emotion

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Emotions: The Physical Gift We Can Name

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Self-Care Tip #148 – Identify your emotions, navigate, and get help.

Mad.  And when Mia was angry she wanted to go eat.  Nervous.  When she was nervous she wanted to go eat.  Like a wire with a current, she couldn’t stop her thoughts from moving and moving.  Although eating soothed her in less than a shard of a second, it was also followed by self-loathing.  Self-loathing brought on more eating and then purging.

Sitting in my office, Mia said it was like she was looking at herself from the outside in and the self on the inside could hear the, “Stop!”  Demands, petitions, and begging to stop came from the other Mia, who was loosing her command-authority in a scary-fast way.

How often we hurt ourselves but blame a trigger, an emotion, a person, or an act of malice.  If only we could say, “Put the offense down and take two steps back.”  But sometimes we can’t.  It’s easy to piously say, with habits and cassocks or soutane (French for traditional priest’s attire) in place, “Don’t make decisions based on emotions.”  It’s easy to say, “Be objective, we can’t trust our emotions.”  But if emotions are what we use to interpret the world around us with, if that’s all we have, what can we do?

Emotions are ideally the color, texture, perfume, music and salt in our physical self.  Emotions are our spiritual sensory system.  Not being able to trust them is a big loss.  Being blind, deaf, anosmic (can’t smell,) unable to taste, and numb would make it really hard to interpret the world around us too.

Paul Brand, MD, coauthored with P. Yancy, “Pain:  The Gift Nobody Wants.”  This book uniquely tells Dr. Brand’s story of working with lepers in India.  Leprosy is a disease that causes a person’s nerves to stop working so they lose their sense of touch and subsequently can’t feel when they hurt themselves.  A once harmless thing like bumping a finger for example, is extremely dangerous.  Lepers can’t feel the pain, and so don’t accommodate for it and protect themselves. You can imagine that bumping a finger but not reacting to it leads to tissue damage when it is done over and over, until one day the finger falls off.

Dr. Brand is right.  Pain is a gift.  And so are emotions.  Including emotional pain, if serving as intended, to protect the individual and not self-destructive things such as bingeing and purging.  The purpose of this post is not to get into what binging and purging is.  That’s just an example of behaviors that might grow out of emotions gone amuck.  Emotions that we used to trust.  That use to tell us who is a friend and who is an enemy.  Emotions that used to know who’s side they were on.  Emotions that forget their own like that can be just as extremely dangerous as leprosy is to our tender fragile fingers.

The purpose of this post is to flatten the mountains of understanding between here and there.  Between understanding that emotions are as physically important as anything else, such as the spinal cord.  The purpose of this post is to furthermore say what to do about it once we can 1) identify the problem and 2) get past the stigma.  Mia did the eating and purging stuff, but she also asked for help.  3) Ask for help.

Lepers have still so few options to help their disease.  Us with emotional illness are very blessed because we do.  We have medications, psychotherapy, coping skills, miracles, and more.  We have a lot.

Question:  How do you define the space between emotions and other “real” medical illnesses such as diabetes?  How do you navigate around stigma?  How do you ask for help?  Please tell me your story.

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There is Less Space Between Emotions And Science Than We Think

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Self-Care Tip #147 – Bridge the gap between emotions and science.  Be a friend to yourself.

She had been through a lot – Aimee.  Lost her baby brother to medical disease.  Was in a stressful marriage and didn’t like her work.  There was more but you get the drift.  She found herself thinking that things would be different if things had been different.

Would they?

Readers, I am referring specifically to her medical condition.  Not to the fact that the universe is different because her brother died.

Madeleine L’Engle talked about death affecting the whole universe.  She compared it to the death of a star.  In death, the star creates a hole in space dark and large, enough so that the absence of it has its own gravitational force, a “black hole.”  L’Engle says that when any part of creation dies, we are all touched.  Life knows and the absence of that bit of creation leaves the surviving universe changed forever.

