Pharmaceutical drug

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Say Yes to Medication And No To Drugs

Please don’t call them drugs.

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Today I spent eight hours in the company of many neuroscientists.  Smart folk.  People I look up to, want to emulate and learn from.  It was an honor.  We covered different stimulating topics about serving our patients, diagnosing better and the development of our field of practice.  We connected collegially, ate too much chocolate, exchanged cards and talked about each other’s families.  I hope to meet them again soon at future related conferences and continue learning from their experiences and study.

The one thing I do not like about any of these meetings however, is hearing people who know better (if they thought about it) naming our good medications “drugs.”

Drugs.  Yuck.  What do you think of when you hear that word?  I think of stigma, addiction, substance abuse, ruined families, fathers who do not come home, needle marks or powder on mirrors, low-living, illegal behavior, dealers, hepatitis and so much more – very little of which is good.  Drugs.  I cannot number how many patients I have spent oodles amount of time on talking them away from the stigma attached to medications because they thought of them as “drugs.”  Blah.  It is not anyone’s fault but we can start over when ever we want to, so let us.  It is time.

Who thinks of anything that actually improves us when thinking of drugs?  Who thinks of life-saving remedies, disease cures, hope, ability to feel pleasure again, forgotten shame, ability to hold a job, restful sleep, speaking well in public, desire to live restored or a mother who no longer wants to drown her baby?  Do you think of that when you hear drugs?

Let’s get together on this and forget the word that carries so much loaded negative meaning.  It is a disservice to ourselves – physician, scientist, grocer, student, surviving family of a suicide victim, newborn baby, patient and all of us who have any connection whatsoever to disease and treatment.

Drugs.  I think of First Lady Nancy Reagan‘s famous campaign in the 80’s, “Just Say No!”  That is not what we want to say or hear when we write or receive a prescription to treat and to heal what can be healed from a debilitating disease.  Just say yes, please.

Medication.  Not drugs.  A word does matter.  A word carries emotion on it like the smell of cookies baking in the oven or the toilet that was not flushed.  A word can start a war or inspire forgiveness.  Words matter.  Words can be part of what helps us be better friends to ourselves.  Why not use them to our advantage?  Let us change our culture and decrease stigma with this simple word – “medication.”

Maybe when I am able to get together with my colleagues again, maybe next year even, we will be using the word “medication.”  Maybe it will be because of the shift in culture people like you and I can start now.

Self-Care Tip:  Please forget about the misunderstood word, “drugs,” and say yes to medication.  Be a friend to yourself.

Questions:  What do you think of when you hear “drug?”  vs. “medication?”  Is there a difference to you?  To you think it would matter to culture and your “Me” if we used “medication” to refer to prescription therapies?  If so, how?  Please tell me your story.

Related Articles:

Fears of Addiction To Medications For Brain Illness

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Demanding Freedom and Other Oxymorons That Empower Our Self-Care

Désirée Nick at "Oxymoron" in Berlin...

Désirée Nick at "Oxymoron" in Berlin, 1999

I read today on bipoblogger’s blog,

I am trying so hard to keep my head wrapped around keeping a hold on this broken heart/life balance/bipolar thing.  It’s been complicated by stupid migraine headaches.  It’s hard to make sense of things and to pay attention.

Today while I was waiting for my laundry to dry, I began writing some deep thoughts, deep like I didn’t want to deal with them. I basically wrote a page of self-help advice.  I appreciate my stubbornness.

My answer:

This sounds like a woman of courage doing it, taking accountability for where she is at, afraid maybe but pressing on to start over any time she chooses, demanding her freedom to self-care.   Demanding freedom seems like an oxymoron but this is what is called for when we feel trapped.

I will add to this “answer” that self-care often seems like an oxymoron.  Such as using the brain (the same organ that is diseased) to figure out what it’s behaviors and emotions mean or everything starts and ends with Me (when we know that there was a beginning before Me) – we see the weaknesses and the conflict and we say yes.  I am an oxymoron.  I am good and bad.  I am healthy and ill.  I am growing and dying.  I am flawed but perfect.  I’m sure you have more.

Demanding freedom is a basic tenet of self-care.  We say that despite the limitations in our lives, in our decision-making, in our suffering or pleasures – despite all, I am free to do self-care.

Questions:  How have you managed to demand your freedom to self-care?  What oxymorons in your life are empowering you in your self-care?  Please tell us your story.

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Our Embrace With Our Powerlessness Stabilizes More Than Our Power

In our growing familiarity with our fears about medication therapies, we are getting to know about control and identity.  Separate those in hopes that will help us bring them together later.

