depression

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Don’t Waste Your Time. Do Your Thing.

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Self-Care Tip #101 – Don’t waste your time if you don’t have to on things you aren’t good at.

Ben is almost 16 years old.  His parents are happy because he’s not as depressed, more interactive and more interested in connecting with others.  They came with him to see me.  Ben gets easily overwhelmed trying to tell me about himself and his parents often interject to help him out.

Ben’s parents are parents to admire.  Patient and clear-sighted regarding values and presence.  I’ve caught my breath more than once in the company of their comfortable regard and affection for their disabled children.  (Ben’s sister also suffers from mental retardation.)

During clinic, Ben struggled to tell me he was bothered and stressed by the school staff pressing him to learn things he didn’t care about.  He lost his words over the bits about how it related to his self-esteem and looked at him mom.

Mom told me Ben doesn’t care about some of the topics he’s taught and he gets sad and anxious when he thinks about it.  He’s embarrassed by it because he doesn’t finish as quickly as others and misses some of his lunch time.

I’m not a high school educator but I still told Mom and Dad that they can feel more confident advocating for Ben’s interests and needs with his teachers.  Ben will excel more in areas he is interested in.  He will find more pleasure in them.  He will be more empowered emotionally.  He will  be more ready for his adulthood needs.

The pressure many of us grew up with to be good at everything, is bogus.  We shouldn’t.  What we should do, is be good at what we are talented at.  We should be good at what we are interested in.  In fact, be shameless about it.  I spoke about this in the post “Do What You Were Designed to Do,” amongst others if you want to read more.

Ben with his parents looked at me with something of relief.  They had “permission” to do what they wanted.  The rest is mostly a waste of time.

Question:  What has opened you up to doing what you want to do in life?  What has that done for you?  Please tell me your story.

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Self-Care is not unChristian

 

Don’t be afraid of self-care.

Self-care is Christian and scientific.  I have awareness of the culture that frowns on taking bad behavior out of the church and into the laboratory.

A few days ago we talked about self-care not being selfish.  That circuitously brought up the question about how “the church” feels about this blog.

Confusing “the church” with Christianity can be problematic.  I have confused them in the past.

When my brother started talking evolution, I felt cold and clammy suddenly.  After my mini-panic attack, he told me about reading the entire works of Darwin and I had another mini-panic attack.  “There’s no way evolution didn’t happen.  There’s just too much evidence supporting it.”  I was confused.

It took me a long time to realize that I didn’t have to be worried about differences between me, science and God.  Funny that my comfort level grew with this as I realized how little I knew.  In fact, my joy expanded, when I realized I would spend all eternity growing my knowledge.  That is a lot of everything that just won’t fit into any box I can think of.

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Now when something crashes through a pet-paradigm, I remember that it’s ok.  (Down fear!  Get down anxiety!  Heal dogs!)  I may see a different reality.  Parts of me may become changed by that knowledge, trauma, death of a dear one.  Becoming changed and different is ok.  Because God is the same.  God already knows whatever about evolution, or that the world is round.  He knows that we try to turn medical symptoms into something spiritual, like depressed mood.  He knows it and He’s still here.  He is the prototype of presence.  Now that people can look into the brain and say where feelings and behaviors come from, we can get past that and on to the next revelation.  So what if it is medicalized.  Science and spirituality are not exclusive of each other.

So is self-care Christian or scientific?  Things aren’t that binary.  Self-care is both.

Self-Care Tip #84 – Don’t be afraid of self-care.  Be a friend to yourself.

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Get Gangster on Your Shame

 

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Shame.  Ah what a cloaked villain!  In this post I’m going to tell you about why shame is not an enemy you want to ignore.

“Michael Corleone” in The Godfather Part II was not the 1st to say it, but maybe was the first to make the quote famous

Keep your friends close and your enemies closer.

Not many people would at first think that keeping shame close might be a good thing, but I’m here to tell you that it is.

Meet Bill the highway patrol.  He’s been seeing me for melancholic depression.  Sometimes he feels a little better, but those times even still are not so great.  Bill has told me about where he thought his anxiety and fear came from.  His story made sense to him.  This wouldn’t be too much of a problem except that he thought about it often.  Very often.  He was running in sprints away from it.  Somehow after all the time he’d spent reluctantly in the presence of his fears, he hadn’t realized that shame was connected.  Shame of being treated the way he had been.  Shame of being misused.  He hadn’t faced his fears because he was always angled away from his thoughts of shame.

