psychotropics

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Tell People When You Fall

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Self-Care Tip #171 – Tell people when you fall.

Driving today, I was slowed by a driver ahead of me.  I started to get irritated, (I know, “I can’t control this“), but then I noticed the car had bumper stickers supporting breast cancer.  In less than a moment my mind grabbed memories of faces, feelings, conversations, stories and personal experiences in my memory relating to breast cancer and I suddenly felt a sense of empathy and some sadness.  It left me a bit surprised and I reminded myself I was irritated at this driver.  While trying to tease apart these seemingly opposing reactions, I realized I didn’t care much any more about the slowness.  Mainly I wondered how there was breast cancer connected and I cared.

Providentially, Erin posted today on her blog-site, Healthy, Unwealthy, and Becoming Wise,

Falling finds friends.

I remembered the driver and you readers and thought, “It sure does.  Especially when we let others know.”

My Ecuadorian sister, Joana Johnson, often tells me one of the biggest contrasts she see’s between our cultures,

connection.

I spent some time in Ecuador doing some clinical work and learning more Spanish between my second and third year of medical school.  I was rarely alone, which frankly creeped me out a little.  Being westernized, I was used to a huge amount of independence and anonymity.  I wonder who I would be if I had grown up knowing someone was always involved in my life.

You might have heard the proverb asking,

If a tree falls in the forest and no one is around to hear it, does it make a sound?

Or,

Water, water everywhere and nothing to drink.

I don’t want to be surrounded but not witnessed, connected or heard.

Telling people about our “falls,” cancer, depression, assault or what not, can feel creepy too, just like I felt loosing some of my anonymity in Ecuador.  However, I now tell myself, “It’s just culture and I can grow.  And I want to.”  Culturally in the “West,” we think of telling about our falls as whining.  That’s a misperception however and a disservice to all of us.  Telling people when we fall is not whining.  The act of telling and the act of whining aren’t contiguous unless we design them to be.

This morning when I saw those bumper stickers, it brought me into the drivers life and connected us.  We are both a little less alone than we were.  These last six months for me have been about taking down boundaries in my well defended life, and I am growing into the difference.  Thank you readers and commenters for that.

Questions:  What has telling others about your “falls” done for you?  How has your culture influenced you in finding friends?  Please tell me your story.

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Choose Self-Care At Your Most Elemental Level

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I can’t believe this is me!

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

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

Mindy said,

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

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

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

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Know What You Are Fighting For – Your Right To Journey.

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Self-Care Tip #162 – Know what you are fighting for.  Be a friend to yourself.

Bridget told me,

I felt free to do something creative without having to feel guilty about it.

She had read the blog post, “Self-Care is Freedom, is Democracy, is Because We Are Accountable.”  I was just starting to think about other good places to go with that but before I got too far she hit me with,

I just hate myself!

Hearing those words is like watching squishy and partly moldy tomatoes hit the wall.  It’s messy.  It’s dirty.  No one’s excited about dealing with it.  And, there is something negative that brought it on.  Readers, you’ll remember this countertransference when you’re the counsellor in some other situation and think, “Darn that Quijada!”

My thoughts bumped and piled up.  Stopped, until they started pulling themselves off of each other.  I tried to put these disparate bits of Bridget’s narrative together.  And I wasn’t alone.

I don’t get it!  Why do I feel this way?

Who doesn’t have conflicting feelings about themselves?  Bridget perceived and celebrated her freedom to self-care, yet was betrayed by her own, just when she was reaching for it.  Is that ok?

What strikes me about Bridget is her journey.  She has struggled with anxiety and depression for many years.  I know with me, she’s been in treatment for five of them.  During that time, she has been lovely although not perfect.  She does her hair, glossy blond in large waves, trim body frame and polite like no one I’ve met.  Many medications have failed her and she has taken those failures and claimed her future over again.  The intense forward movement of her inner self has never been muted, even when she has had thoughts of wanting to die.

I have learned what she values, what she’s willing to let go of and what she isn’t.  Her appearances matter.  She is artsy and gets energy from being alone.  She loves people.  Her marriage is rocky.  She struggles with parenting.  She loves her husband and her children.  Bridget’s journey is a journey of imperfection, beauty and courage.

