behavioral health

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Hear, Be Heard, Believe and Speak In Your Language.

c. 1868

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Self-Care Tip #187 – Say it better by saying it in your voice.  Be a friend to yourself.

We all have our own language.  I’m not talking about Hungarian or Spanish.  I’m roughly talking about Jungian typology.  We speak and hear, we are heard and we find that we believe better with it.  But we don’t all know that and so don’t treat ourselves with enough courtesy.

For example, many of us used to think that listening to emotions was silly and that using graphs and quoting studies was smart.  (Who ever heard of smart emotions or even spiritual intelligence for that matter?!)  We used to hold our breath and hope our brains would change if we despised our own wiring enough.  As if our genes would get the hint, give up their mortgage and leave town, disgraced.

Hopefully after the paternity of the genes in question was established, and if we grew a little, we noticed that there is no better way to speak than what is our own voice.

Say it.

That was lovely.  Thank you.

We can listen to the beautiful music of Celine Dion French Album, or watch the foreign film Like Water for Chocolate (Spanish: Como agua para chocolate) without subtitles, or sing the African-American spiritual song from the 1930s, Kumbaya.  We will get a partial understanding of what is intended, what is said, what is felt.  We will know that someone is desperately in love with someone else, for example, in Como Agua Para Chocolate – but not get the full story of course unless we hear the words in the language we know.  Saying that one language is greater than another is hopefully buried with Hitler.  Our temperaments speak uniquely as well by design.  They are not qualified differently from each other.  True, they are better suited for different tasks, jobs, audiences.  But that doesn’t make one smarter or dumber than another.  Regardless of the bank account any one or many may hold, there is no difference in value between them.

If we want to say something, ….  Well all I can say is this just feels right?  You know what I mean?  😉

Question:  What has helped you discover your language best?  How has it helped you understand your connections better?  Please tell me your story.

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Get Out Of The Company Of Comparisons. Forget About Fairness.

Tail lights, lights, rain on my windshield, co...

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Self-Care #186 – Forget about fairness.

It’s raining here; herding us.  I don’t like driving at night, but driving in the rain at night is worse.  Driving in the rain at night, with a rabid sheepdog tailgating me is still worse.  However, I do love slowing way down when I’m tailgated.  That was nice.  And seeing some family, including my folks, made it all worth it.

My kids were in on it too.  They were doling out banana smoothie and repeating a favorite theme called, “Make it fair!”  In Parenting, the frequent reminder that life will never be fair for my kids, and wondering if they’ll ever get it, gives me almost as much pleasure as being tailgated at night in the rain.

“Make it fair,” isn’t far from any of our hearts desires.  It’s easy for me to forget humility and judge my kids, but when people aren’t looking, I’m also checking to see how much I got.

I met a girl in clinic, Britt, who was also working this out for herself.  She was holding it in her hands and turning it over; a foreign object.  Britt said,

It doesn’t matter what has happened to me, I’m still responsible for taking care of myself…

She said it many ways, and the tail of her pauses kept flipping up into question marks without actually asking,

With my abuse…?  No one else will…?

I could see her with all the rest of us suffering folk, checking the fluid line in our glasses, saying

With all the hurt I’ve received…

I was poor my whole life…

I just can’t seem to get a break!

For Britt, coming to a point of owning her self-care felt like losing social support.  She had for so long sipped on her succor as a victim in the company of her received wrongs, that she felt awkward.  Britt needed to find a new group of friends.  She stood there toeing the floor,

I have to take care of myself.

Britt will be alright.  She will be emotionally healthier and in better company very soon.  She will move past where so many of us are still gripping our goblets asking about why we didn’t get more.  She will say, without that question, self-care begins and ends with “Me.”

Britt hasn’t been able to do this without medical help.  For her, part of seeing herself as a victim to what life gave her was symptomatic of her major depressive disorder.  She was personalizing what wasn’t personal.  Not everyone will need medication.  Some of us will do well just recognizing that, “Life is not fair,” and will be able to move on.

Question:  How have you gotten out of the company of comparisons?  How has putting fairness aside been a form of self-care for you?  Please tell me your story.

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When You Are Pushed Down, Push Back

A Push and a Shove

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Self-Care Tip #185 – When you are pushed down, deliberately push back with The Force in  you.  Be a friend to yourself.

