Medicine

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Get Your Butter Knife Out and Spread Your Biopsychosocial Self Together

Grape Jelly is Spread Over Peanut Butter

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Probably when you have thought about psychiatry in the past, before this blog, you weren’t thinking about self-care.

What do you think of psychiatry?  Would any of you shout out a word, can I have a word, give me a word, any word that shoots to the front of your thoughts?

Psychiatry has changed.

There is a progression of how we view mental health now vs. even thirty years ago.

Back in the day, things went along the lines of poisonous medicines, close the window because sunshine is unhealthy for you, surgery without anesthesia, maggots… drilling holes in people’s heads to let evil spirits out and offering cigarettes to calm the nerves – or cigars as I wonder if any of u would argue.

Truth be told, I’m still learning about psychiatry.  I imagine I will be forever, because I think it is a science that flattens the universe and is unhinged from Time.  I don’t know how big or involved that is, but I’m thinking more than my sum of years can master.

For now, we understand that there is interplay between biological, psychological, and social issues that make us who we are.  We call this the Biopsychosocial Model.  Pretty cool word – biopsychosocial.  It hit me last night when I was working over these thoughts that self-care can also be organized, framed, conceptualized and all that to help it make more sense to us.

What is self-care?  Self-care is a philosophy that everything starts and ends with Me.  And that Me is all of me.  My biological, psychological and social self.

Self-Care is teaming up with our biology.  So where do behaviors and emotions come from?  This to me is one of the most challenging questions to answer from a cultural and moral level.  Can you tall me your gestalt?  Where do our emotions and behaviors come from?  What do they mean about who we are?

Self-Care is Empowerment and not victimization.  This is part of our “psychological” selves.  No one is responsible for our emotions but “Me.”

Self-Care is knowing our Essence. This is part of our “social” selves.  Our Essence is what we find after we get sick, after we change in every way but one, it is our identity, who or what we are.

To understand our essence, knowing our connections helps:

Connection:

  1. God/Love
  2. People
  3. knowledge

When we get sick, our identity, who or what we are – our essence might feel threatened.  Some people call this our “soul” instead of essence.  I found it interesting to think of the soul or essence as part of our “social” selves but it is and it helps me bring it all together better.  My soul is created for connections.  With you in fact.  And my soul has been more connected to the rest of me since you came.

Self-Care is Freedom.  This is another part of our “social” selves.  You may remember that phrase, “To love someone, you have to let them go.”  Freedom brings connection.  Lovely, no?

Now get out our butter knife and let’s smear all this together in a sandwich.  That is who we are.  Without dividers.  That is important if we plan on getting friendly with ourselves.

Self-Care Tip #211 – Whatever is tripping you up when you go, blend it in with the rest of you and things will get more friendly (smoother.)

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Be Willing to Stick Your Toe In The Water of Self-Care – Just Start.

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Self-Care Tip #204 – Be willing to stick your toe in the water of self-care – just start.

I’m not interested in medications.

I used to really wonder why anyone would come to me and say this.  Sometimes we would both realized that they didn’t know what a psychiatrist was.  My degrees seemed transparent as they hung so quietly on the wall.

My girlfriend, who’s an Ophthalmologist, loves it when her patients homogenize her work with what optometrists do.   And it wasn’t until I read Madeleine L’Engle did I understand more of the differences between astrology and astronomy by understanding their similarities first.

For the magi, astronomy and astrology were one science, and it is probably a very sad thing that they ever became separated. That is yet another schism which looks for healing…

–Watch for the Light: Readings for Advent and Christmas.

In those cases when my patients don’t know who they came to see, I have tried to bridge the awkwardness with something to put them at ease.

Don’t run for the door.  There’s no cage.  See, the doors unlocked.  There’s no implication that you have to take medication just because you came to see a psychiatrist instead of a psychologist.

But I’m not interested in medication.

Then there are those who know who they came to see.  But they may not know the connection between behaviors, emotions and their brain health.  (Of course there are other reasons to see an MD I’m not covering here.)

I’m not interested in medication.

Who wouldn’t wonder?  Now I realize an MD is good for more than just prescribing, if she wants to be.  I know.  Wild and outrageous idea, right?  So before I educate anyone on my enormous fund of knowledge or my stealth abilities to diagnose and treat, I think about what it is that this someone thought they might get from coming to see me.

(Enters Fatima:)  Fatima came in this way.

I’m not interested in medication.

