I Can’t Make Friends – Anxiety

voyagerMr. Clark stopped talking and walked to the ringing rotary phone on the wall.

We were experts, as 7th graders, in anticipating what phone calls would be about. I’m surprised we never got around to making bets. I missed my chance to be a bookie. When the phone rang, it could mean someone was in trouble and had to go to the principle’s office.

Everyone was quiet waiting to see if their name would be called. No. That wasn’t it.

It could mean there was a school announcement. It could mean there was something wrong with our bathroom plumbing! But it had never meant that a space ship had exploded. Seventh grade was not the time to grasp what this meant. If we couldn’t grasp it, if our perceptions were unable to see it, then it could not actually exist. Right?

We kids had other things we were trying to sort out. Boys and girls. Getting your period or facial hair. Zits. What Melissa said about you when you thought she was your friend. These were space occupying in our minds. There was little room for understanding that this phone call announced the end of 8 lives, a billion-plus dollars blew up, nor especially not what it meant politically! Spouses and children, watching and cheering in the bleachers live, front row and center, witnessed as their own individual loved one exploded into tiny particles.

Mr. Clark walked, white-faced and perspiring, to the radio, asked for silence over the hum that had built up, and we heard. The challenger, the 8 people aboard (one of them a teacher), in 1986, was gone.

A spaceship exploding is about what anxiety feels like. That may sound extreme but it is the truth. And those who have experienced it, as if their were going to come apart, will do anything not to experience it again. This urge to avoid anxiety expresses itself in emotions and behaviors. But often, when anxiety doesn’t reach a full explosion, the afflicted individual doesn’t even know that they are sensing the urge to avoid, nor how they are responding to this avoidance. The afflicted person and those who know him get think that these medical symptoms are actually the afflicted’s personality. “It’s just the way I am.” 

You may be someone who feels inner congruence with decisions. By temperament, you like closure! But even so, against your own hard-wiring, you find that you have trouble making decisions. How you talk is driven by indecision. You’re couching what you say, being careful. Your self-esteem erodes.

Manuel had some similarities to this, but also, on top of his medical condition with avoidance symptoms, his personality was one that got energy from being alone. That doesn’t mean Manuel didn’t like people or interpersonal relationships. It just means that he got energy from being alone. And he did stay alone most of the time. When around others, the energy poured out of him like lemonade through an open spigot. However, he wanted others. Being lonely was not his goal. But there he was, more energy when alone combined with a thrumming buzz of nerves when he tried to make friends, when he tried to date, or when he was approached by someone spontaneously in public who asked the time.

Fudge! She only wanted to know the Blinking! Time! he screamed inside.

Manuel had some friends with whom he was deeply bonded to by shared experiences. But he had gone on to college and his friends had not. It was niggling in whispering thoughts that he might still be hanging out with them because they didn’t disrupt him. Because he came apart. Terror, like a spaceship exploding in the atmosphere after take-off, filled his perceptions, if he tried to hang out with anyone else! And Manuel didn’t like thinking about his friendships that way. They lost value when tattered by that persistent wind. Nor did Manuel like thinking about himself as someone who couldn’t get other friends if he wanted to. As someone who would use the faithful. Friendship by default? No. He felt shame just thinking it and he knew it’s falseness. In his most essential self, he knew he loved them for more than proximity. But he really didn’t know if he was weak. It was a possibility. And besides! What girl would want a weak man?

People with anxiety have barriers to any number of connections in life, like coming up to an energy force field we can’t see. There are interpersonal connections we might have had, but never initiated or explored because the anxiety held you in place. This is what anxiety does to us. Anxiety takes away our freedom to choose. And as the consequences and fruition play out, we live out the related losses.

Manuel came to me because, “Mom told me I better come and talk to someone.” Mom was fed-up with his isolation, hours of video games, and she had noticed that he was spending even less time with his childhood friends. 

Talking to Manuel, unearthing these patterns in his life, his insight grew a bit. But once he looked at anxiety, even with a sideways glance, which was anxiety provoking in itself, he came up against the need to decide,

Should I treat?

Deciding to treat is a decision to make between the patient, perhaps including their support system, and their treating clinician. When there isn’t a clear answer though, like a blood test that shows the vitamin D levels are low, we respond with vitamin D replacement therapy, but in these areas of diagnosis, it often feels nebulus to the patients on what to do.

When the decision doesn’t have clear form, like an undefined space, go toward the data. You may trust your clinician to know that data integrate it into all the information that goes toward deciding on treatment. Or you may choose to spend time researching and evaluating the data on your own and then go forward. Either way, if you stay with what you’ve been doing, you will remain ill and the illness will progress over time.

So either way, going with the data, either via your clinicians recommendations directly, or indirectly. Accept treatment. In fact, run toward it! You will have a much higher quality of life. And… those around you will too.

Self-care tip – Go toward the data!

Questions: What had influenced your choices in treatment or not to treat? Please tell us your story. We need your voice!

Feeling Trapped is Doom

Freedom

Freedom (Photo credit: Intrepidteacher)

Did someone put a knife in my neck?