So much in life pushes down on us.  I am amazed that we push back – considering how awful some of it is.  After 7 years of private practice in psychiatry, I still get caught off guard by some of the particularly horrible stories I am told.  Blinking my own stinging eyes, I look in amazement at the person in front of me.  What I see is this pushing-back Force.

Last week after diagnosing PTSD in Margie, a mother of a murdered son, I could hardly believe that she still chooses life.  She takes care of herself despite.  That’s how amazing she is.  And I’m her psychiatrist!  It’s such an honor.  And thinking about that straining towards life, that thread in us, all of us – I saw that it was the best description of the brilliance and power that is God.  True, sickness can mute our perception of this beautiful thing in us, whether it’s depression or liver disease.  But all of us have seen some of how hard the thrashing against that loss is.

In thinking on this amazing force, this thrashing about, this straining against the push of whatever is set at tipping us over, I named it God in us.  And I thought, for all the time I spend on the stuff pushing me around in bad ways, I’m going to more actively team up with the struggle to live.  I’m going to choose to strain and thrash about and move at that chink of space in the dark room as much as I can.  Hopefully I can be brave too, like that mother of a murdered son, Margie.

I can choose to ally myself, with what I want to live for.  I’m going to partner with that Force that keeps me thrashing against the push and be stronger, like you have readers.

After our post on suicide a couple days ago, many of you responded with your own stories about how you were pushed and pushed back.  Karal said,

Like all difficult experiences we face in life, there is the possibility of growth from the ashes.  It requires strength and a willingness to walk through that fire.  Unfortunately for survivors of suicide (i’m referring to those left behind) we’re often chastised into feeling that our grieving, our walking through the fire is both wrong, and  unnecessary.  I totally disagree.  Like you said, caring for people is a choice, and being a friend to yourself means making sense of, or at least peace with, what may never make sense.

Karal is allying herself with that Force to make as much sense of what will always be jumbled.  I’m not going to quote all the rest of the brilliant comments.  Please read them.  They were amazing demonstrations of pushing back in a collaborative way with The Force that makes their lives worth living.  This is active in us at times, and not deliberate at others.  Being better to ourselves, we could more deliberately choose when given the push.  We are not thrashing alone.  Push back.

Question:  How do you deliberately choose your alliances in your life for working against what pushed you down?  How do you define that Force in you that pushes back?  Please tell me your story.

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Goodbyes Are A Way To Connect

15th century adaptation of a T and O map. This...

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Self-Care Tip #184 – Respond to your goodbyes deliberately to be friendly to yourself.

One of the Regional Centers that I work at is closing their telemedicine clinic.  This means I’ve said goodbye to many beloved patients and their families, whom I’ve worked with since round 2003 I think.  Saying goodbye to people we respect and enjoy is not as casual as we stylin’ people make it look.

Two days ago I said goodbye to my girlfriend of around five-plus years and her family.  Moving far far away makes the flat world feel lumpy and luminous.  I now have all her leftover food and knock-offs she didn’t want to haul across the lengthening world to remind me that she is gone.

Watching parents and/or grandparents age is also an exercise in saying goodbye.  My parents have a hard time making it over to visit on week-ends for all the funerals they go to.  Their calendar sends over that whispering voice that they are growing old.  “Look,” it says.  “See me.  I am aging.  Time is connecting and taking me with it.” Even so, their essence holds its own, apart from Time.  That makes me feel more comfortable.  When that whisper gets louder I may respond differently, I can’t know until then.  But for now, this is good.

“Goodbye” is something that begs a response.  “Oh yes!  Goodbye!  See you later.”  I even say, “See you later” to people I know I have less than one percent chance of running into again.  The word calls to me and I respond.  The word implies a disconnection, but even so, beckons us to connect.  It spreads us over the space of our time shared and into the future apart.  Peanut butter and jelly, it sandwiches us up with the one who says “Goodbye” when we say back, “Until then.”

Today with these people and remembering all the ones I won’t get to see before my contract ends, I feel the pull to respond.  My response can be something deliberate.  It is another bit of something I get to choose.  I hope it will connect me.

Question:  How have you responded to the goodbye’s in your life?  How has it been a connecting force for you?  Please tell me your story.

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It Is My Choice to Take Care of Someone, Even in The Context of Suicide

Detail of The Death of Socrates. A disciple is...

