Mental Health

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God Exists and God is Personal

God and me

As there are so many views on what “God” means, and because that’s not what we want to debate here, we have a useful premise. 

God exists.  God is personal. 

Nor is our purpose to worry over the function of religion, to roll between index and thumb the business relationship between us and God, nor to tidy up the religious wars between our nations. 

The purpose here is to discuss how to be a better friend to Me, in the context of the premise, God is and God is personal to Me. 

If God is, then He is personal.  Otherwise, there is no point to God, as far as you and I are concerned.

Question:  How do we treat ourselves well in the context that God is personal to Me?  If God exists and isn’t personal, what is the point of Him?  How does working under the premise that God is and God is personal improve the way you care for yourself?  Please speak out.  We need you.

Self-care Tip:  Accept that God is and is personal to you and keep on.

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Between Me and Thee While We Are Apart

apart

I woke up and thought, I love and am loved. I heard the birds. I recognized different songs. I know “our” birds outside our door. So grateful. The morning noises in the house, kids – This is what I pray about when I pray, “Be between me and thee while we are apart one from another.”

Every day takes us.  We go toward and away.  We connect and disconnect.  What do you hope stays close when you weave your pattern?  When you are taken into your day?

It may be a day.  It may be education.  It may be divorce, bankruptcy, or a change in condos that takes you.  It may be as simple as getting a haircut.

As hairstylist Jane said, “I see people come in here all day trying so hard to be unique, and I can’t believe that they don’t see just how un-unique they are.”  She was noticing that “unique” implies disconnect. Those of us in this condition may be grooming toward disconnectedness and missing that even the pursuit of this is inherently a connecting force between me and thee.

Let us acknowledge the connections, not fear them.

Back in the day, there was Laban and Jacob, who had shared space for many years.  When they separated, they artfully practiced connection.

Now therefore come thou, let us make a covenant, I and thou; and let it be for a witness between me and thee.And Jacob took a stone, and set it up for a pillar.And Jacob said unto his brethren, Gather stones; and they took stones, and made an heap: and they did eat there upon the heap….And Laban said, This heap is a witness between me and thee this day. And Mizpah (“watchtower”); for he said, The LORD watch between me and thee, when we are absent one from another.

Here, many centuries later, we remember our declaration of independence from Great Britain on July 4, 1776.  It is our watchtower of sorts, a time when we celebrate our freedom, beautifully crafted into what brings us together.  Freedom is not synonymous with disconnection.  It is the ability to choose, to move in and out, to live with boundaries that are made of ribbons rather than walls, to have distance and still remain close to where our heart is.

Questions:  What connections over Independence Day weekend are you celebrating?  Please speak out.  We need to hear you.

Self-Care Tip:  Let your uniqueness and freedom be a connecting force in your life.  Be a friend to yourself.

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Sequestering Physicians from the Muggles

muggles

When in the exam room, we do not want it to be about the physician.  However many of us don’t want it to be about the patient.

Some of us want it to be about the system, whatever system we are in, so that the system can run as smoothly as possible and get all our protocols met. Are we are making physician-robots?  We isolate them and ourselves. There is a pressure when working in a system to sequester the physicians, such as wizards from the Muggles.

As physicians, we care better for our patients when we realize what we are getting out of the relationship.  We give much better when we know what we are hoping to get and perhaps hoping not to get.  We give better even with medical care.  Is it comforting to think that when it is medical, it is objective, about data?  More safe, perhaps.   However, this binary logic, is false.  We do not practice in such.  We practice in a place where people smile and cry and bond and connect and receive from us and give to us.  When we practice, it is personal.  It is obvious that it is professional.  The delusion is that professional is an either/or condition.  Either professional or personal.  Not both.  Never both.  That is a buttered wall to grip before sliding into patient doctor sexual relations.  Sneeze.

There is a term called, Grace, you may have heard of.  Grace is the condition of receiving without purchase.  Having been gifted and celebrating in the gift without qualifying it.  Perhaps getting a great review from a patient on-line you are expected to respond to, and just saying, “Thank you.”  We have a hard time with this in our world.  “Getting” well.

I struggle with “getting.”  I cannot describe yet how to get well.  How to receive.  When a patient gives to me, I struggle not to qualify what I am getting in the same way I qualify taking a trip to Hawaii, “Oh, I’m going to a medical conference.”  Or, “Look at this new patio set I got from Home Depot!  It was totally on sale.  I got a great deal.”

In practicing medicine, we need to grow to an acceptance of what we receive, and receive with Grace.

I am sure being a patient is better when we realize what we are getting from the exchange too.  We get more, or perhaps differently, than what the insurance and copay gives purchase to.  I hope the patient-doctor relationship is more than what can be had on the street of a Turkish bazaar.

Question:  What are you getting from your patient-doctor relationship?  What is your clinician getting from you?  How can you receive with Grace?  Does this affect your accountability to yourself?  Is this an act of friendship to Me?  Please tell us your story.

Self-Care Tip:  Get you some Grace, with Grace.

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Love Relationships for Power or Dependence

He takes care of me.

