What is your daytime energy like? Alertness, attention, and memory? Do you sleep well in relation to this?
Please tell your story. Keep on.
This post is a simple plug for one of the best things I’ve ever done for myself.
You have heard me talk about neural grooves and changing habits such as those that are not friendly to Me. In a post, “Pay a Dollar,” I said,
When you feel trapped by your own self, get friendly by remembering this. You’re mistaken. You’re talking about a brain groove, not a vampire. It’s not hopeless. Not much more, not much less than what it is. A groove can be abandoned. New paths can be made and when the stressor hits next time, you will have a longer moment to decide on which behavior to play. You will have a choice and you will realize more often that you are not trapped by what you thought; you are not hopeless and ugly.
So how long does it take to form a habit? Or break one? To change neural grooves in the brain. Many say, twenty-one days. Others say, you have to do it every day for a year.
This game, StepBet, is designed to get us moving as a habit. I’m loving it. I invite all my patients to join me. My team. My friends! I’m not leaving you out! Smile. Check it out.
You put $40 up that says you will walk a determined number of steps every day, except one, each week for six weeks. If you miss a day, you lose your forty bucks. Some days, I start thinking, …”It’s just forty dollars…(whine – a long high pitched complaining cry.)” The money from those who don’t make it to six weeks goes into a kitty and later dispersed amongst all those who did. Yah! So fun!
Please join me, and let me know how it goes for you.
How StepBet Works
1. Get Your Goals
2. Place Your Bet
3. Step it Up!
Question: What do you do to be kind to yourself, habitually? Please tell your story!
Living with someone like tomorrow might be their last is much harder to do when it is actually the case.
My dad told me, after my nine-year old niece died, that a parent should never outlive their child. When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.
When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.
My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying. He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.
The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character. He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.
Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?
Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.
In Life and Other Near-Death Experiences, by Camille Pagán, Libby Miller decides to live, just live, rather than die perfectly. And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.
Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.
Question: How do you “live well?”
We were experts, as 7th graders, in anticipating what phone calls would be about. I’m surprised we never got around to making bets. I missed my chance to be a bookie. When the phone rang, it could mean someone was in trouble and had to go to the principle’s office.
Everyone was quiet waiting to see if their name would be called. No. That wasn’t it.
It could mean there was a school announcement. It could mean there was something wrong with our bathroom plumbing! But it had never meant that a space ship had exploded. Seventh grade was not the time to grasp what this meant. If we couldn’t grasp it, if our perceptions were unable to see it, then it could not actually exist. Right?
We kids had other things we were trying to sort out. Boys and girls. Getting your period or facial hair. Zits. What Melissa said about you when you thought she was your friend. These were space occupying in our minds. There was little room for understanding that this phone call announced the end of 8 lives, a billion-plus dollars blew up, nor especially not what it meant politically! Spouses and children, watching and cheering in the bleachers live, front row and center, witnessed as their own individual loved one exploded into tiny particles.
Mr. Clark walked, white-faced and perspiring, to the radio, asked for silence over the hum that had built up, and we heard. The challenger, the 8 people aboard (one of them a teacher), in 1986, was gone.
A spaceship exploding is about what anxiety feels like. That may sound extreme but it is the truth. And those who have experienced it, as if their were going to come apart, will do anything not to experience it again. This urge to avoid anxiety expresses itself in emotions and behaviors. But often, when anxiety doesn’t reach a full explosion, the afflicted individual doesn’t even know that they are sensing the urge to avoid, nor how they are responding to this avoidance. The afflicted person and those who know him get think that these medical symptoms are actually the afflicted’s personality. “It’s just the way I am.”
You may be someone who feels inner congruence with decisions. By temperament, you like closure! But even so, against your own hard-wiring, you find that you have trouble making decisions. How you talk is driven by indecision. You’re couching what you say, being careful. Your self-esteem erodes.
