Stay Awake! to sleep well

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(Whomever it is that originated this stinking hilarious picture and quote, thank you!)

The glass half empty view on sleep and age:

When you are a child, you don’t want to sleep. When you are a parent, you could if you would, and you want to, but there are the kids. When you are fortunate enough to grow old, you want to, don’t have kids, but can’t.

 

The National Sleep Foundation Recommends:

Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13) School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11) Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)

Younger adults (18-25): Sleep range is 7-9 hours (new age category) Adults (26-64): Sleep range did not change and remains 7-9 hours. Older adults (65+): Sleep range is 7-8 hours (new age category)

Should-a, could-a, would-a, right?

“The amount of sleep required by the average person is five minutes more.”

~Wilson Mizner

One thing that gets left out of most sleep books (um, did I include it in my book??) and sleep talks, is how to be awake. Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.

Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.

Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.

This is where I additionally bring in the concept of a stimulating medication such as Modafinil. Don’t confuse this with taking caffeine. Caffeine is metabolized way to fast to be helpful in this regard. There are others one may discuss with their treatment provider.

Self-care tip: Get awake, really awake, during the day to sleep well at night.

Questions:

What is your daytime energy like? Alertness, attention, and memory? Do you sleep well in relation to this?

Please tell your story. Keep on.

Blood, Sweat, and Imperfections – Mommy Don’t Look!

Naked and Voyer

Naked and Voyer

Blood soaked and layered with fallen governments, the Acropolis remains, a witness and teacher to a summer fling. 

A tour of the Acropolis and its new museum taught much. #1 – Never go on such travel without a tour guide. She made all the difference. Without her, I might have lasted for an hour, or an hour and a half. I would have thought, “Check! Did the Acropolis! Next?” With her, I felt like I couldn’t get enough. Four hours later. Evi was an intelligent, independent woman, making her way in the world, with the talent of putting ideas together. Another mentor to pick up along my life journey. #gratitude.

(I’m going to try to describe Athens, as seen by a psychiatrist. Smile.)

Evi integrated the paradigms at play, seamlessly, and in flow, from the 800’s B.C. to the 400’s A.D. She spoke about the mathematics involved in The Parthenon architecture, the classical culture seen in the architecture such as the emphasis on the human senses, the development of language and democracy, and more.

None of the construction of The Parthenon is “perfect.” The columns slant, and the stairs bow in their middle. All of this is done to capture the human senses. It was constructed so that when you stand at one corner, you can see almost the entire construct, like inflation of air rounds a balloon. When you look straight on, you are almost able to see entirely around the balloon’s girth. The architect sacrificed perfection toward the ultimate and most valued goals – to experience all the human senses to their fullest, and the classical construction. 

The Greeks developed the idea that whatever is created by man, (scantily garbed statues, architecture, ship making, etc…) should demonstrate, but not surpass the excellence of the human at his or her absolute best. Perfectionism smechsonism.

The kids were a bit horrified by the genitals everywhere. “That’s inappropriate!” or “Mommy, don’t look!” with a hand posturing the Stop! sign, improved my experience 10-fold. 

The Greeks in the 400 A.D.’s recognized the irony in the loveliness of human senses; sight, emotions, spirit, intellect, etc, integrated with the flaws. We are greater, in the best of our imperfect self, than the perfect, mathematical, or any other kind of perfection, eg., 1 + 1 = 2, in a perfect world. 

For example, by tilting the columns, the architect understood that it would give an illusion of straight columns, yet still capturing more of the circumference as seen by the individual. Straight would be perfect. Tilted but looking straight is more representative of a human at her best. Never perfect. And the illusion created by the tilted columns made the construct look shorter, thus not surpassing “the human” capacity to sense it’s grandeur. 

Also, the government ruler at the time, Pericles, was the first known leader to integrate a form of democracy. He used citizens and slaves for the labor. Yet he paid them, including the slaves! Furthermore, he gave them freedom in their work to form independent decisions, stating that someone who is told what to do, doesn’t learn anything. Someone who makes their own mistakes, has the opportunity to learn from his mistakes. This was the fulcrum which our civilizations turned on toward human rights and free thought. Pretty powerful.

The Greeks gave their alphabet to the world, from which Latin developed, and thereafter the Latin languages. For example, I never knew that “Agoraphobia,” comes from the location, named at the time, “Agora,” where all the debates were held, again, inspired by this ruler during the 400’s B.C., spurring on freedom of thinking. You can imagine what happened during heated debates. Some people would suffer anxiety in that context, which would deteriorate into a disabling fear of being humiliated by another potential panic attack when in public places.

The priests of the Greek gods served also as their community’s medical practitioners. For example, they used snake venom to both treat headaches and prophylactic against strokes. It turns out that snake venom is an anticoagulant. Totally brilliant. Snake venom in Greek, is called, “physika”, which means “venom.” The caduceus, a symbol that we still use for the physician’s medical practice, shows a snake wrapped around a staff. Later Aristotle used “physika” to name his treaty on nature and the work evolved into “physician.” Way cool. 

