patient

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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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Reworking Choices With Your Physician as Part of Your Team

What do you want? 

It is one of my challenges as a physician when someone comes to see me for reasons I’m not able to accommodate.  I can’t validate them.  I can’t tell them what they want to hear.

What can I do?  Help them “realize” that they came to see me for another reason.  Another way to say it is to help them “choose” another agenda.  A part of them realizes their need for help; they came.  A part of them believes I am a person that can help; they came.  A part of them.  A part that I and the patient are responsible to find and shift agendas deliberately or by any wiles possible.

Hands touching

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We are an unusual team in this.  How often do you find another so awkwardly paired?  Yet these are some of my best patient-doctor relationships.

What do you want?

When there is a meeting up, a connection and everyone is working for the same “want,” both presence and movement are natural responses.  It’s like we’re standing still in the moment, senses taking it in, and moving all the while.  The process of moving itself brings pleasure and healing.  It is not always about arriving.  It is not always what we think we want.

Self-Care Tip – Enjoy your re-choices and what you will get from them.

Questions:  Have you every found yourself being “helped” to have a different agenda that improved your presence and movement in your personal journey?  Please tell us your story.

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Stop! Don’t Stop! – Affecting Our Practice Of Medicine and Other Agendas

Self-Care Tip #281 – Be aware of how your “Stop!  Don’t stop!” behavior is interfacing with your agenda.

One of the challenges in practicing medicine is the inevitable “Stop!  Don’t stop!” petitions.

stop & go

Image by Joseph Robertson via Flickr

It’s similar in a few ways to being a shoe cobbler who receives clients that don’t want her to use leather.  Ms. Cobbler spends 40-60% of her time with clients persuading them of her capacity to use leather, the objective and subjective evidence behind the use of leather and empowering her clients to wear their leather shoes despite public opinion.

This sounds silly and is not meant to be disrespectful to patients, including myself as a patient of physicians and my own difficulties being a patient.  It is only to describe the forces we are all working with when we work together in medical care – physician and patient.

Quenn came in reminding me of this.  Quenn was a 32 year-old married mother of three, who complained of trouble swallowing, sleeping and ability to feel pleasure over the past two months.  She had struggled with this after her mother died nine years ago, but the problems went away over the following year.  However nine years-ago, Quenn was not a mother.  Nine years-ago, Quenn could shake, stay in the house with the shades down, silent or crying loudly, not eating lying in bed for days and if she wanted, nine years-ago no one would know.  This time however, Quenn told me she was desperate.

I have to get better!  This time, I’ll do anything!  But please start with something natural.  I don’t want to get addicted!  I’m someone who never does meds.”

Quenn, why are you seeing me?  

This is challenging for everyone.  Together, the physician and the patient work with this influence on their agendas.

My brothers and I used to play a game on each other when we were kids.  Maybe you did this too.

Stop!  No don’t!  Stop!  No don’t! Stop!  Don’t!  Stop! Don’t! Stop! Don’t stop! Stop! Don’t!  Don’t Stop!  Don’t Stop!

And for some reason that was hilarious to us.  I like to remember this when I’m in the office and smile despite being played by the “Stop!  Don’t stop!” behaviors and emotions.

Questions:  How about you?  How are the “Stop!  Don’t stop!” behaviors and emotions playing on your agendas?  Please tell me your story.

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Our Patient-Doctor Relationship Improved by Self-Care and Back At You!

NICU Nursery

Image by EMS Shane in Portland via Flickr

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #265 – Use your connections to help yourself and use your self-care to improve your connections (such as your patient-doctor relationship.)

Damaged and premature, my niece was born needing help to live. Now, one year later, I am playing ball with her on the floor. Her intelligent smile, thriving body, and especially the lovely nape of her neck with that baby-curl of hair lipping up makes remembering her near death-dive into life surreal. I don’t want to remember it anyway. But when I can’t help myself, what I like to think of is how my brother and sister-in-law were treated.