Fatima wasn’t feeling good.  Her emotions were corrupting her behaviors and quality of life and she was trying to help herself, stretching her toe into the pool of science, slowly.  She had never been a person to jump in and splash.

After speaking with Fatima for some time, we were able to come up with what she felt she needed help with, what she thought might be medical, what she might be willing to try – for now that meant engaging in psychotherapy, starting omega 3’s and vit D, working on her sleep hygiene, trying to get more aerobic exercise in (like a pill) and doing a mood chart.  We decided together that she would see how this goes for her over the next two to four months.  After that, if she wasn’t doing better or better enough, we’d consider a medical intervention.  We’ll see if she’s interested in medication.  Maybe not.  She can choose when she believes she’s making the right choice.

Questions:   What helped you take the plunge into medication therapy?  What held you back?  Or in someone you know?  Please tell me your story.

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Rosa Parks Protesting From the Tower of Babel On The West Coast – We Have Choices in Self-Care

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Self-Care Tip #201 – Make a choice that takes care of your inner self and your quality of life.

Dear Sarah McGaugh alerted me yesterday to the #2 emailed article from the New York Time‘s besmirching the intentions of medication prescribing psychiatrists.  Funny thing is, it’s quoting psychiatrists bemoaning their own prescribing practices, victims to managed care and the force of the mighty money mongrel pharma agencies.  You who’ve been reading this blog already know my thoughts on that and might be able to take these boys aside for me and quietly help them learn about self-care.  Politely without whining you know.  You might not get in the New York Times doing it, nor photographed with a furrowed brow.  I’m sorry about that.  Self-care has never been glamorous.

I definitely know where these physicians are coming from when they complain about these qualities in their practices.  The good news is that they don’t have to practice that way if they don’t want to.  Yes they’ll earn less or they won’t.  I don’t know how it will pan out for them.  But they do have choices.  I know many physicians who feel the same way these men do and many others who enjoy working mainly with medication therapy.  It is their choice.

When I was studying on the East Coast, I saw more psychiatrists still using their “couch” skills in psychotherapy.  There were those that viewed West Coast practitioners as the Babelers who were responsible for the fall of the tower that would have should have led them to heaven.  They spoke of the culture of the West Coast psychiatrist.  They questioned periodicals authored by them and wondered if they ever read Kreplin.

Now WHO is this exactly who wrote this?  Never read something without first knowing who wrote it.  What authority do they have on this topic?

Not a bad thing to do as there are a lot of posers out and about, quill fast at work.

I remember my patient Dorinda, divorcing a meany who wouldn’t leave their home.  They had other places they could move out and into, smaller than the one they were in, but neither of them would go.  They both had their reasons.  In our popular New York Time’s article, the psychiatrist explains that he wouldn’t want a cut in pay and asks, “Who would?”  Dorinda and her meany husband would answer, “Not me.”  I would too and agree that probably, so would all of you.  But we do have choices.  I told Dorinda so much and quickly got on her “Meany-list.”  She was nice about it though.

My children learned about Rosa Parks in school a year ago.  They still bring her up at random times,

Mommy, she was a COURAGEOUS woman!  She changed how all the black people were treated.

My five-year old told me Rosa’s age when she started her

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work leading to desegregation and how long Rosa struggled before she and others were allowed to finally ride public transportation with whites.  She even described how these people protested; united together, refusing to ride public transportation at all until the law changed.  My kids have pretty great teachers at River Springs Charter School.

Maybe, if it’s alright with you, my daughters and their teachers could join you when you talk to these boys about self-care.

Questions:  How do you empower yourself when you feel caught in a web and victimized?  How have you seen others do it?  What do you think about this NYT article?  Please tell me your story.

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Just to Feel Pleasure

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Self-Care Tip #189 – Heal for yourself, and you’ll see that also, everyone heals.

The best thing I ever did was go on antidepressants.

Bianca sat, but her whole body was talking.  She was telling me about her changing life.  She had read some of her journal from a year ago when she pounded on herself for her behaviors.  She thoroughly grieved the time with her children when they heard her scream about small things that kids do.  She told me about her sons face when she was irritable.  He showed all the waiting tension that an open child will when waiting for Mom to lose it.  She was trying to push it aside and think rather about how she now could finally enjoy them.  Bianca said,

I just had no idea before how much better life could be.

