Find Hope When You Otherwise Must Die – Depression

Jane Eyre

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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.

Name Your Fear To Know You Are Free

She knew the Horned King‘s secret name.

His name?  … I never realized a name could be so powerful?

Yes….  Once you have courage to look upon evil, seeing it for what it is and naming it by its true name, it is powerless against you, and you can destroy it.

The Book of Three by Lloyd Alexander

Science Fair Wins Ribbons

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Mistakes and the mist of shame thicken about us and it is hard to hope.  As if each effort of our intended labor produced Seconds and Flops we must stand in our Besties beside what we have done to get a participant appreciation ribbon tagged onto our lapel.

And somehow standing there, the layer of sweat thick under too many clothes, we remember the secret name, it comes and we whisper.  We whisper it; our last courage still enough for that.  There is a moment of surprise, as if we and whatever pressed us down didn’t know we might still live.

We can see now that we are not alone; just there, in fact you are there with your own passed over table.  I remember you working nights on it, your tired eyes, a happiness in your muscles still.  In those days.

We can see that we are special for more than injury; we hear now.  We feel concern for more and taste newness that filled the space.  The secret name.

We won’t tell you or it wouldn’t be secret any more.  But now that we remember we are free.  Now that we have the knowing, we will keep the power, thank you.

There is power in a name.

We won’t forget what came after evil and will speak more readily into dark spaces, will wait less and fear less because we have already been there.  Going toward the pain like that.  What’s the worst that can happen when you name your fear?  It takes no more than a whisper to be strong.

Self-care Tip – Speak into your dark spaces the name of your fear.  Be a friend to yourself

Question – What reminds you that you are free despite the fears that tell you otherwise?  How is freedom your truth in life even when your senses tell you otherwise?  Please tell us your story.

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No One is Choosing For You – Know Your Choices For Health

Yesterday we asked some pithy questions re: Why Psychiatry?  Your responses were received with gratitude and humility.  It takes courage to understand our connection with psychiatry considering ongoing stigma.  Today we’re reviewing that some and taking it one bit further.

When referred to a psychiatrist for medical care, we can feel confused.

Why is my physician sending me away?  Does this mean I’m at my last resort?  Does this mean I’m that sick?, or,

Does he think I’m crazy?  I’m not insane!, or personalizing with,

Does my physician not want to work with me?  I’m that bad of a patient?  Cast off?

Our expectations when we first see our psychiatrist are often also similarly reactive.  Maybe,

I’ll give this one chance but if she doesn’t fix whatever it is that’s going on, I’m out of here. 

I am not going to be dependent on medications!

I do not want to be made into a zombie!

Are we looking for a cure?

Also, we might be confused by the amount of time that she spent with us the first appointment as compared to our follow-up appointments.

I need to talk about my problems!  I need time!

There’s a lot to take in.

Unfortunately, when we are referred to a specialist, often our referring physician hasn’t effectively communicated as to why we are being sent there.  This is for many possible reasons, including Me not hearing him.  Many other reasons are also understandable with insight but we aren’t always given the opportunity to hear the inside story of why our physician does what he does.  That doesn’t mean we have to accept it.  But if we do, we did and it’s our choice.

Choice

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We have choices.  Before accepting the referral, we can ask, Why?  Keep asking why until we are satisfied with our level of understanding.  Schedule a follow-up appointment with the referring physician if necessary to gain more time if we think we need it.  Sometimes, despite our physicians best efforts, we won’t understand as well as we’d like and we have to make our choice with the information we have.  We can read up on our symptoms ourselves.  I read in Twitter from @NathanBransford,

The 11th Commandment: Thou shalt not ask someone a question thy could easily Google thyself.

That’s ridiculous although I cracked up.  The World Wide Web comprehensively and including Google or any other source within that World Wide Web are not designed to practice medicine.  When we read something, we need to ask for qualifications behind the author of the print, references and so forth.  The Internet is a tool worth our attention but you decide how far you are willing to take what you read before you consult with your own physician.  I think if Doctor Seuss were alive today, he’d write a book (or many) about health care; Oh The Tools We Can Use!  (Maybe Carl and Thysleroux will do a series or a post on this?  Should be fun.  – Asking, “Why?”  Becoming our own friend.  Connection.  Going towards shame, pain, anxiety.  Growing bank – and more.)

And so that brings us to today’s questions:  What choices do you perceive you have in referrals like these?  In your continuing medical care?  In your ability to collaborate with your physician?  In obtaining an understanding of your illness(es)?  Please tell me your story.

