Psychotherapy

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Get You Some of That – Medical Treatment for Medical Illness

…Continued from yesterday.

Cole_liveCole Swindell – Get Me Some Of That

Why do I feel so horrible when I start a treatment that is supposed to help?

Medication treatments for depression and anxiety, and some other brain illnesses, often worsen how you feel before you feel better. I can’t tell you how many patients have told me that if they had known this before, they never would have stopped their mediation(s).

Yesterday, our post discussed a Dr. Jones and Presley.

Presley fired Dr. Jones when after following her directive, he subsequently experienced an extreme panic attack. Dr. Jones may not have done anything wrong in her treatment recommendations. Presley was just an individual, as compared to a “number on the curve” of treatment responders. Escitalopram, the medication discussed as an example yesterday, (one medication option out of many), may have been dosed at an initial amount that Presley’s body couldn’t handle “straight out of the gait”, so to speak. But likely, if he had started at a lower dose, maybe ½ or even ¼ of the tablet, and then waited for his body to accommodate to the medication. Then Presley would have tolerated it. Presley would have tolerated slowly increasing the medication if approached, rather, piece-by-piece of a pill. I’ll even joke with patients,

I don’t care if you lick the pill. Just get on it.

When slowly titrating a medication, it allows the individual’s neurotransmitter receptors to down-regulate whilst the agent floods the receptors. If there is a neuron targeting another neuron, there’s a baseline balance in time. There is a baseline understanding between these neurons. An agreement, of sorts. “I’ll sit here and receive your messages,” (neurotransmitters, or chemical messengers such as serotonin, norepinephrine, and/or dopamine). “I’ll then carry those messages on your behalf to their intended recipients,” (such as the amygdala or hippocampus). But then this person artificially takes a higher quantity of these messengers, for example, by way of medications, and floods the system. The receivers, (or neuroreceptors), have to adjust to this to establish a new healthy baseline. 

In this initial time of treatment, when 1st introduced to the increased neurotransmitter-load, (ex: as released by a tablet of Escitalopram), there can be a negative response, such as panic and/or depression emotions. We call this, “initiation side effect’s.” Once the neuroreceptors get used to the new load, then the response improves. 

After accommodating to the new pharmacology, the brain is allowed to experience the blessing that comes from treatments, and heal.

Some individuals are outside of the curve and cannot tolerate the standard initial treatment dosage, like Presley was. Some are inside, and can without much difficulty. The point in treatment, though, is that the person just needs to get on it.

Get on treatment. However you do it. You have to make the treatment work for you, an individual, in your own way. The prescriptions are there to serve you. You aren’t there to serve the medications. I like to analogize Jesus’ statement,

The Sabbath is there for man, not man for the Sabbath.

Make it yours as an individual and reap the benefits; the blessings inherent there. (See Mark 2:27). 

If you don’t get on the treatment, you won’t get better. Anything less than this will be inadequate. It’s like drying water off your face with a hand towel while still walking in a rainstorm.

What is your agenda in treatment? List it. Write it out. Then, go get you some!

Outside a medical approach is like flicking water off in the context of a rainstorm. If your agenda is getting to your healthy self. Get out of the storm and get dry. Then go get it. 

You have a medical condition. Treat it with the assistance of a medical professional. 

I don’t go to a plumber to help with my electrical home repair. I don’t go to an accountant or a church counselor to treat a medical one. 

The plumber, the accountant, the church counselor are what they are. This is not minimizing their efficiency in their own fields of excellence. But why do we seek care in psychiatry from those who haven’t studied this? From those who are not experts in this? Maybe stigma keeps us away from psychiatric care. Maybe misinformation directs our search for mental health treatment elsewhere. 

Self-Care Tip: Get you some medical therapy for medical illness.

Question: What are further concerns you may have about taking medications? How would you prefer your medical providers to work with you? Please tell us your story. 

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What Are Our Treatment Options in Psychiatry?

choosing

I go through this almost every time I see a new patient.  I often hear that this is all they really wanted, “To know what my options are and that I’m not choosing something way out there.”

First off, most treatments for psychiatric brain illnesses are not done with intention to cure, but rather to restore health and increase quality of life.  Healthy is not the same as disease free.

This applies to all the treatments listed here.

1.  Hospitalization:

Inpatient – 24 hour locked unit, voluntary and involuntary, little psychotherapy, and daily physician care.

Partial Hospital – Day Hospital that runs during business hours such as 9AM-3PM, voluntary only, includes intensive psychotherapy, and weekly physician care.

