Psychology

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Exercise and the Brain – and Dancing to Enrique Iglesias

taylor swift

Greg went to arrange his annual colonoscopy.  Because he was having a chronic cough, his gastroenterologist (GI specialist) was wise enough to schedule him the “double dip” colonoscopy and endoscopy.  Greg was not pleased.  He was less pleased when Dr. GI found gastritis (inflammation) in his colon, an ulcer (inflammation) in his stomach, and esophogitis (location of inflammation intrinsic to word, esophogitis.)

I got the scoop on Greg’s inflammation story when he came in to see me, (yours truly, psychiatrist, brain doctor.)  And why?  Because of his colon and stomach?  Well perhaps.

True.  Greg was not happy.  He had not been happy for a very long time in fact.  Greg was suffering.  And no, he could not exercise.  He just could not.  Fill in the blanks of why he could not.  We have all given those reasons.

Discussing Greg’s story with him, we agreed that ignoring the inflammation story of his GI would be ignoring something that just might relate to the, “Why?” of why he was in to see me.  The same inflammatory process affecting his gut was affecting his brain, the same brain where his emotions and behaviors came from.

Inflammation.  We think about pus-filled blisters, puffy painful knees, spitting back spasms.  But do we think about frothing road rage?  Do we think about forgetting car keys in the supermarket where we bought five things we did not want and nothing of what we planned?  Do we think about divorce?  About losing our job, or not wanting to get out of bed?  When we hear about inflammation, do we think about brain disease?  I think not, Count Powerball.

The other day, we were in the Kaia, “Juicy JAM” class.  (Seriously. That is what it is called.) Coach Becca does these Juicy JAM classes about once every three to five months with us, just for fun.  It combines dance with athletics in a way that is designed to burn calories, yet effectively reduces grown women, responsible women of our community, parents, book-keepers, encyclopedia saleswomen, psychiatrists, (I am just guessing at least one of us moves like a psychiatrist) and such…, into giggling, hopping, human bumper cars.  And it is hard!  It is not easy to squat, pop, and then pull your fisted arm down super latino-drama-style over your just so angled body to Enrique Iglesias… I think it was, “Tonight I’m Loving You.”

By the time we had survived our first number, all I knew was that Becca looked really good.  Me, eh, not so much.  It is too bad we can not collect disability for this, not being able to dance.

When we dance, we do not usually notice how everyone else is dancing around us, as much as we think about how we are, ourselves.  Like any other behavior or emotion, we are trapped by our own design.  Look who is telling us that after all!  Our own brain.

Then Becca’s tattoo pokes out and we all think, she is such a bad ass!  (It’s right there just above the line of her pants.)

Where do these emotions, and behaviors come from?  Do they come from the good merit we have earned by hard work?  Maybe a really sweaty muscle bending Juicy JAM work-out?  No they do not.  You are right.  The emotions and behaviors come from our brain.  They come from that bit of us that is, after all, connected to the rest of our body.  Our body, where our muscles pump, where our pancreas balances our insulin levels, where our bowels, which flaunt the highest number of serotonin receptors of our whole selves, move and flow.  Our bodies, where nerves stop or start sending pain signals to our brain, where our heart and lungs pump all the blood that touches every part of us like a master control room – this is what matters to our brain health.  It is a relationship, like Garth will always go with Brooks.  Body goes with brain.  An inflamed body, an inflamed mind.

Now we know you are all thinking about bowels and what exercise does to bowels, and you are uncomfortable.  As you should be.  At least standing at a respectful distance.

I’ll never forget some months ago, and probably most of my Kaia-peers won’t either, when Coach Alyssa was taking us through Kaia-flow, a series of twisting yoga poses slash killer exercises.

Good job women!  This is also great for your stomach and bowels.

I thought, there-after only about stomach and bowels!  It was like a beacon.  No matter what I did, I was thinking about my gut.  And then like the answering horn of a trucker to a kid’s arm signal, “please honk,” there I went.  A slow twist, quiet music in the background, the soothing voice of Alyssa urging us on, and, honk.

There was no way to hide it.  No way to pass it off on my dog or kids or farmland creatures.  I was in the middle of the room and suddenly, like Taylor Swift on a center stage, everyone heard and looked.  Just one more bit of savory evidence that exercise decreases inflammation.

With this understanding, we can perhaps consider exercise like a pill.  Like a prescription.  Do exercise because we do what is friendly to ourselves.  Do exercise because we like being friendly to others.  We know that we cannot give what we do not have – to ourselves or to others.  We exercise because if we do not, we will be the barking mom we do not like, dad, sister, child or whomever.

We will not be nice to our partners when we have ill brains.  We will not feel pleasure as deeply.  If we are kindly toward ourselves, such as exercising, we will protect the soft underbellies of them others we love.  We will treat ourselves better.  We will.

One hour later, after dancing or twisting our inflammation, shame, and inhibitions into the ground, after passing a little gas, we are reduced to inspiration, humbly thinking, “Yes. I am that good.”  And that is the Magic there. We are bad arss.  Body meets brain meets community meets Magic.

And for you scholarly folk who don’t believe me when I say, exercise decreases inflammation decreases brain illness, here are a few articles:

Question:  How have you noticed your body speaking on behalf of your brain?  Or vice versa?  Please tell us some of your story.

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Value Yourself

tiger cat

The room is dark, shades drawn for hours. Sandra stays unwashed in her blanket.  Around her are gathering piles of laundry and stale air.  Pictures have fallen over in their frames.  Sandra hears her daughter, “Mommy, please get up now.  Let’s get up Mommy.  I want you to get up.”  Sandra’s body feels like a bag of concrete and she tries to explain this to her seven-year-old.  “I’m just so tired, Honey.  You go play.”

Days and then months go by, like this.  Some of them, Sandra is up and functioning.  But mostly just.  She finds her thoughts are not clear.  It is hard to find words, let alone anything around the house.

