Medical Specialties

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Why Psychiatry?

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If we have ever seen a psychiatrist, then there has been some point in our lives when someone told us to go or we told ourselves.  I have some questions for you.

How did you hear about psychiatry?

What are your thoughts?

What did/do you understand?

Please tell me your story!

Self-Care Tip – Explore your connection with psychiatry.

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To Connect Because you Want To But Would Be Advised Otherwise, Set Your Rules

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When we want to take what is good and leave the rest, to keep the best and let the otherwise character pathology pass us by, to make good memories with someone who torches the ground and air they breath, splits families and catastrophizes the little and ignores the big personal flaws – when we actually turn around and say with a fully informed consent, “I want us in each others lives,” make rules.

1.  Take care of “Me” (bio-psycho-social)

2.  Have walk-away power

3.  Nothing violates what you say is impermeable; such as you and your spouse, your nuclear family, your home

4.  Consistency combined with as blind a vision as you can bare

5.  Take nothing personal

6.  Pick your fights carefully

7.  Let them save face

8.  Set them up for success in your relationship

Each one of these generally takes hard work.  Some of it will be natural and easy.  A lot of it will be hard.

Setting boundaries for the other person helps them control their chaos and they’ll feel safer with themselves.  The boundaries, when clear for a person with character pathology, helps them trust themselves more and subsequently us more.

Again, if these things seem exhausting and insurmountable efforts, it might mean that medically – emotionally and behaviorally …–>  Go back to #1.  Take care of “Me.”

Self-Care Tip – To connect because you want to even when you’d be advised otherwise, set your rules.

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Guest Post by Richard

Chronic pain

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Guest Post by Richard, who was kind enough to send me his recap on last night’s Self-Care Workshop:

Salient points:

  1.        We are not special by our pain, we are special by who we are.
  2.        I use what I have (am).
  3.        The natural laws stay constant. There are small differences between each person. The divisions are flat.
  4.        Benefit of medical evaluation first to rule out physical causes, then look at outside of medical.
  5.        We inflict the pain not the biology.
  6.        We are in the present, trying to reach goals that will never be completely reached.
  7.        The agenda within, (such as your job.)
  8.        Unwrap and fight for your freedom, illustrated by our national history.
  9.        Stigma is biological.
  10.       Guilt is not always a choice.
  11.       Relinquish opinions of others. Cannot  change how others consider or view us as related to those who knew who we were at a different point in “our story.”  …I guess stigma is in the eye of the beholder?
  12.       The initiation of self-care is a difficult first step.

Question: how do you get loved ones to take the first step or do you?

-Richard

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Where to Find Your Council On Self-Care Outside of Yourself

Not sure where to look

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Self-Care Tip #226 – Find your council for self-care outside of yourself with psychiatry.

Many may wonder why a psychiatrist would talk about being a friend to yourself.  People who know psychiatry involves medicine, who think psychiatry excludes psychotherapy, who think self-care is holistic (i.e. holistic they interpret as non-medical) or who don’t bridge the gap that voluntary choices and choices regarding what is involuntary is still self-care – these people may wonder…  It’s no fault or judgment, it just is, as we like to say.

After all, psychiatry has changed a lot in the last thirty-plus years.  This category of people I speak of includes even physicians.  It is not easy to keep up on each other’s specialties.

I make my case for “microphone-time” (taking liberties to speak on this) based on the Biopsychosocial Model.  I boldly say that because Psychiatry flattens the planes between biology, psychology, sociology, then Psychiatry should speak up on self-care.  It is a broad perspective and often with some affecting differences from religion, clergy, laymen, psychology or other therapies by reputation (I’m not speaking about individuals.)

The beautiful bridge linking voluntary behaviors and emotions with the involuntary, and how that relates to our choices, our self-care, our freedom, saying all health begins and ends with Me is an enormous step in friendship with oneself.

Questions:  Where do you find your own opinion on this spectrum of thought?  And why?  What has your experience been with this?  Please tell me your story.

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Get Your Butter Knife Out and Spread Your Biopsychosocial Self Together

Grape Jelly is Spread Over Peanut Butter

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Probably when you have thought about psychiatry in the past, before this blog, you weren’t thinking about self-care.

What do you think of psychiatry?  Would any of you shout out a word, can I have a word, give me a word, any word that shoots to the front of your thoughts?

Psychiatry has changed.

There is a progression of how we view mental health now vs. even thirty years ago.

Back in the day, things went along the lines of poisonous medicines, close the window because sunshine is unhealthy for you, surgery without anesthesia, maggots… drilling holes in people’s heads to let evil spirits out and offering cigarettes to calm the nerves – or cigars as I wonder if any of u would argue.

