medication

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

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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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The Spider Sat Down Beside Her – Mental Illness

Self-Care Tip #178 – Find your courage and answer to stigma.

The Little Miss Muffet scenario explained by D...

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Something as simple as taking pills can sabotage us.  The act of putting it in our mouths signifies all sorts of things from religion, to freedom, to personal identity and beyond; even someone who is trustworthy versus not.  Pill – take away her children.  No pill – could be president.  Pill – discredit whatever he says.  No pill – worth listening to.

Martha is a mother of four lovely girls.  Her husband is divorcing her and she wonders what he will do in the process.  She’s been depressed in the past and anxious with a history of panic attacks.  She took two years to get over them using breathing exercises and other therapies. She didn’t use medication.  I don’t need to tell you what her husband thought of meds or of her during that time.  It was a miserable time for her.

Now, during this new stressful time, she has relapsed in mood and anxiety problems and is terrified that if her husband finds out, he’ll take the kids.  Martha sees mental illness as a bullying tool for anyone to dump her over.  Little Miss Muffet is a story she often has compared to her situation.  The spider is the mental illness she feels is dangled over her to her demise.  Martha is bullied and scared away.

Taking pills makes me feel like I’m crazy!

Note: it’s a type of crazy she interprets as being something different from the crazy of mental illness.  For Martha, the crazy that comes with medication therapy is more sinister and discrediting than the worst experience of terror any of us have ever gone through, i.e. panic attacks.

Every day, we who take medication for emotional illness have to answer to those accusations.  We contend with the fingers pointing our way, the jeering in our memory of loved ones and the boxed presumptions we find ourselves in.

This may sound a little dramatic to some out there, although familiar.  To others, it is an understatement of what they courageously confront to take care of themselves.  Each of us must come up with our own answers and find our own courage.

Martha finally decided on medication treatment and within two days she was amazed to find that she could eat without throwing up and no longer felt anxious.  She still insisted that taking medication was only temporary but getting a pill dispenser had helped her get past some of her daily battle with stigma.  She just opened the lid and poured the pills into her palm, threw them back and swallowed without looking.  Martha found it easier not to dispense each pill each day out of each bottle.  It was also easier for her to keep this information secure in the confines of our office.  For Martha, for now, this was how she answered.

Question:  How do you answer to stigma?  How do you maintain your sense of freedom when other forces tell you that you are not free?  Please tell me your story.

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Work Hard to Take Care of Yourself If You Want An Easier Time Taking Care Of Others

Self-Care Tip #174 – Work hard to take care of yourself if you want an easier time taking care of others.

My marriage has never been better.

Freedom Press (UK)

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Kirsten had good posture.  She made eye contact and she wasn’t fidgeting when she told me about the changes in her life.  I hadn’t seen her in clinic for two years and apparently in that time she had set her husband free.  She was seeing less of him than she ever had and they were both busier than any other time in their lives.  Yet their marriage was at its peak.  I felt like I was getting off the point of why she came and wondered if asking her for details was unprofessional.  I did want to know.  Lucky for me, she wanted to tell and I just let it happen, as if I was doing her a favor.

I admit, sometimes I get something out of my clinicals.  I’m not always the best therapist.  I don’t always keep things about my patient when I let myself receive, or even actively take from them.  None of us are that altruistic.  Therapy is supposed to be one place any of us can go, and know that when we go, we can expect to receive everything except the fee-for-service.  Therapy should be the closest thing to a one way street in this non-altruistic world.

To my rescue, Kirsten said,

He has been meeting with friends, exercising, eating out and working the 12-Steps twice a week.

Yes he was sober, but he was also a bunch of other stuff.  Taking care of himself, he became a better husband.  Better body, clearer mind, happier, more attentive, less angry; she could hardly stop listing.

Freedom is useless....

Taking care of himself took a lot of work but it made taking care of her a lot less work.  True, she wasn’t the center of his life, she gave up on some fantasies, she didn’t ask him for more time, but all those in the past had only grown her own point of anger and blame and not the marriage dreams she thought they would – letting them go was a good thing.  Yet, cutting him free still felt risky to her.  She came to me because she was becoming more aware of what that fear was doing.  When she was afraid, she was sabotaging herself.  Bits of herself recognized that she could feel as free as her husband did.

To be free of fear for Kirsten, she needed medical help.  Kirsten’s fear came from nowhere, out of the blue and was not only triggered by suspicions about her husband.  To be free for Kirsten’s husband required other forms of self-care.

Question:  What kind of self-care does your freedom need?  How has your hard work on your own self-care spilled over into less work to care for others?

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Say, “I Can’t Control This” When You Can’t

Playing in the Sink

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Self-Care Tip #169 – When there is negative chaos, remember and say, “I can’t control this.”

