Consider Sleep as a Symptom of Brain Health

English: Lou Ruvo Brain Institute

English: Lou Ruvo Brain Institute (Photo credit: Wikipedia)

When the brain gets sick, what does it look like?  Do we grow warts, or turn purple or loose our thumbs?  How does our brain say,

Help!

Through emotions and behaviors.  That’s how.

If we were an internist, a primary care physician, we would look at the vital signs.  We’d put our fingers on the wrist, count beats of the heart and breathing, and measure the pressure in the blood filled arteries.  This would tell us some of the story, the introduction to the body.

A church secretary came in complaining of indigestion times two weeks….

Or,

In a far off land, there once was a young maiden who by chance came to a magic filled glade…

Smile.

How does one do this in psychiatry though?  We start with the vital sign of SLEEP.

A farmer in the vast expanse of corn fields went each night to his bed with determination, gritted teeth and racing thoughts.  He worried over things that others thought were insignificant.  He ruminated and chewed over information.  Making decisions followed him around as if each were a crisis life balanced on.  The farmer was awake in the night for hours before his mind turned off.  And when he awakened, he was not refreshed….

Question:  Are you comfortable with considering sleep as a symptom of brain health?  When do you decide to look for medical reasons for poor sleep verses adjustment issues?  Please tell us your story.

Self-care tip:  Get to know your story to know better about your health.

Hatred and Brain Health

Hatred

Hatred (Photo credit: dton23)

Have you ever noticed that hating the person who hurt you is never enough?  The damage does not respond.  The edges do not come back together.  Hating them harder, hating them more effectively, with your voice, with your body, committing your talents toward their detriment, recruiting forces, community – this is not enough.  Finally, you grow plans from dragon teeth.  You wish them death and an after-life of repeating hateful deaths.  It is still not enough.  You are left with you.

When the extreme, when the hate that is to say, is not enough something is wrong.  But it’s not what you think.  The thing that is wrong is not that.

We could say you are a sinner.  We could say pray more.  We could say exercise, destress, do yoga, karate, eat less sugar and drink grass juice.  We could and perhaps we do.  But this time, please put that aside.  It is not disqualified.  It’s just not the bit we are going to talk about.  Don’t be mad at me.

The hate is in the brain.  The brain picked this to perseverate on and return to like the tongue over a canker.  Lick.  Ouch.  We don’t ask for these emotions.  We don’t ask for these behaviors.  They come, symptomatically telling us a story about our condition.  Hear the story?

It goes something like this.  We are persons who know enough to know that this is a feeling stronger than deserved. This is a response not entirely rational.  This is a behavior that we would choose not to do otherwise and nor would a friend of ours support.  Our mother would tell us, “No.”  We experience a whole body response that surprises some level of our awareness and that part stands by uncertainly with her fingers picking at her lip.

The story tells about the other times when we endured worse and responded without as much personalizing.  We remember that someone else we knew acted like this and we didn’t think much of it.  We thought they were “off.”  We realize that what we are experiencing might not have as much to do with the crime as we thought.  It might just be that we are not feeling and behaving well.  It might be our brain.

That darn double-crossing organ!  How is anyone supposed to trust themselves?  It’s tough but we have each other and we have our story and we have grass juice.  We have God.  We have medication.  We have ECT (electroconvulsive therapy.)  We have acupuncture, our support groups and DBT (dialectical behavioral therapy.)

Considering where emotions and behaviors come from is the bit that gives us a chance to find and be found by help.  Hate is a very strong emotion from the brain and it isn’t so friendly to Me.  If we can’t put it aside, consider the brain.

Self-Care Tip:  When emotions and behaviors come that you don’t want, and won’t go away even when you say, “Please,” consider your brain health.

Question:  What has helped you disentangle the effect from a cause that wasn’t really the cause?  

How do you allow for the biology of brain health when it comes to feelings so personal?  

How is considering the brain a friendly thing to Me?  Please tell us your story.

Guest Post by Michael Cornwall PhD – Bandaid Your Emotional Injury

The Brain Limbic System

Image via Wikipedia

The physical home of emotion – the limbic area, is located in the center-region of the brain. The limbic system consists of a series of interconnected structures that include the frontal area, the hippocampus, amygdala, hypothalamus (anterior thalamic nuclei), septum, limbic cortex and fornix.  It is believed that these structures support a variety of cognitive, emotive, behavioral and biological functions including emotional behavior and long-term memory often necessary for emotional behavior to occur.

It is NOT essential for you, the reader, to know the names and functions of these structures – although it could benefit you.  Knowing that there are anatomical, electro-bio-chemical and hormonal correlations between your emotions and your brain is, however, critical to improving your emotional intelligence. Although you may decide not to know these structures, you will have to remember, at minimum, where your emotions live.

Your emotions live in your head.