The clinicians at UCSD were unbelievable, my brother said. They included him in their decision-making and informed him of medical study results. If you don’t know, if you’ve never been sick or been in a medical setting otherwise, this doesn’t always happen. It isn’t traditional to share medical information directly with patients (such as x-rays, laboratory results, differential diagnoses, and to ask their opinion. Can you imagine?!  “…Um. Yes PLEASE! Can I be your patient!?” Sounds like fantasy.)

I’ve also struggled to collaborate. Hovering over charts and laboratory results, many of us practitioners behave as if our patients were at any moment going to throw us into court. It’s embarrassing, even though the truth is, too many of us clinicians are stalked by litigious intentions, whilst the truly awful practitioners seem to sail away on unsinkable malpractice without pursuit.

I have not enjoyed myself when I’ve done this. When I’ve acted suspicious of the very people I’m meant to team up with, work was not good for me. I don’t think my patients felt comfortable with the doctor-patient relationship either during those times. Hearing my brother talk about how he was treated has emboldened me to engage with more trust in the care I offer patients. Moreso, being friendly to myself has helped me be a better physician.  It’s tail chasing but with productive and enriching effects.

Making a choice to choose trust and transparency with patients and clinicians, even being present with the fear, is self-care although high pressure. With people’s lives on the line, clinicians and patients know mistakes will happen. The self-care will grow our ability to forgive each other.

My journey with self-care has brought me to see people differently. I look at them from the self-care angle. I look for those sticky bits where we can connect and collaborate. I expect things from them. I ally myself with their self-respect, with their intuitive desire to be friends with themselves. I am bored at work when I don’t do this. I am bored at work when my patients don’t do this too. Without self-care for myself and without my patient’s interest in self-care, medical practice becomes everything that the negative reputations advertise about the physician and the patient.

Yes. My quality of practice has definitely improved.

Who isn’t blessed when she sees the courage to face stigma, shame and bewildering illness? Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live, fights hard like my niece did and shows what that fight is worth?

Who doesn’t learn from that? When someone loses her identity to the defacing ravages of disease but still knows she is worth the fight, like PattyAnne, working beside her is one of the best places in the world to be. For Me. It starts and ends with Me.

Building trust in a patient or a clinician starts with us staying connected to others in our personal circle and along the ripples as the circle widens. We have to have a voice and hear their voice and we do this by maintaining a community of people.

Connection is part of self-care for both clinician and patient. In the case of PattyAnne, (yes, she’s still in our story,) she could take an action toward her self-care with the intention of gaining stronger connection to her community and to me. She could ask herself about her intentions. In fact, we both would do better self-care approaching each other this way.

Connection via the patient-doctor relationship is self-care and then back the other way too!

It starts and ends with Me.

Questions: Has your patient-doctor relationship been a friendly part of what you’ve given yourself?  What are some examples or in what ways have other connections you’ve chosen improved your self-care?  How has self-care inversely improved your patient-doctor relationship?  Please tell me your story.

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Self-Care Is Not A Moral Issue

Facial emotions.

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I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #263 – Experience, use, observe and interpret emotions, but don’t moralize them.

We sometimes forget about the involved journey to a healthy Me.  Because of this, we become fearful that it means alone-care, apart-from-God-care, selfish-care, excluding experienced-and-professional-input-care and so on.  It’s not.  Self-care is collaborative, yet that doesn’t negate the fact that it must start and end with Me.

When we take care of “Me,” we can connect more with others, including God, have more inside of us to give to others, and have more interest in the world around.  The opposite disables our abilities to do those things.  No one can give what she doesn’t have.

We have this person, “Me,” to take care of.  This “Me” is valuable, of high priority, to be celebrated and cheered on.

Please, shake it off.  Self-care is not a moral issue.  It just is.  It is a choice, a freedom and an opportunity.  It is not about salvation and has no influence on our worth.  It just is.

