The Sins of the Fathers, and Mental Health

 

“We know the Bible speaks of sins of the fathers passing to the 3rd and 4th generations while God imbues his kindness and mercy far beyond that to those who love him and keep his commandments.”

Rosa had no experience in the world of mental health, or so she thought. She had spent her formative years studying the world through the perspective of her church and interpretations of the Bible. As you know, there is a lot in both with a lot to say about emotions and behaviors. However Rosa was taught and modelled that these were moral issues and not biological. An either or, verses, part of the same thing. Could we call it sequent variants, maybe something like genetic alleles? Or maybe something better to describe this is out there, rather than an either or.

Rosa Leticia Montoya, at this point in her development, with her own overwhelming emotions and her husband’s plummet into dark moods, felt forced into considering mental health. She did not want to go there, but here in the space of losing control, not trusting herself or Carl any more, and before she was willing to say she didn’t trust God, she was doing what was a last resort. Considering that she was going crazy was the only thing this chaos could mean.

Before she completely surrendered to the idea that biology was behind this sinister change, she had to ask, “Is this because of our parents?” She had spent her life trying to untwist the bad choices her parents had made and the consequences those choices had on her life. Drugs, alcohol, and cheating were what she had grown up with. Quietly. Hiding it in the church. Rosa there, praying a lot to live well and be forgiven. Praying that bad thoughts would go away. Praying to depend on God and not on herself, as seen through her perseverating worries ever since she was a child. Worried and worried. Not speaking of the wrong Bible-breaking life her parents wore like underwear beneath nice tailored clothes. Would she ever be forgiven? Would she ever stop sinning?

So she asked me, “What do you think?”

That’s a lot to work with as a psychiatrist. So I did what most of us do. Ran to the shelter of medicine. Whew! But there is the added benefit that God created medicine, psychiatry, and all that there is in my tool bag worth working with.

Even so, there was only so long that I could avoid the topic of God and His punishments, per her perspective. It came up every visit.

If you believe in God, at some point within your discovery of mental health, this question will come up. Rosa is not alone. Are the emotions and behaviors gone amok, such as seen in anxiety disorders and depression, secondary to moral weakness? Living with “too little” dependence on God’s power? Is it this? Or is it an “either or”, with our biology? …a matter of cellular grey matter composed of DNA-expressing pathology? And is this something evil woven into my DNA because of what parents did? Well, I’ve spent 30-some years in school and now 15+ years in practice in this space and am still trying to understand.

I’m wondering if you would help me articulate this. It’s fundamental for us in self-care. It’s not possible to be very friendly to ourselves with the dissonance.

So in our self-care question today, please answer us. What is the relationship between “the sins of the fathers” and biology? Please speak!

Self-care Tip: Pursue kindness in your belief systems toward yourself.

Thank you for speaking with us! Keep on!

The Heroic Patient

imagesSorena wore a black knit scarf around a thick neck, folds between scarf and skin. She came in with reflective smooth skin and frozen brow.  After many botox injections, she increasingly found it difficult to change her expression.  People often accused her of not caring about difficult things they were disclosing, and she realized the issue was, she couldn’t move her forehead.

She had a lot of empathy and was frustrated that people didn’t understand this.

We pulled at this idea for some time, recognizing a tension unplugged for her with each injection, a relief she experienced at visceral level. She just felt like she had to get her injections, driven toward them, like a bee toward the hive.

At some level it takes courage to get through the day.  She sees the effect.  Despite the fact that she should take a break from Botox, she can’t stop and this feels frightening.  She’s freezing her face.  It’s a terrible thing to know she has to stop something she is driven to do. It’s really hard. She’s trying to get through each day.

I told Sorena, “What you do every day to deal with this is brave. It’s harder. You have so much strength. You are doing it. You are getting through.”


I’m considering starting a podcast, “The Heroic Patient.” What do you think?

I want to interview Sorena and others with heroic life journey’s for you to discovery, connect with, increase awareness of, and appreciate.

The idea is to interview a world-community patient who will tell their “story.” It enters through the physician’s office doorway and increases transparency.

Many in our world community do not have a great understanding of what a physician nor a patient do in this exchange. You may think, “Well, everyone is a patient so at some level they do.” But:

  • How many, do you think actually go into a physician’s office?
  • How many variety of physicians does any one patient see in a lifespan?
  • How many get to tell their story?
  • How many of us hear each other’s stories?
  • How many of us understand how a physician solicits the details of a story so someone is “heard?”

If a patient were to learn the ‘behind the scenes,’ thought processes, interview techniques and analysis of the physician, would that be helpful to the patient?  Would the doctor learn from this dynamic interplay, and would the interview process evolve and grow from this? How would this effect stigma of all variety? Who knows?

What do you think? Is there a need for the “Heroic Patient” Podcast? If so, what are your recommendations and opinions?