Aimee wasn’t talking about that.  Aimee thought her emotional illness was largely secondary to her life stressors.  Because this influenced Aimee’s choices regarding her medical treatment, I had to tell her no.  Gently.  It was hard for her to hear.  “Aimee, your sadness you feel now, four years after your brother’s death, your isolation and amotivation, your low sex drive, your difficulty feeling pleasure in other things, your sleepiness during the day – these things are not because you have suffered your brother’s death, nor because your marriage is hard.”

There are times when directly saying things is the more gentle approach.  No one going through what Aimee is going through wants to hear about how I feel about it.  Yuck.  There’s not much that is slimier than going to someone for objective feedback and getting their emotions and personal opinions all over you.

Aimee left saying she understood and with a new medical treatment for the medical illness propagating emotional and behavioral symptoms in her.  We’ll see if she did some days from now.  But what about you?  Do you believe that her emotions and behaviors were secondary to medical illness?

Readers, life stress will continue to happen.  What may change is how we respond to it.  If our response does change and it isn’t serving us or others well we need to think that we might not be interpreting how we feel objectively.  We might be having changes to our biology that “taste like chicken.”  It helps to get a physician’s opinion – someone who sees behavior as more than the spirit, the abstract, the puppet of our volition.

Question:  How do you bridge the seemingly abysmal distance between emotions and science?  Please tell me your story.

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Grieve to Be Present With Yourself

 

Maria Yakunchikova "Fear" 1893-95

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We grieve when we get sick.  And we grieve again when after getting well, we get sick again.  Then the grieving can be even more terrible because you know what’s coming.  In Pearla’s case, she didn’t know she was grieving but she knew she was sad and terrified at the same time.

I asked her if she thought that staying in bed, loosing interest, isolating, crying jags out of the blue might be related her grief about getting sick again.  She said no at first and then said, “I’m disappointed.  I thought this was over for me.”  All over, she couldn’t trust herself.

Pearla was afraid. And that fear was always there.  Now she couldn’t put it out of her mind.  “What if I have another panic attack?  I can’t take it!”  “What if,” was always on her mind.

Readers, a panic attack is more terrifying than just about any immediate experience.  If you’ve never had one, it is almost impossible to imagine the depth of terror it causes.  It is so horrible, that people even change professions because of it.  I remember a surgeon who actually went back to residency and studied a new specialty because he linked his panic to his profession.  That’s another 4 years of grueling work, readers.  That’s the kind of fear panic produces.

Pearla was not only in the throes of this fear, she was also in the throes of grief.  This is a deep sadness any of us who have lost a beloved hope can relate to.  Pearla didn’t know that was why she didn’t want to get out of bed.  All she knew is over the last 2 weeks she was loosing herself and in exchange, getting something she desperately did not want.

Somehow though, after hearing about her sadness from her own mouth, Pearla agreed.  She saw the grief and after seeing grief, she could be more present with it.  It was almost like her face materially came out from hiding.  Grief lost some hold on her.  She was a little less sad and a little less afraid.

Self-Care Tip #111 – Let yourself grieve.  Be a friend to yourself.

Question:  How do you grieve?  Was it worth it to you?  Please tell me your story.

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Forget About Divisions In Knowledge.

The World Is Flat

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Self-Care Tip #103 – Forget about divisions in knowledge.  Be a friend to yourself.

Knowledge does not separate into parts of religion, diet, stars, or geometry.  It is one thing, although we may not see its entirety.  Like the blind men with the elephant, we might be standing by the foot or the trunk.  But it is one thing.  Spiritual truth, nature, physics, medicine, music, art, it’s the same story told in pieces and in different ways.

Working in psychiatry, I’ve struggled with this because it so often affects my freedom in practice.  It so often affects people’s choices for treatment, people’s choices for lifestyle and their own empowerment with self-care.  It affects the choices people make in medication therapy and in physicians.

Merging the tables of learning affects our quality of life either way.  If we are able to do this, we have less conflict, fewer chairs to walk around.  If we can’t, we find ourselves constantly checking the seating charts.  It’s terrible throwing a party where people don’t know what connects them.  There’s the same discomfort inside of us when our life paradigms are afraid of each other.