Carol had worked there for seven years.  The supervisor had just asked her for more hours and Carol felt almost good to be able to say she didn’t have any more to give.  Yet when Carol got the email that her job position was closing in a month, she was physically affected.  Her autonomics (“fight-or-flight” reactions) were on full alert.  If there was an attacking bear, she might have out run him.

Healthy Carol had been to enough 12-Step meetings to remember, “I can’t control this.”  She said it a few times and turned it over to her Higher Power.  She did not crave or relapse in her addiction’s disease.  Her pulse was still fast and her hands were still tingling for the next several hours but she didn’t “use.”  She went to her meeting and she pushed on.

When Carol thought about her future and the things she could do to prepare, she inevitably thought about the things she couldn’t do.  She said,

I can’t control this.

When Carol imagined what other people would think after hearing about her unemployment, she said,

I can’t control this.

In mental health we struggle with that a lot.  The emotions that grow self-loathing, the behaviors that distance us from our support and loved ones, and/or the physical changes that keep us from performing – are all confusing.  At what point do we say, “I can’t control this?”

I remember a Seinfeld joke about water faucets in  public bathrooms.  The ones that you have to hold down to keep the flow going.  I’ll spare you the misery of me trying to retell it and get to the point.  Why do they have those faucets?  It’s as if they think people will have a water party in there or take free sponge baths if they could turn the faucet on long enough actually to wash their hands.

baby elephant | playing in the water

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When we say something like “I can’t control this” to the idea of emotions and behaviors, the general fear is that people will take wild liberties, – splashing emotions around and behaving like elephants after the summer Serengeti drought ends.  Mayhem will ensue and the staunch healthy-minded with dry pants will have to clean continually after us.  Not many people want to be sullied by the emotions and behaviors of others and this, “I can’t control” business is a boundary issue.  Maybe stigma is one of the ways we change out the faucet on others.

There are some very primitive characters and severely ill people who might say in fact that they cannot control all feelings and behaviors.  This is more than most of us armored with some healthy coping skills would believe or say.

“I can’t control this,” is not a free pass to vandalism, vengeance, volley-ball or any other very vexing behavior.  It is not there to hand over like a ticket to other people for their excuse, justification or condolence of our situations.  It is there for us to hold up to ourselves for the purpose of honesty, submission to our Higher Power, humility and healing.  No one can control the flow out of that.  That is free self-care.

Questions:  When have you felt like you had to explain to others your behaviors and feelings even when you didn’t have an explanation?  How did you bring it back “home” to your own self-care and get past the stigma?  Please tell me your story.

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Celebrate Insight, Choice, and Hope. Celebrating Can Be Self-Care.

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Self-Care Tip #161 – Celebrate your insight, your choice, and your hope to be a friend to yourself.

I realize autism has taken over my life and I’m not sure how I feel about that.

When April said this, I jumped.  The insight into her situation, the implication of her own ability to choose, the hope of what those potential choices might do for her and her children – all these leapt at me, so of course I jumped.  Startled.

April was the parent of three lovely although autistic children.  She was wiping her face.  “I never cry.  I’m usually really strong.”

And then she said those words.  Her realization.  I don’t know how much thought she had put behind them.  She certainly didn’t have much time to self-actualize.  Getting only a couple broken hours of sleep every night.  Responding to complaints from the school.  Springing towards her son every time he tried to hit himself in the head to stop him.  April was busy.  Mostly all that I had been able to do so far in our treatment together was help her kids via medication therapy.  We were clearly still working on things in that department.  She was willing to wait for us to make our slow way towards her children’s health, even though she was falling apart in the process.

Go low and slow.

Nothing like a cowgirl psychiatrist in the saddle.  I try to keep my spurs off and make no more than one medication change at a time.  Then, when something happens, negative or positive, we know what we are looking at.  April’s children were taking their time getting to their therapeutic responses.  But at least we hadn’t done more harm than good.

We had made the changes to our plan of care that we were going to make, and April was about to leave.  She had just said what she said and my mouth was open.  Unfortunately for April, I’m not consistently articulate.

Yes April!

And then she left, while I was still bouncing on the chair.

I don’t know if she’ll celebrate that marvelous epiphany.  If she does, I know her kids will benefit.  I’m confident about that.  If she does what is not intuitive, that is self-care, she will still be able to do what is intuitive.  Taking care of our kids is the most natural instinct.  Wild dragons and other mythical or natural creatures could not keep us away from it.  Now taking care of them well, however, is something that definitely is more likely to happen when we as parents are healthy, too.

For now I will celebrate this.  April has insight.  She has choice.  She has hope.

Yes April!

Question:  What has your life been about?  Where is your choice and hope?  Please tell me your story.