If we don’t go where the shame is, we won’t be free from its effect on us.  Fear is a big bad bully.  Until you turn around and say stop, you’ll be running for a long time.

 

 

We all need to be a bit “gangsta” at times.  Ignoring shame is not.  It’s not emotion-street smart.  I’m waiting for Bill to think, “What’s the worst thing that could happen?”  And sit in the feelings that come with those thoughts long enough to realize that he’s still ok.

In obsessive compulsive disorder, there is a psychotherapy treatment called “exposure and response prevention.”  In this treatment, the person with the ego-dystonic fear exposes themselves to their fear for a progressive amount of time.  They realize that after going where the fear is over and over and materially seeing that nothing bad happens, the fear looses more and more control over them.

This is effective in any anxiety condition, including shame.

Self-Care Tip #83 – Get gangster on your shame.  Be a friend to yourself.

Question:  Has shame bullied you?  Please tell me your story.

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Between Me and Thee, Don’t Believe it

He felt blamed by his daughter.  It is one thing to perceive it.  Believing what we perceive might be separate.

There is a disease process named obsessive compulsive disorder.  In this illness, we perceive things that at some level we understand are not likely nor true. These fears are called “egodystonic,” when we can tell that our fears don’t make sense.  For example, it may preoccupy my thoughts that I fear I just ran over a pedestrian with my car, even though at some level I know I didn’t.  Not driving back and forth on the street to look for the victim where I fear the accident happened for hours is therefore terrifying to my core.  If asked outright if any of it made any sense, I’d say no.  We all have features of this disorder but don’t necessary to the full extent.  And that is where we got terms like “Step on a crack, break your mother’s back.”

It goes to reason that fears consistent with our inner selves are “egosyntonic.”  In its diseased states, we see this in disconnected thought form disorders such as schizophrenia.  The healthier examples are much easier for most of us to understand and relate to.  I fear if I speed, I will get a ticket.  Healthy and connected fear.

Now what was going on with the man I mentioned above?  Did his daughter ever say she blamed him?  Was he trusting his feelings?  His Jedi-intuition?  Was this egodystonic or egosyntonic?

Egodystonic fears in a much milder form include simple personalizations.  Making something about us that isn’t.  Your girlfriend makes jokes about you being irresponsible.  A friend doesn’t return your calls.  Your daughter is moving away.  You can see the potential fears building up.  Will we believe them?

Believing our perceptions depends on different paradigms.  There are our biological illnesses that predispose our perceptions (major depressive disorder, obsessive compulsive disorder, generalized anxiety disorder, etc…).  We have our temperaments to answer to.  Some of us are wired to be more suspicious v. trusting.  There are adjustment issues, related to stressors around us.  We have our own coping skills.  And how about poor self-care such as poor sleep hygiene and little exercise?  All of that will play on what we are going to do with our perceptions.

Truth is, generally very little of what we hear has anything to do with us.  Now there is the other extreme of course.  A personality disorder who has little insight into the way they are influencing the world around them and take little responsibility.  But that is the exception.  More often, we walk around licking wounds that came from a series of misperceptions and personalizations.  It takes up a lot of time and is a disconnecting force between me and thee and thee and thee.

Self Care Tip #72 – The best way to keep the space between us open, honest, healthy, connected – is take care of our own selves.  Be a friend to yourself.

Question:  What has happened in the space between you and the ones you love?  Please tell me your story.

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Down With Guilt!

Down with guilt, I say!  Let that mighty tree be felled and burnt and each season that brings up new creepers into life again – let them be taken down!  Guilt!  How many times it has weakened us.  A sickness, that ebbs the energy and confuses the mind.  Often unrelated to deed or intent, in comes the uninvited guest.  As in Mansfield Park, guilt is our own Henry Crawford courting Fanny Price.  He may dress well – in church attire, in a business suit, or in a child who thinks she should spend more time with grandma.

Like lucifer’s apple, guilt brings knowledge that can’t be trusted.  Swallow it and you’ll be looking for fig leaves.  See if any good will come of guilt.  I dare you.  See when you plant it, what will grow.  See when you hide it, how you are tethered.  Let it educate you and notice that you grow smaller.

