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.

DSC03321

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.

Work Hard to Take Care of Yourself If You Want An Easier Time Taking Care Of Others

Self-Care Tip #174 – Work hard to take care of yourself if you want an easier time taking care of others.

My marriage has never been better.

Freedom Press (UK)

Image via Wikipedia

Kirsten had good posture.  She made eye contact and she wasn’t fidgeting when she told me about the changes in her life.  I hadn’t seen her in clinic for two years and apparently in that time she had set her husband free.  She was seeing less of him than she ever had and they were both busier than any other time in their lives.  Yet their marriage was at its peak.  I felt like I was getting off the point of why she came and wondered if asking her for details was unprofessional.  I did want to know.  Lucky for me, she wanted to tell and I just let it happen, as if I was doing her a favor.

I admit, sometimes I get something out of my clinicals.  I’m not always the best therapist.  I don’t always keep things about my patient when I let myself receive, or even actively take from them.  None of us are that altruistic.  Therapy is supposed to be one place any of us can go, and know that when we go, we can expect to receive everything except the fee-for-service.  Therapy should be the closest thing to a one way street in this non-altruistic world.

To my rescue, Kirsten said,

He has been meeting with friends, exercising, eating out and working the 12-Steps twice a week.

Yes he was sober, but he was also a bunch of other stuff.  Taking care of himself, he became a better husband.  Better body, clearer mind, happier, more attentive, less angry; she could hardly stop listing.

Freedom is useless....

Taking care of himself took a lot of work but it made taking care of her a lot less work.  True, she wasn’t the center of his life, she gave up on some fantasies, she didn’t ask him for more time, but all those in the past had only grown her own point of anger and blame and not the marriage dreams she thought they would – letting them go was a good thing.  Yet, cutting him free still felt risky to her.  She came to me because she was becoming more aware of what that fear was doing.  When she was afraid, she was sabotaging herself.  Bits of herself recognized that she could feel as free as her husband did.

To be free of fear for Kirsten, she needed medical help.  Kirsten’s fear came from nowhere, out of the blue and was not only triggered by suspicions about her husband.  To be free for Kirsten’s husband required other forms of self-care.

Question:  What kind of self-care does your freedom need?  How has your hard work on your own self-care spilled over into less work to care for others?

Listen to Your Mind and Body When Doing Something As Simple As Cleaning

I Heart Cleaning

Image by Valerie Morrison via Flickr

Self-Care Tip #170 – Listen to your mind and body when you do things like cleaning, even if it makes you feel better or worse.  Be a friend to yourself.

Whenever someone in the house can’t find something, I ask them to please just start cleaning and sooner or later they’ll find it.

Today my kids and I spent two hours cleaning their play room.  My daughters were amazed at all the treasures they found tucked under, over, this way and that way in their clutter.  Although there was a lot of crying and gnashing of teeth along the way, in the end everyone was happy and pleased with themselves.

One of the blog-sites I enjoy reading is “Earthquakes and Rattlesnakes” by Zahara.  The other day she said,

I have a lot on my mind.  It seems when my mind is in a jumble, my house is in a jumble.  Cluttered, disorganized.  Can I unclutter my mind by cleaning my house?  Probably.

According to BBC News, cleaning improves mental health through the exercise that is inadvertently done.

And as Louise Hay once said,

Cluttered closets mean a cluttered mind. As you clean the closet, say to yourself, ‘I am cleaning the closets of my mind.’ The universe loves symbolic gestures.

But there are times when this goes awry.  In Obsessive Compulsive Disorder, people may clean ritually and compulsively to avoid an egodystonic fear; a fear they know doesn’t make sense but still terrifies and overwhelms them.

Or in Major Depressive Disorder, the illness affects their brain and body so much so at times that they can’t do basic life functioning, such as cleaning their house or even showering.

So I’ll tell the mothers out there such as myself, the BBC News, Louise Hay and the rest of us that cleaning is good self-care.  The milieu around it is also a good indicator on when it is time to go get professional help.  Listen to your body and mind.

Questions:  When and how has something as simple as cleaning improved your mental state?  When has something as basic as doing your activities of daily living shown you that you or someone you love might need to see their doctor?  Please tell me your story.

Leave Space in Your Beliefs to Grow

 

standing up to stigma - mambo.org.uk

Self-Care Tip #144 – Leave space in your beliefs to grow.  Be a friend to yourself.

Madeline brought her son in.  He was born male but has always allegedly believed he was female inside.  It was Madeline’s appointment with me, not her son’s.  But he came in with her and I could either listen to her concerns about her son or ask him to leave against her wishes and still hear her talk.  So I listened.