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No Matter Why, Where, or What Happens, Self-Care Starts and Ends With Me

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Self-Care Tip #158 – No matter why, where or what happens, self-care still starts and ends with Me.

It’s no secret that I look at behavior through many paradigms.  Most of what I’ve shared on this blog is medical because I’m a physician.  That’s my specialty.  I’m not a physicist and don’t spend my posts on explaining how physics influences our behaviors – although I believe it does.  However, I don’t want you to think that I think behaviors and emotions exist within only the medical paradigm, even though that’s what you hear me talk mostly about.

According to Dr. Q, the roughly sketched breakdown of how stress intersects with medicine:

1.  Stress influences how we behave and feel. We “see” the stressors, and we see the emotional and behavioral responses, and we know their sources.  We know that emotions and behaviors are produced by a human.  Where else?  Anything magical or otherwise comes from Someone from another place.

2.  Stress influences our medical condition. Stress will awaken sleeping genes that carry the names of different diseases; cancer, major depressive disorder, schizophrenia, and so on.  Would those genes have awakened on their own without the external trigger flipping the switch?  We don’t always know.

3.  Because there are so many factors that influence the reasons a disease process demonstrates itself, we cannot say that it is causally related to the stressors.  Many people try to do this, and sometimes the disease’s labeled cause comes down to the jury’s decision.  But we don’t have to have read, “To Kill A Mockingbird” by Harper Lee to know that people’s opinions and judgments are biased.

4.  People try to find the reasons why.  This is natural and in my opinion appropriate.  However, where we look for the reasons for the feeling and behaviors is equally important.  Seeking accountability for how we feel and behave to come from outside of ourselves, to come from external reasons, to come from a source to fault is more often missing our chance to get friendly with ourselves.

“It just is,” as many say, and the 12-Steps would say “Surrender what is out of your control to your Higher Power.”  These are not inconsistent with owning that mental health begins and ends with Me.

Sure, there are the despicable situations of abuse, trauma, violence and other horrible biology changing events.  These are known to cause the one non-genetically related psychiatric disease process called post-traumatic stress disorder (PTSD.)  These are situations consistent with our previous post on not being responsible for our history but being responsible for our futures.

5.  Stress, other than in situations of PTSD, is not causal for the progression of mental illness.  Everyone has stress, but how we deal with it, how we cope makes the difference.  Even horrible events, such as losing ones wealth and the sequelae of it are not causal for the continuance of brain disease.

6.  Medications, lifestyle change, Love and various other therapies effectively influences the way genes express themselves, our biology, and our medical condition….

7.  …In so doing, medications, lifestyle change, spirituality and various other therapies effectively influence our emotions and behaviors.

Question: How has your understanding of how stress intersects with with how you feel and behave affected you?  Please tell me your story.

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Celebrate Your Imperfections

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Self-Care Tip #153 – Celebrate your imperfections and adequacy.  Be a friend to yourself.

Chrystal came in.  Years with degrees of depression pulling her up and down leave her hoping to reach euthymia (steady level mood).  Chrystal and I frequently find ourselves talking about the grief that comes with this.  But not so much today.  She was hopeful after a new medication trial gave her a week with less melancholy.

In depression, even a few hours of relief from the dark inability to feel pleasure or interest, even a few hours when hope slips in can be enough to remind us what it is about life that is worth living for.  Chrystal has stood in and out of that shard of hope many times.  Each time it returns, she turns her face into it.  Hungry.  Wanting.  Alive still.  Responding to what any of us do, as any of us would, when hope is on us.

Celebrating a little together this lovely hope, she was nevertheless aware that it might sneak off again.  She said, “We’ll see.”  I said, “We’ll see.”

And then I remembered.  “Why can’t we celebrate your flaws?  Who says we can’t?”  They have beauty.  They have depth and shape and the loveliness that comes only from pain.

Chrystal looked at me doubtfully.  “Really?  I’m not so sure about that.”

I remember Someone perfect.  Last I heard, He had some pain and scars too and it didn’t change His status, value, or essence.

If we can’t celebrate our imperfections, we can’t celebrate anything because that is who we are.  Imperfect, all of us, except for One.  All of us adequate.

Adequate.  I celebrate that I am adequate today.  Adequate to live, to love, to do what I do.  “Adequate” implies a personal balance between perfection and flaws.  It implies a presence with both poles.  It does not quantify.  It does not mean that we don’t continue to grow or hope.

I’m not sure about everyone’s opinion about my self-perception, my attitude, or my effort at life.  However, I am growing surer of my own and am getting glad about that.  I’m wondering if Chrystal can celebrate her flawed self as much as she celebrates the hope of escaping her suffering.  What about you?

If each of us in turn were as pleased with ourselves as that, still hoping, still growing, still hurting, still suffering, what then?  Let’s celebrate together, alone, healthy, ill or wherever we find ourselves.  Let’s celebrate our imperfections and adequacy.

