coping skills

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Turn Toward Something Better

Had a great time at, “Seams of Gold.”  Great example of how community is friendly to “Me.”  Met a wonderful man.

Me:  Hi!  I’m Dr. Quijada!  I’m a psychiatrist.

Him:  I’m Frank.  I’m a recovering Alcoholic.

Got to love love that kind of company.  Thank you to all who participated and volunteered.

images

Found after our evening, was thinking about that darn “justice” ever skirting so much of Me.  The way becoming the victim to abusive treatment drives “Me” into helplessness all around us.  Things like money turn us to blame and ugliness.  In the end, telling our story, we hear from our own selves more about the behavior of the curmudgeon than would ever leave cause/change/control space for an innocent like “Me.”  Yep.  It’s them.

Using the behaviors and emotions of others is never useful to explain/justify the emotions or behaviors of “Me.”  We are as free to choose to be a victim as we are to not.

Programs like, Seams of God, and people like Frank, remind us that turning toward something better is, Way!  It is way, like opening a window to a hot room, like turning the lights on, like biting into a ripe home-grown cherimoya.  Turning toward something good rather than away from “bad” is choosing to be free.

Be free. Everything starts and ends with Me.

 

Keep on, dandies.

your own,

Q

 

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The hard work of being friendly to Me – talking about ECT

i take drugs

i take drugs (Photo credit: the|G|™)

I give a lot of talks in my community on understanding electroconvulsive therapy, (ECT,) as a treatment option for brain illness and I am finally able to bullet point most of it.  It has been and continues to be a long love-labor I am honored to be involved in.  (It looks so simple! – Not!) These seven points, believe me or don’t, represent many hours of research, training, practical experience and time looking into my own motives of interest.

Even here! everything starts and ends with me.  Ah.  So sweet.  😉

drum-drum-drum-drum… rollllllll!

Number 1.  20% more effective than medication at any point in treatment.

In other words, if it is a first episode or fifth episode of brain illness, ECT is 20% more likely to get a positive treatment response than psychotropics.

Number 2.  It starts working in 1-2 weeks, versus medication therapy takes 6-8 weeks.

Number 3.  It does not touch the body systems – does not affect metabolism, heart, weight/appetite, sex drive/performance, cause dry mouth, or vomiting and diarrhea, life-threatening rash or anything else common or bizarre side effect to the body.

Name it, imagine it, confabulate about it but ECT does not do that to your body.  It does not touch the body except the brain where we are trying to make therapeutic changes.

Number 4.  It is the gold standard in pregnancy and peripartum for the same reasons – does not touch the body systems.

For the fetus – there really are not yet any psychotropics that are considered “safe.”  Even serotonin agents that once were the go-to pills for Ob-gyn physicians, are now known to risk increasing bowl irritability, lung function problems and possibly even heart disease.

Number 5.  It is the gold standard in the elderly for the same reasons – does not touch the body systems.

As we age, medications metabolize differently, interact more and cause a lot more life threatening side effects.  Even medications we’ve been safely on for years, one day, cause dizziness and falls.  Out of the blue, we start having nausea.  As if betrayed by an old friend, we don’t metabolize them well, our organs are sickened by them, we develop kidney disease.  Etcetera.  It goes on.

ECT does not.  ECT does not do any of this.  It does not touch the body systems.

Number 6.  ECT has been around for eighty years.

That is a big deal.  That is helpful if kept in mind when we consider if it is fad, a gimmick, secondary-gain driven procedure, motives for treatment and other concerns against its use.

So often in practice, we thrill at the medication samples in their shiny colorful boxes so well marketed with commercials on the television to support their use.  Our physicians pull their drawer out and present them as a new chance at treatment response, which they are.  These medications have been around for how long though?  Surely not eighty years.

How long does their patent last even?  Eight to ten years maybe.

What will we discover about study-medication-X over that amount of time?  Maybe nothing dangerous or too intolerable   How bout eighty years of time?  Still, study-medication-X might remain in a relatively safe category.   Maybe.  Or not.

Most medication trials, to get a medication legalized in the USA, are designed to study medications for about 8-12 weeks on any one patient.  Many trials are done over years, and they are compared with each other using complicated mathematical statistical analysis and governments.  It is not bad and I am grateful to be a part of this community of physicians who studies and prescribes medications from this pool of treatment options.  Still, I think how despite the huge number of persons who received this study-medication-X, none of them were individually treated with that compound for very long.

Deciding to launch a medication into the community is based on this.  Once it is on the market, data is collected and made transparent to the community progressively thereafter. But initially, we are making our decisions to use or not to use with this at our spine.