Manuel had some similarities to this, but also, on top of his medical condition with avoidance symptoms, his personality was one that got energy from being alone. That doesn’t mean Manuel didn’t like people or interpersonal relationships. It just means that he got energy from being alone. And he did stay alone most of the time. When around others, the energy poured out of him like lemonade through an open spigot. However, he wanted others. Being lonely was not his goal. But there he was, more energy when alone combined with a thrumming buzz of nerves when he tried to make friends, when he tried to date, or when he was approached by someone spontaneously in public who asked the time.
Fudge! She only wanted to know the Blinking! Time! he screamed inside.
Manuel had some friends with whom he was deeply bonded to by shared experiences. But he had gone on to college and his friends had not. It was niggling in whispering thoughts that he might still be hanging out with them because they didn’t disrupt him. Because he came apart. Terror, like a spaceship exploding in the atmosphere after take-off, filled his perceptions, if he tried to hang out with anyone else! And Manuel didn’t like thinking about his friendships that way. They lost value when tattered by that persistent wind. Nor did Manuel like thinking about himself as someone who couldn’t get other friends if he wanted to. As someone who would use the faithful. Friendship by default? No. He felt shame just thinking it and he knew it’s falseness. In his most essential self, he knew he loved them for more than proximity. But he really didn’t know if he was weak. It was a possibility. And besides! What girl would want a weak man?
People with anxiety have barriers to any number of connections in life, like coming up to an energy force field we can’t see. There are interpersonal connections we might have had, but never initiated or explored because the anxiety held you in place. This is what anxiety does to us. Anxiety takes away our freedom to choose. And as the consequences and fruition play out, we live out the related losses.
Manuel came to me because, “Mom told me I better come and talk to someone.” Mom was fed-up with his isolation, hours of video games, and she had noticed that he was spending even less time with his childhood friends.
Talking to Manuel, unearthing these patterns in his life, his insight grew a bit. But once he looked at anxiety, even with a sideways glance, which was anxiety provoking in itself, he came up against the need to decide,
Should I treat?
Deciding to treat is a decision to make between the patient, perhaps including their support system, and their treating clinician. When there isn’t a clear answer though, like a blood test that shows the vitamin D levels are low, we respond with vitamin D replacement therapy, but in these areas of diagnosis, it often feels nebulus to the patients on what to do.
When the decision doesn’t have clear form, like an undefined space, go toward the data. You may trust your clinician to know that data integrate it into all the information that goes toward deciding on treatment. Or you may choose to spend time researching and evaluating the data on your own and then go forward. Either way, if you stay with what you’ve been doing, you will remain ill and the illness will progress over time.
So either way, going with the data, either via your clinicians recommendations directly, or indirectly. Accept treatment. In fact, run toward it! You will have a much higher quality of life. And… those around you will too.
Self-care tip – Go toward the data!
Questions: What had influenced your choices in treatment or not to treat? Please tell us your story. We need your voice!
I’m enjoying this all too fast passing time at the APA annual meeting in Toronto. What I am most enjoying is the education, the community and connection with new and old friends, and the reminder of what this is all about – you and I. In honor of us, I’m “pressing” this excellent post from our national advocators and stigma-fighters at NAMI.
Check it out and let me know your thoughts. How does this resonate, or not, with you. We need to hear!
Be well and keep on!
Finished the CME talk I did last week and thought, you might find some use for it.
I’ve received bad press many times for not being, in so many words, legit or academic enough. Check out the comments on my ECT book on Amazon.com for examples :). Maybe this one leaning into that bosom of greatness will turn public opinion. (Sneeze.)
…Formatting has been a real bear.
As you go through it, please talk out. Tell me what you think. I may do it again. (That’s right. I’m not afraid to threaten. You heard me.)
Keep on, Friends.
How to Speak to a Psychiatric Patient
This is a fail safe method of communication to pretty much hit all the difficult misperceptions we are contending with in psychiatry – demonic possession, shame, violent tendencies, weak character, and poor moral choices.
I’d like to give you the 1,2,3’s on how to talk to psychiatric patients. But as I researched this topic, it became apparent that this wasn’t the direction for us to go in. You have better algorithms, systems, and manuals based on research for this in your own departments. I know you have people who are specialists in the administrative side of things.
For us today, we are going to turn rather toward the innuendos that interplay in communication between caregiver and patient.
