mental illness

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It is okay to be Wrong …and Fears

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There was an exhale. A ripple out, like dropping eyelids, a wave on a slow shore, turning a shoulder away and the head following; this was how her disclosure soundly rolled through the room.

I failed.

I don’t care how cocky you are, everyone fears. In the brain and body, sometimes, the parasympathetic is dominant and one feels calm. Fear isn’t on the mind. Another time, the sympathetic tone rises and you think, “A bear is chasing me!” Or, “That girl is coming to talk to me!” (It can feel synonymous. Wink.) Yes, that is fear. But the kind of fear I’m talking about here is the one germane to our conscious or even before conscious awareness that we will never be enough. There will always be someone. Smarter Her beat Me in AP Calculus. Someone the boy desires… more. The things like food, shelter, clothing, the money, the votes, the power, and someone other will trump Me. This fear comes from the Amygdala, an almond in the middle of the brain that holds our sensitive selves carefully within it’s tiny shell. Others will argue that it also comes from a magical outside-of-biology-morality. A qualifier or quantifier of personal value. Plink. A widow’s mite drops in; an offering of our small or great selves.

But wait. There’s another choker, ring and leash that sparkles around our slender neck; the whole perfectionism culture. This is the psychological influence on what makes us who we are, including our constitution of fear. This is what I wish I gave better to my world, to those I am in contact with. I wish, like Pinocchio, because I believe perfectionism is dishonest and lacks moral fiber. We are made better by our failures rather than worse. And if I were a philosopher, I’d recognize the tiring loop this swings me into… It is a failure to live in shame of my failure to receive the gain that failure brings. Round and round. An ice cream truck sounds music in the distance but I have no change. I’d like to especially tell my kids with my life, my actions, my all – “It is ok to be wrong.” Wrong wrong wrong is just fine. Pause. And then also, “It is ok to not pass, to miss, to play flat notes, to sit alone, to be unchosen, to work hard and fail.”

Beatrice, a graduate of the Medical School of Manila and residency in internal medicine, and later after six years of practice, immigrated to the US of A. She had taken the USMLE Boards Step One, twice and both times, failed. She could not do the training in the states that would allow her to practice here until she passed. In the mean time, her kids back in the Philippines, needed funds to live. Beatrice worked Door-Dash, while she studied and feared.

It would have been clanging “toxic positivity” for me to chirp, chirp, “It takes a lot of failures in order to succeed.” But help me, I wanted to! And forgive me, I have with others. Ugh.

What is the balance? Because there is truth here. All successes are preceded by a large mote of failures, conscious awareness of them or not. However that doesn’t prove that successes will follow. What’s the term in logic that this is in danger of? I think it would be a blend between causal fallacies and a hasty generalization. Sometimes there is just failure. A dump in the mossy monster infested water.

Because we are good psychiatrists, we will shake it down, and dutifully approach fear here with our “bio-psycho-social” paradigm. We have the brain, including the amygdala and it’s influences. We have the psychology of perfectionism. And we have the social of Beatrice’s children’s basic needs to survive.

How do we do self care with all this? If we have enough bank, we go toward the elements, separate and whole, in this paradigm. We pluck away where our suffering calls out to us most. We go forward knowing that whatever it is we are going through, we are not alone. It is common and normal, although unique because we are, each of us, an un-duplicated wonder. We use the reminder this approach offers that things are always more than they seem to our conscious selves and if we give to it, we will weave together a greater hope, with both the good and the bad, all seated at the Thanksgiving dinner table this year.

For Beatrice, we grieve with her the difficulty in her journey. We celebrate her hopes. We encourage without losing honesty. And we give treatment for the biological expression of underlying disease that harms the way she perceives her reality. This is our privilege.

Self-Care Tip: It is okay to be wrong, wrong, wrong. Keep on!

Questions: Would you please tell us about your fear?

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Besmirching God with My Crazy

I’m sitting here in a volunteer medical clinic for a 60K attendee camporee. It’s humid and hot and we are seeing a lot of dehydration, amongst other things. 

As a psychiatrist, I’m humming the Hallelujah chorus as I discover how much general medicine I still remember, from gout, viral rashes, respiratory and ear infections, cuts and bruises, and so forth. The group I came with teases me that if someone comes in for a cough, two hours later they will have disclosed that they were abused as a child and be swallowing prozac.  I am ignoring this implication that I am missing “the point” by treating for psychiatric needs. Ignoring and missing, at least it’s consistent.

Our theme from this camporee week is appropriate.  We have been looking at the life of David. In these, we see a whole lot of psychiatry going on, both medical/biological, and that which has to do with volition. King Saul demonstrated a sure biological mental illness. And David pretended to be crazy – call it, “acting out.”  

God put this in the Bible for some reason(s). Question: What does this say about God’s character? I mean, we certainly don’t look up to people with acting out behavior, like David. Nor do we necessarily look up to people with mental illness like Saul, either. What does this say about who God is? Why does God put this in the Bible?

The Bible didn’t describe this as psychiatric, behavioral, acting out, or general medical.  It just told the story. These ages later, we can do more with the story. Here in time, with the knowledge that the generations have given us, we could say something psychiatric was going on. But generally, despite this knowledge, we ignore the medical condition. We still talk about them with a weighted moral perspective, as if they departed from their spiritual walk in these behaviors, rather than consider the medical condition of their brains.

David is getting a javelin thrown at him while playing the harp. Patton State Hospital for the criminally insane might have housed king Saul if he were alive today. Then, David is in front of the Philistines with King Akesh, where he “pretended to be insane; and while he was in their hands he acted like a madman, making marks on the doors of the gate and letting saliva run down his beard.” (1Sam 21.) 