            I don’t want to lose control of my choices to the control of medication.

sugar_frosted

Image by sillydog via Flickr

Jane had pocks on her face from childhood acne.  Kids had bullied her.  She learned to fight.  Jane’s mother had a boyfriend who victimized Jane.  She fought harder.  Not against her mom or her mother’s boyfriend, but against kids.  Jane left her mother’s home when she was fourteen and lived between friend’s houses.  Her story continued to develop.  Jane learned to really fight.  She bloodied herself to get control and she still had her teeth.

Jane had sold marijuana for five years when I saw her.  She had used one to two bowls a day since she was twelve.  It was one of the first things that had given her a sense of control.  Emotions sparking, nerves peeled back and exposed, dilated eyes, afraid and shaking; Marijuana took the peaks and filled in the valleys.

And what brought Jane in to my clinic?  This scraping, scratching survivor?  Weeping, Jane’s pocks folded as her face scrunched up.  Thirty-one years old and she was not in control.  Jane was suspicious of everyone who crossed her path, she couldn’t concentrate and just suffered an at fault motor-vehicle accident when she was ticketed for carrying marijuana.  Jane awaited her trial.

Reader, you see the push-me pull-me in the room.  Was Jane ever in control?  Are any of us?  Our embrace with our powerlessness stabilizes us more than our power.  This was the time in Jane’s life where she was available for help.  This was one of the best times of her life, even if she didn’t know it.  It is the surrender of all that we are, controlled and uncontrolled, to our Higher Power that stabilizes us.  Control comes from the outside in.

But being a friend to ourself isn’t about control.  It is about putting ourselves immediately and ultimately in the care of Love.   What does Love want for us?  To be good to ourselves.

We offer medication therapy (and sobriety) not to put us in control or to take away control.  Assuredly some of our goals will happen.  But still, we offer medication therapy when the benefits outweigh the risks to “Me.”  When it is friendly.  Not to erode us.  See blog-post, Self-Care Works You, Pushes You, Tires You Out Until You Are Happily Spent On Your Friend – You.

Over the past two days, we have asked a lot of questions and gotten insightful, perceptive, inspired and intuitive answers with power to connect us and point toward healing.  We will continue to explore these questions and these answers, as they will continue to influence our relationship with and ability to befriend “Me.”  For today, however, I will bank these Q & A pages and pause Jane’s story.  I send you into blog-post, Are Your Meds Safe?

 

Self-Care Tip #286 – Embrace what your powerlessness offers you.
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Other Fears of Medication For Brain Illness

Yesterday we talked about fears of addiction to medication therapy.  There are other fears that influence our choice to use or not use medication therapy for brain illness.

In clinic, we hear about people’s preference not to take medication, as if it were like ordering mushrooms or no mushrooms on pizza.

I am not someone who likes to take pills.

veggie pizza

Image by mccun934 via Flickr

Again, I think most of us agree entirely.  Who of us set out in life thinking, “I hope my life depends upon medication therapy?  I just want to have a reason to medicate.”

So tell me about this.  Questions:

  1. Are nonprescription substances safer for us?
    1. If so, why?
    2. If not, why?
  2. What are other risks you fear of taking medication for brain illness as compared the risk of brain illness remaining and likely progressing untreated?

Fears can provoke us to grow stigma and biases.  However they can also be used a tool for getting friendly with ourselves.  We can use our fears.  We can use them to gain clarity to know better why we are making our choices – stigma? Or friendship to Me?

Nothing is all right or all wrong.  But we should know our motives if we can because of it’s potential usefulness.  It is a friendly thing to do.

Self-Care Tip #285 – Know your fears so you know why you are making your choices.

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Fears of Addiction To Medications for Brain Illness

I don’t want to get addicted!

We agree.  Who does set out to get addicted?  Is that really a starting motive for anyone?  “Ok.  I’m going to take this pill crossing my fingers that I get addicted.”  Even those of us who have suffered from addictions of illicit substances such as cocaine didn’t get into it hoping it would hook us real good.

pills galore

Image by "Boots McKenzie" via Flickr

So here are some questions for you:

  1. Do you have this concern about psychotropic (i.e. for the brain) medication?
  2. How do you see prescription medications for brain illness in comparison to illicit drugs?
  • Are they related?
  • And if so, how?
  1. Is there a difference in addictive qualities between one medication for the brain and another?
    • Is there a difference in addictive qualities between a medication for the brain and a medication for the rest of the body?
  2. Does the amount of time we stay on medication affect our risk of addiction?
    • I.e., more time, more addiction?
  3. What are other fears re: the risk of addiction with psychotropic medication that you have or think others may have?

Fears can be anxiety provoking filling us with dread and avoidance, including fears of medication addiction.  However, they can also promote a more deliberate course.  We can use our fears to get friendly with ourselves.  We can use our fears.  Fears can be a the energy we needed to do the work, to gain clarity about what we need to consider fair warning and what should be thrown out.

