Conditions and Diseases

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Getting Yourself Healthy Protects The Freedoms of Others

hey if you are too stinky we will ask you to l...

hey if you are too stinky we will ask you to leave not really sorry (Photo credit: stevendepolo)

Some of our most difficult cases are when we, the medical care-givers, think we know better how to take care of someone than we do take care of ourselves.

When a person maintains decision making capacity, but whose brain health disables them, if we care, we care.

Monty was one of these.  He was ill!  He was ill on so many tectonic plates, no one near him could keep their footing.  His quality of life wasn’t what he wanted.  He was disconnected from meaningful relationships.  He was suffering.  However, he couldn’t decide to engage in therapy.

Monty wanted to go “natural” but couldn’t name any natural therapies he’d be willing to try.  He didn’t want to continue suffering, but couldn’t accept medications “just yet.”  We went into one option after another, invested time together learning about brain illness and coming to terms with the biological involvement in where emotions and behaviors come from, and we did it many times.  Monty had a full informed consent.

Deciding not to treat or to treat is not easy for any of us.  Watching Monty step away into the foggy chaos of sex abuse and obsessive compulsive rituals was really hard.

We fight for our freedoms when we fight brain illness.  I suppose we fight for the freedoms of others as well, simply by taking care of our own selves.  Letting Monty choose even when his choices are affected by his illness is still his right and I defend him.  We all who take care of ourselves have more to offer Monty than if we didn’t, including a defense against the losses that brain disease brings – like processing information.

I’m not sure yet how to explain how taking care of ourselves influences the freedoms of those around us who are less inherently free by brain illness.  I suppose like anything good, freedom is contagious, a little bit of light in any room, Love being stronger than death and the Gettysburg address – this is along those lines.  It makes a difference to the Monty’s out there that we all take care of ourselves.

Self-Care Tip:  When frustrated that you can’t help others, get yourself healthy.  It’s contagious.

Question:  Have you been in the place where you thought you knew what was better for someone else then that person’s own choices?  How did you deal with that?  Please tell us your story.

Recommended Reading:

Why not skip medication And Go Natural?

Mistaken Expressions of Freedom and Medication Compliance

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Draw Sleep Hygiene Into Your Culture

hbofamily.com

Thomas didn’t want to organize his life.  It wasn’t fun when things were predictable.  Lately however, that was the problem.  He wasn’t having fun anyways.  Thank God for work.  It was the one firm construct in his life.  Wake up, shower, drive and work until he drove home.  It was like Harold and his purple crayon had drawn this into place but forgot to draw up the rest.  When to go to bed?  When to eat?  When to play?

“Harold!  Get back here.”  

Before, Thomas had resented any imposed restrictions on him.  He liked to graze.  Now, with bewildering awareness of his unhappiness and unbounded self, he wanted help.  If help meant medication and the opinion of others, then so be it.  At least until he found out what happened him.

When Thomas came in to see me, he said he had lost himself.  His personality had changed and he was suffering.  We approached things from the biopsychosocial model.  We ran labs, got him in to see his primary doctor for a physical, considered life-stressors and his support structure.  We started medication and we introduced sleep hygiene.  I almost lost Thomas there.  Changing his sleep was changing his culture and he had enough recollection of his identity to know that he had liked to stay up at night.

Out came the sleep journal.  Thomas turned his body away and looked at me sideways.  We agreed to try improving Thomas’ field of knowledge on sleep and see if he would buy into this for himself.  We set a time-frame for his research and decision.  If he didn’t do the work to get informed, than he’d go with my recommendations until his brain illness improved enough to allow him to do more for himself.  We’d work together with our purple crayon and drawing in some lines.

Sleep hygiene is one of those purple lines in our life that help us know a better sense of who we are.  It does this for many many reasons you can read more about in previous posts listed below if you like – but it does do it.  Regardless of our temperament, if we like to graze or run to the barn, we all need solid refreshing sleep.

Self-Care Tip – Use sleep hygiene as a tool to get friendly with yourself.  Don’t be afraid.

Questions – Do you consider sleep hygiene as a useful tool in your life?  Does it come naturally or do you have to work at it?  How do you draw your lines in?  Please tell me your story.