The is the first place for us to start, let’s just talk about it here.
What is it like for you to talk with a psychiatric patient?
I: Clinician/Caregiver barriers
II: Patient barriers
III: Understand Personal Biases – Likes and dislikes
IV: Define Stigma
1. Prejudice – Attitudes, feelings/emotions (Amygdala)
2. Discrimination – attitudes lead to actions
What are our fears? Fears are an emotion and/or attitude…
Caregiver stigma – “self-stigma” comes when we internalize public attitudes and turn it onto ourselves
2. Discrimination – How we act on those prejudices.
Who has Stigma?
Everyone. It is in our community, including we who serve and are involved in mental healthcare services.
Example: Mr. Whineheart misses his medications approximately three times a week due to logistical reasons. However, we know that Mr. Whineheart has had a long history of difficulty with treatment noncompliance. As we explore further, we discover that Mr. Whineheart dislikes taking medication. It makes him feel like he is weak. Not taking his medication is Mr. Whineheart’s discriminating behaviors against himself in response to his prejudices, (emotions and attitudes of shame.)
V: What are the barriers to talking with psychiatric patients?
VI: Why bother about Stigma?
Because It Affects:
Because It Engenders:
1. Traditional agendas in the medical model:
a. Serve altruistically.
c. Serve patient (Service)
2. Traditional agendas of business
3. Quality of work experience
1. Start with Me. Own that we have stigma: prejudice and discrimination.
2. “Contact based” solutions.
3. Education (Still important and demonstrates degree of efficacy)
I never realized, until this experience, that during a full body massage, one’s “girls” seem to swell and grow,… and no, the “girls” were not directly handled.
What brought it to my attention was the door opening. That misty moment hung in the air – between the massage ending, the masseuse leaving the room, and the sheet coming off my body just before getting re-dressed. The salon’s hostess stood there and squeaked,
Oh! I sorry!
First reaction, should this happen to you, is to laugh a little. This is what you will do. “Ha-ha.” Then you will think, “What? Did I just laugh?! Oh. Those must be ‘comedy boobs.’ …Can I have my virginity back?”
And then, “Is this covered in the insurance?”
I’m simply really glad it was not more than one lady who was at the door. It could have been a crowd. And I’m not implying any of them would have liked it either. (Boys, shush. You don’t have to remind us that a male’s response to a woman opening a door on him when he is naked is entirely different.)
But I should have known this would happen. When I was being “roomed,” the hostess wandered her facility like she was on an easter egg hunt.
Is this the place? No? Here?
‘Oops! I Sorry!‘
How bout behind this door?
Yep. You got that. She did walk in on someone else while trolling around with me. I was forewarned. Yet, did I leave? No. Rather, I deferred with, “She’s mortified. This is the bottom of her career, poor thing. She’ll never do that again! I’ll act like I didn’t notice.” Optimism rears its perky head.
During our room-hunt, we came upon a large one with many cots. It appeared to be a community massage room.
These massages must be cheaper.
Because who wouldn’t wonder, “Is that relaxing?!”
Again. Males are different, I’m sure, but really. All you do is smell feet. Or maybe it’s like the swingers version of massage therapy. You might not walk out with the same wife.
Finally roomed, stripped and prone, my masseuse came in. She had such “rolling-pin” strength in her one arm… “She must work out.”
Bone…still bone. Yup. You’re still on bone.
My face went numb pressed into a doughnut, but I kept on. (I once got an award for being “The Most Tenacious.” I think I was like ten. How did they peg me?) My back was getting worked over, and I had faith, at some point, it would feel wonderful. Just like I thought no one would walk in on me and my restored, and more than, decolletage.
I never actually saw her. My masseuse. She came in, did her rolling pin thing and was gone. No face-to-face. The experience was difficult to identify. What shall we name this?
But you know the next part of the story. The door opened.
I don’t have a self-care tip to share today. It could be to go get a massage. Or not. I, with what looks like a more full than empty glass, thought this experience was too rich not to share with my friends. Keep on.
Question: When has your optimism v. pessimism steered you wrong!? Please spill. Please. Spill.