Question:  How do you live with your adequacy?  Please tell me your story.

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The Healing Process Can Be Confusing.

Self-Care Tip #127 – Because feelings can be confusing during self-care, keep connected to someone(s) objective.

A colleague told me the other day about his patient.  Of course he didn’t name him, but I’ll call him Brent.  Struggling with melancholic depression for many years, Brent started medication therapy.  He began feeling better emotionally.  But at the same time, he started to believe that he didn’t love his wife any more and started a dialogue with her about possible divorce.

It’s tempting to judge Brent.  Easy to say, “What the…!?”  Still, because we don’t know the full story, nor his thoughts, nor consider ourselves his Judge, we won’t.

Self-care can be a tricky road.  It’s not all ah-ha moments and nirvana.  Have you been there?  Confused by your feelings as you heal?

A common reaction to improving is associating the things in our “ill” life – when we were feeling terrible – with other elements that may not have had anything to do with our bad feelings.  Perhaps Brent’s wife was guilty by association and at some level he may have connected her to the dark emotions he so desperately never wants to feel again.  Bits of this idea are also in a previous post about panic disorder and grief.  For example, someone may change her profession because she believes her previous work is causally linked to the way she felt when ill.  Maybe Brent wanted a change in spouses for the same reason.

When we are going through the healing that self-care brings, we might not find our new emotional baseline for a while.  During that time, and because feelings are often not trustworthy, stay connected to the support network, confidants, the trusted few who can be our third-party advisors.

Although taking action on for our own health involves lifestyle changes, knowing when and how to get feedback is key.

Question:  What has confused you about your healing and self-care journey?  Please tell me your story.

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Put The Struggle Down and Take 3 Steps Back

I almost gave up on tonight’s post.  But after taking a Glee break watching Kurt get bullied, get defended, then get out of his school, I felt more refreshed.  Go figure.  What I have to tell you about self-care tonight is to go back to the basics.

When you become inundated with all the good things out there to do, go back to the basics and let it rest.  Get your sleep.  Take your omega 3’s and vitamin D.  Take your medications regularly and step back from the struggle not to.  In fact, if possible, put all struggles down and take 3 steps back.  There is time enough to pick them back up when ever.  Go to sleep and sleep well.  If you don’t think you will, take something to help.  Something safe that will protect your deep sleep.  Then, get up, worship God, exercise and see what’s next.

Any time you want, any time you need, any time, you can go back to the basics any time.  These are mine.

Good night folks.

Self-Care Tip #120 – Get basic with yourself.

Question:  What are your basics?  Please tell me your story.

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Branding and Branded. Stigma Goes Both Ways.

 

mentalhealth.wa.gov.au

 

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

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

In Jesus’ own words:

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

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

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

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

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

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

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Your Life. Your Choice. Why Are You Still Negotiating?

 

 

Self-Care Tip #102 – Take what is yours and live.  Be a friend to yourself.

Cheri came, still dressed in work scrubs, with her 2 daughters, 8 years old and 3 years old.  Having finished their dinner date, they were swinging by for her appointment before going home.  Cheri told her kids, “Get out now and go sit in the lobby!  If you don’t listen to me I’ll….”  Turning to me, she said, “It’s never enough!  I just took them to dinner and they do this to me!  No matter what I do…!”

1.  Cheri tells me she’d like to cope better with simple stressors such as redirecting her kids

2.  We talk at length about her perception of her kids abusing her.

Cheri is married.  Her husband laughs at her for “…having to take those drugs to be normal!”  “…But he just sleeps his problems away.  He doesn’t deal with them like I do.  He has no idea!”

3.  We talk more about her perception that her husband is responsible for her place in life.

Cheri believes if she doesn’t take more than 2 pills a day, she is less “dependent” on drugs.  She says, “I don’t want to go on like this!”  Her tears continue talking when her voice stops.  She is ashamed.

4.  The concepts supporting taking care of yourself as being the kick-off point to caring for anyone else comes up.

5.  We talk some more about who is “The Why” for what we do or don’t do.

Cheri feels less shame, but it’s still there.  She is willing to give a new medication a try but clearly doesn’t buy it all yet.  She’s going home with her girls to her husband with new pills.  And hope?  Yes.  It is all connected.  It all pulses together and is a living negotiation of sorts.

Disease <–> behavioral/emotional negative symptoms <–> victim role <–> self-neglect <–> greater crisis <–> seeking help <–> responsible self-care <–>  healing <–> fewer behavioral/emotional negative symptoms <–> emotional abuse from husband may continue but is no longer seen as responsible for personal choices and self-care <–> less shame <–> further healing and so on….  (Lub-dub…Lub-dub…)

 

hbofamily.com

 

Cheri is still negotiating her deal in life.  She doesn’t realize that it’s already hers for the taking.  Her life.  Her choice.