Related Articles:

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Just Go To Sleep

Sleep

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A multitude of sins would be forgiven, pills would be forgotten, pain would be diminished, hope would be restored, brain would be healthy if we would but go to sleep.

Questions:  What keeps you from self-indulging when it is time to go to bed but you’d rather not?  What helps you get your restorative brain rest?  Have you noticed that everything is better with sleep?  Would you describe it to us?

Self-Care Tip – Get solid restful sleep.  Be a friend to yourself.

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Demanding Freedom and Other Oxymorons That Empower Our Self-Care

Désirée Nick at "Oxymoron" in Berlin...

Désirée Nick at "Oxymoron" in Berlin, 1999

I read today on bipoblogger’s blog,

I am trying so hard to keep my head wrapped around keeping a hold on this broken heart/life balance/bipolar thing.  It’s been complicated by stupid migraine headaches.  It’s hard to make sense of things and to pay attention.

Today while I was waiting for my laundry to dry, I began writing some deep thoughts, deep like I didn’t want to deal with them. I basically wrote a page of self-help advice.  I appreciate my stubbornness.

My answer:

This sounds like a woman of courage doing it, taking accountability for where she is at, afraid maybe but pressing on to start over any time she chooses, demanding her freedom to self-care.   Demanding freedom seems like an oxymoron but this is what is called for when we feel trapped.

I will add to this “answer” that self-care often seems like an oxymoron.  Such as using the brain (the same organ that is diseased) to figure out what it’s behaviors and emotions mean or everything starts and ends with Me (when we know that there was a beginning before Me) – we see the weaknesses and the conflict and we say yes.  I am an oxymoron.  I am good and bad.  I am healthy and ill.  I am growing and dying.  I am flawed but perfect.  I’m sure you have more.

Demanding freedom is a basic tenet of self-care.  We say that despite the limitations in our lives, in our decision-making, in our suffering or pleasures – despite all, I am free to do self-care.

Questions:  How have you managed to demand your freedom to self-care?  What oxymorons in your life are empowering you in your self-care?  Please tell us your story.

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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.

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What Is Your Life-er?

Cover of The Cowardly Lion of Oz.

Image via Wikipedia

I’ve been doing my usual struggle with lifestyle, health, weight and image maintenance.  It’s one of my life-ers.

There are some things we will courageously and sometimes cowardly maintain our fight with.  These are our life-ers.  We will have it on our docket every day.  There are times when this will blow us away with frustration, hopelessness and feelings of impotence.  Other times we will see it more calmly for what it is.  It is.  No more or less.

It’s helpful to say these things out loud.  That way when we wake up and see the life-er there, or catch a reprieve with distraction, or work like a mad-dog to get friendly with ourselves despite it all and find that that doesn’t take these life-ers away, we will maintain hope.  We will see these life-ers, although part of us, don’t define us.  We will own them and weave them into our friendship with ourselves – flawed and perfect selves.

What is your life-er?

Self-Care Tip – Knowing what your life-er is, is part of being a friend to yourself.

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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.

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Summarizing What You Say About Friendship With Yourself

Friendship

Image by Rickydavid via Flickr

In Summary:

Q1:  What does being “a friend to yourself” mean?

  • self-awareness
  • Acting on that self-awareness
  • Grieving who I wished I was
  • Valuing Me

Q2:  What helps?

  • Knowing where emotions and behaviors come from
  • No self-injury or aggression to others
  • Knowing God
  • Gratitude/self-inventory
  • Support from outside of Me
  • Personal check-points in place to offensively guard again self-sabotage

Q3:  What doesn’t help?

  • Perfectionism
  • Ingratitude
  • Untreated or treatment resistant brain illness
  • Stigma
  • misdirected efforts to feel empowered (such as, preoccupied thoughts = control)
  • isolation
  • habit

Q4:  What helps despite this?

  • Self-forgiveness
  • Realism/Without catastrophizing
  • Tenacity
  • Remembering what your self-care has done
  • Presence

Q5:  What is the relationship between biology and choice when it comes to understanding where emotions and behaviors come from?

