’s still may not remove us from the stressor.  We are however more present with ourselves and others despite the stressor.

Another reader BeeBlu’s, brought up that famous “fine line,”

I agree that it’s healthy to have this attitude to certain things in our lives, but as you say, it is also no excuse for bad behaviour and letting emotions go into free fall at the expense of others. I think there is a very fine line between the two. bb

…And her signature, “bb,” – awesome.

A line that is thin implies insecurity, danger and something precarious that may end up all wrong.  I wonder about that line.

On one side we have the 3 C’s:  cause, control, change.  On the other side of the line we have responsibility for the boundaries of others.  I wonder if there really is a dividing line after all or if it is just bad lighting.  If there wasn’t, there would be no need to thicken the line, to defend, or to pick sides.

Emotional health makes shadowy lines disappear.  It takes someone who has emotional health to be able to say their 3 C’s and still consider the internal and external milieu of others.  It takes someone who has done their self-care and put money in the bank; someone who has reserve built up that spills over into empathy.  We can’t emote empathically so well when we aren’t emotionally healthy.  The less of that, the more real the line becomes.  The less of that, the more precarious we are.

Gaining emotional health may take medication, exercise, sunlight, granola, grandma’s kisses and all sorts of things.  Each of us has to figure it out for our own selves and just do it.

Questions:  What do you think about this business of shadows, lines, and living cautiously?  When you have been healthiest, how have you been able to embrace both the 3 C’s and emote empathically at the same time?  Please tell me your story.

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Tell People When You Fall

It's no laughing matter ladies... Monthly brea...

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Self-Care Tip #171 – Tell people when you fall.

Driving today, I was slowed by a driver ahead of me.  I started to get irritated, (I know, “I can’t control this“), but then I noticed the car had bumper stickers supporting breast cancer.  In less than a moment my mind grabbed memories of faces, feelings, conversations, stories and personal experiences in my memory relating to breast cancer and I suddenly felt a sense of empathy and some sadness.  It left me a bit surprised and I reminded myself I was irritated at this driver.  While trying to tease apart these seemingly opposing reactions, I realized I didn’t care much any more about the slowness.  Mainly I wondered how there was breast cancer connected and I cared.

Providentially, Erin posted today on her blog-site, Healthy, Unwealthy, and Becoming Wise,

Falling finds friends.

I remembered the driver and you readers and thought, “It sure does.  Especially when we let others know.”

My Ecuadorian sister, Joana Johnson, often tells me one of the biggest contrasts she see’s between our cultures,

connection.

I spent some time in Ecuador doing some clinical work and learning more Spanish between my second and third year of medical school.  I was rarely alone, which frankly creeped me out a little.  Being westernized, I was used to a huge amount of independence and anonymity.  I wonder who I would be if I had grown up knowing someone was always involved in my life.

You might have heard the proverb asking,

If a tree falls in the forest and no one is around to hear it, does it make a sound?

Or,

Water, water everywhere and nothing to drink.

I don’t want to be surrounded but not witnessed, connected or heard.

Telling people about our “falls,” cancer, depression, assault or what not, can feel creepy too, just like I felt loosing some of my anonymity in Ecuador.  However, I now tell myself, “It’s just culture and I can grow.  And I want to.”  Culturally in the “West,” we think of telling about our falls as whining.  That’s a misperception however and a disservice to all of us.  Telling people when we fall is not whining.  The act of telling and the act of whining aren’t contiguous unless we design them to be.

This morning when I saw those bumper stickers, it brought me into the drivers life and connected us.  We are both a little less alone than we were.  These last six months for me have been about taking down boundaries in my well defended life, and I am growing into the difference.  Thank you readers and commenters for that.

Questions:  What has telling others about your “falls” done for you?  How has your culture influenced you in finding friends?  Please tell me your story.

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Listen to Your Mind and Body When Doing Something As Simple As Cleaning

I Heart Cleaning

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Self-Care Tip #170 – Listen to your mind and body when you do things like cleaning, even if it makes you feel better or worse.  Be a friend to yourself.

Whenever someone in the house can’t find something, I ask them to please just start cleaning and sooner or later they’ll find it.

