freedom of choice

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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.

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Guilt Furiously Chasing You Is Commonly Experienced In Illnesses Of The Brain

Orestes Pursued by the Furies, by John Singer ...

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Self-Care Tip #221 – If you feel chased down by guilt, stop running and get friendly with yourself.

I’m so busy!  I am trying to work, raise three kids, and be a wife!  …and I’m just spread so thin!

It was new for Connie to think that where she was at in life was linked with her choices.  Somehow she intuitively felt taken along by it all, a current of life as people say, of either randomness or design.  Who could know, but it was more than her choices, she was sure, and she resented the influence on her life’s design.  Not that she had intended on taking over what was playing on her.  She just simmered in the house of cards hoping that when she got to make a play of her own, she’d make a good one and come out better for it.  In the mean time, she just had to keep moving fast.

Things would have been fine, except that over the past six months, she hadn’t been enjoying what she was living for, her kids, parenting, being a wife or her employment.  Yes, she was also  living for God but no, she wasn’t enjoying Him either.  Did she want to?  Did she feel guilty about it?

I feel guilty all the time.  It’s the guilt that gets to me.  It’s like I can’t see or feel much else.  Just when I think I’m about to get into what I’m doing, guilt comes chasing at me in a fury!  Distracting me and worrying me.  I’m on edge more and irritable from feeling defensive, and trying to get away from whatever this is.

Connie looked at me when I said,

Self-care begins and starts with “Me.”  Although we may be living for others and other things, even living for God, if we don’t take care of ourselves, our health first, our emotions and behavioral health included, we can’t give much, in the way of living, to those others.

I could see her pupils change and I got a little excited.  She was hearing something that affected her whole body and I sensed it was hope.  (See, I am an Emotions Jedi.)

We talked more about approaches she was using, prayer/meditation, exercise, grit and determination, waiting it out for better days to come and others.  Then I introduced the medical paradigm.  (You’ve heard me say it.)

Behaviors and emotions come from the brain.  We culturally think that they are volitional, under our control.  But how much can we really control of what the brain does?  Some.  But when we do the best we can with what we can control, and our behaviors and emotions are still hurting us, affecting our quality of life, damaging our relationships and connections – we need to look for biological reasons.  That’s where choice can still come into play.

She was looking and nodding.  This was at her “consideration stage” of introducing these new ideas.  I said,

I thought of telling you about this when you talked about guilt Connie because maybe your guilt is coming because of a brain illness.  It’s common in several emotional illnesses, like depression or anxiety, and in these illnesses it commonly comes in force, like you’ve described.

Her pupils had reduced to their earlier size, and her posture said she was winding down for that visit.  Whatever we discussed after that would be low yield, so we made a follow-up appointment and called it a day.

These days later, remembering Connie gets me thinking about what I would have said if she had been available to still hear more.  This bit about freedom to choose self-care, yet saying we have little to do with how our brain works can get confusing.  It might seem contradictory.  Tomorrow, I’m going to discuss it more, but for today, it would be wonderful to hear what you think.

Questions:  With behaviors and emotions coming from a material biological organ, the brain, yet knowing that we are free to choose for our self-care, what gives?  How do these ideas jive?  How have you seen it play out in your life?  Please tell me your story.

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Free to Be Accountable

dosomething.org

Self-Care Tip #97 – Protect your privilege to be accountable and your freedom of choice.  Be a friend to yourself.

Number Four on Bella’s List:

“The day has been ruined!” Bella said.  Her eyes sparkled and flashed as she spoke of her injury.  Bella was not so pleased with her labor’s reward.  She was not so satisfied with being accountable for her children‘s behaviors.

Are parents accountable for their children’s behaviors?  That can be a question at the level of the law and a question of cultural moral values.  From a psychiatrists stand-point, is there a medical interplay?