2.  Counselling/Psychotherapy:

Talk therapy and exercises of various forms.  May be with physician or nonphysician.

3.  Stimulation Therapies, such as:

Deep Brain Stimulation (DBS) requires brain surgery to implant an electrical stimulation device in the specific brain area, controlled by a device implanted in the gut. Effective, but higher risk.  Least time consuming for maintenance care.

Transcranial Magnetic Stimulation (TMS) – The patient sits in a chair with a magnet at the head’s surface that uses magnetism to stimulate the brain for treatment, 1 hour a day, 5 days a week for various weeks, according to the patient’s need and funding.  Few side-effects.  Time consuming.  Not as effective as DBS or ECT but comparable to some medications.

Electroconvulsive Therapy – Uses electricity to stimulate the brain, inducing a short seizure for treatment.  Considered safe and of low risk.  Most effective.  Response is speedy.  Few, and mostly temporary side effects.  Does not enter into the body systems.  Less time consuming.

4.  Medications:

Chemicals for treatment in the form of pills, liquids, injections, patches, powders, vapors, gases – enter into the body systems causing physical side effects that, as with any treatment, must be weighed against the benefits.

Pills – generally taken daily, which is a challenge to treatment compliance, and activate internal conflict and personal stigmas.

Injections – generally done in a clinical setting, bimonthly or monthly.

5.  Aerobic exercise 50+ minutes, 5 days a week.

6.  Sleep hygiene.

7.  Diet

8.  The spirit also needs nurturance.

9. Alternatives – such as over the counter herbals, naturalistic supplements, meditation, spiritual, acupuncture, acupressure, massage, or no treatment.

Questions:  What do you think of your options?  What do you choose?  And why?  Please tell us your story.

Did I miss anything?

Self-Care Tip:  Get informed about your treatment options.

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Treatment Settings in Psychiatry

HEALTHCARE WITH GOVERNMENT OPTIONS PLAN: IS TH...

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I thought I’d just talk briefly about some treatment settings in psychiatry.  It is confusing for anyone in the community, from nonpsychiatric physicians to architects, to know the differences between these.  Some of us have been through some of these programs but many many of us haven’t.

  • Inpatient, which is 24 hours a day and includes voluntary and involuntary admissions.  Here we have a skeletal number of group therapies and see the physician daily for psychopharmacology adjustments.
  • Partial Hospital Program, (PHP,) which is generally Monday – Friday, from 9am to 3pm, and always voluntary.  Here, we work in intensive psychotherapy most of the day, and psychopharmacological treatments with the physician at minimum once a week.
  • Outpatient, such as in a physician’s private office where psychotropic medication and psychotherapy are used.

It generally takes time to influence the way the genes express themselves in any therapy, whether it is talk therapy, medication or ECT, to name a few options.

This is skeletal.  Any comments or additions?

(Random) Self-Care Tip 🙂 – know your options

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The Gift of Desperation

Life (23/365)

LIFE

Misty sounded relieved,

Yes.  That’s it.

She had just realized that life isn’t fair.  Sure.  She knew that before, but she just realized what she knew.  Don’t we all love that moment when our senses join up – sight, hearing, taste, touch, smell, emotion, intellect, spiritual and the rest.  That is a lot to coördinate after all and sometimes some of them don’t make the train.

Misty was a single mom of three.  Her ex-husband was what she called, “Disney-Dad,” and her kids relished their time with him.  Misty complained that she didn’t get to spend the special times with her kids.  She mainly took care of them, but missed out on irresponsible fun.  She was sure her kids wouldn’t look back and think of her like they would their father.  She was getting angrier about it all the time, ruminating about it and it was getting in the way of her ability to connect with others and feel pleasure.  There it was in front of her blocking her from seeing her kids even, let alone herself.

Then after weeks of this along with medication and talk therapy, she told me,

Yes.  That’s it.  Life is not fair.  There are many other things in my life that aren’t fair either and if I look for them, I could spend my whole day every day counting them off.  

It broke my heart a bit to hear her and see her there.  Humble like that; she would I think affect you the same way.  So real.

Yesterday, Carl D’Agostino replied to our post about growing our understanding of our choices beautifully.

…we wait until we are at our wit’s end before we seek assistance…. considering reaching out as personal failure or inadequacy re: our own self-esteem…. Foolishly we wait until our way just is not working anymore. That is why AA calls this a gift: the gift of desperation. …For many, the depths into which we have succumbed are now found not to be so deep at all and in fact, ladders are readily available if we use them in recovery. 

