anxiety

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Don’t Waste Your Time. Do Your Thing.

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Self-Care Tip #101 – Don’t waste your time if you don’t have to on things you aren’t good at.

Ben is almost 16 years old.  His parents are happy because he’s not as depressed, more interactive and more interested in connecting with others.  They came with him to see me.  Ben gets easily overwhelmed trying to tell me about himself and his parents often interject to help him out.

Ben’s parents are parents to admire.  Patient and clear-sighted regarding values and presence.  I’ve caught my breath more than once in the company of their comfortable regard and affection for their disabled children.  (Ben’s sister also suffers from mental retardation.)

During clinic, Ben struggled to tell me he was bothered and stressed by the school staff pressing him to learn things he didn’t care about.  He lost his words over the bits about how it related to his self-esteem and looked at him mom.

Mom told me Ben doesn’t care about some of the topics he’s taught and he gets sad and anxious when he thinks about it.  He’s embarrassed by it because he doesn’t finish as quickly as others and misses some of his lunch time.

I’m not a high school educator but I still told Mom and Dad that they can feel more confident advocating for Ben’s interests and needs with his teachers.  Ben will excel more in areas he is interested in.  He will find more pleasure in them.  He will be more empowered emotionally.  He will  be more ready for his adulthood needs.

The pressure many of us grew up with to be good at everything, is bogus.  We shouldn’t.  What we should do, is be good at what we are talented at.  We should be good at what we are interested in.  In fact, be shameless about it.  I spoke about this in the post “Do What You Were Designed to Do,” amongst others if you want to read more.

Ben with his parents looked at me with something of relief.  They had “permission” to do what they wanted.  The rest is mostly a waste of time.

Question:  What has opened you up to doing what you want to do in life?  What has that done for you?  Please tell me your story.

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Are You a Victim or What?!

 

 

Number Two of Bella’s List – victim or what!?:

Last night I took my 5 year-old daughter on a sleep-over date at a hotel.  Generous I thought …and boy was it!  To me!!  I couldn’t believe how much fun I had.  I quickly realized why I had done this.

A bit of me still wants to float away on wings of the modern-martyred-Mom, and I can, because it did take a lot of time and money and energy and….  But it’s not too friendly to me.  As attractive as that flight may seem, I’ll lose air at some point and take a big fall.  Ouch.  I might fall on my kid too which is against my intuitive effort here.

Being a victim is attractive at some level, no?  My story is a softer example, but we all have tougher ones.  Like Bella’s when “she spoke of her injury.”  The gravity of her injury was created by her perception of things.  Our perception makes our emotional success.  My story about last night with my daughter sounds pretty because that’s how I perceived it.  However, I have other stories that have negative power over me as Bella’s had on her and as yours have on you.

The key here is that when we take the victim role, we aren’t just telling our story or venting.  We are feeling self-pity. But venting is not necessarily self-victimization.  Venting can be healthy.  Venting can be done without taking a victim air-bus to no-where good.  Venting can be a way of being present in your suffering, of going where the pain is and letting it lose power over you.  Self-pity only gives the suffering more power.

The great novelist and philosopher, David Foster Wallace, who courageously lived and died with major depressive disorder, encouraged,

To be just a little less arrogant. To have just a little critical awareness about myself and my certainties.

The willingness to learn or grow is the foot-path away from victim-ville.  Could we even say that being a victim is “arrogant?”  We – Me, my patient Bella, you – have we taken steps to tell our story, to be present, to live with the humility it takes to look at ourselves and not escape/fly-away?

Whatever it is you are going through, it might help to vent it!  Grow and learn and get bigger than that experience.

Self-Care Tip #94 – Get in your own space to choose freedom from self-pity.  Be a friend to Yourself.

Question:  What barriers have you felt to telling your story?  What has made it difficult to be in the space of your own feelings?  Please tell us.

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Recipe for Treating Panic Disorder, According to Me

 

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Recipe for Treating Panic Disorder, According to Me:

1.  If it’s taking you to the emergency room feeling like you’re going to die, or your spouse can’t peel you off with your phone calls and new needs – you have a medical illness.  Get medication.

2.  If you are afraid of being humiliated by an episode so much that you avoid public places, or if you are more fearful than not – you have a medical illness.  Get medical treatment.

3.  If you are panicking out of the blue, without something setting you off/triggers like finding your husband in bed with your dentist – this is biological.  Get a medical physician’s opinion.

4.  If you are awakening from sleep in a panic attack, when you feel like you have to get out of bed and escape and the episode lasts for about 10+ minutes before you recover yourself – this is not because you’re not trying hard enough.  Get on a serotonerigic therapy and a sleep aid(s).

5.  If you are drinking more alcohol to relax and out of fear of going to bed – get suspicious and get smart.  Medication therapy or alcohol?  It stumps me when someone says they don’t feel comfortable with taking medication that has beed studied in double-blind studies on thousands of people and reviewed and analyzed and more… but they do feel comfortable with alcohol.  That’s not friendly with yourself.

6.  If you think you are going crazy and realize your fears and suspicions don’t make sense; if you think you are possibly going psychotic over and over – you’re having a medical illness of the brain and body called panic disorder.  Get to your nearest treating physician and trust them.