Today a friend asked me how things were.  I remembered yesterdays.  Wonderful with sunny emotions.  A collection of connected moments.  I wanted to say something about them.  I was looking in at a shop window.  Chocolates on the shelves behind the glass.  But remembering today, I was denied.

I yelled from my darkened face.  And then I yelled again.  That was the morning.  Then the kids went to school and I went to work.  What a way to walk.  I thought of this and out popped:

I yelled at the kids which I hated, but I don’t hate myself.

It even surprised me.  Saying that to my friend, let me realize that today wasn’t an all-or-none parenting moment.  Many earlier days that began much the same weren’t so forgiving.  And because I didn’t forgive myself so easy, I didn’t forgive others so easy.  The anger chases it’s ratty tail, you know until Guilt tires him out.

Because I didn’t spend the day guilty, the afternoon and evening had a chance.  Down with guilt!  Up with new chances!  Hooray!

Self Care Tip #68 – Take the new chance!  Be a friend to yourself.

Question:  How have new chances redeemed you?  Please tell me your story.

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A Little Bit is Not Enough – Claim Full Health

The good news is, I just ate 3 chocolate chip cookies.  You already know the bad news.  Has nothing to do with my post.  I’m just sharing it for the sake of your own

Schadenfreude 🙂

…Onward.  Question:

Does emotional disease get worse even while on medication therapy?  Sometimes.  It does so more often when the disease process is treated but only partially treated.  Read a little more about this in this post if your interested.  A primary care physician recently told me, “I think the term ‘Partial Responder’ is a marketing gimmick to get physicians to prescribe more medications.  I don’t think it even exists.”

There’s a lot to be said about interview skills in sussing out the partial responder.  If I asked someone if they felt better, many things play into their response. Everyone’s responses are biased of course.  We don’t have sterile minds.  For example there’s the patient who wants to please their physician.  “Yes I’m better!”  i.e. “Yes you’re a good doctor!”  There are the patients who don’t want to be patients and minimize whatever they’re going through.  There is the physician who leads the interview.  “So, you’re feeling better?”  “The medication is helping?”

Partial response means that at the end of a full treatment initiation period, there is some disease remaining but a reduction of disease.  For example, in depression, I may no longer be suicidal, but I still have trouble feeling pleasure in life.  In cancer it means that there is tumor reduction of at least 30%.

Now why would a physician presumably agree that there is a partial response in cancer, but not agree that it happens in mental health?  Anyways….  (Ahem.)  When we partly respond to mental health treatment and don’t push further for full response, about 70% will relapse.  Versus maybe 25% in those who reached their pre-disease baseline emotional health through treatment.

Don’t get lost in this.  The point is, get treated and get fully treated.  Mental illness is progressive and causes changes at the cell level.  The brain is connected to the rest of our body.  The brain is human.  A bit better, is not enough.

Self Care Tip #61 – Go all the way!  Claim health.  Be a friend to yourself.

Question:  Did you find this to be true in yourself or someone you know?  Please tell me your story.

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If You Are Ill

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A reader commented on yesterday’s post, “Afraid of Meds,”

My fear, I think, would be not so much the dependence—but what would happen if I did need that medicine and it suddenly became unavailable, like I couldn’t get my prescription because of a natural disaster or something like that.  …Would going off of those meds cold turkey put me at a real disadvantage?

In my late 20’s I had similar fears, only for me it was related to my eye-glasses.  Because I didn’t tolerate contact lenses, I especially had vivid fears of getting into the driver’s seat of my car without my eye-glasses anywhere to be found.  Living on loans at the time, I took out extra money and got LASIK eye surgery.  Oh the joy when I woke up one morning and could see clearly, high-definition, no glasses to grope around for, freedom!

Unfortunately in neuropsychiatry, we don’t have the privilege yet of offering many curative options like LASIK surgery for emotional illnesses.  I don’t believe it’s too far off in the future.  It wouldn’t be wild to say our children may have those options some day.  For example, embryonic stem cells may offer a cure for disorders such as depression and schizophrenia.  However, until a cure becomes as available as Prozac or even LASIK eye surgery, the reader quoted above has a reasonable fear.  Medication becoming unavailable is a disadvantage.