More specifically, your emotions are an expression of your thoughts.

Without thought, you would have no emotion.

If you wish to change your emotion, you will have to change your thinking.

The limbic neighborhood, when in balance, can be described as resting.  While at rest, however, it can be instantaneously energized by thought and perception in an all-out effort to protect the body from real or perceived harm or the threat of harm. The stress response will cooperate with your thinking and automatically release neurochemicals and hormones into the bloodstream that are intent on providing the fuel you will need to protect yourself  from real or perceived threat. You can expect a sudden increase in heart rate, perspiration, flushing of the skin, hair standing on end, etc. All designed by Nature to give you the strength, energy and focus to run away very quickly, fight very bravely or just to freeze, motionless, in the hopes you will appear unthreatening to your attacker.

Let’s find a more familiar image to understand this phenomenon.

Imagine that you have a paper cut.

Blood flows from the cut, no matter how much you are against that from happening.

It is an automatic response to injury.

You can commit to do something about the cut by attending to it. You might wash it, put it in your mouth or cover it with a Band-Aid (or plaster).  Your effort to stop the bleeding will likely shorten the time the wound is active and susceptible to infection. While attending to the cut, you commit to memory how the accident occurred and tell yourself how to avoid similar injuries in the future. Injury and trauma are, in many ways, opportunities for learning.

But how does cutting your finger and attending to it compare to the expression and remediation of emotion?

Your perception of an event as threatening or dangerous is like injuring the nuclei of your brain.  Your thoughts activate a response in the brain that starts an automatic flow of neurochemicals and hormones into the bloodstream. These hormones and neurochemicals:

  1. Increase heart rate and blood pressure;
  2. Dilate the pupils;
  3. Constrict the veins in skin and send more blood to major muscle groups;
  4. Increase blood-glucose levels;
  5. Tense up the muscles that have been energized by adrenaline and glucose;
  6. Relax smooth muscles in order to allow more oxygen into the lungs;
  7. Shuts down the digestion and immune system to allow more energy for emergency functions; and
  8. Improves the ability to focus on the task of determining the location of the threat and how to respond to it.

Much like cutting your finger, there is an automatic flow of neurochemicals and hormones into the bloodstream that happens without your consent.  Similar to tending a paper cut, you can be a passive observer or you can actively respond by providing wound care.

You can put a Band-Aid on your emotional injury.

Here I will provide you with some self-care techniques and suggestions.

First, it should be noted that if the injury to the emotional areas of your brain were visible – if the flow of neurochemicals and hormones rushing here and there inside your head could be observed, rather than having it all happen deep inside your skull, you may be more active in responding to it, without all this comparison to a paper cut.

Instead, we will just have to imagine and increase our awareness of the phenomenon.

Wounds inflicted by thought require as much attention and enthusiasm for treatment as an injury to skin or bone.  We might imagine the paradigm from the following perspective:

  1. An Event Occurs: “You did a horrible job!”
  2. An Injury Results from Thinking About the Event: “You have no right to talk to me like that! I am a good employee.  I am a good person. I should be treated better.  It is awful that you are treating me this way.  I need your approval in order to be happy in my life.”
  3. An Automatic Protective Response Results from Thinking:   Your threatening thoughts instigate the flow of neurochemicals and hormones into your bloodstream, causing your body to go into a protective mode (a stress response).  These chemical will flow for some period of time specific to you.  The longer you ruminate about your perceived threat, however, the longer the chemicals will remain flowing through your bloodstream. It could be minutes, months or even years (chronic stress).  If you do not tend to the wound, you will be susceptible to infection, fatigue and a continued loss of homeostasis and likely reopen the wound each and every time you encounter the same or a similar misfortune.
  4. Attention to Thinking: “I am not in dangerI am viewing this situation as threatening. I don’t have to view the situation as threatening.  I can view it as unfortunate. It is unfortunate that I am being talked to this way.  It is regrettable that I am being criticized this way.  I am being treated badly and that is difficult, but it is not awful. I can stand it and I will.  I can express my concerns.  I have a right to ask for respect, but I have no right to get it. I don’t need approval in order to be happy in my life.  It would be nice to have approval, but it certainly isn’t a necessary element of my continued happiness.”
  5. Interfering with the Flow of Neurochemicals and Hormones: Using more rational thought is the essential part of attending to the emotional wound.  It is also the first step toward improving emotional intelligence.
  6. The fact that the hormones and neurochemicals are already in your bloodstream will present some problem.  Although you may be thinking more rationally, your physical body will need time to readjust and return to balance.
  7. Be assured that these hormones and neurochemicals will dissipate, if you stop them from flowing using more rational thought.
  8. Your new thinking will eventually win over the process and you will be free of these toxic substances.  At least until you encounter misfortune, again – something you can certainly expect.
  9. To encourage the return to balance, you may breathe deeply, stimulating your vagus nerves.
  10. Breathing deeply (through your mouth, into the pit of the stomach and out your mouth) sends a message to the brain that all is well and that it is safe for the body to return to balance.

