Mental Health

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Brain Health is A Tool

Red

Red (Photo credit: tankgirlrs)

Bernice flushed.  A pink perfused her face and neck.  Her eyes looked away.

Why don’t I feel better?

Bernice was one of those fortunate lasses who flushed and blushed no matter what emotion she experienced.  When I first met her and she told me some of her story, she was also a-flame.

I’ll do anything to feel better.

She though she was feeling bad because her husband did not love her.
I knew, however, that this was not why.  She did not understand why she was feeling so bad.  It was a conundrum to her.

She began intensive psychotherapy and pharmacotherapy.  In two weeks, she forgot she did not want to live.  In four weeks, she remembered why she did want to live.  In six weeks, she liked herself again.  She was still blushing, but she was alive and well.

We sat separated by a small desk and laptop.  I was typing notes and watching the pink bloom.  Too sweet.

Why do you think you feel better, Bernice?  What is making the difference?

We all know something about the relationship blood has with the lung and heart.  We know that all the blood in our body flows through those two organs.  They are the hub of our body, the authority of the blood communication.  For better or worse, they are also a filter.  Pollution can clog them, hence heart attacks, cancer.

So with emotions and behaviors, we know there is a grand central station where they come from.  Things that assault the hub such as a a death in the family, similar to a glob of cholesterol toward the heart, stress on us affects brain health.

Red hair distracted me from these thoughts.  Bernice had a lot of it.  Irish I guessed from who knows how many generations back.  I remembered the red-head girl who won the beauty contest my Mom forced me into when I was ten.  Awkward.  I pushed my focus back.

Irish Bernice had experienced what happens when we approach healing at the central station of behavioral and emotional illness.  The brain.  She stumbled, trying to explain her story, although, intuitively, she had insight into, “Why?”

I don’t know!  I’m trying hard to be mindful and I’m treating my husband differently.  (I.e. They are having sex again.)

She paused and her face reddened.

Well, I really like my meds!  I think they help a lot too!  I am feeling calmer and I don’t cry as much.  I’m sleeping through the night…

She peetered off into her averted gaze.  I wondered that the conjunctiva of her eye-balls were still white, inside the almost crimson lid and cheek around them.

We with Bernice ask why the medical paradigm including psychotherapy, nutrition, exercise, community, medications, ECT, is the best way to healing a sickness.  It is not about the healthy exercise in itself.  It is about what all these have in common.  They all act upon and draw forth emotions and behaviors from the brain.  Their vital exchange with our brain, the grand central station, are much better understood when we start with understanding of what brain health offers.

Self-Care Tip:  Use brain health, as the grand central station of Me, to handle the multiplicitous paradigms that make us who we are.

Question:  Is it helpful to use brain health as a tool toward who you consider yourself to be, rather than a definition of who you are?  Does it influence where you spend your energies?  Your blame?  How you approach shame?  Your hope?  Please tell us your story.

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Roughly What We Covered With The University Students

Psychiatry logo

Psychiatry logo (Photo credit: Wikipedia)

What is psychiatry?

Components intersecting at cross-point where stands Psychiatry:

  • The practice of medicine
  • The practice of business
  • The practice of one’s personal life
  • The doctor-patient relationship
  • The pursuit of Quality of Life

Who should go into psychiatry?

  • Consider temperament
  • There are areas of medicine that are more procedural based versus more weighted toward patient-doctor exchange.
  • The medical system is incentivized by codes and governed by layers of administration.
  • But the question begins with Me; what am I incentivized by?  Again, consider temperament.  Temperament encompasses perceived moral values, and where pleasure comes from.

What is brain illness?

  1. Biological
  2. psychological
  3. sociological

We are not in this to cure anything.  We enter psychiatry to improve quality of life – through approach of the biopsychosocial model.

Questions for you:  

  1. What is psychiatry?

  2. Who should go into psychiatry?

  3. What is brain illness?

Self-Care Tip:  Approach brain illness w/o expecting a cure, but rather a process.

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Patient-Doctor Relationship

shoes

Tonight I pulled together all the posts we have on the patient-doctor relationship into one page.  Please let me know your reactions.  This is a journey I am really grateful to travel with you.  Keep on.

 

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Allow yourself to transcend the naming of your symptoms

French political cartoon of French cardinal Je...

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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Planning helps, even on vacation

A boy in a children's swimming pool.