Dr. Martorell, a neonatologist, told me,

“I see so many people afraid to discuss problems such as depression, anxiety, other psychiatric illnesses and even family problems or abuse.  Yes, partly due to the fact that they may be judged as not having enough faith or not taking care of their health or not following certain principles.  

Primary Care Nurse Practitioner Carrie stated, 

“God and psychiatry go hand in hand I believe, but many Christians don’t think psychiatry has anywhere to go in the church. This is sad because my mom had bipolar, but nobody could help her.  She needed the ‘extra help’. The church thinks we should be able to handle it ourselves.”

You may have seen the lock-down type who says, “Keep it in the family. Don’t tell others what goes on here. It’s none of their business.”  

Dr. Martorell said, 

Our cultural or family upbringing has a lot to do with how free we feel to discuss these issues.  In certain cultures mental health problems are simply not discussed.  If it gets brought up, the family directly or indirectly tells the affected person suffering not to discuss these outside the home, as though it were some dark secret that cannot be disclosed.

Nurse Carrie said, 

“Everyone thinks we should deal with things on our own, and we shouldn’t have to talk to people about our problems and what’s going on in our lives.”

Ironically she is describing a condition of the church of independence. Yet inherent to being a believer is the learning to depend on someone else, God. 

Nurse Carrie said, 

“Why is it with depression and such, we can’t work as a church and have medical get it done.”

Many say, ‘If you go see a psychiatrist, it’s a sign of weakness. You’re not a good Christian.’ These are the comments I’ve heard of through the years.  You should just pray, and God can take everything away.”  

When my aunt suffered colon cancer, she didn’t get medical treatment in the beginning, preferring to have herself anointed, and follow a “homeopathic” approach. Later as it progressed, she changed her mind and found it was too late. So although largely, it isn’t only in psychiatry that we misrepresent who God is, we need ask ourselves, Who is God if what we believe about this is true?

Dr. Martorell shared,

As a neonatologist, I see infants born prematurely. Their brain develops outside the womb and are simply not the same as those that develop in a dark, quiet environment listening to mother’s heart rate, free of noxious/painful stimuli inside the womb.  As much as we try to imitate a womb with our incubators we can’t provide the same care.  When these infants are followed up for years, some develop physical deficits such as cerebral palsy, blindness, the need for oxygen, and the inability to eat on their own. These physical problems are easily seen and various treatments can be provided.  They are also at greater risk for developing learning deficits, hyperactivity/inattention problems, depression, anxiety and some academic papers even suggest increased risk of schizophrenia.  The thought behind these is that billions of synapses are occurring during pregnancy and the way these synapses connect is different in premature infants.  It is also interesting to note that the brain volume preset at birth occurs during the last 4 week of pregnancy. As these children grow up they need treatment for physical problems as well as psychiatric problems they may develop.  

I realize that it is not just in our churches that we are afraid to address this issue but I see it in the families of my newborns.  So many of these moms self medicate with illicit substances in order to treat their anxiety or depression.  Our culture as a whole has neglected to look at these issues as a medical problem that needs treatment.  So many children and teens are committing suicide.  Our own “well educated” health professionals have some of the highest suicide rates and yes it is occurring in our christian institutions as well as outside.  

Nurse Carrie said, 

“In this kind of approach, people are saying S/He’s not a loving and forgiving God and S/He doesn’t understand us.  If you deal with psychiatry, you’re a sinner. Why can’t you get it done with God on your own. He’s not a loving God, saying this person is not allowed to take medication. The pastor’s describing a cruel God because he’s not allowing the person to get the help he needs.  Like if someone’s leg is bleeding and you refuse to give that person a band-aid. 

But, God is always loving. This can’t be true.

I don’t think the pastor has a right to tell the parishioner that.”

Maybe we just succumb to the awkwardness of it all.  Too awkward to talk about God in our community.  Too awkward to talk about psychiatry in our church. There are so many reasons we approach emotions and behaviors this way but in the church or outside of it, let’s consider the question, What does this ay about God’s character?

I was cleaning up a leg laceration about 1 1/2 inches long and 2cm deep. I placed the triple antibiotic ointment and approximated the edges with steri-strips, yet still encouraging the patient and her guardians to take her to the urgent care to get stitches. This wasn’t a sterile environment and our supplies were limited. While working on the wound of the young teen, I asked a few brief psychiatric intake questions. It turns out, no. She didn’t have anxiety, or depression, or psychosis. What do you know!? Not everyone does. But she and her guardians were super pleased to pray together before they left and I was blessed by them.  

God is a God of love and the kind of God that cares about all of it in all of us. S/He is kind and not miserly, discriminatory, or punitive in interest and connection to us.  

It sounds like from what i’m writing that psychiatry isn’t seen as a legitimate form of medicine in the church. Or maybe the church doesn’t refer to it, or support it.  

A friend from my group read this post and responded. 

“We hear a lot about emotions and behaviors in the church, and related directives. We don’t hear however about where emotions and behaviors come from. 

I hear, ‘just pray more,’ or that I am lacking in faith. The people in the church get defensive, as if they have to defend God. And that’s not it. Honestly, it’s not complimentary to me that they think I’m insulting God. They are in a way attacking my spirituality. But I know God is helping me and He’s here with me. But I’m still this way. I still feel this way.

There’s a taboo that mental health and disorders all get grouped into this one cringeworthy word, “Crazy.” We’re almost protecting God from crazy by staying away from it in the church. We forget about the sin factor. The separation between us and God. The loss of connection. The word crazy isn’t very nice. So if we say crazy and we say psychiatry and God, it’s almost like we are besmirching God.  

Self-Care tip:  Ask, and ask again, What does “this” say about the character of God? It comes back to “Me.”