We are more willing to buy into the, “It just is,” self-care tool when we understand where emotions and behaviors come from – the brain. This biological stance is the evidence for deescalating our drive to moralize emotions and behaviors.  They are not from an aura, a gear we can shift, or any nidus of control outside of our human bodies.  Emotions are how we interpret the world around us.  They are not linked to morality.  Please don’t take them to the pulpit.  If you do, I will still be polite, although breathing through a mask.

Emotions are our interpretive lens for our physical self.

Questions:  How’s the clarity of your lens holding out after considering this part of self-care?  What influence does what you “see” with your emotions have on your ability to befriend yourself?  Please tell me your story.

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Presence Encourages Self-Care

The Forgetful Professor

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I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip – Sit back and listen to the emotion to be present in your own life.

There are two terms we’ve used in psychotherapy since before Freud and Jung were around:

  • Transference – putting our feelings on the clinician.  For example, my clinician looks like my father.  I will transfer onto him my feelings about my father and subconsciously think he is like my father.
  • Countertransference is the opposite.  The clinician thrusts her own memories and associations on her patient.

These can be positive or negative.  Of course they do not stay in the clinic.  Transference and countertransference happen between all of us all the time.  Often it is healthy.  It helps us grow, model others, fantasize and move towards fantasies long enough to make them true.

Remember PattyAnne from yesterday?  …In PattyAnne’s and my case, PattyAnne could be said to have transferred her fear of being treated as a lesser person.  But what was my reaction and what is yours in similar situations?  What is our countertransference?

I have often been guilty of negative countertransference in situations like this.  I remember feeling dirtied by people’s prejudices and fears.  Almost like I needed to bathe afterwards.  The truth is, though, we don’t have to feel this way.

When people are afraid of us, we do not have to be afraid of them.  We do not have to anger, agitate, or feel “soiled.”   We can just be with them.  Let it be about them and not run away.  Be present.

Clinicians can be open to hearing this song.  When any patient starts in again, this time, sit back and listen to her fear rather than worry about what words carried it.  Patients will be better for it.  Maybe clinicians will be, too.  And that is key.  The gift we give first is to ourselves.  By just being with someone in her fear, we can just be with ourselves too, and vice versa.  Quite friendly to us both.

Presence encourages self-care.  It helps guard us against the temptation to see ourselves as victims.  When we do not realize that our emotions and behaviors come from us, were not imposed upon us from external sources or realize more specifically the transference or countertransference that we are responsible for – we can feel like victims.

Any time we do not own our emotions and behaviors, this is a quick path to losing our connection to our personal journey and become “absent” rather than present with ourselves.

Still, many wonder: at what point does “too much self-care” become part of the symptomatology?  This concern will resolve when we see how emotions are not moral implications.  “See” you tomorrow!

Questions:  How has feeling like a victim disconnected you from others and yourself?  How have you collected your absent self and come together again?  Please tell me your story.

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Introduction to Self-Care

Questions:  How do we collaborate with our patients, or with our clinicians, to take action on behalf of health?  What can we as clinicians or patients do to teach, learn and practice the tenets of the field of self-care?

Self-care is living consistently with the belief that the success of our health (emotional, physical, spiritual) begins and ends, not with “me,” but with “Me.” To teach and practice self-care comes when we understand that the essential self, the Me, is always worth fighting for, always worth the journey, always of value even in the throes of mental illness.  Here at FriendtoYourself.com, we work to define and teach self-care daily, we attack guilt, we stand up to shame, we live as we choose despite stigma and we work harder than we ever have on perhaps the hardest job of our lives.  Self-care is not weak but rather courageous.  It brings us to humble accountability for our lives, not seeking to erase our history but still reminding us that we are free to start over any time.

I will be writing a series of blog-posts outlining self-care in which we will examine the tenets of self-care: self-knowledge, presence, moral neutrality, and connection. We will look at self-care as an essential practice for both clinician and patient, examining the ways in which a self-caring clinician may, in turn, provide better care to her patients, and patients take better care of themselves.

Self-Care Tip #260 – Clarify what it means to be your own friend.

By the way, check out a still unknown glorious writer at ASkirtAWeek.com.