Marrying for security is like bombing for peace.  It was not too long after saying this when Amy told me she had been served divorce papers.  She had been seeing me for several years.  In that time, we had worked through her most recent episode of major depressive disorders and a debilitating anxiety.  She had done marvelous.  Courageously fought for her own health, to be accountable to herself and grow.  Is it that surprising that when that happened, he left her?

Abuse.  When one partner uses the power in them to dominate and control the other.

On the other side, there are those of us choosing the abused role such as for the security of logistics.  Example, “I take care of his/her basic needs, s/he buys me health insurance.”

Marriages, or committed Love bonds, require full dependence on each other.  That is different than power.  It is not qualifying that each of us have different levels of power.  Of course.  But using that power to generate intimacy is like having sex to become a virgin.

Question:  How can you grow dependency in your love relationships?  Even with yourself?  Please tell us your story.

Self-Care Tip:  Move away from power as a method to increase intimacy.

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Exercise and the Brain – and Dancing to Enrique Iglesias

taylor swift

Greg went to arrange his annual colonoscopy.  Because he was having a chronic cough, his gastroenterologist (GI specialist) was wise enough to schedule him the “double dip” colonoscopy and endoscopy.  Greg was not pleased.  He was less pleased when Dr. GI found gastritis (inflammation) in his colon, an ulcer (inflammation) in his stomach, and esophogitis (location of inflammation intrinsic to word, esophogitis.)

I got the scoop on Greg’s inflammation story when he came in to see me, (yours truly, psychiatrist, brain doctor.)  And why?  Because of his colon and stomach?  Well perhaps.

True.  Greg was not happy.  He had not been happy for a very long time in fact.  Greg was suffering.  And no, he could not exercise.  He just could not.  Fill in the blanks of why he could not.  We have all given those reasons.

Discussing Greg’s story with him, we agreed that ignoring the inflammation story of his GI would be ignoring something that just might relate to the, “Why?” of why he was in to see me.  The same inflammatory process affecting his gut was affecting his brain, the same brain where his emotions and behaviors came from.

Inflammation.  We think about pus-filled blisters, puffy painful knees, spitting back spasms.  But do we think about frothing road rage?  Do we think about forgetting car keys in the supermarket where we bought five things we did not want and nothing of what we planned?  Do we think about divorce?  About losing our job, or not wanting to get out of bed?  When we hear about inflammation, do we think about brain disease?  I think not, Count Powerball.

The other day, we were in the Kaia, “Juicy JAM” class.  (Seriously. That is what it is called.) Coach Becca does these Juicy JAM classes about once every three to five months with us, just for fun.  It combines dance with athletics in a way that is designed to burn calories, yet effectively reduces grown women, responsible women of our community, parents, book-keepers, encyclopedia saleswomen, psychiatrists, (I am just guessing at least one of us moves like a psychiatrist) and such…, into giggling, hopping, human bumper cars.  And it is hard!  It is not easy to squat, pop, and then pull your fisted arm down super latino-drama-style over your just so angled body to Enrique Iglesias… I think it was, “Tonight I’m Loving You.”

By the time we had survived our first number, all I knew was that Becca looked really good.  Me, eh, not so much.  It is too bad we can not collect disability for this, not being able to dance.

When we dance, we do not usually notice how everyone else is dancing around us, as much as we think about how we are, ourselves.  Like any other behavior or emotion, we are trapped by our own design.  Look who is telling us that after all!  Our own brain.

Then Becca’s tattoo pokes out and we all think, she is such a bad ass!  (It’s right there just above the line of her pants.)

Where do these emotions, and behaviors come from?  Do they come from the good merit we have earned by hard work?  Maybe a really sweaty muscle bending Juicy JAM work-out?  No they do not.  You are right.  The emotions and behaviors come from our brain.  They come from that bit of us that is, after all, connected to the rest of our body.  Our body, where our muscles pump, where our pancreas balances our insulin levels, where our bowels, which flaunt the highest number of serotonin receptors of our whole selves, move and flow.  Our bodies, where nerves stop or start sending pain signals to our brain, where our heart and lungs pump all the blood that touches every part of us like a master control room – this is what matters to our brain health.  It is a relationship, like Garth will always go with Brooks.  Body goes with brain.  An inflamed body, an inflamed mind.

Now we know you are all thinking about bowels and what exercise does to bowels, and you are uncomfortable.  As you should be.  At least standing at a respectful distance.

I’ll never forget some months ago, and probably most of my Kaia-peers won’t either, when Coach Alyssa was taking us through Kaia-flow, a series of twisting yoga poses slash killer exercises.

Good job women!  This is also great for your stomach and bowels.

I thought, there-after only about stomach and bowels!  It was like a beacon.  No matter what I did, I was thinking about my gut.  And then like the answering horn of a trucker to a kid’s arm signal, “please honk,” there I went.  A slow twist, quiet music in the background, the soothing voice of Alyssa urging us on, and, honk.

There was no way to hide it.  No way to pass it off on my dog or kids or farmland creatures.  I was in the middle of the room and suddenly, like Taylor Swift on a center stage, everyone heard and looked.  Just one more bit of savory evidence that exercise decreases inflammation.

With this understanding, we can perhaps consider exercise like a pill.  Like a prescription.  Do exercise because we do what is friendly to ourselves.  Do exercise because we like being friendly to others.  We know that we cannot give what we do not have – to ourselves or to others.  We exercise because if we do not, we will be the barking mom we do not like, dad, sister, child or whomever.