Self-Care Tip – Grow your understanding of your choices for your health and medical care.

Related Articles:

  1. Stay Connected For Your Sake and For Theirs
  2. Connecting To Others Is a Condition of Freedom
  3. Safety in Connections

Why Psychiatry?

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If we have ever seen a psychiatrist, then there has been some point in our lives when someone told us to go or we told ourselves.  I have some questions for you.

How did you hear about psychiatry?

What are your thoughts?

What did/do you understand?

Please tell me your story!

Self-Care Tip – Explore your connection with psychiatry.

Taking Care of Our Own Emotional Junk Empowers us Not to Take Care of Theirs

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Yesterday we started a narrative series on understanding where emotions and behaviors come from:

  1. Emotions Are Contagious
  2. Our own Emotional Junk (today’s post)

Yesenia and Rob chorussed,

Yes! I am worse when Yesenia is not doing well. Who can cope around that!?

Yes! Rob is making me sicker!

Saying emotions are contagious is not the same as explaining causality or fault. It’s talking about an influence. I didn’t want Rob to misunderstand me. Saying emotions are contagious is information to use to empower us; not to make us feel like victims. It is to help disclose our own vulnerabilities, our own needs and our own quest towards healing and presence.

But how to be present with “falling knives,” as Cindy described this in yesterday’s comments?

It starts and ends with Me. So getting back to Me simplifies things and short-cuts our confusion.

It’s easier for us to be around so much charged air when we have already gone toward our own flaws, pain, emotions and anxieties. It is easier for us to not make something personal that isn’t if we have already stayed in our own nasty space for a time, did that process over and over, and each time stayed long enough to see what is there/what will happen until we realize – not much. (That was what I like to call a “super-sentence!) Taking care of our own junk helps us be available for other people when they are spilling theirs. We are less controlled by shame and fear.

This may not happen when complicated by our brain disease. Personalizing things may be inevitable if we do not get medication therapy. Being present with our own journey might not happen without medical help.

Sometimes when we are ill, we feel like we are spectators of our own life story, standing off to the side, just watching the show. With healing, we join with that living active self and can be present and whole. With healing, we don’t have to personalize someone else’s emotion-spills. With healing, we can improve our quality of life. When they don’t fight for brain health, such as taking needed medications, or whatever it is that would have been friendly for them to do – we don’t have to make it about us.

And! And if we choose to, we can be with them. We can be with the people we love! Isn’t that great?! Even when they don’t do their own self-care. Even then. Or not. But we are choosing now rather than reacting defensively.

Kaily said it yesterday like this,

Now, when I notice that my mood is starting to mimic the negative mood or negative atmosphere around me, I stop myself and realize that just because those around me are negative, stressed, uptight, etc., I have the choice and the power to stay positive and at peace within myself. Just because everyone else is jumping off the cliff doesn’t mean that I have to follow.

Self-Care Tip #268 – Taking care of our your own emotional junk helps you not try to take care of theirs.

Where Do Emotions and Behaviors Come From?

Emotion

Last night at our self-care workshop, we asked the question,

Where do emotions and behaviors come from?

The answers, were nice and varied; none the same.  It’s such a great question though, don’t you think?  It would be great to hear from you as well.

Where do emotions and behaviors come from?

Then, would you tell us if it has qualified your worth?  self-esteem?  confidence?

Has it affected where you go for help with them?

Self-Care Tip #266 – Answer, “Where do emotions and behaviors come from?” for better self-care.

Our Feelings Begin and End With Me. We Are Not Victims.

Freedom is useless....

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Self-Care Tip #245 – Our feelings begin and end with Me.

Are we victims of victims?  I know I blame people and am not above a good rant on all the why’s “I feel this way!”….  However, the cleanest air I’ve ever breathed is when I’ve stepped out of that space and started naming myself responsible for my own feelings.

Slavery comes in many ways.  Thinking about being a slave by our own design is an odd twist but choosing the victim role does it.  Choosing freedom to self-care is liberation by the same government.  This is a cornerstone of understanding the “Five W’s and One H” of self-care.

Victims also generate victims not only of themselves but also of others.  Somehow the emotions, heavy, immobilizing, irritable, angry, coming off of the person in the victim role are absorbed by others if those others aren’t seriously insightful and vigilant against them.  Considering this, we can understand the difficulty of being present, in the moment and not either running away or trying to change the person in the victim role.  (Remember the 3 C’s?)  Anyone porous to them is at risk.  Too often, we all find ourselves pointing, pounding, pity-party preaching victims – none of us naming ourselves responsible for our own feelings.