Self-Care Tip #284 – Use your fears as a tool to clarify what precautions are worth keeping and cleanse your stigmas otherwise.

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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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Mental Illness Relapses When Medications Are Stopped

Free face of a child with eyes closed meditati...

Image by Pink Sherbet Photography via Flickr

Self-Care Tip #246 – Collaborate with your physician to change your medications.

It keeps happening.  People are stopping their medications and then getting more sick.  Recently it was Olivia.  I can always tell when she’s off medications – she personalizes things way more and she acts like a victim to many many random things.  She is irritable.

Olivia, did you stop your meds?

Olivia on medication was not a super easy-going person but she dropped much of the edge, her thoughts were clearer and she was able to see other people around her.  Today Olivia felt like her bullets were in place and about to fire.  She answered my question obliquely.

There are sooo many reasons I am better without those in me!   I used to not be able to feel God.  When I prayed, I didn’t sense His Spirit.  Besides, I’m doing fine.  There’s nothing wrong with me.  I’m happy!

The biggest bummer about getting into the scene after the medications were stopped verses before, when stopping them was just a consideration – is that the patient doesn’t see themselves clearly.  They don’t see how bad it’s gotten.  They can’t be objective largely because they are using the same organ that is ill to describe itself.  If I could have discussed it with her before she stopped her medication, she would have been in a healthier state and more able to weigh her risks and benefits of medication verses no medication.

Sometimes we do agree together, patient and physician, to stop medications and sometimes we don’t.  Doing it together is the key though.

Questions:  How do you work with someone who wants to come off their medication?  How about yourself?  Has this ever been a problem for you and if so, how did you deal with it?  Please tell me your story.

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Number One Reason For Relapse In Mental Illness

The Sleep of Reason Produces Monsters (etching...

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Self-Care Tip #230 – Remember why you feel the way you do.

Olive was doing well.

How are you doing Olive?

Oh fine.  Just fine,

Olive would say.  And she was.  A sense of rightness filled her when she thought about it.  Right with the world, her garden, her work and even her kids.  She wondered that there had ever been a time when she hadn’t been.

It was almost easy for Olive to forget about why she was better.  Almost, except for her probably thirty seconds of opening the lid, dumping the contents into her hand, tossing them, all of them into her mouth.  One swallow with water and it was over.  Thirty seconds she thought.  I’m doing it for my kids.

Then came the best reason she ever needed.  And despite knowing that she had done this before and had relapsed, something about the rightness of the reason made her feel like the relapse wouldn’t be allowed.  The rightness would keep it away.  After all, she was stopping her medication for her kids.  If she didn’t have medical insurance than she would be a huge burden financially and she would die before doing that to her children.

So quietly Olive stopped.

By stopping medication, many of us have this sense of eliminating the reason we started the medication in the first place.  Take medication.  Disease continues.  Stop medication.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You’re gone.  Turn back.  You reappear.  Turn.  And just like that, you’ve been eliminated.  Even now, remembering it delights me.

Not so cute however, is the number one reason for relapse in mental illness – stopping medication.  For Olive, she turned her head, and hoped her recurrent Major Depressive Disorder would not be there when she turned back around.

How are you Olive?

(Sigh.)  Fine.  Just Fine.  (Sigh.)

But Olive wasn’t.  Even though she knew she had been better on her medications, she couldn’t see any more, how much better.  Her face tightened up, her thoughts wandered and she exploded more.  Self-loathing of course followed and she felt like her suffering was unique to her.  No-one understood her, especially her ungrateful children.  She was doing this for them, just like everything she did through her whole unappreciated life.  This was all wrong.

Is this why I worked all those years and raised them?!

Readers, you may not agree with the crystal clear logic that emboldened Olive’s heroic stopping of her medications, but it’s not the only one out there.  This being the number one reason for relapse implies that there are many that seem to make really good sense.  So forget about they specific “why” of why Olive turned, and just know that many of us do.  Many.

Question:  What has helped you stay on your medication when it seemed to make sense not to?  What do you think about people who choose to stay on medications for life?  Please tell me your story.

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Be Willing to Stick Your Toe In The Water of Self-Care – Just Start.

Three Capetian French scholars consulting an a...

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Self-Care Tip #204 – Be willing to stick your toe in the water of self-care – just start.

I’m not interested in medications.

I used to really wonder why anyone would come to me and say this.  Sometimes we would both realized that they didn’t know what a psychiatrist was.  My degrees seemed transparent as they hung so quietly on the wall.

My girlfriend, who’s an Ophthalmologist, loves it when her patients homogenize her work with what optometrists do.   And it wasn’t until I read Madeleine L’Engle did I understand more of the differences between astrology and astronomy by understanding their similarities first.

