medication

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Do I have to stay on medication?

Medication treatment duration is a multi-threaded rug.

Some ask about the effect “wisdom and growth” has on their need for ongoing medication versus growing out of the need for medication therapy. It is normal logic to think that we should behave better and feel better when we know better. This leads many to wonder if it’s time to come off of medication therapy.

Let’s work on this by considering these variables.

  1. Coping skills. 

Coping skills are how we deal with stressors. When something happens to us, like getting yelled at, honked at when driving, or suffering a loss like a break up – our automatic thoughts and actions may be kind or unkind to ourselves. They may serve us well or may not. Coping skills can be intentionally grown, such as through dialectical behavioral therapy, and/or may require medical treatment. Coping skills regress with mental illness. But there are therapies that will improve them, helping our resilience, and helping us choose to continue vs. taper down medications.

  1. Recurrence.

Has the patient had multiple episodes. Multiple episodes of mental illness will signal differently, as compared to a single episode, in regards to risk of relapse.

  1. Genetic loading. 

What’s the family history of mental illness? Genetic loading. Genetic loading. Genetic loading. It tells the story of our biological risks. 

  1. Risks and Benefits.

Weighing the disabling impact the disease processes have on a patient’s life against the risks of medications. Consider the psychic suffering. We suffer and the suffering is real. Compare this to what we don’t like about taking medication. Weigh it and find your balance. Medication may be too “costly” to continue.

  1. Impact of disease process on future brain health. 

Mental illnesses in general are progressive, and the medication therapies not only treat the current symptoms but also are prophylactic (preventative and protective) against further brain insult. The brain now, if mental illness goes on, will be a different brain in ten years. We are fighting for that person too when we fight mental illness. Our future selves.

  1. Full treatment response.

Even though the patient has been on medication for a long time, what is the current condition of the diseases and the treatment response? Is the patient fully treated? Symptom free? Or does the patient have ongoing symptomatology even if improved from prior to treatment? For example, if the patient’s depression has resolved but they still have symptoms of anxiety then they are at a higher overall risk if medications are stopped. Being better may not be good enough. Or it might.

Self-Care Tip: Staying on medication can be discomfiting but take a turn with your treatment provider to consider.

Question: What is being on medication like for you? Tell us your story if you stopped it or if you chose to stay on it.

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In the mean-time, Waiting for Treatment Response

A crowd of Neuro-receptors fill our brain like a high school mosh pit. It’s noisy and possibly dangerous up there. It’s hard to focus. The negative thoughts are drumming. Medical treatment for depression is the Arthur Murray instructor to our brain-dance. And it takes time.  

When we take medication, the neurotransmitters targeted in our brain have to respond to the neuro-messengers that are the medication. Some receptors downregulate, i.e., decrease in number or activity. Other receptors likewise, upregulate. Again, this takes time. For example, fluoxetine, or Prozac, which came on the market in the late 80’s, is one of our most familiar antidepressants. When we start the medication, (and please don’t call them drugs because no one is panhandling for fluoxetine… Nor are we taking fluoxetine to get a high, but rather to treat a medical illness)… 

When we start fluoxetine, it can take 3-6weeks to start experiencing the benefits. Furthermore, during the first few weeks it is common to feel worse before we feel better. Worse anxiety, worse depression, this is because the receptors are learning a better dance. And it takes time to learn. And learning in this case feels worse before it feels better. 

You ask, what do we do until the medication takes effect? Marvelous consideration. Because here we are, asking for help, and our psychiatrist gives us something that makes it worse. Ummm. 

In the first couple weeks, which can feel like forever, perspective being what it is, a cloudy lens, feeling worse is described by the health of our brain. The brain, from which all emotions, behaviors, and sense of reality come from, takes time to heal.

We come to the psychiatrist by the hair of our chinny chin chin, almost dead inside. We waited, of course, to make the appointment. Waited for our courage to catch up with our disease. And then we waited for an appointment to open up three months later, seemingly forgotten at the train station scanning the crowd for kindness and help to come. And then? Then we receive treatment that takes another month to start, to start I say, not finish, the healing it promised, (a promise that values at about 50-60% of the time to come through. That’s the statistic for fluoxetine to be effective for each of us with our first trial of depression treatment. Thereafter, the likelihood of responding to fluoxetine diminishes after each trial.) 

This is the lighting on the stage for your question, “What do we do in the meantime?” We survive?

It’s too easy to come up with behavioral solutions that if they were to work, they would have already done so during that waiting – ex: 2 months of worsening mood, 2 months to call the psychiatrist, 3 months to get in for your appointment, 1 month for the medication to start working = 8 months. 

You’re not a dummy. But we’ve been advised as if we were by our community. “Feel better.” “Snap out of it.” “Pull yourself together.” “Be strong.” It’s not like you didn’t think of these on your own and were waiting for someone wiser to tell you to get on with life. But, If you are able to, please do get on with it. Go exercise. Sleep better. Eat better. Look at the world with hope.

For the rest of us with melancholia, ie. major depression, the choice left us when we lost brain health. Similar to the alcoholic choosing not to drink, choosing to feel well isn’t a choice. When the medical illness recovers, we gain our freedom to choose those things back. 

During these “8 months” there are some things that can be done however. 

Go to a psychiatric partial hospital program, (“PHP”).  This is a day hospital where you attend for about 6 hours, 5 days a week, for about 4-9 weeks. It’s incredibly supportive. But more than that, PHP teaches dialectical behavioral therapy, (“DBT”), a type of therapy that has been shown to make changes at a cellular level. There are changes to our automatic thoughts, so that when something triggers us, our pre conscious response is more friendly to “Me.”  It’s not a “stick-shift”, but rather increasingly automatic. The key is to work toward brain health. 

Others will collaborate with their psychiatrist to augment fluoxetine, or whichever antidepressant of choice, with another medication that can help pop you out of depression sooner. These treatments are not generally long lasting and don’t treat the underlying illness. Rather they treat the symptoms here and now. Some examples used include stimulants or thyroid replacement therapy. 