A boy in a children’s swimming pool. (Photo credit: Wikipedia)

It is amazing how little time there is to write when living through a day as perfectly uncomplicated as string cheese, reading books and guarding the swimming pool.  In between this higher living, I have been thinking and thunking about what we will say to the university folk about psychiatry, but it has been as if space got in the way of clear thought.

I took a nap, but when I awoke, although rested, there it was.  The space and timelessness of no schedule plugged up whatever clever thoughts were waiting to come.  It was like those expensive tires that patch themselves when you ride your bike over a nail.  I imagine there is green foamy stuff all over my brain, stopping up holes where super thoughts might have tried to pass through.  And before it could be clearly grasped that this was not accidental, that these thoughts were wanted, indeed solicited and not hot air, wouldn’t you know it!  The day is over and I am flattened.

And so for tomorrow I am planning, rather than hoping.  I plan to write.  And I know when too!  And it will not disallow the necessary open space.  I will write and have my space with it.  My cake and eat it, you know, or some other sort of adage to explain that planning can enhance and add much flavor to the space of time around us.

Self-Care Tip:  Plan for what you want to do.

Question:  How does planning improve or diminish your space?  Please tell us your story.

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What do you think they need to hear?

Hello, Friend to Yourself Community!

Please let me know what you think these fine folk need to hear from us?  It is our chance to talk to college pre-med students!

English: red apple

This is the caption of our invite-letter:

Dear Dr. Quijada,

Thank you for participating in MDCN 204: Introduction to Medicine at —-University. It is my pleasure to have you join our lecture series this year. 

Students are very excited about the prospect of meeting a physician and learning more about medicine. For many of them this is a firm choice and they would like to add to their knowledge base, while others are simply exploring medicine as a possible health career. Many students in the class are freshman, but several are sophomores, and juniors; a few of them are seniors.

I am really looking forward to hearing your thoughts, questions, if you were them, and recommendations.

Thank you friends.  Keep on.

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Our Wanting Could Make Our Reality A Whole Lot Better

Fantasy Garden Goddess by Tucia

Fantasy Garden Goddess by Tucia (Photo credit: Tucia)

Katalyn was forever bewildered by the contrast between the success of what she called her life and the failure of her relationships.  As the assistant to the director of Polk Hill’s only advertising firm, she knew everyone.  She was a blooming flower, her petals unfurled and her ability to know just where to turn the pitch was like opening to the sun.  She had talent. But more than that, Katalyn was a darn good worker.

Sitting across from me in the couch chair, her long and graceful fingers tapped the chair arm as if they were used to keeping time with her moving thoughts.  “Here it comes,” I said to myself, and tried to relax into the complexity of her story.

“Why am I alone?  Why aren’t I in a relationship?”

Katalyn chewed her lip and blinked a little faster.  “I will not cry!” I could almost hear her mind say.

Time cracked open there into reflection.

We all have this dissonance in our life story.  We make our choices with where we put our hard work.  But we leave our fantasies disconnected from this investment of ourselves.  We think that fantasies, (fantasy as in: contemporary, epic and/or paranormal – not necessarily fish-net hose,)…  We think that fantasies should materialize via magical forces rather than deliberate efforts. Irony, again.  Qualifying accessibility to our fantasies, (or we could say, wants,) this way verses to what we think is real is our own doing.

Reminds me that we treat our loved ones worse than any stranger.  Put our best years and best hours of the day into impersonal labor, we give this way.  We think the least of our own beauty, success and intrigue, and the most in those we know little about.  Then we wonder about the disconnect.

There is something raw and vulnerable about showing our wanting to ourselves.  It is one thing about our wanting in privacy, a place of personal ridicule and shame, and it is another to want in public life-process.

Imagine if Katalyn deliberately allowed herself to relax into her wanting at work as well as in privacy.  What would happen?  How would she do that?  What is the worst that could happen?

Imagine Katalyn as a woman who fantasized as she worked hard.  Would her work experience be different?  What would happen to her quality of life?  What would happen to her perception of reality?

Self-Care Tip:  Let your wanting, (or we could say, fantasies,) out into public.

Questions:  What would be different in your quality of life experience if you deliberately included your wanting into what you perceived was your reality?  What would happen if you worked hard to bring those together?  Have you seen this at work in your life?  Please tell us your story.

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Live with an agenda

dionna, 1991.

dionna, 1991. (Photo credit: paul posadas)

The blue dragon lifted her head from near-sleep.  She knew.  Pouncing onto the rocky ledge gave her the advantage.  No one would challenge her.  The fresh corpse was for her alone.  As she ate the remains of Dionna, the red dragon who had never flown, the memories of Dionna infused her.  The blue dragon in this had saved those memories and would live them into the forwardness of time.  