A subspecialty in psychiatry is called consultation liaison, which is psychiatry for the medically ill and usually hospital based.  In this setting we often get asked is a patient has decision-making capacity.  I spoke about it briefly in the post, “Choose, Gladly, Using Resources.”  This is difference from competency, which is determined by the court. Decision-making capacity is a medical assessment of the patients ability to:

1.  understand:

  • their illness,
  • it’s consequences,
  • it’s relationship to their values

2.  manipulate their options,

 

3.  and communicate their decisions.

Can kids do that?  Medically it depends on their developmental level.  The court however has its own forum on that – I won’t try to go there as psychiatry isn’t law.

Another area in psychiatry where we decide that someone does not have the freedom to choose and we hold someone else accountable for them (called a “5150“) is when they are:

  • not able to provide for themselves food, shelter, clothing
  • a danger to themselves
  • danger to others

Are kids able to do these things?  From a medical perspective, it depends on their developmental level.  Deciding what we want for ourselves and for our children is a privilege for those who are able.  It is also a privilege for us who want it.  Freedom is not free, as they say.

Please watch City Councilman Joel Burns tell us about bullying and how we need to be accountable to each other: “It Gets Better.”  Completely amazing testimony and speech.  Cuts out all the b.s.

Question:  What do you think about our accountability to our children and to our community?

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Choose, Gladly, Using Resources

Being a friend to yourself includes choosing, being glad that you can, and using resources to make your choice a good one.

Mrs. Smith told me with a barely noticeable arch in her back that she was still planning on God healing her daughter.  I don’t know if Mrs. Smith thought about how her daughter felt about that.  Was Kristy personalizing her illness?  Did she think God rejected her?  The problem of her continued illness must show something more than a physical flaw in her perhaps.

Will we know it when we are healed?  Until then, what to do?

Years ago, I met Fran.  She was pulling her hair out.  Her annoyed husband disrespected her for it.  Fran kept willing herself to stop.  She said,

I’m doing it less now I think.

The good news for Fran is that she responded well to fluoxetine.  Her anxiety decreased and she almost stopped pulling out her hair.  She’d wear her growing bristles pressed down with bobby-pins and hide it with her long hair.  As her hair grew longer, she had fewer bobby-pins and I knew she was taking her medication.  There were other problems between Fran and her medications.  Taking medication shamed her.  And, she blamed her fluoxetine for her weight gain and rash on her face.  She felt uglier than ever in her husband’s eyes.

I don’t pull hair any more.

Fran stopped her fluoxetine and half her head went bald.  She did not lose weight and she still had a rash on her face.  Fran went back on her fluoxetine and she has cycled on and off of it this way over the years we’ve worked together.  Somehow despite all our time together, Fran does not believe me when I tell her that when she is better symptomatically, she is not healed.  Fran does not grasp that her behaviors come from something at a genetic level.  We can treat her, influencing the way her genes express themselves, but in her case, not cure her.

We are a team.  She and I, and sometimes her husband, and sometimes her sister.  I give her medications when she thinks she needs it.  I don’t leave her when she doesn’t.  Either way, we keep trying.  It is very hard for Fran to know that she has not been healed.

I don’t have many clear examples of treatment-to-cure in psychiatry.  The statistics vary between diseases as to their rates of recurrence.  The brain being human, we can yell at the serpent for our insanity.  However, in the end, here we are.  As Billy Joel says in his great ’70’s hit song “My Life”

Either way it’s okay to wake up with yourself.

The opportunity to choose our own answers, to decide what to do about it, and believing if we are sick or not sick  – is all our own.  These can be hard decisions but until we lose capacity to choose, we own them.  Decision making capacity of course is a medical decision.  But competency is a legal decision made in a court of law.  Having the right to choose is a beautiful privilege.  This does not mean to ignore counsel, evidence, data.  On the contrary.  That would not be a friendly thing to do to yourself.

Self Care Tip # 75 – Choose well and be glad you can.  Be a friend to yourself.

Question:  What do you think?  Agree or disagree.