In the end, be in a community of support – be it PHP,  outpatient therapy, or NAMI. 

Support is the shell to our drippy egg, while we wait for our medical treatments to take effect. 

Question: Have your efforts in treatment worked out? What’s your story?

Self Care Tip: Don’t give up! Pursue treatment. Your illness is treatable. But in the meantime… be in a community of support. Keep on!

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God in the Space of Synthetics

Hello Friends!

I’m going to try something a little different today. I’m posting a dictation between a patient of mine and me because I think it has flow and a nucleus. (There are a few small changes made in liberty, and no identifying data.) Let me know what you think of the content.

Psychiatrist:  …And so we were talking about perfectionism, right? 

Patient:  Yes. 

Psychiatrist:  And about how you are not being kind to yourself when you expect yourself to be all healthy.

Patient:  I’m not being kind to myself when I don’t want to take this or that because I don’t do synthetics. (This is what my patient was using to describe medications.)

Psychiatrist:  I like that you used the word synthetics, because I’ve never put it in that perspective with patients, and you did that for me. 

Patient:  Well, there are non-synthetic and there are synthetic. 

There’s body recognizing things, plants, and then there are the synthetics, what the pharmaceutical companies produce. And I’m a very negative pharmaceutical company person. 

Psychiatrist:  Compare that to other inconsistencies in our life. Such as, I’m going to be all-natural, I’m only going to wear hemp.

Or take it to the point where I’m going to weave my own clothes because it’s really natural and I know exactly what’s in it. Versus saying that I’m moving forward and I’m going to take what science has offered to us. I’m wearing polyester right now. 

Or, I’m willing to take over the counter “herbs” because they don’t have the pharmaceutical stamp on it, or maybe I like that it grows out of the ground. But none of that has been governed. Aside from the “he-said-she-said evidence,” there’s often little science behind some popular over the counter remedies either. 

Let’s consider that perhaps the study data, comparing in a regulated way, one patient with another, defined synthetic agents, and then allowed my body to be its healthier self. It gave us objective data. Numbers. Sure they have their flaws and weaknesses as we learn in statistics that all does. Poke holes in it as you wish, but at least there is a degree of transparency.

Patient:  Maybe for me it’s more trust, because I feel like people are so over-medicated today. And it’s easy to write out a prescription than to really deal with the issue. 

(Me, on the sly: This view, that practitioners prescribe for reasons other than for the medical benefit of the patient, is one that I honor with humility, and stand up and listen when others voice it. Annals fill the internet search engines on it, I’m sure. I will still pick at it a little, I’m a stubborn nubby person like that.

Let us note together that the word, “easy,” in this context isn’t so kind to our person. Taking medication to treat a medical illness is often not easy. It is one of the most courageous acts in someone’s life. And this wonderful lady, who came into my scary office, was a great example of this kind of courage. She wasn’t here doing what was easy. She was giving her emotional entrails a work-over with her psychiatry venture.

This patient, whom I will name hereafter, Lady Courage, was “really dealing” with the issue, in contrast to her self-described mores. Might we suspect the insidious tendrils of “Mister Stigma” shaming her? Yet here she was… Just fabulous!)

Lady Courage: I’m more one that, “Let’s really deal with your issues, and then your mind should come around, everything should come around.” That’s how I view it, because if you don’t fix the underlying problem you’re never going to fix the problem with meds.

Psychiatrist:  Okay. But you’re willing to say there might be some inconsistencies in that right now.

Lady Courage:  Right, no, I’m not … 

Psychiatrist:  It might not be entirely false, but it might not be entirely true. 

Lady Courage:  Exactly. 

Psychiatrist:  We were saying, “I can be healthy but still have disease in my life.” 

Lady Courage:  Yes, that’s true. 

Psychiatrist:  Because I don’t have to be perfect. 

Lady Courage:  Right. And I do find that a little bit hard. But since you put it in that aspect of being, “healthy with disease,” I can see that. I probably never saw that before, because I did always separate the two, either you’re one or the other. 

Psychiatrist:  Wow. 

Lady Courage:  Yeah. 

Psychiatrist:  That’s poignant. Is that how you see God as well? 

Lady Courage:  In what aspect? Like, yeah … Well, you know what? I try to strive to walk in His ways. I haven’t always walked in His way, so I do have guilt about that, but I shouldn’t have that and I know He’s already said He’s forgotten it, He’s washed me clean. So it’s just receiving it for myself. And that just is faith. And I know then it makes me feel like I’m lacking a little faith, but I know I should be stronger. But, yeah, The Word is something that I strive to follow, and it’s hard. 

Psychiatrist:  So do you feel like God is, “either/or,” in the way He looks at you? What about the parts of you that are diseased? 

Lady Courage:  Well, no, yeah, He’s going to heal that. 

Psychiatrist:  But what if He doesn’t right now? What does that mean about who God is?

Lady Courage:  Well, He sent me here probably in hopes that you can help me to heal. He provides these avenues for us, so that we can get healed. 

(Folks! So good! Smile.)

Psychiatrist:  So you somehow think that God enters into the space of the synthetic. 

Lady Courage:  Well, yeah, I guess so, yeah. I do, okay. It’s so contradictory, but in one aspect I do take a thyroid medication that is a synthetic, but I know I have to take that and I understand it and I don’t feel it’s abusive. And I look at my blood work and I know where I’m supposed to be and how much I should be, so I feel confident. But when it comes to things like this that I’m not used to taking, and that don’t show up on labs, and it involves transforming my brain, I’m not really on board with that. 

Psychiatrist:  So when you use the word transforming my brain, I understand you’re saying that it’s making you into something different? 

Lady Courage:  It can alter your brain, yes. 

Psychiatrist:  Okay, so that’s the part I think that’s very scary for people, because they think it’s making them into somebody they’re not. But in reality the medications are there for healing who you already are. So for example, today you feel more like yourself than you did last week. 

Lady Courage:  Well, yeah, last week I was desperate and hurting and losing weight and scared. 

Psychiatrist:  And today you’re closer to who you think your healthy self is. 

Lady Courage:  I think today I’m … Yes, I’m much closer to my healthy self. 

