Mental disorder

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Allow yourself to transcend the naming of your symptoms

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Mental illness, diseases of the mind, behavioral disorders or however our community allows it to be named, it is all inadequate.

Mental illness, is a stale description.  It has sat in the open community air, over the many years when our awareness grew too slowly, when stigma and ignorance gave it the old cold frost-bite.  It reminds of me of the, Confessions of Georgia (Anne) Nicolson series, by the most hilarious Louise Rennison, When Georgia Anne says, “Have you gone mental?!,” in one-thousand-and-one ways.  There is just so much sniffing and eye swirling around the term.  I do not mind Georgia Anne using it at all.  It is fresh in her mouth.  It is not, however, winter green in ours.

Dr. Thomas Insel, Director of the National Institute of Mental Health, states that these terms are “impediments to progress.”  He uses the term, brain disease, as a way to diminish barriers to scientific investigation, hopefully leading to earlier detection and treatment.

Others, however, challenge even this term, brain disease, stating that it is premature and narrow.  The illnesses that demonstrate emotional and behavioral pathology involve more than brain and mentum.  They include the magic, the internal/external stressors, the arguments and the weather.  They include the intersecting paradigms that make us who we are, often referred to as the biopsychosocial model.  These, “Others,” argue that it is presumptuous to name pathological symptoms of emotions and behaviors with, “brain disease,” until we know what the brian does in the first place.

Questions:  But what do you think?  Are the terms we use more impediments to progress than they are tools toward?  Do you have any recommendations?  How have these terms affected your life?  Please tell us your story.

Self-care tip:  Allow yourself to transcend the naming of your symptoms.  

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More on ECT – TV Episode happened upon

Hello Friends.  I don’t know if you’re interested or not, but we’ve opened discussion on ECT (electroconvulsive therapy) in the past and because it remains open, I wanted you to know that I just ran across this TV episode online that is done surprisingly well.  Check it out and let us know what your thoughts are.  Keep on.

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Emotions – One Part of The Multi-Paradigm Weave That Makes Us Who We Are

Immanuel Kant developed his own version of the...

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Yesterday we spoke about the emotion, happiness, as it connects to and does not connect to spirituality.  Traditional western religions squirm  or  more, disagree when they hear this.  Everything is spiritual in their school of thought.  However, as our understanding of where emotions and behaviors come from, we have happily disentangled ourselves from the stigma and judgment that comes from the way many people have (mostly unwittingly and often without intended malice) abused us with mental illness.

I know that I have also been in this crowd of prejudiced.  Coming out of that has been fun.  There is still so much that I think I see clearly but don’t, as it is for us all.  The growth we’re talking about is part of the high adventure that brings pleasure to life.

To say it plainly:

  1. Emotions come from the brain.
  2. Emotions are not always directly chosen as we can’t directly choose the way our brain works.
  3. Emotions are what we use to interpret the world around us.
  4. Emotions don’t have intrinsic moral value.  Morality is bigger than the way we feel.
  5. Emotions are not constant between us.
  6. Emotions are a sense.  We’ve called them the Sixth Sense.  Senses are subjective and not objective.

How does this fit into your biopsychosocial model of how you see yourself?

Biology.  Psychology.  Socially.

How does it influence the way you befriend yourself?

How might this influence stigma surrounding emotional illness?

Emotions are just one of the many things that make us who we are.  Many many things.  As we tease these bits of ourselves apart, it is not the same as denying the multi-paradigm weave that makes us who we are.

Self-Care Tip – Enjoy your emotions but don’t put your life on them.

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Safety in Connections With Others

Nami 01

Marcy came in looking like a question mark.  Despite her gorgeous face and swank, she still looked uncertain.

Marcy was born into chaos.  Get this.  Her father who spent her whole childhood using drugs, alcohol and strange women, who was emotionally and mentally absent most of her life, who is possibly still using, is the one person in the whole world Marcy calls her confidante.  “He gets me.  I can really talk to him.  Even my husband doesn’t understand me like he does, you know, emotions.”

Marcy, despite years of fear, panic attacks, the survivor of abuse and neglect was clinging to her dad.

Marcy was lost in the headlights of the oncoming life.  She thought after having spent her entire life afraid, it was time to heal so she though she’d give medication therapy “a try.”

