Panic disorder

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Paper Doll Syndrome – Changing Symptomotology Can Be an Opportunity to Remember and Celebrate

Paper Doll Photographer - 2/52

Paper Doll Photographer – 2/52 (Photo credit: Mark Hopkins Photography)

Fred didn’t remember his panic.  He thought his main problem was his sleep.  His
so-called “main problem” changed with his symptomatology.  Fortunately or unfortunately he didn’t know it was happening.

Fred reminded me of a paper doll.  Now I’m a veterinarian, now I’m a clerk.  Of course there are all the stories that accompany each outfit.  Our smithy imagination is fast.  Pull this off and press this in and now I’m a fire-fighter.  Now I’m a noble, now I’m a… patient.

The other day after the Hemet NAMI meeting, (they meet monthly on the first Wednesday at the Hemet Seventh-Day Adventist Church), a member told me that when they do outreach, they begin their stories with something like, “We are people who,” or “I am a person who,” deliberately avoiding the word, “patient(s.)”  Hoping to allow others to connect with their humanity, the specialness of their, “Me,” rather than the distortion that suffering is special they try to keep away from the paper doll experience.

Thinking of NAMI, thinking of Fred, I splayed the biopsychosocial-model tools I use.  What was here for Fred?  Fred’s biology was toward healing as he wasn’t having panic attacks any more and his thought processes were less circular.  That’s what we wanted and signified that his treatments, (including medications and psychotherapies,) were at least not harming him as far as we could tell, and might even be part of what influenced his healing process.  However, his ongoing symptomatology as seen in his poor insight, (paper-doll syndrome,) insomnia and persistent worrying thoughts demonstrated that his biology was only partially treated.

Fred, like you and I, and like women who labor babies into this world never remember their pain, by forgetting his panic, he lost his point of reference.  I said,

Fred!  This is significant!  Yay!  

Fred looked at me like I didn’t get it.  He wasn’t sleeping.  What was I thinking, “Yay?”  Well…  “Fred I was thinking you aren’t panicking on a gurney in the emergency-room today.  Yay.”

Remembering our suffering isn’t necessary but it can be a friendly reference point if we want.

Self-Care Tip:  Use previous suffering as a reference point to celebrate when you aren’t.  Be a friend to yourself.

Question:  Have previous sufferings lost their strength in your memory and diminished your celebrations?  How has suffering been used after they are gone to your advantage?  Please tell me your story.

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Work Hard If You Think You’re Worth It

Road Trip!

Image by -Snugg- via Flickr

Self-Care Tip #144 – Work hard if you think you’re worth it.

On the last day of our family road-trip, thinking about self-care and I don’t know where to go with that!  In the past when I thought about road trips, I’d sooth myself with visions of ice-cream stops, cheese puffs, and other expected and unexpected delicious treats to enjoy and bribe the kids with.  However, I’m taking care of myself these days, (hard work!) which subsequently results in me taking better care of my kids, …my family.  They had a nap, which was nice but now they are awake, refreshed and talking.  A lot.  So close to my head in fact that it feels like I have headphones on.  Volume adjuster not currently functioning.  Oh where are the bags of junk food!? (Disclaimer:  No offense intended to my kids.)

But old habits die hard, so I imagine this one will hold on at least as long as our road-trip.  In the mean time, without inserting needles into my eyeballs, I am thinking instead about self-care.  Thankful, despite gritted teeth and ringing ears, that I will lose the baby-fat before I forget that I was any different before the babies.  The memory is already distorted a bit by the fact that I have thrown away any clothes I used to wear and haven’t allowed any pictures of me below my shoulders to pass before my eyes in years.  I’m a happy frog in a Jacuzzi getting hotter and hotter and have to find a way out before I get eaten by someone French.  (Disclaimer:  No offense intended to the French.)

Thankful also about the ripple effect to my kids.  I’m gifting them a healthy me (because I will succeed), to offer them and theirs in their future.  I’m gifting them better odds that they won’t be in my same position in time.
I’m gifting my husband as well with the hope he continues to voice that I am around to care for him when he is dyeing.  Whenever that is.  (That is a gift if it ever happens!  He can be a real baby when he’s sick.)  (Disclaimer:  No offense intended to my husband.)