Shiny boxed pills with a few years gathered round them at most of information from individuals who probably used the study-medication-X no longer than several weeks total, verses, ECT that has eighty years of transparent data regarding what we want to know – side effects, efficacy and any other sense.

Can’t poo poo that.  Eighty years has its own kind of luminescence.

Number 7.  ECT works by changing how different parts of the brain communicate with each other.

ECT “turns down” those areas that have overreactive connection.

It turns out, this is similar with how medications work for brain illness, but without the medication side effects.

For a long time, stigma-related opinions about ECT exposed that we knew ECT worked but did not have studies demonstrating how.  That is no longer true.  This is an important milestone for the history of our treatment choices.

None of this is to say that one person’s choice of treatment is superior to another or not.  Rather, the import of this is that ECT is underutilized largely because of ignorance and stigma.  Not that it is qualified as better or worse.  Better or worse is the opinion of you and I with an informed consent.

Who are we to say that a side effect of ECT is more worth enduring than those of one medication or another?  Only the patient can say this and then how that side effect(s) compare for her against the benefits received from treatment.

However, psychiatry is not an area of medicine that yet has a huge array of treatment options.  To obscure one of this caliber, life-saving heroics and life-changing import is a huge loss.  ECT is another paradigm of treatment.  It is not an either/or.

Oh, but to share in what this does, mmmm.  That gives Me a sense of value, connection to you and improves the way I care for my professional and personal self.  Rich.

Gratefully,

Dr. Q

Self-care tip:  Share in what improves your sense of value, connections and the way you take care of yourself.

Questions:  I’d like to continue to improve this.  Any suggestions?

Does any of this ring a bell in your mind of something important to you?  Please tell us about it.

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Don’t Let Your Sense of Need Get Away From You

Pinocchio Illustration - When He Becomes a Donkey

Pinocchio Illustration - When He Becomes a Donkey (Photo credit: Kev.Kirsche)

Self-Care Tip:  Find your need, grip it tight enough to not let it be taken from you and loose enough that fatigue will not lose it for you.

If we don’t know our need, if we don’t know our wanting, the reason we say “Evangelize,” “Buy this!,” “Don’t miss it!,” if we don’t know why we care what other people are doing, we will not be so productive.  We will be a poor salesman.  We will have a droll experience.  Things will not make sense to us and will be something other than friendly.  We bore ourselves when we don’t know why.

What was it like when not being a friend to Me?  Remember the way we treated others, the disconnection from the people we wanted and the way life didn’t absorb.  Remember why we started with Me.

This is everywhere in our lives – taking medications and resenting it, skipping our exercise, staying up late at night when we are feeling so good, turning our addictions over to our Higher Power becomes rhetoric and you know what more.

This is just a short trip into this idea today.  I’ve been blessed remembering my lows, being in my lows, and experiencing my wanting.  I’ve been messed up when I didn’t.  I don’t want so many goodies that I turn into a donkey.

Keep on.

Questions:   How has remembering your wanting improved your ability to be a friend to yourself?  How do you keep the memory of your wanting even when you don’t?  Please tell me your story?

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Presence – What is Turning In You?

How the pages turn slowly in life

Image by Nina Matthews Photography via Flickr

It’s summer break already and that means more Mom-time for the kids,… and a few other things.  But if there’s more Mom-time for the kids, we all know what there is more of for Mom.  These things come together and equal more spending-money-time combined with less work-time.  This can’t be without consequence.

I’m thinking stress, memory-makers, lots of kissing marshmellow-cheeks and tears to show.  Always tears.  The kids cry of course but if I do, its all,

Mom!  Oh NO!  Mom!  Stop crying!  Agh.  I can’t stand it when you do that!

Lots of exclamation points are involved.  I’m thinking this summer will have some of that because some days are stressful and painful.  Others are just too beautiful to leave unstained with tears to sign my name by.  Get ready kids!

Tonight, this is what I have.

I am licking my finger and turning a page.  I feel the book as the page slowly fights the air to pass over.  I haven’t seen the other side yet but the way the page lifts up and toward me, I know that this part is significant in itself.  Lick my finger, press it down and sweep up.  Up and passing over, just.  The page is turning and so are we.

Question:  What is turning in your life?

Self-Care Tip #280 – Pay attention to what is turning in you.

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The Testimony of The White-Headed People – Connection and Aging

Once again, I find myself in a café.  This doesn’t happen often enough for me.  But here,Almond paste tart with chocolate mouse and blueberries

I am

at the wonderful le Croissant Bakery, indulging not only in the quiet of my private thoughts, not only in my delectable chocolate croissant with coffee, but also in the ambiance.