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I was a teenager I think when a woman in our church suicided.  Dad pointed out the man sitting alone.

His wife just killed herself.

Dad asked me what I thought of suicide.  Imagine.  What a compliment really for a teen, to be asked her thoughts.  Being a “Feeler,” I oozed something empathic I’m sure, but still I only remember what Dad said,

I believe God has a special way of seeing these cases.

This was at a time when culturally most of the western world saw suicide as sin.  It was quite forward for Dad to say what he did again later to the grieving man in the pew.  I did not realize at the time, but now I see that people judged him and his wife for what she did.

Later in psychiatry training, my attending said,

Suicide is the most selfish act anyone can do.  It is the ultimate punishment aimed at those who still live.

I don’t know what you think, but I couldn’t help wondering.  I still do.  I think this may be true for some and not others.  I haven’t had a chance to ask them.  They’re dead.

Suicide is terrifying to a psychiatrist.  We all tremble at the thought.  Statistically we know women attempt it more than men, but men are more “successful” when they do try.  They use methods that are generally more lethal than women.  They don’t get a chance to realize that in a month or a day they will want life again.  Or an hour.  They could have lived.

In the intensive-care unit of a hospital, “unsuccessful” suicide attempts hover in life in a space where their self-injury placed them.  The nurses are kept running between medicines, treatments, physician orders and prayers for these lives that tried to die.  Sometimes, the “chronically suicidal” become familiar patients to this critical care ward and that has it’s effect on those who have spent themselves so heroically to save them.

A nurse once told me angrily about her patient who kept coming back.

I fought for that woman’s life!  I prayed over her!  I worked all night for several nights and didn’t know if she would live until much later.  And then she was transferred out to the step-down ward (to a floor where the patients aren’t in such a life-threatening condition), and that lady probably never knew what I went through to keep her alive.

Then later, she came back, and later again, almost dead but not dead.  She kept trying to kill herself!  Finally, when she was conscious again, I just told her how it is.  ‘Listen!  I fought hard for you!  You better go out there and live!  You better figure out what it is you want and go for it.  Stop trying to die!’

This lady-patient was hurting more than herself.  Suicidal thoughts and attempts are dangerous.

There was a patient who tried to use his bed-sheets as a noose before the nurse lifted his wet body from the door frame.  In the emergency room (ER) he was examined, x-rayed and determined fit to return to the ward.  Alive.  Talking to the ER physician, I learned that the reason most people die when they hang themselves isn’t because of suffocation.  It’s because they break their neck.  Done.  No more chances to choose life.  Even an hour.  My pulse was still beating on me to the rhythm of, “He could have died!  He could have died!”  This time, no broken neck.

Regardless of our culture, we are not the judges of these people who want to die.  Regardless of our emotions, their emotions before, any previous conflicts, regardless, we cannot measure their final act by degrees or intentions.

We fight together for their lives and they may or may not know about what that does to the rest of the world.  When we don’t want to fight for them any more, we should change jobs.  It is our choice, each of us.  Whether we are fighting as professionals or as a wife, brother, friend, volunteer or the hired tutor, we fight for their lives because we choose to.  If we cannot keep it up without judging, shaming, accusing the suicidal, we need to own that and take care of ourselves first.  “Can’t give what you don’t have.”

The truth is, suicidality is hard for everyone.  It is hard in ways and in people that aren’t talked about, such as the nurses or the x-ray tech who is the first to find the cervical fracture (broken neck) on film.  It is hard for the church parishioners, the person separated by seven-degrees or the grocer.  Suicidality is hard for all of us.  We give what we choose to give and remember to say, “I can’t control that,” when we can’t.  It is our choice.

Self-Care Tip #182 – Taking care of someone is your choice, even in the context of suicide.  Be a friend to yourself.

Question:  How has suicide touched your life?  Please tell me your story.

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Pain Can Be Something More and Better Than Just Pain

English: Vladimir Bystrov. 2006 Russian Premie...

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Self-Care Tip #181 – Look for help if your pain never becomes something more than pain.  Be a friend to yourself.

Glee is back!  I’m so glad because it makes great work-out distraction.  Good music, drama, beautiful people, and wonderful ah-ha concepts like,

Use your pain and loneliness to inspire you to make something beautiful.