“Who is this person?” Sandra thinks about herself.  She wonders if her husband will leave her.  He is trying to have sex less and less.  They do not talk and she is pretty sure her last real orgasm was a year ago, Thursday.  She cannot believe he even likes her when she dislikes herself so much.

Sandra is not treating anyone very well.  She has lost what was in her bank and cannot account for her own value.

Our value is not a very politick thing to celebrate, to speak of, or to put at the front of the line, but we, individually are worth it.  Sandra is worth it.

You are worth it.

Sandra was having trouble like this.  She had been missing more and more work, for “sick days” and she was worried she would be replaced.  “Who are these people?” she wondered about her colleagues, whom she used to enjoy, joke with, and compete with.

It occurred to Sandra, at last, that everything that was worth living for was only insecurely hers.  She thought, if she lost them, she would die.  She needed to get better.  She wanted to get better.  All the way better, back to herself, funny and sexy and showered.  That would be real nice.

Sandra took, what for her felt like, a desperate action.  Sandra went to see a psychiatrist.  It was not easy understanding her treatment options but basically they came down to, medications, psychotherapy, and stimulation therapies of which electroconvulsive therapy, or ECT, is the gold standard.

To grasp what these options meant, Sandra needed to think about how long it takes to respond to treatment, the chance of responding to treatment compared with not responding, either at all or only partially, and side effects.  Because of knowing she was about to lose “it all,” (home, marriage, employment, possibly parenting rights, and more,) she decided she needed treatment that was the most likely to work and work fast. (ECT can be up to 90 percent effective in reducing the severity of symptoms.)  Sandra did not want to gain weight.  “I would rather die,” she said.  And she did not want to get other medical problems from trying to treat another.  (We call these iatrogenic, when a medical treatment causes another disease, such as an antidepressant causing obesity.)  Because ECT allowed for all these, Sandra launched her ECT index treatment.  She started in treatment even before she started having hope.  Sandra took the action she was able to, toward her value.

This a a short story about Sandra, but her story goes on in a much richer, and pleasure filled way.  I wrote her story to give you an idea of how someone who has never tried medication therapy may decide on choosing ECT as their first treatment effort when struggling with brain illness.  Because of her value.  Because of our value.

Question:  When you explore your value, what would you like to do that more directly honors you?  What does valuing yourself do for those you value outside of yourself?  How can you show that you value others but caring for yourself?  Please tell us your story.

Self-Care Tip:  Care for yourself to care for others.

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Between You and Me, Interpersonally, Do this

Between you and me

Between you and me (Photo credit: flekotech)

First, allow transparency.

Second, practice the Three C’s – I didn’t Cause this, I can’t Control this/him/her, I’m not responsible to Change it/him/her.

Third, use the Three C’s to practice presence with yourself and within the connection you seek – interpersonal or otherwise.

Fourth, move into pursuit of “Quality of Life” – what increases your quality of life experience.

Be a friend to yourself.  It starts with Me.

Question:  Does any of this feel kind and in the interest of you? and thereby, others?  Please tell us your story.

 

Related:

What Was Missing Was You  2011/01/28

 

How do we get ourselves to actually receive Love?

Pick A Love!

Pick A Love! (Photo credit: theotherway)

Despite the distance he had come, he still controlled much in his acts of intimacy.  The timing, the moves, the style, Bernard was not always aware even of how or when he called the how and when, but he did, still, on occasion, like someone with a clipboard and whistle.

He was sincere in his love-making.  It was not false.  He was even in love.  At odd moments of the day, the wonder of it would come over him.  Without forethought, he would respond to the magic and he would call her, needing her voice to reassure him.  He was in love with her and she loved him back.  The backside of where he came from reflected in his rearview mirror like inky, murky swamp-mass and his sense of salvation swelled around him.  He knew he wanted to be connected.  This was right.

Then, Bernard would be working in his shop, pressed under a cabinet, where he could reach the corner spot and she would be there.  Home from work, she would sidle up and want to …What did she want?  He was dirty.  He was involved.  He was not prepared for that.

How do we receive Love?  It is not the wanting.  It is not the need.  It is not even the availability of Love that opens us up to receive it.  Receiving Love is a quandary.

So often I hear patients complain, “I shouldn’t feel this way.  Everything is really good in my life.  I have so much.  I should be happy.  I should be grateful.”  And then they list some of these happy-life-qualifiers, and peter out into a shrug or cry before they are done.  Before either of us are convinced about how great their life is.  This list of why they apparently should receive Love is not enough to actually bring it in.

Bernard wondered how this was happening to him.  “No!” he would scream to unknown forces.  ”I want Love.  Don’t leave me!”  Bernard hated being an island.  The Bernard Island.  It had its own name.  It was landscape.

How do we receive Love?

And the dichotomy of wanting Love, of needing Love, of Love being available, yet while not receiving Love would acidly crawl up Bernard’s esophagus.  It burned.

How do we receive Love?

Love loved us first.

Love, Love everywhere and nothing to drink.  Is that the way it goes?

I propose that receiving Love is more than the perception of receiving it.

It flows across all of the paradigms and dimensions known and unknown.  Love is.  Receiving it therefore does not depend on its availability.

Our need is constant, integral of course to life’s breath.  In deep.  Out.  Love is.  Receiving Love is not dependent on our need.

Wanting Love, now that depends on our perceptions.  Knowing this, we can return to our earlier discussions on where perceptions come from – the brain and magic.  To know our want, we need both.  To receive Love, however, doesn’t depend on our wanting it.  Love comes because Love is.

Question:  How do you increase your Love quotient?  Please tell us your story.

Self-Care Tip:  Grow your Love intake.

Psychiatrist is In

Psychiatrist is In

Lucy’s psychiatry booth

Did you notice?  In this picture, the patient became the psychiatrist.

Question:  Have you ever felt like your psychotherapist or psychiatrist blurred their boundaries with you?  Have you ever struggled with your own boundaries with him or her?  Please tell us your story.

Self-Care Tip:  Enjoy your boundaries and let them lie.