Why is it that we repeat the mistakes of our forefathers?  It would be nice if we could somehow be able to capture their hard-earned life experiences.  If dragon lore were true, perhaps.

In Papua New Guinea, Congo, cannibals on the Disneyland Jungle Cruise and who knows where else, eating brain to preserve the life force, save your daughters or avoid the mistakes Dad made gets you a bad and yucky disease called, kuru.  Nothing good comes from eating brain.

And so the blue dragon, whose scales shone in the morning sun, began to tremble and seemed confused over the years.  Her brain got holes like a sponge and she laughed at inappropriate times.  

We just cannot get a leg up on wisdom and experience.  We are not made for it.  Each of make our own mistakes, have to work our own fingers to the bone, and other knowing clichés that in this case just are the darn truth.

What blue dragon and kuru are trying to tell us are that the agenda Love has for us is not to build up experiences like some sort of mental tower of babel.  It is not about the mistakes.  It is about our life experience.

We cannot help but wonder, though.  After working in psychiatry for these many years, I wonder what a joy it would be to give that experience, knowledge, skill of practice and such to my daughter some day.  Ah.  As if it had its own life force, passing it on to my daughter feels like a bit of immortality.

When I die, just eat my frontal lobe, darling.  Not the limbic system.

We are meant to live.  In that living, we inevitably repeat foibles and build up muscles and manage to survive all kinds of suffering.  In that living, we are beat up and rejected.  We are perfect.  We are flawed.  We are marvelous.

Maybe the agenda is not to get it better with each generation or to get it right.  Maybe the agenda is to live.

Question:  Have you ever been frustrated at how quickly your gains in life will be/are lost?  What is the agenda of your life?  Please tell us your story.

Self-Care Tip:  Live life with a quality-experience agenda.

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Tell us, What is the the long and short of being your own friend?

Sarah
That’s a really, really good question. At first, the hardest part was mourning part of my old lifestyle. I knew I was giving up some things—not just certain foods, but certain hobbies and ways of being (i.e. sleeping as late as the children and not exercising, baking, a coffee culture, social eating, and making excuses). My best friend put it to me this way: “You cannot be a SAHM who bakes as a hobby and not expect to gain weight.” Boom.It was also hard to get into the mindset of daily weighings and—gasp—being accountable. I had to learn calories for various foods and proper portioning. Not a lot of food it felt like at first…but after a few months, a surprising amount of food if I chose to eat veggies and to eat clean.The hardest part mid-way through was a distancing of a person close to me who is very, very much into the food culture and who knows that she is overweight. We used to be into food and overweight together. The distance partly comes from this person and partly from me. Food used to be a major shared interest…and now it isn’t. Now I think we wonder what we both still have in common… But I view food as being like a drug, at least for me. It is fine in medicinal doses, but it is like being a recovering addict in many ways. I’ve had to switch cultures, to keep my mind on the right track. This person isn’t ready to make this journey. I don’t judge that: she’s just not ready. I try not to take our mutual distancing personally, and we’re still friendly.

Right now, I am struggling to switch my mindset from “losing weight” to “maintaining weight.” In some ways, it is easier for me to be in a “losing weight” mindset than it is to be in a “maintaining weight” mindset…if that makes sense. Long term, I am scared of losing control over myself again. There is part of me that knows I won’t, because I have educated myself now about food and calories. The documentary Forks Over Knives has been huge for me, as well. But part of me knows the potential is there for a relapse, and I live with that every time I come downstairs to do dishes and feel the tug of my past late-night snacking habit.

The challenge long term is also to keep goals ahead of me. I do best when I have something to work for. I met my weight goal, but now what? I have been thinking about focusing on strength now, and performance. I have to stay hungry for achievement, versus being hungry for food.

Questions:  How about you? What have you found to be the biggest challenges long and short-term?  Please tell us, also, what is your story.  We need to hear.

Sarah McGhaugh is the auther of blog, birdinyourhand, where she describes herself as, “a teacher, entertainer, four star general, and nurse: in other words, a mom.”  Too cute!  She is also my friend :).  Thank you Sarah for engaging with us.  Keep on.

 

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Tell Us What You Are Doing

A pair of Hopper balloons.

This morning, running with Kaia Fitness, I did not have a good book downloaded on my iphone and I was in-between groups of girls I could have chatted with. What to do while running?