And I haven’t forgotten about you either.  You will have me indefinitely to chirp on and on about self-care.  It really is the holidays!

It’s a good thing I’m belted in because I might start levitating. OH!  I just remembered I have ear-plugs in my purse!  Yes!

Ah.  That’s better.  I know I’m working hard for good reasons.  And all the reasons start and end with “Me.”

Question:  Why are you working so hard for yourself?  What has been the hardest thing for you on your self-friendship journey?  Please tell me your story.

 

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Lament, Celebrate, Negotiate to Take Care of Yourself

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Self-Care Tip #146 – Negotiate to get friendly with yourself.

How do you fit in socially when you’re taking care of yourself?  To be social you need another person.  How does that socialization become compatible with self-care?

These were the questions my brilliant sister-in-law, Trixie Hidalgo asked.  It isn’t so apparent really and I get what she’s asking.  Self-care is not all about the self.  There is clearly an exchange.  We are getting something from our environment that in turn is taking from us.  That environment can be anything, such as music, movies, books, work, or interpersonal relationships.  We negotiate with that.  We agree to what we get and what we give contextually.

How does one person in wanting to define self-care for themselves harmonize the exchange?  It’s a reduction of laments and celebrations.  For example, in going to medical school I lost time, opportunity to be a young mother, and joined without directly asking to, the competitive world that is culturally considered masculine – to name a few.  Yet the celebrations, although never equal to the losses, and vice versa, I agreed to.  I made the exchange between myself and my social context.

The self-care skill comes in the experience of your own self-discovery.  How does one do this?  Look inside yourself over and over again.  Lament.  Celebrate.  Negotiate.

For You:  I’m dying to hear your responses.  I have a feeling that they will complete the post, as so often they do.  Please tell me how you reconcile the effort towards self-care with the inherent social context.

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The Healing Process Can Be Confusing.

Self-Care Tip #127 – Because feelings can be confusing during self-care, keep connected to someone(s) objective.

A colleague told me the other day about his patient.  Of course he didn’t name him, but I’ll call him Brent.  Struggling with melancholic depression for many years, Brent started medication therapy.  He began feeling better emotionally.  But at the same time, he started to believe that he didn’t love his wife any more and started a dialogue with her about possible divorce.

It’s tempting to judge Brent.  Easy to say, “What the…!?”  Still, because we don’t know the full story, nor his thoughts, nor consider ourselves his Judge, we won’t.

Self-care can be a tricky road.  It’s not all ah-ha moments and nirvana.  Have you been there?  Confused by your feelings as you heal?

A common reaction to improving is associating the things in our “ill” life – when we were feeling terrible – with other elements that may not have had anything to do with our bad feelings.  Perhaps Brent’s wife was guilty by association and at some level he may have connected her to the dark emotions he so desperately never wants to feel again.  Bits of this idea are also in a previous post about panic disorder and grief.  For example, someone may change her profession because she believes her previous work is causally linked to the way she felt when ill.  Maybe Brent wanted a change in spouses for the same reason.

When we are going through the healing that self-care brings, we might not find our new emotional baseline for a while.  During that time, and because feelings are often not trustworthy, stay connected to the support network, confidants, the trusted few who can be our third-party advisors.

Although taking action on for our own health involves lifestyle changes, knowing when and how to get feedback is key.

Question:  What has confused you about your healing and self-care journey?  Please tell me your story.

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Grieve to Be Present With Yourself

 

Maria Yakunchikova "Fear" 1893-95

Image via Wikipedia

 

We grieve when we get sick.  And we grieve again when after getting well, we get sick again.  Then the grieving can be even more terrible because you know what’s coming.  In Pearla’s case, she didn’t know she was grieving but she knew she was sad and terrified at the same time.

I asked her if she thought that staying in bed, loosing interest, isolating, crying jags out of the blue might be related her grief about getting sick again.  She said no at first and then said, “I’m disappointed.  I thought this was over for me.”  All over, she couldn’t trust herself.