The deal is already made.  Take it or leave it.  Your life to live.

Question:  How are your negotiations?  Do you see them as still in progress or settled.  Please tell me your story.

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Your Heroic Self – Waiting For Normal

Self-Care Tip #82 – Have courage to go for what is lovely to you in life.  Be a friend to yourself.

Pretty, blond, about 5’6″, slender, in her 30’s, mother and wife, no funny shapes or movements but Britt still asked me, “Am I normal?”  It takes guts to ask someone that.

I just finished this heart-squeezing book, “Waiting For Normal,” by Leslie Connor.  (Yes!  I finally read a book!  It took me 5 times as long but it was no less pleasurable.)  Connor tells us about pre-teen Addie who grew up on the waves of her bipolar mom’s chaos, salvaging bits of wreckage along the way to survive.  Addie is the life-preserver her mom uses for life.  Addie’s own buoy through it all is her hope of one day finding normalcy.  She uses all her smarts to avoid the thrust her mom’s messes force on her.  It requires her full attention.  Addie must have looked pressed for something because her Mom finally asked her

What’s so special?  What are you chasing after?!

Addie was fisting optimism when she answered

I’m not chasing after anything.  I’m waiting.  Waiting for normal.

Later Addie explains to her mom

Normal is when you know what’s gonna happen next.  Not exactly what because probably nobody gets that.  But normal is being able to count on certain things.  Good things.  And it’s having everyone together – just because they belong that way.

My son used to have shaggy hair with curls that flew at the world around him.  He came home the other day and told me he wanted it short.  I finally figured out that because none of the other boys in his class had longer hair, neither should he.  He showed me pictures of what his hair should look like.  The whole process was too cute.

We are all looking for normal.

Putting aside defining normal, for now I am content to just contemplate the largeness of the effort to find it.  The journey, the process, the coming into such a thing reveals the beauty in one’s character and essence.  It is that, rather than the “hair-cut” that makes me say, “Wow!”

When Britt, my patient, strove towards her health and normalcy, her intent in context was lovely.  She seemed to me, in those moments we shared together, as one of the great heroes of our day.  A woman of courage.

Self-Care Tip #82 – Have courage to go for what is lovely to you in life and appreciate the beauty in your heroic self.  Be a friend to yourself.

Question:  Have you struggled with the question, “Am I normal?”  Please tell me your story.

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Connect With Others to Get Friendly With Yourself

Self-Care Tip #81 – Connect with others.  Be a friend to yourself.

So you have bought into the famous, “You are not alone” stock.  After 2 months on psychotropics (medications for emotional illness,) you finally have an interest in people.  You are at least a little motivated and less afraid of things that move.  You don’t feel like you are the reason for original sin and more often than not, you think happiness might be more than what shopping can offer.  What is this strange and unfamiliar sensation?  And what to do with it?

It is time to connect.  Many of us get to the point where we no longer want to hide, we don’t hate ourselves, and we don’t hate others.  We get to the place of showing our under-belly just a little to the big wide world and are shocked that the only thing we feel is the wind as everyone is rushing by!  Just when we start wanting what we spent so much time hiding from, we seem to have forgotten how to connect with others.

It is no secret.  America is culturally impoverished.  We have little of cobblestone streets to meander down, dressed in clean clothes after a days work, checking up on neighbors and gossip.  We have few degrees of activity between full throttle and dead/no heart beat.   Come now!  How to connect in a world where our parents expected us to pay rent when we turned 18years old?

If you find yourself in something of this situation try on one of these basic tools and see what fits.  You can’t expect them all to.  So if you strike out a few times, keep on!

1.  Volunteer – for example, and in no particular order…

2.  Meetup.com – an awesome site to find people interested in what you are interested in.  e.g. book clubs, skiing, small business, Italian

3.  Support groups

4.  Write!  Although this at first thought may appear isolating, it is not necessarily.

  • Blog!  🙂
  • Journal

5.  Toastmasters

There is so much more.  Please let me know your thoughts and I’ll keep adding to this list!

Self-Care Tip #81 – Connect with others.  Be a friend to yourself.

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It Might Be Your Brain

How are you feeling? If it’s not good, it might not be “you.” It might be your brain.

When you don’t feel good, look at what’s happening inside.  Think about where feelings come from.  It’s hard to use your brain to think about your brain.  (Read more at “Basic but Effective.”)  But what to do?  Doctor Dolittle‘s pushmi-pullyu’s might have been able to tell us something of our missed opportunities by not having two heads and two brains.  (Unfortunately they’re extinct!)

