Emotions: The Physical Gift We Can Name

Leprosy hand affected fourth digit

Image via Wikipedia

Self-Care Tip #148 – Identify your emotions, navigate, and get help.

Mad.  And when Mia was angry she wanted to go eat.  Nervous.  When she was nervous she wanted to go eat.  Like a wire with a current, she couldn’t stop her thoughts from moving and moving.  Although eating soothed her in less than a shard of a second, it was also followed by self-loathing.  Self-loathing brought on more eating and then purging.

Sitting in my office, Mia said it was like she was looking at herself from the outside in and the self on the inside could hear the, “Stop!”  Demands, petitions, and begging to stop came from the other Mia, who was loosing her command-authority in a scary-fast way.

How often we hurt ourselves but blame a trigger, an emotion, a person, or an act of malice.  If only we could say, “Put the offense down and take two steps back.”  But sometimes we can’t.  It’s easy to piously say, with habits and cassocks or soutane (French for traditional priest’s attire) in place, “Don’t make decisions based on emotions.”  It’s easy to say, “Be objective, we can’t trust our emotions.”  But if emotions are what we use to interpret the world around us with, if that’s all we have, what can we do?

Emotions are ideally the color, texture, perfume, music and salt in our physical self.  Emotions are our spiritual sensory system.  Not being able to trust them is a big loss.  Being blind, deaf, anosmic (can’t smell,) unable to taste, and numb would make it really hard to interpret the world around us too.

Paul Brand, MD, coauthored with P. Yancy, “Pain:  The Gift Nobody Wants.”  This book uniquely tells Dr. Brand’s story of working with lepers in India.  Leprosy is a disease that causes a person’s nerves to stop working so they lose their sense of touch and subsequently can’t feel when they hurt themselves.  A once harmless thing like bumping a finger for example, is extremely dangerous.  Lepers can’t feel the pain, and so don’t accommodate for it and protect themselves. You can imagine that bumping a finger but not reacting to it leads to tissue damage when it is done over and over, until one day the finger falls off.

Dr. Brand is right.  Pain is a gift.  And so are emotions.  Including emotional pain, if serving as intended, to protect the individual and not self-destructive things such as bingeing and purging.  The purpose of this post is not to get into what binging and purging is.  That’s just an example of behaviors that might grow out of emotions gone amuck.  Emotions that we used to trust.  That use to tell us who is a friend and who is an enemy.  Emotions that used to know who’s side they were on.  Emotions that forget their own like that can be just as extremely dangerous as leprosy is to our tender fragile fingers.

The purpose of this post is to flatten the mountains of understanding between here and there.  Between understanding that emotions are as physically important as anything else, such as the spinal cord.  The purpose of this post is to furthermore say what to do about it once we can 1) identify the problem and 2) get past the stigma.  Mia did the eating and purging stuff, but she also asked for help.  3) Ask for help.

Lepers have still so few options to help their disease.  Us with emotional illness are very blessed because we do.  We have medications, psychotherapy, coping skills, miracles, and more.  We have a lot.

Question:  How do you define the space between emotions and other “real” medical illnesses such as diabetes?  How do you navigate around stigma?  How do you ask for help?  Please tell me your story.

Full Treatment Response Means a Better Future

wethree by Nancy Denomme

Self-Care Tip #140 – Push for full treatment response.  Be a friend to yourself.

Frankie was 45 now, feeling it, and feeling grumpy.  “I’m on Lexapro!” she said as if that should exempt her from her present condition.  She had teenagers.  “Enjoy these times when your kids are young.  It just gets worse!”  Frankie thought that if her kids weren’t stressing her out, she’d be fine.

Maybe parenting and other life-stressors do get worse as we progress through years.  Even if it’s true, it isn’t the point.

Frankie told me that she had felt “normal” until the last approximate four weeks when she wasn’t able to let stress go.  She was taking things personal, even when her mind knew they weren’t about her.  She didn’t like herself as much and was angry when she thought that her kids were thinking the same thing about her.  She was just a little angry.  Not like she was before she was taking medication.  “I’m not so bad.  I’m ok.  I’ll be fine.”  About 70% of Frankie believed that she was still good.  About 30% of her knew at some level that she wasn’t.

