Medicine

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Branding and Branded. Stigma Goes Both Ways.

 

mentalhealth.wa.gov.au

 

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

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

In Jesus’ own words:

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

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

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

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

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

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

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Free to Be Accountable

dosomething.org

Self-Care Tip #97 – Protect your privilege to be accountable and your freedom of choice.  Be a friend to yourself.

Number Four on Bella’s List:

“The day has been ruined!” Bella said.  Her eyes sparkled and flashed as she spoke of her injury.  Bella was not so pleased with her labor’s reward.  She was not so satisfied with being accountable for her children‘s behaviors.

Are parents accountable for their children’s behaviors?  That can be a question at the level of the law and a question of cultural moral values.  From a psychiatrists stand-point, is there a medical interplay?

A subspecialty in psychiatry is called consultation liaison, which is psychiatry for the medically ill and usually hospital based.  In this setting we often get asked is a patient has decision-making capacity.  I spoke about it briefly in the post, “Choose, Gladly, Using Resources.”  This is difference from competency, which is determined by the court. Decision-making capacity is a medical assessment of the patients ability to:

1.  understand:

  • their illness,
  • it’s consequences,
  • it’s relationship to their values

2.  manipulate their options,

 

3.  and communicate their decisions.

Can kids do that?  Medically it depends on their developmental level.  The court however has its own forum on that – I won’t try to go there as psychiatry isn’t law.

Another area in psychiatry where we decide that someone does not have the freedom to choose and we hold someone else accountable for them (called a “5150“) is when they are:

  • not able to provide for themselves food, shelter, clothing
  • a danger to themselves
  • danger to others

Are kids able to do these things?  From a medical perspective, it depends on their developmental level.  Deciding what we want for ourselves and for our children is a privilege for those who are able.  It is also a privilege for us who want it.  Freedom is not free, as they say.

Please watch City Councilman Joel Burns tell us about bullying and how we need to be accountable to each other: “It Gets Better.”  Completely amazing testimony and speech.  Cuts out all the b.s.

Question:  What do you think about our accountability to our children and to our community?

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Recipe for Treating Panic Disorder, According to Me

 

shoponline2011.com

 

Recipe for Treating Panic Disorder, According to Me:

1.  If it’s taking you to the emergency room feeling like you’re going to die, or your spouse can’t peel you off with your phone calls and new needs – you have a medical illness.  Get medication.

2.  If you are afraid of being humiliated by an episode so much that you avoid public places, or if you are more fearful than not – you have a medical illness.  Get medical treatment.

3.  If you are panicking out of the blue, without something setting you off/triggers like finding your husband in bed with your dentist – this is biological.  Get a medical physician’s opinion.

4.  If you are awakening from sleep in a panic attack, when you feel like you have to get out of bed and escape and the episode lasts for about 10+ minutes before you recover yourself – this is not because you’re not trying hard enough.  Get on a serotonerigic therapy and a sleep aid(s).

5.  If you are drinking more alcohol to relax and out of fear of going to bed – get suspicious and get smart.  Medication therapy or alcohol?  It stumps me when someone says they don’t feel comfortable with taking medication that has beed studied in double-blind studies on thousands of people and reviewed and analyzed and more… but they do feel comfortable with alcohol.  That’s not friendly with yourself.

6.  If you think you are going crazy and realize your fears and suspicions don’t make sense; if you think you are possibly going psychotic over and over – you’re having a medical illness of the brain and body called panic disorder.  Get to your nearest treating physician and trust them.

 

juno.cumc.columbia.edu

 

7.  If this is you, don’t go get insight or supportive psychotherapy at least until you have been on medication therapy for 6-8 weeks.  What you are going through is not because your mom yells at you too much.  It doesn’t have to have a reason.  It is medical.  Treat it medically.  If you go to therapy too soon, you will see that you can’t give what you don’t have.  (I may have offended some people saying this.  Sorry.)

8.  If you don’t get treatment, expect that depression may likely follow soon.  Anxiety and depression are bedfellows and can’t be apart for long.

    Self-Care Tip #92 – View Panic as a medical illness.  It is.  Be a friend to yourself.

    Question:  Have you or someone you known used a similar recipe or a different one?  Please tell me your story.