(Q: Closer to who God is creating you to be? Closer to God’s will even?)

Psychiatrist:  In all of these scenarios, at each point we want to think, “What does this say about who God is?” If He or She, (but we will say He to simplify because it’s culturally appropriate,) is kind and loving like you mentioned, then would this belief, X, Y or Z, be true?

Self-Care Tip: Lay out our beliefs next to that standard, that premise in our life. And because we’re a lot crueler to ourselves, then we would allow other people to be, it can rescue us on occasion.

Questions: “What does this say about who God is?” Please speak out!!! …and, Keep on!

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Medication vs Drugs

I imagine some day I’ll understand why users think drugs are healthier options for them then medications.

“Doctor, I don’t think my wife will be comfortable with me adding another medication. It seems like I’m already taking so many!”

Context: Brennon is using THC “for sleep” he explains. Not recreation. It’s “medicinal.”

Boy. We are going to have to redefine what “medicinal” means in the urban dictionary vs. in the medical. 

It’s as if the masses out there are acting like it is stigma behind any opposition of THC vs. science. Folks, there may be stigma involved but it’s mostly science. THC is, 99%, not medicinal. 

My cousin is a hospice nurse and she and I were discussing this. Along the meandering conversation way, we came across, that in her field, many are taking CBD. (I know most of us think CBD is THC-free but it’s not unless it’s thoroughly governed by the FDA.) When we were in our wandering conversation about this, I imagined out loud to her, “If I were dying, I’d want to take a good trip on LSD, do a line of cocaine, and have free access to heroine. Why not?! “

My cousin politely explained that in end-of-life, most people, not apparently ignoramus blind bigots such as myself, prefer to stay alert in their last moments with their loved ones. 

That makes a lot of sense. My “free ticket” to white clouded oblivion suddenly didn’t look as appealing. I’d like that too. I’d really like to have connection with my loved ones. At any time. 

This is the effort in psychiatry as well, believe it or not. When we medicate, we are seeking to align ourselves with the patient’s agenda, toward connection and not away. Toward quality of life and not to harm. Toward hope. When we encourage to take medication, it is not to seek oblivion and isolation. Rather medication is for connection.

Brennon is not alone. Many think that medication takes us away from connection. Away from connection to ourselves by turning us into something we are not. “Doctor, I don’t want to take anything that will turn me into someone I’m not.”

Away from connection to God by taking our willingness to submit to His/Her will, away from His/Her power and toward depending on science instead, as if there is an either/or. No, there is no either-or unless we put it there. There are no dividers between science and God. He/She made them both. They are fluid to Him/Her.

Nor is taking medication taking us out of connection to our partners, nor our family who thinks medication is a cop out and whom are loaded with their own journey of self-discovery over their own self-stigma toward medication. As if taking medication makes our patients less loyal to their loved ones, thereby less connected.

It’s so layered why we think medication is worse. Even worse than mind-altering THC. Even worse, than the disabling illness, or whichever idea it may be.

Question: What is medication worse than for you?

Self-care tip: Seek connection, “even” through medical ways. Be a friend to yourself. Keep on!

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Emotions come from the brain.

Margarit was a lovely twenty-something, with blue-black bouncing hair above a slim pixy framed physique. She smiled easily and chattered like she was on telephone call that was about to lose reception. Her hands moved, conducting her thoughts between us. She was dressed like one of the cool girls on campus, out of my echelon, and who just might stab me in the back if I didn’t know better. But I did. She wasn’t mean. She was super sweet, like honey, and cane sugar, and mangos. Margarit was nice. But she had always wondered if she was being so nice all the time, because she was too nervous to be otherwise.

She came because she was constantly preoccupied by worries over things, “no one should be worried about”.

There had been the counsellors, therapists, and pastors consulted. Margarit and her parents had done their due diligence. With initiating each effort toward getting help for Margarit’s anxiety, they anticipated some degree of success. They thought things would get better. And sometimes they did, in degrees, and for a period of time. but the anxiety always came back. It got to the point that Margarit was put in home school, referenced her looping thoughts for everything, and was socially immobilized.

Maybe you’ve read, Gulliver’s Travels, 1726 by the Irish writer and clergyman Jonathan Swift. When Gulliver shipwrecked and washed ashore unconscious, the numerous tiny Lilliputians effectively tied him down. The rope anchors were so small, like acupuncture needles, yet Gulliver could not move. That’s what anxiety does to us. We become internally preoccupied by it and can’t think much outside of our thoughts. We are immobilized.

The anxiety Margarit had been harassed with since a child took her freedoms away. It chose for her before she even knew what she would decide. Example; friends want me to go to the mall with them. “No,” Before her thoughts could even play with the option. Maybe she wouldn’t have gone anyways. Or maybe she would have. The anxiety chose first though and she wasn’t given the chance.

By Margarit’s third visit, she had improved significantly. She was getting to know herself, she thought, for the first time. I met the parents this visit and they looked at me as a front. I supposed it had been them up against so much for so long now, that they had learned to go at the world this way, like a man plow they both held on to. They asked me why no one had ever recommended for Margarit to seek medical treatment for anxiety.

"We would have done anything asked by one of these professionals we took her to. We thought they should know what to do, but they didn't tell us to get her medical help."

In my mind, I flashed to Naaman being told by Elishah to dunk in the dirty Jordan river seven times to cure his leprosy (2Kings 5). Psychiatry is the filthy river and dunking in it is the nonsensical act of taking psychotropics based on magic and miracles. They were here reluctantly having preferred to start with clergy and therapists, beat up by inappropriate guilt, but ready now to consider that anxiety, in Margarit’s case, is a medical symptom of a biological illness.

The question of why no one had referred them toward a medical approach for their daughter’s illness is a good one, though. I asked a pastor what he thought, and he spoke of the difficulty of not being a medical specialist; not knowing when to refer people. And what of the therapists? Likewise, I guess, that they generally have been trained to approach emotions and behaviors through a psychological and sociological paradigm. And what of the parents themselves? Did they, when their daughter broke her collar bone in the 3rd grade after Christy pushed her off the swings, take her to the emergency room or to the movies for a night out? The ER. But when her daughter showed preoccupied thoughts that permeated her days, affecting her choices, small or large, affecting her sleep, and so forth, they did not think that the thoughts were related to anything medical, coming from her brain. They did not think that the thoughts were more than coping skills, or habits, or choice.