Take Crystal.  She is a Latina Catholic.  Or make her protestant Filipina, or say White Texan.  Crystal grew up thinking that what was said by her tias (aunts,) or her pastor, or performed by her grit and spine, lay like bookmarks between human behavior issues and the rest of her life.  Behaviors may have something to do with the church, or emotions with the girls room, or nothing to do with anything in her mind.  Thinking behaviors and emotions might relate to what gave her black hair color, and to why water separates from oil is just bizarre to her.

When, Thomas Friedman wrote The World Is Flat: A Brief History of the Twenty-First Century, he was talking about a leveling of the playing field of commerce.  To take it further, I hear him talking about a flattening of prejudices, knowledge, access to information and hierarchies.  The world is too flat to separate the brain from the rest of the body.  When the world is flat, working as a psychiatrist means enlisting all of science, religion, social issues, hobbies, food preferences, and all the other things that make someone’s life worth living for their treatment.  When the world is flat, a patient trying to get help for their emotional-behavioral illness doesn’t separate it from anything else in their journey.

It turns out that we have a lot of information on where emotions and behaviors come from.  We should use it, don’t you think?

Of course, we don’t have it all.  Not close.  We don’t know how the soul factors in.  We don’t know what miracles are.  We don’t know God face to face.  But we do know that it is the same table of knowledge.  It is the same elephant in the room.  It all comes from the same Love.

Walk around.  Feel around.  Let your quality of life get better.  Don’t cut yourself off from another part of you if you don’t have to.

Question:  How are you keeping your personal journey one that is connected?  Or not?  Please tell me your story.

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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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Are You a Victim or What?!

 

 

Number Two of Bella’s List – victim or what!?:

Last night I took my 5 year-old daughter on a sleep-over date at a hotel.  Generous I thought …and boy was it!  To me!!  I couldn’t believe how much fun I had.  I quickly realized why I had done this.

A bit of me still wants to float away on wings of the modern-martyred-Mom, and I can, because it did take a lot of time and money and energy and….  But it’s not too friendly to me.  As attractive as that flight may seem, I’ll lose air at some point and take a big fall.  Ouch.  I might fall on my kid too which is against my intuitive effort here.

Being a victim is attractive at some level, no?  My story is a softer example, but we all have tougher ones.  Like Bella’s when “she spoke of her injury.”  The gravity of her injury was created by her perception of things.  Our perception makes our emotional success.  My story about last night with my daughter sounds pretty because that’s how I perceived it.  However, I have other stories that have negative power over me as Bella’s had on her and as yours have on you.

The key here is that when we take the victim role, we aren’t just telling our story or venting.  We are feeling self-pity. But venting is not necessarily self-victimization.  Venting can be healthy.  Venting can be done without taking a victim air-bus to no-where good.  Venting can be a way of being present in your suffering, of going where the pain is and letting it lose power over you.  Self-pity only gives the suffering more power.

The great novelist and philosopher, David Foster Wallace, who courageously lived and died with major depressive disorder, encouraged,

To be just a little less arrogant. To have just a little critical awareness about myself and my certainties.

The willingness to learn or grow is the foot-path away from victim-ville.  Could we even say that being a victim is “arrogant?”  We – Me, my patient Bella, you – have we taken steps to tell our story, to be present, to live with the humility it takes to look at ourselves and not escape/fly-away?

Whatever it is you are going through, it might help to vent it!  Grow and learn and get bigger than that experience.

Self-Care Tip #94 – Get in your own space to choose freedom from self-pity.  Be a friend to Yourself.

Question:  What barriers have you felt to telling your story?  What has made it difficult to be in the space of your own feelings?  Please tell us.

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Escape Self-Loathing

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Self-Care Tip #91 – Put the fight down and take 2 steps back.  Be a friend to yourself.

He came in looking really good.  Chris had seen me for many years and he hasn’t always looked this way.  I said

You look great!

Chris shrugged and told me he had just had a long messy argument with his partner and somehow still felt alright.  In the past, after they fought and the self-loathing set in, he might have hurt himself – like using alcohol or cutting on himself to

…just feel something different.

I was ready to move past the story as he sounded like he was ok with it.  We talked past each other.  Me asking about his sleep, and Chris telling me clips and phrases from the argument.

But amazingly I’m fine!  If he wanted me out today, I’d be out of there, no problem.  He just needs to say the word!