Question:  Do see the Bible and your church talking about psychiatry? Where and how? What does it say about who God is? 

Keep on!

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Emotions come from the brain.

Margarit was a lovely twenty-something, with blue-black bouncing hair above a slim pixy framed physique. She smiled easily and chattered like she was on telephone call that was about to lose reception. Her hands moved, conducting her thoughts between us. She was dressed like one of the cool girls on campus, out of my echelon, and who just might stab me in the back if I didn’t know better. But I did. She wasn’t mean. She was super sweet, like honey, and cane sugar, and mangos. Margarit was nice. But she had always wondered if she was being so nice all the time, because she was too nervous to be otherwise.

She came because she was constantly preoccupied by worries over things, “no one should be worried about”.

There had been the counsellors, therapists, and pastors consulted. Margarit and her parents had done their due diligence. With initiating each effort toward getting help for Margarit’s anxiety, they anticipated some degree of success. They thought things would get better. And sometimes they did, in degrees, and for a period of time. but the anxiety always came back. It got to the point that Margarit was put in home school, referenced her looping thoughts for everything, and was socially immobilized.

Maybe you’ve read, Gulliver’s Travels, 1726 by the Irish writer and clergyman Jonathan Swift. When Gulliver shipwrecked and washed ashore unconscious, the numerous tiny Lilliputians effectively tied him down. The rope anchors were so small, like acupuncture needles, yet Gulliver could not move. That’s what anxiety does to us. We become internally preoccupied by it and can’t think much outside of our thoughts. We are immobilized.

The anxiety Margarit had been harassed with since a child took her freedoms away. It chose for her before she even knew what she would decide. Example; friends want me to go to the mall with them. “No,” Before her thoughts could even play with the option. Maybe she wouldn’t have gone anyways. Or maybe she would have. The anxiety chose first though and she wasn’t given the chance.

By Margarit’s third visit, she had improved significantly. She was getting to know herself, she thought, for the first time. I met the parents this visit and they looked at me as a front. I supposed it had been them up against so much for so long now, that they had learned to go at the world this way, like a man plow they both held on to. They asked me why no one had ever recommended for Margarit to seek medical treatment for anxiety.

"We would have done anything asked by one of these professionals we took her to. We thought they should know what to do, but they didn't tell us to get her medical help."

In my mind, I flashed to Naaman being told by Elishah to dunk in the dirty Jordan river seven times to cure his leprosy (2Kings 5). Psychiatry is the filthy river and dunking in it is the nonsensical act of taking psychotropics based on magic and miracles. They were here reluctantly having preferred to start with clergy and therapists, beat up by inappropriate guilt, but ready now to consider that anxiety, in Margarit’s case, is a medical symptom of a biological illness.

The question of why no one had referred them toward a medical approach for their daughter’s illness is a good one, though. I asked a pastor what he thought, and he spoke of the difficulty of not being a medical specialist; not knowing when to refer people. And what of the therapists? Likewise, I guess, that they generally have been trained to approach emotions and behaviors through a psychological and sociological paradigm. And what of the parents themselves? Did they, when their daughter broke her collar bone in the 3rd grade after Christy pushed her off the swings, take her to the emergency room or to the movies for a night out? The ER. But when her daughter showed preoccupied thoughts that permeated her days, affecting her choices, small or large, affecting her sleep, and so forth, they did not think that the thoughts were related to anything medical, coming from her brain. They did not think that the thoughts were more than coping skills, or habits, or choice.

It is a condition of our humanity to want to look at thoughts and behaviors as many bits of our life control to be manipulated intentionally. As if we could. Like “The Matrix.” Or cooking a soufflé. Or driving a 1969 Chevrolet Camero. Shift already! There’s the good intentioned phrase, “Calm down.” “Take a chill pill.”

Oh good. Someone finally said it. If they didn’t I never would have thought of that. Now I am calm because I was told to be calm.

Emotions and behaviors come from the brain. Take the brain out and no matter what chaos hits, we would feel fine. Take the chaos away, and leave the brain in, we are still left with the brain, and what ever condition of health the brain is in.  So if the brain is ill, it expresses itself in a way that is ill. If the brain is healthy, the emotions and behaviors are healthy. They are symptoms of a medical condition.

Question: Where do you find your sense of control comes from, considering the biological paradigm? Let’s talk folks!

Self-Care Tip: Consider the biology behind whatever it is that feel and do.

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Unlikable: Me Too

Poem:

I feel unlikable

It sounds young

Immature

It sounds like I’m fishing

But I feel unlikable and it is what it is

I can list my attributes

And do also remember

What others have said

In their own throws of comparisons

It is disconnected though

Me talking to myself

An echo in a cavern

Otherwise quiet

Unlikable might be better said

Disconnected

And I was created for connection

I’ll never survive any pilgrimage on my own

I’m designed to say, “Me too”

But just this

Improves my sense of company

I can’t know why

Writing it out

Makes me think of you reading it

And saying something back

Selfcare Tip: Look for connection. You are not alone.

Question: What improves your connection? Will you tell us an example of a time you turned it around; went from feeling alone to then connected?

Keep on!

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Live Imperfectly, Dad is dying, and I Have no Power.

wilted flower

Living with someone like tomorrow might be their last is much harder to do when it is actually the case.

My dad told me, after my nine-year old niece died, that a parent should never outlive their child.  When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.

When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.

My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying.  He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.

The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character.  He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.

Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?

Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.

In Life and Other Near-Death Experiences, by Camille Pagán, Libby Miller decides to live, just live, rather than die perfectly.  And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.

Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.

Question: How do you “live well?”

Keep on!

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Making our way through the questions on ECT – Top 3 Reasons for Being an Advocate

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

fancy

Ooh La La!