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    Lure Yourself Like a Lover

     

    Art Gallery Bangkok

    Art Joy by Marie Schem

     

    Self-Care Tip #88 – Win yourself over.  Be a friend to yourself.

    Dr. White works with mostly women in primary care medicine.  She tells me that her women so often come in tired, overextended, and they say they don’t feel good.  She wonders why they think they can run 2 full-time jobs (parenting and employment) without suffering for it.  Her counsel is to down scale.

    My patients do so much better when they are working part-time.

    Christie, a mom of 3 who works full-time, tells me tonight,

    It’s hard.

    That’s not new news but nor is it small news.  How many of us nod when on the subject of self-care.  We sagely stroke our chin yet are nowhere to be found on the list of topics of interest.  Do we even get pleasure out of taking care of ourselves?

    I think there’s a misperception here.  The hard part is not doing the 2 jobs that Dr. White’s patients work.  It is working our own person.  Maybe if we found more pleasure in caring for ourselves we would.  Maybe if we connected that caring for ourselves is the minus-1 to the starting point of caring for others.  We can get hooked.  We can.  But it won’t be the same for all of us.   Any way you turn it though, we have to make it sticky, linked to pleasure, and making sense.

    Question: Is there anything specific you can think of that contributes to self-care being a positive thing in your life?  Please tell me your story.

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    Rebel Against Your Own Intuition

    Cover of "You've Got Mail"

    Cover of Youve Got Mail

    Self-Care Tip #87 – Be a rebel towards your own intuition.

    My husband was telling me about how consumers are demanding a more human approach to industry.

    In the 1990’s the film written and directed by Nora Ephron, You’ve Got Mail, showed us how the small personal touch was muscled out of business by the book-superstore.  Today, my husband told me that the inverse is happening now because technology allows it to.  Counterintuitive to thinking, the very thing that took out the mom-and-pop store is the very thing that is bringing it back.

    Author of the blog CreatingBrains, Joana Johnson, wrote a post, “Is Barnes & Noble Changing for the Worse?”  She describes their palliative efforts to feel their way through the current changes in the book sale market.  Clearly, buyers and readers are wanting something different from the superstore ambiance again.

    Readers have written in to me about their demands for a more human approach to their own selves.  Here are 2 recent examples.

    My mother always said that it was selfish to attend to your own needs when you were a wife and mother.  I’m happy to see a Christian woman refute that so eloquently.

    I have been recovering from a complete emotional breakdown for 16 years and… the hardest thing I have had to convince myself to do for nearly 70 years now is learn to be a friend to myself.

    These women are rebels in their own way and time.  I’m not a sociologist but I see these changes influenced also by technology and information.  It’s not so easy to stay barefoot and pregnant these days even if you wanted to.  “All things bright and beautiful” beckon to us.  Nor is it quite as easy to fool ourselves into believing that we’ll be able to take care of anyone – children, work, rescue dogs – if we haven’t taken care of ourselves first.  And although we still try to all the time, we just can’t believe any more that we can give what we don’t have.  Our current upside down economy is also testimony to that.

    I wrote a blog post some time ago titled “A Woman’s Work,” that largely speaks to this as well.  Because of many contributors, including temperament and conditioning, in many of us self-care is not intuitive.  It is disruptive.  Taking care of ourselves is even a bit scandalous …but it is more humane and it is possible.

    Self-Care Tip #87 – Be a rebel towards your own intuition.  Be a friend to yourself.

    Question:  What barriers are you passing to care for yourself?  What is making it possible?  Please tell me your story.

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    Growing Old

    Growing old.  When do we stop looking forward to the future?  My husband, who is a Palliative Care specialist, says that even in the end stages of life, we still look forward.

    Erikson‘s psychosocial crisis theory of human development says life is a balance between conflicts.  Ambivalence, two opposing forces, is something to embrace and walk with.  I don’t think Erikson ever said it in so many words, but he was largely talking about having a sense of presence in our lives.  He based most of his theory on watching kids grow and then spread the rest over adulthood like the last bit of peanut butter on the knife.  Is that what adulthood is like?