Pearla was afraid. And that fear was always there.  Now she couldn’t put it out of her mind.  “What if I have another panic attack?  I can’t take it!”  “What if,” was always on her mind.

Readers, a panic attack is more terrifying than just about any immediate experience.  If you’ve never had one, it is almost impossible to imagine the depth of terror it causes.  It is so horrible, that people even change professions because of it.  I remember a surgeon who actually went back to residency and studied a new specialty because he linked his panic to his profession.  That’s another 4 years of grueling work, readers.  That’s the kind of fear panic produces.

Pearla was not only in the throes of this fear, she was also in the throes of grief.  This is a deep sadness any of us who have lost a beloved hope can relate to.  Pearla didn’t know that was why she didn’t want to get out of bed.  All she knew is over the last 2 weeks she was loosing herself and in exchange, getting something she desperately did not want.

Somehow though, after hearing about her sadness from her own mouth, Pearla agreed.  She saw the grief and after seeing grief, she could be more present with it.  It was almost like her face materially came out from hiding.  Grief lost some hold on her.  She was a little less sad and a little less afraid.

Self-Care Tip #111 – Let yourself grieve.  Be a friend to yourself.

Question:  How do you grieve?  Was it worth it to you?  Please tell me your story.

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Recipe for Treating Panic Disorder, According to Me

 

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Recipe for Treating Panic Disorder, According to Me:

1.  If it’s taking you to the emergency room feeling like you’re going to die, or your spouse can’t peel you off with your phone calls and new needs – you have a medical illness.  Get medication.

2.  If you are afraid of being humiliated by an episode so much that you avoid public places, or if you are more fearful than not – you have a medical illness.  Get medical treatment.

3.  If you are panicking out of the blue, without something setting you off/triggers like finding your husband in bed with your dentist – this is biological.  Get a medical physician’s opinion.

4.  If you are awakening from sleep in a panic attack, when you feel like you have to get out of bed and escape and the episode lasts for about 10+ minutes before you recover yourself – this is not because you’re not trying hard enough.  Get on a serotonerigic therapy and a sleep aid(s).

5.  If you are drinking more alcohol to relax and out of fear of going to bed – get suspicious and get smart.  Medication therapy or alcohol?  It stumps me when someone says they don’t feel comfortable with taking medication that has beed studied in double-blind studies on thousands of people and reviewed and analyzed and more… but they do feel comfortable with alcohol.  That’s not friendly with yourself.

6.  If you think you are going crazy and realize your fears and suspicions don’t make sense; if you think you are possibly going psychotic over and over – you’re having a medical illness of the brain and body called panic disorder.  Get to your nearest treating physician and trust them.

 

juno.cumc.columbia.edu

 

7.  If this is you, don’t go get insight or supportive psychotherapy at least until you have been on medication therapy for 6-8 weeks.  What you are going through is not because your mom yells at you too much.  It doesn’t have to have a reason.  It is medical.  Treat it medically.  If you go to therapy too soon, you will see that you can’t give what you don’t have.  (I may have offended some people saying this.  Sorry.)

8.  If you don’t get treatment, expect that depression may likely follow soon.  Anxiety and depression are bedfellows and can’t be apart for long.

    Self-Care Tip #92 – View Panic as a medical illness.  It is.  Be a friend to yourself.

    Question:  Have you or someone you known used a similar recipe or a different one?  Please tell me your story.

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    Self-Care is not unChristian

     

    Don’t be afraid of self-care.

    Self-care is Christian and scientific.  I have awareness of the culture that frowns on taking bad behavior out of the church and into the laboratory.

    A few days ago we talked about self-care not being selfish.  That circuitously brought up the question about how “the church” feels about this blog.

    Confusing “the church” with Christianity can be problematic.  I have confused them in the past.

    When my brother started talking evolution, I felt cold and clammy suddenly.  After my mini-panic attack, he told me about reading the entire works of Darwin and I had another mini-panic attack.  “There’s no way evolution didn’t happen.  There’s just too much evidence supporting it.”  I was confused.