After initiating medications for Marcy’s post-traumatic stress disorder and after her panic-attacks stopped, Marcy started attending NAMI.  What a believer in NAMI she became!

They just make it easy for me to talk about myself, say things I can’t even tell my husband, and they know what I’m going through.

Listening to her talk about them was letting fresh air into our room.  Hope floated in.  Now Marci doesn’t believe that her dad is the only one in the world she can connect with at this level.  Now Marci does not feel as alone.  Why?  Because she went and got connected.  She whacked through the briar hedge of misperceptions, biases and insecurities between her and others.

Marci still thinks largely of her father, but he’s not the only one.  He has some competition to the throne which means, Marci has a better chance of being influenced by someone healthier.  Rather than attack Marci’s attachment with her Father, NAMI is giving her more to fill her heart with.

Self-Care Tip #285 – Find safety in healthy connections with others.

Questions:  When have the connections in your life saved you from warped views?  How do you think we could do better with this?  Please tell me your story.

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Grief Can Be Treasured At The Same Time That We Celebrate Life

Self-Care Tip #283 – Find the treasure in your grief while celebrating life.

Today is my daughter’s sixth birthday.  If ever there was a person who doubled the love she received, it is this chid.  She is all passion.  Yes, both ways, but that isn’t to judge.  Just, there is so little I can offer in words to describe her power of self.

They're asleep!

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Tonight, we pushed two twin beds together so she and I could sleep beside each other.  Her sister slept nearby on another twin bed.  Her brother set his bed up in the closet.  (I know.)

If I wasn’t so tired, old and broke, I might be made vulnerable by times like this to having more kids.  Since that’s not going to change, these chubs are what we will stick with.  Happily.

My mind is turned toward God by this girl.  I somehow arrive in the moment praying when with her, perhaps for strength and patience or for humility and gratitude.  I learn from her.

Mommy, when I’m scared I talk to Jesus.

Often in times like this, I think of my niece, dead now six years, and how her parents and we wanted what was, what was stripped.  Still grieving and still living the life with us and in us, our braided thoughts and emotions easily lose their flow.

But today I have this clarity.  My niece is gone now six years and ten days.  Today my daughter is six years old.  Today I am sleeping with my three children.  Today I know that this is precious but this is not all we want.  We want what comes after our living years.  We want to let loose to Love the grief and the life; to untangle.  Not more.  Not less.  But we want.  We want what we have, now, although still in the unknown dimension of our forever.

In psychiatry, we are alert to grief that warps the ability to engage in life.  Grief that mars the connections of survivors.  Grief that becomes pathology, brain disease and a medical condition.  This grief disables and, for example, in the case of my daughter’s birthday today, would dissolve my ability to feel pleasure.

It is difficult to gain access to treatment as many of these survivors have ill opinions about medical care.  Such as; fearing medications will mute their connection with the deceased; mute their grief, or in other words, tribute/offering to the deceased; take away the personal punishment for surviving…

Questions:

  • What do you say to these weeping lives?  How can we de-stigmatize medical care for them?
  • How have you been able to treasure your grief and the life with you and in you?
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A Testimony of “Being A Friend To Yourself,” From Bipo Blogger

You might recognize these five questions from yesterday’s blog-post.  Thank you for your testimonies.  Is there anything more powerful than hearing someone’s personal story?  I think not!  Here is what Bipoblogger has to say.

Q1:  What does being a friend to yourself mean to you in real-time life practice?

A1:  That’s easy, but not so easy, LOL!  Being “a friend to yourself” means that I acknowledge I need to respect myself, just like I do other people.  It means not sabotaging my self, plans, job, relationships, etc.  I love myself enough to not kick myself when I am down. 

Being bipolar can be so detrimental to my being, but just like normal people, I still have the need to …allow for room and time to grieve about whatever horrible circumstances (were) caused (by) the bipolar disorder.  

…Stop every once in a while to acknowledge my accomplishments and own that.

Q2:  What helps you do this one time vs. another?

A2:  Yes, I have found that BPD is in part an anger disorder and knowing the true source of the anger can help me go forward.

I have chosen to no longer hurt myself cause when I do, and anyone else, I build up layers of hurt and it hurts to start to take the layers off when I’m ready, so why even do it? …

Also it helped me so much to learn that God doesn’t deal with me the way I deal with myself or another.  I’m not a fanatic, but I just believe in what makes sense.

