Disorders

by

The Good and Bad of Anxiety

In response to yesterday’s blog, a reader wrote,

I often feel my flight and fight response triggered even in situations (mostly social) that should not (theoretically) even be frightening. What do you think about that?

This is like the degrees of water temperature in our shower.  Pretty much every one falls somewhere on the spectrum of this type of anxiety.  When is it ok, and when does it become not ok?  My brother, friend, mentor, Cameron Johnson MD said in so many words

Anxiety is what makes us work hard.  If we didn’t have anxiety, we’d all be slobs.  We’d stink.  We wouldn’t get our homework done.  We wouldn’t say as many nice things.

My children still see most things in all-or-none fashion.  They would say at this point of the discussion, “Anxiety is good.”

A teenager I treat began responding to her medication.  Her mom began to complain.  “She never let this happen before!”  Her room was a mess.  She was less prompt to obey and she started voicing her opposing opinions more.  In some ways, without the anxiety, it was like her mom was getting to know her for the first time.  

This was however, better than anything this girl and her mom had hoped for.  Now the girl wasn’t throwing up, having panic attacks, avoiding just about any social experience.  She was making eye contact with me and she was able to present in class.  She told me that she can’t even think about how she felt before.  It was so bad.

It is really hard for any one who has never suffered from debilitating anxiety to realize the level of suffering and terror it causes.  Someone who may look stuck up, aloof, disinterested, quiet, bored, may in fact be at hells door.

My children might now say, “Anxiety is bad.”

And so to my reader quoted above, I’d say with my children, anxiety is good and anxiety is bad.  Come and paint the stars with me for a time.  Talk and tell me your story.  We shall in degrees of mind and manners, unwind the mysteries together.

Self Care Tip #49 – If anxiety is affecting you in a negative way, consider a medical reason.  Be a friend to yourself.

by

Look Around At The Other Reasons – Depression

Flagellants mortifying the flesh, at the time ...

Image via Wikipedia

“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?

by

Get to Know Yourself to Be A Friend to Yourself.

On the Threshold of Eternity

Image via Wikipedia

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?

by

Fear

I dropped my kids off today.  All of them.  We had been very happy about this.  After laboring towards patient parenting for 7 years, I was also looking forward to today.  I’d never had all three out of the house at once, and the strangle squeeze on my insides grabbed me by surprise.

We used to have this black cat when I was a kid who would hide in our plants.  In the middle of the night when I’d occasionally wake up and go to the kitchen to get a drink, she’d jump out at me with her claws.  While walking today between preschool, kindergarten, and 2nd grade, life jumped.  What left me breathless was how easy it was to get rid of my kids.  Appropriately by social standards.  School you know.  They’re doing what they need to do.  And just like that, if I wanted, they could be mostly gone.  I suddenly felt how it could happen to us, easy like that.  Like a body returning to dust.  My spirit, my soul, my essence yelled a loud “Wait!”

My reaction can be confused by some as a hidden desire.  Sure, I acknowledge the obvious need for parents, including yours truly, to get space from their kids. But that wasn’t the slap I felt.  It was fear.

I’ve treated many mothers, but one in particular comes to mind.  She voluntarily admitted herself to the hospital because she was afraid she would hurt her baby.  She wasn’t fantasizing about it.  She was having specific vivid imaginings that cut into her consciousness.  After enough of those, she lost confidence in herself and hid.  She confused these day-terrors with a fear that they were really some unconscious desire she didn’t understand.  Common for panic disorder.  It is the medical disease that historically gave us the phrase of “I feel like I’m going crazy!” With medication therapy she returned to a capable woman who trusted herself.

Have you ever noticed that in the Bible, whenever God or an angel is talking, they almost always start out by saying, “Fear not for I am with you,” or some version of that?  I didn’t, until my kids came home from Vacation Bible School 2 years ago, and the refrain for the week was “Fear Not!”  They still scream it at each other with glee.  I love that about God.

However when I hear that Bible verses or prayer or God should make us overcome fear, I am more than bored.  I’m angry.  Fear comes for many reasons.  It isn’t a spiritual thermostat.

Today I did several things to deal with my fear.  I cried.  I prayed.  I went to work.  I felt better.  However, my patient did not feel better after doing those things.  What should God have done for her fear?  I knew that she came to my hospital.  I knew that what she felt were symptoms of a medical illness affecting her human brain.  I knew that medications could play a part in helping her.  Maybe that came from God.

Question: What do you think? Agree? Disagree?

Self Care Tip #31 – Fear not!  Be a friend to yourself.