Goodbye sex.  Goodbye flirting.  Goodbye self-esteem.  It was a down-right turnoff for life, let alone sex.  He could not think of one thing worth living for, but killing yourself turned out to be a lot harder than self-loathing.

Sheez, pain was distracting.  Unable to work out in his club with anything that jiggled him waste-line and up, Monty knew he should look for a pool but he could not focus on even that long enough to Google it.  He felt guilty and then angry that he felt guilty about something he was trapped by.

Monty told me about how his life was now closed off from everything he found pleasure in.  He described his circumstance like a walled in monk with a small envelope-sized window through which he received water and bread.  The difference between him and the monk was that he did not choose to be cloistered.  He was a victim of his injury and nothing could help.

Feeling trapped is doom.  I listened to Monty describe his life without freedom to choose. His life was not there for him to participate in.  He was excluded.  Monty was doomed, per Monty.  So what was the point, indeed?  What was the doom-script doing for him?  Was he getting anything besides yuck from it?

Monty, the way you describe yourself does not have any place for you.  Either you really are trapped, or there is a door, or a false wall, or a sun-roof that you do not know about.  Or maybe you have a brick-braking tool available?

People from every point on the spectrum of brain illnesses defend their position of entrapment with more volition than a the red-tailed hawks flying above the groves around my house.  Even family members of persons with brain illnesses have defended the perception that their loved one does not have freedom to choose, as if suggestions of freedoms were the essence of social injustice, ignorance and stigma.

But it is not the pursuit of freedom that traps us. It is our fear.

Feeling trapped serves a purpose however.  It protects us from something that feels shameful.  It protects us from that which invokes fear.  Wanting not to feel shame or fear is not so wrong though, is it?  Wanting not to go toward what might be unbearable seems reasonable to me.  If it were truly unbearable.  If it were friendly to Me.  If it was not the road out of that hell-existence, out of that bricked in crypt, toward a place of greater safety.  If then, it would not be so bad.

Self-care tip:  When feeling trapped, do what does not feel safe and go toward your shame and fear.

Question:  How have you been able to find freedom in places where you feel trapped?  How do you manage to go toward shame when you feel so much fear?  Please tell us your story.

Feeling Afraid

Celine was made to fidget by something moving inside her.  It tooled with her body while working her over.

I’m afraid.

Rich.  We are all afraid.  Knowing it and naming it is more than many of us have the spit to do.  But not being named doesn’t make us more courageous.

I am afraid.

Celine wanted help and as her perception grew of what she was looking for, she knew.  It was fast.  Awareness appeared in progressive pictures into her own flip book.

Remember those flip books when we were kids like, Mickey Mouse tapping his foot as the pages sped by, leaning over to kiss Minnie?  Celine’s flip book showed her that she felt unappreciated at work.  She resented her authorities, lack of control and felt ashamed that she wasn’t acknowledged.  Scenes in her life gave her the illusion of movement toward more than just danger though.

Being in fear is not in itself wrong or amoral.  Sure as yams are sweet, it’s going to happen.  We all have fear.  Feeling afraid doesn’t mean that we are bad.  It doesn’t confirm the accusation or shame.  It doesn’t close on us.  It just is.  Fear.  Celine’s illusion was that she was moving toward being the wrongness, being amoral, and being especially bad.

Ironically, Celine found some comfort in this and decompressed.

The medical reasons behind fear are of all varieties and certainly important, but this post isn’t about those.  It’s about our flip books.  Lick thumb and finger and let’s see what pictures we’ve sequenced into our own illusions. We all have a book.  We all have fear.

Question:  What does looking at your flip book do for your sense of value?  Please speak.

Self-Care Tip:  Remember what makes “Me” special by being present with fear.

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

Image by OakleyOriginals via Flickr

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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Don’t Run Away. You Might Fall In Love With Your Flaws.

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Empower yourself by going towards what scares you.  Take it to the table and be with it.  Get to know it and openly share company with it.

Opal was throwing up.  She threw up more when she gained weight or felt fat.  Throwing up didn’t help her lose weight.  It was just a tool she had to deal with it all.  Opal was told often not to worry about her weight.  Told, she looked fine and not to weigh herself.  No one said openly, “Opal, you’ve gained weight and you’re going to get other illnesses because of it if it keeps going.”  They were afraid saying anything like that would make her throw up.  Hm.

What do you say?

We remember the three things that help maintain long-term weight loss.  Well one of the main reasons they work is because they help keep us present with “the problem” or “fear” or “shame” or however we name it.  Our natural instinct is to go away from fear but this is another example of when we don’t get help following our instincts.

What empowers Opal is to get tools to contend with her struggle with obesity.  It is probably a life-er for her and oh-well!  We can love our flaws better if we stop running from them and grow our skills in living with them in a friendly way.

Get empowered with whatever you are afraid of in yourself.  If you can’t do what you need to do to be in the place of that fear, it may be that you have a medical illness keeping you from coping better.  It doesn’t mean you’ve failed.  Staying with your journey, even to taking medication, even to naming brain illness in your life is so courageous.  You become one of the great ones.  Heroic.  It is so much easier to disconnect and lose our opportunity to love our flaws.