Today my kids and I spent two hours cleaning their play room.  My daughters were amazed at all the treasures they found tucked under, over, this way and that way in their clutter.  Although there was a lot of crying and gnashing of teeth along the way, in the end everyone was happy and pleased with themselves.

One of the blog-sites I enjoy reading is “Earthquakes and Rattlesnakes” by Zahara.  The other day she said,

I have a lot on my mind.  It seems when my mind is in a jumble, my house is in a jumble.  Cluttered, disorganized.  Can I unclutter my mind by cleaning my house?  Probably.

According to BBC News, cleaning improves mental health through the exercise that is inadvertently done.

And as Louise Hay once said,

Cluttered closets mean a cluttered mind. As you clean the closet, say to yourself, ‘I am cleaning the closets of my mind.’ The universe loves symbolic gestures.

But there are times when this goes awry.  In Obsessive Compulsive Disorder, people may clean ritually and compulsively to avoid an egodystonic fear; a fear they know doesn’t make sense but still terrifies and overwhelms them.

Or in Major Depressive Disorder, the illness affects their brain and body so much so at times that they can’t do basic life functioning, such as cleaning their house or even showering.

So I’ll tell the mothers out there such as myself, the BBC News, Louise Hay and the rest of us that cleaning is good self-care.  The milieu around it is also a good indicator on when it is time to go get professional help.  Listen to your body and mind.

Questions:  When and how has something as simple as cleaning improved your mental state?  When has something as basic as doing your activities of daily living shown you that you or someone you love might need to see their doctor?  Please tell me your story.

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

Playing in the Sink

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

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

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

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

I can’t control this.

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

I can’t control this.

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

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

baby elephant | playing in the water

Image by Adam Foster | Codefor via Flickr

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

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

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

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

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Taking Care of Yourself is The Best Part of Your Treatment Cocktail.

IMAG0142

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Self-Care Tip #163 – Taking care of yourself is the best part of your treatment cocktail.

We often talk about partial or failed treatment in medicine, in each other, in relationships.  But those are only about 40-60% of the time.  There are many people who get full treatment response to medication and self-care.  Mindy is one of them.

Mindy has seen me for about four years in clinic for her depression.  She’s never been very anxious, which is less usual as anxiety and depression tag-team so often.  Mindy’s depression had lurked in her, stepping out in the light and slipping into the shadows, for years even before she started working with me.  We seemed to hit by chance or skill the right medication cocktail that had evaded her, and she was not depressed anymore.  However, she never told me she was great.  She was “pretty good.”  She was, “doing alright.”  She was, “you know, good.”  Mindy wasn’t great.  She was good.  We spent three and a half years like that.

Then about six months ago, Mindy came in looking hot!  (I can say that because I’m a girl.)  She had lost the mom bumps around the midline, dropped padding in the hips, her hair wore a fresh coat of glossy brown, and I could tell her outfit hadn’t been worn more than twice.  Mindy was smiling and sincere when she said,

I’ve never felt better!  I had no idea what taking care of myself would do for me!

Her eyes were telling me their own conversation.  They were so expressive saying,

I can’t believe this is me!

Mindy told me in testimonial fashion, about the strangers who now noticed her.  Being noticed was an elixir and she was drinking it as often as it was served, but not in an arrogant way.  Mindy was still very human.  She wasn’t manic or grandiose.  She was doing what Gary Vaynerchuk describes in his book, Crush It!

“Do what makes you happy.  Keep it simple.  Do the research.  Work hard.  Look ahead” (p 12).

Mindy said,

I used to think that what I got from life was good enough; from my husband and from the people out there.  I didn’t know I could get this by just doing what I wanted to do for myself all along.

Mindy was still taking her medication cocktail and had no plans of tapering any of them.  She thought the combination of these medications that took her out of depression, along with exercise and other self-care measures were just right.  Mindy had not forgotten her years of melancholy and sadness even though it was now four years since.

Questions:  1) What is your reaction to Mindy and the 40-60% of people who get full treatment response?  2) Do you have any questions you wish you could ask the “Mindy’s” out there?  3) Or something to say for the other 40-60% of people who don’t get full treatment response?  Please tell me your story.