The issue was a matter of salvation.  Madeline was fighting for her son’s salvation as a mother might.  That part was lovely to watch.  I thought of God hearing her and being present with her pain and being The One behind her fierce love in the first place.

We talked a little about the biology of homosexuality.  What is transgenderism?  If God’s Word is absolute, what part does a progressive understanding of biology play in our perception of truth?

Madeline’s son asked to leave.  I thanked him for coming in and he shrugged.  His whole family abused him, Madeline said, gulping and losing form.  She had spent many years defending him even though in her heart she was terrified that her son was damned.

Some of you may have read the powerful blog-post, “My son is gay” in which a mother described her halloween experience.  Her son dressed up as Daphne from Scooby-Doo.  She and he were promptly abused. As a mother I empathized, and as a scientist, I wanted to scream things like, “You thought the world was flat too!”

But Madeline was worried not only about bullying.  She was worried about the Last Judgment.

Stigma comes from all directions.  Inside of us, our homes, our churches, our schools, our government, up, down, sideways, this way, that…  Stigma is everywhere and it is usually a painful encounter for everyone involved.  Perpetrator included.

So here’s the scoop folks.  Homosexuality is biological. We have as much choice in it as the shape of our nose.

I’ve seen kids be mean about noses.  I’m half-Lebanese and believe me, I know what big noses are.  The nose that makes you wonder how the head escaped the vaginal canal without injury.  But I’ve never heard anyone hate someone’s nose and believe that he’s going to loose his salvation for it.  I’ve never seen someone turn her back on her brother and leave him to die without the love of family around because she thought she was condoning his nose if she did.  I’ve never heard about moral judgment being attached to a culturally incorrect nose.

In my son’s church class the other day, the teacher was trying to get him and the rest of the other oppositional three-year-olds to wear angel and shepherd costumes for the song they were going to perform. Only the stage-hams garbed up.  She kept giving the rest of us parents her pleading eyes, pleading words, and pleading emotions. She was making the wrong people feel guilty.  The kids were unfazed in both compliance and emotion.  The ones who were genetically inclined to get energy from performing that way, were.  The others were not.  I could have said to my son, “Get this on!…!”  And made him feel like he was bad if he didn’t.  But attaching morality would never change where he gets energy.  That part is genetic and it won’t change despite his conditioning.

It’s a bummer that Paul’s letters were translated the ways they were in the 1950’s using the word homosexuality.  A lot of people are scared when they read it.  Fear has threatened and hurt a lot of people.  Reverend Mel White posts about this.

I don’t know if Madeline was given anything she came looking for.  I’m not always the best teacher or student myself.  But I do know that we, all of us, will continue to learn through all eternity.  We will never know enough, love enough, or be sinless and perfect enough to take over that awesome job of being Judge.  I once heard of a beautiful beloved angel who tried.

Question:  What has been attached to morality in your life that you know is not?  How have you dealt with stigma?  Please tell me your story.

Courage Not To Presume.

Pony Express

Self-Care Tip #116 – Have courage not to presume.

Courage.  Courage is doing what frightens us.  I heard this definition and as usual I got a little stiff.  Definitions sometimes feel sticky to me and I’m trying to understand why.  Why is my lip curled?

In line the other day for the theater, a grandfather in front of me got talking.  I didn’t get any names; just that he was a grandfather of a 7-year-old girl who owned him.  Naturally he drifted into stories about her, including their most recent vacation to Knott’s Berry Farm.  They rode “The Pony Express” despite his fear and instincts.  I asked him if he was proud of his granddaughter’s courage and he replied, “She wasn’t scared!  So she wasn’t the one with courage.  I was!”  He laughed, and then I laughed, but I walked away to the ticket booth whispering, “What does he know about her thoughts?”

I see so many faces flashing across my mind’s eye.  I see them, and I hear them.  I realize their whispers have become mine because I believe them.  My patients are courageous.  These, who have not told others.  Who have not screamed when they wanted to.  These people who have put on the appearance of calm despite their fears.  They are a study in functional mental illness.

Functional mental illness, although historically refers to mal-behaviors and emotions without medical cause, now after years of increased knowledge and study, it includes their biological organic etiology.

As an example of functional mental illness I’ll tell you about Miranda, a mother of 2.  Miranda says her kids stress her out and she can barely take care of them.  However at her job, she performs adequately and no one would say she seems depressed.  She falls into bed when her kids do between 7 or 8 PM yet never feels refreshed.  Crying while pouring their cereal each day, she packs them dry bread and a pickle for their lunches.  No one would know the courage it takes for her to survive the moment and then the next.  They all presume she is fine.