We will not be nice to our partners when we have ill brains.  We will not feel pleasure as deeply.  If we are kindly toward ourselves, such as exercising, we will protect the soft underbellies of them others we love.  We will treat ourselves better.  We will.

One hour later, after dancing or twisting our inflammation, shame, and inhibitions into the ground, after passing a little gas, we are reduced to inspiration, humbly thinking, “Yes. I am that good.”  And that is the Magic there. We are bad arss.  Body meets brain meets community meets Magic.

And for you scholarly folk who don’t believe me when I say, exercise decreases inflammation decreases brain illness, here are a few articles:

Question:  How have you noticed your body speaking on behalf of your brain?  Or vice versa?  Please tell us some of your story.

Psychiatrist is In

Psychiatrist is In

Lucy’s psychiatry booth

Did you notice?  In this picture, the patient became the psychiatrist.

Question:  Have you ever felt like your psychotherapist or psychiatrist blurred their boundaries with you?  Have you ever struggled with your own boundaries with him or her?  Please tell us your story.

Self-Care Tip:  Enjoy your boundaries and let them lie.

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Old and Dying – Why We Are Still Alive

geriatric lady

Sweaty, well-worn, in bike-ware, she was eating comfortably with her friend.  I kept trying not to stare and just had to fight it!  I wanted to imprint her shiny wrinkled yet blooming geriatric status and break down what I saw into categories of self-care moves to grow old by.  She looked really good.

I managed to finish eating at, (Oh my word! Yum! My new binge and bolt location,) Zinc Cafe, without ruining her appetite with a big hug and smooch from crazy-staring-stranger, me.  I almost congratulated myself, it was so hard not to do.  Nevertheless, when walking out I did stop and tell her she was beautiful and that I wanted to grow up to be her.  She bloomed even more, right there and then.  It was swell.  Good food.  Good role-model to remember.

We think it is our best years that people will identify us by.  But they do not just do that.  They think of us as how we are now too.  More importantly is how we think of ourselves – of Me.

It is different for everyone.  Why we want to be here.  Understanding why, is a universal interest.  It is the other side of value in the aging process.

My parents are getting old.  I am.  My patients and their parents are getting old.  We are dying.

My dad is old.  He just turned seventy-nine.  He is not wearing bike shorts.  He is not a blooming geriatric.  But I value him and saying why, well, I realize starts with “Me.”  It is not because of him thirty years ago. It is about his life these last thirty years.  It is about his Me, now.

The present does not prove nor negate the past.  Our value is more than that.

Sometimes I visit community practitioners.   Please visualize that all of this is in the middle of their busy clinic day, racing between exam rooms to meet patient needs.  I am standing at a nurses station perhaps, dressed in something über professional, (to hide the gypsy in me as well as I can.  But if it were you, you would not be fooled by the cut of my lapel!)  I catch the eye of the clinician and receive a strained smile, almost hearing her say, “Come on!  I’m dying here!  I have three patients waiting!”  But generally they do not actually say it, generally.  And sometimes, they are snagged by the magic of connection, take my elbow and draw me away into a private space where they can share their story.  In a matter of moments.

We are skilled at shaving moments here and there.  Skilled at putting as few words into a fat minute that can convey the large concept needed just Now!  We learn this over brow-beating years of managed care medical practice, personal choices, convoluted expectations and need to please – self, other, insurance or what not.  When clinicians share stories, we do it like we are late catching the train to heaven.

From these visits, I get more to my quality of practice.  I get known, and get to know.  Awesome.  It is a newer part of my “work,” that I have been doing this, and I am loving it.  I meet the people who are the other side of our patient’s treatment team.  I meet people who are both human and medical clinicians.  Realness surrounds them.  Life stories come from them.  In a fat minute I hear about their past, gain some understanding of their present and from that, I am given much.  One physician told me of his beloved daughter who suicided, another of her husband’s chronic brain illness and how their family struggles.  I shared how my young cousin hung himself and that part of me who is groping toward that space and time before he died.

To know who we are despite our changing emotions and behaviors, our changing identities, improves our understanding of life value.  Somehow, Dad has known that, without bike shorts.  He continues to mentor me in that.  I do not know about the beautiful geriatric at breakfast, but who is to say she does not know her value?  Not Me.  But I am going to explore my own, for my sake.  I am getting old.

Self-Care Tip:  Look and look some more for why you are valuable.

Questions:  What is valuable about you, even though you have lost so much in life?  Why are you still alive?  Please tell us your story.

Related articles

 

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Treating Depression with Electroconvulsive Therapy

mcfadden-moMaureen McFadden, a two time Emmy Award winning journalist, at WNDU.  In November 2007, she documented a winning medical series called Rewiring the Brain. 

  See part of the Emmy award winning story on a local man’s path to a better life in the series “Rewiring the Brain.”

I am sharing my response to Ms. McFadden with you, my friends, colleagues, and community, because I choose you for company.  Thank you for that.