Can’t remember it verbatim though and I noticed after an hour surfing the web for Mercedes quotes (and getting detoured to all sorts of other fun stuff for grazing) that whoever writes these quotes up didn’t find this one worth it.

Joni Eareckson Tada on the Larry King Show said that when she thanked God for her paralysis, she began to be productive through what paralysis offered.

It is however sometimes impossible to take what hurts and let it fuel our fires.  Sometimes it’s just a cold lump of coal.  Sometimes, we aren’t adaptable.

Luckily we aren’t sitting in a cave during the ice-age and can trust that a bear won’t come and eat us when we are wounded.  But there are other predators.  In my line of work, I could call disease process a preying force.  It takes over more and more cells, space, grey matter, consuming bits of our identity and changing our ability to cope with stress.

It’s easy for people to say, “Turn your pain into energy for creativity,” as if it were a volitional option for you like it was a choice for them.  Or we call it bits of morality; maybe a fourth of an inch on the rim of our gold crown we get in heaven.  Those of us who care about that crown look at our shoes, apologize and promise to try harder.

It is not easy to explain these apologies and inactivity to someone who has never been immobilized by mental illness.  Even those of us who have experienced it first hand have a hard time remembering the real texture of what we went through once it is passed.  Illness can be so awful that even our subconscious shudders when turned back to remember.  It is no wonder that we find it difficult to explain.

However, it doesn’t have to be this way.  If we aren’t able to adapt, aren’t elastic and sit stunned in the presence of pain, immobile to the newness that it can offer – recognize this as a flag to turn towards medical help.

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  Please tell me your story.

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Sharing Will Take You Out of Isolation

Flowers for Valentine's Day

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Self-Care Tip #180 – Sharing will take you out of isolation.  Be a friend to yourself.

If Valentine’s is about Love, today felt like Valentine’s Day to me.  Your support, my friends, came to me like bouquets of home-grown roses, lilies, daisy’s and bird-of-paradise.  You swept me up and carried me over a threshold of something I didn’t want to cross alone.  Thank you.

Carl, dear Carl, is always surprising us.  He told us yesterday about his own amazing dad and then said,

I can truly say I know how you feel.

Even though much of this feels unique to me, I know it is not.  Pain is not unique.  It is our choice to experience it alone or in community.  I choose you.  Thank you for choosing back.  Thank you for my flowers.

Mom has always been a fierce lover of flowers.  She arranges them dramatically and gives them out, believing that their beauty is enough for now.  She never worries about when she won’t have any.  I actually don’t ever remember Mom without them.  She just can’t stay away.  Either she goes where they are, or they seem to some how follow her.  Sounds like story fodder but it’s true.  She will be one of the loveliest in heaven, just because she was designed to be.  I can’t imagine all that Mom will learn on beauty through an existence disconnected from time.  I’ll know where to go when I want to gather some for you.

Mom goes to see Dad every day.  She’s usually wearing something shiny or bright or both.  Dad’s hospital room is in full bloom and there is always food for nurses or visitors.  This is how Mom does her fighting for Dad.  Through beauty.  Not bad, huh?  She washes him every day so she can spare him as many further humiliations that come with illness.  He is lotioned up; more able to receive than he ever is outside of the hospital.  In their own way, he and she give to each other like that.  I’ve seen Dad cry and Mom just push aside the tubing and get in beside him on his electric bed.  In the hospital, a lot can happen.

Tomorrow is Valentine’s Day and Dad said,

Well, I guess I’ll just have to let this one pass.

But if Valentine’s is about Love, he doesn’t have to worry too much.

Since round high school, Dad has told me that I have to sing some day at his funeral, “The Only Thing I Want Is To Be With Jesus,” By Joni Eareckson Tada.  I am sure I never will but he refuses to believe it.

The only thing I want is to be with Jesus.  Just to see Him smile and say well done, what a day that’s gonna be.  I want to feel His strong and Loving arms just hold me to His side, and to be with Him, throughout eternity.  Just to be with Him is heaven enough for me.

My seven year old asked the other day,

Mommy, will Papa be alive when I have kids?

I told Dad and he laughed.  He’s an easy laugh.

That’s a really good question.  What a mind.

Dad has almost died about a zillion times and it’s easy to feel like he will live forever.  All I know is that if he keeps putting me through this, I’ll need you there to take me out of the isolation and remind me that none of us have been chosen to be alone.