Q3:  What still hinders your efforts?

A3:  Wanting to be better than I already am.  Not accepting that the balance I have is better than having less or no balance at all, …(which means various kinds of) risky behavior.

Q4:  What has pushed you past those barriers?

A4:  Really just forgiving myself for how I was affected by BPD and remembering that I am breakable and valid as a human, just like all of us.  If I keep practicing a constructive way of life, I will be okay, and that has been true for the last 3 years.

Last push.

Q5:  How do you understand the interplay between biology and choice in being “a friend to yourself?”

A5:  I was created with the choice to choose how I live my life and I do, BPD or none.  Natural inclination is to do the wrong thing because I am imperfect.  I seek power, fame, notoriety and in someway someone, including myself is gonna get hurt in the process.  …People without mental deficiencies don’t experience or don’t carry out to this degree.  So in short, biologically the deficient brain makes more extreme choices, overly withdrawn or overly outward and destructive.

Whoa, I smell smoke.  I never think that hard.  LOL.

Questions for you:  

  1. Anything you’d like to share with Bipo Blogger? 
  2. If you had a blank page for this, what would your own questions be?  What would you answer?  
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Mental Illness Relapses When Medications Are Stopped

Free face of a child with eyes closed meditati...

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Self-Care Tip #246 – Collaborate with your physician to change your medications.

It keeps happening.  People are stopping their medications and then getting more sick.  Recently it was Olivia.  I can always tell when she’s off medications – she personalizes things way more and she acts like a victim to many many random things.  She is irritable.

Olivia, did you stop your meds?

Olivia on medication was not a super easy-going person but she dropped much of the edge, her thoughts were clearer and she was able to see other people around her.  Today Olivia felt like her bullets were in place and about to fire.  She answered my question obliquely.

There are sooo many reasons I am better without those in me!   I used to not be able to feel God.  When I prayed, I didn’t sense His Spirit.  Besides, I’m doing fine.  There’s nothing wrong with me.  I’m happy!

The biggest bummer about getting into the scene after the medications were stopped verses before, when stopping them was just a consideration – is that the patient doesn’t see themselves clearly.  They don’t see how bad it’s gotten.  They can’t be objective largely because they are using the same organ that is ill to describe itself.  If I could have discussed it with her before she stopped her medication, she would have been in a healthier state and more able to weigh her risks and benefits of medication verses no medication.

Sometimes we do agree together, patient and physician, to stop medications and sometimes we don’t.  Doing it together is the key though.

Questions:  How do you work with someone who wants to come off their medication?  How about yourself?  Has this ever been a problem for you and if so, how did you deal with it?  Please tell me your story.

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Number One Reason For Relapse In Mental Illness

The Sleep of Reason Produces Monsters (etching...

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Self-Care Tip #230 – Remember why you feel the way you do.

Olive was doing well.

How are you doing Olive?

Oh fine.  Just fine,

Olive would say.  And she was.  A sense of rightness filled her when she thought about it.  Right with the world, her garden, her work and even her kids.  She wondered that there had ever been a time when she hadn’t been.

It was almost easy for Olive to forget about why she was better.  Almost, except for her probably thirty seconds of opening the lid, dumping the contents into her hand, tossing them, all of them into her mouth.  One swallow with water and it was over.  Thirty seconds she thought.  I’m doing it for my kids.

Then came the best reason she ever needed.  And despite knowing that she had done this before and had relapsed, something about the rightness of the reason made her feel like the relapse wouldn’t be allowed.  The rightness would keep it away.  After all, she was stopping her medication for her kids.  If she didn’t have medical insurance than she would be a huge burden financially and she would die before doing that to her children.

So quietly Olive stopped.

By stopping medication, many of us have this sense of eliminating the reason we started the medication in the first place.  Take medication.  Disease continues.  Stop medication.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You’re gone.  Turn back.  You reappear.  Turn.  And just like that, you’ve been eliminated.  Even now, remembering it delights me.

Not so cute however, is the number one reason for relapse in mental illness – stopping medication.  For Olive, she turned her head, and hoped her recurrent Major Depressive Disorder would not be there when she turned back around.

How are you Olive?