 

juno.cumc.columbia.edu

 

7.  If this is you, don’t go get insight or supportive psychotherapy at least until you have been on medication therapy for 6-8 weeks.  What you are going through is not because your mom yells at you too much.  It doesn’t have to have a reason.  It is medical.  Treat it medically.  If you go to therapy too soon, you will see that you can’t give what you don’t have.  (I may have offended some people saying this.  Sorry.)

8.  If you don’t get treatment, expect that depression may likely follow soon.  Anxiety and depression are bedfellows and can’t be apart for long.

    Self-Care Tip #92 – View Panic as a medical illness.  It is.  Be a friend to yourself.

    Question:  Have you or someone you known used a similar recipe or a different one?  Please tell me your story.

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    Escape Self-Loathing

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    Self-Care Tip #91 – Put the fight down and take 2 steps back.  Be a friend to yourself.

    He came in looking really good.  Chris had seen me for many years and he hasn’t always looked this way.  I said

    You look great!

    Chris shrugged and told me he had just had a long messy argument with his partner and somehow still felt alright.  In the past, after they fought and the self-loathing set in, he might have hurt himself – like using alcohol or cutting on himself to

    …just feel something different.

    I was ready to move past the story as he sounded like he was ok with it.  We talked past each other.  Me asking about his sleep, and Chris telling me clips and phrases from the argument.

    But amazingly I’m fine!  If he wanted me out today, I’d be out of there, no problem.  He just needs to say the word!

    Chris was sitting back in his chair, relaxed until then.  His hands came up and took control of his space, thrusting as he spoke.

    Being a psychiatrist, my expertise kicked in and I realized I should turn back.  Chris wasn’t ready to talk about sleep.  You see what all those years of school can do.  Not everyone knows how to pick up on such subtleties.

    Chris, maybe you aren’t so happy you argued.

    We talked more about his energy, appetite and motivation.  Then we came back to his argument.

    It’s none of his f—— business where I am during the day!  I’m not his child.  I’m his partner!  I told him…!

    And so on.  Chris still looked better than when he was in the grip of post-traumatic stress disorder symptoms, or when he was catatonic.  But he didn’t sit comfortably with himself.  And I thought, Chris has fought so hard for himself, why can’t he handle what I want to say?  And I did.  And he did.  Beautifully.  He was a brave knight on a black steed holding his wounded sides.  Life had been a battle for him, but he was making choices to fight less and live more.

    “Ok.  Yes.  You’re right.  I will next time.  That makes sense.”

    When you’re about to engage in something that in the end will make you loath yourself, choose not to.  That’s friendly to you and your other.  Say something like,

    When I was gone you felt jealous?

    Give over stage and anger and open windows and breath.  Just choose not to hurt yourself.  Winning or losing the argument, in the end, you hurt by your own choice.

    Biologically and probably spiritually Chris wouldn’t have known what to do with that years ago.  But he did now.  I saw him relax again and put his hands away.  I knew Chris had a love for Love and this clicked for him.

    I can’t describe how happy I was/am.  Being a part of his journey is a great honor.

    Question:  How have you escaped self-loathing and your mean self in the heat of the moment?  Please tell me your story.

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    Self-Care is not unChristian

     

    Don’t be afraid of self-care.

    Self-care is Christian and scientific.  I have awareness of the culture that frowns on taking bad behavior out of the church and into the laboratory.

    A few days ago we talked about self-care not being selfish.  That circuitously brought up the question about how “the church” feels about this blog.

    Confusing “the church” with Christianity can be problematic.  I have confused them in the past.

    When my brother started talking evolution, I felt cold and clammy suddenly.  After my mini-panic attack, he told me about reading the entire works of Darwin and I had another mini-panic attack.  “There’s no way evolution didn’t happen.  There’s just too much evidence supporting it.”  I was confused.

    It took me a long time to realize that I didn’t have to be worried about differences between me, science and God.  Funny that my comfort level grew with this as I realized how little I knew.  In fact, my joy expanded, when I realized I would spend all eternity growing my knowledge.  That is a lot of everything that just won’t fit into any box I can think of.

    iwantthatpainting.com/Why-does-it-always-rain-on-me.html

    Now when something crashes through a pet-paradigm, I remember that it’s ok.  (Down fear!  Get down anxiety!  Heal dogs!)  I may see a different reality.  Parts of me may become changed by that knowledge, trauma, death of a dear one.  Becoming changed and different is ok.  Because God is the same.  God already knows whatever about evolution, or that the world is round.  He knows that we try to turn medical symptoms into something spiritual, like depressed mood.  He knows it and He’s still here.  He is the prototype of presence.  Now that people can look into the brain and say where feelings and behaviors come from, we can get past that and on to the next revelation.  So what if it is medicalized.  Science and spirituality are not exclusive of each other.

    So is self-care Christian or scientific?  Things aren’t that binary.  Self-care is both.

    Self-Care Tip #84 – Don’t be afraid of self-care.  Be a friend to yourself.

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    Get Gangster on Your Shame

     

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    Shame.  Ah what a cloaked villain!  In this post I’m going to tell you about why shame is not an enemy you want to ignore.

    “Michael Corleone” in The Godfather Part II was not the 1st to say it, but maybe was the first to make the quote famous

    Keep your friends close and your enemies closer.

    Not many people would at first think that keeping shame close might be a good thing, but I’m here to tell you that it is.