The next time you encounter some perceived danger or harm, try these techniques and suggestions.  How did it work for you?  Would it help to keep the suggestions in your purse or wallet, for when you find yourself in the middle of misfortune and want a quick guide?

Michael Cornwall, PhD  is an author, lecturer, clinical supervisor, educator and child behavior therapist in private practice.  In our community, you may know him as the author of blog, Emotional Intelligence Theory.

(502) 564-4321 x 2008

Pay a dollar

Repost from July 29, 2010.

We all have a number of our own eddies, currents that spiral behaviors. Assuming that when those are friendly behaviors, then like “casting your bread upon the water” you’re bound to see something nice coming back your way. Some people say these patterns come from neurological loops, grooves in your brain like indian trails. When you go back down over your same footsteps 100 more times, you now have an open path without resistance, easy to travel. That is how the connections – neurological, electrical, chemical, are all biased in our brains.  Adaptability to stress, in part, means that your pattern of coping is on a path that serves you well when you need it to.

Come on, though! Who spends even five minutes talking about good behavior? What we do ruminate over, is why we keep doing what we don’t want to do. …Such as screaming at the kids when what we really want to do is to grow up and practice the good skills we’ve read about in all those parenting books!

Why is it so hard to stop?  Why are we “triggered” so easily?  Grooves, my friend.  Grooves.  Any day we can list off several seemingly unrelated events – but our reaction is all too familiar.  It feels like getting sucked into a tornado with a word spout, as if today turns you round and round the same way you did the day before.  Inevitable self loathing follows, which can set off more self-destructive behavior.  The cycle goes on.

When you feel trapped by your own self, get friendly by remembering this.  You’re mistaken.  You’re talking about a groove, not a vampire.  It’s not hopeless.  Not much more, not much less than what it is.  A groove can be abandoned.  New paths can be made and when the stressor hits next time, you will have a longer moment to decide on which behavior to play.  You will have a choice and you will realize more often that you are not trapped by what you thought; you are not hopeless and ugly.

For example, now when I yell at my kids, regardless, I pay a dollar to the family money jar.  Anyone can call me on it.  That’s my effort to steer clear of the “yelling-groove.”  The innumerable reasons for righteous anger, took me on miserable trips.  Round and round.  Yelling equaled me jamming myself all over again.  That’s right.  Who did it to me?  Me.  Now that’s not too friendly.  So something’s got to change.

It may be something different for you, but if you end up hating yourself in the end, it couldn’t have been good.

Self Care tip #5: You are not trapped. Pay a dollar. Be a friend to yourself.

Questions:  What has helped you abandon old grooves and make new ones?  When you don’t feel hopeful, how do you recognize that even though you feel that way about yourself, there is hope and the feeling is deceiving?  Please tell us your story.

Seeing Your Brain As The Place Emotions and Behaviors Come from is Terrifying

Terror

Image by pablokdc via Flickr

Where do emotions and behaviors come from?

Now think about it and answer your true beliefs.

I was speaking with a wonderful physician the other day to whom I asked this question, (let’s call her Doctora.)

I respect Doctora for her character, personality, standard of medical practice and interpersonal beauty. She is a bulldog in the operating room. When patients need studies done that insurances won’t pay for, she tears barriers to treatment apart with vicious tools of rightness. And she cares.  She sits.  She asks.  And she cares.  She sees the person in the paper gown, each one for the person she knows them to be and the person yet unknown.

I admire Doctora greatly not only for these qualities but also because it gets personal.  I, who have my own special practice of medicine, cannot do her’s.

When just a green bumbler in medical school, there was a fateful day when I shadowed another great artist of medical care into a locker room.  I suited up in that blue sack they call scrubs.  I put little blue sacks over my tennis shoes too.

Do you know why there are blue sacks on the surgeon’s shoes?  So that when wet things come out of the human body and fall onto their feet, their toes won’t feel squishy. Yep. That’s what was going through my mind as I scrubbed my hands, each finger and each finger nail the ten minutes it takes to reach what is considered clean.

Surgery in progress, the color red mixed with a smell and monstrous sensual force that clobbered me to the ground.  I swooned, gagged and promptly ended my surgical career.

There is nothing more irritating to a surgeon than someone who doesn’t appreciate the “fun” of “cutting.” Yes. I irritated this mentor and others too I’m afraid.

This doesn’t keep me unfortunately from pleasuring in telling people, “I am licensed to do surgery.”  I am you know.  Any Jane with a medical license can pick a scalpel up and bring back the dark ages, or contemporary, depending on who holds the license.  I’m irritating to my mentors, remember.  It reminds me how anyone can go online and pay to become a marriage registrar, i.e. perform a marriage ceremony for couples.  My brother did that twenty years ago and has yet to perform the marriage ceremony for a willing couple.  For real judges and clergy, this might be irritating too and that makes me a little happy as well.