Apparently I cannot do one thing at a time, such as simply running. Multitasking is one of my geniuses but also one of my many achilles. My friends at Viking Clinical Research say I have not floundered since I was in-utero. Which is not true.

There were orange groves on my left, vineyards on my right and in front coming out of the morning frost floated eight hot air balloons. Seriously gorgeous.

I decided to call my Missouri-brother and say, Happy Sabbath. Of course, when he picked up he said, “I hope you’re running Sana, cuz if you aren’t…?” I told him I was running.
To the fridge and he said, “That’s good, cuz it means you’re out of bed.”

Well connecting with him was fun, despite his snark. And now with you.

Happy Sabbath, friends. Please tell us today what you are doing to be a friend to yourself? Speak out! We need to hear you. Keep on.

Dr. Q

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another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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The hard work of being friendly to Me – talking about ECT

i take drugs

i take drugs (Photo credit: the|G|™)

I give a lot of talks in my community on understanding electroconvulsive therapy, (ECT,) as a treatment option for brain illness and I am finally able to bullet point most of it.  It has been and continues to be a long love-labor I am honored to be involved in.  (It looks so simple! – Not!) These seven points, believe me or don’t, represent many hours of research, training, practical experience and time looking into my own motives of interest.

Even here! everything starts and ends with me.  Ah.  So sweet.  😉

drum-drum-drum-drum… rollllllll!

Number 1.  20% more effective than medication at any point in treatment.

In other words, if it is a first episode or fifth episode of brain illness, ECT is 20% more likely to get a positive treatment response than psychotropics.

Number 2.  It starts working in 1-2 weeks, versus medication therapy takes 6-8 weeks.

Number 3.  It does not touch the body systems – does not affect metabolism, heart, weight/appetite, sex drive/performance, cause dry mouth, or vomiting and diarrhea, life-threatening rash or anything else common or bizarre side effect to the body.

Name it, imagine it, confabulate about it but ECT does not do that to your body.  It does not touch the body except the brain where we are trying to make therapeutic changes.

Number 4.  It is the gold standard in pregnancy and peripartum for the same reasons – does not touch the body systems.

For the fetus – there really are not yet any psychotropics that are considered “safe.”  Even serotonin agents that once were the go-to pills for Ob-gyn physicians, are now known to risk increasing bowl irritability, lung function problems and possibly even heart disease.

Number 5.  It is the gold standard in the elderly for the same reasons – does not touch the body systems.

As we age, medications metabolize differently, interact more and cause a lot more life threatening side effects.  Even medications we’ve been safely on for years, one day, cause dizziness and falls.  Out of the blue, we start having nausea.  As if betrayed by an old friend, we don’t metabolize them well, our organs are sickened by them, we develop kidney disease.  Etcetera.  It goes on.

ECT does not.  ECT does not do any of this.  It does not touch the body systems.

Number 6.  ECT has been around for eighty years.

That is a big deal.  That is helpful if kept in mind when we consider if it is fad, a gimmick, secondary-gain driven procedure, motives for treatment and other concerns against its use.

So often in practice, we thrill at the medication samples in their shiny colorful boxes so well marketed with commercials on the television to support their use.  Our physicians pull their drawer out and present them as a new chance at treatment response, which they are.  These medications have been around for how long though?  Surely not eighty years.

How long does their patent last even?  Eight to ten years maybe.

What will we discover about study-medication-X over that amount of time?  Maybe nothing dangerous or too intolerable   How bout eighty years of time?  Still, study-medication-X might remain in a relatively safe category.   Maybe.  Or not.

Most medication trials, to get a medication legalized in the USA, are designed to study medications for about 8-12 weeks on any one patient.  Many trials are done over years, and they are compared with each other using complicated mathematical statistical analysis and governments.  It is not bad and I am grateful to be a part of this community of physicians who studies and prescribes medications from this pool of treatment options.  Still, I think how despite the huge number of persons who received this study-medication-X, none of them were individually treated with that compound for very long.

Deciding to launch a medication into the community is based on this.  Once it is on the market, data is collected and made transparent to the community progressively thereafter. But initially, we are making our decisions to use or not to use with this at our spine.

Shiny boxed pills with a few years gathered round them at most of information from individuals who probably used the study-medication-X no longer than several weeks total, verses, ECT that has eighty years of transparent data regarding what we want to know – side effects, efficacy and any other sense.

Can’t poo poo that.  Eighty years has its own kind of luminescence.

Number 7.  ECT works by changing how different parts of the brain communicate with each other.