  • Biological template determines function
  • Choice is there for using that template
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Guest Post by Richard

Chronic pain

Image via Wikipedia

Guest Post by Richard, who was kind enough to send me his recap on last night’s Self-Care Workshop:

Salient points:

  1.        We are not special by our pain, we are special by who we are.
  2.        I use what I have (am).
  3.        The natural laws stay constant. There are small differences between each person. The divisions are flat.
  4.        Benefit of medical evaluation first to rule out physical causes, then look at outside of medical.
  5.        We inflict the pain not the biology.
  6.        We are in the present, trying to reach goals that will never be completely reached.
  7.        The agenda within, (such as your job.)
  8.        Unwrap and fight for your freedom, illustrated by our national history.
  9.        Stigma is biological.
  10.       Guilt is not always a choice.
  11.       Relinquish opinions of others. Cannot  change how others consider or view us as related to those who knew who we were at a different point in “our story.”  …I guess stigma is in the eye of the beholder?
  12.       The initiation of self-care is a difficult first step.

Question: how do you get loved ones to take the first step or do you?

-Richard

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Codependent,… Or Something?!

Inquisition condemned (Francisco de Goya).

Image via Wikipedia

Codependent.

It’s a term a lot of people use but I don’t think we are all using it to mean the same thing.  It is poorly defined and confusing.  If codependency were a medication, we would call it a “dirty medicine,” because it hits so many “receptors.”  It is nonspecific.

Who hasn’t ever been shamed by the fear that they are codependent?

You are codependent! 

Am I codependent!!!??

The word implies blame.  Blame for what?  And that is one of the places we walk away without benefit.  Was the word useful to any of us in any way?

In general, vaguely, codependence implies awareness and participation with mal-behavior that we are powerless to.  Treatment preferably includes a twelve-step program that includes the surrender of what we don’t have power over to our Higher Power.  Codependence may incidentally be combined with brain disease and of course that would need medication therapy.

There are however a few things that must be cleared up.

  1. There is nothing shameful about being married, the child of or of any relation to an addict.  That position doesn’t diagnose us with codependency unless that’s what that word is being used to define.  You never know.
  2. There is no shame in wanting to be with people, depend on people, seek people out to problem-solve and get energy from being with people.  That position does not diagnose codependency unless that’s what the word is being used to define.  You never know.

However,

  1. There may be a relationship to family of addicts
  2. There may be a relationship to anger problems
  3. There may be a relationship to kids of parents who expected perfect kids, spouses of spouses who expect perfect spouses, pet-owners who… (Oh wait.  That’s not right.)

BUT, per Dr. Q, if we find ourselves…

  1. in recurring negativity – perhaps an argument that happens over and over
  2. with an increasingly limited ability to participate in life
  3. powerless
  4. doing things we wouldn’t normally do/out of character
  5. tied into someone else’s mal-behavior
  6. consciously aware of that someone’s mal-behavior

IT’S WORTH THINKING ABOUT IT.  We might not be codependent, whatever that means, but we do need help.

Questions:  How do you identify this in your life or someone you know?  How have you been able to stop being dependent on someone you knew was repeatedly doing mal-behavior?  Please tell me your story.

Self-Care Tip #275 – Forget the shame and just get about your work to figure this out.

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The Biopsychosocial Model for Where Emotions and Behaviors Come From

Waitress.

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We are doing a narrative series on understanding where emotions and behaviors come from:

  1. Emotions Are Contagious
  2. Our own Emotional Junk 
  3. Positive Emotions and Behaviors are Contagious Too 
  4. Our Conscious Self is Our Board and Paddle at Sea 
  5. (today’s post) 

What we’ve covered so far in our series is that we know emotions are contagious.  We know that if we take care of our own first, we might not be as “susceptible” to negative “contagion” in turn and perhaps, more available to giving and receiving positive “emotion-contagion,” so to speak.  Further, we hope that if we do this, we might have the ability to choose to be with people we love even if they don’t do their own self-care and have that connection without personalizing what isn’t about us.  Sigh.  That is nice, isn’t it?  …Yesterday took us out to sea away from our narrative for a bit, where we talked about the pleasure in engaging with what bits of biology are directly available to us and the relationship we maintain with the rest.

Self-Care Tip #271 – Use your biopsychosocial model as a tool to help your friend – You.