And here she is again.  Conflicted self, ill, hopeful and claiming her future.  Bridget is right on her course.  I wish I could help more.  I wish she wasn’t still ill.  But I can at least be as courageous as she is.  I can hope with her.  I can stand with her or walk.  I know that put to the question, Bridget prefers this journey than losing the right, the privilege, to journey at all.  Bridget is free.  Many of us are not as free as she is, who knows what she is fighting for.

Question:  What are you fighting for?  If nothing were to ever change for the better in your life, what makes your journey worth it?  Please tell me your story.

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Lost But Now Found

A three-year-old labradoodle.

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

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

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

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

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

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

Pyrenean Mountain Dog

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

2 White dogs found!

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

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

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

Keep on!

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Self-Care is Freedom, is Democracy, is Because We Are Accountable

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Self-Care Tip #159 – Be accountable for and to yourself.

It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain alert.  Just when I thought I could hold out no longer, I saw him.  Big and expressive, the long form of Abraham Lincoln was there, surrounded by loud irreverent people.  My brother and I were wiping sweat out of our eyes trying to keep track of our kids.  We wanted to read the Gettysburg Address for our kids, and found ourselves screaming.  The kids could barely hear the words above the disinterested rabble around us.  Despite all this, I was choking; a weepy, sweaty, nearly anesthetized but free American.

Four score and seven years ago our fathers brought forth on this continent a new nation, conceived in liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation, so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

Just down the corner from Lincoln is a president’s list of sites to see, informers and reminders of who we are and where we came from.  However, none of them were “my Lincoln” experience.

But, in a larger sense, we can not dedicate, we can not consecrate, we can not hallow this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion…

A couple of days ago, writing the post about how stress intersects with medicine, I remembered “my Lincoln.”  It may seem like a stretch at first but take a minute.  Self-care is a way of saying, “I am free.”   In places where life is cheap, almost without value, self-care is not much of an option.  It is because of freedom that we can extricate the meddling fingers, the invasions, and be the keeper of our own private spaces however we choose to.  It is because of freedom that we can tell people that although my brain is ill and although I take medication, I am equal. Saying that is self-care.  Saying that is possible if we take that freedom to keep our own accountability for our own selves.  Accountability is not the same as blame.  Having accountability for our freedom is not the same as being at fault for what came before freedom, nor our current conditions.

—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.

If you’re not accountable to your inner self, if you’re only accountable to your actions, or you’re only accountable to what others determine and define about you, than you are not free.  You are blamed.

Accountability is such a tender privilege.  We might lose it if we forget who we are, where we came from and our rights to freedom.  Democracy is self-care.

Question:  How do you see the relationship between self-care and your freedoms?  Please tell me your story.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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Celebrate Your Imperfections

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Self-Care Tip #153 – Celebrate your imperfections and adequacy.  Be a friend to yourself.

Chrystal came in.  Years with degrees of depression pulling her up and down leave her hoping to reach euthymia (steady level mood).  Chrystal and I frequently find ourselves talking about the grief that comes with this.  But not so much today.  She was hopeful after a new medication trial gave her a week with less melancholy.

In depression, even a few hours of relief from the dark inability to feel pleasure or interest, even a few hours when hope slips in can be enough to remind us what it is about life that is worth living for.  Chrystal has stood in and out of that shard of hope many times.  Each time it returns, she turns her face into it.  Hungry.  Wanting.  Alive still.  Responding to what any of us do, as any of us would, when hope is on us.

Celebrating a little together this lovely hope, she was nevertheless aware that it might sneak off again.  She said, “We’ll see.”  I said, “We’ll see.”

And then I remembered.  “Why can’t we celebrate your flaws?  Who says we can’t?”  They have beauty.  They have depth and shape and the loveliness that comes only from pain.

Chrystal looked at me doubtfully.  “Really?  I’m not so sure about that.”

I remember Someone perfect.  Last I heard, He had some pain and scars too and it didn’t change His status, value, or essence.

If we can’t celebrate our imperfections, we can’t celebrate anything because that is who we are.  Imperfect, all of us, except for One.  All of us adequate.