Truth be told, I’m still learning about psychiatry.  I imagine I will be forever, because I think it is a science that flattens the universe and is unhinged from Time.  I don’t know how big or involved that is, but I’m thinking more than my sum of years can master.

For now, we understand that there is interplay between biological, psychological, and social issues that make us who we are.  We call this the Biopsychosocial Model.  Pretty cool word – biopsychosocial.  It hit me last night when I was working over these thoughts that self-care can also be organized, framed, conceptualized and all that to help it make more sense to us.

What is self-care?  Self-care is a philosophy that everything starts and ends with Me.  And that Me is all of me.  My biological, psychological and social self.

Self-Care is teaming up with our biology.  So where do behaviors and emotions come from?  This to me is one of the most challenging questions to answer from a cultural and moral level.  Can you tall me your gestalt?  Where do our emotions and behaviors come from?  What do they mean about who we are?

Self-Care is Empowerment and not victimization.  This is part of our “psychological” selves.  No one is responsible for our emotions but “Me.”

Self-Care is knowing our Essence. This is part of our “social” selves.  Our Essence is what we find after we get sick, after we change in every way but one, it is our identity, who or what we are.

To understand our essence, knowing our connections helps:

Connection:

  1. God/Love
  2. People
  3. knowledge

When we get sick, our identity, who or what we are – our essence might feel threatened.  Some people call this our “soul” instead of essence.  I found it interesting to think of the soul or essence as part of our “social” selves but it is and it helps me bring it all together better.  My soul is created for connections.  With you in fact.  And my soul has been more connected to the rest of me since you came.

Self-Care is Freedom.  This is another part of our “social” selves.  You may remember that phrase, “To love someone, you have to let them go.”  Freedom brings connection.  Lovely, no?

Now get out our butter knife and let’s smear all this together in a sandwich.  That is who we are.  Without dividers.  That is important if we plan on getting friendly with ourselves.

Self-Care Tip #211 – Whatever is tripping you up when you go, blend it in with the rest of you and things will get more friendly (smoother.)

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Pain Can Be Something More and Better Than Just Pain

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Self-Care Tip #181 – Look for help if your pain never becomes something more than pain.  Be a friend to yourself.

Glee is back!  I’m so glad because it makes great work-out distraction.  Good music, drama, beautiful people, and wonderful ah-ha concepts like,

Use your pain and loneliness to inspire you to make something beautiful.

Can’t remember it verbatim though and I noticed after an hour surfing the web for Mercedes quotes (and getting detoured to all sorts of other fun stuff for grazing) that whoever writes these quotes up didn’t find this one worth it.

Joni Eareckson Tada on the Larry King Show said that when she thanked God for her paralysis, she began to be productive through what paralysis offered.

It is however sometimes impossible to take what hurts and let it fuel our fires.  Sometimes it’s just a cold lump of coal.  Sometimes, we aren’t adaptable.

Luckily we aren’t sitting in a cave during the ice-age and can trust that a bear won’t come and eat us when we are wounded.  But there are other predators.  In my line of work, I could call disease process a preying force.  It takes over more and more cells, space, grey matter, consuming bits of our identity and changing our ability to cope with stress.

It’s easy for people to say, “Turn your pain into energy for creativity,” as if it were a volitional option for you like it was a choice for them.  Or we call it bits of morality; maybe a fourth of an inch on the rim of our gold crown we get in heaven.  Those of us who care about that crown look at our shoes, apologize and promise to try harder.

It is not easy to explain these apologies and inactivity to someone who has never been immobilized by mental illness.  Even those of us who have experienced it first hand have a hard time remembering the real texture of what we went through once it is passed.  Illness can be so awful that even our subconscious shudders when turned back to remember.  It is no wonder that we find it difficult to explain.

However, it doesn’t have to be this way.  If we aren’t able to adapt, aren’t elastic and sit stunned in the presence of pain, immobile to the newness that it can offer – recognize this as a flag to turn towards medical help.

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  Please tell me your story.

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Live And Live Despite The Ongoing Loss

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Self-Care Tip #141- Live and live despite the loss.  Be a friend to yourself.

The other day, my hair was barely pinned back in a knotty mass, when I arrived at clinic late with my house slippers still on.  I didn’t realize this of course until I heard this flapping sound echoing behind me as I hooned down the hall.  Distracted by myself, I seemed to suddenly come upon an old man.  He was lovely really, wrinkled, clearly handsome in his day, shuffling my same direction, and also in his house slippers.  It was less than a second when I took this all in and I suddenly felt very self-conscious.  Not awkward for the normal reasons that I should have been, like my nappy appearance, but I’ve never really thought I was “normal.”  No, I felt rude.  I’m much more sensitive to rude than ugly.