We return today to Rob and Yesenia.  (Remember Rob?)  Rob has shown us three important ways of considering where his emotions and behaviors come from.  This is the biopsychosocial model of looking at our functioning in the context of illness.

  • Rob’s biological factors include his own genetic primary illnesses as well as his genetic vulnerability to emotional milieu on his genes’ expression.  It also includes Rob’s temperament.

Going toward what our temperament finds pleasure in will naturally bring more good things to/in us and others around us.  (See blog post, Hear, Be Heard, Believe and Speak in Your Own Language.)

  • His psychological factors include how he is or is not able to cope with his wife’s emotions and behaviors.  There is obviously more involved but, snore.  (Ahem.  Oh.  There I was.)
  • Rob’s social factors include his wife’s emotions and behaviors.  Yesenia’s untreated emotional illness gives Rob a difficult interpersonal relationship to contend with.  …Where to start?

Questions:  How has looking at your biopsychosocial self collectively as well as in parts been a useful tool for understand your own emotions and behaviors?  Is it difficult to do this for yourself?  If so, what limits you?  Please tell me your story.

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Sleep Does Not Lose As Gracefully As He Lets Us Think

Cougar sleep

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Self-Care Tip #244 – Sleep when the day is over, and play another time.  Be a friend to yourself.

Sometimes it is hard to let the day end.  Michael told me that he was having trouble sleeping.  I asked him to tell me more and heard him describe fun-filled hours of movies, computer, phone-calls and late-night snacks that were disturbing his sleep-initiation.  Just listening to him, I felt a yearning catch spark in me to have the freedom to be spontaneous again.  You might know what I mean.

The opportunities to be spontaneous have shrunken up as our choices have brought us expanding fillers for time, attention, money, energy, emotion, personal resources and magic.  It is no wonder that letting the day end meets reluctance.  Those last few hours that sleep called shot-gun for are ours with less fist than big brother used to stage.  Sleep doesn’t put up much fight …at first.  At first, it concedes to us.  It lifts it’s chin casually until given turn.  However, much like the loan shark, sleep will never go unpaid.  It will take it’s due.  Maybe just not tonight.  Maybe you won’t hear about it until later.  And there are no promises that it won’t take by force, from one part or another of our body, our brain, our beauty, our emotions – debts are not forgotten here.

Michael says, as if he were the victim here,

It takes most people about thirty minutes to fall asleep.  But me!  It takes me hours to.  

We started talking about sleep hygiene and Michael just wasn’t interested.  I asked him to simply read about it and just see what he thought he might be able to start with.  One change maybe that he thought was tolerable.

These negotiations are sometimes best when the patient feels like they came up with the idea.  Michael is going to read about this and hopefully become his own advocate.  He will hopefully “sell” it to himself with the information both from facts but also from experience.  It’s no accident that Costco sets up samples at ever turn of their superstore.  Nor that we can never seem to leave without spending at least $100 in cash – not credit!  Cash!  (Argh.)  Maybe Michael will sample and decide to sleep rather than play at night.  He might have to “taste it” to believe and choose for himself.

Spontaneity will always lure us, dangle her jangly jewelry, give her side-ways glance and make us long for those midnight hours to open up in playful company.  However, sleep is not as gracious as it seems.  Don’t be fooled.

Question:  Do you consider sleep hygiene important to self-care and why?  How do you see it related to you being a friend to yourself?  Please tell me your story.

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Your Pain is Not Special. It Is Normal.

Self-Care Tip #243 – See yourself as special rather than your pain and know that you will find your normal again.

What is your normal?

When we were kids, we all had a perspective of what normal was.  Let’s say it was “here.”  Let’s imagine we were lovely then, nurtured and emotionally bonded.  We struggled through peer conflicts, social anxiety and rivalry.  We wanted a bike.

Two Sisters

Image via Wikipedia

Then we got a little older.  Maybe our parents divorced.  Maybe, a sibling died.  Maybe we were abused or in an accident and damaged.  Damage changes normal.  What we never would have thought would be acceptable in our lives became acceptable.  We suffered.  We lived.  Life was indiscriminate and ignored our status.  We think there must be a mistake.