Chris was sitting back in his chair, relaxed until then.  His hands came up and took control of his space, thrusting as he spoke.

Being a psychiatrist, my expertise kicked in and I realized I should turn back.  Chris wasn’t ready to talk about sleep.  You see what all those years of school can do.  Not everyone knows how to pick up on such subtleties.

Chris, maybe you aren’t so happy you argued.

We talked more about his energy, appetite and motivation.  Then we came back to his argument.

It’s none of his f—— business where I am during the day!  I’m not his child.  I’m his partner!  I told him…!

And so on.  Chris still looked better than when he was in the grip of post-traumatic stress disorder symptoms, or when he was catatonic.  But he didn’t sit comfortably with himself.  And I thought, Chris has fought so hard for himself, why can’t he handle what I want to say?  And I did.  And he did.  Beautifully.  He was a brave knight on a black steed holding his wounded sides.  Life had been a battle for him, but he was making choices to fight less and live more.

“Ok.  Yes.  You’re right.  I will next time.  That makes sense.”

When you’re about to engage in something that in the end will make you loath yourself, choose not to.  That’s friendly to you and your other.  Say something like,

When I was gone you felt jealous?

Give over stage and anger and open windows and breath.  Just choose not to hurt yourself.  Winning or losing the argument, in the end, you hurt by your own choice.

Biologically and probably spiritually Chris wouldn’t have known what to do with that years ago.  But he did now.  I saw him relax again and put his hands away.  I knew Chris had a love for Love and this clicked for him.

I can’t describe how happy I was/am.  Being a part of his journey is a great honor.

Question:  How have you escaped self-loathing and your mean self in the heat of the moment?  Please tell me your story.

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Criticize if You Love Me.

On the receiving end of criticism.  Different from playing football or tag, no one wants to be chased, i.e. criticized.  If given the choice, which would you choose?  Chase vs. flee?  Humans can be a bit predatory when it comes to offering up feedback.

However, what I’m talking about has nothing to do with abuse.  Verbal emotional abuse is about unequal power.  Abuse of any kind, including spoken abuse, is scary, painful and shameful.

What I’m talking about is simply criticism.  You mismanage something at work and your boss, corrects you.  After coming home from that, tired and feeling beaten up, your children are picking on each other.  Then you get them in bed and find that you forgot to write-up a report and it has to be done.  Your spouse tells you that he misses his time with you.  

It takes a lot of love to deal with something.  Turns out, it’s much easier to let it go.  Walk away.  Examples of trying to promote criticism are the advertisements targeting parents to tell their kids not to use drugs.  It takes love to say no.  Loving yourself as well as love for someone else.  Kids who don’t get this feel neglected and confused.  Adults can also feel lost in so much impersonal space and act out just to get noticed.  Some people might call this “gamey.”  I just call it normal.  It’s a normal instinct to want the boundaries of someone who cares pressing around you.  It’s normal to feel adrift without knowing that you are worth somebody’s bother.

I say,

spare the rod and spoil the child

…at all levels.  At any age or station.  And further more, with your self-to-self included.  If you love yourself, you end up wanting to do and be better.  Coming from any direction, we can take it when we know we are loved.

The best part of Proverbs 12:24 is the second half,

but he who loves him is careful to discipline him.

So now, if given the choice, which would you choose?

Self Care Tip #56 – Bring it!  Take it!  Give it!  You are loved.  Be a friend to yourself.

Question:  Have you been criticized and known you were loved?  What’s your story?

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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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Own It. Our Life’s Work.

We can control what others do about as much as we can control the Democratic government.

My patient asked me if her medications were changing who she was.  After asking her more about where that came from, she disclosed that her husband was blaming her medications for the emotional distance between.  He was not blaming his daily alcohol intake nor that he see’s her as “The Patient” and not himself.  This is after she has spent years investing in herself through medications, some counseling, and regular exercise.  This woman had courage.  Yet she still bought into what her husband was telling her.