Question:  How has pain been a connecting force in your life?  What has helped you share what seemed impossible at once to let outside of yourself?  Please tell me your story.

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Dad Is In The Hospital. My Reality.

Open-face helmet.

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Self-Care Tip #179 – Get inside your reality and be with Love.

When I was eight my family left me at Grandma’s farm for the summer.  There’s not much more inland to go than Iowa.  If the United States of America were a house, Iowa would be perhaps it’s cellar; full of smells, goods and it is a great place to play.  I played a lot that summer – as well as stepping in a cow-pie or two, riding tractors with Grandpa Jack cutting hay, pulling on cow tits and seeing the milk come out to shoot right into the cat’s mouth.  And I gathered eggs from pecking feisty chickens that would scare the bravest of any Coasters (those of us from the East and West.)  Grandma was no-nonsense and didn’t waste much time on coaching.

Just stick your hand in there and take the eggs.

As an eight-year-old you haven’t known real fear until you face down a mother hen in a musty unlit poop filled coup, and reach under her feathered skirts for eggs.

That summer Dad came to get me early.  I was really happy to see him.  Uncle Mel and my cousin Dougy had been in a motorcycle accident.

Dad is an orthopedic surgeon and since my summer in Iowa,  Dad has called motorcycle helmets, “brain-buckets.”  He’s seen a lot of them in emergency rooms, so he knew what his brother had looked like.  Dougy was in a hospital bed being introduced to his now forever useless arm.  I came in shy, because Dougy was so cute.  I was thinking about what he thought of me.  I know.  I did.  Despite my diva-self, despite the horror and grief, Dougy gave me a brilliant white-boy American smile.  I hid under Dad’s arm where I didn’t have to look but could still hear Dad’s voice.  I think I may have even whined.  I’m still embarrassed.

These days, unfortunately I rarely get to see Dougy, but when I do, I still want to hide under Dad’s arm as if he’d remember me there.  I wonder if he remembers Dad’s voice.

Today, Dad is in a hospital bed with a blood clot the size of a rattle-snake crawling up his leg, fighting for his right to walk, let alone live.  It is his voice, or maybe the bed, that brought Iowa back to me.

Cousin Patty was crying at Uncle Mel’s funeral.  She wouldn’t go up to the casket, just sat and cried.  I was a little bummed my cousins weren’t interested in me.  It was who I was at eight years old.

Grandma, who left me unsupervised to gather eggs from angry-chickens, cried and asked me for more kisses.

They taste like brown-sugar!  Give me some more.

Dad’s hands now have Grandma’s same wormy veins, raised over blotched ecchymosis (purple patches from leaking blood vessels into the skin); begging to be touched.

I went to see her with my brother Cam before she died.  She was delirious.  But I trusted her so.  I laid beside her in her hospital bed and looked up for a shoe she told me was stuck in the ceiling.  I thought, “There just might be one and these people don’t believe her.”  I was miffed.  Now I realize I was mostly angry because Grandma was dying.

The farm is gone and I wish I had the metal tub Grandma bathed me in outside on the lawn.  But I do have this connection in me to all she gave, the people who came from her and her showing me how to live and die.

If she was still alive and knew Dad was in this danger, she’d say, “Rob, I’m praying for you.  I Love you.”  And unlike my emotives, that would be about it.  She was from Iowa, you know.

This is my reality.  Dad is in the hospital.

Self-care includes being in our reality.  Sometimes it’s too much for one person to handle.  People need Love.  The reality of the world and of the individual is that we need Love.  We are better to ourselves and others when we can be inside our reality.

Telling you about this is my self-care.  This is part of my Love story.

Question:  What is yours?  Please tell me your story.

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The Spider Sat Down Beside Her – Mental Illness

Self-Care Tip #178 – Find your courage and answer to stigma.

The Little Miss Muffet scenario explained by D...

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Something as simple as taking pills can sabotage us.  The act of putting it in our mouths signifies all sorts of things from religion, to freedom, to personal identity and beyond; even someone who is trustworthy versus not.  Pill – take away her children.  No pill – could be president.  Pill – discredit whatever he says.  No pill – worth listening to.

Martha is a mother of four lovely girls.  Her husband is divorcing her and she wonders what he will do in the process.  She’s been depressed in the past and anxious with a history of panic attacks.  She took two years to get over them using breathing exercises and other therapies. She didn’t use medication.  I don’t need to tell you what her husband thought of meds or of her during that time.  It was a miserable time for her.