    It took me a long time to realize that I didn’t have to be worried about differences between me, science and God.  Funny that my comfort level grew with this as I realized how little I knew.  In fact, my joy expanded, when I realized I would spend all eternity growing my knowledge.  That is a lot of everything that just won’t fit into any box I can think of.

    iwantthatpainting.com/Why-does-it-always-rain-on-me.html

    Now when something crashes through a pet-paradigm, I remember that it’s ok.  (Down fear!  Get down anxiety!  Heal dogs!)  I may see a different reality.  Parts of me may become changed by that knowledge, trauma, death of a dear one.  Becoming changed and different is ok.  Because God is the same.  God already knows whatever about evolution, or that the world is round.  He knows that we try to turn medical symptoms into something spiritual, like depressed mood.  He knows it and He’s still here.  He is the prototype of presence.  Now that people can look into the brain and say where feelings and behaviors come from, we can get past that and on to the next revelation.  So what if it is medicalized.  Science and spirituality are not exclusive of each other.

    So is self-care Christian or scientific?  Things aren’t that binary.  Self-care is both.

    Self-Care Tip #84 – Don’t be afraid of self-care.  Be a friend to yourself.

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    Be Empathic to Others to Get Friendly With Yourself

     

    Drawn by early 20th-century commercial cat ill...

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    Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

    Yesterday I wrote about considering intent and context when comparing self-care with selfishness.  That carries over to the people sharing life with those of us who have mental illness.  Do they see us as selfish?  For example, how is the spouse of the Panic Disorder going to make sense of the 40 phone-calls he gets while at work?

    Mary’s husband told me that she’s been calling him “all day,” terrified she was going to die.  Checking to see when he was coming home.  She couldn’t go to the market because people would laugh at her.  Afraid.  Afraid.  Just plain afraid.  Really, everything had become about her.  She was like a scared kid.  Frankly it was annoying.  He was in a stressful work situation with the economy slumping.  People he knew were being laid off.  The other day he had to leave in the middle of an important job to go home and reassure her.  She was sobbing in the living room.  Sure she was going crazy.  He realized that he might have to tell his boss what was going on but what was going on?!  Who had his wife turned into.

    In yesterday’s blog, we spoke about the ability to abstract v. concrete thinking.  Being able to abstract helps with empathy – connecting emotional content between people.  To put yourself in someone else’s shoes, as if you were them.  This is a critical part of relating, i.e. being in a relationship.  Many different mind illnesses affect our ability to abstract, including panic disorder.

    In Mary’s case, she was not empathic when she was anxious.  She was thinking about herself.  Understandably, if you read the part about her believing she was going to die or go crazy.  But when you’re married to her, empathizing with her gets old.  It’s not so easy when it seeps into your work life, you haven’t had sex for months, and you have to do everything that has anything to do with going outside of the home.  Some part of you knows it’s not true, but another part of you screams, “Get over it you selfish child!”

    Is Mary selfish?  Some might be able to answer even after all the phone-calls and unrecognizable behaviors, no.  Mary is not selfish.  They can do this specifically because they can abstract.  They can empathize.  They can consider the context of Mary’s disease and the intent of her behaviors.

    Not everyone does this.  Not everyone is able to let “It” be about someone else.  Not everyone doesn’t have to have “It” be about them.

    The best thing for those in relationships with someone emotionally ill, is to view the way they are behaving as biological.  When treated medically, than Mary or whoever it is in your life can do their own self-care.  But until then, staying in their lives requires maintaining an empathic view that considers intent and context.  It also means furthermore, doing your own self-care individually.

    There are over-lapping flaps to our lives.  Scales on the back of an armadillo.  Me as encased by my body.  Me, that includes the space between me and you.  Me, that includes you, because you will always be a part of me.  Self-care really involves all that by degrees.  A chain-link.

    So the question is, can empathy be chosen?  With money in the bank and wisdom, yes.

    Self-Care tip #79 – Be empathic to others.  Be a friend to yourself.

    Question:  Does any of this ring true for you?  Please tell me your story.

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    The Good and Bad of Anxiety

    In response to yesterday’s blog, a reader wrote,

    I often feel my flight and fight response triggered even in situations (mostly social) that should not (theoretically) even be frightening. What do you think about that?