Anywho, Doctora and I were rolling with the injustices haranguing us in the practice of medicine, both from the angle of the physician and the patient. I was pumping her up for being the cutting-wonder who she was and she was dutifully marveling at my jabber-mouth work that she would, “never be able to do in a million years.”  Somehow this brought us round to how our culture avoids embracing the biological paradigm of anything inside our skull but is so willing to celebrate it for any other part of our human bodies.

Where do emotions and behaviors come from?

Doctora answered me with a frozen breath. Then after I soiled the air with a lot of jabbering and she was finally able to speak, she said,

I would just be horrified if my brain got sick!

I wondered if it was scary enough to clobber her to the ground, but I do agree.  Terrifying.  Don’t you think?

Question:  Is that why hardly anyone can speak about the brain being human and largely responsible for where our emotions and behaviors come from? How has this played into your experience of self-care?  Please tell me your story.

Self-Care Tip – Go to the fear that keeps you from embracing your biology to gain more freedom.

Say Yes to Medication And No To Drugs

Please don’t call them drugs.

Image via Wikipedia

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

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

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

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

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

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

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

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

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

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

Related Articles:

Fears of Addiction To Medications For Brain Illness

 

Are You Empowered to Start Everything and End Everything With Me?

Yesterdays blog-post brought a few neighborly questions for us to follow-up with.

One is regarding emotions from bluebee.  Is jealousy medical?  Followed by, What part of emotion is under our control?  Indeed.

Second, Sarah quietly slipped the question under our door of how to respond to emotions and behaviors that come from brain illness.  How?  Indeed.

Third, Carl banged a little louder when asking, what keeps him in a relationship with someone who is maltreating him verses leaving?  Indeed.

There is a nice flow to these.  They are leading into the next and circle back.  Emotions and behaviors come from the brain, much which is out of our control and some of which is.  The choice to engage in the life of the ill is like any other choice.  Our own.  If it matters to us if the way the brain is working in the “other” is in their control or not, we can spend more time trying to sus that out.  I’m not sure myself when I get it good from someone mean, but it has become easier to take care of my junk rather than there’s.  For that, I will say a million thanks.  If I’m getting yelled at, I do the checks on myself – anxiety? fear? anger? fatigue? shaking? dizzy? tone of my voice? do I know what this person is yelling about? (most often it has nothing to do with Me), empathy? empowerment? You’ve told me that you are growing in similar refreshing ways.

Face Down w/Laundry and Gwen Stefani

Image by NCM3 via Flickr

I’ve seen this play out a little in my children.  My daughters and son are supposed to do the laundry every morning before they play.  I don’t know how many years now, but their arguments haven’t changed.

I’m doing this all by myself.  No one is helping me!

Mom!  He’s just laying on top of the clothes!  

Mom!  …

These questions above…;

  • where emotions and behaviors come from,
  • control over biological symptoms,
  • do I respond to others with brain illness
  • or do I walk away

These questions don’t mean much if we don’t find where our empowerment comes from.  Me.  Everything starts and ends with Me.

I’m ill for reasons I have nothing to do with, yet I will be accountable for myself and how I affect others.

I feel emotions I didn’t ask for, behaving ways that I am a spectator to rather than a whole person, yet I will do what I can to gain health.  In that, I have control.

I surrender what I don’t control to my Higher Power.  I take medication.  I exercise, guard my sleep hygiene and get regular sleep, eat responsibly, gather and engage community, attend therapy groups and/or individual, I try while at the same time I let go, I love my flaws as I love my perfections, I try to develop my natural genius, try as often as I can to pour any energies I have in that direction as I know I will heal faster, enjoy life more and be more successful at all my efforts when I do.

It reminds me of that saying, that if I have success, it is from standing on the shoulders of giant midgets.  We are all flawed.  We are all wonderful.  We are supported by others who also are full of flawed perfections.

Do I have control?  You bet.  …And no way.  Always, there are both.

Do I talk when someone is mistreating me? or mistreating themselves by neglecting their own self-care? by letting their illnesses shape their lives?  Do I walk away as that may be what my self-care demands.

Everything starts and ends with me.  There are a lot of stops along the way with other forces, but empowerment is mine.  Indeed.  That’s what I hope my kids will learn when doing the laundry.

Do You Believe In God?

Yesterday, sitting with all the intellectuals, the thinkers and the brains, my “Big Fat F” felt like I was dressed wrong more than once.  However, thanks to you guys and what we’ve done together, I was able to recognize it and make it through without sautéing the shame of being who I am wired to be.  See blog-post, Hear, Be Hear, Believe and Speak in Your Language.