(Sigh.)  Fine.  Just Fine.  (Sigh.)

But Olive wasn’t.  Even though she knew she had been better on her medications, she couldn’t see any more, how much better.  Her face tightened up, her thoughts wandered and she exploded more.  Self-loathing of course followed and she felt like her suffering was unique to her.  No-one understood her, especially her ungrateful children.  She was doing this for them, just like everything she did through her whole unappreciated life.  This was all wrong.

Is this why I worked all those years and raised them?!

Readers, you may not agree with the crystal clear logic that emboldened Olive’s heroic stopping of her medications, but it’s not the only one out there.  This being the number one reason for relapse implies that there are many that seem to make really good sense.  So forget about they specific “why” of why Olive turned, and just know that many of us do.  Many.

Question:  What has helped you stay on your medication when it seemed to make sense not to?  What do you think about people who choose to stay on medications for life?  Please tell me your story.

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

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

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

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

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

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

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

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

He made me so mad…!

She really hurt me.

You ruined my life!

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

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

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

We really are free, already, to choose.

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

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Living Where We Feel Safe is Part of Self-Care

Self-Care Tip #213 – Live in safety.  Be a friend to yourself.

In My Fridge

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I love psychiatry because for me it is a safe place.  A place where I am comfortable pushing aside distractions.  The blinking lights disappear and I don’t have to waste myself on B.S.  Some time ago, I told you about how Mom has been when Dad’s been hospitalized in the past.  When she pushed his tubing aside and just got in bed with him to hold him.  All that mattered then was Love.  They didn’t see the clutter any more.  That’s what psychiatry offers.  If we want, we  can come together and be real.  In twenty to forty minutes, we can hune and warp time and find a gravity where we breathe differently.

Chewbacca

Image by Andres Rueda via Flickr

Unfortunately, I have found that the longer I do this psychiatry thing, the worse I am with life otherwise.  Whether I’m with the grocer, dog-trainer, my child’s teacher or person in front of me in the coffee-line – I just don’t graze well.  (See blog-post, “Do You Feel Pleasure.”)  I’m always yelling, “Hit it Chewbacca!” and we’re off at warp speed into asteroids of personal information; perhaps inappropriate to the setting.  (See blog-post, “Using The Force.”)  I hate to think what I’ll become when I’m more thoroughly demented and disinhibited.  These things just get more pronounced with age and soon I’ll just be that crazy Auntie with her bra snapped on top of her bathing-suit in winter yelling at the young kids to turn the music down so we can talk.

The truth is, I’ve never been so wonderful in tinsel-town.  I found home and found that home needs to be a place where we are safe.  In fact, this is true materially in the home we live in.  It starts there and diffuses out.  If at home we are able to speak uncensored knowing we respect others and are respected because we are human, not because we have to earn it, if we can enter our kitchen and not fear temptation from chocolate chip cookies, open the fridge and know as an alcoholic the wife or husband didn’t buy beer, argue and trust that we are loved enough to be a priority, we know the issue won’t be lazily passed up, we know we are safe – then there is a ripple and a ring of safety and another ripple and another ring of safety and soon safety follows us because we just aren’t interested in anything else.  (That was a super-sentence.)  We have found home.

Questions:  How do you define safety?  What feels safe for you?  How do you grow your circle of safety?  Please tell me your story.

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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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Bring Your Separate Selves Together – Personal Journey

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Self-Care Tip #199 – Bring together what you are naturally inclined to do with what you spend your energies on.

When we do what we like to do, what is congruent with our hard-wiring, what is naturally inspiring, fatigue becomes part of our pleasure in my life.  Cliché,

Enjoy the burn,

…is common for a reason.  There are times when pain, fatigue, difficulty and hard-surfaced days are bits of what make life journey one of richness, rather than diminished.  I was reminded by Jaclyn Rae’s Blog-post today, that when we can say,

I’ve learned that I’m tired but still want to do what I do,

…we are paddling the same river our life is floating down.  When we by mental illness, misfortune, choice or neglect, don’t – we are more observant of our lives rather than participants to them.  We find being present in the process difficult.  It’s not something everyone can do in all aspects.