We know that we are more prone to personalizing things when we suffer different emotional illnesses.  In this case, we can’t help but catch the familiar features of depression.  There are other illnesses of course with these symptoms, but an irritable depression is one of the most difficult to endure for all parties. Sometimes, simply gaining insight into our coping skills can make us better friends to ourselves.  That is such a relief.

Too often however, being the victim is not fully under our control.  Too often being the victim is a symptom of the disease process that came without an invitation.  Also, just as often or more, the person in the victim role doesn’t have insight into any of these aspects – their choice into slavery, their influence on others, their medical condition generating these symptoms or their options to gain healing.

I could easily tell you a number of word-pictures, maybe describing the before or after treatment, maybe letter-layering the innumerable ripples that self-care made on the world after treatment or maybe I will more easily just not.  All these stories bring me, at this late hour of our week, too close to those contagious emotions and I’d just rather not.  Maybe you’d like to share though?

Questions:

  • When you started owning your feelings for things that you never thought had anything to do with you, what were your thoughts?  How did it ripple out of you and affect others?
  • What do you see at the cornerstones of self-care?
  • Please tell us your story!

Patient on Patient Crime – Our Response to Our Own Illness

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

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

Pause button.

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

Well of course!  She had cancer!

Or,

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

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

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

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

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

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

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

Where Do You Think Behavior and Emotion Come From?

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

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

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

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

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

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

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

I mirrored Naomi’s question,

Why do you think you feel depressed when that happens?

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

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

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

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

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

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

Guilt Furiously Chasing You Is Commonly Experienced In Illnesses Of The Brain

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Self-Care Tip #221 – If you feel chased down by guilt, stop running and get friendly with yourself.

I’m so busy!  I am trying to work, raise three kids, and be a wife!  …and I’m just spread so thin!

It was new for Connie to think that where she was at in life was linked with her choices.  Somehow she intuitively felt taken along by it all, a current of life as people say, of either randomness or design.  Who could know, but it was more than her choices, she was sure, and she resented the influence on her life’s design.  Not that she had intended on taking over what was playing on her.  She just simmered in the house of cards hoping that when she got to make a play of her own, she’d make a good one and come out better for it.  In the mean time, she just had to keep moving fast.

Things would have been fine, except that over the past six months, she hadn’t been enjoying what she was living for, her kids, parenting, being a wife or her employment.  Yes, she was also  living for God but no, she wasn’t enjoying Him either.  Did she want to?  Did she feel guilty about it?

I feel guilty all the time.  It’s the guilt that gets to me.  It’s like I can’t see or feel much else.  Just when I think I’m about to get into what I’m doing, guilt comes chasing at me in a fury!  Distracting me and worrying me.  I’m on edge more and irritable from feeling defensive, and trying to get away from whatever this is.

Connie looked at me when I said,

Self-care begins and starts with “Me.”  Although we may be living for others and other things, even living for God, if we don’t take care of ourselves, our health first, our emotions and behavioral health included, we can’t give much, in the way of living, to those others.

I could see her pupils change and I got a little excited.  She was hearing something that affected her whole body and I sensed it was hope.  (See, I am an Emotions Jedi.)

We talked more about approaches she was using, prayer/meditation, exercise, grit and determination, waiting it out for better days to come and others.  Then I introduced the medical paradigm.  (You’ve heard me say it.)

Behaviors and emotions come from the brain.  We culturally think that they are volitional, under our control.  But how much can we really control of what the brain does?  Some.  But when we do the best we can with what we can control, and our behaviors and emotions are still hurting us, affecting our quality of life, damaging our relationships and connections – we need to look for biological reasons.  That’s where choice can still come into play.

She was looking and nodding.  This was at her “consideration stage” of introducing these new ideas.  I said,

I thought of telling you about this when you talked about guilt Connie because maybe your guilt is coming because of a brain illness.  It’s common in several emotional illnesses, like depression or anxiety, and in these illnesses it commonly comes in force, like you’ve described.

Her pupils had reduced to their earlier size, and her posture said she was winding down for that visit.  Whatever we discussed after that would be low yield, so we made a follow-up appointment and called it a day.

These days later, remembering Connie gets me thinking about what I would have said if she had been available to still hear more.  This bit about freedom to choose self-care, yet saying we have little to do with how our brain works can get confusing.  It might seem contradictory.  Tomorrow, I’m going to discuss it more, but for today, it would be wonderful to hear what you think.