Hello Ms. McFadden,

Thank you so much for your work increasing community awareness of ECT and diminishing social stigma.  Thank you for having a life-work, such as this, for obtaining a powerful voice that people want to listen to, and doing what you have done to get attention.  Your influence, hard-earned, is collateral and that you spent it “here” is huge.  I am so grateful.
I am a psychiatrist.  It is difficult for me to work with these, community awareness and social stigma.  I am not special in this difficult experience, of course, and I know that the bummer feeling that I am “alone” in it is a distortion.  Thank you for your company and illuminating presence.  Keep on.
Sana Johnson-Quijada MD
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Words Like: Distended abdomen! and Connection

distended abdomen

A friend of mine told me the other day,

Mentally I went to a bad place during exercise on Tuesday. Like “I’m so slow, I want to go home, the other girls probably think bad things about me”. In my head space now I see those thoughts as ridiculous. But it was tough to get through.

Excuse me but she is brilliant.  She speaks for millions.

So many times we think about the rough out there.  The words that slow our swing down, that are not said right, that somehow take away points from our identity.  We are not a two-dimensional scorecard.  Speaking up does not qualify us.  Good or bad.  Speaking up does not change our value.

I loved her voice.  I am thinking she should start up her own blog.  If she can be this transparent on a blog, she is a needed voice.

If I could fantasize a little, (Now! Now!  Stop that,) I would have her and you go back to our own, here at friendtoyourself.com, and start methodically answering each self-care question, post by post, in your own authentic way.  And just you see what a stroke speaking up makes.  Just see what it does for you inside and out.  Just see what it does for others. …Me for example.  See?  I am affected by you.

As for my transparency, in brief, …I did not survive halloween.  I ate like a motor.  Chocolate.  Chocolate and more chocolate.

Otherwise.  I think this greens-and-beans-effort I am doing has been ok.  I am eating a lot of plants.  Trying to keep the simple carbs low.  Not always the fact but the goal.  I do still eat in volume which I will see if it makes a difference or not when it is this type of volume.  All that fiber is making a difference to my gut though!  my abdomen is distended!  TMI.

A couple posts ago we shared Jessica’s, “Do This.”  My question is, what is yours? What is your, “Do This?”  Please do not make me use any more golf analogies, but where are your …words?  Your words are important for you.  They bring friendship to you from you.  They bring you to connection, community, clarity of thought, and as said in a post long ago:

“And if we stop speaking, we will lose.  If we do not respect the opportunity to connect, if we do not treat it as the treasure that it is, not only will the world miss out on the ‘Me,’ we miss out on the world at large.  It goes both ways.

We have a choice.  Get friendly with yourself.  Speak.  Listen.  Connect.

Self-Care Tip – Stay connected for your sake and for theirs.”

Question:  What has speaking up done for your friendship with yourself?  How are your words kinder said than not? Please tell your story.

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Nurse tells her experience – Suicide

Guest Post

by, Leslie Oneil, RN

Nurse extraordinaire! Person to know. More.

Nurse extraordinaire! Person to know. More.

In The Ring

I sat at a table in a large meeting room watching Dr. as she stood in front of the room. She stood in front of us with poise…armored with stories, analogies, statistics, and invisible red boxing gloves to match her red dress. She was ready to defend mental illness, and fight for its proper place in medicine and in the spot light where it belongs…right next to the heavy hitters: cancer, heart disease, diabetes.

Dr. delivered the statistics….”1 in 5 people suffer from depression.” She counts the room, “1, 2, 3, 4, depressed. 1, 2, 3, 4, depression.” She continued, “Put all of the depressed people in a room, and look around. 1 in 15 of those suffering from depression will go on to commit suicide.” It’s dramatic. The room was silent. It usually is. I am not comfortable with the topic anymore than I was the first time, but I am getting used to hearing the same phrases, the same statistics, and responding to the same questions from the audience. I am now familiar with the language of mental illness.

Last Friday, as I stood in the middle of the PACU, our eyes met. It felt intense. it was an emergency, and an emergency in behavioral health means…

Then I heard Michael Buffer, the master of ceremonies, in my head. He introduced the statistic to the ring. Dramatic music played, and before I had the chance to raise my gloves, the statistic nailed me…First with a left hook, then went below the belt. I was knocked out. Speechless with my face in my hands. Gloves were off.

 

Your patient committed suicide.

 

No amount of training prepares you. No power point presentation. No book. No doctor.

TKO.

I never even imagined how I would handle the news. I was weak in the knees and shook.

The patient was starting electroconvulsive therapy in 3 days. The patient had just called me. The patient denied any suicidal thoughts. The patient…….It doesn’t stop.

The gravity of what I do hit me. It hit me hard.

As I drove home I thought, “Have I entered a losing battle? I’ve wanted to be a nurse to comfort people, advocate for them, care for them, and try to help improve their quality of life if possible.” If possible are the key words.

Am I okay with, “We did everything we could. Stop. Time of death….”

 

My question to you: “Do you find gratification with the result or with the process?”

You think you know the answer…until you’re in the ring.

 

Leslie Oneil, RN, is a ECT specialist nurse.  She writes at a blog worth following, A Very LOshow.

 

Honking my horn

….check it out ( yay! smiling!)