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Know What You Are Fighting For – Your Right To Journey.

You Should Be Living

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Self-Care Tip #162 – Know what you are fighting for.  Be a friend to yourself.

Bridget told me,

I felt free to do something creative without having to feel guilty about it.

She had read the blog post, “Self-Care is Freedom, is Democracy, is Because We Are Accountable.”  I was just starting to think about other good places to go with that but before I got too far she hit me with,

I just hate myself!

Hearing those words is like watching squishy and partly moldy tomatoes hit the wall.  It’s messy.  It’s dirty.  No one’s excited about dealing with it.  And, there is something negative that brought it on.  Readers, you’ll remember this countertransference when you’re the counsellor in some other situation and think, “Darn that Quijada!”

My thoughts bumped and piled up.  Stopped, until they started pulling themselves off of each other.  I tried to put these disparate bits of Bridget’s narrative together.  And I wasn’t alone.

I don’t get it!  Why do I feel this way?

Who doesn’t have conflicting feelings about themselves?  Bridget perceived and celebrated her freedom to self-care, yet was betrayed by her own, just when she was reaching for it.  Is that ok?

What strikes me about Bridget is her journey.  She has struggled with anxiety and depression for many years.  I know with me, she’s been in treatment for five of them.  During that time, she has been lovely although not perfect.  She does her hair, glossy blond in large waves, trim body frame and polite like no one I’ve met.  Many medications have failed her and she has taken those failures and claimed her future over again.  The intense forward movement of her inner self has never been muted, even when she has had thoughts of wanting to die.

I have learned what she values, what she’s willing to let go of and what she isn’t.  Her appearances matter.  She is artsy and gets energy from being alone.  She loves people.  Her marriage is rocky.  She struggles with parenting.  She loves her husband and her children.  Bridget’s journey is a journey of imperfection, beauty and courage.

And here she is again.  Conflicted self, ill, hopeful and claiming her future.  Bridget is right on her course.  I wish I could help more.  I wish she wasn’t still ill.  But I can at least be as courageous as she is.  I can hope with her.  I can stand with her or walk.  I know that put to the question, Bridget prefers this journey than losing the right, the privilege, to journey at all.  Bridget is free.  Many of us are not as free as she is, who knows what she is fighting for.

Question:  What are you fighting for?  If nothing were to ever change for the better in your life, what makes your journey worth it?  Please tell me your story.

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Celebrate Insight, Choice, and Hope. Celebrating Can Be Self-Care.

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Self-Care Tip #161 – Celebrate your insight, your choice, and your hope to be a friend to yourself.

I realize autism has taken over my life and I’m not sure how I feel about that.

When April said this, I jumped.  The insight into her situation, the implication of her own ability to choose, the hope of what those potential choices might do for her and her children – all these leapt at me, so of course I jumped.  Startled.

April was the parent of three lovely although autistic children.  She was wiping her face.  “I never cry.  I’m usually really strong.”

And then she said those words.  Her realization.  I don’t know how much thought she had put behind them.  She certainly didn’t have much time to self-actualize.  Getting only a couple broken hours of sleep every night.  Responding to complaints from the school.  Springing towards her son every time he tried to hit himself in the head to stop him.  April was busy.  Mostly all that I had been able to do so far in our treatment together was help her kids via medication therapy.  We were clearly still working on things in that department.  She was willing to wait for us to make our slow way towards her children’s health, even though she was falling apart in the process.

Go low and slow.

Nothing like a cowgirl psychiatrist in the saddle.  I try to keep my spurs off and make no more than one medication change at a time.  Then, when something happens, negative or positive, we know what we are looking at.  April’s children were taking their time getting to their therapeutic responses.  But at least we hadn’t done more harm than good.

We had made the changes to our plan of care that we were going to make, and April was about to leave.  She had just said what she said and my mouth was open.  Unfortunately for April, I’m not consistently articulate.

Yes April!

And then she left, while I was still bouncing on the chair.