The idea is that we are designed for connection. It’s friendly, remember? 🙂

Keep on!

Self-care Tip: Get transparent to get connected! Be a friend to yourself.

Live Imperfectly, Dad is dying, and I Have no Power.

wilted flower

Living with someone like tomorrow might be their last is much harder to do when it is actually the case.

My dad told me, after my nine-year old niece died, that a parent should never outlive their child.  When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.

When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.

My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying.  He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.

The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character.  He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.

Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?

Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.

In Life and Other Near-Death Experiences, by Camille Pagán, Libby Miller decides to live, just live, rather than die perfectly.  And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.

Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.

Question: How do you “live well?”

Keep on!

Questions From Someone Important – On ECT

Hi. I was hoping I could ask you a couple questions about ECT for a research paper I am writing.

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?
My thesis statement is:
Although there are many different treatments for Bipolar Disorder, Electroconvulsive Therapy (ECT) has proven to be the most effective therapy, treating both mania and depression.
Thanks in advance,
Priscilla

Good morning Friends!

What would you answer to Priscilla?  Do you have personal experience with ECT, primary, secondary, etc? Where did your beliefs and attitudes about ECT come from?

Last week I almost lost control of my functions when my patient told me about his sister’s comments.

Frank, my patient, had called up his sister, asking her to help drive him to ECT in the morning. Frank’s sister hadn’t even known Frank was getting ECT. She was alarmed but didn’t say anything until they were in the car together, a California dawn and sleep in their eyes for context.

Is this for real Frank? Where are we really going?

Frank was straight faced in his pragmatic style.

She thought maybe we were either going to doughnuts or the devil.
I don’t want this to sound bad or anything, but you know how people go, like to TJ, Mexico, to get some sort of cancer therapy that makes their skin fall off, that’s what she thought. Or we were going to get the psychiatry equivalent of a coat-hanger abortion in someone’s garage.
Don’t judge me for peeing a little.

One of my secretly favorite comedians, Amy Schumer, has a way of taking the worst negative biases in our community and denuding them w/o remorse. She did this with “rape.” The internet exploded that, demonstrating that sure enough, our community doesn’t get it. We don’t understand what rape is!

Then Schumer did it again with women. The idea is that we lose value because of age. Sure enough, the world started talking. For example, a few someone’s noticed when Maggie Gyllenhall was told she was too old, at 37, to get the role of a 55 year-old man’s girlfriend.

I wish Schumer would do a skit on electroconvulsive therapy, (“ECT.”) I wonder what she’d play with. Because there is awesome material there!

First introduction to ECT, some people wonder where the leather straps are. Dr. Schumer, in her white coat would say, “Oops! I forgot them at home.”

And what do you wear in an operating room, really? Scrubs for spine surgery. Scrubs for gastrointestinal procedures. And psychiatry?

Dr. Schumer, psychiatrist: “I’m a surgeon!”

Funny how you celebrate things you would otherwise not…”Hey, what a great seizure!” (High fives all around.) Never Say say, “I just push a button.”

Adding to the list of things not to say in the operating room (“OR”):

  • My Bad
  • Who is this?
  • Whoops!
  • I hope this works

ECT patient: “I want to be the placebo guy.” Patient (an older man:) Lifted his head, slightly, after the procedure was over, and asks, “Can I still have children?”

Patient: Being wheeled out of the OR (operating room) on the gurney, she stares up at the ceiling and mutters, “I can see why I need a driver.”two steering wheelsHow do People learn how to drive a gurney?! I just touch the thing and it’s like solid objects appear everywhere. The patients get nervous. One said, “Doctor, there can’t be two steering wheels.”

Dr. Schumer: “I want to reduce staff work load, and since I’ve proven to be an unsafe driver of gurneys… I now control the Tylenol. I am a physician and I hate it when people say that I just ‘push a button.’ They can hardly trust me not to shock myself…. But the Tylenol, the Tylenol is mine!”

Anesthesia: “Versed isn’t really an abused street drug—if you have a good time using it. You don’t remember anything anyway.”

Dr. Schumer: “Yes, I’ve put vaseline on my nipples to help with chaffing.” (Patient: In his ‘twilight’ sleep…we thought, bursts out laughing.) Dr. Schumer: “Yeah, try and not picture your doctor in pasties… It’s not good for your healing.”

Patient to Dr. Schumer: “You’re pretty good at this.” Dr. Schumer:I’ve watched this on the Discovery Channel.” (Then, all of a sudden, she realized “I am not perfect. Such a shame.”) Dr. Schumer: “I really don’t do a whole lot in the OR… In fact, can we just get another gurney in here so that I can lie down?”

Cheap medical service, do you really want that?

Sweaty and Worried – Generalized Anxiety Disorder

Hank had to sing an Italian song for his tests.