Now I’m not great at twisting reasoning powers, so I’ll say this as best I can.  That’s like not getting eye-glasses because we are afraid of loosing them.

So to this reader quoted above and to you I ask,

Question:  What do you think?  Treatment or no treatment?  Please tell me your story.

Self Care Tip #53 – If you are ill, get as better as you can.  Be a friend to yourself.

Related Articles From FriendtoYourself.com

  • Mental Illness Relapses When Medications Are Stopped http://bit.ly/pA4kxo
  • Number One Reason For Relapse In Mental Illness  http://bit.ly/rt1qJf
  • Are Your Meds Safe?  http://bit.ly/lh1cBh
  • Say Yes to Medication And No To Drugs  http://bit.ly/oX12i0
  • Fears of Addiction To Medications for Brain Illness http://bit.ly/oWY8i4
  • Other Fears of Medication For Brain Illness  http://bit.ly/qdHksR
  • Afraid of Meds  http://bit.ly/rjt7wY
  • Full Treatment Response Means a Better Future  http://bit.ly/ph84ZU
  • When It Is Time To Take Medication   http://bit.ly/nbIYLT
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Scare Yourself If You Must, With Caution

A patient came in depressed and anxious.  After our initial interview he disclosed that he and his girlfriend were playing around with sadomasochism and it was scaring him.  We discussed that to help him get healthy, he would need to do healthy things for himself.  Anything directly harmful or potentially life-threatening doesn’t fit in to that.  We agreed not to formally engage in therapy until he had thought this through and what he was going to do with his sex-practices.  He came back wanting treatment, and spoke like this whole S&M thing was old history.  “Oh that!  I talked it over with my girlfriend and she understands.”  Ok.

Why do we scare ourselves on purpose?  Like watching horror movies, or even movies that are more mainstream but have suicide scenes, abuse, car accidents or other freaky things.  Some are thrill-seekers through extreme sports like sky diving.  Others cut themselves or do other forms of self-injury.  This may seem like an odd bundle but they all share volitional fear experiences.  Even as do team sports like tag or football when getting happy from being chased like a rabbit from a fox.

When we scare ourselves on purpose, our bodies release a number of wonderfully feeling chemical messengers.  There is adrenaline, dopamine, cortisol and more that give us a rush, a lift.  It is positive feedback.  (Dopamine is the main pleasure molecule that all addictive drugs target as does food or even a back scratch.)

Psychoanalytically one might say, like Boston College professor Peter Gray, PhD

…our greatest real fear becomes, in play, our greatest joy.

When this goes wrong is when we hurt ourselves in the process.  “Look out!” is what I say.
Other examples that are more common are film, television and video games.  We now have data that supports evidence of primary emotional illness induced and driven by watching violence – such as post traumatic stress disorder.  Post traumatic stress disorder is a bummer.  It is the only primary emotional illness that has no clear genetic origin but comes after a life threatening event either experienced by yourself or observed by you.  Just don’t get it on purpose for crying out loud!

When I am hankering for a good thriller movie, I try to use this understanding to steer me.  I try to remember that I am extremely valuable.  Along with the obvious but not so obvious good advice,

…whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.

Self Care Tip #48 – Scare yourself if you must, with caution.  Be a friend to yourself.

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Look Around At The Other Reasons – Depression

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“I’ve done some bad things.”  Patient tells me she can’t sleep well, is nauseated, depressed mood, worried with perseverating thoughts about acts that shame her and ramifications, doesn’t feel as much pleasure in life, isolating, tearful and more.  I was alarmed!  What could she have done that deserved this kind of self-flagellation?  When she told me, I didn’t realize it.

I was still waiting for the rest of the story.  I got caught up in her own self-judgment and found myself sitting beside her “in court.”  Once I realized what I was doing, I was chagrined.  Here I was collaborating with her in her inappropriate guilt.  It took me too long to register that her reaction was not proportionate to the offense.  I told her I was sorry she was going through all this emotion.  She said, “It’s my own fault.”  Is it though?  We needed to start looking at additional reasons that might be influencing the way she felt.

Start looking at other paradigms when the emotional response is out of proportion to the event(s).