The self-care tip: Work your damndest, while embracing and integrating your imperfections along the way, and in this Grecian effort, you will gain the greatest sensorial experience with the world around you, the individual beside you, and your own self.

Question: 1. How do your imperfections enhance your best self? Please tell us your story!

The Perfect Doctor – Healthy With Disease

looking

One of the difficulties we have in talking to psych patients is realized with the dawning truth that we are not curing anyone.  Working in those conditions of not curing, you both, patient and psychiatrist, have to come to terms with each others’ agendas.  The physician says, “(‘I’m a failure.’)  I can’t cure anything.”  Now eye contact is even tough.

“If I don’t look them in the eye, some other emotion will surface and they’ll stop crying.”

Rachel was crying and crying hot and hard in the emergency room.  She was unable to stop the lava flow.  It was bewildering to her.  The people around her shifted their gazes.  Those who didn’t, looked angry instead, as if to say, “Pull yourself together, Woman!”

Psychiatrists have the advantage perhaps to these others in the lobby and receiving rooms and gurney shelves. Supposedly psychiatrists can grip and tug at the corner of the large sweater that is human behavior and say, “Emotions and behaviors come from the brain.”  They can imagine, if not entirely believing at a visceral to cognitive level, that the person they observe is responding to symptoms of what is happening biologically, at a cellular level. When they are tempted to avert their eyes, or look back impatient with the messy emotions, they can say, “This is medical.”  Impatience with emotional chaos from psychiatrist to patient, is equivalent to the ER doc saying to the trauma patient, “How dare you bleed in a public area?”

When someone cries on the medical unit, you may hear, “Nurse! Call the psychiatrist! There’s an emotion on the ward!” Later when things are calm, I walk out and they say, “Doctor!  You’re amazing!  What did you do?”

“Well, I bit off the head of chicken and sacrificed a goat on the patient’s chest.  Then I said, take this pill and everything will be as it should.”

Luckily I have several chins now, and when I gesticulate, their quiver contributes to me looking very capable. As if I could cure something.  I don’t know much about art history but, The Thinker, a bronze sculpture by Auguste Rodin, is probably what that Frenchman’s psychiatrist looked like when they both came to terms with the fact that psychiatrists don’t cure anything. (Heresy.) At least he got to get nude while he did it.

Talking to psychiatric patients can be that difficult.

There are studies on patient satisfaction that demonstrate that patients don’t like us when they think we give them bad news.

You see the predicament here, don’t you? So, some of the difficulty the world at large may be having with talking to psychiatric patients is that we have distorted perceptions of good and bad news. We may have difficulty with our own humanity, frailty, infirmity, and seeing it out there “without a scarf on” for decency, is a hard reminder.

We will never be cured of so many things. All of us. And the best we can hope for…

What is the best we can hope for?

(We are all gluttons and all hope for many unpublishable things but please! Just humor me.)

Say: “I hope to be healthy with disease.” There. Now we will all speak better to each other. It all starts and ends with Me.

Questions: Have you ever had difficulty talking to a psychiatric patient? Have others had difficulty speaking with you? Why do you think that is? What could help? Please tell us your story.

Self-Care Tip: Hope to be healthy with disease. 

(I bet Carl D’Agostino could make an excellent cartoon with this rich irony to work with! That’s right Carl! You heard me! Maybe a blue ribbon with a hole in it?… Ah heck. I’m sticking with practicing psychiatry and leaving the toons to you!)

NAMI: National Alliance on Mental Illness

Hello Friends,

I’m enjoying this all too fast passing time at the APA annual meeting in Toronto. What I am most enjoying is the education, the community and connection with new and old friends, and the reminder of what this is all about – you and I. In honor of us, I’m “pressing” this excellent post from our national advocators and stigma-fighters at NAMI.

NAMI: National Alliance on Mental Illness | NAMI: The National Alliance on Mental Illness.

Check it out and let me know your thoughts. How does this resonate, or not, with you. We need to hear!

Be well and keep on!

Q

Why do I Keep Living? – Chronically Suicidal.

trainwrecklife

Carl D’Agostino is a retired high school history teacher. His interests include woodcarving and blogging. Cartoon blog at carldagostino.wordpress.com.   Cartoons published in book, “I know I Made You Smile, Volume I.”

Marvin lived hard for years, used up his bank, his talents used up like putting a flame to his wick.  He was wired to live in the moment. Living that way, when he had gifts galore freely given, living was different than when those gifts were used, diminished, and broken. Marvin was smart enough to rationalize his way into a chronic suicidality thereafter.