Do the younger seem rude to the older?  There with their supple joints, perky bodies and minds, hope, and shorter medication lists?  I felt rude.  Rude combined with awkward is not something most people are comfortable looking at, which is what I unfortunately offered up to this innocent man.  Walking fast felt wrong.  Not sure what to do, I sort of slowed, yet my tardiness to clinic didn’t let my gait relax.  Giving an uncertain smile, I managed not to make eye contact when I said “Hi there,” lest the eye contact lead to further tardiness.  Then off I galloped, luckily for both of us, only 3 doors down.

I didn’t spend more than a few seconds with that stranger, yet remember well what he symbolized for me.  I remember him when I get grumpy about not being able to eat as much as I did 10-years ago.  When I get resentful with my feet, (a size and a half HUGER since I had my first kid,) I see his lordosis (hunched back often from a collapsed spine.)  I wonder how he is doing with his losses.

There’s not much romance in growing old.  What is romantic is a beautiful person, who has been real with their losses and with the joys of life that are still available to them.  There’s no point in my denying that I can’t have cereal and pasta every day any more.  There’s no point in being angry about it.  I’ll just eat slower and force, er, I mean find more pleasure out of what I do eat.

I like to think that the old man in the hall made his and makes his peace with losses and is more glad than not for his life.  If so, maybe he was ok with my fast pace when he couldn’t.  Maybe it makes him more comfortable in a world in which he is becoming more and more of a stranger.  That is something to admire.  That is something that is worthy of life’s privilege.

After yesterday’s blog-post, a reader said it quite fine,

I did not know depression was progressive.  That’s depressing.  As is the realization that aging is progressive.  …On the other hand I can say I’ve had 61 more Christmas times than a new-born and perhaps that makes it worth it!

Question:  What losses are you struggling with?  How do you come to terms with your losses?  Please tell me your story.

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Go Toward The Pain To Get Connected

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Audrey came in looking fresh.  Better than before for sure.  She had an aura that brought to mind the moment just when tearing off wrapping paper.  It was nice to see her.

I am doing better.  I’m able to let more of the little things go, like the house doesn’t bother me as much when it’s not clean.

She was more able to do self-care with less forethought.  What did take her by surprise though, was her guilt.  She could see that it was inappropriate but insight didn’t entirely remove what shouldn’t be there.  She said these thoughts and feelings were something her husband likely never struggled with.  She didn’t think he was worried about her home doing dishes when he was at work.  However, the reverse for her was true.  She gave a coughing laugh.

I do!  I feel bad when he does the things.  It doesn’t make sense.  If he wasn’t washing dishes when I was working he’d just be watching TV.  But I still feel bad.

For her, working her job, taking her jogs, and attending Mommy groups were all in a grey category of “extras” for life.  Not necessary but bonuses she was spending their retirement on.  However, despite this, she looked the champion she was when saying,

I still am able to take care of myself.  Even though those thoughts come.

Audrey, by thinking about, talking about, and materially man-handling these thoughts, she was able to join her personal journey.  These things became connecting forces in her life.  They drew her closer to her family and not away.  Resentment dissipated and she was able to take part in her available positive emotions and thoughts.

It could have been different.  It had been different at other times, before medications and other positive deliberate choices in her life.  But it wasn’t now.  The could-have-beens trickled away together, the other near misses that sometimes we know about and sometimes we don’t.  There they go…

Going toward the pain in life, not averting from it, is a connecting force in our lives.

Question:  What have you been avoiding?  What has it done for you when you went toward the pain?  Please tell me your story.

Self-Care Tip #124 – Go toward the pain to feel connected.  Be a friend to yourself.

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Branding and Branded. Stigma Goes Both Ways.

 

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Oh, the struggle to understand that behaviors may have something to do with the brain! I shake my fist at stigma! I shake my fist at prejudice!

Now, I can go on a little calmer and say, if you are struggling with this yourself, you are not alone. Even if you are the one propagating it. You stand on the shoulders of others.

In Jesus’ own words:

Father, forgive them for they know not what they do.

He was talking to me, I know, and you.   We have all been rude and ignorant in our own time and our own place.   We find ourselves holding 2 positions, accuser and accused. The context of our various roles changes with knowledge, coping skills, experience, maturity, pain, mental capacity and so on.   But that we hold both roles in some space of time and place will never change in this world.   Even in heaven when we “see face-to-face” we won’t be completely informed.  We know we will continue learning timelessly. What will change is the abuse, the prejudice, the judgement.  Once and for all, we will finally let that go and believe at a chromosomal level that God is and deserves to be the only Judge.