Bianca’s face became tight and she didn’t make eye-contact,

There’s no way to describe what it’s like to not enjoy your kids – My own kids! – for most of their born lives and then wake up and experience something different.  I just can’t explain what it means to now actually like being with them.  I’ve always loved them but I didn’t feel the pleasure and I hate that.  I want that time back but I can’t have it and I can’t give it to them either.

I’m so scared it will end, the pills will stop working and I’ll lose this new life.

Before her medication, Bianca worked hard at taking care of herself.  She was a check-list of responsible self-care.  Bianca thought it was important that I knew this.

  • Aerobic exercise – check!
  • Healthy diet – check!
  • Sleep hygiene – check!
  • Bianca talked about God but things got confusing for her there.  She didn’t like to think about Him being on “a list.”  He was in her life and didn’t feel He failed her even though she couldn’t feel pleasure or joy.

Still, she continued to coil up and release hard punchy words at her kids and then hate herself for it.  She had prayed so much about this and wouldn’t even mind if God had to puppet her, if that’s what it took, in order for her to treat her kids better.  She could not stop herself from being what she called,

Crazy Mommy.

But now, after she was treated, Crazy Mommy was gone.

Aside from dropping the shame, the best thing for Bianca was knowing that her kids could trust her, felt safe with her and that she felt safe with herself.  Everyone was healing subsequent to Bianca healing.

How many of you have told us a similar story.  A similar rescue.  Yet, never-the-less others of us are afraid to go there.

Question:  How are you present with others who don’t understand your rescue story?  How do you stand beside someone who needs medical help for emotional illness but won’t accept it secondary to stigma?  Please tell us your story.

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Goodbyes Are A Way To Connect

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Self-Care Tip #184 – Respond to your goodbyes deliberately to be friendly to yourself.

One of the Regional Centers that I work at is closing their telemedicine clinic.  This means I’ve said goodbye to many beloved patients and their families, whom I’ve worked with since round 2003 I think.  Saying goodbye to people we respect and enjoy is not as casual as we stylin’ people make it look.

Two days ago I said goodbye to my girlfriend of around five-plus years and her family.  Moving far far away makes the flat world feel lumpy and luminous.  I now have all her leftover food and knock-offs she didn’t want to haul across the lengthening world to remind me that she is gone.

Watching parents and/or grandparents age is also an exercise in saying goodbye.  My parents have a hard time making it over to visit on week-ends for all the funerals they go to.  Their calendar sends over that whispering voice that they are growing old.  “Look,” it says.  “See me.  I am aging.  Time is connecting and taking me with it.” Even so, their essence holds its own, apart from Time.  That makes me feel more comfortable.  When that whisper gets louder I may respond differently, I can’t know until then.  But for now, this is good.

“Goodbye” is something that begs a response.  “Oh yes!  Goodbye!  See you later.”  I even say, “See you later” to people I know I have less than one percent chance of running into again.  The word calls to me and I respond.  The word implies a disconnection, but even so, beckons us to connect.  It spreads us over the space of our time shared and into the future apart.  Peanut butter and jelly, it sandwiches us up with the one who says “Goodbye” when we say back, “Until then.”

Today with these people and remembering all the ones I won’t get to see before my contract ends, I feel the pull to respond.  My response can be something deliberate.  It is another bit of something I get to choose.  I hope it will connect me.

Question:  How have you responded to the goodbye’s in your life?  How has it been a connecting force for you?  Please tell me your story.

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Pain Can Be Something More and Better Than Just Pain

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Self-Care Tip #181 – Look for help if your pain never becomes something more than pain.  Be a friend to yourself.

Glee is back!  I’m so glad because it makes great work-out distraction.  Good music, drama, beautiful people, and wonderful ah-ha concepts like,

Use your pain and loneliness to inspire you to make something beautiful.

Can’t remember it verbatim though and I noticed after an hour surfing the web for Mercedes quotes (and getting detoured to all sorts of other fun stuff for grazing) that whoever writes these quotes up didn’t find this one worth it.

Joni Eareckson Tada on the Larry King Show said that when she thanked God for her paralysis, she began to be productive through what paralysis offered.

It is however sometimes impossible to take what hurts and let it fuel our fires.  Sometimes it’s just a cold lump of coal.  Sometimes, we aren’t adaptable.

Luckily we aren’t sitting in a cave during the ice-age and can trust that a bear won’t come and eat us when we are wounded.  But there are other predators.  In my line of work, I could call disease process a preying force.  It takes over more and more cells, space, grey matter, consuming bits of our identity and changing our ability to cope with stress.