    Meet Bill the highway patrol.  He’s been seeing me for melancholic depression.  Sometimes he feels a little better, but those times even still are not so great.  Bill has told me about where he thought his anxiety and fear came from.  His story made sense to him.  This wouldn’t be too much of a problem except that he thought about it often.  Very often.  He was running in sprints away from it.  Somehow after all the time he’d spent reluctantly in the presence of his fears, he hadn’t realized that shame was connected.  Shame of being treated the way he had been.  Shame of being misused.  He hadn’t faced his fears because he was always angled away from his thoughts of shame.

    If we don’t go where the shame is, we won’t be free from its effect on us.  Fear is a big bad bully.  Until you turn around and say stop, you’ll be running for a long time.

     

     

    We all need to be a bit “gangsta” at times.  Ignoring shame is not.  It’s not emotion-street smart.  I’m waiting for Bill to think, “What’s the worst thing that could happen?”  And sit in the feelings that come with those thoughts long enough to realize that he’s still ok.

    In obsessive compulsive disorder, there is a psychotherapy treatment called “exposure and response prevention.”  In this treatment, the person with the ego-dystonic fear exposes themselves to their fear for a progressive amount of time.  They realize that after going where the fear is over and over and materially seeing that nothing bad happens, the fear looses more and more control over them.

    This is effective in any anxiety condition, including shame.

    Self-Care Tip #83 – Get gangster on your shame.  Be a friend to yourself.

    Question:  Has shame bullied you?  Please tell me your story.

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    Be Empathic to Others to Get Friendly With Yourself

     

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    Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

    Yesterday I wrote about considering intent and context when comparing self-care with selfishness.  That carries over to the people sharing life with those of us who have mental illness.  Do they see us as selfish?  For example, how is the spouse of the Panic Disorder going to make sense of the 40 phone-calls he gets while at work?

    Mary’s husband told me that she’s been calling him “all day,” terrified she was going to die.  Checking to see when he was coming home.  She couldn’t go to the market because people would laugh at her.  Afraid.  Afraid.  Just plain afraid.  Really, everything had become about her.  She was like a scared kid.  Frankly it was annoying.  He was in a stressful work situation with the economy slumping.  People he knew were being laid off.  The other day he had to leave in the middle of an important job to go home and reassure her.  She was sobbing in the living room.  Sure she was going crazy.  He realized that he might have to tell his boss what was going on but what was going on?!  Who had his wife turned into.

    In yesterday’s blog, we spoke about the ability to abstract v. concrete thinking.  Being able to abstract helps with empathy – connecting emotional content between people.  To put yourself in someone else’s shoes, as if you were them.  This is a critical part of relating, i.e. being in a relationship.  Many different mind illnesses affect our ability to abstract, including panic disorder.

    In Mary’s case, she was not empathic when she was anxious.  She was thinking about herself.  Understandably, if you read the part about her believing she was going to die or go crazy.  But when you’re married to her, empathizing with her gets old.  It’s not so easy when it seeps into your work life, you haven’t had sex for months, and you have to do everything that has anything to do with going outside of the home.  Some part of you knows it’s not true, but another part of you screams, “Get over it you selfish child!”

    Is Mary selfish?  Some might be able to answer even after all the phone-calls and unrecognizable behaviors, no.  Mary is not selfish.  They can do this specifically because they can abstract.  They can empathize.  They can consider the context of Mary’s disease and the intent of her behaviors.

    Not everyone does this.  Not everyone is able to let “It” be about someone else.  Not everyone doesn’t have to have “It” be about them.

    The best thing for those in relationships with someone emotionally ill, is to view the way they are behaving as biological.  When treated medically, than Mary or whoever it is in your life can do their own self-care.  But until then, staying in their lives requires maintaining an empathic view that considers intent and context.  It also means furthermore, doing your own self-care individually.

    There are over-lapping flaps to our lives.  Scales on the back of an armadillo.  Me as encased by my body.  Me, that includes the space between me and you.  Me, that includes you, because you will always be a part of me.  Self-care really involves all that by degrees.  A chain-link.

    So the question is, can empathy be chosen?  With money in the bank and wisdom, yes.

    Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

    Question:  Does any of this ring true for you?  Please tell me your story.

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    It Might Be Your Brain

    How are you feeling? If it’s not good, it might not be “you.” It might be your brain.

    When you don’t feel good, look at what’s happening inside.  Think about where feelings come from.  It’s hard to use your brain to think about your brain.  (Read more at “Basic but Effective.”)  But what to do?  Doctor Dolittle‘s pushmi-pullyu’s might have been able to tell us something of our missed opportunities by not having two heads and two brains.  (Unfortunately they’re extinct!)

    Feeling bad, irritable, guilty, sad, like everything is flat, nervous, emotions that are out of proportion or inappropriate to the situation or trigger?  These feelings might have nothing to do with “you” and everything to do with your brain.  At some point if you get tired of beating yourself for the holes in your purse, if you don’t understand why things feel the way they do, if you want to rest, think medical.

    Fred came in with his father, hiding himself in his shirt, in his father’s shirt, like a mouse who couldn’t find his hole.  The teacher from his special education class came in to help give history and told me about everyone’s efforts to bring him out.  Skinny, Fred preferred not to eat in front of people.  He started shaking in strange situations and climaxed into a tantrum if pushed to transition too quickly.  He was vulnerable to physical contact and avoided anyone touching him.  When he was really upset, he banged his head so hard that he had to wear a helmet.  When I asked his parents if they thought he was anxious, they said no.  No he wasn’t nervous his teacher said.  Hmm.