Adequate.  I celebrate that I am adequate today.  Adequate to live, to love, to do what I do.  “Adequate” implies a personal balance between perfection and flaws.  It implies a presence with both poles.  It does not quantify.  It does not mean that we don’t continue to grow or hope.

I’m not sure about everyone’s opinion about my self-perception, my attitude, or my effort at life.  However, I am growing surer of my own and am getting glad about that.  I’m wondering if Chrystal can celebrate her flawed self as much as she celebrates the hope of escaping her suffering.  What about you?

If each of us in turn were as pleased with ourselves as that, still hoping, still growing, still hurting, still suffering, what then?  Let’s celebrate together, alone, healthy, ill or wherever we find ourselves.  Let’s celebrate our imperfections and adequacy.

Question:  How do you live with your adequacy?  Please tell me your story.

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Emotions: The Physical Gift We Can Name

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Self-Care Tip #148 – Identify your emotions, navigate, and get help.

Mad.  And when Mia was angry she wanted to go eat.  Nervous.  When she was nervous she wanted to go eat.  Like a wire with a current, she couldn’t stop her thoughts from moving and moving.  Although eating soothed her in less than a shard of a second, it was also followed by self-loathing.  Self-loathing brought on more eating and then purging.

Sitting in my office, Mia said it was like she was looking at herself from the outside in and the self on the inside could hear the, “Stop!”  Demands, petitions, and begging to stop came from the other Mia, who was loosing her command-authority in a scary-fast way.

How often we hurt ourselves but blame a trigger, an emotion, a person, or an act of malice.  If only we could say, “Put the offense down and take two steps back.”  But sometimes we can’t.  It’s easy to piously say, with habits and cassocks or soutane (French for traditional priest’s attire) in place, “Don’t make decisions based on emotions.”  It’s easy to say, “Be objective, we can’t trust our emotions.”  But if emotions are what we use to interpret the world around us with, if that’s all we have, what can we do?

Emotions are ideally the color, texture, perfume, music and salt in our physical self.  Emotions are our spiritual sensory system.  Not being able to trust them is a big loss.  Being blind, deaf, anosmic (can’t smell,) unable to taste, and numb would make it really hard to interpret the world around us too.

Paul Brand, MD, coauthored with P. Yancy, “Pain:  The Gift Nobody Wants.”  This book uniquely tells Dr. Brand’s story of working with lepers in India.  Leprosy is a disease that causes a person’s nerves to stop working so they lose their sense of touch and subsequently can’t feel when they hurt themselves.  A once harmless thing like bumping a finger for example, is extremely dangerous.  Lepers can’t feel the pain, and so don’t accommodate for it and protect themselves. You can imagine that bumping a finger but not reacting to it leads to tissue damage when it is done over and over, until one day the finger falls off.

Dr. Brand is right.  Pain is a gift.  And so are emotions.  Including emotional pain, if serving as intended, to protect the individual and not self-destructive things such as bingeing and purging.  The purpose of this post is not to get into what binging and purging is.  That’s just an example of behaviors that might grow out of emotions gone amuck.  Emotions that we used to trust.  That use to tell us who is a friend and who is an enemy.  Emotions that used to know who’s side they were on.  Emotions that forget their own like that can be just as extremely dangerous as leprosy is to our tender fragile fingers.

The purpose of this post is to flatten the mountains of understanding between here and there.  Between understanding that emotions are as physically important as anything else, such as the spinal cord.  The purpose of this post is to furthermore say what to do about it once we can 1) identify the problem and 2) get past the stigma.  Mia did the eating and purging stuff, but she also asked for help.  3) Ask for help.

Lepers have still so few options to help their disease.  Us with emotional illness are very blessed because we do.  We have medications, psychotherapy, coping skills, miracles, and more.  We have a lot.

Question:  How do you define the space between emotions and other “real” medical illnesses such as diabetes?  How do you navigate around stigma?  How do you ask for help?  Please tell me your story.

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There is Less Space Between Emotions And Science Than We Think

The supermassive black holes are all that rema...

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Self-Care Tip #147 – Bridge the gap between emotions and science.  Be a friend to yourself.

She had been through a lot – Aimee.  Lost her baby brother to medical disease.  Was in a stressful marriage and didn’t like her work.  There was more but you get the drift.  She found herself thinking that things would be different if things had been different.