His music instructor did not believe that he had been practicing two hours a day. When Hank asked his voice teacher to sign off on those hours, his voice teacher still did not believe him.  He had nothing to feel shame about.  “Then why did I?” Hank wondered.  Card in his hand, signed off, Hank resentfully kicked at the rocks covering the path back to administration.

Looking out over mostly empty hard wooden seating in the music hall, Hank slaughtered the song. Even so, it was still the best performance he had ever done.  His father was there in his stained tie and largeness.  His mother in her too many colors, smiled loudly.  She was tone deaf.  Frank’s shame followed him.  He had practiced.

Hank’s older brother dressed in silk shirts, a big gold medallion, a tuft of hair coming out of his barely suppressed neckline.  When they prayed, Hank heard these smacking noises, and thought, “Pray for my nausea,” hoping they would stop kissing.  His brother always had a girlfriend.  The girlfriend was at his recital.  There were noises.

Everyone was scared Hank’s brother would marry too early and maybe marry for the wrong reasons.  His dad was always like, “Wait, wait!” But with Angie, Dad was like, “Get married now!”  Angie was the best in a long line of noisy kissers.

They asked Hank to sing at their wedding.  They insisted.  His brother, his brother’s girlfriend, his parents – they spoke in harmonics all at once.  “Hank!  You sing like Sinatra! Don’t worry so much! You should sing!”

In a rented tuxedo, Hank sang.  The mike didn’t work.  Aunt Augusta told him to sing louder.  Aunt Augusta didn’t hear well, even if there was a mike.  Hank forgot his words and had to start over.  Sweat filled his shirt and he thought about the dry cleaning.

Hank has never had a girlfriend and he is almost twenty-five.  Standing in front of all those people without the song lyrics, the only words that came to him were, “I am like a sweaty doorknob.”  His brother, facing a battle of his own between his ruffled shirt and his manliness, did not help.  Hank thought, “He is probably waiting for prayer so he can start kissing.”

The second year of college, Hank got caught with pornography.  “Hank!” His mother pulled his ear, towing him while she shook the fisted magazine through the house.  He didn’t listen to her words.  He only listened to his memories asking his music instructor for his signature. Was it as bad as the wedding?  Talking to Sarah or walking across the campus greens were bad. He fingered his worries like a beaded necklace.  He worried a lot.  Worry and shame.  He wished he could have a girlfriend but thought that was a hopeless cause.  Hank was already planning on buying a new magazine before Mom had thrown that one in the garbage.

It is so easy to explain away why Hank is the way he is.  We have heard enough to say, his parents, his brother, his isolation, his treatment from teachers.  We can use these to say, “Who wouldn’t be anxious, worried, down, and isolated, when going through these experiences?”  If we did though, we might miss the generalized anxiety disorder, the medical.  Conceptualizing the medical in this way can be so difficult.  We could call it, “the un-reasons why” we feel and do what we do.  So then we don’t have to deny it.  The un-reasons why don’t have to make sense.  They are un-reasons, after all. We don’t have to deny them by our inherent need to point at the cause and effect, or explain into uselessness the reason we are this way.  We don’t have avoid eye contact just because they can’t be seen.

Hank, like so many of us, is included in the statistics that generalized anxiety disorder, or GAD, is one of the top reasons why we don’t get intimate with others.  The anxiety is distracting.  It isolates us.  It preoccupies our thoughts.  It fills us with self-doubt and develops over time, almost inevitably if not treated, into depression.

Getting by with something as subtle as GAD, or other brain illnesses such as degrees of depression, have potentially devastating effects on what occupies our life-line.  The moments that construct the overall devastation may be explained away by one injustice or another, by what are thought to be personality quirks, or simply by neglect of self. But they could be different. The moments, the otherwise same moments, could be different.  The same rude, distrustful teacher, the rejection from Sarah, the quiet mike – those moments could have been different with the same guy, different only in his brain health.  Brain health makes the sameness different.

As Nancy A. Payne, of New York University (NYU) Silver School of Social Work, wrote about treating brain illness,

“There is tremendous satisfaction gained from facilitating the transition from profound illness to equally profound recovery.”

The life-line takes courage to look at.  It takes courage to believe that the effect of our negative thoughts and distorted perceptions could indeed have that pervasively profound effect.  It takes courage to consider that medical treatment can likewise, profoundly change our quality of life.

Hank tried to take his life with a rope before we met.  I’m so glad he didn’t break his neck or die.  He is now well treated and his disease is in remission.  His life-line has changed.Bo-J0zyIEAA_Y3h

Questions:  What are you brave with?  What do you spend your courage on?  Tell us about it.  We gain so much from community and connection.  Keep on.

Self-Care Tip:  Look also at the un-reasons, at the reasons less apparent, at what isn’t seen – look  into those reasons of why we feel and do.

Know You Are Blessed

ulysses

 

Think of the worst of us.  Think of the worst about us.  Think of those with self-loathing.  Those with low self-awareness, the violent, and the violated, think of them.  Where is the blessing?