“Frankie, stress is always going to happen.  It won’t get better necessarily when your kids move out.  Life will keep the spin on.  Frankie, the difference can be in you, not life.  How you cope can be different.  Things don’t have to feel that hard to get through.”

We talked about partial treatment response and what that meant in regards to disease progression.  Depression progresses as does anxiety as disease processes.  Also, people lose response inconsistently to various treatments.  However, it is not the time to throw our hands up and say, “Bummer!  Life really is harder on me than necessary!”  It is the time to say, “This is medical.”  And explore if there are any other things we can do to improve treatment response and decrease disease progression.

Leaving ourselves partially treated is leaving a leaky pipe in the wall of our health structure.  We will worsen faster, more dramatically, and be harder to treat in the long run.  We will lose treatment options over time simply by not doing as much as we could earlier than later.

This is not to say, that if this blog-post finds you at a “later” position in life, that it is of no use.  Unless that’s how you see your future.  Which if true, I’d respond that this is distorted thinking.  Possibly secondary to the disease process and all the more reason to get treatment, again, sooner than “more” later.

I was so happy to have had this brief discussion with Frankie because it resonated with her.  Her approach to her self-care tweaked and she saw her negative emotions and behaviors were coming from her condition more than from the chaos around her.  She made friendly choices to heal.  Medically heal.

Later in our treatment together, I asked her about how her kids were.  Frankie brightened up with stories of their successes.  I asked further if they were stressing her out, and she looked at me like, “Why in the world are you asking me that!?  That’s out of left field!”  She had already forgotten that she had held them responsible for her feelings not too long ago.

Question:  What barriers have you been up against to get full treatment response?  Please tell me your story.

Stop Blushing. It’s Not About “Me.”

Beckwith James Carroll Lost in Thought

Image via Wikipedia

Self-Care Tip #137 – Take yourself out of it to be more present in it.

When I started Toastmasters, I blushed, I stammered, I um-d my way through every talk.  I thought about “Me” a lot.  I thought about others in relation to Me.  I kept thinking, “What’s the worst thing that can happen?”  (Which, by the way, is supposed to desensitize Me and make Me feel better.)  But I just got more doe-eyed in the headlights.

I lasted about a year in this speaking club before life grew over it and I dropped out.  I still consider myself a Toastmaster, though, and, many friendly critiques later, I remember my hard-earned lessons:

1.  In other people’s eyes, it is not about “Me.”

Bob Freel, from Toastmasters International, often coached us to think about our emotional connection with our audience.  He made it clear that the reason so many of our talks stunk was that we were so caught up in ourselves.  We were not looking at “their” faces.  Thinking about “their” feelings.  Speaking to “their” interests.

Now how does this relate to self-care you ask?  Well, when anxiety hits my patients, they seem to find a little solace hearing that most of the things people do or say around them, to them, about them, etc. has nearly nothing to do with them.  Even when they are named by the person speaking.  That can be confusing, but just because our name may be on someone’s lips, on the program, on the tag — that doesn’t make it about us.

I am amazed at how true this is when flipped around too.  When I think about how often I’m thinking about others, (or not thinking about others,) I stop in my own tracks.  I’m pretty darn self-absorbed.  Yet, that is not a bad thing.  It’s just how it is.  For all of us.

Pulling our own selves out of the equation, helps us in fact to be more present in it.  For our own selves and later for others.

Sometimes we just can’t do this though.  That’s when we need to think biology is getting in our way from getting out of ourselves.  Let’s do it and stop blushing.

To read about #2 on this fine list, tune in tomorrow fellow friends-to-ourselves!

Question:  How has pulling your own self out of the equation helped you be more present in it?  Please tell me your story.

You Are Enough.

Self-Care Tip #119 – Remember that you are enough.  Be a friend to yourself.

Forrest Gump (after watching his girl Jenny throw rocks at her childhood home of abuse,)

Sometimes, I guess there just aren’t enough rocks.

That movie grabbed almost everyone’s heart-strings.  And when I saw my patient Sarah, I kept thinking about Jenny throwing rocks.