Sleep Well

Sleep Well: A “Friend to Yourself” Resource

by Sana Johnson-Quijada MD (Author)

In a culture that demands our time, our attention, and our energy 24-7, sleep has gotten a bad reputation. A full night of rest can feel like a weakness, an indulgence, something selfish. But sleep, says Dr. Sana Johnson-Quijada, is critical to our mental and physical health. And when we are not getting enough quality sleep, our lives suffer. Dr. Q explores the reasons why we sabotage healthy sleep patterns, identifies our unique sleep temperaments, and offers practical, positive, and achievable goals for sleeping better. From a daily sleep log to the 12 Rules of Sleep Hygiene, readers will walk away with the motivation and tools to get the rest they need.

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Your Fabulous Stardom

Image“Taylor Swift is a rock star!”

The girl was in awe.  She had written versions of this all over her paper in various star-quality designs.  Everything was about Taylor Swift.  I was watching her at the park and drifting among my own thoughts, when her father leaned over and said, “Now write, Susan is a rock star.”  Young TS-Fan, alias Susan, looked up with an expression capturing a combo of wisdom with a big flip-off.  My thoughts were not adrift.  She was my interest.  She was a star.

And so was her dad!  What a guy!

Think about what your temperament gave you.  Think about what you like most to do, what your thoughts noodle when you aren’t “thinking.”  Is there someone who emulates the “star?”  Write that person’s name down in a bumper sticker statement.  Now write your own name in another.  You are peers.  Meet your cohort.

Susan’s dad had it going.  Be productive at any age.  Know that you have something to offer.  You have valuable stock.  Put you name out there, where ever that is.

Christian is a brilliant gardener.  Mindy is being her real self all the time.  Craig works words in classic timeless style.  You are a star.

Self-care tip:  Put your name into print.

Question:  What are you a star at?  Please tell us your fabulous story of self.

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Bank and Book-Keeping

Lathe operator machining parts for transport p...

Lathe operator machining parts for transport planes at the Consolidated Aircraft Corporation plant, Fort Worth, USA (1942). (Photo credit: Wikipedia)

We are like the national bank of our own nation.  If we do not invest and do book-keeping, we get the great depression.  But what does that mean?  What is investing in Me?  What is book-keeping?  “I am not an accountant and I am not good with numbers,” we say.

We are talking about putting it in and seeing into when it is running low.  Putting it in, well, it might be fun, intuitive, the best part of what makes life worth living, or it might feel like working nine to five.

How do we get money in our bank?  We work.  We work jobs we like, and ones we do not.  This is not meant to be a discussion on the employment crisis we are in, but rather our basic needs.   Basic needs, like energy, self-esteem, a desire to live, freedom, the ability to feel pleasure, think about those.

Have we considered them as our entitlement for being human?  Are they a choice?  Investing in me is the big and small, the easy and difficult of practicing accountability to Me.

One of the weaknesses of this primitive analogy is that it piggy-backs a cultural opinion of failure if we find our bank empty.  Without spending time today on that, please accept the premise that emotions and behaviors in this discussion are not moral qualifiers.

The behaviors that bring bank might be any number of things, exercise, diet, marrying God, sleep, taking prescription medication, ECT, using CPAP, avoiding violent content, Love magic, and so forth.  However, to do these things with most success.  Pursue them through the framework gifted to us via genetics, what came to us by way of temperament.  That is style, form, and inspiration.

Temperament provides for us, like a great uncle’s inheritance. Going with that style of personality will tap into what was put aside for us without any work on our part.  It is a fortune each of us have.  This is in compliment to what bank we work for, as described above.

There are many ways we receive that we do not work for.  Love, for example.  But the choice to receive may not come easy.  The choice to pursue what is freely given to us, to unwrap a gift, to open an envelope that carries our uncle’s will, to receive Love – the choice is ours.  The choice can be as difficult or more so than hours in a sweatshop.

How do we get money in our bank?  We work and we receive.

So this is what “bank” is and book-keeping at FriendtoYourself.com, and maybe it is as interesting as tax season but I thought revisiting it might lend balance.  Keep on.

Question:  What is your bookkeeping activity?  Please tell us some of your story.

Self-care tip:  Work and receive actively.

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Answering Jim, professionally and personally – ECT

A few days ago, Jim, from blog, “I Don’t Want To Talk About It,” asked in his comment to my blog post,

What is your educated opinion about this?  A friend of mine is seriously considering this.

Jim was asking regarding ECT – electroconvulsive therapy.

021 Side Effect

021 Side Effect (Photo credit: Jester Jay Music)

Responding to a question that asks me to answer both personally and professionally is a little uncomfortable but this is my best effort.

…Alright, Provocateur Jim, I have been chewing my cheek on this, wanting to say something profound, considered “educated,” 🙂 yet not to turn anyone off with an up-tilted schnoz.

I do love ECT as a treatment option.

ECT is not for everyone of course, as nothing is, but consider it if you are looking for a treatment to work quickly and effectively .

Quickly is important.

  1. Can be life-saving, (“Timing is everything,” they say)
  2. Brain health short and long-term
  • less dementia,
  • less onset of other brain illnesses that come when one brain illness is not fully treated,
  • easier to respond to any future necessary treatments when we get more rapid and full treatment response to current illness episode,
  • ECT (as with medication therapy) that is done earlier in illness episode has a more robust response,
  • relapses are less severe, and we do not drop as rapidly when treatment is obtained more quickly for current illness episode

3. Quality of life,
4. Halt the damage to interpersonal relationships,
5. Diminish financial demise secondary to disability of brain illness,
6. Minimize side-effects,
7. Minimize medications.