Would they?

Readers, I am referring specifically to her medical condition.  Not to the fact that the universe is different because her brother died.

Madeleine L’Engle talked about death affecting the whole universe.  She compared it to the death of a star.  In death, the star creates a hole in space dark and large, enough so that the absence of it has its own gravitational force, a “black hole.”  L’Engle says that when any part of creation dies, we are all touched.  Life knows and the absence of that bit of creation leaves the surviving universe changed forever.

Aimee wasn’t talking about that.  Aimee thought her emotional illness was largely secondary to her life stressors.  Because this influenced Aimee’s choices regarding her medical treatment, I had to tell her no.  Gently.  It was hard for her to hear.  “Aimee, your sadness you feel now, four years after your brother’s death, your isolation and amotivation, your low sex drive, your difficulty feeling pleasure in other things, your sleepiness during the day – these things are not because you have suffered your brother’s death, nor because your marriage is hard.”

There are times when directly saying things is the more gentle approach.  No one going through what Aimee is going through wants to hear about how I feel about it.  Yuck.  There’s not much that is slimier than going to someone for objective feedback and getting their emotions and personal opinions all over you.

Aimee left saying she understood and with a new medical treatment for the medical illness propagating emotional and behavioral symptoms in her.  We’ll see if she did some days from now.  But what about you?  Do you believe that her emotions and behaviors were secondary to medical illness?

Readers, life stress will continue to happen.  What may change is how we respond to it.  If our response does change and it isn’t serving us or others well we need to think that we might not be interpreting how we feel objectively.  We might be having changes to our biology that “taste like chicken.”  It helps to get a physician’s opinion – someone who sees behavior as more than the spirit, the abstract, the puppet of our volition.

Question:  How do you bridge the seemingly abysmal distance between emotions and science?  Please tell me your story.

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Full Treatment Response Means a Better Future

wethree by Nancy Denomme

Self-Care Tip #140 – Push for full treatment response.  Be a friend to yourself.

Frankie was 45 now, feeling it, and feeling grumpy.  “I’m on Lexapro!” she said as if that should exempt her from her present condition.  She had teenagers.  “Enjoy these times when your kids are young.  It just gets worse!”  Frankie thought that if her kids weren’t stressing her out, she’d be fine.

Maybe parenting and other life-stressors do get worse as we progress through years.  Even if it’s true, it isn’t the point.

Frankie told me that she had felt “normal” until the last approximate four weeks when she wasn’t able to let stress go.  She was taking things personal, even when her mind knew they weren’t about her.  She didn’t like herself as much and was angry when she thought that her kids were thinking the same thing about her.  She was just a little angry.  Not like she was before she was taking medication.  “I’m not so bad.  I’m ok.  I’ll be fine.”  About 70% of Frankie believed that she was still good.  About 30% of her knew at some level that she wasn’t.

“Frankie, stress is always going to happen.  It won’t get better necessarily when your kids move out.  Life will keep the spin on.  Frankie, the difference can be in you, not life.  How you cope can be different.  Things don’t have to feel that hard to get through.”

We talked about partial treatment response and what that meant in regards to disease progression.  Depression progresses as does anxiety as disease processes.  Also, people lose response inconsistently to various treatments.  However, it is not the time to throw our hands up and say, “Bummer!  Life really is harder on me than necessary!”  It is the time to say, “This is medical.”  And explore if there are any other things we can do to improve treatment response and decrease disease progression.

Leaving ourselves partially treated is leaving a leaky pipe in the wall of our health structure.  We will worsen faster, more dramatically, and be harder to treat in the long run.  We will lose treatment options over time simply by not doing as much as we could earlier than later.

This is not to say, that if this blog-post finds you at a “later” position in life, that it is of no use.  Unless that’s how you see your future.  Which if true, I’d respond that this is distorted thinking.  Possibly secondary to the disease process and all the more reason to get treatment, again, sooner than “more” later.

I was so happy to have had this brief discussion with Frankie because it resonated with her.  Her approach to her self-care tweaked and she saw her negative emotions and behaviors were coming from her condition more than from the chaos around her.  She made friendly choices to heal.  Medically heal.