What is our normal at one point, filtered through remaining hopes, grew into regenerating fantasies, through real potential and it moved again.  We are older now and more suffering comes.

Where is our normal?  We survive our child, our own dear perfect boy, hanging from a tree.  Normal?  No dear God!  No!  And we continue to live.

Two years.  Two years are what it takes for our biology to catch up to the shock.  Two years are what it takes for us to begin to accept and realize that in this new normal we care again.  We choose it in fact.

People don’t remember his name or talk about him and we can’t remember his eyes.  We are ashamed and lose our breath from panic just trying to see them.  We want to bang our head because we know there is something wrong about feeling normal! Ever! Again! after that.  But we do.

Our normal mutates over financial ruin, abandonment and a growing healthy list of disfiguring illnesses.  We accept them and say yes please.  Live.  We want to live.  This is acceptable.  This is normal.  Our friends die.  Our memory.  We can’t find our teeth.  Our heart stops.  We die and the world finds normal.  The world chooses just like we did.

What we don’t think will ever be allowed to happen while we brush hair, clip our nails and microwave food, happens. We endure these changes.  We find normal again.

What is your normal?

My brother, Vance Johnson MD, is a physical medicine and rehabilitation specialist.  He said that during his residency, close to 100% of spinal cord injury paralysis survivors he worked with wanted to die after their injury.  Many of them would beg him to let them die.  They would cuss at him for keeping them alive.

I leaned very heavily on the studies and data during those times.  It was very hard.

Vance said that what kept him faithful to his task was knowing that close to 100% of them after two years would be glad they were kept alive.

Even the ones who were basically breathing through a straw and that’s all that moved on them; even they wanted to live.  These people found a new normal.

Where is our normal?  We will want it.  We will adapt.  Biology will catch up to our reality.

Remember that your pain is not special.  You are special.  Not your pain.  Pain is normal.

Question:  When this happened to you, how did normal find you despite the rubble?  How does this concept feel to you, that your pain is not special?  Does it make you angry or what?  Please tell me your story.

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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.

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Patient on Patient Crime – Our Response to Our Own Illness

a "low profile" sole provides a grea...

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Self-Care Tip #238 – Think about your response to your own behaviors and emotions.

Bianca agreed with her husband.  She was too depressed.  She never wanted to go out and cried a lot. Perhaps she even deserved to be cheated on and abandoned because she was so unbearably dull.

Pause button.

We have discussed where behaviors and emotions come from – the brain.  We have identified the brain as human material, matter, biological and as susceptible as anywhere else on the body to illness.  In short, We could say at this point that Bianca is in a Major Depressive Disorder – a medical disease.   There are many medical diseases secondary to design, behaviors or lack of behaviors.  Or for other reasons.  However, I don’t know many medically ill that when the spouse walks out on her, we say,

Well of course!  She had cancer!

Or,

He lost his leg in a car accident, get someone else!

But throw in some aberrant emotions and behaviors for unacceptable time, and the escaping spouse is given running shoes as a gift from their concerned community.

How could he stand her!  Of course he left.  She wasn’t taking care of his needs.

You see the disparity and when written this way, it looks really ugly and I apologize.  I’m not trying to thumb people for biases and prejudice.  Both parties are hurt.  I’m also not trying to say that this happens only in marriage.  It happens in almost any setting.  Emotions and behaviors are just not considered to be symptoms of disease.

Have you ever heard the term, “Women on women crime?”  Well this is something like that.  I’m thinking much of this will improve when we treat ourselves with more insight and understanding consistent with our biopsychosocial model.  If we don’t do this first, who will.  We aren’t responsible for how others treat us, but we are responsible at least for ourselves.

This is one more wonderful way of claiming our right to say, self-care starts and ends with Me!

Questions:  How can we wrap our beliefs around this seemingly enigmous concept that when someone is crotchety, negative, irritable, inattentive or boring – it might not have been because they chose to be that way?  How do you own if in yourself?  Please tell me your story.

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Just to Feel Pleasure

week-end-pleasure

Image via Wikipedia

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.

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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)

Image via Wikipedia

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.)

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.

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Tell People When You Fall

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

Image by zpeckler via Flickr

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

Image by Valerie Morrison via Flickr

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.