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Patient on Patient Crime – Our Response to Our Own Illness

a "low profile" sole provides a grea...

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Self-Care Tip #238 – Think about your response to your own behaviors and emotions.

Bianca agreed with her husband.  She was too depressed.  She never wanted to go out and cried a lot. Perhaps she even deserved to be cheated on and abandoned because she was so unbearably dull.

Pause button.

We have discussed where behaviors and emotions come from – the brain.  We have identified the brain as human material, matter, biological and as susceptible as anywhere else on the body to illness.  In short, We could say at this point that Bianca is in a Major Depressive Disorder – a medical disease.   There are many medical diseases secondary to design, behaviors or lack of behaviors.  Or for other reasons.  However, I don’t know many medically ill that when the spouse walks out on her, we say,

Well of course!  She had cancer!

Or,

He lost his leg in a car accident, get someone else!

But throw in some aberrant emotions and behaviors for unacceptable time, and the escaping spouse is given running shoes as a gift from their concerned community.

How could he stand her!  Of course he left.  She wasn’t taking care of his needs.

You see the disparity and when written this way, it looks really ugly and I apologize.  I’m not trying to thumb people for biases and prejudice.  Both parties are hurt.  I’m also not trying to say that this happens only in marriage.  It happens in almost any setting.  Emotions and behaviors are just not considered to be symptoms of disease.

Have you ever heard the term, “Women on women crime?”  Well this is something like that.  I’m thinking much of this will improve when we treat ourselves with more insight and understanding consistent with our biopsychosocial model.  If we don’t do this first, who will.  We aren’t responsible for how others treat us, but we are responsible at least for ourselves.

This is one more wonderful way of claiming our right to say, self-care starts and ends with Me!

Questions:  How can we wrap our beliefs around this seemingly enigmous concept that when someone is crotchety, negative, irritable, inattentive or boring – it might not have been because they chose to be that way?  How do you own if in yourself?  Please tell me your story.

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Self-Care As it Affects Your Professional Self

Of the patients waiting at the Out-Patient Dep...

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Self-Care Tip #236 – Think about what self-care is doing for your professional self.

When speaking with managing editor of the Journal of Participatory Medicine (JoPM,) Kathleen O’Malley yesterday, I struggled to explain the presumed simple description of what effect self-care has had over the past many months on my professional self.  I realized that I hadn’t spoken much about that yet.  The words spilled out, messy and ungraceful.  I’d like to say it better so I’m going to try again, and then many more times.  Self-care has helped me be a better physician.

I see people differently.  I look at them from the self-care angle.  I look for those sticky bits where we can connect and collaborate.  I expect things from them.  I ally myself with their self-respect, with their intuitive desire to be a friend with themselves.  I am bored at work when I don’t do this.  I am bored at work when my patients don’t do this too.  Yes.  My quality of practice has definitely improved.

Who isn’t blessed when they see the courage to face stigma, shame and bewildering illness?  Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live when disease is damaging them, fights hard like my niece did and shows what that fight is worth?  Who doesn’t learn from that?  Who doesn’t want more?  When someone loses their identity to the defacing ravages of disease but still knows who they are, is for me, one of the best places in the world to be.

Working harder on myself personally is working harder to improve myself professionally.  One healthy is another healthy Me.  Self-care has helped me find more pleasure at work because I know I am responsible about how I feel when I’m there.  I take care of myself when I’m there and then I’m able to give more to my patients because of it, including just being present.

Being present is really a lot to get and a lot to give.  I sense this in my kids who want me to see them.  They call out for observation of activities; riding without training wheels, jumping super high, running in fast shoes, building awesomeness.  But those are code.  They want me to see them.  I just can’t do that when I’m self-neglected.  It carries over in all spheres of my life, including the office.  Who wants to consult a physician who is half asleep in the chair?  (Now if I need a nap, I just go all the way and sleep! j/k.)

I know my self-care is participating in the practice of this kind of medicine with you.  I’m hoping to get better saying it.