Blessed are the depressed and anxious.

Think of the healthy.  Think of the diseased.  The misunderstood, the ones who live miles apart from connection, who ever push like a dingy from the peer into waves and self-destruction, think of them.

Blessed are the poor and lonely. 

Where is the blessing when your real estate is brought low by the creeping up of low-life.  Where is the blessing when you get cancer just when you might retire, when your own body calls you stupid, when you lose your eyes after training as a surgeon?

Blessed are those whose bodies are dying.

Think of every corner, every shadow and open space and the turns you still don’t know about inside of your life.  Think of the unacceptable, the character you wrestle against to moderate away from extreme.  The rope you swing on and try to bring to rest, think of the grey you think you will never achieve.  This bit and chapter, this part of your construction, this surprise in how you deliver is Loved.

There is no aberration from the norm that can separate you from that Love.  There is no addiction or misdemeanor or illness or mutated cell that can lose blessing.

This is fact.  Our life is to live with it.

Blessed am I.  Blessed am, “Me.”

Question:  Where is the blessing in what you like least about yourself?  Please tell us your story.  We need to hear you! Keep on.

Self-Care Tip:  Be your own friend in adversity as in prosperity.  Know you are blessed.

Trying to explain, temporary memory loss in ECT

rain gauge

I’m trying to help explain, “Why temporary memory loss in ECT versus loss of memories prior to ECT?” It is “friendly” to understand our treatment options and dispel stigma, starting with “Me.”  Please let me know if this effort is helpful in any way. 🙂

Community opinion of ECT, largely influenced by the media rather than data, has a very hard time believing that the memory loss is of new memories, (or imprinting memory, ) during the course of the index trial; not memories before ECT, not memories after the index trial is done, not memories when maintenance ECT is going on.  

The best way I can explain this, (and this is my own Dr. Q effort,) is that the memory loss is related to mechanical issues, like a cork in a bottle.  Think of a rain gauge, for example.  After it rains, we see on the gauge that it rained 2.3 inches last night.  We uncork it at the bottom, and all the rain water flows out until the rain gauge is empty.  We let the water out. The rain gauge may fill again when it is recorked.

The electrical stimulus and subsequent seizure to a brain cell is like the process of uncorking the rain gauge.  The natural process of the brain is to “recork” after a stimulus, be the stimulus pressure, magnetic, chemical, or in this case, electrical, and let the cell fill back up each time it happens.  The recorking process happens all the time in our brain, (in vitro,) after natural stimuli act upon a cell, be those natural stimuli pressure, magnetic, chemical, electrical, or another.  

ECT is a medical therapy that uses the basic recovery methods of our own physical design and perhaps, this is one of the reasons it is so effective.

Unless the cell has that inside content, it cannot lay down new memories.  The stimulus and stimulus response does not damage the cell.  They empty it. The response is mechanical.

This idea also works to help understand why the memory loss is most often temporary rather than long-term.  The cells replenish between treatments.  It is a cumulative effect, so the closer the treatments are, the more the degree of memory loss.  As the time between treatments increases, the recovery time is so brief, that the patient doesn’t notice memory loss.  The patient is able to imprint memories without difficulty.  The rain gauge, we could say, has its cork in for longer periods of time.

Question:  Have your choices toward treatment ever changed based on dispelling your own stigma?  Has information and greater understanding of your treatment options ever specifically improved your self-care?  Please tell us your story.

Self-Care Tip:  Use information and greater understanding of your treatment options to improve your self-care.  Keep on.

Exercise and the Brain – and Dancing to Enrique Iglesias

taylor swift

Greg went to arrange his annual colonoscopy.  Because he was having a chronic cough, his gastroenterologist (GI specialist) was wise enough to schedule him the “double dip” colonoscopy and endoscopy.  Greg was not pleased.  He was less pleased when Dr. GI found gastritis (inflammation) in his colon, an ulcer (inflammation) in his stomach, and esophogitis (location of inflammation intrinsic to word, esophogitis.)

I got the scoop on Greg’s inflammation story when he came in to see me, (yours truly, psychiatrist, brain doctor.)  And why?  Because of his colon and stomach?  Well perhaps.

True.  Greg was not happy.  He had not been happy for a very long time in fact.  Greg was suffering.  And no, he could not exercise.  He just could not.  Fill in the blanks of why he could not.  We have all given those reasons.

Discussing Greg’s story with him, we agreed that ignoring the inflammation story of his GI would be ignoring something that just might relate to the, “Why?” of why he was in to see me.  The same inflammatory process affecting his gut was affecting his brain, the same brain where his emotions and behaviors came from.