Questions:  With behaviors and emotions coming from a material biological organ, the brain, yet knowing that we are free to choose for our self-care, what gives?  How do these ideas jive?  How have you seen it play out in your life?  Please tell me your story.

Never Let Go of Hope, Even When Depressed and Anxious

Linda, Lake of the Woods Run, 15 K

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Self-Care Tip #214 – Never let go of hope, even when depressed and anxious.

Some blog-posts ago, Be Aware of Your Feelings was written and “M” asked,

What is the difference between depression and anxiety?

Anxiety and depression are like brother and sister.  They often go together.  When we think of “paradigms,” we think of an arch that might intersect with another arch.  However, when I think of the affective (or mood) spectrum intersecting with the anxiety spectrum, I see them weaving, interlaced or chasing each other.  Not a line and nothing tidy.  So understanding the difference also includes understanding their relationship.

In training, I remember presenting a patient with anxiety and depression to my psychiatry attending physician.  I hadn’t clarified the timeline of onset of symptoms.

When presenting, every resident physician knows the moment when they are found out.  The other residents on the rounding team instinctively lean back, try to take a step away even, so the lightening doesn’t singe them when it strikes.  I’m sure I smelled like fear too.

The reason the time of onset of symptoms is important, is that it tells us the primary disease process.  Knowing that, influences the speculations on patient recovery, duration of illness and our choices for treatment.  Some medications for depression can really activate anxiety and the patient might not enjoy the free-fall into hell after starting the antidepressants.  Also, there are some treatments that work better for different disease processes and such.

It’s common for someone who has suffered from depression on and off for years, but never from anxiety, to have their first panic-attack out of the blue, without trigger.  Bummer!  Then they start to roll.  Bam!  Bamm!  BAm! BAAM! BBBAm!  The panic attacks may come in spurts and then go away for a time.  The opposite is also true, starting off with anxiety, and followed by depression.

I don’t think anyone, including “M,” is asking me to talk about the differences between anxiety and depression in that depression is a state of sadness, and anxiety is a state of autonomic nervous system activation.  Rather there is the wonder of why they follow each other in course, why the are so often in each other’s company, why so many medications that treat one will treat the other, why they run in family histories and/or why they are both “so common.”  We have some ideas we use to answer but we don’t have enough objective information to explain.

Some of the good news is that these diseases are treatable.  The sooner they are treated and when treated to full recovery, the better the hope for long-term brain health is.  I have seen people feel defined by these diseases and trapped.  My job isn’t to minimize that, but rather to highlight what might bring hope.  Selling hope turns out to be one of my biggest jobs.  The same attending physician I mentioned above told me that.  He never stopped talking about hope.  Even for me.

Questions:  How do you answer “M’s” question?  How have you seen depression and anxiety move together and how have you responded to it?  What has given you hope when they did?  Or, when you saw this in someone else.  Please tell me your story.

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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

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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

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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.

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

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

symptoms and signs

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

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

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

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

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

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

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

We were both quiet for a bit.

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

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

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

Hear more than words.

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

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

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

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

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

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

So Many Choices, So Little Time …For Self-Care

"Sophia Western", engraving after Bu...

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Self-Care Tip #198 – Being a friend to yourself might be saying,

No.

Our culture is brimming.  Brimming with…, well take your pick; walking the dogs, turning in a take-home test, watching The King’s Speech, writing a journal entry, making pancakes or reading Savvy – we have options.

However, today and often, options are stalkers we think difficult to restrain.  …More difficult, say than filing a restraining order against your husband.

Walter filed for divorce with his unhappy wife.  Vengefully, his wife turned around and filed a restraining order on him and just like that, he was unable to see his kid for over two months.  That was easy.  All she had to do was file it.

And when we have these many options, all we need to do is say, “Yes,” to one and to the rest,

No.

I love it when my four year-old son is rocking carelessly on my outstretched legs, flopping about, a happy-drunk bird-on-a-wire, and predictably although unintentionally falls.  Crumpled on the floor, he flicks his bangs back and says rather coolly,

I was okay, Mommy.  I was okaaaay.

I had tried to rest on the couch and type, doing my self-care thing after doing Mommy-stuff with the kids for a large chunk of the day.  But telling him to stop doing that really cute thing he does was not so easy.