I don’t know if she’ll celebrate that marvelous epiphany.  If she does, I know her kids will benefit.  I’m confident about that.  If she does what is not intuitive, that is self-care, she will still be able to do what is intuitive.  Taking care of our kids is the most natural instinct.  Wild dragons and other mythical or natural creatures could not keep us away from it.  Now taking care of them well, however, is something that definitely is more likely to happen when we as parents are healthy, too.

For now I will celebrate this.  April has insight.  She has choice.  She has hope.

Yes April!

Question:  What has your life been about?  Where is your choice and hope?  Please tell me your story.

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

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

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

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

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

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

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

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

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

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

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

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

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No Matter Why, Where, or What Happens, Self-Care Starts and Ends With Me

Cover of "To Kill a Mockingbird: 50th Ann...

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Self-Care Tip #158 – No matter why, where or what happens, self-care still starts and ends with Me.

It’s no secret that I look at behavior through many paradigms.  Most of what I’ve shared on this blog is medical because I’m a physician.  That’s my specialty.  I’m not a physicist and don’t spend my posts on explaining how physics influences our behaviors – although I believe it does.  However, I don’t want you to think that I think behaviors and emotions exist within only the medical paradigm, even though that’s what you hear me talk mostly about.

According to Dr. Q, the roughly sketched breakdown of how stress intersects with medicine:

1.  Stress influences how we behave and feel. We “see” the stressors, and we see the emotional and behavioral responses, and we know their sources.  We know that emotions and behaviors are produced by a human.  Where else?  Anything magical or otherwise comes from Someone from another place.

2.  Stress influences our medical condition. Stress will awaken sleeping genes that carry the names of different diseases; cancer, major depressive disorder, schizophrenia, and so on.  Would those genes have awakened on their own without the external trigger flipping the switch?  We don’t always know.

3.  Because there are so many factors that influence the reasons a disease process demonstrates itself, we cannot say that it is causally related to the stressors.  Many people try to do this, and sometimes the disease’s labeled cause comes down to the jury’s decision.  But we don’t have to have read, “To Kill A Mockingbird” by Harper Lee to know that people’s opinions and judgments are biased.

4.  People try to find the reasons why.  This is natural and in my opinion appropriate.  However, where we look for the reasons for the feeling and behaviors is equally important.  Seeking accountability for how we feel and behave to come from outside of ourselves, to come from external reasons, to come from a source to fault is more often missing our chance to get friendly with ourselves.

“It just is,” as many say, and the 12-Steps would say “Surrender what is out of your control to your Higher Power.”  These are not inconsistent with owning that mental health begins and ends with Me.

Sure, there are the despicable situations of abuse, trauma, violence and other horrible biology changing events.  These are known to cause the one non-genetically related psychiatric disease process called post-traumatic stress disorder (PTSD.)  These are situations consistent with our previous post on not being responsible for our history but being responsible for our futures.

5.  Stress, other than in situations of PTSD, is not causal for the progression of mental illness.  Everyone has stress, but how we deal with it, how we cope makes the difference.  Even horrible events, such as losing ones wealth and the sequelae of it are not causal for the continuance of brain disease.

6.  Medications, lifestyle change, Love and various other therapies effectively influences the way genes express themselves, our biology, and our medical condition….

7.  …In so doing, medications, lifestyle change, spirituality and various other therapies effectively influence our emotions and behaviors.

Question: How has your understanding of how stress intersects with with how you feel and behave affected you?  Please tell me your story.

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Go Toward Mental Illness and Take It To The Floor

Sean and Cheryl: Drama on the dance floor

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

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

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

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

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

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

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

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

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Receive When a Gift is Offered

Ms. Stephanie Cocks

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Self-Care Tip#149 – Receive when a gift is offered.  Be a friend to yourself.

I am totally charmed.  Sitting in the coffee-shop, and this lovely man came up and handed me his James Patterson book.  “I’m going to throw it away and thought you might like to read it.  I’m done and it was great.”  Judge and Jury looks suspenseful and I’m too fragile I think for it, but I took it anyway.  I was more charmed by the intent and character of the giver.

I try to tell my daughter about this.  When someone offers you a gift, just accept it.  It’s not so hard.  Say thank you and in doing so, give them the gift of giving and receive the gift of receiving.  It’s powerful for both parties.  The ability to receive isn’t always natural.  It’s something I’ve tried to understand my whole life.