For the magi, astronomy and astrology were one science, and it is probably a very sad thing that they ever became separated. That is yet another schism which looks for healing…

–Watch for the Light: Readings for Advent and Christmas.

In those cases when my patients don’t know who they came to see, I have tried to bridge the awkwardness with something to put them at ease.

Don’t run for the door.  There’s no cage.  See, the doors unlocked.  There’s no implication that you have to take medication just because you came to see a psychiatrist instead of a psychologist.

But I’m not interested in medication.

Then there are those who know who they came to see.  But they may not know the connection between behaviors, emotions and their brain health.  (Of course there are other reasons to see an MD I’m not covering here.)

I’m not interested in medication.

Who wouldn’t wonder?  Now I realize an MD is good for more than just prescribing, if she wants to be.  I know.  Wild and outrageous idea, right?  So before I educate anyone on my enormous fund of knowledge or my stealth abilities to diagnose and treat, I think about what it is that this someone thought they might get from coming to see me.

(Enters Fatima:)  Fatima came in this way.

I’m not interested in medication.

Fatima wasn’t feeling good.  Her emotions were corrupting her behaviors and quality of life and she was trying to help herself, stretching her toe into the pool of science, slowly.  She had never been a person to jump in and splash.

After speaking with Fatima for some time, we were able to come up with what she felt she needed help with, what she thought might be medical, what she might be willing to try – for now that meant engaging in psychotherapy, starting omega 3’s and vit D, working on her sleep hygiene, trying to get more aerobic exercise in (like a pill) and doing a mood chart.  We decided together that she would see how this goes for her over the next two to four months.  After that, if she wasn’t doing better or better enough, we’d consider a medical intervention.  We’ll see if she’s interested in medication.  Maybe not.  She can choose when she believes she’s making the right choice.

Questions:   What helped you take the plunge into medication therapy?  What held you back?  Or in someone you know?  Please tell me your story.

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Rosa Parks Protesting From the Tower of Babel On The West Coast – We Have Choices in Self-Care

Photograph of Rosa Parks with Dr. Martin Luthe...

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Self-Care Tip #201 – Make a choice that takes care of your inner self and your quality of life.

Dear Sarah McGaugh alerted me yesterday to the #2 emailed article from the New York Time‘s besmirching the intentions of medication prescribing psychiatrists.  Funny thing is, it’s quoting psychiatrists bemoaning their own prescribing practices, victims to managed care and the force of the mighty money mongrel pharma agencies.  You who’ve been reading this blog already know my thoughts on that and might be able to take these boys aside for me and quietly help them learn about self-care.  Politely without whining you know.  You might not get in the New York Times doing it, nor photographed with a furrowed brow.  I’m sorry about that.  Self-care has never been glamorous.

I definitely know where these physicians are coming from when they complain about these qualities in their practices.  The good news is that they don’t have to practice that way if they don’t want to.  Yes they’ll earn less or they won’t.  I don’t know how it will pan out for them.  But they do have choices.  I know many physicians who feel the same way these men do and many others who enjoy working mainly with medication therapy.  It is their choice.

When I was studying on the East Coast, I saw more psychiatrists still using their “couch” skills in psychotherapy.  There were those that viewed West Coast practitioners as the Babelers who were responsible for the fall of the tower that would have should have led them to heaven.  They spoke of the culture of the West Coast psychiatrist.  They questioned periodicals authored by them and wondered if they ever read Kreplin.

Now WHO is this exactly who wrote this?  Never read something without first knowing who wrote it.  What authority do they have on this topic?

Not a bad thing to do as there are a lot of posers out and about, quill fast at work.

I remember my patient Dorinda, divorcing a meany who wouldn’t leave their home.  They had other places they could move out and into, smaller than the one they were in, but neither of them would go.  They both had their reasons.  In our popular New York Time’s article, the psychiatrist explains that he wouldn’t want a cut in pay and asks, “Who would?”  Dorinda and her meany husband would answer, “Not me.”  I would too and agree that probably, so would all of you.  But we do have choices.  I told Dorinda so much and quickly got on her “Meany-list.”  She was nice about it though.

My children learned about Rosa Parks in school a year ago.  They still bring her up at random times,

Mommy, she was a COURAGEOUS woman!  She changed how all the black people were treated.

My five-year old told me Rosa’s age when she started her

Redback and victim

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work leading to desegregation and how long Rosa struggled before she and others were allowed to finally ride public transportation with whites.  She even described how these people protested; united together, refusing to ride public transportation at all until the law changed.  My kids have pretty great teachers at River Springs Charter School.

Maybe, if it’s alright with you, my daughters and their teachers could join you when you talk to these boys about self-care.

Questions:  How do you empower yourself when you feel caught in a web and victimized?  How have you seen others do it?  What do you think about this NYT article?  Please tell me your story.