ECT “turns down” those areas that have overreactive connection.

It turns out, this is similar with how medications work for brain illness, but without the medication side effects.

For a long time, stigma-related opinions about ECT exposed that we knew ECT worked but did not have studies demonstrating how.  That is no longer true.  This is an important milestone for the history of our treatment choices.

None of this is to say that one person’s choice of treatment is superior to another or not.  Rather, the import of this is that ECT is underutilized largely because of ignorance and stigma.  Not that it is qualified as better or worse.  Better or worse is the opinion of you and I with an informed consent.

Who are we to say that a side effect of ECT is more worth enduring than those of one medication or another?  Only the patient can say this and then how that side effect(s) compare for her against the benefits received from treatment.

However, psychiatry is not an area of medicine that yet has a huge array of treatment options.  To obscure one of this caliber, life-saving heroics and life-changing import is a huge loss.  ECT is another paradigm of treatment.  It is not an either/or.

Oh, but to share in what this does, mmmm.  That gives Me a sense of value, connection to you and improves the way I care for my professional and personal self.  Rich.

Gratefully,

Dr. Q

Self-care tip:  Share in what improves your sense of value, connections and the way you take care of yourself.

Questions:  I’d like to continue to improve this.  Any suggestions?

Does any of this ring a bell in your mind of something important to you?  Please tell us about it.

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Treatment Settings in Psychiatry

HEALTHCARE WITH GOVERNMENT OPTIONS PLAN: IS TH...

HEALTHCARE  (Photo credit: roberthuffstutter)

I thought I’d just talk briefly about some treatment settings in psychiatry.  It is confusing for anyone in the community, from nonpsychiatric physicians to architects, to know the differences between these.  Some of us have been through some of these programs but many many of us haven’t.

  • Inpatient, which is 24 hours a day and includes voluntary and involuntary admissions.  Here we have a skeletal number of group therapies and see the physician daily for psychopharmacology adjustments.
  • Partial Hospital Program, (PHP,) which is generally Monday – Friday, from 9am to 3pm, and always voluntary.  Here, we work in intensive psychotherapy most of the day, and psychopharmacological treatments with the physician at minimum once a week.
  • Outpatient, such as in a physician’s private office where psychotropic medication and psychotherapy are used.

It generally takes time to influence the way the genes express themselves in any therapy, whether it is talk therapy, medication or ECT, to name a few options.

This is skeletal.  Any comments or additions?

(Random) Self-Care Tip 🙂 – know your options

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Marcos and his brain illness

Man portrait

Man portrait (Photo credit: @Doug88888)

He had always been a small man with wizened lines, a moguled nose that sloped over a deep philtrum and two ears that flew like flags on the sides of his head.  Looking at Marcos has always been a study of human terrain.   For someone with so much activity and exchange with just being seen by others, it was an apparent contrast to how disconnected he remained emotionally.  Brain illness had harmed Marcos.  It was as if he had been scooped out in places.

Marcos and I had worked together for ten years in psychotropic and psychotherapeutic remedies with only partial treatment responses that curved up toward an imagined healthy baseline on currents of hope.  His improvements however, never reached where he would call himself, “well,” and too soon they drifted down despite our cumulative efforts.

About that time, I had returned from Duke University for an update in training on electroconvulsive therapy, (ECT,) and had just opened up a new outpatient ECT surgery treatment center.  When Marcos and I discussed this as a new option, (new for our living location,) he wanted it without contest.

The evidence for efficacy as compared with the side-effect profile in ECT is dramatic.  When I tell patients about it, ECT might sound too good.  However, it has been around for so long that it celebrates itself. Marcos wanted in.

It has been a year already since we started ECT together but I still remember the way he leaned back in his chair that day in my office, animated almost for a change.  His scrubber eye brows were like punctuation marks around his eyes.  “Yes.  I want it.”

Marcos has not been able to taper down ECT at this point in his treatment to less than one treatment every two weeks.  He and his wife argue for it.  We have tried many times to taper down but every time we do, his symptoms come back.  He and his wife ask me separately and together, “Why doctor?  What is the point of decreasing treatments?  I do not understand?  When they work so well and we are not having any problems from them, why are we trying to reduce them?”  So, for now, he maintains one ECT treatment every two weeks.

His wife tells me he is better than he was on their wedding day.  She has never known him to be doing this well and they both think he is closer to whatever that baseline is for brain health he has always thought he was never going to get.  More connected with her, their sex life is having a run.  More connected with their kids, everyone feels like he has become a giver and the kids grades are even getting better.  By taking, Marcos became more of a giver; taking time, courage, emotional energy, even a ride there and from ECT, Marcos took and then was able to give.