However, we don’t have to be defined by those particulars, choosing instead to do the hard work of processing our choices, our energy and where it comes from, our emotions and see how they weave into our constitution.  Then, some time when breathing hard, limping and spent, we will remember this and reconnect the experience with the choice and the emotion a little quicker.  We will less often separate from the water our life is traveling.  Not become observers but participate more often, more actively, more tangibly with that kernel in us that stays, our essence.  (See blog post, My Essence.)

In the marvelous work, “His Dark Materials” trilogy, Philip Pullman describes us as split persons, a body and a spirit (“demon”) that might be parted by neglect, carelessness, abuse, or other disasters.  But when it is separated, the body suffers and is disconnected from it’s life purpose, what brings pleasure and presence in the world around.  (See blog post, Soul and Body.)

There are medical illnesses that do this, as mentioned above, and in those cases, perhaps all to do is get medical care, heal, treat and get on with life.  Other times, it might be that we forgot ourselves in the midst of caring for children, a demanding job, an opinion that victim-hood defines our life possibilities or what not.  We have options.

As Jjen reminded us some days ago,

The bad doesn’t disappear but it is not a qualifier for the rest of life’s potential.

Questions:  How have you reconnected to your life journey?  Your essence?  What is constant about you in your changing self?  Please tell me your story.

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Getting or Giving Bad News Without Fear

Slalom skier

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I was reading an article on awareness of obesity the other day telling us that many times, people don’t know they are obese until they are told by someone else.  Ouch.  Pass the Band-Aides.  But it aired our need to stay connected, speak up, and listen.  It also prompted me to reflect on mental illness.  How often I’ve sat with someone’s emotions-history in my hands, looked at them and realized they didn’t know.  They were there, emotions bleeding all over the place but didn’t grasp their injury.

Um, excuse me ma’am.  Let’s apply some pressure on that and get you some help.

Bloody news like this reminds me of my friend Jack.  He was waterskiing with my brother and I when we were college’ish-age.  Jack was not so capable on the water, although he wasn’t afraid.  As you probably know, three is the perfect number for waterskiing – one to drive, one to hold the flag when the skier is setting himself up, and then of course the skier.  Any more and there are way too many polite smiles and way too much advice for the bobbing body in the water.  Jack was working on his slalom moves, thrilled with his progress and after about the third fall, was still ready for another go.

Hit it!

Our boat, Rosewater, eased him out of the water and he was up.  Jack has a way of celebrating like no other.  He whoops and yells and his whole body joins in.  And so he was in his happy place, up on a single ski, unconcerned with the world at large.  It was lovely.  Until the wake of that other huge boat threw him down and his face slammed into his spectacular single ski.  Up he came and we just looked at him, quietly at first.  Jack paddled up to the boat and wondered if he should try again.

Um, sorry Jack.  Let’s apply some pressure on that and get you some help.

Jack had a huge gash, copiously bleeding all over his face and he had no idea.  He was wet already, cold from the water and didn’t feel a thing.  I still feel the creepies skittering up my arms and chest thinking about it.

When we told Jack, he was a little unbelieving.

Are you sure?  Is it bad?  I think I’m alright.  It’ll wash out and I can try again….

Oh there wasn’t much pleasure in telling him the bloody news.  Generally there isn’t that much pleasure in telling someone they are fat or suffering from mental illness either.  It’s the follow-up to that statement where the fun comes in.  The hope that we link the first punch-line to.  Good news is, …along comes the second punch-line.  Hope.  And presence.  Being with someone where they are at, as they are, and with patience doesn’t mean leaving him in the dark, bleeding out.

The reverse is true of course as well.  If we don’t stay connected with others, we may lose the opportunity to see ourselves through their eyes.  It is an opportunity.  When we are with someone we trust, respect and think see’s us as the precious thing that we are, it is.

Self-Care Tip #195 – Stay connected with others and listen without fear – something good is coming.  Be a friend to yourself.

Questions:  How do you deliver “bad news?”  What is the best way you’ve ever been given “bad news?”  Please tell me your story.

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Starting With Your Own Answers to The Big Questions Leads to Reducing Stigma In Others

Alexander Ostuzhev as Quasimodo, 1925.

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Question:  How do you see the paradigm of spirituality intersecting with the paradigm of biology?

As a psychiatrist who blogs that behaviors come from the brain and not a theater script we voluntarily revise to perform, this is a good question.  As readers, and perhaps subscribers to this same belief, this is a good question.