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The Spider Sat Down Beside Her – Mental Illness

Self-Care Tip #178 – Find your courage and answer to stigma.

The Little Miss Muffet scenario explained by D...

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Something as simple as taking pills can sabotage us.  The act of putting it in our mouths signifies all sorts of things from religion, to freedom, to personal identity and beyond; even someone who is trustworthy versus not.  Pill – take away her children.  No pill – could be president.  Pill – discredit whatever he says.  No pill – worth listening to.

Martha is a mother of four lovely girls.  Her husband is divorcing her and she wonders what he will do in the process.  She’s been depressed in the past and anxious with a history of panic attacks.  She took two years to get over them using breathing exercises and other therapies. She didn’t use medication.  I don’t need to tell you what her husband thought of meds or of her during that time.  It was a miserable time for her.

Now, during this new stressful time, she has relapsed in mood and anxiety problems and is terrified that if her husband finds out, he’ll take the kids.  Martha sees mental illness as a bullying tool for anyone to dump her over.  Little Miss Muffet is a story she often has compared to her situation.  The spider is the mental illness she feels is dangled over her to her demise.  Martha is bullied and scared away.

Taking pills makes me feel like I’m crazy!

Note: it’s a type of crazy she interprets as being something different from the crazy of mental illness.  For Martha, the crazy that comes with medication therapy is more sinister and discrediting than the worst experience of terror any of us have ever gone through, i.e. panic attacks.

Every day, we who take medication for emotional illness have to answer to those accusations.  We contend with the fingers pointing our way, the jeering in our memory of loved ones and the boxed presumptions we find ourselves in.

This may sound a little dramatic to some out there, although familiar.  To others, it is an understatement of what they courageously confront to take care of themselves.  Each of us must come up with our own answers and find our own courage.

Martha finally decided on medication treatment and within two days she was amazed to find that she could eat without throwing up and no longer felt anxious.  She still insisted that taking medication was only temporary but getting a pill dispenser had helped her get past some of her daily battle with stigma.  She just opened the lid and poured the pills into her palm, threw them back and swallowed without looking.  Martha found it easier not to dispense each pill each day out of each bottle.  It was also easier for her to keep this information secure in the confines of our office.  For Martha, for now, this was how she answered.

Question:  How do you answer to stigma?  How do you maintain your sense of freedom when other forces tell you that you are not free?  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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Choose Self-Care At Your Most Elemental Level

Buchenwald-100625-14486-Schwerte-hell

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Self-Care Tip #167 – Choose self-care at your most elemental level.

Carl, who writes blog-site, StillFugue, said after yesterday’s post on self-care being for everyone,

Sometimes depression blocks this type of self-care regardless of how good our cognitive strategies are.

Carl reminded me of Dr. Lang.  He was a physician, a father, a man of high character who never had depression in his life.  Then after a series of life stressors depression expressed itself and he, who once was the warm-fuzzy in the hospital, the man who never lost his optimism, the man who turned anyone’s bad mood around – this man came to me under a black cloud, heavy with melancholy, and raining tears.  He cried all the time.  This giant of a man cried and cried on his wife’s shoulder, and she was bewildered by him.  She told me he had done this for a month now, although the depression started about four years ago.  He kept wanting her to read to him the book of Job and cried more barely hearing the words.  He had already been through a series of well-chosen medications, but still he sank deeper.  No form of treatment kept up with the leak in his ship.  What was self-care for Dr. Lang?

Did Dr. Lang have good coping skills?  Well he wasn’t coping well now even though he knew the strategies.  He didn’t understand why he couldn’t use the coping skills.  Did he have intelligence?  Yes.  Did he have resources?  Yes.  However, none of that is what this was about.  Asking Dr. Lang to cope with his feelings is the same as asking someone blind to see.  Physically, biologically he could not.  His brain could not.  Much of his ability to choose behaviors and emotions were drowned by illness.

So again, the implied question comes to us, – “Is self-care for everyone?”

Mr. Rick C. threw this life-saver out in response to our question,

During times when chaos ensues, either internally or externally, self-care seems to become the basis on which all other positive actions are built.

Sarah McGaugh also referred to self-care as “action,”

A call to action may also be a higher calling than one’s own self….

What action did Dr. Lang do?  He cried on his wife’s shoulder and read the Bible, i.e., he leaned on the support he had built up before the hard times came.  After failing medications, he sought another opinion and other treatments.  Sure, he couldn’t get out of bed otherwise even to bathe himself, but he had made it to my office.  What did Dr. Lang do?  He got electroconvulsive therapy (ECT) and in two months, along with his medication (only one antidepressant was needed at this point), Dr. Lang was no longer crying.  In four months, he was laughing again.  In six months, he stopped ECT altogether and maintained his emotional health with his monotherapy medication.  It’s been seven years since Dr. Lang went through all that and he has not relapsed yet.