Efficacy… do we really need to even say that the goal is to use a treatment that works?  ECT works more often and more thoroughly than any other treatment options.

Furthermore, we suffer less illness relapse when ECT is continued in maintenance.

Treatment response is much more robust when ECT is combined with medication.

Side Effects:

The side effects can only be measured on an individual basis, as qualified by the person going through them.

First off, there is no brain damage done by ECT, as seen in medical studies. This is a common fear.

Neither does ECT go through the body systems, it is not metabolized, and does not touch our body organs.  Yay, right!?  Medication side effects are a huge pill-dotted elephant in the room.  ECT does not touch the body (i.e. It is not a substance ingested or entered materially into the body,) all related potential side effects never happen.

The number one reason for relapse in brain illness is medication noncompliance.   This is due to many reasons, such as intolerable side-effects and the cascade of subsequent related issues.  Even dry mouth can lead to root canals.  We do not think of osteoporosis from serotonin agents.  Not taking our medication daily can be for more obvious reasons, like not climaxing during orgasm.

Zoloft Side effects in women

Zoloft Side effects in women (Photo credit: Life Mental Health)

Plus, it is just hard to remember.  Even the most consistent of us generally miss one to two days of medication a week or a month.  It is tough to be consistent.
ECT is less difficult to remember and maintenance ECT is much less frequent than taking pills every day.  Even when the ECT is combined with medication, if a day or two is missed, at least the ECT will be consistent as it has the support of the community of ECT staff and the transportation person to and from the surgery center.

In these regards, ECT has fewer barriers to treatment compliance that the majority of us suffer with medication therapies.  That is a big deal.

The side-effects of ECT are generally headache and temporary memory loss.

During index treatment, (about the first 3-4 weeks,) it is common to experience difficulty imprinting/recording memories. This typically takes about five weeks after the index treatment to return toward baseline. 80 years of data do not demonstrate that there is other memory loss but there are individual complaints of that.

Headaches are common for the the first couple treatments until the anesthesia becomes customized to the individuals experience. Generally after the first few treatments, the personalized anesthesia medications are able to resolve these from causing too much suffering. Not universally of course, but generally. Then once the maintenance treatments get going, memory loss and headaches are not common complaints.

…Big breath…

Did I do it?  Any questions about this diatribe?  🙂  Thank you for your patience.  I am trying…  Please let me know.  Keep on.

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Past week, latest on ECT on the web

  1. Shock therapy used to treat depression video from wzzm13.com community
  2. Wrong Planet Autism Forum Index -> Bipolar, Tourettes, Schizophrenia, and other Psychological Conditions
  3. Why are we still using electroconvulsive therapy?
  4. By Jim ReedBBC Newsnight
  5. PLOS ONE  :  Electroconvulsive Therapy Induces Neurogenesis
Cured by Electroshock Therapy,  Wall Street Journal

And, refreshing our memory… from http://www.FriendtoYourself.com, Related:
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Getting Older and Getting Born

Sana_Set09_LeoChaves_032

Sana_Set09_LeoChaves_032 (Photo credit: LeoChaves)

Turned another year over. Forty one now. Sometimes I already feel like there is a toe tag on me. Other times I ride the consciousness of now and innocence, as if I have forever to do whatever it is I am living for. As if fear did not pulse around me, as if life held no shame, then I carry my 41 years as lightly as a daughter spatters kissies over her mother’s arms.

Getting older is all the hype now. I was not alive 100 years ago but I wonder if 40 was the “new sexy” then. Gwyneth Paltrow is lovely. Me and Gwyneth. We have so much in common.

Huffington Post featured 30 Celebs Who Are Aging Gracefully. Tina Turner, Sting, Sigourney Weaver, the list is full of real people sharing our life-space. Remember Working Girl? Boom.

I look at my parents, friends, patients, myself, strangers on the street and stories that symbolize a person’s life lived. I look and I think of someone who climbs Everest. I think of frostbite. I think of a long long journey. I think of death.

The day before my birthday, the excitement made waiting too much to endure. A small chocolate bar, a handmade card with misspelled words and two tightly folded dollar bills disregarded the calendar date. Neatly arranged on my night table, I was told by their giggling toe-toe hopping agents, “Happy Birthday tomorrow, Mommy! I’m so glad you were born!”

And I was born again. Just like that. Love labor.

Some women have birth the way it is supposed to happen and others suffer. After my third child, my OB-Gyn, I love that woman, told me with nothing more than fatigue and honesty, “Sana, you should probably stop at three. Pregnancy and delivery is just not easy for you.” My pregnancies and deliveries were not that easy for her either.

Our rebirths also come easy and come hard. We almost die. We cruise through as if we were made for it. “She was made to have babies!” (Dodge the loogie I cannot help but hurl. Damn those women with baby-making bodies!)

I know we think things like this about people without brain illness, (if they even exists.) Maybe we think they do not have the suffering we do. Maybe we think we have it worse. We think at least we are misunderstood, when we hear,

“Get over it!”

“Just calm down!”