After teasing apart my thoughts on courage, my lip has uncurled.  I understand that definitions bother me because they can sometimes imply freedom to presume more than one should.  We can never know people’s thoughts, motives, feelings entirely and that bit that we don’t know, may be the bit that changes their story.  If you want to read more, check out this post.

So for now, I can push down my fear of definitions, put on the face of calm, …and what?  Be a friend to myself.

And you?

Question:   Where do you need the most courage to do good for yourself?  How do you deal with your fears?  Please tell me your story.

Grieve to Be Present With Yourself

 

Maria Yakunchikova "Fear" 1893-95

Image via Wikipedia

 

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.

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.

iwantthatpainting.com/Why-does-it-always-rain-on-me.html

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.

Get Gangster on Your Shame

 

Photo by Wesker

 

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.

Be Empathic to Others to Get Friendly With Yourself

 

Drawn by early 20th-century commercial cat ill...

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Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

Yesterday I wrote about considering intent and context when comparing self-care with selfishness.  That carries over to the people sharing life with those of us who have mental illness.  Do they see us as selfish?  For example, how is the spouse of the Panic Disorder going to make sense of the 40 phone-calls he gets while at work?

Mary’s husband told me that she’s been calling him “all day,” terrified she was going to die.  Checking to see when he was coming home.  She couldn’t go to the market because people would laugh at her.  Afraid.  Afraid.  Just plain afraid.  Really, everything had become about her.  She was like a scared kid.  Frankly it was annoying.  He was in a stressful work situation with the economy slumping.  People he knew were being laid off.  The other day he had to leave in the middle of an important job to go home and reassure her.  She was sobbing in the living room.  Sure she was going crazy.  He realized that he might have to tell his boss what was going on but what was going on?!  Who had his wife turned into.

In yesterday’s blog, we spoke about the ability to abstract v. concrete thinking.  Being able to abstract helps with empathy – connecting emotional content between people.  To put yourself in someone else’s shoes, as if you were them.  This is a critical part of relating, i.e. being in a relationship.  Many different mind illnesses affect our ability to abstract, including panic disorder.

In Mary’s case, she was not empathic when she was anxious.  She was thinking about herself.  Understandably, if you read the part about her believing she was going to die or go crazy.  But when you’re married to her, empathizing with her gets old.  It’s not so easy when it seeps into your work life, you haven’t had sex for months, and you have to do everything that has anything to do with going outside of the home.  Some part of you knows it’s not true, but another part of you screams, “Get over it you selfish child!”

Is Mary selfish?  Some might be able to answer even after all the phone-calls and unrecognizable behaviors, no.  Mary is not selfish.  They can do this specifically because they can abstract.  They can empathize.  They can consider the context of Mary’s disease and the intent of her behaviors.

Not everyone does this.  Not everyone is able to let “It” be about someone else.  Not everyone doesn’t have to have “It” be about them.

The best thing for those in relationships with someone emotionally ill, is to view the way they are behaving as biological.  When treated medically, than Mary or whoever it is in your life can do their own self-care.  But until then, staying in their lives requires maintaining an empathic view that considers intent and context.  It also means furthermore, doing your own self-care individually.

There are over-lapping flaps to our lives.  Scales on the back of an armadillo.  Me as encased by my body.  Me, that includes the space between me and you.  Me, that includes you, because you will always be a part of me.  Self-care really involves all that by degrees.  A chain-link.

So the question is, can empathy be chosen?  With money in the bank and wisdom, yes.

Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

Question:  Does any of this ring true for you?  Please tell me your story.

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.

Let it Make You Strong

She is young, golden, blushes easily, bright solar eyes, with graceful speech, not rushed or loud.  Like so many others, she doesn’t believe her beauty.   She came to me to get help.  Crippled by anxiety that hits out of the blue, like a hooded man grabbing her in an alley.  She feels during those times like she is dying or going crazy.  She started avoiding public places and became fearful looking over her shoulder for the next attack.  She was humiliated on all accounts by her uncontrolled emotions and thought people could see how crazy she was just by looking at her.  Branded and tortured.

When Nathaniel Hawthorne wrote The Scarlet Letter, he made plain the cultural pressure to define what is apparent, seen, and interpreted.  But more importantly he made plain the ability of an individual to define themselves on their own terms regardless.  Hester Prynne wore her letter A at first by mandate and then by choice, letting it represent who she was, where she came from, and where she was going.  She wore her letter and when people tried to change its meaning to something culturally less scarlet, “A” for “Able” she made it clear that she is the one who will decide the meaning of her life’s events.  Her and God and no one else.