 

Ma-Student03

Image by rimabek via Flickr

 

There are temperaments that find it easier to believe in God I think; feelers, more so than thinkers at least.  But definitely not across the board.  Whatever our temperament or brain health, we are all deciding what to do with the surging evidence of the evolutionary history of our world.  This can translate into an all-or-none decision for the existence of God.  When logic and knowledge make a seven-day creation unbelievable, than believing in God might too.  When we discover the repeating themes between religions, Buddhist with Christianity with Mayan and so forth, than rather than believing in a message that is bigger than culture and Time, we might believe that there is no message.  When we understand emotions and behaviors on the cellular, hormonal and related biology and draw the line even more clearly to evolutionary origins, we might nod our heads.  “No God.”   When we say,

Everything starts and ends with me,

and in the connections we find, discover humanism decreasing the perceived need to depend only on God, we might pull a hand back, take in breath, go silent and think,

Is this all?

Yesterday, talking about oxytocin, how it was measured and manipulated, how emotions and behaviors were measured and manipulated, I was in awe.  I always am by these discussions.  It amazes me over an over again that we can have this beautiful understanding about emotions and behaviors.  However, there was the curtained message that there is no God.  I can’t say exactly how I believe this to be true.  But I do.  I felt a chill and remembered, even if these things are true, doesn’t say anything about God not existing.

All these things that I use to define my reality, which of them can be really trusted?  Love, Emotions, Time, biology, personality, senses, brain, essence, connections and external input, learning and knowledge, the Bible, visions and more – they don’t have to define the existence of God but for many of us they may.

So I ask you, of all the things you use to define your reality, what do you trust?  Do you use them to grow your belief in God or vice versa?

Self-Care Tip – Work these questions over deliberately before these questions work you over unsuspecting.

Other Fears of Medication For Brain Illness

Yesterday we talked about fears of addiction to medication therapy.  There are other fears that influence our choice to use or not use medication therapy for brain illness.

In clinic, we hear about people’s preference not to take medication, as if it were like ordering mushrooms or no mushrooms on pizza.

I am not someone who likes to take pills.

veggie pizza

Image by mccun934 via Flickr

Again, I think most of us agree entirely.  Who of us set out in life thinking, “I hope my life depends upon medication therapy?  I just want to have a reason to medicate.”

So tell me about this.  Questions:

  1. Are nonprescription substances safer for us?
    1. If so, why?
    2. If not, why?
  2. What are other risks you fear of taking medication for brain illness as compared the risk of brain illness remaining and likely progressing untreated?

Fears can provoke us to grow stigma and biases.  However they can also be used a tool for getting friendly with ourselves.  We can use our fears.  We can use them to gain clarity to know better why we are making our choices – stigma? Or friendship to Me?

Nothing is all right or all wrong.  But we should know our motives if we can because of it’s potential usefulness.  It is a friendly thing to do.

Self-Care Tip #285 – Know your fears so you know why you are making your choices.

Fears of Addiction To Medications for Brain Illness

I don’t want to get addicted!

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

pills galore

Image by "Boots McKenzie" via Flickr

So here are some questions for you:

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

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

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

We Try Knowing We Will Fail. The Wonderful Journey Of Flawed People.

The t-shirt

Image by plαdys via Flickr

It’s 9:23 PM and our little kids are still awake!  They’ve cried.  They’ve laughed.  We’ve cuddled.  We’ve spanked.  They’ve taken two showers and brushed their teeth twice.  We ate several times.

I was riding my bike, watching a movie, (I love that!), and my daughters were taking turns coming in to complain, wet me with their tears, snuggle, hold me; you get it.  My exercise and my movie were peppered with refreshing breaks.  Sitting on the couch chair nearby with my five-year old during one of these intermissions, holding her, I was able to say,

It’s okay.  

I was able to do this because I was the one in the casita getting pumped up and my husband was the one in the house herding children to bed.  He had the tough job that turns me into a turnip and I had this.

You can do it.  You can try again.  You can try again, even if you are trying for the one-hundredth time.  You try and you try and you try again because that’s what makes our lives beautiful.  The trying part mostly.  Not the arrival.  

And that’s when I grabbed her and held on.  I suddenly felt so blessed.  From this off-night, I was given the reminder that the trying part of life is where it is at.

It’s 9:33 PM and I think they’re asleep.  Sigh.  Tonight was awesome.

We are flawed people.  We try, knowing we will fail.  Who does that?!  Why would anyone do that to themselves!?  Smile.  Ah.  Sounds wonderful.

Questions:  How is your journey?  Have you been enjoying your failures lately?  Please tell me your story.

Self-Care Tip #273  – Enjoy your failures.

Choose Back! …As Long As Life Chooses You.

A Girl On A Footbridge

Image by jyryk58 via Flickr

Self-Care Tip #241 – As long as life chooses you, it is your right to choose back – so do.