Questions:  What has self-care done for you in your professional world?  How has it helped you work better as a team-member?  How has it helped you receive better from others who have something to give – such as teach you or give directions?  Please tell me your story.

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Where to Find Your Council On Self-Care Outside of Yourself

Not sure where to look

Image by quinn.anya via Flickr

Self-Care Tip #226 – Find your council for self-care outside of yourself with psychiatry.

Many may wonder why a psychiatrist would talk about being a friend to yourself.  People who know psychiatry involves medicine, who think psychiatry excludes psychotherapy, who think self-care is holistic (i.e. holistic they interpret as non-medical) or who don’t bridge the gap that voluntary choices and choices regarding what is involuntary is still self-care – these people may wonder…  It’s no fault or judgment, it just is, as we like to say.

After all, psychiatry has changed a lot in the last thirty-plus years.  This category of people I speak of includes even physicians.  It is not easy to keep up on each other’s specialties.

I make my case for “microphone-time” (taking liberties to speak on this) based on the Biopsychosocial Model.  I boldly say that because Psychiatry flattens the planes between biology, psychology, sociology, then Psychiatry should speak up on self-care.  It is a broad perspective and often with some affecting differences from religion, clergy, laymen, psychology or other therapies by reputation (I’m not speaking about individuals.)

The beautiful bridge linking voluntary behaviors and emotions with the involuntary, and how that relates to our choices, our self-care, our freedom, saying all health begins and ends with Me is an enormous step in friendship with oneself.

Questions:  Where do you find your own opinion on this spectrum of thought?  And why?  What has your experience been with this?  Please tell me your story.

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Living Where We Feel Safe is Part of Self-Care

Self-Care Tip #213 – Live in safety.  Be a friend to yourself.

In My Fridge

Image by Nikita Kashner via Flickr

I love psychiatry because for me it is a safe place.  A place where I am comfortable pushing aside distractions.  The blinking lights disappear and I don’t have to waste myself on B.S.  Some time ago, I told you about how Mom has been when Dad’s been hospitalized in the past.  When she pushed his tubing aside and just got in bed with him to hold him.  All that mattered then was Love.  They didn’t see the clutter any more.  That’s what psychiatry offers.  If we want, we  can come together and be real.  In twenty to forty minutes, we can hune and warp time and find a gravity where we breathe differently.

Chewbacca

Image by Andres Rueda via Flickr

Unfortunately, I have found that the longer I do this psychiatry thing, the worse I am with life otherwise.  Whether I’m with the grocer, dog-trainer, my child’s teacher or person in front of me in the coffee-line – I just don’t graze well.  (See blog-post, “Do You Feel Pleasure.”)  I’m always yelling, “Hit it Chewbacca!” and we’re off at warp speed into asteroids of personal information; perhaps inappropriate to the setting.  (See blog-post, “Using The Force.”)  I hate to think what I’ll become when I’m more thoroughly demented and disinhibited.  These things just get more pronounced with age and soon I’ll just be that crazy Auntie with her bra snapped on top of her bathing-suit in winter yelling at the young kids to turn the music down so we can talk.

The truth is, I’ve never been so wonderful in tinsel-town.  I found home and found that home needs to be a place where we are safe.  In fact, this is true materially in the home we live in.  It starts there and diffuses out.  If at home we are able to speak uncensored knowing we respect others and are respected because we are human, not because we have to earn it, if we can enter our kitchen and not fear temptation from chocolate chip cookies, open the fridge and know as an alcoholic the wife or husband didn’t buy beer, argue and trust that we are loved enough to be a priority, we know the issue won’t be lazily passed up, we know we are safe – then there is a ripple and a ring of safety and another ripple and another ring of safety and soon safety follows us because we just aren’t interested in anything else.  (That was a super-sentence.)  We have found home.

Questions:  How do you define safety?  What feels safe for you?  How do you grow your circle of safety?  Please tell me your story.

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It Is My Choice to Take Care of Someone, Even in The Context of Suicide

Detail of The Death of Socrates. A disciple is...