Now, during this new stressful time, she has relapsed in mood and anxiety problems and is terrified that if her husband finds out, he’ll take the kids.  Martha sees mental illness as a bullying tool for anyone to dump her over.  Little Miss Muffet is a story she often has compared to her situation.  The spider is the mental illness she feels is dangled over her to her demise.  Martha is bullied and scared away.

Taking pills makes me feel like I’m crazy!

Note: it’s a type of crazy she interprets as being something different from the crazy of mental illness.  For Martha, the crazy that comes with medication therapy is more sinister and discrediting than the worst experience of terror any of us have ever gone through, i.e. panic attacks.

Every day, we who take medication for emotional illness have to answer to those accusations.  We contend with the fingers pointing our way, the jeering in our memory of loved ones and the boxed presumptions we find ourselves in.

This may sound a little dramatic to some out there, although familiar.  To others, it is an understatement of what they courageously confront to take care of themselves.  Each of us must come up with our own answers and find our own courage.

Martha finally decided on medication treatment and within two days she was amazed to find that she could eat without throwing up and no longer felt anxious.  She still insisted that taking medication was only temporary but getting a pill dispenser had helped her get past some of her daily battle with stigma.  She just opened the lid and poured the pills into her palm, threw them back and swallowed without looking.  Martha found it easier not to dispense each pill each day out of each bottle.  It was also easier for her to keep this information secure in the confines of our office.  For Martha, for now, this was how she answered.

Question:  How do you answer to stigma?  How do you maintain your sense of freedom when other forces tell you that you are not free?  Please tell me your story.

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Waiting For Self-Care to Start

Self-Care Tip #176 – Don’t wait to start caring for your self.  

I’ll get to it when things slow down for me.

I can’t handle one more stress on top of the kids and all the people who take, take, take.

Don’t take this away!  It’s my only vice!

I don’t have time because I’m working so much.

There are so many good reasons to wait for self-care.  I don’t belittle them.  I do them too.  There’s a reason we here at FriendtoYourself.com call self-care the hardest work.  It is not for anyone who isn’t willing to go through the fire of putting themselves first.

“The fire,” you say?  Yes.  Fred taught me that.  He was down twenty pounds, working out almost every day with aerobic and anaerobic exercises, putting his ear-plugs in when sounds escalated his nerves, more motivated, interested and active.  Fred was growing again.  He said that it had been years since he’d done any of these things for himself and couldn’t believe what the world looked like when he felt so good.

Fred was sad though.  Not depressed.  No, he hadn’t been depressed for at least a year on his medication and even less so since he was taking care of himself physically.  But sad.  His wife wasn’t interested in his changes, she was disconnected emotionally, and more so every day it seemed to him as he began to change physically, emotionally and behaviorally.  His friends were growing distant.  He wasn’t interested in office politics either.  It was a simultaneous coming together of life in himself and a falling away of the life connection in his “previous life,” as he called it.  Surprisingly, the people he loved the most weren’t so happy for him.  Weren’t supportive of him.  He was sad for that.  There are never gains without losses.

This is not to forget the new relationships he was growing.  There was new life all around him and he still maintained hope for the connections he had before.  But those people who he had called his own for years were the ones who gave him all the reasons to wait for self-care.  He was way past waiting.  He was already on the other side enjoying the sun.

Question:  What have you overcome to get at your own self-care?  Is there anything your are still waiting to do?  Please tell me your story.

*Art work (assumed) courtesy of carldagostino.wordpress.com.

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Work Hard to Take Care of Yourself If You Want An Easier Time Taking Care Of Others

Self-Care Tip #174 – Work hard to take care of yourself if you want an easier time taking care of others.

My marriage has never been better.

Freedom Press (UK)

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Kirsten had good posture.  She made eye contact and she wasn’t fidgeting when she told me about the changes in her life.  I hadn’t seen her in clinic for two years and apparently in that time she had set her husband free.  She was seeing less of him than she ever had and they were both busier than any other time in their lives.  Yet their marriage was at its peak.  I felt like I was getting off the point of why she came and wondered if asking her for details was unprofessional.  I did want to know.  Lucky for me, she wanted to tell and I just let it happen, as if I was doing her a favor.