It is a condition of our humanity to want to look at thoughts and behaviors as many bits of our life control to be manipulated intentionally. As if we could. Like “The Matrix.” Or cooking a soufflé. Or driving a 1969 Chevrolet Camero. Shift already! There’s the good intentioned phrase, “Calm down.” “Take a chill pill.”

Oh good. Someone finally said it. If they didn’t I never would have thought of that. Now I am calm because I was told to be calm.

Emotions and behaviors come from the brain. Take the brain out and no matter what chaos hits, we would feel fine. Take the chaos away, and leave the brain in, we are still left with the brain, and what ever condition of health the brain is in.  So if the brain is ill, it expresses itself in a way that is ill. If the brain is healthy, the emotions and behaviors are healthy. They are symptoms of a medical condition.

Question: Where do you find your sense of control comes from, considering the biological paradigm? Let’s talk folks!

Self-Care Tip: Consider the biology behind whatever it is that feel and do.

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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!

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Making our way through the questions on ECT – Top 3 Reasons for Being an Advocate

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

fancy

Ooh La La!

So much fun to play dress up! When I was a scrub, a solid big boned unkempt of the Cleveland National Forest bordered lemon groves, when I walked barefoot, disappeared for the entire day in the rattlesnake infested chaparral, when I followed my brothers around like a desperate child, I still liked to play dress-up. I would sneak into my mother’s long closet, a dressing room really, with folding doors. I could hide behind her dresses, or climb up onto her shelves and be nothing more than luggage. But mostly I remember staring at her clothes and shoes. I remember one of her all time best outfits – a blue knit bell-bottomed jumper. A wide white belt with a hand-made gold buckle was an excellent accent. Yes, it would drag down below, but all the better to cover my brown feet.

When I think of my top three reasons for being an advocate for ECT, I think of dress-up. There are so many great options to put on, and I can and do exchange them with aplomb, as Fancy Nancy would say. That’s a French word for poise. It’s fancy. If you catch sight of my brown feet here and there, well, you can’t take the hills out of the psychiatrist I guess.

For today, Reason Numero Uno, (Fancy for #1, in honor of the second language I wanna-be speak):

  • It works most consistently, and most quickly of any treatment available. One must pick her fights after all, mustn’t she?

Reason Ithnān, (Arabic for two, in honor of my fancy mother):

  • It doesn’t touch “the body,” i.e. metabolics. Clean.

Reason Trois, pronounced I think like, twa, (Fancy Nancy’s favorite language. Need anyone explain? “French is fancy”):

For example, just by requiring someone to help with transportation, it’s built in. That thereby inherently increases community awareness of mental illness, something we rarely speak of with each other.

Then there is the medical staff. Our nurses are every patient’s advocate. Our masseuse increases oxytocin and other healing neurotransmitters when the patient’s get their massage waiting for treatment and then when in recovery. Our anesthesiologists are knowledgable, see the patient in their “whole person,” often picking up other issues that then will get the patient to receive treatment and improve the patient’s quality of life (QOL); such as hypertension, obstructive sleep apnea, etc…

There’s more, but basically in ECT, none of our patient’s are alone. That stands.

Question: What are the top three reasons you prefer the treatments you engage in? 

Self-care Tip: It is always helpful to write out why you are doing what you are doing, when it comes to medical treatments.

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The Modular Brain Doesn’t Need God?

I’ve been a little scared of losing God most of my professional education and practice life.  Everyone knows that no one can make it through psychiatry and still believe in God.  And those that do make it through psychiatry and still believe in God, don’t get it. Or so the opinion goes.

When I started medicine, I thought I’d most likely go into psychiatry.  I read my Bible every day. I was crushed by landslides of information I had to learn. With the equivalent of dirt in my hair, broken bones, and blood, I participated in prayer groups and Bible studies. I had to sleep eight hours a night.  If I didn’t, I couldn’t lay down knowledge and I couldn’t cope.  You may be one of those lucky persons who only need four to six hours of sleep at night to be human.  This an advantage equivalent to getting a silver silk parachute airdrop of food, medicine, and weapons in the Hunger Games.  I graduated from medical school and still had God.

Psychiatry residency opened up and I got closer to the the lions den.

What I found is that if you believe in God you are distrusted by colleagues.  If you believe in God you are distrusted by Christians because you’re a psychiatrist. And by Scientologists.

Innocents seem to be fine when they enter into psychiatry residency.  Then they come out totally changed. It disappoints Dad. Surrounded by cerebralists.  It changes the plans sponsors have made for the psychiatrists.  The psychiatrist doesn’t get invited to speak at church. The sponsors think they must have let him or her down.  And the sponsors thought the psychiatrists let them down.

Psychiatry is very high risk to the psychiatrist.  Why is it harder for them to keep God? It’s just generally not taught to utilize God in remedial processes with broken people. “And yet that is what God does best,” says my orthopedic buddy.  He says, “Psychiatry breaks down interpersonal relationships rather than include the spiritual. Unless the psychiatrist feels very comfortable with the healing and revitalizing powers of God, they don’t use it for themselves in practice.”  Is there a God-desensitization process built into their education.?

When studying where emotions and behaviors come from, God can’t be scaled.  There is no way to measure God.

We delve into human behaviors and emotions so intimately in psychiatry.  Once you realize that those things we used to moralize our life parameters with, once we realize that a perception of God is that “easily explained,” we don’t know what or who God is if not that.  Psychiatry deals with the mind and spirit and not the musculoskeletal world.  They are are right in the middle of breakdowns in that field where good bones and joints don’t make the difference.  They are right there where good behaviors and emotions are valued,  and explained in terms of grey matter.  Psychiatrist come to understand that everything is modular in the brain.  At that point, there is no need for God anymore.