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I was a teenager I think when a woman in our church suicided.  Dad pointed out the man sitting alone.

His wife just killed herself.

Dad asked me what I thought of suicide.  Imagine.  What a compliment really for a teen, to be asked her thoughts.  Being a “Feeler,” I oozed something empathic I’m sure, but still I only remember what Dad said,

I believe God has a special way of seeing these cases.

This was at a time when culturally most of the western world saw suicide as sin.  It was quite forward for Dad to say what he did again later to the grieving man in the pew.  I did not realize at the time, but now I see that people judged him and his wife for what she did.

Later in psychiatry training, my attending said,

Suicide is the most selfish act anyone can do.  It is the ultimate punishment aimed at those who still live.

I don’t know what you think, but I couldn’t help wondering.  I still do.  I think this may be true for some and not others.  I haven’t had a chance to ask them.  They’re dead.

Suicide is terrifying to a psychiatrist.  We all tremble at the thought.  Statistically we know women attempt it more than men, but men are more “successful” when they do try.  They use methods that are generally more lethal than women.  They don’t get a chance to realize that in a month or a day they will want life again.  Or an hour.  They could have lived.

In the intensive-care unit of a hospital, “unsuccessful” suicide attempts hover in life in a space where their self-injury placed them.  The nurses are kept running between medicines, treatments, physician orders and prayers for these lives that tried to die.  Sometimes, the “chronically suicidal” become familiar patients to this critical care ward and that has it’s effect on those who have spent themselves so heroically to save them.

A nurse once told me angrily about her patient who kept coming back.

I fought for that woman’s life!  I prayed over her!  I worked all night for several nights and didn’t know if she would live until much later.  And then she was transferred out to the step-down ward (to a floor where the patients aren’t in such a life-threatening condition), and that lady probably never knew what I went through to keep her alive.

Then later, she came back, and later again, almost dead but not dead.  She kept trying to kill herself!  Finally, when she was conscious again, I just told her how it is.  ‘Listen!  I fought hard for you!  You better go out there and live!  You better figure out what it is you want and go for it.  Stop trying to die!’

This lady-patient was hurting more than herself.  Suicidal thoughts and attempts are dangerous.

There was a patient who tried to use his bed-sheets as a noose before the nurse lifted his wet body from the door frame.  In the emergency room (ER) he was examined, x-rayed and determined fit to return to the ward.  Alive.  Talking to the ER physician, I learned that the reason most people die when they hang themselves isn’t because of suffocation.  It’s because they break their neck.  Done.  No more chances to choose life.  Even an hour.  My pulse was still beating on me to the rhythm of, “He could have died!  He could have died!”  This time, no broken neck.

Regardless of our culture, we are not the judges of these people who want to die.  Regardless of our emotions, their emotions before, any previous conflicts, regardless, we cannot measure their final act by degrees or intentions.

We fight together for their lives and they may or may not know about what that does to the rest of the world.  When we don’t want to fight for them any more, we should change jobs.  It is our choice, each of us.  Whether we are fighting as professionals or as a wife, brother, friend, volunteer or the hired tutor, we fight for their lives because we choose to.  If we cannot keep it up without judging, shaming, accusing the suicidal, we need to own that and take care of ourselves first.  “Can’t give what you don’t have.”

The truth is, suicidality is hard for everyone.  It is hard in ways and in people that aren’t talked about, such as the nurses or the x-ray tech who is the first to find the cervical fracture (broken neck) on film.  It is hard for the church parishioners, the person separated by seven-degrees or the grocer.  Suicidality is hard for all of us.  We give what we choose to give and remember to say, “I can’t control that,” when we can’t.  It is our choice.

Self-Care Tip #182 – Taking care of someone is your choice, even in the context of suicide.  Be a friend to yourself.

Question:  How has suicide touched your life?  Please tell me your story.

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Waiting For Self-Care to Start

Self-Care Tip #176 – Don’t wait to start caring for your self.  