“Would you relax?!”

Breath. Yummy. How we love that. The list of these is longer than the path up Everest. And so helpful. Who has actually calmed down when told? Notice the exclamation points. Exclamation points symbolize emotion, in case the mountaineering porters saying the helpful emotion-directives did not know.

During our long long or short journeys we get to be born once, twice, forty-one, or the last time, because of Love. We do not get a Love that is measurable liquid or linear, like Time. Love is not healthy or unhealthy. It does not curl into our DNA, and is not dispensed by privilege. Nor a jury of Sherpas. Calm down.

Love is. Love is, and Love offers us a newness over and over and over and over because.

We have different birthing experiences, but I am glad you were born. You are loved.

Self-Care Tip:  Allow Love to bring you new beginnings.

Questions:  How has birthing gone for you?  What have been some of the new beginnings you knew Love brought you.  Please tell us your story.

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What would brain illness look like

Look Mommy! Look at my note!

 

crinkledShe pulled out a crumpled treasure.

See?!

It was a white paper. Blank. I paused with the, “I’m very interested,” and, “I’m a good Mom to whom you want to divulge your innermost thoughts and secrets to,” expressions on my face. I am you know. All that. Sniff.

Another mystery maker, handy, said,

Where’s your pen?!

She was getting agitated. I did not get it. I was less of a P.I. than she had hoped. She had a non-P.I. mom. Just great.

A third wheel rolled in and stuttered out,

You need the pen, Mommy! You need it! You need the light!

I noted the multiple exclamation points hovering about and knew the sand in the glass was almost out. Communication needed to be received or my three secret agents were going to increase their level of effort. Be warned.

I am an emotions-Jedi after-all. I sense these things. The Force is strong in me, still, young Padawans.

Then, there it was. Under the blue penlight, shown the hidden messages.

No. I do not remember them. Just the sense of them. And…

And, I thought it was a super illustration of how brain illness is there but not generally seen.

I am sure this was disconcerting to my investigative kids, who had dreamed I would do what they wanted with my life and thoughts. I wish they would just let me be me! (Flipping hair.)

Brain illness does not get as much air time as cancer. It is not as obvious as a withered hand. Nor a rash. Nor a big outcropping of plantar warts seeded across the soles of our feet – brain illness is not.

Brain illness does not engender connection easily because not everyone has the Force in them. Not everyone is a Jedi like you and I. It does not have the advantage to connection as a name tag illness. Brain illness does not wear itself on our visage like an invitation to others to embrace us in shared experience.

Where is the Light?

Right. In us. We are the light. We are what brings awareness to this secretive suffering. We are secret agent Jedis. Yes. Exclamation point. Exclamation point. Exclamation point.

Questions: What would brain illness look like if it was visible?

How has brain illness become more of a shared experience? How can it?

Please tell us your story.

Self-Care Tip: Share your experience.

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A Young Man’s Wrenching Journey

Children!

On Jun 18, 2013, Anon wrote:

Hello Dr. Sana L. Johnson-Quijada,

Thank you for coming to talk to share some of your experiences and views associated psychiatry. I am sorry I have not emailed you sooner.  This was my first year taking three sciences and when it came time to study for finals, I pretty much ignored everything except school.

Thank you for giving the class and myself some exposure to psychiatry. Your talk was very intriguing, especially how you see a person, in particular how their brain health affects their personality. When you started to talk about homelessness it brought back painful and confusing memories from my childhood.

My parents divorced when I was seven and the majority of my time was spent with my mother because my now deceased father had a difficult time keeping a roof over his head and doing the activities of daily living. When I was a little older I even loaned my dad some money when his car was impounded. I could not understand why my dad was in the situation he was in and why I was seemingly more capable than him. I loved him very much and wanted to help him in any way I could.  But in the end, I could not make any of his decisions for him.

My older brother is living in a shelter and he reminds me of my dad in so many ways. When we lived together, before my parents divorced, my brother was just about as hard to get along with as my dad, and my dad was physically abusive to him. I was so confused and could not understand why we could not love each other or ourselves. My dad’s incessant fear of doctors and my brother’s fervent choice to self medicate only complicated the situation we were in.

My heart goes out to my family and people like them and I have a strong desire to help people. Your short talk resonated with me and I was intrigued by psychiatry because I thought it might be a way for me to help. How do I learn more?

Sincerely,

Anon

On Jun 18, 2013, at 5:16 PM, Sana Quijada wrote:

Hey. So good to hear from you. I remember you well. Sniff. Big hug. You are not alone, dear man. 

How to learn more?  Hmm. I would start by attending some local NAMI meetings. Follow up with me in a bit after you do and we can keep the lines open and ideas flowing. It is an honor to connect with you. 

I celebrate your focus and completion of finals. 

I would love to post your email letter on FriendtoYourself.com … 

Your story is seriously powerful.  As my six-year-old says, boom! Smile. 

Till next time,

Sana Johnson-Quijada MD
www.FriendtoYourself.com

On Jun 24, 2013, at 5:00 PM, Anon wrote:

Yes you may post my email I feel honored. It took a lot of courage to write and I am glad you were receptive.

This is a "thought bubble". It is an...