It’s easy for people to say, “Turn your pain into energy for creativity,” as if it were a volitional option for you like it was a choice for them.  Or we call it bits of morality; maybe a fourth of an inch on the rim of our gold crown we get in heaven.  Those of us who care about that crown look at our shoes, apologize and promise to try harder.

It is not easy to explain these apologies and inactivity to someone who has never been immobilized by mental illness.  Even those of us who have experienced it first hand have a hard time remembering the real texture of what we went through once it is passed.  Illness can be so awful that even our subconscious shudders when turned back to remember.  It is no wonder that we find it difficult to explain.

However, it doesn’t have to be this way.  If we aren’t able to adapt, aren’t elastic and sit stunned in the presence of pain, immobile to the newness that it can offer – recognize this as a flag to turn towards medical help.

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  Please tell me your story.

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Listen to Your Mind and Body When Doing Something As Simple As Cleaning

I Heart Cleaning

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Self-Care Tip #170 – Listen to your mind and body when you do things like cleaning, even if it makes you feel better or worse.  Be a friend to yourself.

Whenever someone in the house can’t find something, I ask them to please just start cleaning and sooner or later they’ll find it.

Today my kids and I spent two hours cleaning their play room.  My daughters were amazed at all the treasures they found tucked under, over, this way and that way in their clutter.  Although there was a lot of crying and gnashing of teeth along the way, in the end everyone was happy and pleased with themselves.

One of the blog-sites I enjoy reading is “Earthquakes and Rattlesnakes” by Zahara.  The other day she said,

I have a lot on my mind.  It seems when my mind is in a jumble, my house is in a jumble.  Cluttered, disorganized.  Can I unclutter my mind by cleaning my house?  Probably.

According to BBC News, cleaning improves mental health through the exercise that is inadvertently done.

And as Louise Hay once said,

Cluttered closets mean a cluttered mind. As you clean the closet, say to yourself, ‘I am cleaning the closets of my mind.’ The universe loves symbolic gestures.

But there are times when this goes awry.  In Obsessive Compulsive Disorder, people may clean ritually and compulsively to avoid an egodystonic fear; a fear they know doesn’t make sense but still terrifies and overwhelms them.

Or in Major Depressive Disorder, the illness affects their brain and body so much so at times that they can’t do basic life functioning, such as cleaning their house or even showering.

So I’ll tell the mothers out there such as myself, the BBC News, Louise Hay and the rest of us that cleaning is good self-care.  The milieu around it is also a good indicator on when it is time to go get professional help.  Listen to your body and mind.

Questions:  When and how has something as simple as cleaning improved your mental state?  When has something as basic as doing your activities of daily living shown you that you or someone you love might need to see their doctor?  Please tell me your story.

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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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Choose Self-Care At Your Most Elemental Level

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Self-Care Tip #167 – Choose self-care at your most elemental level.

Carl, who writes blog-site, StillFugue, said after yesterday’s post on self-care being for everyone,

Sometimes depression blocks this type of self-care regardless of how good our cognitive strategies are.

Carl reminded me of Dr. Lang.  He was a physician, a father, a man of high character who never had depression in his life.  Then after a series of life stressors depression expressed itself and he, who once was the warm-fuzzy in the hospital, the man who never lost his optimism, the man who turned anyone’s bad mood around – this man came to me under a black cloud, heavy with melancholy, and raining tears.  He cried all the time.  This giant of a man cried and cried on his wife’s shoulder, and she was bewildered by him.  She told me he had done this for a month now, although the depression started about four years ago.  He kept wanting her to read to him the book of Job and cried more barely hearing the words.  He had already been through a series of well-chosen medications, but still he sank deeper.  No form of treatment kept up with the leak in his ship.  What was self-care for Dr. Lang?

Did Dr. Lang have good coping skills?  Well he wasn’t coping well now even though he knew the strategies.  He didn’t understand why he couldn’t use the coping skills.  Did he have intelligence?  Yes.  Did he have resources?  Yes.  However, none of that is what this was about.  Asking Dr. Lang to cope with his feelings is the same as asking someone blind to see.  Physically, biologically he could not.  His brain could not.  Much of his ability to choose behaviors and emotions were drowned by illness.

So again, the implied question comes to us, – “Is self-care for everyone?”

Mr. Rick C. threw this life-saver out in response to our question,

During times when chaos ensues, either internally or externally, self-care seems to become the basis on which all other positive actions are built.