I’ll get to it when things slow down for me.

I can’t handle one more stress on top of the kids and all the people who take, take, take.

Don’t take this away!  It’s my only vice!

I don’t have time because I’m working so much.

There are so many good reasons to wait for self-care.  I don’t belittle them.  I do them too.  There’s a reason we here at FriendtoYourself.com call self-care the hardest work.  It is not for anyone who isn’t willing to go through the fire of putting themselves first.

“The fire,” you say?  Yes.  Fred taught me that.  He was down twenty pounds, working out almost every day with aerobic and anaerobic exercises, putting his ear-plugs in when sounds escalated his nerves, more motivated, interested and active.  Fred was growing again.  He said that it had been years since he’d done any of these things for himself and couldn’t believe what the world looked like when he felt so good.

Fred was sad though.  Not depressed.  No, he hadn’t been depressed for at least a year on his medication and even less so since he was taking care of himself physically.  But sad.  His wife wasn’t interested in his changes, she was disconnected emotionally, and more so every day it seemed to him as he began to change physically, emotionally and behaviorally.  His friends were growing distant.  He wasn’t interested in office politics either.  It was a simultaneous coming together of life in himself and a falling away of the life connection in his “previous life,” as he called it.  Surprisingly, the people he loved the most weren’t so happy for him.  Weren’t supportive of him.  He was sad for that.  There are never gains without losses.

This is not to forget the new relationships he was growing.  There was new life all around him and he still maintained hope for the connections he had before.  But those people who he had called his own for years were the ones who gave him all the reasons to wait for self-care.  He was way past waiting.  He was already on the other side enjoying the sun.

Question:  What have you overcome to get at your own self-care?  Is there anything your are still waiting to do?  Please tell me your story.

*Art work (assumed) courtesy of carldagostino.wordpress.com.

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Self-care Begins and Ends With “Me” – Own It

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Self-Care Tip #129 – Self-care begins and ends with “Me” – own it.  Be a friend to yourself.

Yesterday we talked about connecting self-care with pleasure to make it sticky.

Today, We’ll talk more about some of the adjustment issues of why we don’t do self-care on the obvious, such as nurture vs. nature.  We’ll talk about the nurture part.  Specifically, our own not what our parents did to us.

Why don’t we stand up to our personal needs?  We don’t.  We don’t own the friendly changes that we would benefit from.

Carol who used to abuse methamphetamines and alcohol many years ago, now tells me that smoking is her only vice and she needs to have at least one.  She says she doesn’t want to stop even though her feet and hands are blue from not getting enough oxygen.

Another part of the answer is that we are so overwhelmed by the wrong we see around us.  We qualify and quantify it away, desensitized to our own needs.

“Have you seen that dietitian?!  How can she possibly give advice on weight loss when she can’t see her feet?”  And we ignore our own central fat, knowing that it has meaning.  Meaning like, we have unseen fat layering onto our central organs.  Meaning, we are more likely to develop metabolic illnesses such as diabetes.

We don’t own it.  We don’t “Just do it.”  We talk about other people and draw lines between their mistakes making pictures that we can hide our own problems behind.  We can make sense of why they are suffering so.  Yet our own problems are some sort of enigma.  Yet to be determined by science!  Open-mouthed, hands splayed in a why stance, we can’t connect our own dots.

All health begins and ends with “Me.”  Including mental health.

Find yourself again.  Amidst all the world’s needs, you still are important.  Peel off Channel 4 News, the internet, the fears about what is outside your front door, and see yourself there under it all.  Needing self-care.

Question:  How do you keep view of yourself despite the distractors?  Please tell me your story.

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Are You a Victim or What?!

 

 

Number Two of Bella’s List – victim or what!?:

Last night I took my 5 year-old daughter on a sleep-over date at a hotel.  Generous I thought …and boy was it!  To me!!  I couldn’t believe how much fun I had.  I quickly realized why I had done this.

