psychiatrist

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The Modular Brain Doesn’t Need God?

I’ve been a little scared of losing God most of my professional education and practice life.  Everyone knows that no one can make it through psychiatry and still believe in God.  And those that do make it through psychiatry and still believe in God, don’t get it. Or so the opinion goes.

When I started medicine, I thought I’d most likely go into psychiatry.  I read my Bible every day. I was crushed by landslides of information I had to learn. With the equivalent of dirt in my hair, broken bones, and blood, I participated in prayer groups and Bible studies. I had to sleep eight hours a night.  If I didn’t, I couldn’t lay down knowledge and I couldn’t cope.  You may be one of those lucky persons who only need four to six hours of sleep at night to be human.  This an advantage equivalent to getting a silver silk parachute airdrop of food, medicine, and weapons in the Hunger Games.  I graduated from medical school and still had God.

Psychiatry residency opened up and I got closer to the the lions den.

What I found is that if you believe in God you are distrusted by colleagues.  If you believe in God you are distrusted by Christians because you’re a psychiatrist. And by Scientologists.

Innocents seem to be fine when they enter into psychiatry residency.  Then they come out totally changed. It disappoints Dad. Surrounded by cerebralists.  It changes the plans sponsors have made for the psychiatrists.  The psychiatrist doesn’t get invited to speak at church. The sponsors think they must have let him or her down.  And the sponsors thought the psychiatrists let them down.

Psychiatry is very high risk to the psychiatrist.  Why is it harder for them to keep God? It’s just generally not taught to utilize God in remedial processes with broken people. “And yet that is what God does best,” says my orthopedic buddy.  He says, “Psychiatry breaks down interpersonal relationships rather than include the spiritual. Unless the psychiatrist feels very comfortable with the healing and revitalizing powers of God, they don’t use it for themselves in practice.”  Is there a God-desensitization process built into their education.?

When studying where emotions and behaviors come from, God can’t be scaled.  There is no way to measure God.

We delve into human behaviors and emotions so intimately in psychiatry.  Once you realize that those things we used to moralize our life parameters with, once we realize that a perception of God is that “easily explained,” we don’t know what or who God is if not that.  Psychiatry deals with the mind and spirit and not the musculoskeletal world.  They are are right in the middle of breakdowns in that field where good bones and joints don’t make the difference.  They are right there where good behaviors and emotions are valued,  and explained in terms of grey matter.  Psychiatrist come to understand that everything is modular in the brain.  At that point, there is no need for God anymore.

Why do people lose God?  Parents blame themselves.  “I’ll never forgive myself.”  They know what they’ve lost.

Remember that song by Sting, “I hope the Russians love their children too“?  God v the Modular Brain might become a war.

My next book is going to be about God and psychiatry.  Wish me luck.  Recommendations, opinions, (no crude gestures,) and silver silk parachutes airdropped are all welcome.  Don’t hate me.  Keep on.

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No One is Choosing For You – Know Your Choices For Health

Yesterday we asked some pithy questions re: Why Psychiatry?  Your responses were received with gratitude and humility.  It takes courage to understand our connection with psychiatry considering ongoing stigma.  Today we’re reviewing that some and taking it one bit further.

When referred to a psychiatrist for medical care, we can feel confused.

Why is my physician sending me away?  Does this mean I’m at my last resort?  Does this mean I’m that sick?, or,

Does he think I’m crazy?  I’m not insane!, or personalizing with,

Does my physician not want to work with me?  I’m that bad of a patient?  Cast off?

Our expectations when we first see our psychiatrist are often also similarly reactive.  Maybe,

I’ll give this one chance but if she doesn’t fix whatever it is that’s going on, I’m out of here. 

I am not going to be dependent on medications!

I do not want to be made into a zombie!

Are we looking for a cure?

Also, we might be confused by the amount of time that she spent with us the first appointment as compared to our follow-up appointments.

I need to talk about my problems!  I need time!

There’s a lot to take in.

Unfortunately, when we are referred to a specialist, often our referring physician hasn’t effectively communicated as to why we are being sent there.  This is for many possible reasons, including Me not hearing him.  Many other reasons are also understandable with insight but we aren’t always given the opportunity to hear the inside story of why our physician does what he does.  That doesn’t mean we have to accept it.  But if we do, we did and it’s our choice.

Choice

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We have choices.  Before accepting the referral, we can ask, Why?  Keep asking why until we are satisfied with our level of understanding.  Schedule a follow-up appointment with the referring physician if necessary to gain more time if we think we need it.  Sometimes, despite our physicians best efforts, we won’t understand as well as we’d like and we have to make our choice with the information we have.  We can read up on our symptoms ourselves.  I read in Twitter from @NathanBransford,

The 11th Commandment: Thou shalt not ask someone a question thy could easily Google thyself.

That’s ridiculous although I cracked up.  The World Wide Web comprehensively and including Google or any other source within that World Wide Web are not designed to practice medicine.  When we read something, we need to ask for qualifications behind the author of the print, references and so forth.  The Internet is a tool worth our attention but you decide how far you are willing to take what you read before you consult with your own physician.  I think if Doctor Seuss were alive today, he’d write a book (or many) about health care; Oh The Tools We Can Use!  (Maybe Carl and Thysleroux will do a series or a post on this?  Should be fun.  – Asking, “Why?”  Becoming our own friend.  Connection.  Going towards shame, pain, anxiety.  Growing bank – and more.)

And so that brings us to today’s questions:  What choices do you perceive you have in referrals like these?  In your continuing medical care?  In your ability to collaborate with your physician?  In obtaining an understanding of your illness(es)?  Please tell me your story.

Self-Care Tip – Grow your understanding of your choices for your health and medical care.

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  3. Safety in Connections
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Why Psychiatry?