Sarah McGaugh also referred to self-care as “action,”

A call to action may also be a higher calling than one’s own self….

What action did Dr. Lang do?  He cried on his wife’s shoulder and read the Bible, i.e., he leaned on the support he had built up before the hard times came.  After failing medications, he sought another opinion and other treatments.  Sure, he couldn’t get out of bed otherwise even to bathe himself, but he had made it to my office.  What did Dr. Lang do?  He got electroconvulsive therapy (ECT) and in two months, along with his medication (only one antidepressant was needed at this point), Dr. Lang was no longer crying.  In four months, he was laughing again.  In six months, he stopped ECT altogether and maintained his emotional health with his monotherapy medication.  It’s been seven years since Dr. Lang went through all that and he has not relapsed yet.

I pick out so many points that I consider self-care choices Dr. Lang made.  They changed over time for him according to his needs and abilities, but he didn’t want to die.  Even at his worst, when he could barely remember why life was so important, that wisp of hope was enough to live for.  It was a higher calling to him, higher than his own dark wants.

That was Dr. Lang’s choice.  He chose self-care at his most elemental level.  It was his response to the call of hope.

Questions:  But what about you?  What do you think?  Is self-care for everyone?  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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Emotions: The Physical Gift We Can Name

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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.

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There is Less Space Between Emotions And Science Than We Think

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Self-Care Tip #147 – Bridge the gap between emotions and science.  Be a friend to yourself.

She had been through a lot – Aimee.  Lost her baby brother to medical disease.  Was in a stressful marriage and didn’t like her work.  There was more but you get the drift.  She found herself thinking that things would be different if things had been different.

Would they?

Readers, I am referring specifically to her medical condition.  Not to the fact that the universe is different because her brother died.

Madeleine L’Engle talked about death affecting the whole universe.  She compared it to the death of a star.  In death, the star creates a hole in space dark and large, enough so that the absence of it has its own gravitational force, a “black hole.”  L’Engle says that when any part of creation dies, we are all touched.  Life knows and the absence of that bit of creation leaves the surviving universe changed forever.

Aimee wasn’t talking about that.  Aimee thought her emotional illness was largely secondary to her life stressors.  Because this influenced Aimee’s choices regarding her medical treatment, I had to tell her no.  Gently.  It was hard for her to hear.  “Aimee, your sadness you feel now, four years after your brother’s death, your isolation and amotivation, your low sex drive, your difficulty feeling pleasure in other things, your sleepiness during the day – these things are not because you have suffered your brother’s death, nor because your marriage is hard.”

There are times when directly saying things is the more gentle approach.  No one going through what Aimee is going through wants to hear about how I feel about it.  Yuck.  There’s not much that is slimier than going to someone for objective feedback and getting their emotions and personal opinions all over you.

Aimee left saying she understood and with a new medical treatment for the medical illness propagating emotional and behavioral symptoms in her.  We’ll see if she did some days from now.  But what about you?  Do you believe that her emotions and behaviors were secondary to medical illness?

Readers, life stress will continue to happen.  What may change is how we respond to it.  If our response does change and it isn’t serving us or others well we need to think that we might not be interpreting how we feel objectively.  We might be having changes to our biology that “taste like chicken.”  It helps to get a physician’s opinion – someone who sees behavior as more than the spirit, the abstract, the puppet of our volition.

Question:  How do you bridge the seemingly abysmal distance between emotions and science?  Please tell me your story.

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Lament, Celebrate, Negotiate to Take Care of Yourself

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Self-Care Tip #146 – Negotiate to get friendly with yourself.

How do you fit in socially when you’re taking care of yourself?  To be social you need another person.  How does that socialization become compatible with self-care?

These were the questions my brilliant sister-in-law, Trixie Hidalgo asked.  It isn’t so apparent really and I get what she’s asking.  Self-care is not all about the self.  There is clearly an exchange.  We are getting something from our environment that in turn is taking from us.  That environment can be anything, such as music, movies, books, work, or interpersonal relationships.  We negotiate with that.  We agree to what we get and what we give contextually.

How does one person in wanting to define self-care for themselves harmonize the exchange?  It’s a reduction of laments and celebrations.  For example, in going to medical school I lost time, opportunity to be a young mother, and joined without directly asking to, the competitive world that is culturally considered masculine – to name a few.  Yet the celebrations, although never equal to the losses, and vice versa, I agreed to.  I made the exchange between myself and my social context.