Marcos is reading everything he can get his hands on about ECT; personal biographies, scientific articles, he has become his own advocate.  He could not read before ECT.  His concentration was too poor.  Now, with improved focus and attention, he perceives his memory is better.  Marcos believes he is interesting because he is interested in himself.  He is more aware of how others see him and smiles back when he catches the looks he gets just by wearing that face.

ECT is not a cure, but it is a treatment option.  It leads to brain healing, quality of life and improved connections.

Questions:  Have you struggled with quality of life?  How do you describe quality of life?  Please tell us your story.

Self-Care Tip:  Consider changing treatment paradigms to improve brain health.

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To Use Tension, Or Run From it…

English: Waterfall near Lepena, Slovenia Slove...

English: Waterfall near Lepena, Slovenia Slovenščina: Slap, Lepena, Slovenija (Photo credit: Wikipedia)

A few days ago, we talked about tension being a tool for balance.  Col, in her comments, asked to expand on this.  Aside from feeling incredibly tense about it, I thought, “Ah!  All right.”

You’ve heard the term, “One’s man’s junk is another man’s treasure.”  Tension is like that.  It’s all kieshy now and pop! to meditate into oblivion, (I exaggerate,) and “medical” marijuana couldn’t be easier to get, but where do we get the opposition that provides so much of the pleasure in the calm?  Tension.

If you’ve never been quite calm yourself, imagine standing under a waterfall trying to dry off  when people say, “relax.”  (Got to love it when people say, “Calm down,” or, “Relax!”  …Ahem.)  Using tension as a tool for balance is learning to do something else in the downpour other than drying up, like take a shower or make a rainbow.

This is easier to say than do, for sure.  But just simply knowing that tension isn’t the enemy is a great boon.

Question:  When have you noticed that tension is a tool for balance in your life?  Do you use tension or run from it?  Please tell us your story.

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When we feel whispered about, undervalued and misunderstood

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The girl, with her thin lashes and small eyes, looked at her.  What was her name again?  Bee?  Bernice?  Benny?  Something with a B.

Angelica looked back and waited.  “Helloooo?!” she thought to herself, and wanted to knock back as if to say the punchline to a knock-knock joke.

Oh mercy!   This job was getting to her.  She was at the same level as her five-year-old nephew who made up what he thought were jokes, like,

“Knock-knock.

(Mommy say, Whose there?)

‘Whose there?’

Robby.

(Mommy say, Robby who?)

‘Robby who?’  Robby poopy face!”

The kid had a brilliant career in comedy coming.

Brianna was still looking at her and Angelica finally asked her how she could help her.

“It’s your note, Maom.”  Bernice, or was it Brenda, had this way of calling her mom and ma’am all at once, reminding her that she was too young to be either, but she may have well of been since she couldn’t remember the note or many other details about her colleagues.  She’d always been like that though.  It bothered her as she became more aware of how undervalued she thought she was.  All Angelica did notice were the criticisms that came to her from administration.  It made her feel like everyone was talking about her behind her back, but she knew she couldn’t be that special.

Angelica shifted in her chair.

The last boss-message was verbally delivered about when she took her lunches.  She had sat there and taken it.  Wondering, where had all the hard work gone, she gave what she thought was a polite smile.  Where was the appreciation?!  Angelica replied with thanks for the feedback and that she would continue to work on her timeliness.  Yes, she would like to revisit this in a month and how supportive that was, boss-man.

Beonca was holding her hand out and Angelica reflexively shook it.  Wait!  Was she crying?!  Hold on here.  And now she noticed that B was swiping her nose with her sleeve.  Oh hell.  Was she sick?  Great!  Now she’d get it.

“Your note was so sweet!  Thank you for giving that feedback on my job performance in to boss-man!”

Oh yah!  Now Angelica remembered.  After she’d last gotten the pearls thrown at her regarding lunch hour timeliness she had decided to put some words on paper that were good.  Since nobody was noticing her goodli-lishissness she’d notice theirs and start her own powerful paper trail.   Just cuz.

One of their customers who was giving Angelica a hard time was really happy with B and had told Angelica about it.  Instead of losing brain time on wondering what the customer did not like about her, Angelica had put in a note about how much the customer had liked B.