Later in our treatment together, I asked her about how her kids were.  Frankie brightened up with stories of their successes.  I asked further if they were stressing her out, and she looked at me like, “Why in the world are you asking me that!?  That’s out of left field!”  She had already forgotten that she had held them responsible for her feelings not too long ago.

Question:  What barriers have you been up against to get full treatment response?  Please tell me your story.

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What Are You Getting From Pain?

For most people the aftermath of a punch in the face means a phone call to the police or a trip to A&E. But not Lucian Freud. His reaction to a nasty altercation with a taxi driver was to put the pain and anger aside and head to the studio to get his rather impressive black eye down on canvas.

guardian.co.uk – Lucian Freud

Self-Care Tip #136 – Get something other than anger from your pain.

Naked came I out of my mother’s womb, and naked shall I return thither: the Lord gave, and the Lord hath taken away.

Say it however you want, everyone gets and everyone looses.  We could say, “Life,” if you prefer.  Or insert wherever you think good things come from and where they go.

Who hasn’t just gotten their fingers around something they wanted, realizing more and more each moment that they really wanted it, pleasure rising, gratitude and satisfaction driving itself deeper inside – just to find it somehow escaping their grasp?

Morris Venden, preached it.  He had a low, hound-dog voice, a face to match and severe social phobia he struggled with life-long that just added to his beauty.  He preached his own shared experiences with people.  People like me and you.

A man working a job he never liked finally retires and buys his little house to grow old in, a garden he could play with, and a year later finds the love of his life suddenly dead with cancer.   And it all turns to ash for him.

 

Early portraits by Lucian Freud

Your firstborn dies.

You were cruel in a debase way.

You develop mental illness.

Your divorce is ugly.

You father commits suicide.

You have a disabled child, and then another.

You’re paralyzed.

You prostituted yourself for drugs.

When I heard Venden give this talk the first time, I thought I got it.  Even now after years and after darkness, I think I get it.

Before one of his talks, when I was still in medical school, Venden asked me to sing this with him.

Angels never knew the joy that is mine, for the blood has never washed their sins away, tho they sing in Heaven there will come a time, when silently they’ll listen to me sing “Amazing Grace.”

We stood there on stage.  Me smiling too largely because that’s what I did in front of people.  He, uncomfortable, a little blunted and suited with a thick knotted tied, stood a few paces away.

And it’s a song holy angels cannot sing, ‘Amazing grace, how sweet the sound. ‘And it’s a song holy angels cannot sing. ‘I once was lost but now I’m found’

I looked at his droopy moustached face and his eyes were red and wet.

Holy is the Lord, the angels sing, All around the throne of God continually.  For me to join their song will be a natural thing.  But they just won’t know the words to “Love Lifted Me.”

This is what Morris Venden thought he was getting from pain.

What ever our pain-story is, was, and becomes, holding the anger is gripping the ash.  For Morris Venden, he took care of himself by finding this instead of anger – more knowledge of God’s love.  Moving his grip to that was his self-care.

Question:  What are you getting from your pain?  How do you do self-care when you lose?  Please tell me your story.

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The Presence of Stress Doesn’t Make the Disease Process Any Less Important

sciencealive.wikispaces.com

Self-Care Tip #135 – If it’s medical, call it medical and not stress.  Be a friend to yourself.

New to me, Stacy came because of her problems with violence.  She was enormous.  5’11” and 200 pounds, she was just too big for her parents to handle her any more.  She was precious to them, their only child.

Taking Stacy’s history, I asked, “Does your family have a religion you practice at home?”  Stacy’s parents were giving her history since Stacy was disabled and used very few words.  Mom looked at me, and asked, “Why?  Why are you asking about our religion?”  She was sensitive.  Worried that I was packaging her up in a religion-box, she personalized my question.  I explained that religion is part of family culture and the question was simply part of getting to know them.  She relaxed a little and then said, “We have more of an ‘Autism’ home-culture these days!”

Mom looked tired although still very much engaged in her daughter’s life.

It often happens, when someone see’s me in clinic for the first time, that my questions take them by surprise.  They aren’t used to someone so directly and objectively asking and speaking about them and to them.  So it went with Stacy’s mom.  Question after question, she seemed to be in a mild state of wonder.  It wasn’t gun fire but she might have felt like it was.