I admit, sometimes I get something out of my clinicals.  I’m not always the best therapist.  I don’t always keep things about my patient when I let myself receive, or even actively take from them.  None of us are that altruistic.  Therapy is supposed to be one place any of us can go, and know that when we go, we can expect to receive everything except the fee-for-service.  Therapy should be the closest thing to a one way street in this non-altruistic world.

To my rescue, Kirsten said,

He has been meeting with friends, exercising, eating out and working the 12-Steps twice a week.

Yes he was sober, but he was also a bunch of other stuff.  Taking care of himself, he became a better husband.  Better body, clearer mind, happier, more attentive, less angry; she could hardly stop listing.

Freedom is useless....

Taking care of himself took a lot of work but it made taking care of her a lot less work.  True, she wasn’t the center of his life, she gave up on some fantasies, she didn’t ask him for more time, but all those in the past had only grown her own point of anger and blame and not the marriage dreams she thought they would – letting them go was a good thing.  Yet, cutting him free still felt risky to her.  She came to me because she was becoming more aware of what that fear was doing.  When she was afraid, she was sabotaging herself.  Bits of herself recognized that she could feel as free as her husband did.

To be free of fear for Kirsten, she needed medical help.  Kirsten’s fear came from nowhere, out of the blue and was not only triggered by suspicions about her husband.  To be free for Kirsten’s husband required other forms of self-care.

Question:  What kind of self-care does your freedom need?  How has your hard work on your own self-care spilled over into less work to care for others?

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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

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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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Choose Self-Care At Your Most Elemental Level

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Self-Care Tip #167 – Choose self-care at your most elemental level.

Carl, who writes blog-site, StillFugue, said after yesterday’s post on self-care being for everyone,

Sometimes depression blocks this type of self-care regardless of how good our cognitive strategies are.

Carl reminded me of Dr. Lang.  He was a physician, a father, a man of high character who never had depression in his life.  Then after a series of life stressors depression expressed itself and he, who once was the warm-fuzzy in the hospital, the man who never lost his optimism, the man who turned anyone’s bad mood around – this man came to me under a black cloud, heavy with melancholy, and raining tears.  He cried all the time.  This giant of a man cried and cried on his wife’s shoulder, and she was bewildered by him.  She told me he had done this for a month now, although the depression started about four years ago.  He kept wanting her to read to him the book of Job and cried more barely hearing the words.  He had already been through a series of well-chosen medications, but still he sank deeper.  No form of treatment kept up with the leak in his ship.  What was self-care for Dr. Lang?

Did Dr. Lang have good coping skills?  Well he wasn’t coping well now even though he knew the strategies.  He didn’t understand why he couldn’t use the coping skills.  Did he have intelligence?  Yes.  Did he have resources?  Yes.  However, none of that is what this was about.  Asking Dr. Lang to cope with his feelings is the same as asking someone blind to see.  Physically, biologically he could not.  His brain could not.  Much of his ability to choose behaviors and emotions were drowned by illness.

So again, the implied question comes to us, – “Is self-care for everyone?”

Mr. Rick C. threw this life-saver out in response to our question,

During times when chaos ensues, either internally or externally, self-care seems to become the basis on which all other positive actions are built.

Sarah McGaugh also referred to self-care as “action,”

A call to action may also be a higher calling than one’s own self….

What action did Dr. Lang do?  He cried on his wife’s shoulder and read the Bible, i.e., he leaned on the support he had built up before the hard times came.  After failing medications, he sought another opinion and other treatments.  Sure, he couldn’t get out of bed otherwise even to bathe himself, but he had made it to my office.  What did Dr. Lang do?  He got electroconvulsive therapy (ECT) and in two months, along with his medication (only one antidepressant was needed at this point), Dr. Lang was no longer crying.  In four months, he was laughing again.  In six months, he stopped ECT altogether and maintained his emotional health with his monotherapy medication.  It’s been seven years since Dr. Lang went through all that and he has not relapsed yet.

I pick out so many points that I consider self-care choices Dr. Lang made.  They changed over time for him according to his needs and abilities, but he didn’t want to die.  Even at his worst, when he could barely remember why life was so important, that wisp of hope was enough to live for.  It was a higher calling to him, higher than his own dark wants.