Since then, Angelica kept a stack of customer feedback slips handy to fill out any time she noticed a colleague and/or herself doing “it” right.  She was going to overwhelm boss-man with good stuff and just enjoy knowing that the stuff had been noticed and said.  No more would she be unappreciated.  Even if only by herself.

Angelica looked at the crumpled paper in B’s hand and read,

“Germaine is an excellent worker.  She found merchandise a customer wanted with speedy response today and the customer specifically told me about it.”

Germaine!?  Ah well.

Angelica leaned over and gave her own wet-eyed sticky hug back.

It is universal for all of us to feel whispered about, undervalued and misunderstood.  And then what?  Let us give it the elbow jab and be our own advocate.  Put it on paper.  Say it out loud.  Be grateful about it and ruminate the gratitude.

Personalizing what is not about us gets worse with brain illness.  It is almost pathognomonic for it in fact, when it gets to the point that it cannot be redirected by conscious decision, when it interrupts interpersonal relationships and when it takes away our ability to feel pleasure.  Taking medical treatment can change the way we feel and behave without beating ourselves up over it and moralizing what is not moral.  However, this kind of elbow jabbing Angelica decided to do is just plane friendly.  And if you want…?  Well?

Questions:  Have you felt whispered about, undervalued and misunderstood?  Have you been able to get friendly with it?  Or do you feel the victim?  Please tell us your story.

Self-Care Tip:  Acknowledge yourself and others.

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Be a Celebrating Hero

An Asian black bear, shot after charging the &...

An Asian black bear, shot after charging the “Old Shekarry”, as illustrated in Wild sports of the world: a boy’s book of natural history and adventure (Photo credit: Wikipedia)

Potty-stench made going to the bathroom awful. Phong would wait for days rather than use a public bathroom. Just going near one left him showering for hours under scalding water and layers and layers of soap. He would work through three bars of soap at a time before he could even think about stopping. Stopping before was too horrific. If he did, before he stopped feeling dirty, than something horrible would happen, or so his thoughts shouted at him. The devil would eat his little girl.

Phong knew that was not going to happen but the thoughts were tormenting and nothing made them better. Sometimes he would rather die than see the bloody gruesome scene in his thoughts another day.

Obsessive Convulsive Disease is a bear. Getting treatment is seriously scary. The treatment not working is petrifying. And just about anything in between is fear invoking. You get the picture. Who will go up against a bear like that?

I remember in the Disney*Pixar movie, Brave, when the dad, Fergus, yells:

Mor’du! Elinor, hide!
[Elinor and Merida run off, one of Fergus’ men passes a spear to him, Fergus charges towards Mor’du (in bear form) but he snaps off Fergus’ spear, then we see Elinor and Merida escape on horseback, then Fergus holds up his sword at Mor’du and shouts]

Fergus, like the beast he fights, growls a bellow:

Come on, you!
[suddenly Mor’du lunges forward and the screen goes blank]

Eventually we learn that Fergus won but suffered the casualty of his leg. The amount of adrenaline in that time and sympathetic hyperawareness Fergus experienced is just close to the amount that Phong has daily or multiple times daily sometimes in his Exposure and response prevention (ERP) therapy and medications. In ERP, he has to choose to expose himself to this nearly incomprehensibly horrible fear, respond to it and then wait until the fear lessons. This is a bad case of, “it must get worse before it gets better.” But Phong does it. Mostly. He just does not want this to go on and like a prisoner of war, he is eating the grass under the fence line to survive. The man has courage. Can you imagine going through that kind of cortisol crisis every day?

And as mentioned, on top of that, he takes his medications. Anyone who takes medications, knows that we don’t need courage once to do it, but every day, hand to pills to mouth, we need sinew. Phong is one of my heroes.

Question: Do you know you are a hero? Any ideas, why? How do you celebrate that? Or would you if you would celebrate this? Please tell us your story.

Self-care tip: Growl a bellow at what you fight! Be a celebrated/celebrating hero.

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Getting Yourself Healthy Protects The Freedoms of Others

hey if you are too stinky we will ask you to l...

hey if you are too stinky we will ask you to leave not really sorry (Photo credit: stevendepolo)

Some of our most difficult cases are when we, the medical care-givers, think we know better how to take care of someone than we do take care of ourselves.

When a person maintains decision making capacity, but whose brain health disables them, if we care, we care.

Monty was one of these.  He was ill!  He was ill on so many tectonic plates, no one near him could keep their footing.  His quality of life wasn’t what he wanted.  He was disconnected from meaningful relationships.  He was suffering.  However, he couldn’t decide to engage in therapy.