Feeling bad, irritable, guilty, sad, like everything is flat, nervous, emotions that are out of proportion or inappropriate to the situation or trigger?  These feelings might have nothing to do with “you” and everything to do with your brain.  At some point if you get tired of beating yourself for the holes in your purse, if you don’t understand why things feel the way they do, if you want to rest, think medical.

Fred came in with his father, hiding himself in his shirt, in his father’s shirt, like a mouse who couldn’t find his hole.  The teacher from his special education class came in to help give history and told me about everyone’s efforts to bring him out.  Skinny, Fred preferred not to eat in front of people.  He started shaking in strange situations and climaxed into a tantrum if pushed to transition too quickly.  He was vulnerable to physical contact and avoided anyone touching him.  When he was really upset, he banged his head so hard that he had to wear a helmet.  When I asked his parents if they thought he was anxious, they said no.  No he wasn’t nervous his teacher said.  Hmm.

I told Fred’s parents.  I restated to Fred’s teacher.  I just said back to them the story they had just told me.  I told them about Fred and asked them what they thought.  After hearing Fred’s story again, did they think Fred might be behaving this way because he was suffering on the inside?  

We can’t give what we don’t have.  Asking Fred to come out and play so to speak, wasn’t something he had to give yet.

After treatment takes effect, then Fred will be able to pull his head out of his shirt and he will do it without being asked to.  It doesn’t do any good for Fred or anyone else to push him to do behavioral changes if he simply can’t.  Fred is not a pushmi-pullyu.  He has no spare brain to offer when the other is ill.

I told Fred’s father that I thought Fred was suffering inside.  Something in his father clicked.  He teared up and nodded and said “Yes!  He is suffering.”  That meant a lot to Dad.  To know that much about his son.  To know that what had confounded him for so long came from somewhere.  It had a name.  This thing might be treated.  Fred might suffer less.

Self-Care Tip #76 – If you don’t feel good, think about your brain.  Be a friend to yourself.

Question: Do you every feel like you expect yourself to give what you don’t have?  Please tell me your story.

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Get Treatment to Move On – Addictions

Molested by his cousin, neglected by his parents, he watched his intoxicated father beat his mother.  Thinking she would die too many times, he ran away, returned in a police car over and over again, as if wanting to get away was a crime.  He came back and raped his neighbor, more than once.  He spent a lot of time trying to get sex even though he knew it was ruining him and others.  He lost interest in almost everything else.  He suffered uncontrollable impulses.

He was 18 years old when he left it all for the safety of prison.  During the next fifteen-some years he was diagnosed, treated, and kept.  But kept for what?  For eating.  He gained weight, until he needed 2 seats to sit in.  Eating became his preoccupation.  He didn’t have sex.  He had food.

He was released to a home for sexual offenders, put on a diet and lost weight.  He lost it big and fast and felt in control.  He started purging and not finishing his meals.  He thought about purging all the time.  He knew he shouldn’t do it.  His voice was changing, raspy and his throat hurt but he still purged.  He wasn’t having sex.  He wasn’t over-eating.  He was purging.

For whatever reason, no one had yet seen the pattern.  Mostly everyone saw sex offender.  Me included.  I was trying.  I was trying to treat him with empathy, trying to get past the bile that comes when I think of rape, trying to consider the courageous things this man was doing now in life.

In one of my favorite scenes from the film, Rachel Getting Married, Kim played by Anne Hathaway argues with her sister about her own chances to have a future:

Rachel: Kym, you took Ethan for granted. Okay? You were high for his life. You were not present. Okay? You were high.
Kym: [Whispering] Yes.
Rachel: And you drove him off a bridge… and now he’s dead….
Kym: Yes, I was. Yes, I was stoned out of my mind. Who do I have to be now? I mean, I could be Mother Teresa and it wouldn’t make a difference, what I did. Did I sacrifice every bit of… love I’m allowed for this life because I killed our little brother?

I thought of this and somehow through all that trying, I did. And because I could empathize, a space opened up for me to be more objective.  That’s when I saw it.  I saw the pattern.

Addictions migrate.  Someone who may have started out as a food addict, might turn to gambling, and then later to alcohol.  Someone with sex addiction, might turn to food and then later to purging.

It can be like that game I used to play at Chucky Cheese, trying to hammer down the little animals that pop out of holes.  We need to treat the disease of Addiction regardless of how it’s dressed, or else it will keep popping up.  And like Kym, if we do, although perhaps terribly wrong in some unchangeable ways, we will still have a future.  If you’d like to read more about this “kainos” (Greek word for the opportunity to be made new,) read the post New versus New.

Self Care Tip #62 – Get treatment to move on.  Be a friend to yourself.

Question:  What do you think?  Please tell me your story.

