Sweaty and Worried – Generalized Anxiety Disorder

Hank had to sing an Italian song for his tests.

His music instructor did not believe that he had been practicing two hours a day. When Hank asked his voice teacher to sign off on those hours, his voice teacher still did not believe him.  He had nothing to feel shame about.  “Then why did I?” Hank wondered.  Card in his hand, signed off, Hank resentfully kicked at the rocks covering the path back to administration.

Looking out over mostly empty hard wooden seating in the music hall, Hank slaughtered the song. Even so, it was still the best performance he had ever done.  His father was there in his stained tie and largeness.  His mother in her too many colors, smiled loudly.  She was tone deaf.  Frank’s shame followed him.  He had practiced.

Hank’s older brother dressed in silk shirts, a big gold medallion, a tuft of hair coming out of his barely suppressed neckline.  When they prayed, Hank heard these smacking noises, and thought, “Pray for my nausea,” hoping they would stop kissing.  His brother always had a girlfriend.  The girlfriend was at his recital.  There were noises.

Everyone was scared Hank’s brother would marry too early and maybe marry for the wrong reasons.  His dad was always like, “Wait, wait!” But with Angie, Dad was like, “Get married now!”  Angie was the best in a long line of noisy kissers.

They asked Hank to sing at their wedding.  They insisted.  His brother, his brother’s girlfriend, his parents – they spoke in harmonics all at once.  “Hank!  You sing like Sinatra! Don’t worry so much! You should sing!”

In a rented tuxedo, Hank sang.  The mike didn’t work.  Aunt Augusta told him to sing louder.  Aunt Augusta didn’t hear well, even if there was a mike.  Hank forgot his words and had to start over.  Sweat filled his shirt and he thought about the dry cleaning.

Hank has never had a girlfriend and he is almost twenty-five.  Standing in front of all those people without the song lyrics, the only words that came to him were, “I am like a sweaty doorknob.”  His brother, facing a battle of his own between his ruffled shirt and his manliness, did not help.  Hank thought, “He is probably waiting for prayer so he can start kissing.”

The second year of college, Hank got caught with pornography.  “Hank!” His mother pulled his ear, towing him while she shook the fisted magazine through the house.  He didn’t listen to her words.  He only listened to his memories asking his music instructor for his signature. Was it as bad as the wedding?  Talking to Sarah or walking across the campus greens were bad. He fingered his worries like a beaded necklace.  He worried a lot.  Worry and shame.  He wished he could have a girlfriend but thought that was a hopeless cause.  Hank was already planning on buying a new magazine before Mom had thrown that one in the garbage.

It is so easy to explain away why Hank is the way he is.  We have heard enough to say, his parents, his brother, his isolation, his treatment from teachers.  We can use these to say, “Who wouldn’t be anxious, worried, down, and isolated, when going through these experiences?”  If we did though, we might miss the generalized anxiety disorder, the medical.  Conceptualizing the medical in this way can be so difficult.  We could call it, “the un-reasons why” we feel and do what we do.  So then we don’t have to deny it.  The un-reasons why don’t have to make sense.  They are un-reasons, after all. We don’t have to deny them by our inherent need to point at the cause and effect, or explain into uselessness the reason we are this way.  We don’t have avoid eye contact just because they can’t be seen.

Hank, like so many of us, is included in the statistics that generalized anxiety disorder, or GAD, is one of the top reasons why we don’t get intimate with others.  The anxiety is distracting.  It isolates us.  It preoccupies our thoughts.  It fills us with self-doubt and develops over time, almost inevitably if not treated, into depression.

Getting by with something as subtle as GAD, or other brain illnesses such as degrees of depression, have potentially devastating effects on what occupies our life-line.  The moments that construct the overall devastation may be explained away by one injustice or another, by what are thought to be personality quirks, or simply by neglect of self. But they could be different. The moments, the otherwise same moments, could be different.  The same rude, distrustful teacher, the rejection from Sarah, the quiet mike – those moments could have been different with the same guy, different only in his brain health.  Brain health makes the sameness different.

As Nancy A. Payne, of New York University (NYU) Silver School of Social Work, wrote about treating brain illness,

“There is tremendous satisfaction gained from facilitating the transition from profound illness to equally profound recovery.”

The life-line takes courage to look at.  It takes courage to believe that the effect of our negative thoughts and distorted perceptions could indeed have that pervasively profound effect.  It takes courage to consider that medical treatment can likewise, profoundly change our quality of life.

Hank tried to take his life with a rope before we met.  I’m so glad he didn’t break his neck or die.  He is now well treated and his disease is in remission.  His life-line has changed.Bo-J0zyIEAA_Y3h

Questions:  What are you brave with?  What do you spend your courage on?  Tell us about it.  We gain so much from community and connection.  Keep on.