The self-care skill comes in the experience of your own self-discovery.  How does one do this?  Look inside yourself over and over again.  Lament.  Celebrate.  Negotiate.

For You:  I’m dying to hear your responses.  I have a feeling that they will complete the post, as so often they do.  Please tell me how you reconcile the effort towards self-care with the inherent social context.

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Live And Live Despite The Ongoing Loss

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Self-Care Tip #141- Live and live despite the loss.  Be a friend to yourself.

The other day, my hair was barely pinned back in a knotty mass, when I arrived at clinic late with my house slippers still on.  I didn’t realize this of course until I heard this flapping sound echoing behind me as I hooned down the hall.  Distracted by myself, I seemed to suddenly come upon an old man.  He was lovely really, wrinkled, clearly handsome in his day, shuffling my same direction, and also in his house slippers.  It was less than a second when I took this all in and I suddenly felt very self-conscious.  Not awkward for the normal reasons that I should have been, like my nappy appearance, but I’ve never really thought I was “normal.”  No, I felt rude.  I’m much more sensitive to rude than ugly.

Do the younger seem rude to the older?  There with their supple joints, perky bodies and minds, hope, and shorter medication lists?  I felt rude.  Rude combined with awkward is not something most people are comfortable looking at, which is what I unfortunately offered up to this innocent man.  Walking fast felt wrong.  Not sure what to do, I sort of slowed, yet my tardiness to clinic didn’t let my gait relax.  Giving an uncertain smile, I managed not to make eye contact when I said “Hi there,” lest the eye contact lead to further tardiness.  Then off I galloped, luckily for both of us, only 3 doors down.

I didn’t spend more than a few seconds with that stranger, yet remember well what he symbolized for me.  I remember him when I get grumpy about not being able to eat as much as I did 10-years ago.  When I get resentful with my feet, (a size and a half HUGER since I had my first kid,) I see his lordosis (hunched back often from a collapsed spine.)  I wonder how he is doing with his losses.

There’s not much romance in growing old.  What is romantic is a beautiful person, who has been real with their losses and with the joys of life that are still available to them.  There’s no point in my denying that I can’t have cereal and pasta every day any more.  There’s no point in being angry about it.  I’ll just eat slower and force, er, I mean find more pleasure out of what I do eat.

I like to think that the old man in the hall made his and makes his peace with losses and is more glad than not for his life.  If so, maybe he was ok with my fast pace when he couldn’t.  Maybe it makes him more comfortable in a world in which he is becoming more and more of a stranger.  That is something to admire.  That is something that is worthy of life’s privilege.

After yesterday’s blog-post, a reader said it quite fine,

I did not know depression was progressive.  That’s depressing.  As is the realization that aging is progressive.  …On the other hand I can say I’ve had 61 more Christmas times than a new-born and perhaps that makes it worth it!

Question:  What losses are you struggling with?  How do you come to terms with your losses?  Please tell me your story.

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The Presence of Stress Doesn’t Make the Disease Process Any Less Important

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Self-Care Tip #135 – If it’s medical, call it medical and not stress.  Be a friend to yourself.

New to me, Stacy came because of her problems with violence.  She was enormous.  5’11” and 200 pounds, she was just too big for her parents to handle her any more.  She was precious to them, their only child.

Taking Stacy’s history, I asked, “Does your family have a religion you practice at home?”  Stacy’s parents were giving her history since Stacy was disabled and used very few words.  Mom looked at me, and asked, “Why?  Why are you asking about our religion?”  She was sensitive.  Worried that I was packaging her up in a religion-box, she personalized my question.  I explained that religion is part of family culture and the question was simply part of getting to know them.  She relaxed a little and then said, “We have more of an ‘Autism’ home-culture these days!”

Mom looked tired although still very much engaged in her daughter’s life.

It often happens, when someone see’s me in clinic for the first time, that my questions take them by surprise.  They aren’t used to someone so directly and objectively asking and speaking about them and to them.  So it went with Stacy’s mom.  Question after question, she seemed to be in a mild state of wonder.  It wasn’t gun fire but she might have felt like it was.