Although I am not a geriatric psychiatrist, I have still been given the pleasure of serving a “golden” few.  What has impressed me has been their willingness to start over.

Starting over takes courage and humility whether it is deliberate or not.  Sometimes fear dances between the lines of all the emotions and intentions. But still, wouldn’t you agree that it takes courage and humility to negotiate fear?

(Enters Hans.)  Hans was seventy-three years old.  He had struggled with brain illness on and off he thinks since he was at least twelve.  There were big spaces of time when his disease exacerbated, and he largely suffered.  But he chose, at this age, to try again for improved brain health.

Is there a time when we start thinking, don’t keep trying to start over?  Maybe in the dying process.  In case you don’t know, the dying process is a specific term.  It means the time when a person is facing impending death.

This area of medicine is not my specialty but I imagine at some point we want to stop with that starting over process, give up, but not in a hopeless way.  In a way that says,

I can stop trying for new anything and sit in the space of what I already have in me…

…Which hopefully includes all the ingredients and interrelations of life.

But how far before that point in life do we consider starting over reasonable?  I’ve heard of kids being told they’re too young to ride a bike, or cut with a knife, or understand the dinner conversation.  No one bobs their head at that.  But find a seventy-three year old who believes that after a lifetime of perceived failure by onlookers or themselves, who still says,

Now let’s give this another go,

…and if it hasn’t been said, it’s been thought,

give it over already!  You’ve hit your seventy-times-seven chances!

It’s like they’re shopping in the teen-ware.  We blink our eyes and angle our heads.  Even the thought of starting over as a real option feels indiscreet.

(Enters Hans.)  Hans is seventy-three.  He is starting over.  Humbly and with courage, he pursues brain health in the face of stigma.

I think I had celebrated my six birthday when my dad asked me if I felt any different from how I felt when I was five.

Yes!  I feel older!

 Then he asked me how old I thought he was.  When I answered some enormous number like, “twenty-two!” he asked,

Does forty-four seem old to you?  

Of course it did!  But I had an intuition that if he was old, than he’d die, so I said a definitive,

NO!  Daddy you’re still young!  You aren’t old!

Now, almost that same age myself, I am in awe of him and the others in their golden or not so golden years (Enters Hans) who believe that as long as life chooses them, they will choose back.  It is their freedom.

Questions:  When all your senses don’t sense pleasure in life, or you feel old and useless, or you feel that you’ve failed too many times, how do you choose to start over?  Who has inspired you and what did they do?  Please tell me your story.

Where Do You Think Behavior and Emotion Come From?

Animation of an MRI brain scan, starting at th...

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Self-Care Tip #229 – See yourself as a friend by including biology in your self-perception.

In clinic, out of the clinic, here, there, if I were to pick one barrier to treatment anywhere, I’d pick the misunderstanding that behaviors and emotions come from somewhere other than the brain, and then from there, the outcropping of understanding why.

I don’t think most of us say it in so many words, but it’s intuitive. Maybe when pressed we’d say, “Where else do they (behaviors and emotions) come from?!” And then agree, the brain. But the connection that allows for self-care is missed. The connection that allows us to choose the freedom to feel good and behave well for our own sakes is lost in the shame of failing to do those very things.   The stance of courage it takes to be our own friend when we don’t even want to be in our own company, takes a lot to maintain.

The marvelous @MarjieKnudsen, tweeted a reference to a wonderful post by Sarah Boesveld, How ‘self-compassion’ trumps ‘self-esteem’. I enjoyed reading it very much as I felt it spoke to me and my generation with great perception… except! that it was without mention of biology, the brain; i.e. where behaviors and emotions come from.

In clinic, Naomi told me about her “failure” when ever she felt anxiety come on.

Why do I feel depressed when I feel the anxiety come?

I’m wondering what you think, reader, about this simply related story and the question.

I mirrored Naomi’s question,

Why do you think you feel depressed when that happens?

Today (similar to Naomi,) girl-crush, alias Rachelle Gardner, Literary Agent, wrote about feeling like a failure as well.  She asked at the end of her post the pithy questions,

What about you? How have you failed? What kind of wisdom has helped you deal with it (i.e. sense of failure)?

And I thought, how to answer? Here I am again “in the presence” of someone wonderful who in her post didn’t make it apparent that she was considering that this emotion might be a symptom of something biological.   We are willing to look under every rock, be in the space of our emotion and ponder reasons why.  We have the courage not to “run” even when we don’t like ourselves, but haven’t said it out loud to ourselves yet,

I might feel this way because my brain is dishing it out.   I might otherwise have not done anything to set this emotion or these behaviors in motion, other than being alive.

Girl-crush remains despite response.  So readers, don’t be scared to answer what you think.   If you even care, I’ll still admire the socks off you! – even if you think you are hyper every day since conception because you ate too much sugar.