Here, there is this completely lovely group of white-headeds, maybe ten of them at a table, sharing the treasured community of each other.  None of them walk completely upright.  One is wearing his oxygen tubing with tank in tow.  The ladies are coiffed irregardless of their folding skin and thin hair.  Fruit tart

I am

so blessed to be in their community, testifying to me that aging doesn’t have to be done alone.  Flourless Chocolate cake with Ganache inside

I am

sure, 100% sure, that none of them are aging as they dreamed.  Each of them have outlived many loved ones and the ground they walk on has changed many many times.  They have, each of them, learned to walk again after suffering the type of loss that put’s any of us in bed.

I am

blessed.  This collection of café moments they have together does not account for these losses.  This does not resolve their ongoing conflicts or pain.

But none of them,

Almond paste tart with chocolate mouse and blueberries

I am

100% sure, did not let those things keep them from having this moment together today.

All this sureness without having checked my notes with them?  Yes.

I am.

Crumbs on a Plate

Image by rockbadger via Flickr

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Self-Care Is About More Than “Me”

Self-Care Tip #208 – If for no other reason, get friendly with yourself simply to survive and you’ll see what that means later.

my self care reminders

Image by CatrinaZ via Flickr

It is not unusual to think of “selfish-care” when we hear “self-care.”  I can imagine children gripping their mother’s skirts more tightly, husbands pulling their helpmate’s hands away from this influence, church-folk sniffing over rejections to service-calls or friends personalizing the way their phone doesn’t ring as much as it used to.  This is a natural response, although it is a false perception.  Think – feeling suffocated by her penance, he’s wearing a martyr’s cross or she’s giving to us from victimhood.  Those are the times we would rather not receive the gifts of time, person or anything dripping with that kind of guilt and implied debt. This kind of service comes from someone impoverished, giving on credit.

I’ve been known to say, “We can’t give what we don’t have.”  Or as Jasmine said,

You can’t give someone a ride if you’re all out of gas!

So when is self-care selfish?  To be true to what self-care is, I’d say almost never.  However, because the question comes from such an intuitive fear in any of us, “never” can’t be an entirely fair answer.  To answer it best though, we need to turn it over and go back to trying to discover why we wanted self-care first.  What brought us here?  Jacqui said it well in yesterday’s post-comments:

Ditto about ‘self-care boot camp’. I may steal that one. You’ve given me permission to be selfish if need be. It’s all about self-preservation.

Sometimes we are reduced to self-preservation.  It has an intensity to it, a survival mode of live or die, which may be appropriate to a desperate condition in life.   Many of us know what that feels like.  So in this context, self-care is in part about survival.  Alright.  But is survival a selfish need?  Are we worth that little?  Does the life in us hold value only at that level?

rejuvenation.self.care.logo

Image by guttersnipe.76 via Flickr

You hear the clomping my words are making and can follow that I answer, no.  Survival has far reaching significance.  I matter.  You matter.  We have value beyond our own selves and Me booting up to live better also ripples over those same infinite number of connections.

I am confident that if for no other reason than getting friendly with yourself simply to survive, you will still see at least some of what more that means later.  Self-care is about more than Me.

Question:  When do you think self-care is selfish?  Why do you think self-care is not?  Please tell me your story.

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Go Towards Your Pain to Relieve It

A family mourns during a funeral at the Lion's...

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Self-Care #197 – Go where your pain is to prepare for what happens badly in life.

Yesterday we talked about the power of loss, grief and pain not being one that can take away the potential of life.

Carl appreciated the idea that “scripted cue cards” with platitudes on them to read off for ourselves or for others when something bad happens – “Good comes out of bad,” “I know what you feel like,” and so on – is nothing anyone wants.  His comment included, in true Carl-style, a great question:

But what else can we say to show respectful empathy?

Goodness.  For crying out loud, we aren’t a bunch of calloused puff heads who don’t care or who don’t have a clue when someone is suffering!  We’ve all asked this question and wanted to help.  We’ve wanted to connect, to serve, to answer Carl’s question when we are in or come into the presence of pain.

In self-care, we can’t help others if we don’t help ourselves first.  We can’t give what we don’t have.  Airplane crashing, put your oxygen on before your babies.  Can’t withdraw if the bank account is empty….  We take care of ourselves and find that we can serve others more as a result.  It’s the same way in grief.  If we don’t go where our own pain is in life, if we aren’t present with our life journey, if we don’t fight hard for who we are, it is very hard to know how to answer this question.

There’s something to say about doing the work before the trouble comes and then when it comes, use it to prepare for more.  I love Ecclesiastes 12 which tells us in Solomon’s depressed and yet feisty words,

Remember your Creator
in the days of your youth,
before the days of trouble come
and the years approach when you will say,
“I find no pleasure in them”—

Solomon was talking about self-care here.  Holding us responsible at the elemental level to use the time we have before trouble comes, so that when it comes, we have a way of answering.