I pick out so many points that I consider self-care choices Dr. Lang made.  They changed over time for him according to his needs and abilities, but he didn’t want to die.  Even at his worst, when he could barely remember why life was so important, that wisp of hope was enough to live for.  It was a higher calling to him, higher than his own dark wants.

That was Dr. Lang’s choice.  He chose self-care at his most elemental level.  It was his response to the call of hope.

Questions:  But what about you?  What do you think?  Is self-care for everyone?  Please tell me your story.

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Taking Care of Yourself is The Best Part of Your Treatment Cocktail.

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Image by schmeezla via Flickr

Self-Care Tip #163 – Taking care of yourself is the best part of your treatment cocktail.

We often talk about partial or failed treatment in medicine, in each other, in relationships.  But those are only about 40-60% of the time.  There are many people who get full treatment response to medication and self-care.  Mindy is one of them.

Mindy has seen me for about four years in clinic for her depression.  She’s never been very anxious, which is less usual as anxiety and depression tag-team so often.  Mindy’s depression had lurked in her, stepping out in the light and slipping into the shadows, for years even before she started working with me.  We seemed to hit by chance or skill the right medication cocktail that had evaded her, and she was not depressed anymore.  However, she never told me she was great.  She was “pretty good.”  She was, “doing alright.”  She was, “you know, good.”  Mindy wasn’t great.  She was good.  We spent three and a half years like that.

Then about six months ago, Mindy came in looking hot!  (I can say that because I’m a girl.)  She had lost the mom bumps around the midline, dropped padding in the hips, her hair wore a fresh coat of glossy brown, and I could tell her outfit hadn’t been worn more than twice.  Mindy was smiling and sincere when she said,

I’ve never felt better!  I had no idea what taking care of myself would do for me!

Her eyes were telling me their own conversation.  They were so expressive saying,

I can’t believe this is me!

Mindy told me in testimonial fashion, about the strangers who now noticed her.  Being noticed was an elixir and she was drinking it as often as it was served, but not in an arrogant way.  Mindy was still very human.  She wasn’t manic or grandiose.  She was doing what Gary Vaynerchuk describes in his book, Crush It!

“Do what makes you happy.  Keep it simple.  Do the research.  Work hard.  Look ahead” (p 12).

Mindy said,

I used to think that what I got from life was good enough; from my husband and from the people out there.  I didn’t know I could get this by just doing what I wanted to do for myself all along.

Mindy was still taking her medication cocktail and had no plans of tapering any of them.  She thought the combination of these medications that took her out of depression, along with exercise and other self-care measures were just right.  Mindy had not forgotten her years of melancholy and sadness even though it was now four years since.

Questions:  1) What is your reaction to Mindy and the 40-60% of people who get full treatment response?  2) Do you have any questions you wish you could ask the “Mindy’s” out there?  3) Or something to say for the other 40-60% of people who don’t get full treatment response?  Please tell me your story.

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No Matter Why, Where, or What Happens, Self-Care Starts and Ends With Me

Cover of "To Kill a Mockingbird: 50th Ann...

Cover via Amazon

Self-Care Tip #158 – No matter why, where or what happens, self-care still starts and ends with Me.

It’s no secret that I look at behavior through many paradigms.  Most of what I’ve shared on this blog is medical because I’m a physician.  That’s my specialty.  I’m not a physicist and don’t spend my posts on explaining how physics influences our behaviors – although I believe it does.  However, I don’t want you to think that I think behaviors and emotions exist within only the medical paradigm, even though that’s what you hear me talk mostly about.

According to Dr. Q, the roughly sketched breakdown of how stress intersects with medicine:

1.  Stress influences how we behave and feel. We “see” the stressors, and we see the emotional and behavioral responses, and we know their sources.  We know that emotions and behaviors are produced by a human.  Where else?  Anything magical or otherwise comes from Someone from another place.

2.  Stress influences our medical condition. Stress will awaken sleeping genes that carry the names of different diseases; cancer, major depressive disorder, schizophrenia, and so on.  Would those genes have awakened on their own without the external trigger flipping the switch?  We don’t always know.

3.  Because there are so many factors that influence the reasons a disease process demonstrates itself, we cannot say that it is causally related to the stressors.  Many people try to do this, and sometimes the disease’s labeled cause comes down to the jury’s decision.  But we don’t have to have read, “To Kill A Mockingbird” by Harper Lee to know that people’s opinions and judgments are biased.

4.  People try to find the reasons why.  This is natural and in my opinion appropriate.  However, where we look for the reasons for the feeling and behaviors is equally important.  Seeking accountability for how we feel and behave to come from outside of ourselves, to come from external reasons, to come from a source to fault is more often missing our chance to get friendly with ourselves.