Ah Carl.  Say it again.

The gift of desperation.

Too good.  Don’t you think?

Questions:  Have you ever received the gift of desperation?  What did it bring you?  Where did it take you?  What did it do to you?  Do you still have it?  Please tell me your story.

Self-Care Tip – Celebrate your gift of desperation.

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Presence Encourages Self-Care

The Forgetful Professor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Three Capetian French scholars consulting an a...

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

I’m not interested in medications.

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

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

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

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

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

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

But I’m not interested in medication.

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

I’m not interested in medication.

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

(Enters Fatima:)  Fatima came in this way.

I’m not interested in medication.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Redback and victim

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

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

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

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What Is Your Most Core Desire? That Is Self-Care

It's a Business Doing Pleasure

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Self-Care Tip #191 – Do what you desire to get friendly with yourself.

What is your most core desire?  I am learning more about mine.

I wonder at the improvement in my quality of life since blogging with you.  It is More than the pleasure of writing; which I do love and have missed for years.  It is More than the pleasure of being productive; a natural high for my temperament.  It is More than the self-care tips listed off that roll back; a tide of all that is sent out comes in again to wash over me and change the shape of my life.

This morning I ran into a newer friend.  We came into each other’s lives, catalyzed by the ingredient that this blog provided.  I am sure I would not previously have allowed myself the pleasure of speaking with her for long without it.  My temperament has always been a driving force that pushes me into “the barn.”  I often miss the journey for the end.  This is “The More” that has been given to me.  Connection.

Now people actually look different.  Despite years of medical education, years of psychotherapy and my years of life, I never saw people to the extent that I do now.  Each of us here for a time with our stories, our pearls to offer and each of us with our essence to share for eternity.  It is one more time for me when I am open-eyed, open-mouthed gawking at the thought of “The More” that is still coming.  Better than this.

Think of your most core desire; what you are driven toward by biology, genes and higher intelligence.  What has given you access to that?  Now think about how to go for More.  That is self-care.

Question:  Oh, you know what I’m going to ask…

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The Spider Sat Down Beside Her – Mental Illness

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

The Little Miss Muffet scenario explained by D...

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

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

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

Taking pills makes me feel like I’m crazy!

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

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

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

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

Question:  How do you answer to stigma?  How do you maintain your sense of freedom when other forces tell you that you are not free?  Please tell me your story.

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Go Toward Mental Illness and Take It To The Floor

Sean and Cheryl: Drama on the dance floor

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Self-Care Tip #155 – Go toward the real issue.  Be a friend to yourself.

Little woman, she had pinched toes in her four-inch heals and wonder what her size has done for her.  Mindy was anxious.  Even though I wonder about her stressors, like possibly her height and the history she is telling me, I know something else.  Even though I wonder about her parenting and marital stressors, and about growing up in a small town but now living with giants, I don’t wonder what she thinks.  Mindy describes these giants as people with large accomplishments, things she would not try herself and that means something to her, but not what she thinks it does.  Mindy wanted to see how things went.  Apparently six months of this wasn’t long enough.

We could spend the next five years breaking all this up and apart and tossing it like a cranberry salad.  But Mindy’s anxiety is mostly not about the salad of life.  Mindy’s feelings are a bit about the stressors and a lot about her brain.

Mental illness is not a small thing.  We trim it down when we say otherwise.  The unfavored sister, Mental Illness isn’t spoken to much at the table.  Her more popular sisters, Stress and Life-Triggers, get a lot of the attention.

With some effort, people who once worked around Mental Illness like it was barely there take a chance and go straight at it, full charge, and swing that woman onto the ballroom floor.

I went for that dance with Mindy.  And she wasn’t talking about waiting and seeing how things went for long.  I told her, like I’ve told you, that how we feel and interpret our stressors comes from our brain.  I told her that mental illness gets worse if it isn’t treated and treated to as full a response as possible.

We weren’t talking about life stressors at that point.  We were talking about her medical condition.  Once treated, Mindy will continue to have life stressors.  We will hopefully also see however, that she responds to life stressors differently.

Question:  How do you make sense of the seemingly meaningfulness of how stress affects us with the seemingly less meaningful concept that we feel that way because of our brain and not because of the stress?  Please tell me your story.

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When Someone Is Afraid Of You, You Don’t Have To Be Afraid Of Them. Just Be.