    I told Fred’s parents.  I restated to Fred’s teacher.  I just said back to them the story they had just told me.  I told them about Fred and asked them what they thought.  After hearing Fred’s story again, did they think Fred might be behaving this way because he was suffering on the inside?  

    We can’t give what we don’t have.  Asking Fred to come out and play so to speak, wasn’t something he had to give yet.

    After treatment takes effect, then Fred will be able to pull his head out of his shirt and he will do it without being asked to.  It doesn’t do any good for Fred or anyone else to push him to do behavioral changes if he simply can’t.  Fred is not a pushmi-pullyu.  He has no spare brain to offer when the other is ill.

    I told Fred’s father that I thought Fred was suffering inside.  Something in his father clicked.  He teared up and nodded and said “Yes!  He is suffering.”  That meant a lot to Dad.  To know that much about his son.  To know that what had confounded him for so long came from somewhere.  It had a name.  This thing might be treated.  Fred might suffer less.

    Self-Care Tip #76 – If you don’t feel good, think about your brain.  Be a friend to yourself.

    Question: Do you every feel like you expect yourself to give what you don’t have?  Please tell me your story.

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    The Price of Manure

    In yesterday’s post I asked “What has happened in the space between you and the ones you love?”  A reader responded,

    Think of being loved but not being able to be touched. …Rituals above spontaneity. Of having Lysol applied to everything you touch. Lysol applied to children’s legs and shoes. Not being able to hug your kids after work until after a bath and your inside-clothes on. The tirades. Most things literal and not humorous. Any cabinet or freezer needing to be as stuffed as possible.
    As a young person it seemed very personal and hurtful. …All the lost years….  After all those years now on the mend.

    It doesn’t matter how old we are, it takes courage to live.  There are many astounding parts of this story, but today I draw attention to “the lost years.”

    I don’t know if any of you readers saw the episode last week from the musical comedy, Glee.  It irreverently tossed together a potato salad of high impact emotions.  (Delicious potato salad!)  The best part was as usual the great Jane Lynch.  That woman is brilliant.  She shows us anger, resentment, and personalization through spitting words.  She contrasts this against her thick velvet love for her older disabled sister. Sue Sylvester (Lynch’s on-screen character) has festered the insults she absorbed on her sister’s behalf, ever since she first realized her sister was different.  It was only until her sister, with a still-waters affect told Sue that she didn’t care what others said about her.  Her disabled sister was whole inside.  Sue started to heal too.

    Being present with our dark history, can summarily be our gain.  Especially if in the end we found love, became connected with our journey and with others, and forgave.  It becomes rather an education of sorts.

    When I was struggling with my ambivalence about vocational choices, my dad told me, “Education is never a loss.”  I plunged forward with that as a talisman.  

    Education is never a loss.  Even our school of suffering?  Look at it as a currency of sorts.  It’s all perspective.  Even manure helps you know.  We had to pay $100 the other day for a truckload of chicken-poo for our farm trees.

    Self Care Tip #73 – Find the value in your suffering.  Be a friend to yourself.

    Question:  Do you agree or not?  Please tell me your story.

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    Between Me and Thee, Don’t Believe it

    He felt blamed by his daughter.  It is one thing to perceive it.  Believing what we perceive might be separate.

    There is a disease process named obsessive compulsive disorder.  In this illness, we perceive things that at some level we understand are not likely nor true. These fears are called “egodystonic,” when we can tell that our fears don’t make sense.  For example, it may preoccupy my thoughts that I fear I just ran over a pedestrian with my car, even though at some level I know I didn’t.  Not driving back and forth on the street to look for the victim where I fear the accident happened for hours is therefore terrifying to my core.  If asked outright if any of it made any sense, I’d say no.  We all have features of this disorder but don’t necessary to the full extent.  And that is where we got terms like “Step on a crack, break your mother’s back.”

    It goes to reason that fears consistent with our inner selves are “egosyntonic.”  In its diseased states, we see this in disconnected thought form disorders such as schizophrenia.  The healthier examples are much easier for most of us to understand and relate to.  I fear if I speed, I will get a ticket.  Healthy and connected fear.

    Now what was going on with the man I mentioned above?  Did his daughter ever say she blamed him?  Was he trusting his feelings?  His Jedi-intuition?  Was this egodystonic or egosyntonic?

    Egodystonic fears in a much milder form include simple personalizations.  Making something about us that isn’t.  Your girlfriend makes jokes about you being irresponsible.  A friend doesn’t return your calls.  Your daughter is moving away.  You can see the potential fears building up.  Will we believe them?

    Believing our perceptions depends on different paradigms.  There are our biological illnesses that predispose our perceptions (major depressive disorder, obsessive compulsive disorder, generalized anxiety disorder, etc…).  We have our temperaments to answer to.  Some of us are wired to be more suspicious v. trusting.  There are adjustment issues, related to stressors around us.  We have our own coping skills.  And how about poor self-care such as poor sleep hygiene and little exercise?  All of that will play on what we are going to do with our perceptions.