    This is like the degrees of water temperature in our shower.  Pretty much every one falls somewhere on the spectrum of this type of anxiety.  When is it ok, and when does it become not ok?  My brother, friend, mentor, Cameron Johnson MD said in so many words

    Anxiety is what makes us work hard.  If we didn’t have anxiety, we’d all be slobs.  We’d stink.  We wouldn’t get our homework done.  We wouldn’t say as many nice things.

    My children still see most things in all-or-none fashion.  They would say at this point of the discussion, “Anxiety is good.”

    A teenager I treat began responding to her medication.  Her mom began to complain.  “She never let this happen before!”  Her room was a mess.  She was less prompt to obey and she started voicing her opposing opinions more.  In some ways, without the anxiety, it was like her mom was getting to know her for the first time.  

    This was however, better than anything this girl and her mom had hoped for.  Now the girl wasn’t throwing up, having panic attacks, avoiding just about any social experience.  She was making eye contact with me and she was able to present in class.  She told me that she can’t even think about how she felt before.  It was so bad.

    It is really hard for any one who has never suffered from debilitating anxiety to realize the level of suffering and terror it causes.  Someone who may look stuck up, aloof, disinterested, quiet, bored, may in fact be at hells door.

    My children might now say, “Anxiety is bad.”

    And so to my reader quoted above, I’d say with my children, anxiety is good and anxiety is bad.  Come and paint the stars with me for a time.  Talk and tell me your story.  We shall in degrees of mind and manners, unwind the mysteries together.

    Self Care Tip #49 – If anxiety is affecting you in a negative way, consider a medical reason.  Be a friend to yourself.

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    Fear

    I dropped my kids off today.  All of them.  We had been very happy about this.  After laboring towards patient parenting for 7 years, I was also looking forward to today.  I’d never had all three out of the house at once, and the strangle squeeze on my insides grabbed me by surprise.

    We used to have this black cat when I was a kid who would hide in our plants.  In the middle of the night when I’d occasionally wake up and go to the kitchen to get a drink, she’d jump out at me with her claws.  While walking today between preschool, kindergarten, and 2nd grade, life jumped.  What left me breathless was how easy it was to get rid of my kids.  Appropriately by social standards.  School you know.  They’re doing what they need to do.  And just like that, if I wanted, they could be mostly gone.  I suddenly felt how it could happen to us, easy like that.  Like a body returning to dust.  My spirit, my soul, my essence yelled a loud “Wait!”

    My reaction can be confused by some as a hidden desire.  Sure, I acknowledge the obvious need for parents, including yours truly, to get space from their kids. But that wasn’t the slap I felt.  It was fear.

    I’ve treated many mothers, but one in particular comes to mind.  She voluntarily admitted herself to the hospital because she was afraid she would hurt her baby.  She wasn’t fantasizing about it.  She was having specific vivid imaginings that cut into her consciousness.  After enough of those, she lost confidence in herself and hid.  She confused these day-terrors with a fear that they were really some unconscious desire she didn’t understand.  Common for panic disorder.  It is the medical disease that historically gave us the phrase of “I feel like I’m going crazy!” With medication therapy she returned to a capable woman who trusted herself.

    Have you ever noticed that in the Bible, whenever God or an angel is talking, they almost always start out by saying, “Fear not for I am with you,” or some version of that?  I didn’t, until my kids came home from Vacation Bible School 2 years ago, and the refrain for the week was “Fear Not!”  They still scream it at each other with glee.  I love that about God.

    However when I hear that Bible verses or prayer or God should make us overcome fear, I am more than bored.  I’m angry.  Fear comes for many reasons.  It isn’t a spiritual thermostat.

    Today I did several things to deal with my fear.  I cried.  I prayed.  I went to work.  I felt better.  However, my patient did not feel better after doing those things.  What should God have done for her fear?  I knew that she came to my hospital.  I knew that what she felt were symptoms of a medical illness affecting her human brain.  I knew that medications could play a part in helping her.  Maybe that came from God.

    Question: What do you think? Agree? Disagree?

    Self Care Tip #31 – Fear not!  Be a friend to yourself.