An American Lady butterfly against a cloud-fil...

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If we have ever seen a psychiatrist, then there has been some point in our lives when someone told us to go or we told ourselves.  I have some questions for you.

How did you hear about psychiatry?

What are your thoughts?

What did/do you understand?

Please tell me your story!

Self-Care Tip – Explore your connection with psychiatry.

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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

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

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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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Starting With Your Own Answers to The Big Questions Leads to Reducing Stigma In Others

Alexander Ostuzhev as Quasimodo, 1925.

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Question:  How do you see the paradigm of spirituality intersecting with the paradigm of biology?

As a psychiatrist who blogs that behaviors come from the brain and not a theater script we voluntarily revise to perform, this is a good question.  As readers, and perhaps subscribers to this same belief, this is a good question.

In church, Bible study, or circle of any kind, there are fewer things that goad me more than listening to descriptions of the moral value in emotions and behaviors.  I have found myself visiting the lady’s room more often, carousing the fellowship hall-kitchen and fridge, or thrusting myself on a poor unsuspecting soul loitering by the door with my fervent uncomplimentary words.  I do this before I stand up and pull rank on the speaker.

(I know.  The words “pull rank” sound just as arrogant, and probably are, but they were said in the heat of the moment.  Please understand that the emotion behind them and including the words came from my brain.)

It wasn’t so long ago that suicides were thought to be the ultimate separation from God.  Oh wait.  That’s still happening isn’t it?  It wasn’t so long ago that anger and sadness were thought to be from separation from God.  Oh wait, they still are.  Ok.  I’ll stop.  This is childish.

The hunched figure of Notre Dame comes to me now, ringing his bell, gazing at Esmerelda – pure heaven in flesh.  He offers up his humble life force, begging to be near her despite his biology.  He is ugly.  He is different.  He is separated by his own beliefs that he is forgotten by God.  His answer to our question is his own isolation.

This pithy topic has no boundaries across the world but yet I reduce it down to Me, one apparently arrogant psychiatrist, kicking up dirt where I stand.  I realize that the best way to protect us from stigma, to help you (again arrogant me swaggers in), is to start with my answer to this marvelous question.  I have to answer it for myself.  I have to start with self-care, spiritual care, relationship care, physical care – I have to start right here with Me.

These kinds of imposed opinions have never been reduced quickly.  We can’t take care of everyone before we take care of ourselves.  We must be patient.  We have the privilege to answer thoughtfully.  It is our freedom.  It is our right.

Self-Care Tip #193 – Answer the big questions in life for yourself, deliberately, and see that a secondary benefit is that it will protect you from the prejudice of others as well as reduce their prejudice.

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Lost But Now Found

A three-year-old labradoodle.

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What a night.  Mr. Rick C. was right.  Sometimes I do sit home and medicate.  It is not self-medicating, though, as I have my own prescriber.  And last night I was using my self-care tools to survive:  0.25mg of alprazolam got me through the first half of the night crisis, and then 2.5mg of zolpidem got me through the rest.  Despite these helpful medications, I dreamed of Timothy and Jack in the worst of circumstances.  I was amazed at how many positions a coyote could hold my Labradoodle in his mouth.  My eyes are still swollen red cherries and my complexion is bad.

Earl and I were not connecting.  Who does when they are afraid and grieving?  I simply told him,

Sorry honey.  I’m no good.  Can’t connect.

Earl is gentle.  He responds easily to words.  He doesn’t react easily to negative emotions.  He is a wait-and-see kind of guy most of the time.  His eyes are not red this morning.  He did not medicate.  He did not make this about him.

We made forty flyers describing our Great Pyrenees Jack and Labradoodle Timothy with our phone numbers and including a lucent plea for anyone to call if they saw them.

Our three kids in the mom-van, I planned to go door-to-door and harass people – I mean ask people – if they knew anything about our dogs.  We first targeted our neighborhood mailboxes where there is a bulletin board for community announcements.  I lifted my flyer to staple in front and center position and, “Darn-it!”  My kids had broken my stapler.

Pyrenean Mountain Dog

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While banging my stapler on the wall, I noticed another white sheet flyer.

2 White dogs found!

More tears.  I called the number and blubbered.  The woman was comforting me, suggesting more alprazolam and a good psychiatrist she knew.  Our dogs were happily frolicking in her back yard with her two German Shepherds.

Timothy and Jack are home now figuratively and literally in the dog house.  We have a dog trainer, at much expense, coming tomorrow to help us.  We will also be placing an electric wire around our fence before the rest of our neighbors cement a reactive opinion about us.  Although our dogs are important, we hope to live here a long long time and don’t want to be picketed out of the neighborhood.

Thank you so much everyone for your kindness, for your empathic responses and patience with your own Dr Q.  It was a large blessing for my fragile self last night to know you were all there.  I hope that blessing comes back to you.

Keep on!

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Courage to take medication

So when is a psychiatrist going to get around to talking about medications already? Nobody really wants to take medications. But it turns out in this world that our brains are just as human as the rest of our bodies. When they get sick, what does it look like? Behaviors and emotions. Our brains are not hovering over us like a supernatural aura. When our brains get sick, our behaviors are in the fist of control about as much as our liver function is.

The people I see in clinic are some of the most courageous people I know. We find each other at an amazing time when they are aware of their plight, that of being disconnected from their journey. They are humble people, willing to consider that behavior is more than something the “will” or “force of character” can control. They use as many healthy means they can to get healthy. They believe that you can’t give what you don’t have, even to yourself.

Counterintuitive to culture and prejudice, taking medication is an act of courage.

Self Care Tip #11 – When your emotions and behaviors are messing you up, think of the many modalities to getting healthy, including meds. Be a friend to yourself.

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