    My little girl told me that she’ll never run out of love for me.  (Every now and then, after hours or days of desert-like behaviors, she’ll break open a rock and out will gush something amazingly nice like that.)  Then she looked me over and said, “You’re not old Mommy!”  I showed her my gray and my spots and my wrinkles.  Maybe I was trying to say, “How can you love me in my future?”  Love is evergreen.  I am not.

    When I was a kid, my parents loaded us up for a couple weeks every year and hauled us 8 hours in a van to Brian Head ski resort in Utah.  It is where I learned that some things stay green no matter what weather they live in.  The Evergreens, tall, tall, covered in snow except for some undergarments showing through were everywhere.  Even thinking about them, I can taste

    Rolo Chocolate Caramel Candies,

    feel the weight of booted feet, hear Dad’s bass voice and bits of my favorite ski-story loud to be heard above the chair lift.

    Evergreen’s for at least 2 weeks a year, surrounded me and my family.  I’ve heard that Brian Head has materially changed a lot since we stopped going.  I wonder about the trees.  I’m sure there are fewer.

    If it is true that every stage of  life has conflicts to resolve, it makes sense to me that in age we must resolve our future with our past.  We can’t just have a past.  If we find ourselves just looking back, than we are turning a blind eye to something we are meant to be present with.  Something that brings balance and fullness to life.  Something that is an evergreen quality.

    For me, it is intuitive to look at God to meet this need – future v. past.  I don’t know what it is for others.  Conflict resolution.

    When the days on life’s scale are tipping backwards, and we see that there aren’t as many days left on our plate, be present.  It is an illusion.  The past does not outweigh the future.  The opposing directions of time are just fine.

    Self Care Tip #71 – Be present with the past by believing in your future.  Be a friend to yourself.

    Question:  Agree or Disagree?  What are your thoughts?

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    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.

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    If You Are Ill

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

    Image via Wikipedia

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

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

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

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

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

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

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

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

    Related Articles From FriendtoYourself.com

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

    Holding her breath, my niece swam the length of the pool underwater.  She popped up like an otter.  Slick, water rolling off of her like nothing in the world would bother her.  Click!  The timer showed her that she beat her record.  She was gasping but smiling like an olympian.

    My niece would have liked to have added another lap before coming up for air but her body wouldn’t let her.  She needed to breath!  Have you seen the same thing happen in your spouse when they are sleeping?  They look like they are holding their breath doing laps and need to come up for air?  Gasp!  Ah!  Oxygen!  Sweet Oxygen!  Nothing like it.  This event when someone stops breathing for more than 10 seconds during sleep is called apnea.  When it happens more than 30 times in a night it is called Obstructive Sleep Apnea.  The gold standard for treatment is a machine that pushes air into the airway to keep it open – either bipap or cpap.

    My patient is young, not obese, exercises regularly and looks healthy.  However, he has tested positive for Obstructive Sleep Apnea during a sleep study and has been prescribed cpap.  My patient used to wear it but frankly doesn’t feel sexy in it.  He feels like he’s wearing a jock-strap on his face.  My patient prefers to snore loudly, go silent, then gasp, over and over through his sleep rather than wear cpap.  No one had told my patient why he must wear cpap, nor did he look it up. We talked a little about his marriage and how he was happy at home.  We talked about school and how well he was performing.  Then we talked again about sleep apnea.  My patient didn’t know.  He didn’t know that he was gifting his wife with a future impotent man.  He didn’t know he was enjoying fewer an fewer functioning brain cells every day.  He didn’t know that he was gifting his children with his early death from heart attack.  He didn’t know that his anxiety might not be responding to his medications because his brain is screaming for oxygen.

    Just thinking about his story made me take a deep breath and pray a prayer of gratitude for the air, oxygen, and life.  He did too.   We’ll see if he decides to use cpap or not over time.

    In medicine, we can’t diagnose a primary emotional illness if someone has an ongoing medical disease that may be causing similar symptoms.  We need to be as sure as we can about where symptoms are coming from.  I liken it to a steam engine train chugging along, steam blowing out of the chimney.  The steam is what we see, but the onward movement of the train is the disease process.  Obstructive Sleep Apnea affects every cell, organ, system in our body because as it turns out, every bit of us needs oxygen to survive.  I’ve seen people after heart surgery, with no idea that they could have avoided all of that by simply using cpap.  I have been treating one woman now for 7 years for severe treatment resistant depression who is still not using cpap.