Well, I didn’t catch the name of the book-man but we chatted despite lacking that social etiquette.  He saw my blog-site on my open computer screen and discovered my background in mental health.

“I have problems,” he said.  “Really I do.”  Maybe he was used to people not believing him and added that to add emphasis.  “I have anxiety.”  “Oh.”  I said.  “That’s torture.”  “It is!” book-man said.  “We don’t choose our emotions!  I used to think we did, but we really don’t!”  I heard it from the source.  Speak it book-man!  We don’t always choose our emotions.

We didn’t talk long.  He walked off before I could offer too much.  Maybe it was the anxiety that called him away.  I felt sad and happy.  Sad, because his suffering connected with me.  Happy, because of all the people in here, he and I connected.

Connecting with people any time any where is a small bit of the supernatural.  It’s not something that we can distil, put in a tube or slide under a microscope.  It’s not something that obeys even the excellent paradigm of temperaments.  It comes both expectedly and unexpectedly.  It comes deliberately through labor and through chance.  An airborne-something from the spirit world.  This is not to say that the natural isn’t also family, the dear child of the supernatural.  It’s just that there is a unique charm in the unknowing.

And so the book-man and the unknown connection stays with me even now after he is gone.  His anxiety, his reaching out, his generosity, the Me drawn into his space and he into mine.  I am receiving and he gave.

Thank you Great Supernatural and Natural God for this.

Question:  When do you connect despite the anxiety of being in the position of receiving?  Please tell me your story.

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Oh Well. That’s How Things Go.

Artist's rendering of Georgiana

Self-Care Tip#146 – Hold your wonderfuls and your non-wonderfuls together.

Oh well.  That’s how things go.

Today the kids were needing “parenting.”  Go figure.  I was trying.  About mid-day I heard,

Oh well.  That’s how things go.

At first glance you may not see its brilliance.  You may not see its hue of acceptance and texture of presence.  If you turn away too fast, you might miss the tension taking the back door out.  See?  The perfectionism is dissolving into the scum on my drinking glass that it is.  So look.  The room is crowded and for such a small statement to be noticed you have to really look hard.

Oh well.  That’s how things go.

Bits of us panic, thinking that sort of low-religion only leads to mediocrity, or worse.  But it’s not an either-or.  We can strive for excellence and still be present with what we don’t think is so wonderful.  We can include the non-wonderful in our consciousness and definition of self.  When the non-wonderfuls come around, wave, chat, take in the weather and carry-on.  There’s no crisis here.  I can see security waving excellence on.  No rubbernecking.  Things are ok.

Oh well.  That’s how things go.

I am reminded of the “The Birthmark,” by Nathaniel Hawthorne.  The gorgeous, lovable Georgiana, has a little hand print on her cheek.  A birthmark.  Her husband Aylmer, begins to detest the birthmark intensely and progressively.  It is so distracting to him that he stops seeing “her.”  In the end, it comes down to either be perfect or die.  Great story, and yes Aylmer, read my blog.

Question:  How have you made your peace with perfectionism?  How has it affected you?  Please tell me your story.

If you’d like to read another post with related information, see, “Adequate.”

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Having Mental Health Means Sleuthing Magical Perceptions Sometimes

Black Magic (comics)

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Self-Care Tip #134 – Looking past the dark magic in your life might require medication.  Be a friend to yourself.

Much of what psychiatrists do at work is help with misperceptions.  Seeing something one way does not make it true.

In Scientific America, there was a great article, “Magic and the Brain: How Magicians ‘Trick’ the Mind,” By Susana Martinez-Conde and Stephen L. Macknik | November 24, 2008 | 17.  It tells us that we misperceive things so easily, that people use that quality to entertain others.  Magicians use it to entertain and exploit the limits of cognition and attention.

Magicians aren’t the only ones to exploit that.  We do.  We exploit ourselves.  Tsk.  Not too friendly and not generally as entertaining.

How is having our misperceptions a form self-exploitation, you say?  Because we nurse them and drive our own selves into the ground with them.  No one else is doing it when down to the last trick.