“It just is,” as many say, and the 12-Steps would say “Surrender what is out of your control to your Higher Power.”  These are not inconsistent with owning that mental health begins and ends with Me.

Sure, there are the despicable situations of abuse, trauma, violence and other horrible biology changing events.  These are known to cause the one non-genetically related psychiatric disease process called post-traumatic stress disorder (PTSD.)  These are situations consistent with our previous post on not being responsible for our history but being responsible for our futures.

5.  Stress, other than in situations of PTSD, is not causal for the progression of mental illness.  Everyone has stress, but how we deal with it, how we cope makes the difference.  Even horrible events, such as losing ones wealth and the sequelae of it are not causal for the continuance of brain disease.

6.  Medications, lifestyle change, Love and various other therapies effectively influences the way genes express themselves, our biology, and our medical condition….

7.  …In so doing, medications, lifestyle change, spirituality and various other therapies effectively influence our emotions and behaviors.

Question: How has your understanding of how stress intersects with with how you feel and behave affected you?  Please tell me your story.

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Blog-Jacking – by Rick C.

Hi Everyone… I thought I would kind of write a guest blog today (call it blog-jacking even) DQ did not specifically asked me to do this, however, I do not have any clear recollection of her specifically asking me not to do this either. With this in mind, I would like to let you know about my unique relationship with DQ (I am just going to write DQ because I have a very limited attention span and am likely to have two or three great ideas flow through my brain by the time I type Dr. Sana Johnson-Quijada and then I also start wondering if she has a middle name too and how she fits all those letters into those forms that have the little boxes on them). Anyway… I communicate with DQ on a regular basis and get interesting insight on a variety of topics. This makes me feel unique and special until I realize that most of the people reading this have the same opportunity. Then I kind of ask myself… “What kind of group have I joined?”

To begin, I would like to talk a bit about my psychiatric qualifications. I spent six years attending college. Technically, these were at a community college, but I did take at least one psych course while I was there. In addition, I am an alcoholic and drug addict in recovery who has previously attempted suicide. I take medications for both depression and ADHD. I had to go through a variety of medication to find the right combination because almost every medication I tried made me sweat profusely and/or break out in a rash. As part of my ongoing training, I am going through a nasty divorce which has caused me to be temporarily unable to see my son or live the life that I have become accustomed to. In addition, I have just lost my job of fifteen years due to cutbacks. All of this in the same month that I turned forty and should be free to seek out a quality midlife crisis.

The fact that I am laying in bed with my shoelaces in my possession in a nice room that I am free to come and go from as I please over two weeks after the divorce/job loss week most likely indicates that I am totally delusional and only think that I am happy or that I actually am. Either way, I am content in the place that I am at. This, to me, is pretty amazing.

I am grateful for that I have been through all the things that I have been through in my life because they have given me the strength and experience to go through what I am going through. Even though I did not do real well in school, I somehow did well enough with a big corporation that they are willing to give me a severance package that will basically pay me for the next four months as long as I do not get a job or accept one of the positions they have offered me. Basically, a bunch of paperwork and legal terms that say to me “Paid, vacation!”

Being an alcoholic and a drug addict have led me to become involved in a program that connects me with others who have previously tried to use alcohol and drugs as a solution for coping with life. These people are a great source of support and experience. As for the prescribed drugs, I am not even really sure that I need them all the time; however, I sure as heck am glad that I was on them when my “Perfect Storm” kicked off. Oh yeah, as part of my challenging week, I found myself with no place to live and immediate access to very little money. A little rational thought and I realized that I have an amazing amount of airline miles from years of travel. In fact, more than enough to take up residence in a nice beach front condo for the next month.

Why am I sharing all of this? For several reasons — First and foremost, I am newly almost single and think that this is a great way to meet ladies without having to ever think about the awkward point in a relationship where I will have to explain my past. In addition, the fact that everyone here is reading this most likely means that you have experience with challenges like mine and I can always use others that I can relate to. Lastly, I have found out that when I have felt that I have a very unique situation, I am usually wrong and that I am actually just not in a group of people who feel comfortable sharing their experiences. It would be kind of cool if everyone just wore a signs with their three biggest “issues” on them. I have a feeling that if everyone formed a group with only the people who had at least one issue in common with them… we’d all be in the same great big group called life.

Thanks for reading to this point. What do you think about this? Are you female and single or considering becoming that way? Could this really be a worse idea than matchharmoneyfinder.com or whatever it is called? Keep on and be a friend to yourself and stuff.

Oh yeah….DQ, please get better soon because this blogging stuff is cutting into my busy schedule!

 

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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

 

shoponline2011.com

 

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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    Choose, Gladly, Using Resources

    Being a friend to yourself includes choosing, being glad that you can, and using resources to make your choice a good one.