“Does anyone in your family have emotional illness?  Any depression, anxiety, suicide, drugs, alcohol…?”  Why do I want to know about the family? her face said.  “No!  No one.”  I was just ready to move on to further history when she said, “Well I… I have been depressed a little on and off but I don’t have depression.  Who wouldn’t feel depressed with this stress?!”  And then Stacy’s case manager said, “Who wouldn’t feel stressed in your situation?!” and smiled and laughed with her to put her at ease.  Stacy’s case manager is a nice person.  She is bonded to the family and cares about each of them.

We completed our history and formulated a treatment plan together.  Stacy had sat mostly quietly through the hour and her parents were now at ease.  Before they left, I was able to share with Mom a couple of sentences on taking care of herself.  On seeing herself as important and in doing so, was giving Stacy the best gift she could.

What I would like to say to Stacy’s mom and to her case manager is that thinking depression is because of stressors is a great lie.  There might be some initial correlation but it is often not the point .  The real issue is medical.  I wanted to tell Stacy’s case manager that she should know better than to promote this.  I wanted to tell Stacy’s case manager that helping Stacy’s mom not minimize what she was going through was friendlier.

Stacy’s mom is not my patient, but I did pick up that she is sad, fatigued, personalizes things that aren’t about her, anxious, a little hypervigilent and suspicious, and that something biological was likely going on.  Everyone has stress, but not everyone reacts the same way.  Some of us get ill for biological reasons.  Using the stressors as decoy to the disease only preserves the state of suffering.  And it affects everyone.  Mom was part of Stacy’s recovery too.

Question:  How do you see the relationship between stress and mental illness?  Please tell me your story.

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Having Mental Health Means Sleuthing Magical Perceptions Sometimes

Black Magic (comics)

Image via Wikipedia

Self-Care Tip #134 – Looking past the dark magic in your life might require medication.  Be a friend to yourself.

Much of what psychiatrists do at work is help with misperceptions.  Seeing something one way does not make it true.

In Scientific America, there was a great article, “Magic and the Brain: How Magicians ‘Trick’ the Mind,” By Susana Martinez-Conde and Stephen L. Macknik | November 24, 2008 | 17.  It tells us that we misperceive things so easily, that people use that quality to entertain others.  Magicians use it to entertain and exploit the limits of cognition and attention.

Magicians aren’t the only ones to exploit that.  We do.  We exploit ourselves.  Tsk.  Not too friendly and not generally as entertaining.

How is having our misperceptions a form self-exploitation, you say?  Because we nurse them and drive our own selves into the ground with them.  No one else is doing it when down to the last trick.

It comes to me that when we feel disconnected from others, we are mistaken.  Some magic turned us awry and we don’t see the gazillioin links touching us all around.  When we feel worthless, when we think we are despised, when we feel singled out for suffering, that be black magic my friends.  When we think our lives our so hopeless that we would be better off ending them, look for the mirrors.  Look for the rabbits and top hats.  We aren’t seeing things right.

When I move the curtains across my clinic day, I often find medical diagnosis hiding behind.  Some sort of biology giving us the slip.

My dad often told me, “Things are never as bad as they seem.”  I realize he was talking about this kind of magic.

Question:  How have you gotten past self-harmful misperceptions?  How have you seen another do it?  Please tell me your story.

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You Can’t Barter With It. Sleep.

Today, clinic was all about sleep.  Sleep being the ugly stepchild of many homes, its delicate nature is ignored, disrespected, discredited.  We are forgetting the contribution to the unit.  Every system suffers if sleep isn’t allowed to run it’s healing cycles round and round through a 7 hour night.  Medications don’t work as well if the very neurotransmitters that they work on don’t get replenished.  The meds are throwing a work-bee without the workers coming in.  Our memories drift away, unconsolidated without the deep stages 3 and 4 coming over and over to weave them into us.  Our cortisol levels don’t get staged and none of our bits and parts heal very well.

Every night we need to heal.  So much happens daily.  There is taking without asking.  We don’t know our cupboards are empty until we are down right sick.  That’s too far.  Why get to that point?

Believe that sleep is medical, structural, biological.  The results of what it does are nonnegotiable and don’t leave room for the reasons we give for why it isn’t served up.