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Get You Some Love

Cemetary

Cemetary (Photo credit: Vu Bui)

The ocean is like an untended cemetery, compared to my youth dives, with shoots of life breaking up the stone and dead coral.  A little family of forceps butterfly fish flutter around the tips of something brown.  I honk sounds through the water to my kids when I spy a trumpet fish, a big one, with some neon lighting up the gray long body.  My kids are so energized.

There are three turtles and I remember I have never swum with turtles before.  “Hey.  That’s cool,” I think.  I try to reconcile the turtles with the changes from when I snorkeled and dove reefs years ago, “Positive?  Negative?”  Something there in me wants to feed this info through my inner hope-machine to convince my other that when my kids swim another future day, the ocean will not be dead.  Foreboding.

I am starting to get disoriented by this and surface to get a grip. My husband pops up and I whisper to him, so our kids do not overhear and lose their energy to my negativity, “It’s like a tomb, Honey!  I can hardly stand it!”  And like a compass, he points to a better direction.  “It’s fine, Sana.  It is what it is.”  Interpretation can distort experience.

Thanks to husband and the reconnection of interpretation with presence, under water, I see this moment, this day, in the parrot fish, the coronets, and the puffers. And I, with more gravity, am able to enjoy what Love is giving now.  A solemn gift.  More informed, my appreciation is deeper and I can receive.

Receiving Love is not as easy as it sounds.  It is the work of a moment.  It is the work of a lifetime.  I am a spoiler, unable to love myself, unless I am able to receive Love from outside of myself and connect with it, in my pathway of Me-to-Me.

I am just starting to get this and am eager to understand and own more, because, this has been amazing.  This is something like how it goes so far; tense up, maybe angry Me, (reason or no reason,) pause, look, pray for it, pause, acknowledge, let it do its thing on Me. Start over. Again. Again.

In we who suffer brain illness, we who suffer cancer, we who are in the dying stage of life, in we who, we, we are in the right place to do this.  This is just where we need to be to receive Love.

Illness does not keep us from the ability to receive Love.  Poverty does not.  Dead coral and loss do not.  Nothing can.

Everything can be used by Love to communicate to us.  Illness can.  Poverty, dying, loss can.  Anything can be used to bring into our circle of Me-to-Me, Love.  Love is now.

I am glad, in age, that I am increasingly aware of the changeability inherent in everything, everything, positive, negative, everything.  This is one more way I am able to receive Love.  Age.

Being able to receive Love requires the process of changing.  It is not stagnant, stationary, unaging.  As far as we are able to understand, it is not.  We are creatures of dimension, creatures of space and time and until we are further created to receive otherwise, this is.

Question:  how do you increase your reception of Love?  How do you receive Love?  How does this affect your friendship with yourself.  Please tell us your story.

Self-Care Tip:  Increase your Love-reception.

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Fatal Game of Playing Chicken

Stubborn in a game of chicken, who will win?

“The principle of the game is that while each player prefers not to yield to the other, the worst possible outcome occurs when both players do not yield.”

chicken race

As said by one avid chicken-owner at the UK World Championship Hen Races, “Listen birdbrain, you either perform for me, or perform for Colonel Sanders.”

Sometimes it is like that between the idea of, everything starts and ends with Me, that we hold here at FriendtoYourself.com and others who say, Love God first.

So, in the spirit of hoping, and “racing well,” let’s discuss.

If we could Love another first, that would just be great.  But we can’t.  (Hear the whine? 🙂  I suppose I have made those sounds before.)  We can’t.  I think that is the curse of Adam and Eve.  We can’t love anyone truly more than ourselves.  It always comes back to me.  We can be thankful for Jesus saving those Garden-of-Edeners, and the rest of us from that lonely circle.  Jesus inserted Himself into our round and round so first, we are never alone, and second, we have Love that is bigger than any catastrophe we think we were born into or happened upon along the way.

When I was a young-in, I studied at Rosario Beach.  We took samples from the ocean and did funky things to them and finally were tested and passed the class.  In this process we studied insertion genes.  These are awesome in their changing power.  This is how mutations happen in nature as well as how we now do genetic engineering.

insertion gene

None of us, like lined up chromosomes, can insert into ourselves the ability to start or end anywhere but with Me.  But, just like the stupidity of working out before you go to the gym, we do not wait for that to be inserted into Me before we pursue Love.   Love inserts in.  Until then, the Love part is foreign to Me.  It is a mystery.  Our life journey of beginning and ending with Me is changed from the one we started with.

Like weaving in magic into the common circle that everything starts and ends with Me,…  But we are not magicians.  I am no magician, although I have watched, “Now You See Me,” 🙂 and I understand that even magicians do not believe what they do is magic.

We have often said and heard others say, “Don’t love Me first, Love God first.”   We are not worth much to our neighbor though if we do not like Me.

So basically any time on our personal life journey, we might have enough insight to perceive the Loving of another more than Me, think Magic.  Someone did you an insert.  Now, even though your circle will still end with Me, your Me is changed and connected to Love.

It is a bummer that so many of us, with inherent self-recrimination, tell ourselves and others to, “Love God first,” when we might as well demand that we do our own gene engineering with Magic.  If and/or when we do love another first, by definition, that is not about Me.

“We love, because He first loved Me.”  ‘Member?  1Jo 4:19

We can, however, enter ourselves in for the insertion.  If we do not put our name in, it is harder to get called I would think.

Self-Care Tip:  Believe in Magic to treat yourself and others kinder, with less self-recrimination, and with more hope.

Questions:  I’m still growing on this.  What do you think?

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Getting Older and Getting Born

Sana_Set09_LeoChaves_032

Sana_Set09_LeoChaves_032 (Photo credit: LeoChaves)

Turned another year over. Forty one now. Sometimes I already feel like there is a toe tag on me. Other times I ride the consciousness of now and innocence, as if I have forever to do whatever it is I am living for. As if fear did not pulse around me, as if life held no shame, then I carry my 41 years as lightly as a daughter spatters kissies over her mother’s arms.