    Truth is, generally very little of what we hear has anything to do with us.  Now there is the other extreme of course.  A personality disorder who has little insight into the way they are influencing the world around them and take little responsibility.  But that is the exception.  More often, we walk around licking wounds that came from a series of misperceptions and personalizations.  It takes up a lot of time and is a disconnecting force between me and thee and thee and thee.

    Self Care Tip #72 – The best way to keep the space between us open, honest, healthy, connected – is take care of our own selves.  Be a friend to yourself.

    Question:  What has happened in the space between you and the ones you love?  Please tell me your story.

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    Are Your Meds Safe?

    A reader asked

    …once one starts a medicinal path, would the symptoms become worse than they were before the meds if the meds were stopped?

    There are many layers to this short question.

    1.  Just the act of stopping the medication may trigger a relapse.  Cold turkey’ing is only good for stories.

    Remember that relapsing in emotional illness threatens brain health.  For example, in depression, every time we relapse in the absence of the protective effects of medication (prophylaxis), we drop faster, we drop harder, and it is more difficult to treat.  It is more difficult to get a medication response.

    Furthermore, some medications that once were effective in treating disease, loose effect if they are stopped and restarted.  Significant in psychiatry as we don’t have innumerable options to treatment.  In one move, a medication was eliminated from our treatment choices and we have to move on to others.  We now try a different medication with possibly more side effects than the one we discontinued.

    Because of this, many people who have found effective treatment choose to stay on it as long as they can.

    2.  Some medications are not treating disease process so much as they are treating the symptoms of the disease.

    For example in anxiety, the class of medications called benzodiazepines (“benzos”) is often a favorite.  Common ones in this class include alprazolam, diazepam, clonazepam and lorazepam.  There are many more.

    Benzos take the symptoms of anxiety away quickly.  They are famously called “tranquilizers” and hit the GABA receptor, the same receptor as targeted by

    alcohol. Some people say that they are like taking alcohol in a pill.  They are not all bad or all good.  However, as pertains to my reader’s question above, the answer is yes.  The symptoms might be worse after stopping them than they were before using them.  If they have been used long enough for a tolerance to develop, and/or if they were being abused, much like alcohol might be abused, than yes.

    Remember, symptoms are what we see or feel.  The disease process itself is often unseen.

    Also, because this class of medications only treats the symptoms, we know that the disease process is likely still progressing.  Then when the medications are stopped, the symptoms show again.  However now that the disease is worse, so are the symptoms.  What the medications are doing in this example is called “masking the symptoms.”

    3.  There’s more I could cover but that’s enough for any of us tonight I am sure!

    Question:  Did any of this help?  Please tell me your story.

    Self Care tip #63 – Take your treatment in comfort, but know what you are taking and why.  Be a friend to yourself.

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    Let it Make You Strong

    She is young, golden, blushes easily, bright solar eyes, with graceful speech, not rushed or loud.  Like so many others, she doesn’t believe her beauty.   She came to me to get help.  Crippled by anxiety that hits out of the blue, like a hooded man grabbing her in an alley.  She feels during those times like she is dying or going crazy.  She started avoiding public places and became fearful looking over her shoulder for the next attack.  She was humiliated on all accounts by her uncontrolled emotions and thought people could see how crazy she was just by looking at her.  Branded and tortured.

    When Nathaniel Hawthorne wrote The Scarlet Letter, he made plain the cultural pressure to define what is apparent, seen, and interpreted.  But more importantly he made plain the ability of an individual to define themselves on their own terms regardless.  Hester Prynne wore her letter A at first by mandate and then by choice, letting it represent who she was, where she came from, and where she was going.  She wore her letter and when people tried to change its meaning to something culturally less scarlet, “A” for “Able” she made it clear that she is the one who will decide the meaning of her life’s events.  Her and God and no one else.

    When anxiety hits, we are scrambling to understand why.  We think, “What could we have done that is so terrible to have brought this kind of torture on?”  As Hester Prynne began her scarlet letter days bewildered by the force of emotion behind her angry neighbors, so victims of anxiety are bewildered by the level of shame and wild fear they presume must be linked somehow to this judgment upon them.  It becomes their life’s work to determine the meaning of a life with this.

    Nathaniel Hawthorne writes,

    The scarlet letter was her passport into regions where other women dared not to tread. Shame, Despair, Solitude! These had been her teachers—stern and wild ones—and they had made her strong…

    Suffering is a schoolhouse for the courageous.

    After some months of medication therapy this twenty-something woman said

    I’m not so uptight about things.  …I didn’t know my anxiety was that bad until I got out of it.”  What amazed her even more was how better the rest of her body felt.  “Even physically I feel much better.”  No more chest tightness, body aches, and shakes.

    She has the rest of her life to figure out how to say what this disease means and how it plays into the way she defines herself.  She will decide I hope.  Not her family, future husband, church, or Brook Shields.  I hope she will take what it teaches her and let it make her strong.

    Self Care Tip #57 – Let it make you strong.  Be a friend to yourself.

    Question:  What do you think?  Please tell me your story.

    by

    If You Are Ill

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    A reader commented on yesterday’s post, “Afraid of Meds,”

    My fear, I think, would be not so much the dependence—but what would happen if I did need that medicine and it suddenly became unavailable, like I couldn’t get my prescription because of a natural disaster or something like that.  …Would going off of those meds cold turkey put me at a real disadvantage?