According to The Economic and Social Research Council,

Having older siblings is not related to children’s happiness with their family, but having younger siblings in the household is associated with lower levels of satisfaction and this effect is greater the more younger siblings present in the household.

It turns out that children feel more happiness in their homes when there are fewer younger children.  They perceive that there is less energy available for them from their parents with each born child.  And I’m here to say, there is.  With my son on the floor, flicking his hair and going,

I was okaaay…,

my middle daughter kissing my shoulder and burrowing into my arm like an ear-wig, my eldest daughter came back to ask for the sixth time if I would play jump rope with her – I remembered this study.  So true.  I don’t need more options, i.e. more children who ask and I say,

No.

With these many wonderful options, choosing Me, is not always easy.  (See post, “‘You’ Are the Best Gift.”)

Now throw in a little inappropriate guilt, some ruminating thoughts, self-loathing, bad sleep, some low motivation and energy and choosing Me becomes the hardest thing anyone has come up against.

Questions: How do you choose you when you could pick so many other great options?  How has this helped quality of life for you and others in your life?  Please tell me your story.

Getting or Giving Bad News Without Fear

Slalom skier

Image via Wikipedia

I was reading an article on awareness of obesity the other day telling us that many times, people don’t know they are obese until they are told by someone else.  Ouch.  Pass the Band-Aides.  But it aired our need to stay connected, speak up, and listen.  It also prompted me to reflect on mental illness.  How often I’ve sat with someone’s emotions-history in my hands, looked at them and realized they didn’t know.  They were there, emotions bleeding all over the place but didn’t grasp their injury.

Um, excuse me ma’am.  Let’s apply some pressure on that and get you some help.

Bloody news like this reminds me of my friend Jack.  He was waterskiing with my brother and I when we were college’ish-age.  Jack was not so capable on the water, although he wasn’t afraid.  As you probably know, three is the perfect number for waterskiing – one to drive, one to hold the flag when the skier is setting himself up, and then of course the skier.  Any more and there are way too many polite smiles and way too much advice for the bobbing body in the water.  Jack was working on his slalom moves, thrilled with his progress and after about the third fall, was still ready for another go.

Hit it!

Our boat, Rosewater, eased him out of the water and he was up.  Jack has a way of celebrating like no other.  He whoops and yells and his whole body joins in.  And so he was in his happy place, up on a single ski, unconcerned with the world at large.  It was lovely.  Until the wake of that other huge boat threw him down and his face slammed into his spectacular single ski.  Up he came and we just looked at him, quietly at first.  Jack paddled up to the boat and wondered if he should try again.

Um, sorry Jack.  Let’s apply some pressure on that and get you some help.

Jack had a huge gash, copiously bleeding all over his face and he had no idea.  He was wet already, cold from the water and didn’t feel a thing.  I still feel the creepies skittering up my arms and chest thinking about it.

When we told Jack, he was a little unbelieving.

Are you sure?  Is it bad?  I think I’m alright.  It’ll wash out and I can try again….

Oh there wasn’t much pleasure in telling him the bloody news.  Generally there isn’t that much pleasure in telling someone they are fat or suffering from mental illness either.  It’s the follow-up to that statement where the fun comes in.  The hope that we link the first punch-line to.  Good news is, …along comes the second punch-line.  Hope.  And presence.  Being with someone where they are at, as they are, and with patience doesn’t mean leaving him in the dark, bleeding out.

The reverse is true of course as well.  If we don’t stay connected with others, we may lose the opportunity to see ourselves through their eyes.  It is an opportunity.  When we are with someone we trust, respect and think see’s us as the precious thing that we are, it is.

Self-Care Tip #195 – Stay connected with others and listen without fear – something good is coming.  Be a friend to yourself.

Questions:  How do you deliver “bad news?”  What is the best way you’ve ever been given “bad news?”  Please tell me your story.

Do You Feel Pleasure? Lacking The Ability to Feel Pleasure Leads to Suffering.

Grazing in Spain

Self-Care Tip – Enjoy what you do or else find out why you don’t.

Pleasure.

I often ask patients when I am taking their mood history,

Are you able to feel pleasure?

I need to figure out how to ask this without you or anyone thinking that I want to know more about lube and feathers.  No, thank you very little.  But what I am trying to ask about is the ability to enjoy what you are doing.  It is not necessarily “joy” but at least it includes having a positive sense about you while you are progressing through something.  Being able to feel pleasure does not mean being happy at a fiesta or while doing kangaroo jumps with your child.  It does not mean changing your personality so that someone who prefers to work turns into someone who is playful, or a grazer* turns into a barn animal*.