Getting older is all the hype now. I was not alive 100 years ago but I wonder if 40 was the “new sexy” then. Gwyneth Paltrow is lovely. Me and Gwyneth. We have so much in common.

Huffington Post featured 30 Celebs Who Are Aging Gracefully. Tina Turner, Sting, Sigourney Weaver, the list is full of real people sharing our life-space. Remember Working Girl? Boom.

I look at my parents, friends, patients, myself, strangers on the street and stories that symbolize a person’s life lived. I look and I think of someone who climbs Everest. I think of frostbite. I think of a long long journey. I think of death.

The day before my birthday, the excitement made waiting too much to endure. A small chocolate bar, a handmade card with misspelled words and two tightly folded dollar bills disregarded the calendar date. Neatly arranged on my night table, I was told by their giggling toe-toe hopping agents, “Happy Birthday tomorrow, Mommy! I’m so glad you were born!”

And I was born again. Just like that. Love labor.

Some women have birth the way it is supposed to happen and others suffer. After my third child, my OB-Gyn, I love that woman, told me with nothing more than fatigue and honesty, “Sana, you should probably stop at three. Pregnancy and delivery is just not easy for you.” My pregnancies and deliveries were not that easy for her either.

Our rebirths also come easy and come hard. We almost die. We cruise through as if we were made for it. “She was made to have babies!” (Dodge the loogie I cannot help but hurl. Damn those women with baby-making bodies!)

I know we think things like this about people without brain illness, (if they even exists.) Maybe we think they do not have the suffering we do. Maybe we think we have it worse. We think at least we are misunderstood, when we hear,

“Get over it!”

“Just calm down!”

“Would you relax?!”

Breath. Yummy. How we love that. The list of these is longer than the path up Everest. And so helpful. Who has actually calmed down when told? Notice the exclamation points. Exclamation points symbolize emotion, in case the mountaineering porters saying the helpful emotion-directives did not know.

During our long long or short journeys we get to be born once, twice, forty-one, or the last time, because of Love. We do not get a Love that is measurable liquid or linear, like Time. Love is not healthy or unhealthy. It does not curl into our DNA, and is not dispensed by privilege. Nor a jury of Sherpas. Calm down.

Love is. Love is, and Love offers us a newness over and over and over and over because.

We have different birthing experiences, but I am glad you were born. You are loved.

Self-Care Tip:  Allow Love to bring you new beginnings.

Questions:  How has birthing gone for you?  What have been some of the new beginnings you knew Love brought you.  Please tell us your story.

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Use something other than your condition to mark your value

typical American family, September 1940

typical American family, September 1940 (Photo credit: austinevan)

I do not really want to examine my faith.  It is just a paper flower.  Where my faith comes from, now that excites, like a outlet into energy.

Watching, The Grapes of Wrath 1940 drama film directed by John Ford, tonight with my family, we all knew that we were frail, one or two missteps from disaster.  One of us asked,

“Why wasn’t it a big deal when someone died?”

Oh, but it was.  The people were breaking, could barely dig a grave for their family member, and that may have come across to a youngin’ as if they did not care.  When we are breaking, we look at life differently.  It is a big deal.

Casy says it at Grandpa’s burial, “All that lives is holy.” Chapter 13, pg. 184

I see this in patients sometimes.  People who are done with the bull.  People who know that whatever it is they thought was so great about themselves is just rubbish.  People who know they are more than the sack of skin that holds their fire.  These people are looking for where their life comes from, for a moment of realness to fuel on.  And these people taking medications, getting electroconvulsive therapy, dialectical behavioral therapy, scraping at life to survive, these people are.

However, we do not really want to examine our hard work, though it is so close to what makes life great.  Our courage and grit rises up like a green mountain.  Where our grit, hard work and courage comes from, that is Holy.

There is strength and Holiness there, no matter about our condition.

Question:  What is special about humanity?

Self-Care tip:  Use something other than your condition to mark your value.

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A Note of Thanks For Collaborating

typewriter 1

June 30, 2013

You
Friend to Yourself
Colleagues
Practitioners
Referral Sources

Hello,

I just wanted to send a note of “Thanks!!!!”
Thank you so much for including us in the care of your patients.  I hope we continue in your and their trust.

Practicing variety psychiatry brings me toward my quality of life experience and I am grateful.  I am not alone in this but blessed to be included in a fantastic team and community of treatment providers.

We believe passionately that our own quality of practice experience is the first step to engaging in a patient-doctor relationship.  Connection brings change and so our patients become a changing force in our lives with their courage.

Our patients work through multiple modalities, pressing toward healing and presence with electroconvulsive therapy, treatment-options awareness groups, medications, psychotherapy, and homeopathic remedies.  If there is more we might benefit from in practice, please let us know.  This is a life-journey we are honored to share.

Keep on.

Dr. Q

951-677-2333 ECT Centers, Medical Director
PrimeTelepsych.com Personal cell available, Concierge Telepsychiatry
951-677-2333 Treatment-Options Awareness Community Groups
800-670-4960 Pharmaceutical Research, such as, for those who cannot afford care otherwise – Principle Investigator
PatientFusion.com or (951) 514-1234 Outpatient Psychiatry Clinic
FriendtoYourself.com Us, you and I, Writing and Public Speaking

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A Young Man’s Wrenching Journey

Children!

On Jun 18, 2013, Anon wrote:

Hello Dr. Sana L. Johnson-Quijada,

Thank you for coming to talk to share some of your experiences and views associated psychiatry. I am sorry I have not emailed you sooner.  This was my first year taking three sciences and when it came time to study for finals, I pretty much ignored everything except school.

Thank you for giving the class and myself some exposure to psychiatry. Your talk was very intriguing, especially how you see a person, in particular how their brain health affects their personality. When you started to talk about homelessness it brought back painful and confusing memories from my childhood.

My parents divorced when I was seven and the majority of my time was spent with my mother because my now deceased father had a difficult time keeping a roof over his head and doing the activities of daily living. When I was a little older I even loaned my dad some money when his car was impounded. I could not understand why my dad was in the situation he was in and why I was seemingly more capable than him. I loved him very much and wanted to help him in any way I could.  But in the end, I could not make any of his decisions for him.