Carl gave his own answer,

…live life on life’s terms like it or not.  If we allow Jesus to embrace us and comfort us it will fortify us through life’s unfortunate tragedies.

Question:  What is your answer to Carl’s question?  Please tell me your story.

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Pain Doesn’t Define Life’s Potential

Close-jen-grieve

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Self-Care Tip #196 – When you are hurting, remember the pain doesn’t define life’s potential.  Be a friend to yourself.

Yesterday we talked about giving and getting bad news without fear.  This was received in a spectrum of ways by you, ranging from – no way is bad news something not to be scared of, to, bad news might be something we could face knowing we might find something good in the end.  No one slammed the hammer down, dinging red at bad news equals good all around – except my dogs who don’t listen anyway and are pretty much always happy.

Jjen was brave, saying,

I would have to also agree that in some cases bad news can bring family members, or even friends together that have been estranged. This has personally happened to me. Kind of a bittersweet thing; good in result of something bad and mending a broken relationship.

“Good comes out of bad.”  Not everyone agrees and I don’t blame them.  Some bad things are better left alone to rot and stink out of our lives entirely.  It even sounds patronizing when someone is hurting to say this.  This kind of discovery should be made by the parties involved, without the rest of us holding scripted cue cards for them.

It is also something that is received easier from another who has been in, or is in their own catastrophe(s), losses, abuse or grief – say Jesus for starters.  I could hear this from Him without wanting to vomit all over the place.  He’s been there, hurt bad, and has been blessed through and by it in ways I will be learning about even after Time unhinges.

When my nine year-old adored niece suddenly died, I didn’t see that.  It’s taken almost six years to see anything good come “from” this unbelievable loss we grieve every moment.  The bad doesn’t disappear for me, but as Jjen said, it is not a qualifier for the rest of life’s potential.

Question:  What has come “from” the bad in your life – more bad or what?  Please tell us your story.

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Stop! Before Hurting Yourself or Others

scream and shout

Image by mdanys via Flickr

Self-Care Tip #192 – Before hurting yourself or others, stop.

Sometimes all we can do is leave.

Not being created as a limp noodle, that’s what Brenda said.

In the moment of conflict with her daughter, she had used up the coping skills she thought of and in the end, her purse had no more gum, lip-gloss, candy-money or crayons.  She couldn’t stop the acidic emotions from taking their turn to burn.  Brenda yelled (yes she knew it wasn’t right) and then she yelled again, this time to her husband that he was on kid-duty.  She left.  The mom-van keys were the last thing left in her purse of things to do to stop the burning she was giving and receiving.

Emotional abuse is equal to or more damaging than physical or sexual abuse.  This made Brenda gulp, who could still hear her own mother screaming with bulging bubble-packing veins and eyes.  Brenda didn’t know she could say,

Let’s stop.  It hurts Mommy.

When she first had her babies, tiny with soft bones, fluffy warm sweet cakes just out of the oven, Brenda was scared.  Her pediatrician gave her baby care directives that said things like,

If you are angry and feel like you’re going to shake your baby, stop!  Call for help.

And there was a number.  Now that her kids were older, her pediatrician never gave her helpful sheets of instructions and rescue phone numbers.  Brenda drove away to stop, hoping to come back with more available to offer.

Not bad, huh?

Question:  When you can’t think of any more coping skills during a crisis, how do you stop?  In what feels like an emotional emergency, what have you seen others do that you think is useful?  Please tell me your story.

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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.

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Dad Is In The Hospital. My Reality.

Open-face helmet.

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

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

Just stick your hand in there and take the eggs.

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

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

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

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

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

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

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

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

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

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

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

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

This is my reality.  Dad is in the hospital.

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

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

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

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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...

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

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

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

Falling finds friends.

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

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

connection.

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

You might have heard the proverb asking,

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

Or,

Water, water everywhere and nothing to drink.

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

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

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

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

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

I Heart Cleaning

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.

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

Playing in the Sink

Image by Paul Mayne via Flickr

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

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

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

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

I can’t control this.

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

I can’t control this.

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

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

baby elephant | playing in the water

Image by Adam Foster | Codefor via Flickr

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

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

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

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

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Choose Self-Care At Your Most Elemental Level

Buchenwald-100625-14486-Schwerte-hell

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Go low and slow.

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

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

Yes April!

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

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

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

Yes April!

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

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Keep Talking

Day 349 of 365 - Self Care/Friends!

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

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

Yesterday, Nancy wrote,

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

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

Sarah,

the civil war inside of us.

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

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

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

Kevin Blumer keeping things light talking about stress,

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

Some days ago, Pattyann wrote,

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

Is there any better way of saying that?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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