So much fun to play dress up! When I was a scrub, a solid big boned unkempt of the Cleveland National Forest bordered lemon groves, when I walked barefoot, disappeared for the entire day in the rattlesnake infested chaparral, when I followed my brothers around like a desperate child, I still liked to play dress-up. I would sneak into my mother’s long closet, a dressing room really, with folding doors. I could hide behind her dresses, or climb up onto her shelves and be nothing more than luggage. But mostly I remember staring at her clothes and shoes. I remember one of her all time best outfits – a blue knit bell-bottomed jumper. A wide white belt with a hand-made gold buckle was an excellent accent. Yes, it would drag down below, but all the better to cover my brown feet.

When I think of my top three reasons for being an advocate for ECT, I think of dress-up. There are so many great options to put on, and I can and do exchange them with aplomb, as Fancy Nancy would say. That’s a French word for poise. It’s fancy. If you catch sight of my brown feet here and there, well, you can’t take the hills out of the psychiatrist I guess.

For today, Reason Numero Uno, (Fancy for #1, in honor of the second language I wanna-be speak):

  • It works most consistently, and most quickly of any treatment available. One must pick her fights after all, mustn’t she?

Reason Ithnān, (Arabic for two, in honor of my fancy mother):

  • It doesn’t touch “the body,” i.e. metabolics. Clean.

Reason Trois, pronounced I think like, twa, (Fancy Nancy’s favorite language. Need anyone explain? “French is fancy”):

For example, just by requiring someone to help with transportation, it’s built in. That thereby inherently increases community awareness of mental illness, something we rarely speak of with each other.

Then there is the medical staff. Our nurses are every patient’s advocate. Our masseuse increases oxytocin and other healing neurotransmitters when the patient’s get their massage waiting for treatment and then when in recovery. Our anesthesiologists are knowledgable, see the patient in their “whole person,” often picking up other issues that then will get the patient to receive treatment and improve the patient’s quality of life (QOL); such as hypertension, obstructive sleep apnea, etc…

There’s more, but basically in ECT, none of our patient’s are alone. That stands.

Question: What are the top three reasons you prefer the treatments you engage in? 

Self-care Tip: It is always helpful to write out why you are doing what you are doing, when it comes to medical treatments.

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Love to Pee

peeThe little boy was standing in the tennis court by the fence, facing out.  Doing what?  Sure enough. 

“I’m nature peeing,” he said.

Have you ever seen as much happiness than in the faces of little people peeing?  Well, I love to pee, too. I think most of us do. That is until we pee inopportunely. Or poo. Ahem. 

I’m getting older and realize that my happy peepee-ing days are numbered.  Three kids later, into my forties, and like the garden faucet outside with minerals crystallized around a corroded fixture, dripping “will,” (ahem,) start. Soooooooo, sooooooome day, …urine will yellow my underwear. Kids, without discretion, will announce that I smell. And for the innocent, and a once happy pee gone horribly wrong, I will be ashamed.

The pelvis is like a woven basket. Muscles criss-cross in a wonderful design between a supportive frame, like plant fronds and wood. 

When I was an eleven-year-old, I travelled to the African continent.  It wasn’t every country, wink, but a few on the southern side. I don’t remember enough of my childhood. Who knows why. But I do remember, in every African market place, I looked on women and children weaving leaves and grasses. They didn’t even have to watch their projects. Their fingers had memory of their own.  Instead, their eyes were watching us watching them. Brilliant more-than-white smiles in chocolate black skin, turned their curious faces up.

My Mom, a lover of all things lovely, looked. She loved them all – the people, the baskets, the freedom of being in Africa, and more. Then the blood of generations of hagglers and market yellers whipped through her Lebanese veins with increasing energy, distracting her from a bigger picture.  She wished mightily for baskets.  She would have purchased every one and made us carry them all back to our home, eleven hours by airplane, if she could. (Those were the days when people smoked inside airplanes. You and I understand what that meant. That air inside airplanes was the same air everyone inside breaths. It was a long flight.)

A decade-plus later, World Market opened. I wondered about all the faces and fingers it must have taken to make all those gorgeous creations, now for sale in Temecula, CA, for twenty some dollars a piece.

How could I be so clueless as a twelve-year-old, but I was, and I didn’t know about the fingers that deftly moved, the brilliant plant dies, the tight strength that remained in a basket, like hands clasping, between each fiber. The baskets held memory.

These are the baskets I think of when I think of the marvel that the pelvis is.  These are the baskets I think of when I think about how much I will despise losing continence. When losing continence, I will also remember that little guy making “nature pee.”  I will pull the backing off another panty-liner and say, I used to really like to pee. 

Our emotions and behaviors are similar to the joy of peeing and the pelvic basket. We at one point in our life may have loved to live, loved to speak with friends, loved our hobbies and our stamps, and our cooking pans. Some day later, we wake up, and people notice the difference, like the urine smell in incontinence, people notice our emotions and behaviors “leak.” Kids point, even, “Mommy, why does Bridget’s Mom always wear those sweat pants? She’s in the same sweat pants every time we see her!”

It’s awkward. People don’t know what to expect from us. Our emotions and behaviors are not what is socially acceptable and they stop knowing how to speak to us. Our professionals who are supposed to help us don’t even know how to speak to us. They shorten their visits with us. They tell us how to feel, “Just decide. Make a choice. Choose to be happy.”

When people don’t know what to expect, it divides us and separates us and is uncomfortable for all. This discomfiture, (less often consciously aware,) is a barrier in knowing how to speak to a psychiatric patient. It takes a heck of a lot of self-awareness on each party’s side to look inside ourselves and figure out where our discomfort is coming from.