My older brother is living in a shelter and he reminds me of my dad in so many ways. When we lived together, before my parents divorced, my brother was just about as hard to get along with as my dad, and my dad was physically abusive to him. I was so confused and could not understand why we could not love each other or ourselves. My dad’s incessant fear of doctors and my brother’s fervent choice to self medicate only complicated the situation we were in.

My heart goes out to my family and people like them and I have a strong desire to help people. Your short talk resonated with me and I was intrigued by psychiatry because I thought it might be a way for me to help. How do I learn more?

Sincerely,

Anon

On Jun 18, 2013, at 5:16 PM, Sana Quijada wrote:

Hey. So good to hear from you. I remember you well. Sniff. Big hug. You are not alone, dear man. 

How to learn more?  Hmm. I would start by attending some local NAMI meetings. Follow up with me in a bit after you do and we can keep the lines open and ideas flowing. It is an honor to connect with you. 

I celebrate your focus and completion of finals. 

I would love to post your email letter on FriendtoYourself.com … 

Your story is seriously powerful.  As my six-year-old says, boom! Smile. 

Till next time,

Sana Johnson-Quijada MD
www.FriendtoYourself.com

On Jun 24, 2013, at 5:00 PM, Anon wrote:

Yes you may post my email I feel honored. It took a lot of courage to write and I am glad you were receptive.

This is a "thought bubble". It is an...

Questions:  How would you recommend a young person find out more about psychiatry, before pursuing years of study?  How did you investigate your profession before committing?  

How do you talk about your family of origin history?  How do you find the courage to share these things, to find community in what hurts?  Please tell us your story.

Self-Care Tip:  Find the courage to connect with others and your story.

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Talking about God in Medicine

train hopping
Why don’t you talk about God more?

This question is familiar to me.

People think that with as much as I see and am seen by, as a psychiatrist, I do not feel awkward.  Not so.  I can face all manner of dragon, beast, friend or foe, but put me with a Christian who wants to know why I do not talk about God as much as they think I should in my medical practice, and I become a wet-eyed girl again, hopping from foot to foot.

This would never have been a question someone would dare have asked Kreplin or Bleuler.  But then I am not Kreplin or Bleuler.  I get asked.  Kreplin and Bleuler would not be caught discussing psychiatry casually nor personally.  I do.  In the history of psychiatry, what has developed the culture of our practice, we have biases toward the practicing of medicine without bias.  I am biased otherwise.

Conversely, the culture of Christianity in our generation is that we do almost the opposite – nothing is not about Christianity.  Everyone is a creation of God so that makes it everyone’s business.

You can see how there is a tension between countries and I am a train hopping hobo.  You know the risk in train hopping, do you not?

Why don’t you talk about God more?  (Hop! Hop!)

I tried to explain this to my Dad.

“Dad, so many people, who have been hurt, perceive that the trauma related to God.  The Christian language, is for them, a wolf in sheep’s clothing and can be activating.  So many people are confused about God and I’m not to confuse them more.”  This is consistent with the culture of psychiatry and standard of practice.

It is uncomfortable on even a more personal level though.  Being Christian means that God and I are united, married, intimate and there is not much more personal than that.

We have discussed before the difficulty in describing behaviors without tagging them with a moral quality.  This is important in part because our emotions and behaviors come from our hard wiring, our temperament, not from a stick shift or consistently from choice.  We intuitively think that what comes naturally from our personality is a thing of rightness or wrongness.

We have explored that emotions and behaviors come from the brain, a human organ, and not Jerusalem, or the city of Oz.  Emotions and behaviors come from a human organ, tissue matter, and are symptoms of the health condition of that organ.   Emotions and behaviors sometimes come without invitation.   When our brain is not healthy, what we feel and do that is not friendly to Me or others are symptoms of that illness.

So now when we describe God, a very personal, intimate union in us, we oft affect our humanness.  If I describe my perception of God to another, there are huge personal implications.  Maybe that person does not want an intimate relationship with “Someone” who has my personality traits, my temperament, and as generated by the condition of my brain health.  Maybe that person might feel violated rather than be in a patient-doctor relationship.  Maybe that person might afterward, as I have felt when others described God to me, think they need to take a good hot shower or at least wash their mouth out.  Icky.  You think?

One of the reasons I love the writing of King David is that he just tells his story.  Not much more convincing than someone’s story.

The Lord is my Shepherd.  I shall not want.  He maketh me to lie down in green pastures.  He leadeth me beside still waters.  Yea though I walk through the valley of the shadow of death, I fear no evil, for Thou art with me….

sheep

Nice.

When a patient is in treatment with me, there are unique moments that come and go when my story comes out, but it is not standard.

Why don’t you talk about God more?

So there you have it.  That is why, for now.  I hope to grow and assume this will not be my opinion nor practice forever.

And between me and thee, at Friend to Yourself, we are also still figuring this out.  Together.

Questions:  Do you wish your physicians talked about God more? or less?  Why?  How has it affected your treatment?  How do you wish it would change?  Please tell us your story.

Self-Care Tip:  When people talk about God, or hurt you and you believe Christianity or religion is involved, remember they are human, not God.

(Even me!  lol!)

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Feeling Trapped is Doom

Freedom

Freedom (Photo credit: Intrepidteacher)

Did someone put a knife in my neck?

Goodbye sex.  Goodbye flirting.  Goodbye self-esteem.  It was a down-right turnoff for life, let alone sex.  He could not think of one thing worth living for, but killing yourself turned out to be a lot harder than self-loathing.

Sheez, pain was distracting.  Unable to work out in his club with anything that jiggled him waste-line and up, Monty knew he should look for a pool but he could not focus on even that long enough to Google it.  He felt guilty and then angry that he felt guilty about something he was trapped by.