What is the point of living, after all? Marvin asked this question, answered it, and asked it again, to the point that it separated itself from Time and place. It is a question that is infinite anyhow.

Sometimes Marvin, with this infinite question, this question that occupies the time of God, kings, and beggars, Marvin would sit in my office with this infinite question in his nicotine-stained and inked fingers, and he would in this bring together the infinite with the finite. I remembered that the whole point, the meaning of the infinite and finite, is increased in value by the other. Marvin, living in the moment, even now years after his coin was thus reduced, was living in the infinite.

Why do I have to keep living? I just need someone to tell me it’s going to be ok if I die.

Marvin, If you are looking for a doctor to help you die, you need to go somewhere else. I will always choose life.

(It seemed like that “FYI” was in order.)

“We” made a plan …that Marvin wasn’t entirely in agreement with. I told him he could not come back to my clinic if he wasn’t engaged in that plan.

Marvin, we are just going to do what the data tells us will work. We don’t have to feel it or even believe it. We have the data at least.

Every time I have ever seen Marvin, I took a hard look, memorized him, knowing this may be the last time. Setting boundaries with him was freaky. It felt like trying to hold broken glass. Would Marvin be back? If not, I knew I’d be hurt.

The patient-doctor relationship is unique to each patient. It is unique to each doctor. For me, in my patient-doctor relationships, if it wasn’t for the hard grip I keep on the seat of my chair, I’d have too many of my patients in a big, but likely awkward, (and my Academy tells me, “Inappropriate”) hug.

This flashed through my mind in fair warning again. I compromised, saying instead,

You matter to me, Marvin.

I think Marvin’s lip actually curled and his canines grew. And I quote,

How can you say that? I just don’t get it.

This was a moment of road’s diverging, 31 Flavors, coins in your hand in front of a mother-loaded vending machine. I could see philosophers, all over the now and then of the ages, slobbering like they were at a nudie bar.

Once, when I called 911 on behalf of a patient who needed to go into the hospital for safety, the police person looked like that, bouncey even, on her toes. I had to check her feet to see if she was actually standing on a pedestal, she sermonized my poor patient so thoroughly. I think she was even eating a candy bar as she left my office, satisfied, (without my patient, by the way. Apparently she thought her tonic words had medicinal powers.)

Marvin was fishing me. There were so many ways to lose with that question. He was hoping I’d flop around with straining gills sucking air for hours while he tugged on the hook.

I’ve done that often enough, and will do it many more times. We can count on mistakes. What took me by surprise was, this time I did not.

Well, I’d guess it has something to do with me and something to do with you.

Yup. It surprised me. The surprise brought a wave of gratitude. “Thank you God.”

And if you aren’t as surprised or grateful by that liner, I can only explain that it was right at the time. Marvin lost his handlebar lip curl. I lost my grip on the chair. Marvin’s still alive, (I know everyone’s worried about the “for now” part of that.) And our universe cares, finitely and infinitely.

To the Marvin’s of the world, the wasted, the used, and the squandered, work your programs.

To the lonely and distorted, to the ones who have tried to die, to you who don’t know why you keep living, follow what the data offers by way of direction.

To you who may not get the same freely given gifts in this life that are now gone, you have good things coming.

We choose to live with you, than without. We choose you again. We choose, every time, what Love will bring. Keep on.

Questions: Have you ever asked yourself and/or others, “Why do I keep living?” What has your answer been? What is your answer now? For yourself. What would you tell your own Me?

Self-care tip: …I think I waxed on and off enough already with that – smile.

Stigma and Me: Me-on-Me Crime

who me?

Me-on-Me Crime!

I was doing my speed walking thing on the Balboa Beach cottage lined shore. Gorgeous, it was. Fluffy thoughts were everywhere. I was purposely passing under the low hanging docks to upscale some lower body muscles. Some string bean teens with their fishing poles moved into the water’s leisurely lipping edge ahead of me. Who wouldn’t be distracted by such poetry?

Can you guess what I did? I looked up. I lost my squatting waddle.

When someone driving on the freeway slows down to look at an accident on the shoulder, we call them “rubber-necks.” What do we call someone who walks taller, someone who loses her shorter self under a low dock when “speed walking” at approximately four-miles-an-hour?

Me.

This was more painful than my three cesarean-sections. Of course, there was no anesthesia when I sped into the solid, immovable wood. I loosely figured, with physics being what it is, that I received in return the equivalent to someone slamming me with a baseball bat. I was never great at physics but I remember that Force = mass * acceleration. I am not telling you how much “maaaass” was involved, so, for the disgruntled forensic’s enthusiasts out there, we just won’t know how hard I was hit back.

As the blood was pouring down my throat, out of my mouth, down my face, and as I gargled the words, summarily “help,” to 911, I thought, “That wood was not there before, because, why would I do this to myself?!”