What will you think of when you “wet your pants?” Or of someone you are with? Feel your energy get sucked into the earth by a depressed colleague? Notice acid escaping your stomach into your throat when an angry child’s emotions fill a room? Your thoughts start to buzz when the white noise of anxious Dad comes around.

Remember the pleasure that came back in the day, see into our Me, identify the nidus of discomfort, and then let it lose it’s power over us – then the unexpected with be an encounter of mutual respect.

Knowing how to talk to a psychiatric patient, means that we are okay not knowing what to expect, not personalizing what isn’t about us, and allowing for a context that is in many ways unknown. With this, we will pull the backing off a panty liner and get on with it.

Questions:  How has the unexpected behaviors of your, or of others you know, been treated by your medical providers? How have you treated yourself in those scenarios? Please tell us your story.

Self-care tip: See into your Me to be better at speaking with the unexpected.

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Join us at, Seams of Gold!

The University Surgery Center, Department of ECT, and myself will be joining our community at Seams of Gold, where we will share life changing stories of ​resilience, restoration and hope.

Thursday, May 1, 2014  

​6:30 pm to 9:00 pm, Doors open @ 6:00 pm

“Event is Free”

PLEASE COME!  🙂

 

A Father’s Lament  contopolos

On May 29, 2010, we lost our 26 year old son, Nick, after a 14 year struggle to find long term, affordable, quality recovery and care from mental illness and addiction. During Nick’s brief life, both he and those of us who loved him were left with a fatal absence of hope while we struggled, as do many others, to navigate our society’s haphazard, fragmented “system of care”.

Months after Nick had died, I recalled a former broadcast on CNN with a woman who had suffered enormous loss after Hurricane Katrina. The interviewer was asking this lady how, in the face of such loss, she was able to continue on and now help others. She said, “at some point, I stopped asking “why me” and began asking “what now”. That statement, in conjunction with an honest admission from my pastor that “during Nick’s life, he had absolutely no idea how to understand nor how to help us”, was what led to the “what now” of Seams of Gold community service events.

Seams of Gold is named after the ancient pottery art of “Kintsugi”. In this ancient art form of Kintsugi we find the inspiration in how we respond to the fragile beauty that surrounds us.”

Seams of Gold is a FREE multi faith, multi denominational community service event. All are invited.

We are asking that all who have been affected by mental illness and addiction as well as those who love and serve them, to come and be inspired, informed, educated and equipped. Join us, as through the prism of our tears, we pilgrimage together towards a “better day” of empathy, compassion and care for those who suffer.

Recovery is Powerful, it is Possible and it is Beautiful! 

                                                                                                                                  –  Jim Contopulos

 

The beauty of the Santa Rosa Ecological Reserve in southern California provides the backdrop for a father’s lament. Seams of Gold founder Jim Contopulos invites the viewer to join him on a journey as he reflects upon losing his beautiful son to addiction and mental illness.

“Birthed from Pain… Inspired by Art”

                                                                   

http://www.youtube.com/watch?v=VGZ1ESOlvbM

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The Energy in Stigma, Yours for the Taking

unicorn

There are nothing like lightbulb jokes in the operating room to make you plume your feathers.  The other day, my nurse “enlightened” me with them.

How many psychiatrists does it take to change a lightbulb?  One, but the lightbulb has to be willing to change.

How many surgeons does it take to change a lightbulb?  One, because while he holds it, the world revolves around him.

How many nurses does it take to change a lightbulb?  If it’s during shift change, no one will touch it.

That is as far as we got, but please share yours, especially if related to psychiatry :).

Lightbulb jokes are common, clean, dirty, and fairly ageless. It does not take the brightest lightbulb in the room (Teehee!) to know that they are so because they capitalize on stereotypes.  Stereotypes, likewise, are widespread, and fairly ageless.  Even in something as objective as brain disease. i.e., The brain is carbon matter, a human organ, mushy grey stuff. The brain gets sick like any other part of the body, human organ, and people bits. Brain gets diseased, people behave and feel diseased.

A primary care physician’s assistant, “PA,” was sharing with me the other day about how she deals with stereotypes when she approaches patients who need treatment toward brain health.

I tell them about all the executives and professionals who get treatment ‘because the stress gets to them and they have nervous breakdowns.’  Then they don’t feel so bad about accepting treatment because they associate themselves with these successful people.

Stereotypes can be positive, negative, or neutral.  Everyone has them.  We clinicians, patients, grocers, those who want nothing to do with medical care, and even executives and other professionals (smile) have them.  But what, in dealing with stereotypes, is friendly to Me?  It starts there.  With Me, one little, or largely valued Me.

We stereotype ourselves and maybe that is why we stereotype others.  For example, this struggle of what to call illness of the brain is common, widespread, and fairly ageless. A Menninger Clinic blogger wrote eloquently about it recently, “Does reframing mental illnesses as brain disorders reduce stigma? by JON G. ALLEN, PHD.”  Most pithy, I thought was this,

…we should be skeptical of the view that regarding psychological problems as brain disorders will abolish stigma. Although the disease model decreases blame, this shift comes with a cost: It increases pessimism about recovery and might also contribute to perceived dangerousness.

I have never forgotten the Spiral Dynamics idea that in the magical level of consciousness, there is a sense of being disempowered. “Perceive dangerousness” is magical. Behind negative stereotypes, there is magical thinking.  We give over what is not to be given and take what is not to be taken.  We have fear.  We feel victimized.  We lose what is freely our own.  Disempowerment is terrifying. There is a lot more stigma out there than there is information but giving stigma and/or negative stereotypes power is our own choice.

A fellow blogger wrote to me how he approaches it,

Change brain illness to mental illness. Our problems really are brain illness from physical dysfunction but I can accept that my psyche is sick easier than my brain is sick.