Why do people lose God?  Parents blame themselves.  “I’ll never forgive myself.”  They know what they’ve lost.

Remember that song by Sting, “I hope the Russians love their children too“?  God v the Modular Brain might become a war.

My next book is going to be about God and psychiatry.  Wish me luck.  Recommendations, opinions, (no crude gestures,) and silver silk parachutes airdropped are all welcome.  Don’t hate me.  Keep on.

Conditional Love With Me

frayed rope

We have a tenuous relationship with ourselves.  Very conditional, as if we were in a constant state of probation. Have you noticed?  Conditional love: part of the human condition.

I was reading the The Golem and the Jinni: A Novel, by Helene Wecker, and found myself getting into her golem-philosophy, that went something like this,

Since so many of us have it, can’t you just say it is the way things are, and not about freedom or fairness?

Wecker in such eloquence ironically describes the human condition from the story of two inhuman beings.

The New York Times, , describes it as,

When they are later confronted by the evil power who controls their fates, they discover that the ultimate expression of free will may lie in the embrace of limitations.

In considering our limitations in loving our own self, this idea can be useful to come to terms with the day in and out internal conflict of loving what is imperfect and distasteful, with what we would otherwise rather not identify with, and with the acts of friendship toward this seemingly inhuman part of our selves.  In embracing our limitations, we may find less conflict in loving Me, less conditioning, or perhaps a shorter probation each day.  We may experience the probation differently, Chava, The Golem, when we say, “It just is this way with all of us.  I have the community of humanity.”

Getting into the space of where our “tenuous bond” between what we love and would otherwise not love about ME, in fact diminishes the frailty and increases the strength in our personal journey.  Rather than putting us into further danger of internal conflict and self-loathing, it allows us to experience what will happen from and in the company of the tension.

More specifically, in brain health, getting into the space of our conditional love for our self, allows us to do things like seek medical treatment when needed, ally with help, with medical treatments that once repulsed us, with something as formulated as putting a pill in our mouth seven days a week indefinitely.  Or another treatment, such as ECT.

We are conditional with ourselves.  It is part of our human condition.  That is pretty close to, “Normal.”

Question: How often are you aware of your own difficulty loving yourself, your Me?  What improves this?  Why does difficulty with loving Me recur and recur without end?  Please tell us your story.

Self-Care Tip:  Get into the tenuous space between the “good and bad” of Me where you are normal.

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Medical Therapies Are Like Old or New Rugs

English: Physician of Rome During the Empire -...

The older I get, the more reputation I accumulate.  I am an old rug.

Have you ever seen a child – their smooth, unblemished skin like marsh-mellows;

their eyes, cupcakes, (my children’s are chocolate);

the way they look at the world open-mouthed swallowing flies;

the way the world looks at them?  Both sides hungry.

We say about these kids in contrast to us old property, “They have it all.”  They have it all because they just have not been around for very long.  They do no have a bunch of mistakes accumulated, crafted and woven into their lives; mistakes that could not be outed.  

Children do not have a limited supply of first beginnings.  When you have been around a while like us, first beginnings seem like they have changed their constitution.  On this side of the freeway, even though we have the freedom to start over at any point in our lives, starting over means something different when you have been around.  

It is not a matter of value.  Being around does not devalue Me.  It does not take away our worth.  It does not improve our worth – the Me we speak of.  Perhaps it will improve our worth in other ways or lessen it – but it won’t touch Me.  

There is nothing like a veteran office staff who knows how to do everything that your office needs.  That person is different from somebody out of high school.   Better for the position – yes, but not a better Me.  There is nothing like having a physician who has practiced for ten or twenty years and seen patients walk out angry, has seen patients die, has seen in action which treatments do what.  There is nothing like a physician who has worked with a medication long enough to know the inside of it; that there is good and there are things that happen that are not so good and that when you cannot unravel those things from that therapy, you try to see it together.  A more valuable physician for the job, but not a more valuable Me.  

The office staff, the physician and the child have reputations.  Those who have been around would take up more ink.  

Treatments are like that too.  The longer they have been around, the more reputation they have.  It is like being at a party and you see somebody who has been to all of the parties.  Somebody who has been the first to come and the last to leave, who has hurt people and been hurt and who has gossips surround them.  When you see that person, you walk in the door and think, “Oh boy!”  Or, “Yes! the party girl is here.”  But no matter what you think of them, there is something to say about them lasting as long as they have in these circles.  There’s a reason they keep getting invited and a reason they weren’t taken off lists.  

A treatment that’s been around a really long time, that has gotten a bunch of heat and perhaps even been referred to as “barbaric,”  has remained in circulation for reasons worth knowing.  If it didn’t offer lasting and unique benefits, if it’s benefits weren’t considered greater than the risks and potential negative outcomes, if people’s lives weren’t improved more than they were damaged – that treatment, like so many others, would have extinguished on their own much earlier in history.  

Questions:  What do you think when you see the treatment that you have been offered.  Has it been around long enough to get a reputation.  Or is it the new kid, the new child with velvet for skin?  Their eyes have not woven in shards of particled light that tangled the loom perhaps?  You with reputations, who are older than this and still around, tell us your story.

Self-Care Tip:  When considering treatments, consider their age as you consider their reputation.  Be a friend to yourself.

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Medications and Being Chosen by Fear

English: In 1870 he lost an arm, in 1917 he lo...

Many have been hurt by medications.  There are those life ending treatments.  There are accidents.  It doesn’t matter what remote or near number in the chance-line the side effect has to the victim or the survivors.  They happened and they happen.

If you are a survivor of something like this, if your child died or your mother almost did, if you lost your favorite thing in life – lost what you identified yourself by or if you were changed without being asked, you know what I am talking about.

How do you come back after that?  How do you endure opening your pill dispenser on Wednesday, on Thursday, every week, every day, how do you take medications when they are prescribed?

On my end as a physician, each prescription is a choice.  Each prescription carries the bit I am allowed to participate in.  Signing my name, I am saying with the informed patient, that the benefits outweigh the risks.