Monty told me about how his life was now closed off from everything he found pleasure in.  He described his circumstance like a walled in monk with a small envelope-sized window through which he received water and bread.  The difference between him and the monk was that he did not choose to be cloistered.  He was a victim of his injury and nothing could help.

Feeling trapped is doom.  I listened to Monty describe his life without freedom to choose. His life was not there for him to participate in.  He was excluded.  Monty was doomed, per Monty.  So what was the point, indeed?  What was the doom-script doing for him?  Was he getting anything besides yuck from it?

Monty, the way you describe yourself does not have any place for you.  Either you really are trapped, or there is a door, or a false wall, or a sun-roof that you do not know about.  Or maybe you have a brick-braking tool available?

People from every point on the spectrum of brain illnesses defend their position of entrapment with more volition than a the red-tailed hawks flying above the groves around my house.  Even family members of persons with brain illnesses have defended the perception that their loved one does not have freedom to choose, as if suggestions of freedoms were the essence of social injustice, ignorance and stigma.

But it is not the pursuit of freedom that traps us. It is our fear.

Feeling trapped serves a purpose however.  It protects us from something that feels shameful.  It protects us from that which invokes fear.  Wanting not to feel shame or fear is not so wrong though, is it?  Wanting not to go toward what might be unbearable seems reasonable to me.  If it were truly unbearable.  If it were friendly to Me.  If it was not the road out of that hell-existence, out of that bricked in crypt, toward a place of greater safety.  If then, it would not be so bad.

Self-care tip:  When feeling trapped, do what does not feel safe and go toward your shame and fear.

Question:  How have you been able to find freedom in places where you feel trapped?  How do you manage to go toward shame when you feel so much fear?  Please tell us your story.

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Just Left of Center, We Celebrate You

Base on balls

Dear One, (You know who you are)

Congratulations on this life-milestone.  Congratulations on what you have come through and what toward.  Congratulations on being connected.  Although you walk, you do not walk away from your life journey.

There are other crossings when we all step away from our life and look on at a safer distance, binoculars in hand, because not to would bring the apocalypse, or at least frizzy hair.

peruvian casi-frizz

peruvian casi-frizz (Photo credit: casimira parabolica)

At this time we see that you are more than a spectator, more than a narrator or a newscaster, not a stranger to yourself described in shame-filled words and judgment, as if you were the sum of right or wrong.  You are, at this intersection, more than your performance, behaviors and emotions.  You are.  You are more.

Some other day, you may find your binoculars again.  You may need them, and that is what it is.  Not good or bad.  For our part, we will celebrate you then too.

We are blessed.  All this that you are is a benediction for us; the walking, breathing wonder of what comes from Love.  We, as might anyone connected to Magic, bless you in return.

“Keep evil away.  Keep walking in Love.  Bless.”

Congratulations for your proximity to what is difficult, for working hard to love yourself, for finding your specialness in more than what hurts in you.  You are special.

You are special, like a seed or a grown and aging tree.  You are special, like San Francisco is in summer or Australia at Christmas.  You are special, like the worst of us.  Like the best, you are special for more than your imperfections.

You stand, with us, just left of center.  We celebrate you.

Self-Care Tip:  Live a celebrated life.

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Brain Health is A Tool

Red

Red (Photo credit: tankgirlrs)

Bernice flushed.  A pink perfused her face and neck.  Her eyes looked away.

Why don’t I feel better?

Bernice was one of those fortunate lasses who flushed and blushed no matter what emotion she experienced.  When I first met her and she told me some of her story, she was also a-flame.

I’ll do anything to feel better.

She though she was feeling bad because her husband did not love her.
I knew, however, that this was not why.  She did not understand why she was feeling so bad.  It was a conundrum to her.

She began intensive psychotherapy and pharmacotherapy.  In two weeks, she forgot she did not want to live.  In four weeks, she remembered why she did want to live.  In six weeks, she liked herself again.  She was still blushing, but she was alive and well.

We sat separated by a small desk and laptop.  I was typing notes and watching the pink bloom.  Too sweet.

Why do you think you feel better, Bernice?  What is making the difference?

We all know something about the relationship blood has with the lung and heart.  We know that all the blood in our body flows through those two organs.  They are the hub of our body, the authority of the blood communication.  For better or worse, they are also a filter.  Pollution can clog them, hence heart attacks, cancer.

So with emotions and behaviors, we know there is a grand central station where they come from.  Things that assault the hub such as a a death in the family, similar to a glob of cholesterol toward the heart, stress on us affects brain health.

Red hair distracted me from these thoughts.  Bernice had a lot of it.  Irish I guessed from who knows how many generations back.  I remembered the red-head girl who won the beauty contest my Mom forced me into when I was ten.  Awkward.  I pushed my focus back.

Irish Bernice had experienced what happens when we approach healing at the central station of behavioral and emotional illness.  The brain.  She stumbled, trying to explain her story, although, intuitively, she had insight into, “Why?”

I don’t know!  I’m trying hard to be mindful and I’m treating my husband differently.  (I.e. They are having sex again.)

She paused and her face reddened.

Well, I really like my meds!  I think they help a lot too!  I am feeling calmer and I don’t cry as much.  I’m sleeping through the night…

She peetered off into her averted gaze.  I wondered that the conjunctiva of her eye-balls were still white, inside the almost crimson lid and cheek around them.

We with Bernice ask why the medical paradigm including psychotherapy, nutrition, exercise, community, medications, ECT, is the best way to healing a sickness.  It is not about the healthy exercise in itself.  It is about what all these have in common.  They all act upon and draw forth emotions and behaviors from the brain.  Their vital exchange with our brain, the grand central station, are much better understood when we start with understanding of what brain health offers.

Self-Care Tip:  Use brain health, as the grand central station of Me, to handle the multiplicitous paradigms that make us who we are.

Question:  Is it helpful to use brain health as a tool toward who you consider yourself to be, rather than a definition of who you are?  Does it influence where you spend your energies?  Your blame?  How you approach shame?  Your hope?  Please tell us your story.

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Planning helps, even on vacation

A boy in a children's swimming pool.