It comes to me that when we feel disconnected from others, we are mistaken.  Some magic turned us awry and we don’t see the gazillioin links touching us all around.  When we feel worthless, when we think we are despised, when we feel singled out for suffering, that be black magic my friends.  When we think our lives our so hopeless that we would be better off ending them, look for the mirrors.  Look for the rabbits and top hats.  We aren’t seeing things right.

When I move the curtains across my clinic day, I often find medical diagnosis hiding behind.  Some sort of biology giving us the slip.

My dad often told me, “Things are never as bad as they seem.”  I realize he was talking about this kind of magic.

Question:  How have you gotten past self-harmful misperceptions?  How have you seen another do it?  Please tell me your story.

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When I Can’t Take Care Of “Me”

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Self-Care Tip #130 – Ask for help.  Be a friend to yourself.

The last two days we’ve talked about self-care,

1.  Bringing pleasure to be sticky

2.  Starting and ending with “Me.”

The natural progression is to now discuss,

3.  Taking care of ourself when we cannot.  When we Cannot take care of “Me.”

Still responsible for the single person that God gave us to take care of, “Me,” we lie down unable to move.  Unmotivated, maybe too scared to do what we need to do, emotions awry, other medical problems chorusing in with pain, stomach upset, even infertility – our own brain betrays us in our need.

When we cannot trust our own brain, our own selves, whom can we trust?

Some of us have found our answers to that.  Our lives starting and ending with God, we go where He is.  But the brain is ill and, sometimes, suspicious of the rest of us around without a visible halo.  When people point at me, and say, “God can heal me.  Do not you believe that?!” I say, “Yes.  God is the Great Psychiatrist.  I love that we are in the same line of work.”  And I do.

I do my best to help tell, educate, and offer opportunities that lead to healing for ill people to choose.  It is their choice.  Self-care in the context of illness, of losing the ability to care for yourself, is a place of vulnerability.  We show our jelly sides, the places without defense and we ask for help.  Taking care of our selves includes asking for help.  Scary, undefined, entrusting yourself with outside sources takes the courage that only those with mental illness could know.

Asking for help does not mean that the thread of self-care has left you.  It cannot really.  You being its source.  Do not be confused by the obvious.  Outside help does not mean you are not doing self-care.

When we cannot do our own self-care, we ask for help.  Asking for help is self-care.

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(In reality, everyone doing self-care needs to know when to ask.  Healthy or ill, we cannot be good at it all.  We are creatures who need each other.)

When we cannot trust our brain, find someone(s) else we are willing to invite to join our self-care efforts.  Ask for help.

Question:  How has asking for help been for you?  Please tell me your story.

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The Healing Process Can Be Confusing.

Self-Care Tip #127 – Because feelings can be confusing during self-care, keep connected to someone(s) objective.

A colleague told me the other day about his patient.  Of course he didn’t name him, but I’ll call him Brent.  Struggling with melancholic depression for many years, Brent started medication therapy.  He began feeling better emotionally.  But at the same time, he started to believe that he didn’t love his wife any more and started a dialogue with her about possible divorce.

It’s tempting to judge Brent.  Easy to say, “What the…!?”  Still, because we don’t know the full story, nor his thoughts, nor consider ourselves his Judge, we won’t.

Self-care can be a tricky road.  It’s not all ah-ha moments and nirvana.  Have you been there?  Confused by your feelings as you heal?

A common reaction to improving is associating the things in our “ill” life – when we were feeling terrible – with other elements that may not have had anything to do with our bad feelings.  Perhaps Brent’s wife was guilty by association and at some level he may have connected her to the dark emotions he so desperately never wants to feel again.  Bits of this idea are also in a previous post about panic disorder and grief.  For example, someone may change her profession because she believes her previous work is causally linked to the way she felt when ill.  Maybe Brent wanted a change in spouses for the same reason.

When we are going through the healing that self-care brings, we might not find our new emotional baseline for a while.  During that time, and because feelings are often not trustworthy, stay connected to the support network, confidants, the trusted few who can be our third-party advisors.