Self-Care Tip #131 – When someone transfers negativity on you, just be.  Be a friend to yourself.

Reading up on the woe’s of Harry Potter, Sam did not let his children near those books.  He’d read “what they say” which shows that when kids read books like Harry Potter, it was the same as inviting the devil into their minds.  “Kids can’t tell the difference between fantasy and truth,” he said.

Sam had a friend.  A best friend named Matthew.  Sam was very afraid for Matthew who didn’t guard against this kind of attack.  Sam said, “Did you know…?”

What was Matthew’s response?

There are 2 terms we’ve used in psychotherapy since before Freud and Jung were around –

  • transference – putting our feelings on the therapist.  For example, say my therapist is a man who looks like my father.  I will transfer on him my feelings about my father and subconsciously think my therapist is like my father.
  • countertransference is the opposite.  The therapist thrusts her own memories and associations on her patient.

These can be positive or negative.  Of course they don’t stay on the couch.  Transference and Countertransference happen between all of us all the time.  Often it is healthy.  It helps us grow, model others, fantasize and move towards fantasy’s long enough to make them true.

In Sam and Matthew’s case, Sam was transferring his fears of immorality on Matthew.  But what was Matthew’s reaction?  What was Matthew’s countertransference?

I have often been guilty of negative countertransference in situations like this.  I remember feeling dirtied by people’s prejudices and fears.  Almost like I needed to bathe afterwards.  The truth is though, we don’t have to.  When people are afraid of us, we don’t have to be afraid of them.  We don’t have to despise them.  We don’t have to be angry, irritated, or feel “soiled.”   We can just be with them.  Let it be about them and not run away.  Just be present.

Matthew, wonderful best friend Matthew had heard this song from Sam before.  When Sam started in on it again this time, Matthew was able to sit back, listen to his fear rather than worry about what words shuttled it.  And Matthew was better for it.  Maybe Sam was too.  But the gift Matthew gave was first to himself.  By just being with Sam in his fear, he was able to just be with himself too.  Quite friendly.

Question:  How has transference and countertransference played out in your life?  How do you, “just be,” when you are inclined to “countertransfer” instead?  Please tell me your story.

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You Are Enough.

Self-Care Tip #119 – Remember that you are enough.  Be a friend to yourself.

Forrest Gump (after watching his girl Jenny throw rocks at her childhood home of abuse,)

Sometimes, I guess there just aren’t enough rocks.

That movie grabbed almost everyone’s heart-strings.  And when I saw my patient Sarah, I kept thinking about Jenny throwing rocks.

Sarah started crying.  I’d never seen her do that in the 8 years we’d worked together.  She was one who talked in spurts.  Sometimes saying nothing for many visits, and then she’d start questioning me about foods, diet questions, or parenting.  Then quiet some more.  Today out of the blue came her tears and words.

When she started on her disclosure, I tensed up thinking, “What am I supposed to say?  She’s never done this before!”  I realized that being a psychiatrist, I should know the answer to that question and got even more insecure because nothing came to mind.

Her lovely face crumpled over the story of her “stupid” father.  He never let her go to school.  He was violent.  Sarah is now teaching herself how to read; and more tears, her lovely face trembling.  She is a mother and there are no books in her home for her children because she is ashamed of herself.  “My dad is an idiot man.”

Post traumatic stress disorder (PTSD) can last a lifetime.  The horrors that are relived by the survivor can be unspeakable for them.  We never know what people are going through really inside.  They could be a survivor like Sarah or Jenny.

So far, I hadn’t said other than a few “psychiatry-sounds” like “hmm,” and “Oh.”  Don’t be too impressed but I remembered someone somewhere wiser than me put it this way,

Sometimes it’s better not to say anything.

And I really didn’t.  She did.  And she did it wonderfully.  We ended up talking about authors she hoped to read eventually.  She’d heard of Isabelle Allende and wanted to get to her books some day.  We hadn’t even started talking about medications yet.  Sarah left after saying that when she stopped learning and growing, she would be dead.

What hit me was that Sarah wasn’t looking for more than me.  I searched, wanting to give her more and came up with what I hoped was an appropriate facial expression.  In a way, by not speaking much, I was able to receive and be blessed by her story.  I might have missed that.

My mentor, author of blog CreatingBrains.com, encouraged me when I was unsure about teaching others.  She said, “Look at your life and who you are.  You would be surprised.”

When we are insecure about something, it helps to remember that we are enough for the task at hand.  As individuals.  We have in us all the days that came before, the experiences, the generations that handed us down, the God who made us and as per my belief, never leaves us.  We have so much.  Considering all this, be still and know.