In church, Bible study, or circle of any kind, there are fewer things that goad me more than listening to descriptions of the moral value in emotions and behaviors.  I have found myself visiting the lady’s room more often, carousing the fellowship hall-kitchen and fridge, or thrusting myself on a poor unsuspecting soul loitering by the door with my fervent uncomplimentary words.  I do this before I stand up and pull rank on the speaker.

(I know.  The words “pull rank” sound just as arrogant, and probably are, but they were said in the heat of the moment.  Please understand that the emotion behind them and including the words came from my brain.)

It wasn’t so long ago that suicides were thought to be the ultimate separation from God.  Oh wait.  That’s still happening isn’t it?  It wasn’t so long ago that anger and sadness were thought to be from separation from God.  Oh wait, they still are.  Ok.  I’ll stop.  This is childish.

The hunched figure of Notre Dame comes to me now, ringing his bell, gazing at Esmerelda – pure heaven in flesh.  He offers up his humble life force, begging to be near her despite his biology.  He is ugly.  He is different.  He is separated by his own beliefs that he is forgotten by God.  His answer to our question is his own isolation.

This pithy topic has no boundaries across the world but yet I reduce it down to Me, one apparently arrogant psychiatrist, kicking up dirt where I stand.  I realize that the best way to protect us from stigma, to help you (again arrogant me swaggers in), is to start with my answer to this marvelous question.  I have to answer it for myself.  I have to start with self-care, spiritual care, relationship care, physical care – I have to start right here with Me.

These kinds of imposed opinions have never been reduced quickly.  We can’t take care of everyone before we take care of ourselves.  We must be patient.  We have the privilege to answer thoughtfully.  It is our freedom.  It is our right.

Self-Care Tip #193 – Answer the big questions in life for yourself, deliberately, and see that a secondary benefit is that it will protect you from the prejudice of others as well as reduce their prejudice.

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

Detail of The Death of Socrates. A disciple is...

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I was a teenager I think when a woman in our church suicided.  Dad pointed out the man sitting alone.

His wife just killed herself.

Dad asked me what I thought of suicide.  Imagine.  What a compliment really for a teen, to be asked her thoughts.  Being a “Feeler,” I oozed something empathic I’m sure, but still I only remember what Dad said,

I believe God has a special way of seeing these cases.

This was at a time when culturally most of the western world saw suicide as sin.  It was quite forward for Dad to say what he did again later to the grieving man in the pew.  I did not realize at the time, but now I see that people judged him and his wife for what she did.

Later in psychiatry training, my attending said,

Suicide is the most selfish act anyone can do.  It is the ultimate punishment aimed at those who still live.

I don’t know what you think, but I couldn’t help wondering.  I still do.  I think this may be true for some and not others.  I haven’t had a chance to ask them.  They’re dead.

Suicide is terrifying to a psychiatrist.  We all tremble at the thought.  Statistically we know women attempt it more than men, but men are more “successful” when they do try.  They use methods that are generally more lethal than women.  They don’t get a chance to realize that in a month or a day they will want life again.  Or an hour.  They could have lived.

In the intensive-care unit of a hospital, “unsuccessful” suicide attempts hover in life in a space where their self-injury placed them.  The nurses are kept running between medicines, treatments, physician orders and prayers for these lives that tried to die.  Sometimes, the “chronically suicidal” become familiar patients to this critical care ward and that has it’s effect on those who have spent themselves so heroically to save them.

A nurse once told me angrily about her patient who kept coming back.

I fought for that woman’s life!  I prayed over her!  I worked all night for several nights and didn’t know if she would live until much later.  And then she was transferred out to the step-down ward (to a floor where the patients aren’t in such a life-threatening condition), and that lady probably never knew what I went through to keep her alive.

Then later, she came back, and later again, almost dead but not dead.  She kept trying to kill herself!  Finally, when she was conscious again, I just told her how it is.  ‘Listen!  I fought hard for you!  You better go out there and live!  You better figure out what it is you want and go for it.  Stop trying to die!’

This lady-patient was hurting more than herself.  Suicidal thoughts and attempts are dangerous.