Questions (In case you want me to write them again, which I’m really happy to do – anything you want so I can hear your responses): Where do you think your behaviors and emotions come from? …such as a sense of failure and/or a depressed mood? What has helped you deal with it? Please tell me your story.

Self-Care Woven and Unravelled Simultaneously for Best Results

Change is good--Kente Cloth Loom

Self-Care Tip #222 – See the different parts of your self-care as independent yet dependent on each other.

One of my truest pleasures would be to teach well.  My temperament is, per Myers-Briggs, designed to be a teacher and I agree that I feel inner congruence when I’m doing just that.

…If you’re feeling your hands closing into a bracing grip, it is probably because you, like many, really don’t want to be schooled – which has happened in my less refined moments, so caution is understood.  This is not what I hope to do here.

After yesterday’s blog-post and comments received, it shows that I have not taught as well as I implied to myself.  Implied intimacy is a danger of any familiar relationship, including with ourselves.  The beauty of you guys, is you help me say things “out loud” decreasing misunderstandings.  You guys are teaching me and I thank you.  So whatever this is we are doing, learning, schooling, teaching or whatever it is that Mr. Rick C. does – what we are doing here together is mucho-much fun.

As we unravel the rug together, we see these threads,

  • emotions and behaviors appropriate to context – yesterday we spoke about guilt
  • emotions and behaviors inappropriate to context – yesterday we spoke about guilt as a symptom of medical illness
  • the magical miraculous beyond our current understanding – before we “see face-to-face– yesterday Carol Ann mentioned the changing power of God
  • freedom to do self-care and related choices
  • what choice yet remains when other choices are lost either by action or disease
  • (this last one I’m just putting in here to finish the pretty rainbow) – helps me get in the barn where I’m comfortable

The reason I think it’s important to see these together yet apart, as well as we can (through a glass dimly), is that too much of one or another of these, diminishes the results of our self-care intentions.  Don’t mistake this for preaching that one can get too much of God in their lives.  It just isn’t true and not in our best interest to get waylaid.

Questions:  How do you see yourself more effective in your self-care efforts and what has influenced those improvements?  In what way have certain bits of your self-care gotten “too much” attention?  Please tell me your story.

If it Matters to You, Even The Hot Shots Say, SELF-CARE BEGINS AND ENDS WITH ME

i i i i i i i i i i i i i i i ! i i i i i i

Self-Care Tip #220 – Take your freedom and be good to yourself.

Free-will keeps cropping creeping climbing clambering up with us.  Go figure.  As usual, Carl pushed buttons and inspired me to remember the lovely word “self-government.”  I was so delighted that not only does the term self-government say it so well, but I felt like I was the first to come up with it.  Then I googled around and found Webster, many countries (possibly yours,) and even our own constitution of the United States (“We the people…”) might have wrinkled time and stolen it from me before I even thought of it (See Einstein and the Fabric of Time.)  Can you believe that!

While calming my unappreciated self, I ran across like-minded David Rigoni’s splendid work at the University of Marseille.  (After reading this, I’m sure he will delight in hearing us named, “like-minded.”)  Dr. Rigoni says,

Folk psychology tells us if you feel in control, you perform better.  What is crucial is that these effects are present at a very basic motor level, a deep level of brain activity.

He and his team studied thirty people over different tasks, using different mediums of examination and deduced that it is better to believe.

If we are not free it makes no sense to put effort into actions and to be motivated.

Dr. Rigoni’s work reminded me of the work of MIT neuroscientist Sebastian Seung.  Some time ago, Dr. Seung gave a wonderful TED conference,

I am my connectome.

Dr. Seung tells us the good news that we are more than our genes.  The connections among neurons are where memories and experiences get stored – not in the genome.

My pleasure grew when I read about the collaborative work from a few schools we’ve heard of – see NYU news.  ….Apparently goals and habits show overlapping neurological mechanisms.

This is all very exciting to our self-government.  I’m sure that we the people would hate to find out that all this time we’ve demanded our freedom – it wasn’t even possible.  But it is – even per the hot-shots of the world. The sophisticated and unsophisticated, in paradigms of thought, Time and Timelessness, learning, beliefs and feelings, in my country and in yours – we continue comfortably and with confidence to say, SELF-CARE BEGINS AND ENDS WITH ME.  (See Ghettysburg Address.)

Questions:  When have you found yourself unable to claim your freedom to be friendly with yourself?  How have you managed to cross the barriers you perceived around yourself or others?  What would you like to tell Carl or Carl?  Please tell us your story.

Be Aware of Your Feelings and Your Body Function When Getting Friendly With Yourself

Self-Care Tip #202 – Be aware of your feelings and your body.

symptoms and signs

Image by madamepsychosis via Flickr

Wordsmith SuziCate commented to our post three days ago on finding depression in those of us who appear “fine.”

