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.

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!

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.

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.

 

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.

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.