Inflammation.  We think about pus-filled blisters, puffy painful knees, spitting back spasms.  But do we think about frothing road rage?  Do we think about forgetting car keys in the supermarket where we bought five things we did not want and nothing of what we planned?  Do we think about divorce?  About losing our job, or not wanting to get out of bed?  When we hear about inflammation, do we think about brain disease?  I think not, Count Powerball.

The other day, we were in the Kaia, “Juicy JAM” class.  (Seriously. That is what it is called.) Coach Becca does these Juicy JAM classes about once every three to five months with us, just for fun.  It combines dance with athletics in a way that is designed to burn calories, yet effectively reduces grown women, responsible women of our community, parents, book-keepers, encyclopedia saleswomen, psychiatrists, (I am just guessing at least one of us moves like a psychiatrist) and such…, into giggling, hopping, human bumper cars.  And it is hard!  It is not easy to squat, pop, and then pull your fisted arm down super latino-drama-style over your just so angled body to Enrique Iglesias… I think it was, “Tonight I’m Loving You.”

By the time we had survived our first number, all I knew was that Becca looked really good.  Me, eh, not so much.  It is too bad we can not collect disability for this, not being able to dance.

When we dance, we do not usually notice how everyone else is dancing around us, as much as we think about how we are, ourselves.  Like any other behavior or emotion, we are trapped by our own design.  Look who is telling us that after all!  Our own brain.

Then Becca’s tattoo pokes out and we all think, she is such a bad ass!  (It’s right there just above the line of her pants.)

Where do these emotions, and behaviors come from?  Do they come from the good merit we have earned by hard work?  Maybe a really sweaty muscle bending Juicy JAM work-out?  No they do not.  You are right.  The emotions and behaviors come from our brain.  They come from that bit of us that is, after all, connected to the rest of our body.  Our body, where our muscles pump, where our pancreas balances our insulin levels, where our bowels, which flaunt the highest number of serotonin receptors of our whole selves, move and flow.  Our bodies, where nerves stop or start sending pain signals to our brain, where our heart and lungs pump all the blood that touches every part of us like a master control room – this is what matters to our brain health.  It is a relationship, like Garth will always go with Brooks.  Body goes with brain.  An inflamed body, an inflamed mind.

Now we know you are all thinking about bowels and what exercise does to bowels, and you are uncomfortable.  As you should be.  At least standing at a respectful distance.

I’ll never forget some months ago, and probably most of my Kaia-peers won’t either, when Coach Alyssa was taking us through Kaia-flow, a series of twisting yoga poses slash killer exercises.

Good job women!  This is also great for your stomach and bowels.

I thought, there-after only about stomach and bowels!  It was like a beacon.  No matter what I did, I was thinking about my gut.  And then like the answering horn of a trucker to a kid’s arm signal, “please honk,” there I went.  A slow twist, quiet music in the background, the soothing voice of Alyssa urging us on, and, honk.

There was no way to hide it.  No way to pass it off on my dog or kids or farmland creatures.  I was in the middle of the room and suddenly, like Taylor Swift on a center stage, everyone heard and looked.  Just one more bit of savory evidence that exercise decreases inflammation.

With this understanding, we can perhaps consider exercise like a pill.  Like a prescription.  Do exercise because we do what is friendly to ourselves.  Do exercise because we like being friendly to others.  We know that we cannot give what we do not have – to ourselves or to others.  We exercise because if we do not, we will be the barking mom we do not like, dad, sister, child or whomever.

We will not be nice to our partners when we have ill brains.  We will not feel pleasure as deeply.  If we are kindly toward ourselves, such as exercising, we will protect the soft underbellies of them others we love.  We will treat ourselves better.  We will.

One hour later, after dancing or twisting our inflammation, shame, and inhibitions into the ground, after passing a little gas, we are reduced to inspiration, humbly thinking, “Yes. I am that good.”  And that is the Magic there. We are bad arss.  Body meets brain meets community meets Magic.

And for you scholarly folk who don’t believe me when I say, exercise decreases inflammation decreases brain illness, here are a few articles:

Question:  How have you noticed your body speaking on behalf of your brain?  Or vice versa?  Please tell us some of your story.

Old and Dying – Why We Are Still Alive

geriatric lady

Sweaty, well-worn, in bike-ware, she was eating comfortably with her friend.  I kept trying not to stare and just had to fight it!  I wanted to imprint her shiny wrinkled yet blooming geriatric status and break down what I saw into categories of self-care moves to grow old by.  She looked really good.

I managed to finish eating at, (Oh my word! Yum! My new binge and bolt location,) Zinc Cafe, without ruining her appetite with a big hug and smooch from crazy-staring-stranger, me.  I almost congratulated myself, it was so hard not to do.  Nevertheless, when walking out I did stop and tell her she was beautiful and that I wanted to grow up to be her.  She bloomed even more, right there and then.  It was swell.  Good food.  Good role-model to remember.

We think it is our best years that people will identify us by.  But they do not just do that.  They think of us as how we are now too.  More importantly is how we think of ourselves – of Me.