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Let it Make You Strong

She is young, golden, blushes easily, bright solar eyes, with graceful speech, not rushed or loud.  Like so many others, she doesn’t believe her beauty.   She came to me to get help.  Crippled by anxiety that hits out of the blue, like a hooded man grabbing her in an alley.  She feels during those times like she is dying or going crazy.  She started avoiding public places and became fearful looking over her shoulder for the next attack.  She was humiliated on all accounts by her uncontrolled emotions and thought people could see how crazy she was just by looking at her.  Branded and tortured.

When Nathaniel Hawthorne wrote The Scarlet Letter, he made plain the cultural pressure to define what is apparent, seen, and interpreted.  But more importantly he made plain the ability of an individual to define themselves on their own terms regardless.  Hester Prynne wore her letter A at first by mandate and then by choice, letting it represent who she was, where she came from, and where she was going.  She wore her letter and when people tried to change its meaning to something culturally less scarlet, “A” for “Able” she made it clear that she is the one who will decide the meaning of her life’s events.  Her and God and no one else.

When anxiety hits, we are scrambling to understand why.  We think, “What could we have done that is so terrible to have brought this kind of torture on?”  As Hester Prynne began her scarlet letter days bewildered by the force of emotion behind her angry neighbors, so victims of anxiety are bewildered by the level of shame and wild fear they presume must be linked somehow to this judgment upon them.  It becomes their life’s work to determine the meaning of a life with this.

Nathaniel Hawthorne writes,

The scarlet letter was her passport into regions where other women dared not to tread. Shame, Despair, Solitude! These had been her teachers—stern and wild ones—and they had made her strong…

Suffering is a schoolhouse for the courageous.

After some months of medication therapy this twenty-something woman said

I’m not so uptight about things.  …I didn’t know my anxiety was that bad until I got out of it.”  What amazed her even more was how better the rest of her body felt.  “Even physically I feel much better.”  No more chest tightness, body aches, and shakes.

She has the rest of her life to figure out how to say what this disease means and how it plays into the way she defines herself.  She will decide I hope.  Not her family, future husband, church, or Brook Shields.  I hope she will take what it teaches her and let it make her strong.

Self Care Tip #57 – Let it make you strong.  Be a friend to yourself.

Question:  What do you think?  Please tell me your story.

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If You Are Ill

The 'Glasses Apostle' in the altarpiece of the...

Image via Wikipedia

A reader commented on yesterday’s post, “Afraid of Meds,”

My fear, I think, would be not so much the dependence—but what would happen if I did need that medicine and it suddenly became unavailable, like I couldn’t get my prescription because of a natural disaster or something like that.  …Would going off of those meds cold turkey put me at a real disadvantage?

In my late 20’s I had similar fears, only for me it was related to my eye-glasses.  Because I didn’t tolerate contact lenses, I especially had vivid fears of getting into the driver’s seat of my car without my eye-glasses anywhere to be found.  Living on loans at the time, I took out extra money and got LASIK eye surgery.  Oh the joy when I woke up one morning and could see clearly, high-definition, no glasses to grope around for, freedom!

Unfortunately in neuropsychiatry, we don’t have the privilege yet of offering many curative options like LASIK surgery for emotional illnesses.  I don’t believe it’s too far off in the future.  It wouldn’t be wild to say our children may have those options some day.  For example, embryonic stem cells may offer a cure for disorders such as depression and schizophrenia.  However, until a cure becomes as available as Prozac or even LASIK eye surgery, the reader quoted above has a reasonable fear.  Medication becoming unavailable is a disadvantage.

Now I’m not great at twisting reasoning powers, so I’ll say this as best I can.  That’s like not getting eye-glasses because we are afraid of loosing them.

So to this reader quoted above and to you I ask,

Question:  What do you think?  Treatment or no treatment?  Please tell me your story.

Self Care Tip #53 – If you are ill, get as better as you can.  Be a friend to yourself.

Related Articles From FriendtoYourself.com

  • Mental Illness Relapses When Medications Are Stopped http://bit.ly/pA4kxo
  • Number One Reason For Relapse In Mental Illness  http://bit.ly/rt1qJf
  • Are Your Meds Safe?  http://bit.ly/lh1cBh
  • Say Yes to Medication And No To Drugs  http://bit.ly/oX12i0
  • Fears of Addiction To Medications for Brain Illness http://bit.ly/oWY8i4
  • Other Fears of Medication For Brain Illness  http://bit.ly/qdHksR
  • Afraid of Meds  http://bit.ly/rjt7wY
  • Full Treatment Response Means a Better Future  http://bit.ly/ph84ZU
  • When It Is Time To Take Medication   http://bit.ly/nbIYLT
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Your flawed self

My niece is sitting beside me and I can barely keep my hands off of her 5 month self.  I am eating a blueberry scone slowly.  She, with her tummy-full of breast milk, is watching every bite, a faint smile on her pink face.  I’m a little afraid she’s learning to eat carbohydrates from me and I want to tell her that I can’t remember the last time I ate one of these.  I start eating faster and turn away so I don’t imprint this on her supple myelinating neurons.