There must be a genetic component to our double lives in this world. This tendency towards stigmatizing. We know there is a lot that isn’t genetic and for that we fight to grow ourselves and grow others for our own sakes and for theirs. The benefits reciprocate as much as the pain does. And even though being branded feels personal, it is not.

For more relating to this, read the blog posts Forget About Divisions In Knowledge, and Forgive to Get Friendly With Yourself.

Self-Care Tip #109 – Don’t take it too personally when people sneer. Be a friend to yourself.

Question: How do you keep yourself objective when prejudice hits you or someone you love? Please tell me your story.

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Free to Be Accountable

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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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Growing Old

Growing old.  When do we stop looking forward to the future?  My husband, who is a Palliative Care specialist, says that even in the end stages of life, we still look forward.

Erikson‘s psychosocial crisis theory of human development says life is a balance between conflicts.  Ambivalence, two opposing forces, is something to embrace and walk with.  I don’t think Erikson ever said it in so many words, but he was largely talking about having a sense of presence in our lives.  He based most of his theory on watching kids grow and then spread the rest over adulthood like the last bit of peanut butter on the knife.  Is that what adulthood is like?

My little girl told me that she’ll never run out of love for me.  (Every now and then, after hours or days of desert-like behaviors, she’ll break open a rock and out will gush something amazingly nice like that.)  Then she looked me over and said, “You’re not old Mommy!”  I showed her my gray and my spots and my wrinkles.  Maybe I was trying to say, “How can you love me in my future?”  Love is evergreen.  I am not.

When I was a kid, my parents loaded us up for a couple weeks every year and hauled us 8 hours in a van to Brian Head ski resort in Utah.  It is where I learned that some things stay green no matter what weather they live in.  The Evergreens, tall, tall, covered in snow except for some undergarments showing through were everywhere.  Even thinking about them, I can taste

Rolo Chocolate Caramel Candies,

feel the weight of booted feet, hear Dad’s bass voice and bits of my favorite ski-story loud to be heard above the chair lift.

Evergreen’s for at least 2 weeks a year, surrounded me and my family.  I’ve heard that Brian Head has materially changed a lot since we stopped going.  I wonder about the trees.  I’m sure there are fewer.

If it is true that every stage of  life has conflicts to resolve, it makes sense to me that in age we must resolve our future with our past.  We can’t just have a past.  If we find ourselves just looking back, than we are turning a blind eye to something we are meant to be present with.  Something that brings balance and fullness to life.  Something that is an evergreen quality.

For me, it is intuitive to look at God to meet this need – future v. past.  I don’t know what it is for others.  Conflict resolution.

When the days on life’s scale are tipping backwards, and we see that there aren’t as many days left on our plate, be present.  It is an illusion.  The past does not outweigh the future.  The opposing directions of time are just fine.

Self Care Tip #71 – Be present with the past by believing in your future.  Be a friend to yourself.

Question:  Agree or Disagree?  What are your thoughts?

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Hold Judgement

There are many traps that slow and trip us in life. Traps that shut us down. Yesterday I spoke about the neurological grooves and the role our choice has in making new grooves.

Behavioral changes are important, like putting up a road block in the path your thoughts usually travel. Knowing that my kids will tell me to put a dollar in the family jar if I yell (a road block), helps me pause long enough before I fall into that neurological loop and I’m blazing a new trail in my brain. Every time I cover that new path, success is more likely the next time. I know I’ll continue to be stressed. Life won’t stop. But, I have more hope that I won’t yell as a way to cope.

Saying that our behaviors are more than just results of our own choices is advanced for our culture, for the opinion of socialites. Knowing that our behaviors are the children of both neurological loops as well as the spirit of choice. Think about the many times in church when you’ve been preached at to turn from your ways, as if you were choosing them in the 1st place. The spirit of choice is the majority of what people talk about in any forum. And we agree, it is important. However, we don’t agree entirely. We now know about neurological loops and understand that the spirit of choice isn’t what’s behind everything other people see. Could there also be more? Yes!

In time, we’ll uncover other influences on the spectrum of behaviors. There are more. There are other paradigms that make us into our personalities. What would social opinion say of that? What does your own critical self say? When getting friendly with yourself, remember, things are never as bad as they seem, even you. As we tease apart the different influences on where our behaviors come from we’ll learn more of the mechanics on what to do with what we find.

Self Care Tip #6: Hold judgement. Be a friend to Yourself!