Have you ever heard someone call their life-er, “my old friend?”  Maybe it is arthritis?  Or recurring cancer?  Maybe it is brain disease.  Some day, we will also name our own, “my old friend.”  And we, with Opal, will mean it.

Self-Care Tip – Empower yourself by your presence.

Questions:  How do you do what is friendly to yourself when your instincts tell you not to?  What has that done for you?  Please tell us your story.

Other Fears of Medication For Brain Illness

Yesterday we talked about fears of addiction to medication therapy.  There are other fears that influence our choice to use or not use medication therapy for brain illness.

In clinic, we hear about people’s preference not to take medication, as if it were like ordering mushrooms or no mushrooms on pizza.

I am not someone who likes to take pills.

veggie pizza

Image by mccun934 via Flickr

Again, I think most of us agree entirely.  Who of us set out in life thinking, “I hope my life depends upon medication therapy?  I just want to have a reason to medicate.”

So tell me about this.  Questions:

  1. Are nonprescription substances safer for us?
    1. If so, why?
    2. If not, why?
  2. What are other risks you fear of taking medication for brain illness as compared the risk of brain illness remaining and likely progressing untreated?

Fears can provoke us to grow stigma and biases.  However they can also be used a tool for getting friendly with ourselves.  We can use our fears.  We can use them to gain clarity to know better why we are making our choices – stigma? Or friendship to Me?

Nothing is all right or all wrong.  But we should know our motives if we can because of it’s potential usefulness.  It is a friendly thing to do.

Self-Care Tip #285 – Know your fears so you know why you are making your choices.

Our Patient-Doctor Relationship Improved by Self-Care and Back At You!

NICU Nursery

Image by EMS Shane in Portland via Flickr

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #265 – Use your connections to help yourself and use your self-care to improve your connections (such as your patient-doctor relationship.)

Damaged and premature, my niece was born needing help to live. Now, one year later, I am playing ball with her on the floor. Her intelligent smile, thriving body, and especially the lovely nape of her neck with that baby-curl of hair lipping up makes remembering her near death-dive into life surreal. I don’t want to remember it anyway. But when I can’t help myself, what I like to think of is how my brother and sister-in-law were treated.

The clinicians at UCSD were unbelievable, my brother said. They included him in their decision-making and informed him of medical study results. If you don’t know, if you’ve never been sick or been in a medical setting otherwise, this doesn’t always happen. It isn’t traditional to share medical information directly with patients (such as x-rays, laboratory results, differential diagnoses, and to ask their opinion. Can you imagine?!  “…Um. Yes PLEASE! Can I be your patient!?” Sounds like fantasy.)

I’ve also struggled to collaborate. Hovering over charts and laboratory results, many of us practitioners behave as if our patients were at any moment going to throw us into court. It’s embarrassing, even though the truth is, too many of us clinicians are stalked by litigious intentions, whilst the truly awful practitioners seem to sail away on unsinkable malpractice without pursuit.

I have not enjoyed myself when I’ve done this. When I’ve acted suspicious of the very people I’m meant to team up with, work was not good for me. I don’t think my patients felt comfortable with the doctor-patient relationship either during those times. Hearing my brother talk about how he was treated has emboldened me to engage with more trust in the care I offer patients. Moreso, being friendly to myself has helped me be a better physician.  It’s tail chasing but with productive and enriching effects.

Making a choice to choose trust and transparency with patients and clinicians, even being present with the fear, is self-care although high pressure. With people’s lives on the line, clinicians and patients know mistakes will happen. The self-care will grow our ability to forgive each other.

My journey with self-care has brought me to see people differently. I look at them from the self-care angle. I look for those sticky bits where we can connect and collaborate. I expect things from them. I ally myself with their self-respect, with their intuitive desire to be friends with themselves. I am bored at work when I don’t do this. I am bored at work when my patients don’t do this too. Without self-care for myself and without my patient’s interest in self-care, medical practice becomes everything that the negative reputations advertise about the physician and the patient.

Yes. My quality of practice has definitely improved.

Who isn’t blessed when she sees the courage to face stigma, shame and bewildering illness? Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live, fights hard like my niece did and shows what that fight is worth?

Who doesn’t learn from that? When someone loses her identity to the defacing ravages of disease but still knows she is worth the fight, like PattyAnne, working beside her is one of the best places in the world to be. For Me. It starts and ends with Me.

Building trust in a patient or a clinician starts with us staying connected to others in our personal circle and along the ripples as the circle widens. We have to have a voice and hear their voice and we do this by maintaining a community of people.

Connection is part of self-care for both clinician and patient. In the case of PattyAnne, (yes, she’s still in our story,) she could take an action toward her self-care with the intention of gaining stronger connection to her community and to me. She could ask herself about her intentions. In fact, we both would do better self-care approaching each other this way.

Connection via the patient-doctor relationship is self-care and then back the other way too!

It starts and ends with Me.

Questions: Has your patient-doctor relationship been a friendly part of what you’ve given yourself?  What are some examples or in what ways have other connections you’ve chosen improved your self-care?  How has self-care inversely improved your patient-doctor relationship?  Please tell me your story.