We closet eat, closet smoke, closet shop, closet sex, closet what we want to protect others from but what we independently are strong enough to handle …or not.  There is a term called “self-sabotaging behavior.”  Reducing this, we find that the process of closeting is in fact the handle on the door to that mal-behavior.  Keeping it real is the same as saying get it out of the closet.

My mentor and brother, Cameron Johnson used to say, “Go where the pain or fear is and it will lose control over you.”  People who work the 12-Steps call this “Rigorous Honesty.”  It is a pealing away of all pretense with yourself.

Avoiding rigorous honesty turns into self-sabotage.  We end up cutting ourselves down at the knees.  Anxiety uses fear to make us hide.  In cases that include emotional illness, of course medication will help our work toward honesty.

It is not about whether we hide our bad sides or not – we do.  It is about trying to keep it real.  The only thing to be ashamed about, if we must, is not trying.

So to my niece, I give her my flawed self and when the time(s) come, I will accept hers as well.

Self Care Tip #45 – Show the world your flawed self.  Be a friend to yourself.

Question:  How have you experienced the freedom that comes from going toward the fear?  Please tell us your story.

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Freud Did Not Know

Bad dreams.  Just woke up from one.  There’s a lot out there on dreams in mental health.  After all, they come from the brain.  When Freud was looking at things, he saw dreams as “unconscious wish fulfillments.”  However since Freud rocked our world, we’ve learned so much more about brain biology and Freud was wrong.  Oochie ouchie.  Just saying that makes me feel like his still very much alive reputation will come at me like an angry ghost and be mean!

Dreams are just that, dreams.  Sometimes they are good, but often they are scary, bad, and even terrifying.  Why?  According to Dr. Quijada ;), yours truly, they are commonly symptoms of emotional disease or side effects of medications, etc….  In anxious states, we dream.  After going through life threatening events to  ourselves or witnessing it in another, we get nightmares.  When there is a disconnection is our sleep architecture, we can get “parasomnias” such as night terrors.  Some medication such as Trazodone can cause vivid dreaming where people say they dream “in color.”  And on and on.

Freud didn’t know this, so no offense taken.  However, we do.  Enough with the hocus pocus moral dilemmas that are discussed in our own thoughts and among some ongoing therapies.  First look to biology to give us the answer. Even after having a nasty scream-your-lungs-out dream, remember that your brain is mortal, human, made up of carbon and not aura.

Sometimes even that much information can help people sleep better.

Self Care Tip # 43 – Don’t make too much out of your dreams.  Be a friend to yourself.

Question:  Do you agree or disagree?  Did this help you in any way?  Please tell me your story.

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Soul and Body

When we get sick, our identity, who we are, our essence might feel threatened.

In “His Dark Materials” trilogy, Philip Pullman says there is no God so we create heaven ourselves. In regards to our spirit, he says we come from and belong to the evolving universe. Perhaps so many have read this trilogy because it openly speaks about our souls. After it won various awards, we could say the man can write. But also that many of us, along with John Milton in Paradise Lost, wonder who our essence belongs to.

Since so much of our culture puts the definition of identity on behavior, it makes it seem that brain patterns define humanness. How do you see yourself? We all agree that our brain is part of our body. The question of soul comes in to play.

Some believe that the soul is a brain pattern. We might not agree that there is a difference between soul and body (or the brain). But if we did, could we even agree that the body is just that, a house for it, as Mr. Pullman says? This inconstant body, this betraying brain, this changing mind?  We’ve got more bank than that.

This is important to sus out. In the immediate sense, it tells us where to go if you need help. Temple? Doctor? Gym? It will affect your self-view when you go through physical loss. It will affect your hope when you haven’t felt like yourself in years.

Who are we if we need to take medication to behave like ourselves? The question I often hear is, am still me? Do I grieve the loss in order to accomodate the new sick me who has tremors and fear of public places? Then when I get better and lose an arm in a car accident do I need to change my view of my identity again? Then after I get better and get to know the new me, I get breast cancer and undergo a mastectomy. Now who am I? Now I’m old and eat with a wooden spoon and my kids take away my drivers license. I get dizzy at the hospital I used to work at and fall and hit my head in front of colleagues I once mentored. Who am I?

Many people I talk to think, like Pullman, that when they die their soul disperses amongst all the spiritual and material matter across the universe.

I have become comfortable with my own answer. My spirit belongs to and is in the care of Love, which is stronger than any change that happens to my body.

Self Care Tip #23 – Find your identity. Be a friend to yourself.