It is different for everyone.  Why we want to be here.  Understanding why, is a universal interest.  It is the other side of value in the aging process.

My parents are getting old.  I am.  My patients and their parents are getting old.  We are dying.

My dad is old.  He just turned seventy-nine.  He is not wearing bike shorts.  He is not a blooming geriatric.  But I value him and saying why, well, I realize starts with “Me.”  It is not because of him thirty years ago. It is about his life these last thirty years.  It is about his Me, now.

The present does not prove nor negate the past.  Our value is more than that.

Sometimes I visit community practitioners.   Please visualize that all of this is in the middle of their busy clinic day, racing between exam rooms to meet patient needs.  I am standing at a nurses station perhaps, dressed in something über professional, (to hide the gypsy in me as well as I can.  But if it were you, you would not be fooled by the cut of my lapel!)  I catch the eye of the clinician and receive a strained smile, almost hearing her say, “Come on!  I’m dying here!  I have three patients waiting!”  But generally they do not actually say it, generally.  And sometimes, they are snagged by the magic of connection, take my elbow and draw me away into a private space where they can share their story.  In a matter of moments.

We are skilled at shaving moments here and there.  Skilled at putting as few words into a fat minute that can convey the large concept needed just Now!  We learn this over brow-beating years of managed care medical practice, personal choices, convoluted expectations and need to please – self, other, insurance or what not.  When clinicians share stories, we do it like we are late catching the train to heaven.

From these visits, I get more to my quality of practice.  I get known, and get to know.  Awesome.  It is a newer part of my “work,” that I have been doing this, and I am loving it.  I meet the people who are the other side of our patient’s treatment team.  I meet people who are both human and medical clinicians.  Realness surrounds them.  Life stories come from them.  In a fat minute I hear about their past, gain some understanding of their present and from that, I am given much.  One physician told me of his beloved daughter who suicided, another of her husband’s chronic brain illness and how their family struggles.  I shared how my young cousin hung himself and that part of me who is groping toward that space and time before he died.

To know who we are despite our changing emotions and behaviors, our changing identities, improves our understanding of life value.  Somehow, Dad has known that, without bike shorts.  He continues to mentor me in that.  I do not know about the beautiful geriatric at breakfast, but who is to say she does not know her value?  Not Me.  But I am going to explore my own, for my sake.  I am getting old.

Self-Care Tip:  Look and look some more for why you are valuable.

Questions:  What is valuable about you, even though you have lost so much in life?  Why are you still alive?  Please tell us your story.

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Words Like: Distended abdomen! and Connection

distended abdomen

A friend of mine told me the other day,

Mentally I went to a bad place during exercise on Tuesday. Like “I’m so slow, I want to go home, the other girls probably think bad things about me”. In my head space now I see those thoughts as ridiculous. But it was tough to get through.

Excuse me but she is brilliant.  She speaks for millions.

So many times we think about the rough out there.  The words that slow our swing down, that are not said right, that somehow take away points from our identity.  We are not a two-dimensional scorecard.  Speaking up does not qualify us.  Good or bad.  Speaking up does not change our value.

I loved her voice.  I am thinking she should start up her own blog.  If she can be this transparent on a blog, she is a needed voice.

If I could fantasize a little, (Now! Now!  Stop that,) I would have her and you go back to our own, here at friendtoyourself.com, and start methodically answering each self-care question, post by post, in your own authentic way.  And just you see what a stroke speaking up makes.  Just see what it does for you inside and out.  Just see what it does for others. …Me for example.  See?  I am affected by you.

As for my transparency, in brief, …I did not survive halloween.  I ate like a motor.  Chocolate.  Chocolate and more chocolate.

Otherwise.  I think this greens-and-beans-effort I am doing has been ok.  I am eating a lot of plants.  Trying to keep the simple carbs low.  Not always the fact but the goal.  I do still eat in volume which I will see if it makes a difference or not when it is this type of volume.  All that fiber is making a difference to my gut though!  my abdomen is distended!  TMI.

A couple posts ago we shared Jessica’s, “Do This.”  My question is, what is yours? What is your, “Do This?”  Please do not make me use any more golf analogies, but where are your …words?  Your words are important for you.  They bring friendship to you from you.  They bring you to connection, community, clarity of thought, and as said in a post long ago:

“And if we stop speaking, we will lose.  If we do not respect the opportunity to connect, if we do not treat it as the treasure that it is, not only will the world miss out on the ‘Me,’ we miss out on the world at large.  It goes both ways.

We have a choice.  Get friendly with yourself.  Speak.  Listen.  Connect.

Self-Care Tip – Stay connected for your sake and for theirs.”

Question:  What has speaking up done for your friendship with yourself?  How are your words kinder said than not? Please tell your story.