Sarah started crying.  I’d never seen her do that in the 8 years we’d worked together.  She was one who talked in spurts.  Sometimes saying nothing for many visits, and then she’d start questioning me about foods, diet questions, or parenting.  Then quiet some more.  Today out of the blue came her tears and words.

When she started on her disclosure, I tensed up thinking, “What am I supposed to say?  She’s never done this before!”  I realized that being a psychiatrist, I should know the answer to that question and got even more insecure because nothing came to mind.

Her lovely face crumpled over the story of her “stupid” father.  He never let her go to school.  He was violent.  Sarah is now teaching herself how to read; and more tears, her lovely face trembling.  She is a mother and there are no books in her home for her children because she is ashamed of herself.  “My dad is an idiot man.”

Post traumatic stress disorder (PTSD) can last a lifetime.  The horrors that are relived by the survivor can be unspeakable for them.  We never know what people are going through really inside.  They could be a survivor like Sarah or Jenny.

So far, I hadn’t said other than a few “psychiatry-sounds” like “hmm,” and “Oh.”  Don’t be too impressed but I remembered someone somewhere wiser than me put it this way,

Sometimes it’s better not to say anything.

And I really didn’t.  She did.  And she did it wonderfully.  We ended up talking about authors she hoped to read eventually.  She’d heard of Isabelle Allende and wanted to get to her books some day.  We hadn’t even started talking about medications yet.  Sarah left after saying that when she stopped learning and growing, she would be dead.

What hit me was that Sarah wasn’t looking for more than me.  I searched, wanting to give her more and came up with what I hoped was an appropriate facial expression.  In a way, by not speaking much, I was able to receive and be blessed by her story.  I might have missed that.

My mentor, author of blog CreatingBrains.com, encouraged me when I was unsure about teaching others.  She said, “Look at your life and who you are.  You would be surprised.”

When we are insecure about something, it helps to remember that we are enough for the task at hand.  As individuals.  We have in us all the days that came before, the experiences, the generations that handed us down, the God who made us and as per my belief, never leaves us.  We have so much.  Considering all this, be still and know.

Question:  When have you been amazed at all that was inside you?  Please tell me your story.

When It Is Time To Take Medication

"Yard with Lunatics"

Image via Wikipedia

When is it time to use medications for mental illness?

It is time to consider a medical cause for your behavior and mood when:

1.  you can no longer control them

2.  they affect the various areas of your life

3.  you start having other physical symptoms not accounted for through medical exam and studies, such as:

  • sleep changes (Pearl:  Sleep is known as the vital sign in psychiatry.)
  • change in energy
  • gastrointestinal – stomach upset, nausea/vomiting/diarrhea, change in appetite
  • neurological – headache, numbness, tingling, shaking, change in response time physically or verbally

I’m sure I missed a few things, but roughly, these are guidelines that can apply to most mental illnesses on multiple spectrums, such as anxiety, mood, psychosis, addictions, and even character pathology.

According the numbers count done by NIMH:

…about one in four adults — suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.  …mental disorders are the leading cause of disability in the U.S. and Canada.

When you next go outside and walk in a crowd, count them.  One, two, three, mental illness.  One, two, three, mental illness.  And so on….  If you suffer from mental illness, you are not alone.

If you buy any of this, if you see these things in yourself, consider seeing a physician for further evaluation and possible medical care.

Self-Care Tip #108 – Take medication if it’s medical.  Be a friend to yourself.

Question:  How has your definition of mental illness affected your ability to get treatment?  Or how has it affected your interaction with those who are in treatment?  Please tell me your story.

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

A Little Bit is Not Enough – Claim Full Health

The good news is, I just ate 3 chocolate chip cookies.  You already know the bad news.  Has nothing to do with my post.  I’m just sharing it for the sake of your own

Schadenfreude 🙂

…Onward.  Question:

Does emotional disease get worse even while on medication therapy?  Sometimes.  It does so more often when the disease process is treated but only partially treated.  Read a little more about this in this post if your interested.  A primary care physician recently told me, “I think the term ‘Partial Responder’ is a marketing gimmick to get physicians to prescribe more medications.  I don’t think it even exists.”