“Does anyone in your family have emotional illness?  Any depression, anxiety, suicide, drugs, alcohol…?”  Why do I want to know about the family? her face said.  “No!  No one.”  I was just ready to move on to further history when she said, “Well I… I have been depressed a little on and off but I don’t have depression.  Who wouldn’t feel depressed with this stress?!”  And then Stacy’s case manager said, “Who wouldn’t feel stressed in your situation?!” and smiled and laughed with her to put her at ease.  Stacy’s case manager is a nice person.  She is bonded to the family and cares about each of them.

We completed our history and formulated a treatment plan together.  Stacy had sat mostly quietly through the hour and her parents were now at ease.  Before they left, I was able to share with Mom a couple of sentences on taking care of herself.  On seeing herself as important and in doing so, was giving Stacy the best gift she could.

What I would like to say to Stacy’s mom and to her case manager is that thinking depression is because of stressors is a great lie.  There might be some initial correlation but it is often not the point .  The real issue is medical.  I wanted to tell Stacy’s case manager that she should know better than to promote this.  I wanted to tell Stacy’s case manager that helping Stacy’s mom not minimize what she was going through was friendlier.

Stacy’s mom is not my patient, but I did pick up that she is sad, fatigued, personalizes things that aren’t about her, anxious, a little hypervigilent and suspicious, and that something biological was likely going on.  Everyone has stress, but not everyone reacts the same way.  Some of us get ill for biological reasons.  Using the stressors as decoy to the disease only preserves the state of suffering.  And it affects everyone.  Mom was part of Stacy’s recovery too.

Question:  How do you see the relationship between stress and mental illness?  Please tell me your story.

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The Biopsychosocial-How-to Be a Friend to Yourself

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There is interplay between biological, psychological, and social issues that make us who we are.  You can work as a team not only  with your family, physicians, therapists, and whomever else is involved in your team approach to getting friendly with yourself – but you can also team up with yourself so to speak.

Think:

1.  Biology

Anything going on materially with my physical body?

Medical illnesses, temperament, sleep issues, diet, exercise, air, rash….

2.  Psychological

i.e., thoughts, emotions, and behaviors.

Things like lack of self-control, coping skills, catastrophizing, and negative thinking.

3.  Social

Such as socioeconomic status, culture, poverty, technology, and religion can influence health.

Think God, friends, marriage, parenting, work, unemployment….

We can do this not only with others who are here to help us, but also in our own thoughts.  We can start seeing ourselves as more than one part or another.  Separate and disconnected.  This might take some practice or it might be natural for you.  Just start wherever you are and run this through yourself.  When you’re stressed, break it down.  Take it apart to bring it back together.

Read more about this at “Forget About Divisions In Knowledge.”

Question:  How do you see the connections within yourself?  How has this played into your healing processes?  Please tell me your story.

Self-Care Tip #125 – See yourself as parts that make up your whole.  Be a friend to yourself.

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Go Toward The Pain To Get Connected

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Audrey came in looking fresh.  Better than before for sure.  She had an aura that brought to mind the moment just when tearing off wrapping paper.  It was nice to see her.

I am doing better.  I’m able to let more of the little things go, like the house doesn’t bother me as much when it’s not clean.

She was more able to do self-care with less forethought.  What did take her by surprise though, was her guilt.  She could see that it was inappropriate but insight didn’t entirely remove what shouldn’t be there.  She said these thoughts and feelings were something her husband likely never struggled with.  She didn’t think he was worried about her home doing dishes when he was at work.  However, the reverse for her was true.  She gave a coughing laugh.

I do!  I feel bad when he does the things.  It doesn’t make sense.  If he wasn’t washing dishes when I was working he’d just be watching TV.  But I still feel bad.

For her, working her job, taking her jogs, and attending Mommy groups were all in a grey category of “extras” for life.  Not necessary but bonuses she was spending their retirement on.  However, despite this, she looked the champion she was when saying,

I still am able to take care of myself.  Even though those thoughts come.

Audrey, by thinking about, talking about, and materially man-handling these thoughts, she was able to join her personal journey.  These things became connecting forces in her life.  They drew her closer to her family and not away.  Resentment dissipated and she was able to take part in her available positive emotions and thoughts.

It could have been different.  It had been different at other times, before medications and other positive deliberate choices in her life.  But it wasn’t now.  The could-have-beens trickled away together, the other near misses that sometimes we know about and sometimes we don’t.  There they go…

Going toward the pain in life, not averting from it, is a connecting force in our lives.

Question:  What have you been avoiding?  What has it done for you when you went toward the pain?  Please tell me your story.

Self-Care Tip #124 – Go toward the pain to feel connected.  Be a friend to yourself.