    In my late 20’s I had similar fears, only for me it was related to my eye-glasses.  Because I didn’t tolerate contact lenses, I especially had vivid fears of getting into the driver’s seat of my car without my eye-glasses anywhere to be found.  Living on loans at the time, I took out extra money and got LASIK eye surgery.  Oh the joy when I woke up one morning and could see clearly, high-definition, no glasses to grope around for, freedom!

    Unfortunately in neuropsychiatry, we don’t have the privilege yet of offering many curative options like LASIK surgery for emotional illnesses.  I don’t believe it’s too far off in the future.  It wouldn’t be wild to say our children may have those options some day.  For example, embryonic stem cells may offer a cure for disorders such as depression and schizophrenia.  However, until a cure becomes as available as Prozac or even LASIK eye surgery, the reader quoted above has a reasonable fear.  Medication becoming unavailable is a disadvantage.

    Now I’m not great at twisting reasoning powers, so I’ll say this as best I can.  That’s like not getting eye-glasses because we are afraid of loosing them.

    So to this reader quoted above and to you I ask,

    Question:  What do you think?  Treatment or no treatment?  Please tell me your story.

    Self Care Tip #53 – If you are ill, get as better as you can.  Be a friend to yourself.

    Related Articles From FriendtoYourself.com

    • Mental Illness Relapses When Medications Are Stopped http://bit.ly/pA4kxo
    • Number One Reason For Relapse In Mental Illness  http://bit.ly/rt1qJf
    • Are Your Meds Safe?  http://bit.ly/lh1cBh
    • Say Yes to Medication And No To Drugs  http://bit.ly/oX12i0
    • Fears of Addiction To Medications for Brain Illness http://bit.ly/oWY8i4
    • Other Fears of Medication For Brain Illness  http://bit.ly/qdHksR
    • Afraid of Meds  http://bit.ly/rjt7wY
    • Full Treatment Response Means a Better Future  http://bit.ly/ph84ZU
    • When It Is Time To Take Medication   http://bit.ly/nbIYLT
    by

    The Good and Bad of Anxiety

    In response to yesterday’s blog, a reader wrote,

    I often feel my flight and fight response triggered even in situations (mostly social) that should not (theoretically) even be frightening. What do you think about that?

    This is like the degrees of water temperature in our shower.  Pretty much every one falls somewhere on the spectrum of this type of anxiety.  When is it ok, and when does it become not ok?  My brother, friend, mentor, Cameron Johnson MD said in so many words

    Anxiety is what makes us work hard.  If we didn’t have anxiety, we’d all be slobs.  We’d stink.  We wouldn’t get our homework done.  We wouldn’t say as many nice things.

    My children still see most things in all-or-none fashion.  They would say at this point of the discussion, “Anxiety is good.”

    A teenager I treat began responding to her medication.  Her mom began to complain.  “She never let this happen before!”  Her room was a mess.  She was less prompt to obey and she started voicing her opposing opinions more.  In some ways, without the anxiety, it was like her mom was getting to know her for the first time.  

    This was however, better than anything this girl and her mom had hoped for.  Now the girl wasn’t throwing up, having panic attacks, avoiding just about any social experience.  She was making eye contact with me and she was able to present in class.  She told me that she can’t even think about how she felt before.  It was so bad.

    It is really hard for any one who has never suffered from debilitating anxiety to realize the level of suffering and terror it causes.  Someone who may look stuck up, aloof, disinterested, quiet, bored, may in fact be at hells door.

    My children might now say, “Anxiety is bad.”

    And so to my reader quoted above, I’d say with my children, anxiety is good and anxiety is bad.  Come and paint the stars with me for a time.  Talk and tell me your story.  We shall in degrees of mind and manners, unwind the mysteries together.

    Self Care Tip #49 – If anxiety is affecting you in a negative way, consider a medical reason.  Be a friend to yourself.

    by

    Scare Yourself If You Must, With Caution

    A patient came in depressed and anxious.  After our initial interview he disclosed that he and his girlfriend were playing around with sadomasochism and it was scaring him.  We discussed that to help him get healthy, he would need to do healthy things for himself.  Anything directly harmful or potentially life-threatening doesn’t fit in to that.  We agreed not to formally engage in therapy until he had thought this through and what he was going to do with his sex-practices.  He came back wanting treatment, and spoke like this whole S&M thing was old history.  “Oh that!  I talked it over with my girlfriend and she understands.”  Ok.

    Why do we scare ourselves on purpose?  Like watching horror movies, or even movies that are more mainstream but have suicide scenes, abuse, car accidents or other freaky things.  Some are thrill-seekers through extreme sports like sky diving.  Others cut themselves or do other forms of self-injury.  This may seem like an odd bundle but they all share volitional fear experiences.  Even as do team sports like tag or football when getting happy from being chased like a rabbit from a fox.

    When we scare ourselves on purpose, our bodies release a number of wonderfully feeling chemical messengers.  There is adrenaline, dopamine, cortisol and more that give us a rush, a lift.  It is positive feedback.  (Dopamine is the main pleasure molecule that all addictive drugs target as does food or even a back scratch.)

    Psychoanalytically one might say, like Boston College professor Peter Gray, PhD

    …our greatest real fear becomes, in play, our greatest joy.