When you take your medications, know that you are not alone.  Know that you are doing this with numbers of other courageous people taking their medications.  Know that your physician, with the research behind this, with the high numbers of other persons generous enough to enroll themselves in those medication trials before the Federal Drug Administration (FDA) approved it.  Know that the FDA is with you and know that the benefits out weigh the risks for you.  That you decided the benefits are greater than the risks means you know what they are and you are choosing to take care of yourself.

Medication isn’t for everyone.  Medication hurts a lot of us.  Taking medication with this knowledge is still something many of us choose.

If we are not taking our medication because the fear precludes it, we can do better than that for ourselves.  We can choose not to take it without being chosen by fear.  On the flip side, we can choose to take medication without being chose by fear.  Being chosen by fear hurts us too.

Self-Care Tip:  Go into the space of where your fears are and let it lose power over you.

Questions:  How do you claim your freedom to choose when it comes to something as complicated and scary as medication?  Please tell us your story.

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How To Stop A Relapse Before It Starts

Australian garden orb weaver spider, after hav...

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Baby I have been here before
I know this room, I’ve walked this floor
I used to live alone before I knew you.
I’ve seen your flag on the marble arch
Love is not a victory march
It’s a cold and it’s a broken Hallelujah…

– Leonard Cohen

Relapsing in brain illness is the pits.  The prodrome, as it starts creeping into our awareness, is worse than knowing we are about to walk into a spider web with the spider and his dinner still in it.  It’s so horrible that even before the prodrome hits, imagining a relapse can trigger foreboding and anticipatory anxiety.

What will I do if I…?  

Dear God no…

Recently we did a brief series on ECT and discussed how ECT can improve brain health, signal neurogenesis and trigger healing.  This brought many of us to wonder about what causes brain damage.  It became apparent that many of us had forgotten that brain illness, in fact, damages the brain.  We still have a hard time, despite all our progressive activism and awareness, believing to the core that the brain is human, that emotions and behaviors come from the brain and that a diseased brain is what generates disease symptoms as seen in emotions and behaviors.  We still have a hard time believing that the brain responds to medication, much like the liver does.

What?!  Depression causes brain damage?

What?  

Now compound that with the spider’s cousin, Medication-For-Life, and you’ll see us doing a funny walk-hop-dance in the dark to avoid what we wish we weren’t getting into.

The wonderful bit about all this is that staying on medications, even for life, is the best way to dodge the worst of it.  Sure, even with medications, as prescribed, compliant and all that fluffy five-star behavior, we still relapse.  “Depression should be considered as a continuous rather than an episodic process,” as stated so well by French biomedical expert, Vidailhet P.   But, (this is really good news,) when we relapse, we do not drop as fast, we do not fall as low and we do not hit as hard when medication compliant.  Staying on medication is prophylactic against those miseries.  Staying on medication is protective against progressive brain disease and it’s deteriorating effects.  Staying on medication is friendly.

…Hallelujah, Hallelujah
Hallelujah, Hallelujah

–Leonard Cohen

Question:  What have you noticed that staying on your medication has done for you?  How do you manage to stay on it even when you don’t want to?  

When you’ve come off of it and relapsed, how was it different from when you relapsed while still maintaining your medication therapies?  Please tell us your story.

Self-Care Tip – Stay on your medication.

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You are Valuable. Being With You Is A Privilege. Even for You.

A scattering of "brilliant" cut diam...

You are valuable.

Things in life; status, emotions, perception of different realities change – but this will not.  You are valuable.  Any time with you, even if only in your thoughts, is an immense privilege – for me or anyone, including you.  You? Privileged to be with you?  Yes.

Have you ever lost yourself?  Have you felt the heat hit your face when your thoughts fly into a rage, words rushing out as if exploding dynamite.  Bewildering, no?  You know then.

Have you forgotten where your car keys are but do not care because you are still in bed and have no motivation to move.  Your calendar, that once excited the tap of your fingers across your keyboard, holds no interest now.  You hide, ashamed but mostly you just do not want to explain to others.  “Too much energy,” you think.  If so, you know then that being with you is a privilege.

All these things you despise are reminders that you are precious and of immense value.  You are worth anything and everything to have the chance of holding once again.  You are the reason people crossed the prairies, fought against the sun and hunted for food to survive.  You are the reason the ark survived for forty days and forty nights.  You are the reason precious metals are considered lovely.  And it is because of you that you want to be your friend.  You are valuable.

In the previous chapter, we talked about Briggs and his wife.  They did not like the condition they were in, but they valued themselves as evidenced by seeking help.  While taking their history, I gathered together the names of medications Briggs had taken, when he took them, why he took them, how long, why he stopped and what they did for him.  And then the foreboding came.  I started thinking about numbers.

Now, you know that I am not a number person.  Remember?  “Big fat F.”  (F for feeler in terms of Jungian Typology.)  But here was Briggs and when the numbers started obstructing my “F” I got uncomfortable.  That meant to me that Briggs was risky.  He could die.

In Chapter One, I asked you, “Is there any treatment you think is too extreme to consider to get brain health?”  I did not say this directly to Briggs but I said it.  In my thoughts, Briggs is so courageous to fight the cruel sun the way he does.  In my thoughts, he is why freedom and fresh flowers and hope remain.  He is valuable.  I wanted to know his answer.

“Briggs, what do you want to do now?” 

Our culture does not remember that Briggs is the reason that diamonds cost more than more.  Culture tells us that he is damaged and not so much of a treasure.  Culture says, some treatments are shameful and the value of hiding shame is more than the value of Briggs, or me, or you.  For shame.  The value of Me is more than the value of hiding shame.

We are part of culture and culture is part of us.  Knowing what we want to do when what we have done has not yet worked, this knowing begins with our culture and with our self-value.  This knowing of Me increases our freedom to choose.  Knowing the value of Me increases our courage to choose what is difficult, what takes energy and hard work and a standing up against stigma and the taking of risks.  Knowing what we want to do when starts with knowing the value of Me.

You are valuable and being with you is a privilege.

Questions:  

  • Do you know your value?  