Question:  When have you been amazed at all that was inside you?  Please tell me your story.

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It’s Time To Grow Up

 

 

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Fragile Annie writes a blog called, “It’s Time To Get Over How Fragile You Are.”  Isn’t that a great name?  She own’s her frailty, own’s that it has affected her life, and own’s what it’s time to do now.  All in a name and a title.

When I was in psychotherapy, talking on about injustices suffered, my feelings, the rightness of my condition – my therapist said, “It’s time to grow up Sana.”  I still feel the punch in my stomach and the quiet immediately following.  I couldn’t breath for a bit.  Just nodded my head.  “Ok.”  …I said, “Ok” a few times.  I don’t remember much else of what he told me but I don’t think I’ll ever forget that.  He’d be satisfied with his work with me if he knew.

After all, it’s not such a small thing to grow up, or “get over” our frailty.  It’s not such a small thing to see our need.  It’s not so little to act on it.  These are things that champions do.  These are things any coach, parent, therapist, teacher would be proud to be a part of.  These are the things that make the difference between falling victim to your history, or claiming the rights to your now and to your future.

Think about what is upsetting you the most.  What seems to keep at you and trip you and keep you back and keep you right where it left you last?  It’s time to grow up.

Self-Care Tip #106 – In Fragile Annie’s own words, “It’s time to get over how fragile you are.”  Be a friend to yourself.

Question:  What has knocked your breath out in a good way, sending you off towards growth?  Please tell me your story.

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Free to Be Accountable

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Self-Care Tip #97 – Protect your privilege to be accountable and your freedom of choice.  Be a friend to yourself.

Number Four on Bella’s List:

“The day has been ruined!” Bella said.  Her eyes sparkled and flashed as she spoke of her injury.  Bella was not so pleased with her labor’s reward.  She was not so satisfied with being accountable for her children‘s behaviors.

Are parents accountable for their children’s behaviors?  That can be a question at the level of the law and a question of cultural moral values.  From a psychiatrists stand-point, is there a medical interplay?

A subspecialty in psychiatry is called consultation liaison, which is psychiatry for the medically ill and usually hospital based.  In this setting we often get asked is a patient has decision-making capacity.  I spoke about it briefly in the post, “Choose, Gladly, Using Resources.”  This is difference from competency, which is determined by the court. Decision-making capacity is a medical assessment of the patients ability to:

1.  understand:

  • their illness,
  • it’s consequences,
  • it’s relationship to their values

2.  manipulate their options,

 

3.  and communicate their decisions.

Can kids do that?  Medically it depends on their developmental level.  The court however has its own forum on that – I won’t try to go there as psychiatry isn’t law.

Another area in psychiatry where we decide that someone does not have the freedom to choose and we hold someone else accountable for them (called a “5150“) is when they are:

  • not able to provide for themselves food, shelter, clothing
  • a danger to themselves
  • danger to others

Are kids able to do these things?  From a medical perspective, it depends on their developmental level.  Deciding what we want for ourselves and for our children is a privilege for those who are able.  It is also a privilege for us who want it.  Freedom is not free, as they say.

Please watch City Councilman Joel Burns tell us about bullying and how we need to be accountable to each other: “It Gets Better.”  Completely amazing testimony and speech.  Cuts out all the b.s.

Question:  What do you think about our accountability to our children and to our community?

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Trust The Momentum of Your Own Desires

Writing every day has blessed me.  It has however also taken away.  Aside from the obvious such as time, I’ve missed reading in the evenings.  I used to spend most of my evenings jamming happily through fast page turning books.  I love bound paper.

I’ve always had something of sensory issues.  My girlfriend Marlo Albritton, MS, CCC-SLP always laughs at me in the car – every other moment adjusting the angle of the vent or the pressure or the direction of the air that can never hit my face or the temperature.  In books, it is so many things as well that get me.  The smell and touch of course, the sound of fingers on page, swish there’s a turn, the visual in my hands or when I set it down.  I fidget but any way I turn, the book is my focal point, a lover!  The book keeps pace with me too.  When I wander, it waits patiently, unpressured and available.  When I must rush because I might die if I don’t reach the story’s climax, the book is the perfect buddy swimmer.  Like a good psychotherapist, the book is there for me.  It is a unidirectional relationship.  There aren’t many good unidirectional relationships.