It can be more apparent in what is not said…. When I was depressed it was the absolute last thing I wanted to talk about. I evaded the subject, and if forced to talk it was about anything but what “I” was feeling.

Yet again, the comment completing the post.  It was on my mind and in my face somehow over these sum of days.  When I would start thinking about something else, a patient would nearly quote SuziCate and I wondered if you all have met behind my back on some other blog site with intent to trip me out.  (Grandiose delusions….)

Margo said yesterday in clinic, with hands moving, eyes wide and leaning in,

When I was really down, I just quieted down, stayed low, did my thing.  The last thing I wanted to talk about were my feelings.  I felt afraid of the Nothing that waited there.

She was talking more quietly now and her whole body receded a little.

You aren’t interested or interesting to anyone.  You don’t have anything to say.

We were both quiet for a bit.

These flattening-of-the-spirit symptoms used to be called “Pseudodementia” because they resembled dementia so much.  A muting of the mental and physical function.  A disease progression slowing the nerves and body.  We now refer to them as “Neurovegetative Symptoms.” **

When thinking about getting friendly with ourselves, we can’t forget about what we don’t say or feel emotionally.  We remember also, that the brain is connected to the rest of our body.  Brain is sick, the rest of us is sick too.  This can be a good check point once we start realizing that something is wrong either by insight or by comments from others.

It can be more apparent in what is not said….

Hear more than words.

Not all depressions are these muting processes.  Some of them are activating and agitating types leading to anger and irritability.  Those are hurtful too.

All types of depression are dangerous when left untreated.  The reason isn’t only the risk of suicide or the distance it creates from others.  The reason also includes the less familiar brain changes that it causes on the brain function.  The sooner we are able to pull out of a depression, heal and return to ourselves, the better health our brains will have the long term.  The longer a depression is left untreated, the more damage is caused to the brain’s health.

Questions:  How did you figure out you were depressed now or then? Or that someone else was depressed?  Please tell me your story.

**Neurovegetative Symptoms are the things about affective disorders that most of us don’t know about.  We think about emotions – depressed, sad, happy, angry and calm when we think about mood or anxiety.  We don’t think about the body.  We don’t think about cognition, concentration, memory and what SuziCate or Margo described so well.

It can be more apparent in what is not said….

Neurovegetative symptoms are called “neurovegetative” because they are caused by the changes in the nervous system and they limit our ability to function.

Just to Feel Pleasure

week-end-pleasure

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Self-Care Tip #189 – Heal for yourself, and you’ll see that also, everyone heals.

The best thing I ever did was go on antidepressants.

Bianca sat, but her whole body was talking.  She was telling me about her changing life.  She had read some of her journal from a year ago when she pounded on herself for her behaviors.  She thoroughly grieved the time with her children when they heard her scream about small things that kids do.  She told me about her sons face when she was irritable.  He showed all the waiting tension that an open child will when waiting for Mom to lose it.  She was trying to push it aside and think rather about how she now could finally enjoy them.  Bianca said,

I just had no idea before how much better life could be.

Bianca’s face became tight and she didn’t make eye-contact,

There’s no way to describe what it’s like to not enjoy your kids – My own kids! – for most of their born lives and then wake up and experience something different.  I just can’t explain what it means to now actually like being with them.  I’ve always loved them but I didn’t feel the pleasure and I hate that.  I want that time back but I can’t have it and I can’t give it to them either.

I’m so scared it will end, the pills will stop working and I’ll lose this new life.

Before her medication, Bianca worked hard at taking care of herself.  She was a check-list of responsible self-care.  Bianca thought it was important that I knew this.

  • Aerobic exercise – check!
  • Healthy diet – check!
  • Sleep hygiene – check!
  • Bianca talked about God but things got confusing for her there.  She didn’t like to think about Him being on “a list.”  He was in her life and didn’t feel He failed her even though she couldn’t feel pleasure or joy.

Still, she continued to coil up and release hard punchy words at her kids and then hate herself for it.  She had prayed so much about this and wouldn’t even mind if God had to puppet her, if that’s what it took, in order for her to treat her kids better.  She could not stop herself from being what she called,

Crazy Mommy.

But now, after she was treated, Crazy Mommy was gone.

Aside from dropping the shame, the best thing for Bianca was knowing that her kids could trust her, felt safe with her and that she felt safe with herself.  Everyone was healing subsequent to Bianca healing.

How many of you have told us a similar story.  A similar rescue.  Yet, never-the-less others of us are afraid to go there.

Question:  How are you present with others who don’t understand your rescue story?  How do you stand beside someone who needs medical help for emotional illness but won’t accept it secondary to stigma?  Please tell us your story.

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?

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.)

This road sign image is in the public domain a...

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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.

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.