  • If you are lost, what are you willing to do to be with yourself again?  

  • How has knowing your self-value increased your freedom to choose?  

  • How has knowing your self-value helped you decide what to do when you were or are ill?

Please tell me your story.

Self-Care Tip – Remember your value.

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Please Get Back on Your Meds!

Please get back on your meds!

Pretha explained that her mom had done better on her medication.  It was the irritability that isolated her.  That and the boredom.

It’s just boring, her daughter said.  It’s boring because there’s just so little there before she falls into her fray.  The venere is so thin.  It’s just boring.  

Pretha’s mom who had taken her medication didn’t see what it was doing for her.  Every day it had hurt her a little, knowing what she knew.  She was better now that she had given it over to God.  Her life without medication was a testimony to the power of God.  She had not been faithful taking medication.

What do you think, doctor?  How am I doing?  Aren’t I doing well?

Pretha’s mom was difficult to maintain eye contact with.  I wanted to please her.  That’s not easy for a physician.  At least for me.  It was more uncomfortable because my thoughts had already skated down the path of what if’s.  Whatever I said, Pretha’s mom wasn’t going to get back on her meds.

Where’s the self-care in this?  Pretha?  Mom?  Physician?  You, reader?  Do you identify with any of us?

Pretha and I have similar jobs.  Keep what is about Me, right there.  Be present with ourselves first and subsequent to that more able to be present with Pretha’s mom.

Pretha’s mom has her job of sifting through her distortions, using her same organ that is diseased to understand her disease.  Pretha’s mom’s job is large.

What is your self-care job reader?  Please tell us your story.

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Supercharge Your Life Purpose

SERVE

Image by elycefeliz via Flickr

Going back to basics is one of the best tours of life. It is exactly how to supercharge our life purpose.

Truth is, we’ve been in this polite exchange between serving others and serving ourselves for the past year. It’s been nice but we are smarter now.

We all agree that “living to serve Me” sounds like a two year-old. We all agree that “living to serve others” sounds like pleasuring a martyr’s stake. Perhaps, as wise Solomon said, there is a time for everything, but most of our time is best spent where we will get our highest yield. I think of that place like a sphere, whose constitution are our basics.

Our basics are all about the wonderland of our biopsychosocial selves and including temperament.

Just as with “all” extremes, the truth is a bit of both. None of us can abandon our need (Me) to self-serve. None of us can abandon our need (Me) to serve others. The commonality in both is Me. Everything starts and ends with Me and that is our sphere’s constitution.

To review some of this, I jotted down:

health

medical illnesses including brain
hungry
tired

things we are doing to ourselves

sleep hygiene
addictive and decadently enticing exercise
food journaling
daily weigh-in’s
victim role
accountability to Me, and including Higher Power
starting over, and over, and over
community

things being done to you

natural disasters
assault/abuse
stigma
environmental milieu
the biopsychosocial condition of those we choose to be connected with

Don’t let this get past basic. If the list bugs you, throw it out. If it’s too long, shorten it.

Self-Care Tip – Supercharge your life purpose by getting at your basic needs

Questions: What constitutes your sphere of “best self?” How did you come to that? How would you describe it to someone who doesn’t understand? Please tell us your story.

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The Gift of Desperation

Life (23/365)

LIFE

Misty sounded relieved,

Yes.  That’s it.

She had just realized that life isn’t fair.  Sure.  She knew that before, but she just realized what she knew.  Don’t we all love that moment when our senses join up – sight, hearing, taste, touch, smell, emotion, intellect, spiritual and the rest.  That is a lot to coördinate after all and sometimes some of them don’t make the train.

Misty was a single mom of three.  Her ex-husband was what she called, “Disney-Dad,” and her kids relished their time with him.  Misty complained that she didn’t get to spend the special times with her kids.  She mainly took care of them, but missed out on irresponsible fun.  She was sure her kids wouldn’t look back and think of her like they would their father.  She was getting angrier about it all the time, ruminating about it and it was getting in the way of her ability to connect with others and feel pleasure.  There it was in front of her blocking her from seeing her kids even, let alone herself.

Then after weeks of this along with medication and talk therapy, she told me,

Yes.  That’s it.  Life is not fair.  There are many other things in my life that aren’t fair either and if I look for them, I could spend my whole day every day counting them off.  

It broke my heart a bit to hear her and see her there.  Humble like that; she would I think affect you the same way.  So real.

Yesterday, Carl D’Agostino replied to our post about growing our understanding of our choices beautifully.

…we wait until we are at our wit’s end before we seek assistance…. considering reaching out as personal failure or inadequacy re: our own self-esteem…. Foolishly we wait until our way just is not working anymore. That is why AA calls this a gift: the gift of desperation. …For many, the depths into which we have succumbed are now found not to be so deep at all and in fact, ladders are readily available if we use them in recovery. 

Ah Carl.  Say it again.

The gift of desperation.

Too good.  Don’t you think?

Questions:  Have you ever received the gift of desperation?  What did it bring you?  Where did it take you?  What did it do to you?  Do you still have it?  Please tell me your story.

Self-Care Tip – Celebrate your gift of desperation.

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No One is Choosing For You – Know Your Choices For Health

Yesterday we asked some pithy questions re: Why Psychiatry?  Your responses were received with gratitude and humility.  It takes courage to understand our connection with psychiatry considering ongoing stigma.  Today we’re reviewing that some and taking it one bit further.

When referred to a psychiatrist for medical care, we can feel confused.

Why is my physician sending me away?  Does this mean I’m at my last resort?  Does this mean I’m that sick?, or,

Does he think I’m crazy?  I’m not insane!, or personalizing with,

Does my physician not want to work with me?  I’m that bad of a patient?  Cast off?

Our expectations when we first see our psychiatrist are often also similarly reactive.  Maybe,

I’ll give this one chance but if she doesn’t fix whatever it is that’s going on, I’m out of here. 

I am not going to be dependent on medications!

I do not want to be made into a zombie!

Are we looking for a cure?

Also, we might be confused by the amount of time that she spent with us the first appointment as compared to our follow-up appointments.