There’s a lot to be said about interview skills in sussing out the partial responder.  If I asked someone if they felt better, many things play into their response. Everyone’s responses are biased of course.  We don’t have sterile minds.  For example there’s the patient who wants to please their physician.  “Yes I’m better!”  i.e. “Yes you’re a good doctor!”  There are the patients who don’t want to be patients and minimize whatever they’re going through.  There is the physician who leads the interview.  “So, you’re feeling better?”  “The medication is helping?”

Partial response means that at the end of a full treatment initiation period, there is some disease remaining but a reduction of disease.  For example, in depression, I may no longer be suicidal, but I still have trouble feeling pleasure in life.  In cancer it means that there is tumor reduction of at least 30%.

Now why would a physician presumably agree that there is a partial response in cancer, but not agree that it happens in mental health?  Anyways….  (Ahem.)  When we partly respond to mental health treatment and don’t push further for full response, about 70% will relapse.  Versus maybe 25% in those who reached their pre-disease baseline emotional health through treatment.

Don’t get lost in this.  The point is, get treated and get fully treated.  Mental illness is progressive and causes changes at the cell level.  The brain is connected to the rest of our body.  The brain is human.  A bit better, is not enough.

Self Care Tip #61 – Go all the way!  Claim health.  Be a friend to yourself.

Question:  Did you find this to be true in yourself or someone you know?  Please tell me your story.

Afraid of Meds

A colleague told me,

I want to get off my sleep meds because I don’t want to be dependent on anything.

Dependence.  Lazy, pass-the-buck, unimaginative, immoral, chemical abuser.  Maybe even doctor-shopper depending on who is speaking.  When someone says it, before we talk about medication use, biology, etc… we need to know what is behind that word.  Working with the tip of an iceberg of prejudice might sink us before navigating much treatment.  Even physicians after 25+ years of education and more of medical practice, find it hard to shed these cultural prejudices about psychotropics (medications used in psychiatry).  What does the word dependence mean to you?

To psychiatrists, substance dependence means that the body has become accustomed to something.  We don’t get as much physical or emotional boost we used to using a substance, such as to nicotine, alcohol, illicit drugs, or prescription medications.  We now need more to get the same effect we would have gotten before with less amount.  It includes physical and emotional cravings – like sweating, shaking and yearning.  A lot of time is spent to do whatever it takes to get it.  Can’t cut back.  Keep doing it even though spilling into personal and professional space.  Keep using even though aware body and mind are worse for it.

Was this a description of my “dependent” colleague?

How about abuse?  Substance abuse is when we do dangerous, mean, and/or irresponsible things when using.  Was he hitting his wife when he was under the influence of a sleep medication?  Was he taking sleep medications when he was at work because he liked how they made him feel?  Driving with them?  You get it.

This guy is no dummy.  Yet he felt guilt and shame about appropriately using a medication for a medical reason.

I was seeing a woman for the first time in my clinic.

“Doctor is this medication going to make me addicted?”

We spoke about her fears.  Turns out, she thought her medication would prejudice the world against her.  Change her personality.  Make her crave it if she ever wanted to stop.  Steal from her geriatric mother and eventually, who knows?  Panhandling?  Now how am I supposed to work with that?  How she ever got the courage to come and see me in the first place with all that on her back, must be pure grit.

So here’s the dirt.  Some medications have no dependency risks.  Some medications do.  Some people abuse any medication they can get their hands on.  There are rave parties where there is a kitty – a bowl full of whatever pills anyone in attendance donates to.  They take them out randomly and swallow to get whatever surprise awaits them.  Is one class of medication more often abused than another?  Yes.

As a prescribing physician, I have sworn to not intentionally do any harm.  As a patient, you contract with me to take your medications as prescribed and safely. We’re in this together.  We will talk about any recommendations and you will hear the risks and benefits to treatment.  You will decide.  There is no conspiracy to turn Americans into bad citizens through psychotropics.

Self Care Tip #52 – Find out where your fear is coming from.  Be a friend to yourself.

Question:  What are your fears about psychotropics?  Agree or disagree with this post?