Although taking action on for our own health involves lifestyle changes, knowing when and how to get feedback is key.

Question:  What has confused you about your healing and self-care journey?  Please tell me your story.

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You Are Enough.

Self-Care Tip #119 – Remember that you are enough.  Be a friend to yourself.

Forrest Gump (after watching his girl Jenny throw rocks at her childhood home of abuse,)

Sometimes, I guess there just aren’t enough rocks.

That movie grabbed almost everyone’s heart-strings.  And when I saw my patient Sarah, I kept thinking about Jenny throwing rocks.

Sarah started crying.  I’d never seen her do that in the 8 years we’d worked together.  She was one who talked in spurts.  Sometimes saying nothing for many visits, and then she’d start questioning me about foods, diet questions, or parenting.  Then quiet some more.  Today out of the blue came her tears and words.

When she started on her disclosure, I tensed up thinking, “What am I supposed to say?  She’s never done this before!”  I realized that being a psychiatrist, I should know the answer to that question and got even more insecure because nothing came to mind.

Her lovely face crumpled over the story of her “stupid” father.  He never let her go to school.  He was violent.  Sarah is now teaching herself how to read; and more tears, her lovely face trembling.  She is a mother and there are no books in her home for her children because she is ashamed of herself.  “My dad is an idiot man.”

Post traumatic stress disorder (PTSD) can last a lifetime.  The horrors that are relived by the survivor can be unspeakable for them.  We never know what people are going through really inside.  They could be a survivor like Sarah or Jenny.

So far, I hadn’t said other than a few “psychiatry-sounds” like “hmm,” and “Oh.”  Don’t be too impressed but I remembered someone somewhere wiser than me put it this way,

Sometimes it’s better not to say anything.

And I really didn’t.  She did.  And she did it wonderfully.  We ended up talking about authors she hoped to read eventually.  She’d heard of Isabelle Allende and wanted to get to her books some day.  We hadn’t even started talking about medications yet.  Sarah left after saying that when she stopped learning and growing, she would be dead.

What hit me was that Sarah wasn’t looking for more than me.  I searched, wanting to give her more and came up with what I hoped was an appropriate facial expression.  In a way, by not speaking much, I was able to receive and be blessed by her story.  I might have missed that.

My mentor, author of blog CreatingBrains.com, encouraged me when I was unsure about teaching others.  She said, “Look at your life and who you are.  You would be surprised.”

When we are insecure about something, it helps to remember that we are enough for the task at hand.  As individuals.  We have in us all the days that came before, the experiences, the generations that handed us down, the God who made us and as per my belief, never leaves us.  We have so much.  Considering all this, be still and know.

Question:  When have you been amazed at all that was inside you?  Please tell me your story.

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Courage Not To Presume.

Pony Express

Self-Care Tip #116 – Have courage not to presume.

Courage.  Courage is doing what frightens us.  I heard this definition and as usual I got a little stiff.  Definitions sometimes feel sticky to me and I’m trying to understand why.  Why is my lip curled?

In line the other day for the theater, a grandfather in front of me got talking.  I didn’t get any names; just that he was a grandfather of a 7-year-old girl who owned him.  Naturally he drifted into stories about her, including their most recent vacation to Knott’s Berry Farm.  They rode “The Pony Express” despite his fear and instincts.  I asked him if he was proud of his granddaughter’s courage and he replied, “She wasn’t scared!  So she wasn’t the one with courage.  I was!”  He laughed, and then I laughed, but I walked away to the ticket booth whispering, “What does he know about her thoughts?”

I see so many faces flashing across my mind’s eye.  I see them, and I hear them.  I realize their whispers have become mine because I believe them.  My patients are courageous.  These, who have not told others.  Who have not screamed when they wanted to.  These people who have put on the appearance of calm despite their fears.  They are a study in functional mental illness.

Functional mental illness, although historically refers to mal-behaviors and emotions without medical cause, now after years of increased knowledge and study, it includes their biological organic etiology.