I need to talk about my problems!  I need time!

There’s a lot to take in.

Unfortunately, when we are referred to a specialist, often our referring physician hasn’t effectively communicated as to why we are being sent there.  This is for many possible reasons, including Me not hearing him.  Many other reasons are also understandable with insight but we aren’t always given the opportunity to hear the inside story of why our physician does what he does.  That doesn’t mean we have to accept it.  But if we do, we did and it’s our choice.

Choice

Image by Scarygami via Flickr

We have choices.  Before accepting the referral, we can ask, Why?  Keep asking why until we are satisfied with our level of understanding.  Schedule a follow-up appointment with the referring physician if necessary to gain more time if we think we need it.  Sometimes, despite our physicians best efforts, we won’t understand as well as we’d like and we have to make our choice with the information we have.  We can read up on our symptoms ourselves.  I read in Twitter from @NathanBransford,

The 11th Commandment: Thou shalt not ask someone a question thy could easily Google thyself.

That’s ridiculous although I cracked up.  The World Wide Web comprehensively and including Google or any other source within that World Wide Web are not designed to practice medicine.  When we read something, we need to ask for qualifications behind the author of the print, references and so forth.  The Internet is a tool worth our attention but you decide how far you are willing to take what you read before you consult with your own physician.  I think if Doctor Seuss were alive today, he’d write a book (or many) about health care; Oh The Tools We Can Use!  (Maybe Carl and Thysleroux will do a series or a post on this?  Should be fun.  – Asking, “Why?”  Becoming our own friend.  Connection.  Going towards shame, pain, anxiety.  Growing bank – and more.)

And so that brings us to today’s questions:  What choices do you perceive you have in referrals like these?  In your continuing medical care?  In your ability to collaborate with your physician?  In obtaining an understanding of your illness(es)?  Please tell me your story.

Self-Care Tip – Grow your understanding of your choices for your health and medical care.

Related Articles:

  1. Stay Connected For Your Sake and For Theirs
  2. Connecting To Others Is a Condition of Freedom
  3. Safety in Connections
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Why Psychiatry?

An American Lady butterfly against a cloud-fil...

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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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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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It Is My Choice to Take Care of Someone, Even in The Context of Suicide

Detail of The Death of Socrates. A disciple is...

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I was a teenager I think when a woman in our church suicided.  Dad pointed out the man sitting alone.

His wife just killed herself.

Dad asked me what I thought of suicide.  Imagine.  What a compliment really for a teen, to be asked her thoughts.  Being a “Feeler,” I oozed something empathic I’m sure, but still I only remember what Dad said,

I believe God has a special way of seeing these cases.

This was at a time when culturally most of the western world saw suicide as sin.  It was quite forward for Dad to say what he did again later to the grieving man in the pew.  I did not realize at the time, but now I see that people judged him and his wife for what she did.

Later in psychiatry training, my attending said,

Suicide is the most selfish act anyone can do.  It is the ultimate punishment aimed at those who still live.

I don’t know what you think, but I couldn’t help wondering.  I still do.  I think this may be true for some and not others.  I haven’t had a chance to ask them.  They’re dead.

Suicide is terrifying to a psychiatrist.  We all tremble at the thought.  Statistically we know women attempt it more than men, but men are more “successful” when they do try.  They use methods that are generally more lethal than women.  They don’t get a chance to realize that in a month or a day they will want life again.  Or an hour.  They could have lived.

In the intensive-care unit of a hospital, “unsuccessful” suicide attempts hover in life in a space where their self-injury placed them.  The nurses are kept running between medicines, treatments, physician orders and prayers for these lives that tried to die.  Sometimes, the “chronically suicidal” become familiar patients to this critical care ward and that has it’s effect on those who have spent themselves so heroically to save them.

A nurse once told me angrily about her patient who kept coming back.

I fought for that woman’s life!  I prayed over her!  I worked all night for several nights and didn’t know if she would live until much later.  And then she was transferred out to the step-down ward (to a floor where the patients aren’t in such a life-threatening condition), and that lady probably never knew what I went through to keep her alive.

Then later, she came back, and later again, almost dead but not dead.  She kept trying to kill herself!  Finally, when she was conscious again, I just told her how it is.  ‘Listen!  I fought hard for you!  You better go out there and live!  You better figure out what it is you want and go for it.  Stop trying to die!’

This lady-patient was hurting more than herself.  Suicidal thoughts and attempts are dangerous.

There was a patient who tried to use his bed-sheets as a noose before the nurse lifted his wet body from the door frame.  In the emergency room (ER) he was examined, x-rayed and determined fit to return to the ward.  Alive.  Talking to the ER physician, I learned that the reason most people die when they hang themselves isn’t because of suffocation.  It’s because they break their neck.  Done.  No more chances to choose life.  Even an hour.  My pulse was still beating on me to the rhythm of, “He could have died!  He could have died!”  This time, no broken neck.

Regardless of our culture, we are not the judges of these people who want to die.  Regardless of our emotions, their emotions before, any previous conflicts, regardless, we cannot measure their final act by degrees or intentions.

We fight together for their lives and they may or may not know about what that does to the rest of the world.  When we don’t want to fight for them any more, we should change jobs.  It is our choice, each of us.  Whether we are fighting as professionals or as a wife, brother, friend, volunteer or the hired tutor, we fight for their lives because we choose to.  If we cannot keep it up without judging, shaming, accusing the suicidal, we need to own that and take care of ourselves first.  “Can’t give what you don’t have.”

The truth is, suicidality is hard for everyone.  It is hard in ways and in people that aren’t talked about, such as the nurses or the x-ray tech who is the first to find the cervical fracture (broken neck) on film.  It is hard for the church parishioners, the person separated by seven-degrees or the grocer.  Suicidality is hard for all of us.  We give what we choose to give and remember to say, “I can’t control that,” when we can’t.  It is our choice.

Self-Care Tip #182 – Taking care of someone is your choice, even in the context of suicide.  Be a friend to yourself.

Question:  How has suicide touched your life?  Please tell me your story.

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