    When this goes wrong is when we hurt ourselves in the process.  “Look out!” is what I say.
    Other examples that are more common are film, television and video games.  We now have data that supports evidence of primary emotional illness induced and driven by watching violence – such as post traumatic stress disorder.  Post traumatic stress disorder is a bummer.  It is the only primary emotional illness that has no clear genetic origin but comes after a life threatening event either experienced by yourself or observed by you.  Just don’t get it on purpose for crying out loud!

    When I am hankering for a good thriller movie, I try to use this understanding to steer me.  I try to remember that I am extremely valuable.  Along with the obvious but not so obvious good advice,

    …whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.

    Self Care Tip #48 – Scare yourself if you must, with caution.  Be a friend to yourself.

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    Look Around At The Other Reasons – Depression

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    “I’ve done some bad things.”  Patient tells me she can’t sleep well, is nauseated, depressed mood, worried with perseverating thoughts about acts that shame her and ramifications, doesn’t feel as much pleasure in life, isolating, tearful and more.  I was alarmed!  What could she have done that deserved this kind of self-flagellation?  When she told me, I didn’t realize it.

    I was still waiting for the rest of the story.  I got caught up in her own self-judgment and found myself sitting beside her “in court.”  Once I realized what I was doing, I was chagrined.  Here I was collaborating with her in her inappropriate guilt.  It took me too long to register that her reaction was not proportionate to the offense.  I told her I was sorry she was going through all this emotion.  She said, “It’s my own fault.”  Is it though?  We needed to start looking at additional reasons that might be influencing the way she felt.

    Start looking at other paradigms when the emotional response is out of proportion to the event(s).

    An analytical approach would look at unconscious reasons, such as other personal choices that conflict with a core beliefs.  Or perhaps, something like unresolved anger coming out in physical and emotional symptoms. Ask about our “closets,” peel away pretense and let your flawed self into the air.  Keep it real.

    Another paradigm is medical.  Inappropriate guilt is a symptom of Major Depressive Disorder, a debilitating disease process of the brain that affects the whole person/body systems.  When distorting things out of proportion, personalizing too much, we must ask if there is a depression going on.  Ask yourself.  Ask others.  But don’t let it continue if at all possible.  Major Depressive Disorder is a progressive disease that does more damage to the brain the longer it goes untreated.  In other words, the brain is affected more over time, it is harder to treat and it is more dangerous to the person.  The average length of an episode is 2 years and the more times it returns, the more chance to have the disease process continue for life.  Treating sooner and for longer, decreases the chance of relapse.

    Excellent for us are the many treatment options for this potentially devastating disease.  Even in the “lifer,” when staying on medications, the relapses are much easier to get through and shorter in duration.  The medication has a protective effect on the brain.  Prophylactic against further insult.

    In the woman I told you about, there was another emotional spectrum disorder, anxiety.  Anxiety and depression are like brother and sister.  They often go together.  But for today, we’ll leave it on the symptom of inappropriate guilt and let it rest on the reminder that the brain is human, mortal, attached to our neck and not an aura.  When the brain gets sick, it shows how it is doing the only ways it can, often through emotions.

    Self Care Tip #46 – Look at all the reasons influencing the way we feel.  Be a friend to yourself.

    Question:  What do you think?  Agree or disagree?  What is your story?

    by

    Your flawed self

    My niece is sitting beside me and I can barely keep my hands off of her 5 month self.  I am eating a blueberry scone slowly.  She, with her tummy-full of breast milk, is watching every bite, a faint smile on her pink face.  I’m a little afraid she’s learning to eat carbohydrates from me and I want to tell her that I can’t remember the last time I ate one of these.  I start eating faster and turn away so I don’t imprint this on her supple myelinating neurons.

    We closet eat, closet smoke, closet shop, closet sex, closet what we want to protect others from but what we independently are strong enough to handle …or not.  There is a term called “self-sabotaging behavior.”  Reducing this, we find that the process of closeting is in fact the handle on the door to that mal-behavior.  Keeping it real is the same as saying get it out of the closet.

    My mentor and brother, Cameron Johnson used to say, “Go where the pain or fear is and it will lose control over you.”  People who work the 12-Steps call this “Rigorous Honesty.”  It is a pealing away of all pretense with yourself.

    Avoiding rigorous honesty turns into self-sabotage.  We end up cutting ourselves down at the knees.  Anxiety uses fear to make us hide.  In cases that include emotional illness, of course medication will help our work toward honesty.

    It is not about whether we hide our bad sides or not – we do.  It is about trying to keep it real.  The only thing to be ashamed about, if we must, is not trying.

    So to my niece, I give her my flawed self and when the time(s) come, I will accept hers as well.

    Self Care Tip #45 – Show the world your flawed self.  Be a friend to yourself.

    Question:  How have you experienced the freedom that comes from going toward the fear?  Please tell us your story.

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    Do What You Were Designed to Do

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    Nike made it popular.  But did we ever take it and run with it?  “Just do it!”  My girlfriend and I were having lunch together and the topic about our life’s profession came up.  She is bored in her work and would like to get into something more creative and artistic.  In an ideal world, maybe she’d think, “Just do it!” and find congruence with her inner self “just” like that.

    However, taking action isn’t only about energy, interest, boredom.  But what is it?  What is it that makes one person take action and another think about it and move on?