Stereotypes may scare us but they can also inspire.  It is up to the individual, to Me, how to respond.  As in lightbulb jokes, we who are targeted by stereotypes can take pride in them.  They are not the same as “stigma” although there is overlap when negative.  Stereotypes can be neutral or even something to be proud of.

How many psychiatrists does it take to change a light bulb? None–the light bulb will change when it’s ready.

How many psychiatrists does it take to change a lightbulb? None. It’s their job to help people find their way in dark places!

There is nothing like the kind of energy in stigma and negative stereotypes to inspire us.  Such force, such Magic, these can get the punk in any of us to love who we are.

I used to be quite turned off by the beatitudes thinking I was supposed to want to be a wimp, and couldn’t quite make myself do it.  Now I realize, being a wimp is just what it is.  The blessing is what is inherently available to Me in my “condition.”

1 Now when he saw the crowds, he went up on a mountainside and sat down. His disciples came to him, 2 and he began to teach them, saying: 3 “Blessed are the poor in spirit, for theirs is the kingdom of heaven. 4 Blessed are those who mourn, for they will be comforted. 5 Blessed are the meek, for they will inherit the earth. 6 Blessed are those who hunger and thirst for righteousness, for they will be filled. 7 Blessed are the merciful, for they will be shown mercy. 8 Blessed are the pure in heart, for they will see God. 9 Blessed are the peacemakers, for they will be called sons of God. 10 Blessed are those who are persecuted because of righteousness, for theirs is the kingdom of heaven. 11 “Blessed are you when people insult you, persecute you and falsely say all kinds of evil against you because of me.

Questions:  How have you been able to use stereotypes and stigma as something toward friendliness in your life?  

What have you found is inherently blessing you from where you find the condition of life to be?

How might you use the energy in them toward being good to yourself?  Please tell us your story.

Self-care tip:  Use the energy available in Magic to empower you, rather than disempower.  

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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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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.

 

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The Fifteen Minute Warning

KIDS HAVE FUN....ME WISH TO BE KID AGAIN TOO

(Photo credit: Kenny Teo (zoompict))

The five-minute warning wasn’t enough for my daughter.

Mommy, please tell me when it is fifteen minutes before it’s time to leave.  So I have time to finish my game.

The truth is, sometimes I forget to give a warning at all and we just have to go when we have to go!  Warning or no warning.  But my daughter had a point that reminded me how often we take for granted or even assume we have a right to be warned.  Oh the rights we possess!  Or not.  Well, not really.  We don’t have many rights in life and “the fifteen minute warning” isn’t one of them.

We have the right to love and friendship, (with who is another discussion,) but not much else.  Yet even without the right, many of us have the privilege of “the fifteen minute warning.”  And time tics away and what have we done with it?

At work we are told about working better as a team member.

At home we are asked to stop yelling when we are upset.

We are warned.  Time passes.  Pride keeps us from being friendly to ourselves often enough.  Friendly would be to forget about how we are right and hear the warning.  Being right is over-rated.  Friendly is the crisis.  Friendly is to go toward the wanting.

If we can’t do this even though we know we hear, maybe we don’t have what it takes?  That’s a turn in the warning to get an opinion of “why” from a medical professional and then to respond to the recommendations.  “The fifteen minute warning” is designed to improve our experience and readiness.  If we can’t, than shift gears into finding out why.

Questions:  What warnings have you heard that improved your experience and readiness?  Please tell us your story

Self-Care Tip:  Deliberately use warnings as the privilege that they are, rather than entitlement, to be friendlier to yourself.

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Sleep Related Blog Posts – A Reference Guide

Sleeping German Shepherd

Sleeping German Shepherd (Photo credit: rightsandwrongs)

Organizing the “shelves” 🙂

  1. Sleep.  Be a Friend to Yourself.

  2. Sleep Hygiene – My Version

  3. Self-Care Does NOT Always Mean Doing What You Want

  4. Draw Sleep Hygiene Into Your Culture

  5. Sleep Is The Vital Sign Of Psychiatry

  6. Just Go To Sleep

  7. Good Sleep

  8. You Can’t Barter With It.  Sleep.

  9. Keep It Simple

  10. Regardless The Reasons Not To, Go Get Your Sleep

  11. Sleep Does Not Lose As Gracefully As He Lets Us Think

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Sleep. Be a friend to yourself.

English: Мy friend is Wikipedian. Русский: Мой...

English: Мy friend is Wikipedian. Русский: Мой друг – википедист. (Photo credit: Wikipedia)

Being a friend to yourself, comes just when we need it.  When conflicts of interest seduce us into confusion, into late nights of activity; a talk perhaps or a project, a subject of interest, yahoo news perhaps – it is then that being a friend to yourself lovingly redirects our thoughts to the priority of sleep.

During sleep, our friend reminds us that we will heal.  We will receive treatment for the stressful day, better than medicine.  We will allow our broken neuronal connections to regenerate.  Our pantry will restock for clear thinking, kind behaviors to ourselves and emotions with ingredients like cortisol, hormones and neurotransmitters.  During sleep, our memories will find there place in the folds between our cells and plant.

When someone wants to talk to us, a conflict grows importantly, or when we mistake good parenting for enabling bad sleeping habits in our children, our friend, Me, says sleep.  Clarity and inner congruence swath us then and we know that we can’t give what we don’t have.  Tomorrow we can do those things.  Now, it’s time to sleep.

To ally yourself with your friend, Me, keep a sleep journal for a week and see how it looks.

Self-Care Tip:  Sleep.  Be a friend to yourself.