We personalize things that have very little to do with us.  Sometimes we know we’re doing it, but more often we don’t.  In this woman’s case, I had to think, how much of this was about her versus the accuser, i.e. husband.  We came to understand together that either way, true or not, the only person in her relationship she could better, is that same person she’s been attending to so well for so long.  In the end we were talking about going to CoDA, Al-Anon, or local support groups through NAMI.  She focussed on herself, excited about her opportunities to grow some more.  She wasn’t thinking so much about her husband getting passed up by his own opportunities.  Nor about the accusations.

Talking to a friend who recently shed 15 unwanted pounds, we did a celebration whoop!  She wasn’t perseverating on her husband who was smoking again. She was hurt by it, but used the energy in that emotion to motivate change in her own life.  Who knows.  Maybe her husband will grow from wanting what he see’s in her.  Courage, self-respect, inner congruence, hope, and so many more great things that come when you fight hard for your precious self.

Not taking things personally though can be much easier said than done.  If you try over and over but see that it continues to get the best of you, consider getting an opinion from someone you trust.  Get a “third-party” opinion to bounce your perspectives from.  Maybe this is something biological and medical as well. Personalization is a familiar problem in medical illnesses such as Affective Spectrum Disorders or Anxiety Spectrum Disorders.

Self Care Tip #35 – Own it.  Be a friend to yourself.

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

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Find your Trust

A knot of tension moving and changing and can’t be trusted is there. Tightness around the eyes and mouth and there is a grim determination not to pull the pin. The determination is supported by love, by choice, by insight, by all that is good.

However, like a dog on a slope, paws outstretched, gripping at the pebbles and dirt, there is the gravity to account for. The mass of triggers accumulated into a planet – kids woke you up and you couldn’t fall back to sleep, emotions, people not keeping their word, your birthday was a flop, knowing that when you get past this moment there will be more and more and more. All this is a force you know you want to suppress.

Wanting is good. But like Randy Travis sings,

“I hear tell the road to hell is paved with good intentions, but Momma, my intentions were the best!”

Like him, we find ourselves with wings singed, wondering how can we try something new? Whatever we’re doing isn’t working. We want heaven to start right here on earth.

Break it down.

There is the matter of trust. Where do we put it? Where is our hope?

There is the matter of patterned behaviors. Have we put up roadblocks? My kids are delighted to see the growing dollars in our family money jar. They are also delighted when a day goes by when nothing went in there. I see it in their growing comfort around me.

There is the matter of biology. Do we remember that the brain is indeed attached to the rest of our body? Do we remember that emotional health affects the rest of our body? That it is contagious to our kids and partners and families. That we can control it as well as we control our liver function. …That doesn’t mean no control.

But today, I’d like to turn back to trust. Trying to stuff emotions can be like trying to push springs into a box. We know at some point, the lid won’t shut. We can’t trust that method.

Each of us needs to find the answer to that question and hold on to it. That is where our energies go when we succeed. Holding on to what we trust with both hands. Then we can let the rest go. Both hands are occupied so to speak.

This morning, I did that. The most beautiful little girl then came, cuddling me in bed, laughing and joking in a way that I knew could only mean she felt safe. I was rewarded with my own self, present with her and my source of Help. It felt like Christmas.

There is the next moment to contend with and the next – the same way. We can put this in the category of coping skills and biology as well. The brain is messy that way. One thing affects the other.

Self Care Tip #17 – Where is your trust? Hold on to it and nothing else. Be a friend to yourself.

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Courage to take medication

So when is a psychiatrist going to get around to talking about medications already? Nobody really wants to take medications. But it turns out in this world that our brains are just as human as the rest of our bodies. When they get sick, what does it look like? Behaviors and emotions. Our brains are not hovering over us like a supernatural aura. When our brains get sick, our behaviors are in the fist of control about as much as our liver function is.

The people I see in clinic are some of the most courageous people I know. We find each other at an amazing time when they are aware of their plight, that of being disconnected from their journey. They are humble people, willing to consider that behavior is more than something the “will” or “force of character” can control. They use as many healthy means they can to get healthy. They believe that you can’t give what you don’t have, even to yourself.

Counterintuitive to culture and prejudice, taking medication is an act of courage.

Self Care Tip #11 – When your emotions and behaviors are messing you up, think of the many modalities to getting healthy, including meds. Be a friend to yourself.

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