Sweaty and Worried – Generalized Anxiety Disorder

Hank had to sing an Italian song for his tests.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Magical-Self Sabotaging Our Biological

take treatment

“I just can’t be on medication when I go back to work!”

I had seen Rowne four times in clinic already and he still had not started his medication treatment trial.  He had seen multiple other medical physicians for other medical problems that needed addressing.  He had made appointments.  He had made phone calls.

“I’ve done so much, doctor!  I don’t want you to think I don’t want to get better!”

Rowne could have painted his house, changed the brakes on his car, had his foot bunions removed, but none of that was directly treating brain illness.  Rowne was mistaking activity for treatment.

Too often, those of us like Rowne, will gather courage to engage in the initial stages of treatment but not execute through.  Going to see a psychiatrist is its own effort.  Taking treatment recommendations and executing is another unto itself.

This is not unique to psychiatry of course.   Not even to the medical field.  Each of you in your own professions, perhaps in an auto body shop, or retail, or as a fifth grade teacher, those who seek our expertise find that the asking is, in their perception, as good as the doing.

None of us are out to create automatons though.  It is the intelligence, the self-interest on both sides, the freedom of the individual and Love that bring much of the value to treatment.  The humanity and magic combined with biology, element, and carbon matter trumps all.

Silly us though, when we allow our magical selves to exclude biology.

Self-Care tip:  Take treatment and execute.

Questions:  How do you bring yourself to take treatment and execute?  Or, what keeps you from doing it?  Please tell us your story.

Mistaken Expressions of Freedom and Medication Compliance

Sabrina

Sabrina (Photo credit: joaoloureiro)

Sabrina is here with her sadness, anxiety and inattention in full swing. She is able to say that she knows she’ll get better. However, her body and expressions tell me she is bewildered. She doesn’t know. She wonders who she really is and how this can be. She is vulnerable. A little girl looking into such a great unknown, though wrapped up in a forty-something year-old body.

One and a half weeks ago, Sabrina ran out of her medication. She knew she was coming in to see me so she didn’t bother with it. She waited. One and a half weeks.

The number one reason for relapse is…? You remember. Medication noncompliance. Is it life stressors? There are so many. No. All those reasons for why we feel what we feel and do what we do, all those forces acting on us from the outside in, they aren’t the reasons we relapse most often.

There is something like a super-bug growing amongst us who take our meds on and off. We take them four or five days a week, not seven. We skip here and there and don’t “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent on medication, demonstrate our freedom. We are free when we take medication or when we don’t. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by medication noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Sabrina and I are working together to take away barriers to consistent treatment.

What are your barriers? Do you mistake how to demonstrate your freedom? Or what is it? Please tell us your story.

Self-Care Tip: Take medication consistently. Be a friend to yourself.

Check Your Read. Even When You Feel Shame, Bullied and Herded, You Are Free.

Eve covers herself and lowers her head in sham...

Image via Wikipedia

Self-Care Tip #219 – Check your read.  Be a friend to yourself.

I’ve been reading the comments on suicide, thinking and reading and starting who knows how many posts for today, but just couldn’t pull it together.  I spent my time rather drawn to the same words that I hear so many others say as well in clinic, in church, on the street, in the home.  Instead of seeing them find their place in me like I normally do with this kind of crowd, the words kept their space; word-snobs – crutch, selfish, dependent, moral and other words, dusting and reapplying in their reflection.

I had to think, “Why?  Why am I staring like this?”  And so the rest of the day, I perused those thoughts, licked my finger, flick, next, paper-cut and so on.  After all, this is SELF-care I’m talking about, implying I am starting with me.

At last, after rereading yesterdays and past comments, I found the shame I was avoiding.  Why I feel shame about these things isn’t important in this post.  (Maybe another post.  So if you have nothing else to keep you reading, you’ll have that dish to bait you.)

Shame comes when implied or direct judgment creeps into our space.  It herds us.  We are bullied and lose our personal boundaries.  It touches and violates.  That is what shame does.  Any time our perception of freedom feels threatened, it is normal to want to defend ourselves.  Separating from stigma is a normal response.

Claiming the shame, however, isn’t forced on us.  It is our choice.  Once we own the shame, then wanting to get away from reminders of it, of course, is natural for anyone.  But jog back and see.  The perception of shame was never forced on us.  We are free.  We are free to feel, to perceive, to believe, to choose or to stop rubbernecking at the sparkling drama.

He made me so mad…!

She really hurt me.

You ruined my life!

I don’t want to take medications because my husband makes fun of me.

I take Prozac but I don’t have mental illness.  I’d be ashamed to…

It is a normal response to not want to be in the space where we feel these things.  That is natural and what many have thought worth fighting for.  But what if our perception, our Sixth Sense, wasn’t getting a good read?  A war might have been avoided.  Our lives might be lived differently.

We really are free, already, to choose.

Question:  How do you see shame affecting your ability to be friendly with yourself?  Or others?  How have different perceptions put you in a place that felt more free and safe?  Please tell me your story.

Choose, Gladly, Using Resources

Being a friend to yourself includes choosing, being glad that you can, and using resources to make your choice a good one.

Mrs. Smith told me with a barely noticeable arch in her back that she was still planning on God healing her daughter.  I don’t know if Mrs. Smith thought about how her daughter felt about that.  Was Kristy personalizing her illness?  Did she think God rejected her?  The problem of her continued illness must show something more than a physical flaw in her perhaps.

Will we know it when we are healed?  Until then, what to do?

Years ago, I met Fran.  She was pulling her hair out.  Her annoyed husband disrespected her for it.  Fran kept willing herself to stop.  She said,

I’m doing it less now I think.

The good news for Fran is that she responded well to fluoxetine.  Her anxiety decreased and she almost stopped pulling out her hair.  She’d wear her growing bristles pressed down with bobby-pins and hide it with her long hair.  As her hair grew longer, she had fewer bobby-pins and I knew she was taking her medication.  There were other problems between Fran and her medications.  Taking medication shamed her.  And, she blamed her fluoxetine for her weight gain and rash on her face.  She felt uglier than ever in her husband’s eyes.

I don’t pull hair any more.

Fran stopped her fluoxetine and half her head went bald.  She did not lose weight and she still had a rash on her face.  Fran went back on her fluoxetine and she has cycled on and off of it this way over the years we’ve worked together.  Somehow despite all our time together, Fran does not believe me when I tell her that when she is better symptomatically, she is not healed.  Fran does not grasp that her behaviors come from something at a genetic level.  We can treat her, influencing the way her genes express themselves, but in her case, not cure her.

We are a team.  She and I, and sometimes her husband, and sometimes her sister.  I give her medications when she thinks she needs it.  I don’t leave her when she doesn’t.  Either way, we keep trying.  It is very hard for Fran to know that she has not been healed.

I don’t have many clear examples of treatment-to-cure in psychiatry.  The statistics vary between diseases as to their rates of recurrence.  The brain being human, we can yell at the serpent for our insanity.  However, in the end, here we are.  As Billy Joel says in his great ’70’s hit song “My Life

Either way it’s okay to wake up with yourself.

The opportunity to choose our own answers, to decide what to do about it, and believing if we are sick or not sick  – is all our own.  These can be hard decisions but until we lose capacity to choose, we own them.  Decision making capacity of course is a medical decision.  But competency is a legal decision made in a court of law.  Having the right to choose is a beautiful privilege.  This does not mean to ignore counsel, evidence, data.  On the contrary.  That would not be a friendly thing to do to yourself.

Self Care Tip # 75 – Choose well and be glad you can.  Be a friend to yourself.

Question:  What do you think?  Agree or disagree.