    One answer has to do with hard wiring.  Some temperaments find that thinking about it is almost as good as doing it.  Imagining what they would have done pretty much satisfies their drive.  Others find that taking action that leads to completion, decisions, just doing “It”, feels like boxes, closing in, closed doors.  They feel separation anxiety just imagining the distance growing between them and their beloved Options.  For these people, maybe the perspective of “Just do it” should be different from our cultural definition.  For them, doing it may mean doing what they do best – grazing their ideas, options, journey.  They are best at playing through life so to speak.

    Western culture measures work generally by the opposite of this, although the truth is, our life’s work is what we were designed to do and be best at.  What looks like play to someone is in fact “good work” for another.  What looks like work to another, looks like something they’d rather jump over a cliff than do.

    If we want to really get something done in life, we will do best taking inventory of what we bring to life with us.

    I haven’t touched on other reasons why many of us do or don’t take action to completion.  Things that have to do with different pathologies.  I’ve only talked about one paradigm of hard-wiring, genetics.  This paradigm is crucial though.  It permeates all others as it is about our architecture.

    Self Care Tip # 44 – Just do what you were made to do.  Be a friend to yourself.

    Question – What do you think?  Have you noticed this concept at play in yourself or others?

    by

    Let It Go and Keep Going

    Like gripping a blade the reflex may be to grip harder.  When to let things go when it feels like we can’t…  How do we, if it is still active in our lives?.  Something negative but still going on with no end in sight?

    A woman comes to me anxious and depressed.  She looks older than her age.  She cries a lot talking about what she is ashamed of.  Staying with her emotionally abusive husband. Probably having sex with him though she didn’t want it.  Unable to leave because she didn’t have money, job, or family support.

    This woman I mentioned, she is courageous.  She has tried for years to find herself again and still tries again and tries another time, times times.  She talks to her kids about it and they say she should never have married him.  She talks to her friends and they sigh and heap insults against him.  She talks to God.

    She comes to me.  Why she comes when she does?  She found the courage to ask for help one more time, times times.  She takes medications.  We spend 6 months together before she starts responding to the combination therapy and each day she had the courage to wait another day times another.  Her face looks younger, slowly, like looking through an album backwards over the next weeks.  She starts talking about doing more than making it through the day.  More fits into her hopes than survival.  Like Mary Poppins‘ travel bag, she keeps pulling more out of her life than she ever thought it had space to hold.

    One day about 1 1/2 years later, she came to me with a secret smile, holding her purse like a stolen cupcake.  The door closed to our room and she pulled out her dog.  She said, “I’d like you to meet my best friend in the whole world.  I just love him so much!”  She is a woman who found courage to love and be loved.

    I am in awe and humbly wonder after her.

    Remember again the addict who so often leads us in this example.

    God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.

    Serenity Prayer

    We surrender when we can, when we think of it, when awareness dawns, the things we cannot control.  It might take a higher thought to “let go” of what we cannot control.  When we are able to do this, we are larger in a sense than the moment.  The recurring yucky events are seen more objectively and less personally.  We are more knowing.

    It takes us back around to how we define ourself.  Our spirit.  Our essence.  This woman, she found it.  She found she was more than her circumstance.

    “How do we surrender what we cannot control?” you ask.  Ask yourself.  I have my answer.  I hold my answer in my mind’s eye, like a Swiss bank account.  My most precious treasure in the care of The One,

    …where neither moth nor rust does corrupt, and where thieves do not break through nor steal.

    This woman, she is courageous.  She journeys without being defined by the events.

    Self Care Tip #36 – If you can’t control it, let it go and keep going.  Be a friend to yourself.

    Question:  What do you think?  Please tell me your story.

    by

    Own It. Our Life’s Work.

    We can control what others do about as much as we can control the Democratic government.

    My patient asked me if her medications were changing who she was.  After asking her more about where that came from, she disclosed that her husband was blaming her medications for the emotional distance between.  He was not blaming his daily alcohol intake nor that he see’s her as “The Patient” and not himself.  This is after she has spent years investing in herself through medications, some counseling, and regular exercise.  This woman had courage.  Yet she still bought into what her husband was telling her.

    We personalize things that have very little to do with us.  Sometimes we know we’re doing it, but more often we don’t.  In this woman’s case, I had to think, how much of this was about her versus the accuser, i.e. husband.  We came to understand together that either way, true or not, the only person in her relationship she could better, is that same person she’s been attending to so well for so long.  In the end we were talking about going to CoDA, Al-Anon, or local support groups through NAMI.  She focussed on herself, excited about her opportunities to grow some more.  She wasn’t thinking so much about her husband getting passed up by his own opportunities.  Nor about the accusations.

    Talking to a friend who recently shed 15 unwanted pounds, we did a celebration whoop!  She wasn’t perseverating on her husband who was smoking again. She was hurt by it, but used the energy in that emotion to motivate change in her own life.  Who knows.  Maybe her husband will grow from wanting what he see’s in her.  Courage, self-respect, inner congruence, hope, and so many more great things that come when you fight hard for your precious self.

    Not taking things personally though can be much easier said than done.  If you try over and over but see that it continues to get the best of you, consider getting an opinion from someone you trust.  Get a “third-party” opinion to bounce your perspectives from.  Maybe this is something biological and medical as well. Personalization is a familiar problem in medical illnesses such as Affective Spectrum Disorders or Anxiety Spectrum Disorders.

    Self Care Tip #35 – Own it.  Be a friend to yourself.

    Question:  What do you think?  Please tell me your story.