How are we our own enemy? I’m learning a lot about stigma these days, in preparation for a couple CME talks coming up. Stigma is a molded and remolded term, but for our purposes, we’ll say that it can be broken down into, prejudice and discrimination.

Prejudice refers to our attitudes, beliefs, and emotions.

Discrimination refers to action, what we do about it, and behaviors.

I really like this. It helps to see where “Me” plays into our own stigma behaviors toward our own selves. For example, skipping our medications on and off.  That would be, discrimination, when it is done in response to a conscious or unconscious prejudice about taking medication. Maybe taking medication induces feelings of shame or blame. Then we behave with missing pills.

Another example of stigma, is seen in our aging “baby boomer” population. Turns out, psychiatric patients are living longer too. Social workers and other professionals are admitting more and more psychiatric patients into senior facilities, e.g., assisted living, nursing homes, home health services at home, hospice, etc., and the staff at these agencies do not know how to work with psychiatric patients.  So, the senior facilities try to send these patients to psychiatric hospitals or hospital emergency rooms, and the nursing home or senior facility won’t accept them back into their program afterwards, stating “We don’t have the staff or programming to work with psych patients.”

Senior nursing home/assisted living facilities are realizing that they need to hire/train their staff to work with psychiatric patients in their senior years and that this is part of their growth as an organization and their commitment to providing quality care to seniors.

The prejudice comes from feelings, such as inadequacy, on the part of those serving psychiatric patients. The discrimination is when the patients are turned away. Everyone loses.

It’s an exciting time for senior facilities. It’s an opportunity for their staff to learn new skills and understand that with even some basic training on communication skills, therapeutic interactions, some do’s and don’ts, they CAN admit and care for psychiatric patients in these senior facilities. Everyone wins.

The most important message in learning about stigma, is we hurt ourselves any way it turns. And why would we do that to Me?

I still have a headache, three days later. My teeth hurt. And I’m not as pretty.

Self-Care Tip: Break it down – What are you feeling? How are you behaving to yourself?

Question: How have you been prejudiced and acting out toward yourself? How have you eliminated stigma toward yourself? Please tell us your story!

Keep on!

Walking in on me after my massage.

walking in on me

I never realized, until this experience, that during a full body massage, one’s “girls” seem to swell and grow,… and no, the “girls” were not directly handled.

What brought it to my attention was the door opening. That misty moment hung in the air – between the massage ending, the masseuse leaving the room, and the sheet coming off my body just before getting re-dressed. The salon’s hostess stood there and squeaked,

Oh! I sorry!

First reaction, should this happen to you, is to laugh a little. This is what you will do. “Ha-ha.” Then you will think, “What? Did I just laugh?! Oh. Those must be ‘comedy boobs.’ …Can I have my virginity back?”

And then, “Is this covered in the insurance?” 

I’m simply really glad it was not more than one lady who was at the door. It could have been a crowd. And I’m not implying any of them would have liked it either. (Boys, shush. You don’t have to remind us that a male’s response to a woman opening a door on him when he is naked is entirely different.)

But I should have known this would happen. When I was being “roomed,” the hostess wandered her facility like she was on an easter egg hunt.

Is this the place? No? Here?

Oops! I Sorry!

How bout behind this door?

Yep. You got that. She did walk in on someone else while trolling around with me. I was forewarned. Yet, did I leave? No. Rather, I deferred with, “She’s mortified. This is the bottom of her career, poor thing. She’ll never do that again! I’ll act like I didn’t notice.” Optimism rears its perky head.

During our room-hunt, we came upon a large one with many cots. It appeared to be a community massage room.

I’m all for community. Community, NAMI, connection – you’ve heard my spiel. But this was a different definition of “community.” I thought,

These massages must be cheaper.

Because who wouldn’t wonder, “Is that relaxing?!”

Again. Males are different, I’m sure, but really. All you do is smell feet. Or maybe it’s like the swingers version of massage therapy. You might not walk out with the same wife.

Finally roomed, stripped and prone, my masseuse came in. She had such “rolling-pin” strength in her one arm… “She must work out.” 

Bone…still bone. Yup. You’re still on bone.

My face went numb pressed into a doughnut, but I kept on. (I once got an award for being “The Most Tenacious.” I think I was like ten. How did they peg me?) My back was getting worked over, and I had faith, at some point, it would feel wonderful. Just like I thought no one would walk in on me and my restored, and more than, decolletage.

I never actually saw her. My masseuse. She came in, did her rolling pin thing and was gone. No face-to-face. The experience was difficult to identify. What shall we name this?

But you know the next part of the story. The door opened.  

I don’t have a self-care tip to share today. It could be to go get a massage. Or not. I, with what looks like a more full than empty glass, thought this experience was too rich not to share with my friends.  Keep on.

Question: When has your optimism v. pessimism steered you wrong!? Please spill. Please. Spill.