Feeling pleasure does not mean that we achieve our fantasies.  It does not mean we are on vacation.

To understand what pleasure is, it helps to understand ones temperament.  It is enjoying what you do when you do your thing.  For example, if you are someone who in any given day or mood and regardless of weather or wealth would want to complete the work for the day – when you do that, are you feeling it?  Are you feeling pleasure?  Or, to contrast, if you are someone who would more often choose an unstructured and unmarked day – how is it going down for you?  Are you feeling pleasure?

Pleasure when you are doing your thing is quality of life.  If you do not feel it, life is crackers without soup.  It comes and goes dry and without anticipation.  If you do not feel pleasure, you lose your perceived connections around you and including with yourself.  Suffering is when you feel alone, even from your self.  Losing the ability to feel pleasure results in suffering.

Goodenough, PhD

Not everyone connects that emotional illness is a state of suffering – whatever one or combination of illness(es) come to us in.  Looking in at ourselves, at our Me, from the outside, we observe expressions and behaviors that we interpret from our own bank of information and intuition.  When I tell someone, what you are observing in your child, or wife or whomever is my patient at the time with mental illness – when I say,

They are really suffering,

it tugs our unconscious awareness into consciousness   We often do not actively know about this internal world where there is no pleasure.  We do not know that lacking pleasure leads to suffering.

Are you able to feel pleasure?  Do you find it harder to feel pleasure than you used to?  What things do you still enjoy? How long has it been since you last felt pleasure?

The ability to feel pleasure is a wonderful gift.

Questions:  What has helped you most in healing your suffering?  What has helped you connect again with others when illness pulls you away?  Please tell me your story.

*Reference:
Temperament definitions according to Dr. Q:
grazer = someone who comfortably wanders from idea to idea
barn animal = someone who is goal oriented and does not like things unfinished

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The Spider Sat Down Beside Her – Mental Illness

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

The Little Miss Muffet scenario explained by D...

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

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

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

Taking pills makes me feel like I’m crazy!

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

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

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

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

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

Waiting For Self-Care to Start

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

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

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

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

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

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

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

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

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

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

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

When You Can’t Control This, Emote Empathically

Self-Care Tip #172 – When you can’t control this, emote empathically.  Be a friend to yourself.

A couple of days ago I wrote about being transparent with ourselves and others when we are not in control of things.  (Say, “I Can’t Control This” When You Can’t.)

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

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It got mixed responses but all worth thinking about.

Jennifer responded on Facebook,

The 3 C’s help me all the time; I didn’t cause it, I can’t control it, I can’t change and or cure it!

Isn’t that wonderful?!

  1. Cause
  2. Control
  3. Change

And it’s helpful to remember that claiming these 3C’s still may not remove us from the stressor.  We are however more present with ourselves and others despite the stressor.

Another reader BeeBlu’s, brought up that famous “fine line,”

I agree that it’s healthy to have this attitude to certain things in our lives, but as you say, it is also no excuse for bad behaviour and letting emotions go into free fall at the expense of others. I think there is a very fine line between the two. bb

…And her signature, “bb,” – awesome.

A line that is thin implies insecurity, danger and something precarious that may end up all wrong.  I wonder about that line.

On one side we have the 3 C’s:  cause, control, change.  On the other side of the line we have responsibility for the boundaries of others.  I wonder if there really is a dividing line after all or if it is just bad lighting.  If there wasn’t, there would be no need to thicken the line, to defend, or to pick sides.

Emotional health makes shadowy lines disappear.  It takes someone who has emotional health to be able to say their 3 C’s and still consider the internal and external milieu of others.  It takes someone who has done their self-care and put money in the bank; someone who has reserve built up that spills over into empathy.  We can’t emote empathically so well when we aren’t emotionally healthy.  The less of that, the more real the line becomes.  The less of that, the more precarious we are.

Gaining emotional health may take medication, exercise, sunlight, granola, grandma’s kisses and all sorts of things.  Each of us has to figure it out for our own selves and just do it.

Questions:  What do you think about this business of shadows, lines, and living cautiously?  When you have been healthiest, how have you been able to embrace both the 3 C’s and emote empathically at the same time?  Please tell me your story.

Tell People When You Fall

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

Image by zpeckler via Flickr

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

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

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

Falling finds friends.

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

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

connection.

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

You might have heard the proverb asking,

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

Or,

Water, water everywhere and nothing to drink.

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

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

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

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