I’m a night owl.

I take long showers.

I’m too anxious.  I can’t turn my thoughts off.

I work the night shift.

Some people think that they can fight sleep with coping skills, water, interpersonal relationships, work, arguments, computer time, hobbies, exercise, medications, and all their good reasons why they can’t get enough.  “Sleep” has heard it all.  Break it into your belief.  This fight is already won.  By sleep.  You will always lose.  Sleep will always win.  You must or you suffer.

Sleep.

It’s not personal.  It’s objective so quit making it personal.  Don’t even let yourself go to that cookie-jar full of excuses, no matter how you crave them.  Just work it out.  Work it out.  No one can really tell you how.  They’re your excuses that make sense to you, so what will you do with them?  What will you do?

Read more blog-posts on this here.

Self-Care Tip #122 – Sleep well to live well.  Be a friend to yourself.

Question:  Why do you buy into this or don’t?  If you buy it, what will you do or have you done?  Please tell me your story.

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Put The Struggle Down and Take 3 Steps Back

I almost gave up on tonight’s post.  But after taking a Glee break watching Kurt get bullied, get defended, then get out of his school, I felt more refreshed.  Go figure.  What I have to tell you about self-care tonight is to go back to the basics.

When you become inundated with all the good things out there to do, go back to the basics and let it rest.  Get your sleep.  Take your omega 3’s and vitamin D.  Take your medications regularly and step back from the struggle not to.  In fact, if possible, put all struggles down and take 3 steps back.  There is time enough to pick them back up when ever.  Go to sleep and sleep well.  If you don’t think you will, take something to help.  Something safe that will protect your deep sleep.  Then, get up, worship God, exercise and see what’s next.

Any time you want, any time you need, any time, you can go back to the basics any time.  These are mine.

Good night folks.

Self-Care Tip #120 – Get basic with yourself.

Question:  What are your basics?  Please tell me your story.

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When It Is Time To Take Medication

"Yard with Lunatics"

Image via Wikipedia

When is it time to use medications for mental illness?

It is time to consider a medical cause for your behavior and mood when:

1.  you can no longer control them

2.  they affect the various areas of your life

3.  you start having other physical symptoms not accounted for through medical exam and studies, such as:

  • sleep changes (Pearl:  Sleep is known as the vital sign in psychiatry.)
  • change in energy
  • gastrointestinal – stomach upset, nausea/vomiting/diarrhea, change in appetite
  • neurological – headache, numbness, tingling, shaking, change in response time physically or verbally

I’m sure I missed a few things, but roughly, these are guidelines that can apply to most mental illnesses on multiple spectrums, such as anxiety, mood, psychosis, addictions, and even character pathology.

According the numbers count done by NIMH:

…about one in four adults — suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.  …mental disorders are the leading cause of disability in the U.S. and Canada.

When you next go outside and walk in a crowd, count them.  One, two, three, mental illness.  One, two, three, mental illness.  And so on….  If you suffer from mental illness, you are not alone.

If you buy any of this, if you see these things in yourself, consider seeing a physician for further evaluation and possible medical care.

Self-Care Tip #108 – Take medication if it’s medical.  Be a friend to yourself.

Question:  How has your definition of mental illness affected your ability to get treatment?  Or how has it affected your interaction with those who are in treatment?  Please tell me your story.

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Related Articles from FriendtoYourself.com
  • Mental Illness Relapses When Medications Are Stopped http://bit.ly/pA4kxo
  • Number One Reason For Relapse In Mental Illness  http://bit.ly/rt1qJf
  • Are Your Meds Safe?  http://bit.ly/lh1cBh
  • Say Yes to Medication And No To Drugs  http://bit.ly/oX12i0
  • Fears of Addiction To Medications for Brain Illness http://bit.ly/oWY8i4
  • Other Fears of Medication For Brain Illness  http://bit.ly/qdHksR
  • Afraid of Meds  http://bit.ly/rjt7wY
  • Full Treatment Response Means a Better Future  http://bit.ly/ph84ZU
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Your Life. Your Choice. Why Are You Still Negotiating?

 

 

Self-Care Tip #102 – Take what is yours and live.  Be a friend to yourself.