That was Dr. Lang’s choice.  He chose self-care at his most elemental level.  It was his response to the call of hope.

Questions:  But what about you?  What do you think?  Is self-care for everyone?  Please tell me your story.

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

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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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Lost But Now Found

A three-year-old labradoodle.

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What a night.  Mr. Rick C. was right.  Sometimes I do sit home and medicate.  It is not self-medicating, though, as I have my own prescriber.  And last night I was using my self-care tools to survive:  0.25mg of alprazolam got me through the first half of the night crisis, and then 2.5mg of zolpidem got me through the rest.  Despite these helpful medications, I dreamed of Timothy and Jack in the worst of circumstances.  I was amazed at how many positions a coyote could hold my Labradoodle in his mouth.  My eyes are still swollen red cherries and my complexion is bad.

Earl and I were not connecting.  Who does when they are afraid and grieving?  I simply told him,

Sorry honey.  I’m no good.  Can’t connect.

Earl is gentle.  He responds easily to words.  He doesn’t react easily to negative emotions.  He is a wait-and-see kind of guy most of the time.  His eyes are not red this morning.  He did not medicate.  He did not make this about him.

We made forty flyers describing our Great Pyrenees Jack and Labradoodle Timothy with our phone numbers and including a lucent plea for anyone to call if they saw them.

Our three kids in the mom-van, I planned to go door-to-door and harass people – I mean ask people – if they knew anything about our dogs.  We first targeted our neighborhood mailboxes where there is a bulletin board for community announcements.  I lifted my flyer to staple in front and center position and, “Darn-it!”  My kids had broken my stapler.

Pyrenean Mountain Dog

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While banging my stapler on the wall, I noticed another white sheet flyer.

2 White dogs found!

More tears.  I called the number and blubbered.  The woman was comforting me, suggesting more alprazolam and a good psychiatrist she knew.  Our dogs were happily frolicking in her back yard with her two German Shepherds.

Timothy and Jack are home now figuratively and literally in the dog house.  We have a dog trainer, at much expense, coming tomorrow to help us.  We will also be placing an electric wire around our fence before the rest of our neighbors cement a reactive opinion about us.  Although our dogs are important, we hope to live here a long long time and don’t want to be picketed out of the neighborhood.

Thank you so much everyone for your kindness, for your empathic responses and patience with your own Dr Q.  It was a large blessing for my fragile self last night to know you were all there.  I hope that blessing comes back to you.

Keep on!

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

A young paper wasp queen (Polistes dominulus) ...

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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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Keep Talking

Day 349 of 365 - Self Care/Friends!

Self-Care Tip #160 – Keep talking.  Be a friend to yourself.

Lingering in the afterglow of what all of you have said in your comments over that past six months, I am distracted in the best of ways.  The comments so often complete the post.  We are a team you know.  I hope that more of you noncommenters will shuck off your shrouded lovely selves and say something to us.  Because it is not true on this blog, that casting your bread upon the water just makes soggy bread.  Nope.  You’ve all been my living examples of this.

Yesterday, Nancy wrote,

“But to associate self-care with freedom actually made me feel free today….”

I could have cried because… I just can’t say all the many reasons why she blew me away with that.  I don’t have enough fingers to point with.

Sarah,

the civil war inside of us.

Mr. Rick C. in his Blog-Jacking #2,

Folks, you have not experienced incomprehensible demoralization until you have had a Flowbee lock onto your head with the full force of a ShopVac behind it.

That one just won’t stop coming back!  The visual itself is an almost permanent gift.

Kevin Blumer keeping things light talking about stress,

I love stress I absolutely love it being busy 10 pizzas to make in 2 mins…

Some days ago, Pattyann wrote,

I think it is much easier to ask for help and receive it when we stop looking at an illness as a personal failure.

Is there any better way of saying that?

Our own articulate CarlDAugostino who shows so much interest and respect to so many of us gave me this,

I have never really heard of this “self -friendship journey” It is a wonderful concept…

Yes, you show me that I matter and that I am not alone and that it turns out, …taking care of myself has been a pretty good idea after all.  You show me that it starts (goes across a few oceans and continents) and ends with “Me.”   Thank you, all of you for that.  There are soooo many things you’ve said, (you know who you are) that have totally rocked me.   Keep talking.

Question:  What shows you that it starts and ends with you?  Please tell me your story.