Monty wanted to go “natural” but couldn’t name any natural therapies he’d be willing to try.  He didn’t want to continue suffering, but couldn’t accept medications “just yet.”  We went into one option after another, invested time together learning about brain illness and coming to terms with the biological involvement in where emotions and behaviors come from, and we did it many times.  Monty had a full informed consent.

Deciding not to treat or to treat is not easy for any of us.  Watching Monty step away into the foggy chaos of sex abuse and obsessive compulsive rituals was really hard.

We fight for our freedoms when we fight brain illness.  I suppose we fight for the freedoms of others as well, simply by taking care of our own selves.  Letting Monty choose even when his choices are affected by his illness is still his right and I defend him.  We all who take care of ourselves have more to offer Monty than if we didn’t, including a defense against the losses that brain disease brings – like processing information.

I’m not sure yet how to explain how taking care of ourselves influences the freedoms of those around us who are less inherently free by brain illness.  I suppose like anything good, freedom is contagious, a little bit of light in any room, Love being stronger than death and the Gettysburg address – this is along those lines.  It makes a difference to the Monty’s out there that we all take care of ourselves.

Self-Care Tip:  When frustrated that you can’t help others, get yourself healthy.  It’s contagious.

Question:  Have you been in the place where you thought you knew what was better for someone else then that person’s own choices?  How did you deal with that?  Please tell us your story.

Recommended Reading:

Why not skip medication And Go Natural?

Mistaken Expressions of Freedom and Medication Compliance

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Tension as a tool for Balance

I wrapped my feet arches with support tape, pulled up my pinkest compression sleeves, had on the leggings, running bra, tank and cap.  I had my dog.  Two bottles of water in my cup-holders and my phone loaded with a dishy novel, I drove to meet my Kaia running group this morning.

Do I sound ready?  Yes I sound ready.  (And old.)

Twenty minutes later, I pulled in to park and get going!  Timothy, my labradoodle, started whining as soon as the car stopped and I pressed down the emergency brake.  He knew he was supposed to be getting out soon and thought his whining might remind me.

Timothy

Then I saw, rather than remembered, what was on my feet.  Slippers.  Sheez.

There are so many ways to react to a time like this.  Reasons why, like wagging fingers, get in our space.  I could be defensive.

I thought I might complain, but Timothy was already whining.  Someone had to be the strong one.

There is a tension between paradigms of any kind.  An ecosystem of microorganisms vs. the human body, the balance resting keeps with labor, this way with that way – and we know that any side is chaos without the other.  Some wonder who could believe in an evil if they don’t believe in God. Or, would there ever be rich if there weren’t the poor, an ugly if not for pretty, happiness without sad?  We could list these through tomorrow if we wanted.

Today, I think my slippers played their own role in this.  I choose to react to them with a knowing appreciation toward balance.

Self-care tip:  Identify what/where your balancers are.
Questions:  

  • Do you think tension is a balancing force?  
  • What is helping you maintain tensions necessary for balance?  
  • Is identifying them useful to your friendship with yourself?  

Please tell us your story.

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Increase awareness of how we are loved

Hearing someone pray to love Sam better put her in that space between forever and never. Enormous awareness that, “Hey! I am loved!”sailed in.

Since then, She prayed more that She is able to see, how.

How? Where? And, “I want to love the Love toward me.” Samantha Gearge, after years of griping loneliness told me in so many words, that she wanted to weave her fantasies into that fine soil. Not pink clouds.

Being able to notice being Loved is infrequently intuitive. Liking how we are loved is also as often, ironically, not.

But, we are. All of us, Loved.

It seems friendly to increase our link to it. It’s a distortion and mispercetion to believe otherwise. A reality perhaps, but not Truth.

Getting to that Truth, shifting our reality, we get with hard work. Recognizing Love also might not come without. Recognizing Love is easier with brain health too.

Hard work and courage come in many ships.  We’ve talked about basics like, sleep, exercise, clean air and clean food.  We’ve talked about further efforts, when we have emotions and behaviors come without asking them to, to seek medical care. Taking medications takes courage over and over again, but it is easier to think clearly with brain health and is worth the press. It is friendly to pursue brain health.

Recognizing how we are Loved is like any other act of friendship in this way. Get deliberate about it. Get friendly.

You are Loved.

Questions: Have you noticed that you are Loved? :).
Do you like how you are loved? How do you get connected to this vitality? It is friendly to do. Keep on! Please tell us your story.

Self-Care Tip: Grow recognition and amity of the Love toward you.

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