    So many of the people I work with have sleep apnea.  They feel embarrassed and ashamed by it.  I’m not sure how to help them better but I’ll keep trying because their lives depend upon it.  To feel the sense of accomplishment my niece felt when she came up for air, “Ahhh!!”  Accepting treatment is that wonderful.  We could celebrate.  It’s all perspective.

    Question:  Do you have any recommendations for those of us suffering and ashamed?

    Self Care Tip #47 – Celebrate treatment and live.  Be a friend to yourself.

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    Get to Know Yourself to Be A Friend to Yourself.

    On the Threshold of Eternity

    Image via Wikipedia

    Let us put our efforts toward becoming who we can become, who we were wired to be, who we want to be, what gives us pleasure.

    We can get beaten up by wanting.  Wanting to be someone who gets energy from being with people rather than from being alone.  Wanting to be someone who is a finisher rather than grazer.  Wanting to blend and lead and be chosen.

    Some of this filters out as we age.  Aging fills our lives up with so many responsibilities that wanting to be anything more than someone who gets solid sleep hasn’t crossed our minds in a very long time.  Children get more of it right than us in this regard.  They have space to want more openly.  Our wanting muffles and cramps when we turn away from who we were genetically designed to be.

    My patient came in depressed again.  Depression was familiar for him.  A psychiatrist works with a specific area of medicine.  So I get to see people after multiple medication trials before their primary physician refers them to me.  Well this patient hadn’t found lasting help from medications. He came to me with doubt.  I wish I could say we worked it out.  I can say that we are still trying.

    What we are working on influences the way his genes express themselves.  We can’t change the genes but we can affect some of how and when they are activated.   We can do this by choices, such as medication therapy, sleep hygiene and exercise.  Choices are more effective when we know what and who we were wired to be.  What are our natural talents?  What are we interested in?  Feeling inner congruence when we are doing something points the way for this.

    In Outliers, author Malcolm Gladwell says

    “the biggest misconception about success is that we do it solely on our smarts, ambition, hustle and hard work.”

    I don’t know if Mr. Gladwell recognized how closely his thoughts harmonized with Carl Jung‘s regarding temperaments.  Doing what is natural for us recruits our best through the path of least resistance – our interest, our attention, our creativity.  Rather than forced effort, drudgery and dragging feet, time looses some heaviness as we get caught up in inner and outer congruence.

    Intuitively, we all surmise that when this happens, we have less stress inside and outside of us.  Ah.  What a relief.  This is what my patient is working on and when he is able to say he is doing what he wants to in life, he is less hopeless and panicked.

    Self Care Tip #40 – Get to know yourself to be a friend to yourself.

    Question:  What do you think?  Have you been using these tools?  Have they made a difference for you?

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    Hold Judgement

    There are many traps that slow and trip us in life. Traps that shut us down. Yesterday I spoke about the neurological grooves and the role our choice has in making new grooves.

    Behavioral changes are important, like putting up a road block in the path your thoughts usually travel. Knowing that my kids will tell me to put a dollar in the family jar if I yell (a road block), helps me pause long enough before I fall into that neurological loop and I’m blazing a new trail in my brain. Every time I cover that new path, success is more likely the next time. I know I’ll continue to be stressed. Life won’t stop. But, I have more hope that I won’t yell as a way to cope.

    Saying that our behaviors are more than just results of our own choices is advanced for our culture, for the opinion of socialites. Knowing that our behaviors are the children of both neurological loops as well as the spirit of choice. Think about the many times in church when you’ve been preached at to turn from your ways, as if you were choosing them in the 1st place. The spirit of choice is the majority of what people talk about in any forum. And we agree, it is important. However, we don’t agree entirely. We now know about neurological loops and understand that the spirit of choice isn’t what’s behind everything other people see. Could there also be more? Yes!

    In time, we’ll uncover other influences on the spectrum of behaviors. There are more. There are other paradigms that make us into our personalities. What would social opinion say of that? What does your own critical self say? When getting friendly with yourself, remember, things are never as bad as they seem, even you. As we tease apart the different influences on where our behaviors come from we’ll learn more of the mechanics on what to do with what we find.

    Self Care Tip #6: Hold judgement. Be a friend to Yourself!