A boy in a children’s swimming pool. (Photo credit: Wikipedia)

It is amazing how little time there is to write when living through a day as perfectly uncomplicated as string cheese, reading books and guarding the swimming pool.  In between this higher living, I have been thinking and thunking about what we will say to the university folk about psychiatry, but it has been as if space got in the way of clear thought.

I took a nap, but when I awoke, although rested, there it was.  The space and timelessness of no schedule plugged up whatever clever thoughts were waiting to come.  It was like those expensive tires that patch themselves when you ride your bike over a nail.  I imagine there is green foamy stuff all over my brain, stopping up holes where super thoughts might have tried to pass through.  And before it could be clearly grasped that this was not accidental, that these thoughts were wanted, indeed solicited and not hot air, wouldn’t you know it!  The day is over and I am flattened.

And so for tomorrow I am planning, rather than hoping.  I plan to write.  And I know when too!  And it will not disallow the necessary open space.  I will write and have my space with it.  My cake and eat it, you know, or some other sort of adage to explain that planning can enhance and add much flavor to the space of time around us.

Self-Care Tip:  Plan for what you want to do.

Question:  How does planning improve or diminish your space?  Please tell us your story.

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Live with an agenda

dionna, 1991.

dionna, 1991. (Photo credit: paul posadas)

The blue dragon lifted her head from near-sleep.  She knew.  Pouncing onto the rocky ledge gave her the advantage.  No one would challenge her.  The fresh corpse was for her alone.  As she ate the remains of Dionna, the red dragon who had never flown, the memories of Dionna infused her.  The blue dragon in this had saved those memories and would live them into the forwardness of time.  

Why is it that we repeat the mistakes of our forefathers?  It would be nice if we could somehow be able to capture their hard-earned life experiences.  If dragon lore were true, perhaps.

In Papua New Guinea, Congo, cannibals on the Disneyland Jungle Cruise and who knows where else, eating brain to preserve the life force, save your daughters or avoid the mistakes Dad made gets you a bad and yucky disease called, kuru.  Nothing good comes from eating brain.

And so the blue dragon, whose scales shone in the morning sun, began to tremble and seemed confused over the years.  Her brain got holes like a sponge and she laughed at inappropriate times.  

We just cannot get a leg up on wisdom and experience.  We are not made for it.  Each of make our own mistakes, have to work our own fingers to the bone, and other knowing clichés that in this case just are the darn truth.

What blue dragon and kuru are trying to tell us are that the agenda Love has for us is not to build up experiences like some sort of mental tower of babel.  It is not about the mistakes.  It is about our life experience.

We cannot help but wonder, though.  After working in psychiatry for these many years, I wonder what a joy it would be to give that experience, knowledge, skill of practice and such to my daughter some day.  Ah.  As if it had its own life force, passing it on to my daughter feels like a bit of immortality.

When I die, just eat my frontal lobe, darling.  Not the limbic system.

We are meant to live.  In that living, we inevitably repeat foibles and build up muscles and manage to survive all kinds of suffering.  In that living, we are beat up and rejected.  We are perfect.  We are flawed.  We are marvelous.

Maybe the agenda is not to get it better with each generation or to get it right.  Maybe the agenda is to live.

Question:  Have you ever been frustrated at how quickly your gains in life will be/are lost?  What is the agenda of your life?  Please tell us your story.

Self-Care Tip:  Live life with a quality-experience agenda.

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The hard work of being friendly to Me – talking about ECT

i take drugs

i take drugs (Photo credit: the|G|™)

I give a lot of talks in my community on understanding electroconvulsive therapy, (ECT,) as a treatment option for brain illness and I am finally able to bullet point most of it.  It has been and continues to be a long love-labor I am honored to be involved in.  (It looks so simple! – Not!) These seven points, believe me or don’t, represent many hours of research, training, practical experience and time looking into my own motives of interest.

Even here! everything starts and ends with me.  Ah.  So sweet.  😉

drum-drum-drum-drum… rollllllll!

Number 1.  20% more effective than medication at any point in treatment.

In other words, if it is a first episode or fifth episode of brain illness, ECT is 20% more likely to get a positive treatment response than psychotropics.

Number 2.  It starts working in 1-2 weeks, versus medication therapy takes 6-8 weeks.

Number 3.  It does not touch the body systems – does not affect metabolism, heart, weight/appetite, sex drive/performance, cause dry mouth, or vomiting and diarrhea, life-threatening rash or anything else common or bizarre side effect to the body.

Name it, imagine it, confabulate about it but ECT does not do that to your body.  It does not touch the body except the brain where we are trying to make therapeutic changes.

Number 4.  It is the gold standard in pregnancy and peripartum for the same reasons – does not touch the body systems.

For the fetus – there really are not yet any psychotropics that are considered “safe.”  Even serotonin agents that once were the go-to pills for Ob-gyn physicians, are now known to risk increasing bowl irritability, lung function problems and possibly even heart disease.

Number 5.  It is the gold standard in the elderly for the same reasons – does not touch the body systems.

As we age, medications metabolize differently, interact more and cause a lot more life threatening side effects.  Even medications we’ve been safely on for years, one day, cause dizziness and falls.  Out of the blue, we start having nausea.  As if betrayed by an old friend, we don’t metabolize them well, our organs are sickened by them, we develop kidney disease.  Etcetera.  It goes on.

ECT does not.  ECT does not do any of this.  It does not touch the body systems.

Number 6.  ECT has been around for eighty years.

That is a big deal.  That is helpful if kept in mind when we consider if it is fad, a gimmick, secondary-gain driven procedure, motives for treatment and other concerns against its use.

So often in practice, we thrill at the medication samples in their shiny colorful boxes so well marketed with commercials on the television to support their use.  Our physicians pull their drawer out and present them as a new chance at treatment response, which they are.  These medications have been around for how long though?  Surely not eighty years.

How long does their patent last even?  Eight to ten years maybe.