An analytical approach would look at unconscious reasons, such as other personal choices that conflict with a core beliefs.  Or perhaps, something like unresolved anger coming out in physical and emotional symptoms. Ask about our “closets,” peel away pretense and let your flawed self into the air.  Keep it real.

Another paradigm is medical.  Inappropriate guilt is a symptom of Major Depressive Disorder, a debilitating disease process of the brain that affects the whole person/body systems.  When distorting things out of proportion, personalizing too much, we must ask if there is a depression going on.  Ask yourself.  Ask others.  But don’t let it continue if at all possible.  Major Depressive Disorder is a progressive disease that does more damage to the brain the longer it goes untreated.  In other words, the brain is affected more over time, it is harder to treat and it is more dangerous to the person.  The average length of an episode is 2 years and the more times it returns, the more chance to have the disease process continue for life.  Treating sooner and for longer, decreases the chance of relapse.

Excellent for us are the many treatment options for this potentially devastating disease.  Even in the “lifer,” when staying on medications, the relapses are much easier to get through and shorter in duration.  The medication has a protective effect on the brain.  Prophylactic against further insult.

In the woman I told you about, there was another emotional spectrum disorder, anxiety.  Anxiety and depression are like brother and sister.  They often go together.  But for today, we’ll leave it on the symptom of inappropriate guilt and let it rest on the reminder that the brain is human, mortal, attached to our neck and not an aura.  When the brain gets sick, it shows how it is doing the only ways it can, often through emotions.

Self Care Tip #46 – Look at all the reasons influencing the way we feel.  Be a friend to yourself.

Question:  What do you think?  Agree or disagree?  What is your story?

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Get to Know Yourself to Be A Friend to Yourself.

On the Threshold of Eternity

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Let us put our efforts toward becoming who we can become, who we were wired to be, who we want to be, what gives us pleasure.

We can get beaten up by wanting.  Wanting to be someone who gets energy from being with people rather than from being alone.  Wanting to be someone who is a finisher rather than grazer.  Wanting to blend and lead and be chosen.

Some of this filters out as we age.  Aging fills our lives up with so many responsibilities that wanting to be anything more than someone who gets solid sleep hasn’t crossed our minds in a very long time.  Children get more of it right than us in this regard.  They have space to want more openly.  Our wanting muffles and cramps when we turn away from who we were genetically designed to be.

My patient came in depressed again.  Depression was familiar for him.  A psychiatrist works with a specific area of medicine.  So I get to see people after multiple medication trials before their primary physician refers them to me.  Well this patient hadn’t found lasting help from medications. He came to me with doubt.  I wish I could say we worked it out.  I can say that we are still trying.

What we are working on influences the way his genes express themselves.  We can’t change the genes but we can affect some of how and when they are activated.   We can do this by choices, such as medication therapy, sleep hygiene and exercise.  Choices are more effective when we know what and who we were wired to be.  What are our natural talents?  What are we interested in?  Feeling inner congruence when we are doing something points the way for this.

In Outliers, author Malcolm Gladwell says

“the biggest misconception about success is that we do it solely on our smarts, ambition, hustle and hard work.”

I don’t know if Mr. Gladwell recognized how closely his thoughts harmonized with Carl Jung‘s regarding temperaments.  Doing what is natural for us recruits our best through the path of least resistance – our interest, our attention, our creativity.  Rather than forced effort, drudgery and dragging feet, time looses some heaviness as we get caught up in inner and outer congruence.

Intuitively, we all surmise that when this happens, we have less stress inside and outside of us.  Ah.  What a relief.  This is what my patient is working on and when he is able to say he is doing what he wants to in life, he is less hopeless and panicked.

Self Care Tip #40 – Get to know yourself to be a friend to yourself.

Question:  What do you think?  Have you been using these tools?  Have they made a difference for you?

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Choose Your Prophesy

A woman today with a frank quick smile found out I wrote FriendtoYourself.com.  She swung open the door to her story.  People like her never bore me.  In brief, she was sad after many life losses.  Then when she made some changes in her life she got better.  “I didn’t know how bad I felt!”  (And who does?)  Now every day has activity she loves.  She gets tearful just telling me about all the gratitude that took her by surprise.

In psychiatry, the way she felt when she was sad is called an Adjustment Reaction.  An Adjustment Reaction doesn’t last long, it is in response to stress, and it goes away when the stressor is removed.