A bit of me still wants to float away on wings of the modern-martyred-Mom, and I can, because it did take a lot of time and money and energy and….  But it’s not too friendly to me.  As attractive as that flight may seem, I’ll lose air at some point and take a big fall.  Ouch.  I might fall on my kid too which is against my intuitive effort here.

Being a victim is attractive at some level, no?  My story is a softer example, but we all have tougher ones.  Like Bella’s when “she spoke of her injury.”  The gravity of her injury was created by her perception of things.  Our perception makes our emotional success.  My story about last night with my daughter sounds pretty because that’s how I perceived it.  However, I have other stories that have negative power over me as Bella’s had on her and as yours have on you.

The key here is that when we take the victim role, we aren’t just telling our story or venting.  We are feeling self-pity. But venting is not necessarily self-victimization.  Venting can be healthy.  Venting can be done without taking a victim air-bus to no-where good.  Venting can be a way of being present in your suffering, of going where the pain is and letting it lose power over you.  Self-pity only gives the suffering more power.

The great novelist and philosopher, David Foster Wallace, who courageously lived and died with major depressive disorder, encouraged,

To be just a little less arrogant. To have just a little critical awareness about myself and my certainties.

The willingness to learn or grow is the foot-path away from victim-ville.  Could we even say that being a victim is “arrogant?”  We – Me, my patient Bella, you – have we taken steps to tell our story, to be present, to live with the humility it takes to look at ourselves and not escape/fly-away?

Whatever it is you are going through, it might help to vent it!  Grow and learn and get bigger than that experience.

Self-Care Tip #94 – Get in your own space to choose freedom from self-pity.  Be a friend to Yourself.

Question:  What barriers have you felt to telling your story?  What has made it difficult to be in the space of your own feelings?  Please tell us.

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Let it Make You Strong

She is young, golden, blushes easily, bright solar eyes, with graceful speech, not rushed or loud.  Like so many others, she doesn’t believe her beauty.   She came to me to get help.  Crippled by anxiety that hits out of the blue, like a hooded man grabbing her in an alley.  She feels during those times like she is dying or going crazy.  She started avoiding public places and became fearful looking over her shoulder for the next attack.  She was humiliated on all accounts by her uncontrolled emotions and thought people could see how crazy she was just by looking at her.  Branded and tortured.

When Nathaniel Hawthorne wrote The Scarlet Letter, he made plain the cultural pressure to define what is apparent, seen, and interpreted.  But more importantly he made plain the ability of an individual to define themselves on their own terms regardless.  Hester Prynne wore her letter A at first by mandate and then by choice, letting it represent who she was, where she came from, and where she was going.  She wore her letter and when people tried to change its meaning to something culturally less scarlet, “A” for “Able” she made it clear that she is the one who will decide the meaning of her life’s events.  Her and God and no one else.

When anxiety hits, we are scrambling to understand why.  We think, “What could we have done that is so terrible to have brought this kind of torture on?”  As Hester Prynne began her scarlet letter days bewildered by the force of emotion behind her angry neighbors, so victims of anxiety are bewildered by the level of shame and wild fear they presume must be linked somehow to this judgment upon them.  It becomes their life’s work to determine the meaning of a life with this.

Nathaniel Hawthorne writes,

The scarlet letter was her passport into regions where other women dared not to tread. Shame, Despair, Solitude! These had been her teachers—stern and wild ones—and they had made her strong…

Suffering is a schoolhouse for the courageous.

After some months of medication therapy this twenty-something woman said

I’m not so uptight about things.  …I didn’t know my anxiety was that bad until I got out of it.”  What amazed her even more was how better the rest of her body felt.  “Even physically I feel much better.”  No more chest tightness, body aches, and shakes.

She has the rest of her life to figure out how to say what this disease means and how it plays into the way she defines herself.  She will decide I hope.  Not her family, future husband, church, or Brook Shields.  I hope she will take what it teaches her and let it make her strong.

Self Care Tip #57 – Let it make you strong.  Be a friend to yourself.

Question:  What do you think?  Please tell me your story.