    Mrs. Smith told me with a barely noticeable arch in her back that she was still planning on God healing her daughter.  I don’t know if Mrs. Smith thought about how her daughter felt about that.  Was Kristy personalizing her illness?  Did she think God rejected her?  The problem of her continued illness must show something more than a physical flaw in her perhaps.

    Will we know it when we are healed?  Until then, what to do?

    Years ago, I met Fran.  She was pulling her hair out.  Her annoyed husband disrespected her for it.  Fran kept willing herself to stop.  She said,

    I’m doing it less now I think.

    The good news for Fran is that she responded well to fluoxetine.  Her anxiety decreased and she almost stopped pulling out her hair.  She’d wear her growing bristles pressed down with bobby-pins and hide it with her long hair.  As her hair grew longer, she had fewer bobby-pins and I knew she was taking her medication.  There were other problems between Fran and her medications.  Taking medication shamed her.  And, she blamed her fluoxetine for her weight gain and rash on her face.  She felt uglier than ever in her husband’s eyes.

    I don’t pull hair any more.

    Fran stopped her fluoxetine and half her head went bald.  She did not lose weight and she still had a rash on her face.  Fran went back on her fluoxetine and she has cycled on and off of it this way over the years we’ve worked together.  Somehow despite all our time together, Fran does not believe me when I tell her that when she is better symptomatically, she is not healed.  Fran does not grasp that her behaviors come from something at a genetic level.  We can treat her, influencing the way her genes express themselves, but in her case, not cure her.

    We are a team.  She and I, and sometimes her husband, and sometimes her sister.  I give her medications when she thinks she needs it.  I don’t leave her when she doesn’t.  Either way, we keep trying.  It is very hard for Fran to know that she has not been healed.

    I don’t have many clear examples of treatment-to-cure in psychiatry.  The statistics vary between diseases as to their rates of recurrence.  The brain being human, we can yell at the serpent for our insanity.  However, in the end, here we are.  As Billy Joel says in his great ’70’s hit song “My Life”

    Either way it’s okay to wake up with yourself.

    The opportunity to choose our own answers, to decide what to do about it, and believing if we are sick or not sick  – is all our own.  These can be hard decisions but until we lose capacity to choose, we own them.  Decision making capacity of course is a medical decision.  But competency is a legal decision made in a court of law.  Having the right to choose is a beautiful privilege.  This does not mean to ignore counsel, evidence, data.  On the contrary.  That would not be a friendly thing to do to yourself.

    Self Care Tip # 75 – Choose well and be glad you can.  Be a friend to yourself.

    Question:  What do you think?  Agree or disagree.

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    Are Your Meds Safe?

    A reader asked

    …once one starts a medicinal path, would the symptoms become worse than they were before the meds if the meds were stopped?

    There are many layers to this short question.

    1.  Just the act of stopping the medication may trigger a relapse.  Cold turkey’ing is only good for stories.

    Remember that relapsing in emotional illness threatens brain health.  For example, in depression, every time we relapse in the absence of the protective effects of medication (prophylaxis), we drop faster, we drop harder, and it is more difficult to treat.  It is more difficult to get a medication response.

    Furthermore, some medications that once were effective in treating disease, loose effect if they are stopped and restarted.  Significant in psychiatry as we don’t have innumerable options to treatment.  In one move, a medication was eliminated from our treatment choices and we have to move on to others.  We now try a different medication with possibly more side effects than the one we discontinued.

    Because of this, many people who have found effective treatment choose to stay on it as long as they can.

    2.  Some medications are not treating disease process so much as they are treating the symptoms of the disease.

    For example in anxiety, the class of medications called benzodiazepines (“benzos”) is often a favorite.  Common ones in this class include alprazolam, diazepam, clonazepam and lorazepam.  There are many more.

    Benzos take the symptoms of anxiety away quickly.  They are famously called “tranquilizers” and hit the GABA receptor, the same receptor as targeted by

    alcohol. Some people say that they are like taking alcohol in a pill.  They are not all bad or all good.  However, as pertains to my reader’s question above, the answer is yes.  The symptoms might be worse after stopping them than they were before using them.  If they have been used long enough for a tolerance to develop, and/or if they were being abused, much like alcohol might be abused, than yes.

    Remember, symptoms are what we see or feel.  The disease process itself is often unseen.

    Also, because this class of medications only treats the symptoms, we know that the disease process is likely still progressing.  Then when the medications are stopped, the symptoms show again.  However now that the disease is worse, so are the symptoms.  What the medications are doing in this example is called “masking the symptoms.”

    3.  There’s more I could cover but that’s enough for any of us tonight I am sure!

    Question:  Did any of this help?  Please tell me your story.

    Self Care tip #63 – Take your treatment in comfort, but know what you are taking and why.  Be a friend to yourself.

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