Printable Sleep Diary

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Anticipate Rejections – Normal And Part of Our Human Condition

Self-Care Tip:  Anticipate rejections and some in-between times, you will be chosen.

I have not failed. I’ve just found 10000 ways that won’t work.

-Thomas A. Edison

Foto einer Glühbirne (an),

In today’s economic climate, we are given more opportunities to seek employment elsewhere.  Of course, “opportunity” is loosely used here and it might sound like I was playing Mad-Libs, a super game in fact so I’m okay with that.

But whether we are applying for employment or asking to be someone’s friend, or like Edison, playing – these various arenas of rejections are normal. They may feel particularly personal, but that’s a distortion.  They’re part of the human condition.  They come to us who do what we love, who do for well-evaluated intentions, who put out with courage and who put in 10,ooo hours.  They come to us who haven’t found what we love, who work for a martyrs salary or who do not have the privilege to go toward their temperament.

Rejections are.  They are like the surface tension, the space between water and air and they hold us together.

We love success and too often are like Drew Barrymore in 50 First Dates.  We forget from sunset to sunrise what a day’s labor brought us before.  We forget easily.

But with Magic and Love, we can lose ourselves once again in the experience of doing what we love to do despite it.  We can remember better with the help of rejections.  Remember all sorts of things.  And without turning this into a script from Cheers, we can still say that rejections become the best parts of our life’s experience.

Those darn personalizations though, those distorted perceptions, those rejection-clots that cut off circulation – if it becomes that the space between water and air gets too thick, if rejections seem life defining, tell your physician about it.  It’s not “just the stress.”  It’s from the brain and might be a symptom of brain illness, much like achy joints and arthritis go together.

Questions:  How are you able to use the rejections you received to be friendly to yourself?  Please tell us your story.

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When To See A Psychiatrist

Singer Brandy Norwood in September 16, 2010.

Even car accidents happen for “good reasons!”

Wanda didn’t want to hear the reasons.

Anything could sound like a good reason for bad performance.  It is what it is.  Just own it!

And Wanda was out.  And just as quickly as she concluded, I flashed back to the quivering resident who messed up on internal medicine rounds.  I stood there with my spine like a steel rod.  My white coat felt heavier with my fair-weather reference books bulging in my pockets.

Keep your chin up and look at her!  I told myself.

This wasn’t the first time for me, so I had the “luxury” of practicing a previous well-described lesson from my attending on how to respond to feedback.  Those days seemed like a series of stings, burns and frost-bite, but I am grateful for that at least – the knowledge of how I’m supposed to “take it.”

Wanda came back into my mind’s focus as memories of internship faded.  Wanda wasn’t even mad at me.  She was telling me this story as an example of her difficulty coping with anger.  Here she was asking for help while justifying her position.  Don’t we all, though?

I saw the irony in her criticism of those who gave reasons for their foibles as compared to her own explanation for anger and medical care.  Yet again, aren’t we all inconsistent like this?  Wanda is not alone.  She even had good insight too.  Explaining away our mistakes is shabby, lacks class and is insincere.

Some time ago in a post, Please Don’t Say “But”, we talked about this, which later we termed “presence.”  But why see a psychiatrist about these things?  Because insight is only worth so much.  If the mechanics to respond to the insight aren’t well, then you’ll be able to withdraw from your self just that.  In Wanda’s case, it was spitting anger, hot to the touch and not much safe.  It had quite an effect on her interpersonal relationships and quality of life.

But Wanda was suffering in more than her apparent psychological and sociological selves.  She was also suffering in her biological self.  (See biopsychosocial model.)  Wanda, was ill.

When we find that we can’t do what we want, don’t respond the way we intend, have negative emotions and behaviors we didn’t invite, see the associated deterioration in our connections and quality of life – when we are suffering, we need to look for help.  It’s hard to be productive and survive without support.  Any bit of nature will tell you that.  Ask a peach tree if you don’t believe me.

Question:  Does it make sense to you that emotions and behaviors might be all we have to show us that we are medically ill?  If not, please tell us why.

Self-Care Tip:  When insight isn’t enough, consider a medical consult.  Be a friend to yourself.

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The Holidays and Lonely Me

Feeling anxious about Christmas, or whichever December holiday celebrated?  We are not alone.  We think we are.  We worry about the in-laws, parents, money, gifts for our kids, keeping the romance, abandonment, alcohol abuse, anniversary-grief of loved ones lost, and on and on.  I’m thinking now especially of our dear blogger-friend, Lisa, who is spending this first Christmas without her mom.

Lisa, we are standing with you.  We are weeping with you.  You are not alone and we value you.

In this precious sum of days, “the holidays,” going into the space that holds our fear seems almost morally wrong.  (Do we really have the responsibility we perceive we do to be “festive?”)  The smiles and joy appear to occupy any organ-cell(s), from the lowest creature to our neighbor, who doesn’t deserve more than a broken shoe in his stocking.  We think,

How can this be?  Why don’t I feel joy or care?

Even when our mind knows the true answers that we are not chosen to suffer, we are not alone and that we are safe to be in the space of our fears – even then, we don’t perceive it.  In the cold environment of our lonely selves, white breath condenses, freezes and, made heavy in winter-thought, falls to the ground before the “knowing” has a chance to reach the rest of us.

There are no universal-tips to dispense, cups of warm cocoa or four-sided tickets, except this.   Remind any part of us that can hear our friend, that is to say Me:

We weep together.  

We are present with our suffering.  This does not take sincerity away from the things we actually do still enjoy and feel pleasure with.  Inversely, feeling pleasure does not deny the grief or other negative feelings.  

We will make it past this.    

We love ourselves and see our flaws as tools to use towards furthering our efforts in self-care – potential assets.  