There was a patient who tried to use his bed-sheets as a noose before the nurse lifted his wet body from the door frame.  In the emergency room (ER) he was examined, x-rayed and determined fit to return to the ward.  Alive.  Talking to the ER physician, I learned that the reason most people die when they hang themselves isn’t because of suffocation.  It’s because they break their neck.  Done.  No more chances to choose life.  Even an hour.  My pulse was still beating on me to the rhythm of, “He could have died!  He could have died!”  This time, no broken neck.

Regardless of our culture, we are not the judges of these people who want to die.  Regardless of our emotions, their emotions before, any previous conflicts, regardless, we cannot measure their final act by degrees or intentions.

We fight together for their lives and they may or may not know about what that does to the rest of the world.  When we don’t want to fight for them any more, we should change jobs.  It is our choice, each of us.  Whether we are fighting as professionals or as a wife, brother, friend, volunteer or the hired tutor, we fight for their lives because we choose to.  If we cannot keep it up without judging, shaming, accusing the suicidal, we need to own that and take care of ourselves first.  “Can’t give what you don’t have.”

The truth is, suicidality is hard for everyone.  It is hard in ways and in people that aren’t talked about, such as the nurses or the x-ray tech who is the first to find the cervical fracture (broken neck) on film.  It is hard for the church parishioners, the person separated by seven-degrees or the grocer.  Suicidality is hard for all of us.  We give what we choose to give and remember to say, “I can’t control that,” when we can’t.  It is our choice.

Self-Care Tip #182 – Taking care of someone is your choice, even in the context of suicide.  Be a friend to yourself.

Question:  How has suicide touched your life?  Please tell me your story.

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Pain Can Be Something More and Better Than Just Pain

English: Vladimir Bystrov. 2006 Russian Premie...

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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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The Spider Sat Down Beside Her – Mental Illness

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

The Little Miss Muffet scenario explained by D...

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

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

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

Taking pills makes me feel like I’m crazy!

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

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

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

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

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

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Tell People When You Fall

It's no laughing matter ladies... Monthly brea...

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Self-Care Tip #171 – Tell people when you fall.

Driving today, I was slowed by a driver ahead of me.  I started to get irritated, (I know, “I can’t control this“), but then I noticed the car had bumper stickers supporting breast cancer.  In less than a moment my mind grabbed memories of faces, feelings, conversations, stories and personal experiences in my memory relating to breast cancer and I suddenly felt a sense of empathy and some sadness.  It left me a bit surprised and I reminded myself I was irritated at this driver.  While trying to tease apart these seemingly opposing reactions, I realized I didn’t care much any more about the slowness.  Mainly I wondered how there was breast cancer connected and I cared.

Providentially, Erin posted today on her blog-site, Healthy, Unwealthy, and Becoming Wise,

Falling finds friends.

I remembered the driver and you readers and thought, “It sure does.  Especially when we let others know.”

My Ecuadorian sister, Joana Johnson, often tells me one of the biggest contrasts she see’s between our cultures,

connection.

I spent some time in Ecuador doing some clinical work and learning more Spanish between my second and third year of medical school.  I was rarely alone, which frankly creeped me out a little.  Being westernized, I was used to a huge amount of independence and anonymity.  I wonder who I would be if I had grown up knowing someone was always involved in my life.

You might have heard the proverb asking,

If a tree falls in the forest and no one is around to hear it, does it make a sound?

Or,

Water, water everywhere and nothing to drink.

I don’t want to be surrounded but not witnessed, connected or heard.

Telling people about our “falls,” cancer, depression, assault or what not, can feel creepy too, just like I felt loosing some of my anonymity in Ecuador.  However, I now tell myself, “It’s just culture and I can grow.  And I want to.”  Culturally in the “West,” we think of telling about our falls as whining.  That’s a misperception however and a disservice to all of us.  Telling people when we fall is not whining.  The act of telling and the act of whining aren’t contiguous unless we design them to be.

This morning when I saw those bumper stickers, it brought me into the drivers life and connected us.  We are both a little less alone than we were.  These last six months for me have been about taking down boundaries in my well defended life, and I am growing into the difference.  Thank you readers and commenters for that.

Questions:  What has telling others about your “falls” done for you?  How has your culture influenced you in finding friends?  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

Image by Valerie Morrison via Flickr

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

Image by Paul Mayne via Flickr

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

Image by Adam Foster | Codefor via Flickr

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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