When anxiety hits, we are scrambling to understand why.  We think, “What could we have done that is so terrible to have brought this kind of torture on?”  As Hester Prynne began her scarlet letter days bewildered by the force of emotion behind her angry neighbors, so victims of anxiety are bewildered by the level of shame and wild fear they presume must be linked somehow to this judgment upon them.  It becomes their life’s work to determine the meaning of a life with this.

Nathaniel Hawthorne writes,

The scarlet letter was her passport into regions where other women dared not to tread. Shame, Despair, Solitude! These had been her teachers—stern and wild ones—and they had made her strong…

Suffering is a schoolhouse for the courageous.

After some months of medication therapy this twenty-something woman said

I’m not so uptight about things.  …I didn’t know my anxiety was that bad until I got out of it.”  What amazed her even more was how better the rest of her body felt.  “Even physically I feel much better.”  No more chest tightness, body aches, and shakes.

She has the rest of her life to figure out how to say what this disease means and how it plays into the way she defines herself.  She will decide I hope.  Not her family, future husband, church, or Brook Shields.  I hope she will take what it teaches her and let it make her strong.

Self Care Tip #57 – Let it make you strong.  Be a friend to yourself.

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

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 fo

rmally 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 su

icide 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.

 

 

Your flawed self

My niece is sitting beside me and I can barely keep my hands off of her 5 month self.  I am eating a blueberry scone slowly.  She, with her tummy-full of breast milk, is watching every bite, a faint smile on her pink face.  I’m a little afraid she’s learning to eat carbohydrates from me and I want to tell her that I can’t remember the last time I ate one of these.  I start eating faster and turn away so I don’t imprint this on her supple myelinating neurons.

We closet eat, closet smoke, closet shop, closet sex, closet what we want to protect others from but what we independently are strong enough to handle …or not.  There is a term called “self-sabotaging behavior.”  Reducing this, we find that the process of closeting is in fact the handle on the door to that mal-behavior.  Keeping it real is the same as saying get it out of the closet.

My mentor and brother, Cameron Johnson used to say, “Go where the pain or fear is and it will lose control over you.”  People who work the 12-Steps call this “Rigorous Honesty.”  It is a pealing away of all pretense with yourself.

Avoiding rigorous honesty turns into self-sabotage.  We end up cutting ourselves down at the knees.  Anxiety uses fear to make us hide.  In cases that include emotional illness, of course medication will help our work toward honesty.

It is not about whether we hide our bad sides or not – we do.  It is about trying to keep it real.  The only thing to be ashamed about, if we must, is not trying.

So to my niece, I give her my flawed self and when the time(s) come, I will accept hers as well.

Self Care Tip #45 – Show the world your flawed self.  Be a friend to yourself.

Question:  How have you experienced the freedom that comes from going toward the fear?  Please tell us your story.

Get in Someone’s Space

The woman writes, but only for herself, she says.  “Why?”  I can’t remember her answer.  My thoughts stayed on the question, wondering why we don’t connect with our community.

Dropping off my children at school this morning, I noticed the pubescent girl with blunted face, guarded eyes, crossed arms, standing alone even surrounded by other kids.  Ouch!  I wanted to hover over her.  Guard her from what ever it is that’s scaring her.  Touch her arms and hair and make her understand that she is important to the universe on a small-scale and large-scale.  Of course I might have been arrested if I did, so I just walked on to safety.

Jeff Wise, author of Extreme Fear: The Science of Your Mind in Danger, writes

A feeling of connection to others is nature’s Xanax.

Some of my families with disabled children struggle hard to take care of their own.  They often wait until at cliffs edge emotionally, financially, physically to consider placement for their disabled child.  When helping them get past their barriers to placement, we find guilt, fear and shame in the way.  These children often do better physically and emotionally when they are in group homes and away from the emotional burdens in their nuclear family homes.  We need community and community needs us.  Each of us.  Joana Johnson, neuroscientist, says that placement, is in fact a way families can connect with their community and with their child.

Some skeptic personalities struggle to trust the links between us, not out of paranoia, but rather because it is the hard-wiring in their nature

to question things. There is also the introvert, who is often alone not because they don’t like people, but because that is how they get energy.  However, regardless of genetic predispositions, we are all designed to have community.

Mary Shelley tells us through her Frankenstein, that we are better people in the company of others.  We see forces that keep us from sharing ourselves.  But let us not believe those forces.  Break past.  Let us believe our own better Creator who tells us, connect.  Tell our stories.  Stick a finger out and get in someone’s space.  Do what we must to let them into ours.

Self Care Tip #42 – Share yourself and get community.  Be a friend to yourself.