Stress is dangerous to us.  It can affect us for different amounts of time, like measuring cups.  During that time, it can affect us to different depths within ourselves, like a scuba diver exploring a coral reef.  If the sad time in this woman’s life went longer, and if she had gotten more sick, it might have become a Major Depressive Episode.  In that case, medication therapy would be appropriate.

Stress affects different intersecting paradigms that make us into who we are, like storm water over farmland.  It crosses over our biology, our genes, what is done to us in life, what we do to ourselves, what is put in our bodies, and how we cope.

Stress can pass over us like a Jewish holiday or it can stay, working, changing, reshaping, adding and taking away bits, always active and busy.  Ants in the walls of our house.  Most often we don’t know what it is doing, for how long, or where it is at work in us.  Stress mutates our cells, turns sleeping genes into loud cancer, depression, anxiety, heart attacks, dementia, old and wasted faces.

But what to do?  Do we avoid stress?  Do we end it?  Do we cure it?  All of that, of course.  My dad told me, “Everyone has problems.  The difference between you and somebody else, is what you do with your problems.”  Not the number of them.

No.  This woman’s story didn’t bore me at all.  The opposite does.

In the film directed by Adam Shankman, “Bedtime Stories,” the character played by Adam Sandler thinks choices have little effect on inevitable negative outcomes. “Life has no happy endings.”  He lives consistent with that belief, until love finds him.  A happy life story can be chosen.  His fantasies are freed to cross the boundary from imagination into the material world where love was waiting, in the shape of family and strangers.  Love showed him that his life had been a self-fulfilling prophecy.  He hadn’t even realized how unhappy he was.  (And who does?)

Self Care Tip #38 – Choose to go towards your fantasies.  Be a friend to yourself.

Question:  What do you think?  What is your story?

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Let It Go and Keep Going

Like gripping a blade the reflex may be to grip harder.  When to let things go when it feels like we can’t…  How do we, if it is still active in our lives?.  Something negative but still going on with no end in sight?

A woman comes to me anxious and depressed.  She looks older than her age.  She cries a lot talking about what she is ashamed of.  Staying with her emotionally abusive husband. Probably having sex with him though she didn’t want it.  Unable to leave because she didn’t have money, job, or family support.

This woman I mentioned, she is courageous.  She has tried for years to find herself again and still tries again and tries another time, times times.  She talks to her kids about it and they say she should never have married him.  She talks to her friends and they sigh and heap insults against him.  She talks to God.

She comes to me.  Why she comes when she does?  She found the courage to ask for help one more time, times times.  She takes medications.  We spend 6 months together before she starts responding to the combination therapy and each day she had the courage to wait another day times another.  Her face looks younger, slowly, like looking through an album backwards over the next weeks.  She starts talking about doing more than making it through the day.  More fits into her hopes than survival.  Like Mary Poppins‘ travel bag, she keeps pulling more out of her life than she ever thought it had space to hold.

One day about 1 1/2 years later, she came to me with a secret smile, holding her purse like a stolen cupcake.  The door closed to our room and she pulled out her dog.  She said, “I’d like you to meet my best friend in the whole world.  I just love him so much!”  She is a woman who found courage to love and be loved.

I am in awe and humbly wonder after her.

Remember again the addict who so often leads us in this example.

God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.

Serenity Prayer

We surrender when we can, when we think of it, when awareness dawns, the things we cannot control.  It might take a higher thought to “let go” of what we cannot control.  When we are able to do this, we are larger in a sense than the moment.  The recurring yucky events are seen more objectively and less personally.  We are more knowing.

It takes us back around to how we define ourself.  Our spirit.  Our essence.  This woman, she found it.  She found she was more than her circumstance.

“How do we surrender what we cannot control?” you ask.  Ask yourself.  I have my answer.  I hold my answer in my mind’s eye, like a Swiss bank account.  My most precious treasure in the care of The One,

…where neither moth nor rust does corrupt, and where thieves do not break through nor steal.

This woman, she is courageous.  She journeys without being defined by the events.

Self Care Tip #36 – If you can’t control it, let it go and keep going.  Be a friend to yourself.

Question:  What do you think?  Please tell me your story.