Self-Care Tip:  Look also at the un-reasons, at the reasons less apparent, at what isn’t seen – look  into those reasons of why we feel and do.

Get Out Of The Company Of Comparisons. Forget About Fairness.

Tail lights, lights, rain on my windshield, co...

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Self-Care #186 – Forget about fairness.

It’s raining here; herding us.  I don’t like driving at night, but driving in the rain at night is worse.  Driving in the rain at night, with a rabid sheepdog tailgating me is still worse.  However, I do love slowing way down when I’m tailgated.  That was nice.  And seeing some family, including my folks, made it all worth it.

My kids were in on it too.  They were doling out banana smoothie and repeating a favorite theme called, “Make it fair!”  In Parenting, the frequent reminder that life will never be fair for my kids, and wondering if they’ll ever get it, gives me almost as much pleasure as being tailgated at night in the rain.

“Make it fair,” isn’t far from any of our hearts desires.  It’s easy for me to forget humility and judge my kids, but when people aren’t looking, I’m also checking to see how much I got.

I met a girl in clinic, Britt, who was also working this out for herself.  She was holding it in her hands and turning it over; a foreign object.  Britt said,

It doesn’t matter what has happened to me, I’m still responsible for taking care of myself…

She said it many ways, and the tail of her pauses kept flipping up into question marks without actually asking,

With my abuse…?  No one else will…?

I could see her with all the rest of us suffering folk, checking the fluid line in our glasses, saying

With all the hurt I’ve received…

I was poor my whole life…

I just can’t seem to get a break!

For Britt, coming to a point of owning her self-care felt like losing social support.  She had for so long sipped on her succor as a victim in the company of her received wrongs, that she felt awkward.  Britt needed to find a new group of friends.  She stood there toeing the floor,

I have to take care of myself.

Britt will be alright.  She will be emotionally healthier and in better company very soon.  She will move past where so many of us are still gripping our goblets asking about why we didn’t get more.  She will say, without that question, self-care begins and ends with “Me.”

Britt hasn’t been able to do this without medical help.  For her, part of seeing herself as a victim to what life gave her was symptomatic of her major depressive disorder.  She was personalizing what wasn’t personal.  Not everyone will need medication.  Some of us will do well just recognizing that, “Life is not fair,” and will be able to move on.

Question:  How have you gotten out of the company of comparisons?  How has putting fairness aside been a form of self-care for you?  Please tell me your story.

There is Less Space Between Emotions And Science Than We Think

The supermassive black holes are all that rema...

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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.

The Great Lie.

One of the great lies of mental illness is that, “If things weren’t so stressful, I wouldn’t feel so bad.”  Look inside ourselves now and see them.  All the numbered and ranked stressors we tick off to explain how we feel and/or behave.  How about someone we love.  Do we tell them, “Of course you feel that way!  Look at all you’re going through!”

Because major depressive disorder (MDD) is mainstream enough, I’ll use it as an example.  Who, when they are down, doesn’t look for reasons why?  Say there is an additive effect of stressors such as home conflicts, financial duress, and poor sleep.  Since these events, you haven’t felt pleasure, you’ve felt sad and depressed.  You aren’t motivated or interested in your usual.  And where you normally would seek people out when you felt down, to get more energy, now you just want to be alone.  And so on.  You are able to say that you started feeling this way progressively since triggered with those stressors about 3 months-ago.  Before that you were “fine.”

Many people in your life, have told you that you are just going through a bad spell.  You have believed them but say, “Even if this is a bad spell, if it goes on much longer I think I’d rather die.”  Your best friend responds, “Anyone would be depressed if their boss was that evil!”

My answer, “No.”  Feeling down is appropriate to stress when it doesn’t disrupt your life for more than two weeks at this level.  And it is never normal to want to die.  Everyone has stress but not everyone responds to stress in the same way.  Not everyone if put under your same triggers would develop MDD.

Would you have developed this disease if you weren’t put under these stressors?  I can’t say.  We develop illnesses for many reasons.  One of the many reasons is external stress.  A hypothesis supporting this is that stressors trigger our genes for MDD much like we know cancer genes can be turned on by stress.  However, we do not have a direct correlation to the stressors as being entirely causal events.

Even if it were, none-the-less, we are left with the disease process in progress.  It is not an adjustment reaction to stress.  It is medical illness.

Feeling this way is not normal for what you are going through.  Telling yourself that it is, that is the great lie.

Self-Care Tip #118 – Don’t believe the lie if what you’re going through is affecting your function in life.  Be a friend to yourself.

Question:  What whispering lies are you struggling against?  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.