Past week, latest on ECT on the web

  1. Shock therapy used to treat depression video from wzzm13.com community
  2. Wrong Planet Autism Forum Index -> Bipolar, Tourettes, Schizophrenia, and other Psychological Conditions
  3. Why are we still using electroconvulsive therapy?
  4. By Jim ReedBBC Newsnight
  5. PLOS ONE  :  Electroconvulsive Therapy Induces Neurogenesis
Cured by Electroshock Therapy,  Wall Street Journal

A Young Man’s Wrenching Journey

Children!

On Jun 18, 2013, Anon wrote:

Hello Dr. Sana L. Johnson-Quijada,

Thank you for coming to talk to share some of your experiences and views associated psychiatry. I am sorry I have not emailed you sooner.  This was my first year taking three sciences and when it came time to study for finals, I pretty much ignored everything except school.

Thank you for giving the class and myself some exposure to psychiatry. Your talk was very intriguing, especially how you see a person, in particular how their brain health affects their personality. When you started to talk about homelessness it brought back painful and confusing memories from my childhood.

My parents divorced when I was seven and the majority of my time was spent with my mother because my now deceased father had a difficult time keeping a roof over his head and doing the activities of daily living. When I was a little older I even loaned my dad some money when his car was impounded. I could not understand why my dad was in the situation he was in and why I was seemingly more capable than him. I loved him very much and wanted to help him in any way I could.  But in the end, I could not make any of his decisions for him.

My older brother is living in a shelter and he reminds me of my dad in so many ways. When we lived together, before my parents divorced, my brother was just about as hard to get along with as my dad, and my dad was physically abusive to him. I was so confused and could not understand why we could not love each other or ourselves. My dad’s incessant fear of doctors and my brother’s fervent choice to self medicate only complicated the situation we were in.

My heart goes out to my family and people like them and I have a strong desire to help people. Your short talk resonated with me and I was intrigued by psychiatry because I thought it might be a way for me to help. How do I learn more?

Sincerely,

Anon

On Jun 18, 2013, at 5:16 PM, Sana Quijada wrote:

Hey. So good to hear from you. I remember you well. Sniff. Big hug. You are not alone, dear man. 

How to learn more?  Hmm. I would start by attending some local NAMI meetings. Follow up with me in a bit after you do and we can keep the lines open and ideas flowing. It is an honor to connect with you. 

I celebrate your focus and completion of finals. 

I would love to post your email letter on FriendtoYourself.com … 

Your story is seriously powerful.  As my six-year-old says, boom! Smile. 

Till next time,

Sana Johnson-Quijada MD
www.FriendtoYourself.com

On Jun 24, 2013, at 5:00 PM, Anon wrote:

Yes you may post my email I feel honored. It took a lot of courage to write and I am glad you were receptive.

This is a "thought bubble". It is an...

Questions:  How would you recommend a young person find out more about psychiatry, before pursuing years of study?  How did you investigate your profession before committing?  

How do you talk about your family of origin history?  How do you find the courage to share these things, to find community in what hurts?  Please tell us your story.

Self-Care Tip:  Find the courage to connect with others and your story.

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another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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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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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

If You Want To Die, Tell Others.

McCulloch Electric Chainsaw. Photo by Eric Bea...

Image via Wikipedia

Have you been having any thoughts about wanting to die?

You folks know about these questions I must ask. Some people are offended by them. Many people are grateful. Trisha was guarded.

Yes.

I asked,

Did you have a plan in mind on how you would kill yourself?

There was a black pause and then,

I’m not sure I want to tell you that.

I could understand your reluctance Trisha but telling me is a good thing. It helps the ideas lose some of their power. It’s no longer as much of an option when you tell someone than it would be if you kept it a secret, I said.

Ok.

Another black pause and then,

I wanted to use a chain saw.

When it comes to ways of suicide, this one sounded pretty painful.

Ouch! I said to Trisha.

Her response, well, I didn’t expect it.

I hadn’t thought about that! The pain from that would have been nothing compared to the pain I was going through!

Trisha’s words schooled me. I don’t care how many times we talk about the darkness, the hopeless horror and the suffering of some brain illnesses, somehow, I know that I really don’t want to have full knowledge. When having your neck sawed off by your own hands with a chain saw seems like it would feel better than the full body despair, not many others will understand. Trisha wasn’t processing well, true. But the point isn’t her poverty of suicide options. What is the point here. Well, there is one major point to take home and there is a minor. Starting with the minor point – We can’t presume much about others. Moving on…. Major point – Tell people when having thoughts about wanting to die and what those thoughts are. Why? Because it’s friendly to Me. Telling someone isn’t as much about what they’ll do for Me, although once in a while someone may do something right on our behalf. Rather, telling someone is about what the telling process and knowledge of the telling does for Me. It lets us know that we are not alone. We lose some of the magical quality to the suicide plan. It dilutes our conviction to self-harm as a solution.