Questions:  How would you recommend a young person find out more about psychiatry, before pursuing years of study?  How did you investigate your profession before committing?  

How do you talk about your family of origin history?  How do you find the courage to share these things, to find community in what hurts?  Please tell us your story.

Self-Care Tip:  Find the courage to connect with others and your story.

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Talking about God in Medicine

train hopping
Why don’t you talk about God more?

This question is familiar to me.

People think that with as much as I see and am seen by, as a psychiatrist, I do not feel awkward.  Not so.  I can face all manner of dragon, beast, friend or foe, but put me with a Christian who wants to know why I do not talk about God as much as they think I should in my medical practice, and I become a wet-eyed girl again, hopping from foot to foot.

This would never have been a question someone would dare have asked Kreplin or Bleuler.  But then I am not Kreplin or Bleuler.  I get asked.  Kreplin and Bleuler would not be caught discussing psychiatry casually nor personally.  I do.  In the history of psychiatry, what has developed the culture of our practice, we have biases toward the practicing of medicine without bias.  I am biased otherwise.

Conversely, the culture of Christianity in our generation is that we do almost the opposite – nothing is not about Christianity.  Everyone is a creation of God so that makes it everyone’s business.

You can see how there is a tension between countries and I am a train hopping hobo.  You know the risk in train hopping, do you not?

Why don’t you talk about God more?  (Hop! Hop!)

I tried to explain this to my Dad.

“Dad, so many people, who have been hurt, perceive that the trauma related to God.  The Christian language, is for them, a wolf in sheep’s clothing and can be activating.  So many people are confused about God and I’m not to confuse them more.”  This is consistent with the culture of psychiatry and standard of practice.

It is uncomfortable on even a more personal level though.  Being Christian means that God and I are united, married, intimate and there is not much more personal than that.

We have discussed before the difficulty in describing behaviors without tagging them with a moral quality.  This is important in part because our emotions and behaviors come from our hard wiring, our temperament, not from a stick shift or consistently from choice.  We intuitively think that what comes naturally from our personality is a thing of rightness or wrongness.

We have explored that emotions and behaviors come from the brain, a human organ, and not Jerusalem, or the city of Oz.  Emotions and behaviors come from a human organ, tissue matter, and are symptoms of the health condition of that organ.   Emotions and behaviors sometimes come without invitation.   When our brain is not healthy, what we feel and do that is not friendly to Me or others are symptoms of that illness.

So now when we describe God, a very personal, intimate union in us, we oft affect our humanness.  If I describe my perception of God to another, there are huge personal implications.  Maybe that person does not want an intimate relationship with “Someone” who has my personality traits, my temperament, and as generated by the condition of my brain health.  Maybe that person might feel violated rather than be in a patient-doctor relationship.  Maybe that person might afterward, as I have felt when others described God to me, think they need to take a good hot shower or at least wash their mouth out.  Icky.  You think?

One of the reasons I love the writing of King David is that he just tells his story.  Not much more convincing than someone’s story.

The Lord is my Shepherd.  I shall not want.  He maketh me to lie down in green pastures.  He leadeth me beside still waters.  Yea though I walk through the valley of the shadow of death, I fear no evil, for Thou art with me….

sheep

Nice.

When a patient is in treatment with me, there are unique moments that come and go when my story comes out, but it is not standard.

Why don’t you talk about God more?

So there you have it.  That is why, for now.  I hope to grow and assume this will not be my opinion nor practice forever.

And between me and thee, at Friend to Yourself, we are also still figuring this out.  Together.

Questions:  Do you wish your physicians talked about God more? or less?  Why?  How has it affected your treatment?  How do you wish it would change?  Please tell us your story.

Self-Care Tip:  When people talk about God, or hurt you and you believe Christianity or religion is involved, remember they are human, not God.

(Even me!  lol!)

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Just Left of Center, We Celebrate You

Base on balls

Dear One, (You know who you are)

Congratulations on this life-milestone.  Congratulations on what you have come through and what toward.  Congratulations on being connected.  Although you walk, you do not walk away from your life journey.

There are other crossings when we all step away from our life and look on at a safer distance, binoculars in hand, because not to would bring the apocalypse, or at least frizzy hair.

peruvian casi-frizz

peruvian casi-frizz (Photo credit: casimira parabolica)

At this time we see that you are more than a spectator, more than a narrator or a newscaster, not a stranger to yourself described in shame-filled words and judgment, as if you were the sum of right or wrong.  You are, at this intersection, more than your performance, behaviors and emotions.  You are.  You are more.

Some other day, you may find your binoculars again.  You may need them, and that is what it is.  Not good or bad.  For our part, we will celebrate you then too.

We are blessed.  All this that you are is a benediction for us; the walking, breathing wonder of what comes from Love.  We, as might anyone connected to Magic, bless you in return.

“Keep evil away.  Keep walking in Love.  Bless.”

Congratulations for your proximity to what is difficult, for working hard to love yourself, for finding your specialness in more than what hurts in you.  You are special.

You are special, like a seed or a grown and aging tree.  You are special, like San Francisco is in summer or Australia at Christmas.  You are special, like the worst of us.  Like the best, you are special for more than your imperfections.

You stand, with us, just left of center.  We celebrate you.

Self-Care Tip:  Live a celebrated life.

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