I listen to audio books sometimes.  When I exercise or drive alone, and they are good.  But they are the fast food of the book pantry.  Never as satisfying.  They leave most of my senses quite alone.

I realize it is of course my own fault!  Not the blog or the writing.  I make the choices that keep me from reading.  I’m going to have to figure something out.  I can’t not read!  Remember when I said that time and energy increase when you do what you love?  (See “There is Room In Our Wanting Selves.”)  Well that’s what I’m putting my money on.  I’m going to trust the momentum of my own desires.

I’m off to read.

Self Care Tip #66 – Trust the momentum of your own desires.  Be a friend to yourself.

Question:  Do you have a sense of where your own momentum is taking you?  Please tell me your story.

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A Little Bit is Not Enough – Claim Full Health

The good news is, I just ate 3 chocolate chip cookies.  You already know the bad news.  Has nothing to do with my post.  I’m just sharing it for the sake of your own

Schadenfreude 🙂

…Onward.  Question:

Does emotional disease get worse even while on medication therapy?  Sometimes.  It does so more often when the disease process is treated but only partially treated.  Read a little more about this in this post if your interested.  A primary care physician recently told me, “I think the term ‘Partial Responder’ is a marketing gimmick to get physicians to prescribe more medications.  I don’t think it even exists.”

There’s a lot to be said about interview skills in sussing out the partial responder.  If I asked someone if they felt better, many things play into their response. Everyone’s responses are biased of course.  We don’t have sterile minds.  For example there’s the patient who wants to please their physician.  “Yes I’m better!”  i.e. “Yes you’re a good doctor!”  There are the patients who don’t want to be patients and minimize whatever they’re going through.  There is the physician who leads the interview.  “So, you’re feeling better?”  “The medication is helping?”

Partial response means that at the end of a full treatment initiation period, there is some disease remaining but a reduction of disease.  For example, in depression, I may no longer be suicidal, but I still have trouble feeling pleasure in life.  In cancer it means that there is tumor reduction of at least 30%.

Now why would a physician presumably agree that there is a partial response in cancer, but not agree that it happens in mental health?  Anyways….  (Ahem.)  When we partly respond to mental health treatment and don’t push further for full response, about 70% will relapse.  Versus maybe 25% in those who reached their pre-disease baseline emotional health through treatment.

Don’t get lost in this.  The point is, get treated and get fully treated.  Mental illness is progressive and causes changes at the cell level.  The brain is connected to the rest of our body.  The brain is human.  A bit better, is not enough.

Self Care Tip #61 – Go all the way!  Claim health.  Be a friend to yourself.

Question:  Did you find this to be true in yourself or someone you know?  Please tell me your story.

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Claim Your Brain

My mind, like rusted gears, was not moving well.  It hadn’t been really since my 1st pregnancy 8 years ago.  There are few things that dumb us down as much as pregnancy and children!   Hormone changes, lack of sleep, fluctuating from 145-200-145 pounds three times, and then the subsequent growing beloveds around me to contribute to mental dissociation.  Simple sensory overload from talking, yelling, crying, petitioning, inquiring kids factors in.  You may read more about sensory issues here.

Daily writing, like a staunch governess, found my brain under cobwebs, bug carcasses, and musty stench.  (Hello old friend!  There you are!)  This helps to explain the joy gripping my hand, like girlfriends on the playground, when I sit down to write!  The world is active to me, including rather than excluding me. My in-between moments used to hang like an old woman’s breasts.   Now much more time full of nourishing thoughts bless me.  I am in awe.

My patient came in sighing deeply.  He wasn’t better.  No, he said.  He lacked motivation and interest and connection from the world.  He felt selected out to suffer.  A dumping ground for misfortune and misunderstood.  Efforts through medication, after medication changes were like looking for love in all the wrong places.

We talked about cognitive distortions, tapping into things that used to make him happy, road-blocks in poorly designed neurological grooves – volunteering at the library or animal shelter, journaling, sharing his life story with others, exploring his spirituality.  No.  No good.  Nor could he consider psychotherapy as he’d been through too much of it already to consider it again.  And he just couldn’t get interested in groups such as through NAMI.

His brain, assaulted by stressors, disease, and disuse was growing silent.

Being a friend means yelling, fighting to reclaim your journey, finding something to connect you to your process of life.  My patient was letting squatters take his property simply by being absent.

Self Care Tip #60 – Claim your right to health.  Be a friend to yourself.

Question:  What has helped you connect with your own journey in life?  What do you think?  Please tell me your story.