As an example of functional mental illness I’ll tell you about Miranda, a mother of 2.  Miranda says her kids stress her out and she can barely take care of them.  However at her job, she performs adequately and no one would say she seems depressed.  She falls into bed when her kids do between 7 or 8 PM yet never feels refreshed.  Crying while pouring their cereal each day, she packs them dry bread and a pickle for their lunches.  No one would know the courage it takes for her to survive the moment and then the next.  They all presume she is fine.

After teasing apart my thoughts on courage, my lip has uncurled.  I understand that definitions bother me because they can sometimes imply freedom to presume more than one should.  We can never know people’s thoughts, motives, feelings entirely and that bit that we don’t know, may be the bit that changes their story.  If you want to read more, check out this post.

So for now, I can push down my fear of definitions, put on the face of calm, …and what?  Be a friend to myself.

And you?

Question:   Where do you need the most courage to do good for yourself?  How do you deal with your fears?  Please tell me your story.

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Toughing It Out! …Is Not What You Think.

Mental Health of our Military

Image by Truthout.org via Flickr

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

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

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

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

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

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

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This calls for thick skin.

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

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

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Grieve to Be Present With Yourself

 

Maria Yakunchikova "Fear" 1893-95

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We grieve when we get sick.  And we grieve again when after getting well, we get sick again.  Then the grieving can be even more terrible because you know what’s coming.  In Pearla’s case, she didn’t know she was grieving but she knew she was sad and terrified at the same time.

I asked her if she thought that staying in bed, loosing interest, isolating, crying jags out of the blue might be related her grief about getting sick again.  She said no at first and then said, “I’m disappointed.  I thought this was over for me.”  All over, she couldn’t trust herself.

Pearla was afraid. And that fear was always there.  Now she couldn’t put it out of her mind.  “What if I have another panic attack?  I can’t take it!”  “What if,” was always on her mind.

Readers, a panic attack is more terrifying than just about any immediate experience.  If you’ve never had one, it is almost impossible to imagine the depth of terror it causes.  It is so horrible, that people even change professions because of it.  I remember a surgeon who actually went back to residency and studied a new specialty because he linked his panic to his profession.  That’s another 4 years of grueling work, readers.  That’s the kind of fear panic produces.

Pearla was not only in the throes of this fear, she was also in the throes of grief.  This is a deep sadness any of us who have lost a beloved hope can relate to.  Pearla didn’t know that was why she didn’t want to get out of bed.  All she knew is over the last 2 weeks she was loosing herself and in exchange, getting something she desperately did not want.

Somehow though, after hearing about her sadness from her own mouth, Pearla agreed.  She saw the grief and after seeing grief, she could be more present with it.  It was almost like her face materially came out from hiding.  Grief lost some hold on her.  She was a little less sad and a little less afraid.

Self-Care Tip #111 – Let yourself grieve.  Be a friend to yourself.

Question:  How do you grieve?  Was it worth it to you?  Please tell me your story.

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When It Is Time To Take Medication

"Yard with Lunatics"

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When is it time to use medications for mental illness?

It is time to consider a medical cause for your behavior and mood when:

1.  you can no longer control them

2.  they affect the various areas of your life

3.  you start having other physical symptoms not accounted for through medical exam and studies, such as:

  • sleep changes (Pearl:  Sleep is known as the vital sign in psychiatry.)
  • change in energy
  • gastrointestinal – stomach upset, nausea/vomiting/diarrhea, change in appetite
  • neurological – headache, numbness, tingling, shaking, change in response time physically or verbally

I’m sure I missed a few things, but roughly, these are guidelines that can apply to most mental illnesses on multiple spectrums, such as anxiety, mood, psychosis, addictions, and even character pathology.

According the numbers count done by NIMH:

…about one in four adults — suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.  …mental disorders are the leading cause of disability in the U.S. and Canada.

When you next go outside and walk in a crowd, count them.  One, two, three, mental illness.  One, two, three, mental illness.  And so on….  If you suffer from mental illness, you are not alone.

If you buy any of this, if you see these things in yourself, consider seeing a physician for further evaluation and possible medical care.

Self-Care Tip #108 – Take medication if it’s medical.  Be a friend to yourself.

Question:  How has your definition of mental illness affected your ability to get treatment?  Or how has it affected your interaction with those who are in treatment?  Please tell me your story.

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