What will we discover about study-medication-X over that amount of time?  Maybe nothing dangerous or too intolerable   How bout eighty years of time?  Still, study-medication-X might remain in a relatively safe category.   Maybe.  Or not.

Most medication trials, to get a medication legalized in the USA, are designed to study medications for about 8-12 weeks on any one patient.  Many trials are done over years, and they are compared with each other using complicated mathematical statistical analysis and governments.  It is not bad and I am grateful to be a part of this community of physicians who studies and prescribes medications from this pool of treatment options.  Still, I think how despite the huge number of persons who received this study-medication-X, none of them were individually treated with that compound for very long.

Deciding to launch a medication into the community is based on this.  Once it is on the market, data is collected and made transparent to the community progressively thereafter. But initially, we are making our decisions to use or not to use with this at our spine.

Shiny boxed pills with a few years gathered round them at most of information from individuals who probably used the study-medication-X no longer than several weeks total, verses, ECT that has eighty years of transparent data regarding what we want to know – side effects, efficacy and any other sense.

Can’t poo poo that.  Eighty years has its own kind of luminescence.

Number 7.  ECT works by changing how different parts of the brain communicate with each other.

ECT “turns down” those areas that have overreactive connection.

It turns out, this is similar with how medications work for brain illness, but without the medication side effects.

For a long time, stigma-related opinions about ECT exposed that we knew ECT worked but did not have studies demonstrating how.  That is no longer true.  This is an important milestone for the history of our treatment choices.

None of this is to say that one person’s choice of treatment is superior to another or not.  Rather, the import of this is that ECT is underutilized largely because of ignorance and stigma.  Not that it is qualified as better or worse.  Better or worse is the opinion of you and I with an informed consent.

Who are we to say that a side effect of ECT is more worth enduring than those of one medication or another?  Only the patient can say this and then how that side effect(s) compare for her against the benefits received from treatment.

However, psychiatry is not an area of medicine that yet has a huge array of treatment options.  To obscure one of this caliber, life-saving heroics and life-changing import is a huge loss.  ECT is another paradigm of treatment.  It is not an either/or.

Oh, but to share in what this does, mmmm.  That gives Me a sense of value, connection to you and improves the way I care for my professional and personal self.  Rich.

Gratefully,

Dr. Q

Self-care tip:  Share in what improves your sense of value, connections and the way you take care of yourself.

Questions:  I’d like to continue to improve this.  Any suggestions?

Does any of this ring a bell in your mind of something important to you?  Please tell us about it.

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Getting Yourself Healthy Protects The Freedoms of Others

hey if you are too stinky we will ask you to l...

hey if you are too stinky we will ask you to leave not really sorry (Photo credit: stevendepolo)

Some of our most difficult cases are when we, the medical care-givers, think we know better how to take care of someone than we do take care of ourselves.

When a person maintains decision making capacity, but whose brain health disables them, if we care, we care.

Monty was one of these.  He was ill!  He was ill on so many tectonic plates, no one near him could keep their footing.  His quality of life wasn’t what he wanted.  He was disconnected from meaningful relationships.  He was suffering.  However, he couldn’t decide to engage in therapy.

Monty wanted to go “natural” but couldn’t name any natural therapies he’d be willing to try.  He didn’t want to continue suffering, but couldn’t accept medications “just yet.”  We went into one option after another, invested time together learning about brain illness and coming to terms with the biological involvement in where emotions and behaviors come from, and we did it many times.  Monty had a full informed consent.

Deciding not to treat or to treat is not easy for any of us.  Watching Monty step away into the foggy chaos of sex abuse and obsessive compulsive rituals was really hard.

We fight for our freedoms when we fight brain illness.  I suppose we fight for the freedoms of others as well, simply by taking care of our own selves.  Letting Monty choose even when his choices are affected by his illness is still his right and I defend him.  We all who take care of ourselves have more to offer Monty than if we didn’t, including a defense against the losses that brain disease brings – like processing information.

I’m not sure yet how to explain how taking care of ourselves influences the freedoms of those around us who are less inherently free by brain illness.  I suppose like anything good, freedom is contagious, a little bit of light in any room, Love being stronger than death and the Gettysburg address – this is along those lines.  It makes a difference to the Monty’s out there that we all take care of ourselves.

Self-Care Tip:  When frustrated that you can’t help others, get yourself healthy.  It’s contagious.

Question:  Have you been in the place where you thought you knew what was better for someone else then that person’s own choices?  How did you deal with that?  Please tell us your story.

Recommended Reading:

Why not skip medication And Go Natural?

Mistaken Expressions of Freedom and Medication Compliance

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Increase awareness of how we are loved

Hearing someone pray to love Sam better put her in that space between forever and never. Enormous awareness that, “Hey! I am loved!”sailed in.

Since then, She prayed more that She is able to see, how.

How? Where? And, “I want to love the Love toward me.” Samantha Gearge, after years of griping loneliness told me in so many words, that she wanted to weave her fantasies into that fine soil. Not pink clouds.

Being able to notice being Loved is infrequently intuitive. Liking how we are loved is also as often, ironically, not.

But, we are. All of us, Loved.

It seems friendly to increase our link to it. It’s a distortion and mispercetion to believe otherwise. A reality perhaps, but not Truth.

Getting to that Truth, shifting our reality, we get with hard work. Recognizing Love also might not come without. Recognizing Love is easier with brain health too.

Hard work and courage come in many ships.  We’ve talked about basics like, sleep, exercise, clean air and clean food.  We’ve talked about further efforts, when we have emotions and behaviors come without asking them to, to seek medical care. Taking medications takes courage over and over again, but it is easier to think clearly with brain health and is worth the press. It is friendly to pursue brain health.

Recognizing how we are Loved is like any other act of friendship in this way. Get deliberate about it. Get friendly.

You are Loved.

Questions: Have you noticed that you are Loved? :).
Do you like how you are loved? How do you get connected to this vitality? It is friendly to do. Keep on! Please tell us your story.

Self-Care Tip: Grow recognition and amity of the Love toward you.

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