We claim our freedom to choose to start over at any time, to choose not to be a victim and to go where our intuitions wrongly advise us not to – our fears and shame.

We take our medication, despite stigma. 

We account to ourselves, despite what has happened in our lives.  

We keep it basic when things complicate.  We return to the home of Me whenever our view  of where we are in time films over.

Keep on my friends.  We are persons of courage and value.

Questions:  What fears complicate your holidays?  How are you friendly to yourself during this time?  Please tell us your story.

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Rotate Your Picture To Connect And Grow Presence In Your Life

Hello Dear Friends.

Seems I’m heading toward a different blog-site level of productivity.  Wasn’t deliberately turning that way, but turn I have.  I’m just saying this so you know that I acknowledge the change in flow and am thunking, thinking on it.

I will post a minimum of one to two times a week.  In between, I hope to develop the material we have now, clean it up and share it again, integrated with your comments and what we’ve worked over this past year.

_______________________________________

That done, I can chat about other stuffy stuff.

20080726 - Melanie's Birthday party - DSCN1530...

Image by Rev. Xanatos Satanicos Bombasticos (ClintJCL) via Flickr

Today, I was thinking about our interpersonal connections we believe so strongly improve our ability to be our own friend.  However, that is not the same as pairing with someone who is bad to us.  We’ve talked about how abuse, any kind, disables us from connecting.  “Get off of me!” is self-care when there is an unequal sense of power being used and we are trying to gain accountability for where we are at in life now.

In my mind’s eye, imagining that, I saw a figure lying on her side and someone heavy lying on top.  “Get off of me!” could mean, “Get off and get away.”  It could also mean, “Rotate the picture.”

See the picture turn 90-degrees?  Now the two figures are standing beside each other rather than subjected.  The two figures are connected, proximate and present to each other’s experiences.  “Get off of me!” doesn’t have to mean, “Get out of my life.”  It might be able to mean, “Rotate.  Stand beside me.  I choose connection in my life and not subjugation.”

Insight isn’t everything though.  If saying, “Get off of me and stand beside me.  Stay connected.  Stop controlling.” doesn’t happen despite insight, we might be looking at behaviors and emotions that are symptoms of brain disease of Me or of the other person(s).  Medical illness needs more than word play and adjusting picture frames.

Questions:  Have you been able to rotate any pictures in your life in any ways that have helped you be a better friend to yourself?  What?  Has that improved your sense of connection with people you didn’t want to lose?  Please tell us your story.

Self-Care Tip – Rotate your picture to connect and grow presence in your life.

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Deliberately Setting Myself Up To Improve

dayspa-1

Image by samuelalove via Flickr

Self-care is about improving life, not harm.  Even though it includes doing things we don’t enjoy and sometimes hurt, it doesn’t harm us.

That’s a useful meter-stick when we wonder about something in our life.  Is this harming us?  Including people.  Do I feel better about myself when I’m with them?  Do they help me become a better person?  A better friend to myself?  Or, do they turn me toward things that harm me?

When thinking about our days activities, our choice of employment, things we put in our body, put them by this “No-Harm Meter-Stick” and see how they measure.

A deliberate check-point in my life is consistent with a deliberate goal.  …”I want to be  healthy.  Is this improving my health?”  “I want to have good self-esteem.  Does this improve my self-esteem?”  And the journey is consistent with the beginning and the end.  If the goals for the moment isn’t consistent with our big picture goals than they might not be the goals we want.  Like putting substances in our body that feel good for the moment but harm our life.  There are innumerable examples of this but you get the picture.

Questions:  What checks you when you need it?  What has been useful to remind you in this area or that to be friendly to yourself?  Please tell us your story.

Self-Care Tip – Deliberately set up feedback in your life to let you know that you are a friend to yourself.

See blog-Post:  “You” Are The Best Gift

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The Gift of Desperation

Life (23/365)

LIFE

Misty sounded relieved,

Yes.  That’s it.

She had just realized that life isn’t fair.  Sure.  She knew that before, but she just realized what she knew.  Don’t we all love that moment when our senses join up – sight, hearing, taste, touch, smell, emotion, intellect, spiritual and the rest.  That is a lot to coördinate after all and sometimes some of them don’t make the train.

Misty was a single mom of three.  Her ex-husband was what she called, “Disney-Dad,” and her kids relished their time with him.  Misty complained that she didn’t get to spend the special times with her kids.  She mainly took care of them, but missed out on irresponsible fun.  She was sure her kids wouldn’t look back and think of her like they would their father.  She was getting angrier about it all the time, ruminating about it and it was getting in the way of her ability to connect with others and feel pleasure.  There it was in front of her blocking her from seeing her kids even, let alone herself.

Then after weeks of this along with medication and talk therapy, she told me,

Yes.  That’s it.  Life is not fair.  There are many other things in my life that aren’t fair either and if I look for them, I could spend my whole day every day counting them off.  

It broke my heart a bit to hear her and see her there.  Humble like that; she would I think affect you the same way.  So real.

Yesterday, Carl D’Agostino replied to our post about growing our understanding of our choices beautifully.

…we wait until we are at our wit’s end before we seek assistance…. considering reaching out as personal failure or inadequacy re: our own self-esteem…. Foolishly we wait until our way just is not working anymore. That is why AA calls this a gift: the gift of desperation. …For many, the depths into which we have succumbed are now found not to be so deep at all and in fact, ladders are readily available if we use them in recovery. 

Ah Carl.  Say it again.

The gift of desperation.

Too good.  Don’t you think?

Questions:  Have you ever received the gift of desperation?  What did it bring you?  Where did it take you?  What did it do to you?  Do you still have it?  Please tell me your story.

Self-Care Tip – Celebrate your gift of desperation.