Cheri came, still dressed in work scrubs, with her 2 daughters, 8 years old and 3 years old.  Having finished their dinner date, they were swinging by for her appointment before going home.  Cheri told her kids, “Get out now and go sit in the lobby!  If you don’t listen to me I’ll….”  Turning to me, she said, “It’s never enough!  I just took them to dinner and they do this to me!  No matter what I do…!”

1.  Cheri tells me she’d like to cope better with simple stressors such as redirecting her kids

2.  We talk at length about her perception of her kids abusing her.

Cheri is married.  Her husband laughs at her for “…having to take those drugs to be normal!”  “…But he just sleeps his problems away.  He doesn’t deal with them like I do.  He has no idea!”

3.  We talk more about her perception that her husband is responsible for her place in life.

Cheri believes if she doesn’t take more than 2 pills a day, she is less “dependent” on drugs.  She says, “I don’t want to go on like this!”  Her tears continue talking when her voice stops.  She is ashamed.

4.  The concepts supporting taking care of yourself as being the kick-off point to caring for anyone else comes up.

5.  We talk some more about who is “The Why” for what we do or don’t do.

Cheri feels less shame, but it’s still there.  She is willing to give a new medication a try but clearly doesn’t buy it all yet.  She’s going home with her girls to her husband with new pills.  And hope?  Yes.  It is all connected.  It all pulses together and is a living negotiation of sorts.

Disease <–> behavioral/emotional negative symptoms <–> victim role <–> self-neglect <–> greater crisis <–> seeking help <–> responsible self-care <–>  healing <–> fewer behavioral/emotional negative symptoms <–> emotional abuse from husband may continue but is no longer seen as responsible for personal choices and self-care <–> less shame <–> further healing and so on….  (Lub-dub…Lub-dub…)

 

hbofamily.com

 

Cheri is still negotiating her deal in life.  She doesn’t realize that it’s already hers for the taking.  Her life.  Her choice.

The deal is already made.  Take it or leave it.  Your life to live.

Question:  How are your negotiations?  Do you see them as still in progress or settled.  Please tell me your story.

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Your Heroic Self – Waiting For Normal

Self-Care Tip #82 – Have courage to go for what is lovely to you in life.  Be a friend to yourself.

Pretty, blond, about 5’6″, slender, in her 30’s, mother and wife, no funny shapes or movements but Britt still asked me, “Am I normal?”  It takes guts to ask someone that.

I just finished this heart-squeezing book, “Waiting For Normal,” by Leslie Connor.  (Yes!  I finally read a book!  It took me 5 times as long but it was no less pleasurable.)  Connor tells us about pre-teen Addie who grew up on the waves of her bipolar mom’s chaos, salvaging bits of wreckage along the way to survive.  Addie is the life-preserver her mom uses for life.  Addie’s own buoy through it all is her hope of one day finding normalcy.  She uses all her smarts to avoid the thrust her mom’s messes force on her.  It requires her full attention.  Addie must have looked pressed for something because her Mom finally asked her

What’s so special?  What are you chasing after?!

Addie was fisting optimism when she answered

I’m not chasing after anything.  I’m waiting.  Waiting for normal.

Later Addie explains to her mom

Normal is when you know what’s gonna happen next.  Not exactly what because probably nobody gets that.  But normal is being able to count on certain things.  Good things.  And it’s having everyone together – just because they belong that way.

My son used to have shaggy hair with curls that flew at the world around him.  He came home the other day and told me he wanted it short.  I finally figured out that because none of the other boys in his class had longer hair, neither should he.  He showed me pictures of what his hair should look like.  The whole process was too cute.

We are all looking for normal.

Putting aside defining normal, for now I am content to just contemplate the largeness of the effort to find it.  The journey, the process, the coming into such a thing reveals the beauty in one’s character and essence.  It is that, rather than the “hair-cut” that makes me say, “Wow!”

When Britt, my patient, strove towards her health and normalcy, her intent in context was lovely.  She seemed to me, in those moments we shared together, as one of the great heroes of our day.  A woman of courage.

Self-Care Tip #82 – Have courage to go for what is lovely to you in life and appreciate the beauty in your heroic self.  Be a friend to yourself.

Question:  Have you struggled with the question, “Am I normal?”  Please tell me your story.