Question: What else do you think telling someone about thoughts of suicide does for Me? Please tell us your story.

Self-Care Tip: If you have thoughts of wanting to die, tell others.

Anticipate Rejections – Normal And Part of Our Human Condition

Self-Care Tip:  Anticipate rejections and some in-between times, you will be chosen.

I have not failed. I’ve just found 10000 ways that won’t work.

-Thomas A. Edison

Foto einer Glühbirne (an),

In today’s economic climate, we are given more opportunities to seek employment elsewhere.  Of course, “opportunity” is loosely used here and it might sound like I was playing Mad-Libs, a super game in fact so I’m okay with that.

But whether we are applying for employment or asking to be someone’s friend, or like Edison, playing – these various arenas of rejections are normal. They may feel particularly personal, but that’s a distortion.  They’re part of the human condition.  They come to us who do what we love, who do for well-evaluated intentions, who put out with courage and who put in 10,ooo hours.  They come to us who haven’t found what we love, who work for a martyrs salary or who do not have the privilege to go toward their temperament.

Rejections are.  They are like the surface tension, the space between water and air and they hold us together.

We love success and too often are like Drew Barrymore in 50 First Dates.  We forget from sunset to sunrise what a day’s labor brought us before.  We forget easily.

But with Magic and Love, we can lose ourselves once again in the experience of doing what we love to do despite it.  We can remember better with the help of rejections.  Remember all sorts of things.  And without turning this into a script from Cheers, we can still say that rejections become the best parts of our life’s experience.

Those darn personalizations though, those distorted perceptions, those rejection-clots that cut off circulation – if it becomes that the space between water and air gets too thick, if rejections seem life defining, tell your physician about it.  It’s not “just the stress.”  It’s from the brain and might be a symptom of brain illness, much like achy joints and arthritis go together.

Questions:  How are you able to use the rejections you received to be friendly to yourself?  Please tell us your story.

Surrender To Help

GrassesWhen I was a just a bit, dirty feet and pig-tails, spending the summer on my grandparents farm with my three similarly dirty big brothers, we took grandpa’s two green John Deer out for a drive. We all delighted in the enormous strength in those beasts. The tires were taller than me, which meant nothing but fun at the time. I never thought about falling out, but I could have.

I rode with one brother and the other two were up ahead. We were toward pasture and hoped for a long run of it. The boys were yelling at each other, provoking and jocular. I was, as usual, amazed at my luck to have them for my own.

Somewhere before we lost interest and after we lost sense, the boys ahead hit mud. My goodness, but we, coming up from behind hollered laughter. Jeering, we watched them whiz those monster tires deeper and deeper. Oh the tears! right up until we followed them into our own mud-sink. Humiliating.

My grandpa farmed corn and hay and some other grains but all I remember about that field is that the ground was really wet beneath tall grass. The green came up almost to the middle of the tractors and the blades were wide and thick. We got to business pulling grass out and feeding it to the muddy tires, thinking to build traction. About an hour later and after the grass had taught our hands a lesson, we tramped back to the barn-house. Nothing to do but tell Grandpa.

That was the last day of our vacation and we heard later that he had pulled them out with his truck, gracious as ever. Grandpa Jack was such a kind and gentle man.

I remember the grass when I’m with Eilene. She is my patient with moderately treated mood and anxiety disease. The rest of her though is not well. Eilene is pulling grass to help her move. The best I can do is stand beside her.

wonder what I’m missing in my life now. Where am I stuck? When will I get over to the barn house to surrender?

And you? Please tell us your story.

Self-Care Tip – Surrender to help. Be a friend to yourself.

Find Hope When You Otherwise Must Die – Depression

Jane Eyre

Image by madelinetosh via Flickr

Briggs was crying again.  His wife, who came with him to our first appointment, looked like a peeled fruit beside him.  She was undefended, giving her last layer of self without knowing what would be left.  Briggs was one case of serious depression, but his wife; she was heartbreaking.  Both of them in their own ways would not last long.

It is not unusual in a specialty clinic to work with people such as Briggs who have been around the treatment shops.  Then, finally, in Jane Eyre-style, they appear at my door in the company of death.  They have been through therapies, practitioners and churches, but disease resists treatment.  Everywhere they walk, it is as if Hades (or Neptune) were visiting.  Hope-blossoms wilt as they pass by and those of us who share space, feel like the ground is going to open up and suck us under.  It is not uncommon in specialty-care, to be told, “…I have no strength to go further.”  Like Jane Eyre, they plead, “I must die if….”  (By the way, Charlotte Bronte is the bomb.)

As the person on the other side of this exchange, I have worn down the rainbow of “specialty” options available to offer.  And what are they?

I’m going to write more about those options next, but my questions for you today are:

What has worked for you or your loved one?  Is there any treatment you think is too extreme to consider to get brain health?  Please tell me your story.

Self-Care Tip:  Find your specialty care.