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Who Cares What Your Diagnosis Is?

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Self-Care Tip #115 – If it’s not serving you well, don’t waste your time on it.  Be a friend to yourself.

Trixie Hidalgo, advocate to end violence in America, tells me that many of the people engaging in gang crimes tell her that they are put in their life positions (poor, stereotyped, impoverished) by the people who have the power, to keep those people in power and to keep them down.  They have some credible arguments we’ve shared before in history relating to oppression such as race, color, gender, money, or status.  Are these people victims?  Sure, why not.  But is that the point here?

The victims reminded me of a clinic I was in the other day.  I was working with Marcus and his father.  The father was torn about where to go to get his disabled son, Marcus, treatment.  Marcus was disabled with both brain illnesses and severe psychosocial stressors.  Currently we found Marcus, 2 years into treatment with me, and as of yet, father and mother (divorced without amicable terms) had yet to engage in treatment with me.  They wanted to know why Marcus was the way he was.  Father pointed at Mother and Mother pointed at Father.  They blamed other things as well, the schools not providing the right services, the medications for not working, his genes, and more.  Meanwhile, Marcus is tearing up his classroom and his own life.  He is barely functional socially.  Moody and volatile.  Anxious with physical symptoms.  He was having multiple medical work-ups going successively for various physical complaints.

Before I let them go, I told his parents, “Who cares what his diagnoses are?  It’s not about the diagnosis.”  The purpose of a diagnosis is to serve the patient.  The patient doesn’t serve the diagnosis.  Right now, Marcus was serving the quest for his diagnoses.  If all they can see is that, and they miss the fact that their son isn’t functioning, he’s depressed and anxious and violent and no one can stand to be around him, Marcus is worsening continually while they go on debating – they’ve missed “IT.”

They’ve missed it.  And so have we when we waste time counting up the offenses we’ve directly or indirectly suffered.  We miss it when we increase our injury by holding ourselves responsible to our history.  I asked Marcus’ parents what the point of what they were doing for Marcus was.  I ask the victims of America, what the point is when they point to history to answer for their present condition.  If it’s not serving you well, if it’s not doing something good for you, than what are you doing with it?  Do good things for yourself.

For the victims, for Marcus, and for Marcus’ parents, 1st make sure we weren’t missing something medical that was keeping them from having life quality.  You can’t give what you don’t have.  Then move on to the psychosocial issues and spiritual and so on.  What ever we ran into that missed our point, we’d walk past it together and on to something that served us well.

If you’d like to read more on this topic, read more in “It’s Time to Grow Up” and “The Whole World Becomes Blind.”

Question:  How have you managed to move past things that weren’t serving you well?  Please tell me your story.

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Toughing It Out! …Is Not What You Think.

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Self-Care Tip #114 – Tough it out.  Be a friend to yourself.

Trying to tough it out is good it’s just not what most people think.

Many people think that toughing it out means staying med-free and getting through melancholy, anxiety, emotional chaos with gritted teeth.  They gather a degree of commendation from weathering out the behavioral and emotional problems until they either feel better or don’t.

This is not the kind of toughing it out that I’m calling worthy of our life efforts.  It is in fact the opposite.  Toughing it out is doing what may be socially and culturally counterintuitive.  Getting medical care sooner than later.  Not waiting to see what will happen before getting medical care if it is indicated.  Believing the medical data, the physician you trust, the knowledge that mental illness is medical, biological and often PROGRESSIVE over time.

Waiting means you are getting more ill on a cell level and at higher risk for your future and waiting is not being tough.

Toughing it out is digging into your courage bank every day to take that pill when you feel ashamed of it.  Toughing it out is fighting for your brain’s future.  Toughing it out is sacrificing what ever you need to, to give your loved ones and yourself the healthiest you possible.  Even if that means talking yourself into it, going up against your fears, ignoring prejudice, ignoring opposing recommendations from your favorite sources.

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This calls for thick skin.

Candace tells me she still intuitively can’t believe this, even though her mind tells her it is true.  She takes her medication but it still hurts a little every time.  Like she’s betraying herself.  Like she must grieve for herself.  Candace says the apparent calm, decrease in anxiety, improved relationship with her children, and the flowering hope eases her inner psychic pain.  Candace is drawing strength every day from the growing evidence of health.  Candace is tough.

Question:  What are you getting tough with in your life?  How do you do it?  Please tell me your story.

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