self care

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He Asked God to End His Life

A woman peering out of a partially opened window with colorful curtains, surrounded by wooden shutters.

Yesterday, we left Cherry coming out of her depression, only to discover that getting well herself didn’t mean that everything around her had healed, especially her relationships with her children.In all personal relationships, I look at healing to come in the way of “Five Simple Steps.” And I put “simple” in there to be entirely silly. Because kid-to-momma relationships are anything but “simple,” of course.

Healing, in any arena, whether it is healing the person or between persons, deserves a biopsychosocial approach. What’s happening biologically? In Cherry’s case, she is getting well. Medically. Biologically. She is healing. Okay. She’s getting money back in her bank and she can now spend on those she loves, so to speak.

But her psychosocial self has been unwell too for some time. And just as when you cast a broken bone, and it knits together, the important atrophied muscles don’t automatically jump to “Hup! Hup!” when you take the cast off. So, when coming out of a terrible depression like this, there are secondary losses, survivors of the trauma that is depression to an underbelly of the parent-child.

And spiritually, well, God never left Cherry, nor her children, who were, by the way, also grieving the loss of their father and the emotional disappearance of their mother. But Cherry hadn’t done the things that she used to do spiritually for a long time now. She hadn’t been praying like she used to. She wasn’t reading her Bible. And face to the wall, she wasn’t looking at Jesus at all.

You may be wondering when I’m going to get to the five steps to healthy relationships, and I will, but first I want to remind you about Elijah.

Elijah was a prophet in the ninth century BCE in the northern kingdom of Israel. During that time, Israel had abandoned God for the worship of Baal under the rule of King Ahab and Queen Jezebel.

Elijah had a great win for God one day at the showdown on Mount Carmel and was riding high. He, in humor, sarcasm, and challenge, got to participate in the humiliation of the Baal prophets when God openly chose his sacrifice. The Baal prophets got nothing and watched as God burnt up Elijah’s sacrifice, dried up all the water in the moat around it, and scorched the rocks. I don’t tell the story as well as 1 Kings chapter 18 does, so read it there. It’s really good.

You can imagine that Elijah was considered a pretty great prophet by then. Maybe he even thought of himself that way too. I don’t know, but I think he might have.

The worst is when you are riding so high, and then face-plant though, right? And shortly after this huge win, Jezebel said to Elijah, “I’m going to kill you, and kill you good within 24 hours!”

And what did Elijah do? He plummeted emotionally. One could say, “He swung.” And dropped into his own terrible anxious depression. He ran away from Jezebel, and ran and ran for a full day. He asked God to take his life and fell asleep. An angel woke him and gave him food and water. Elijah ate and went back to sleep. The angel woke him a second time and fed him.

But the real question is, what did God do?

He stayed right beside Elijah. When Elijah stopped running, God fed him and let him sleep. He didn’t say, “Hey, Elijah! You dud! You just had that win in your hand! What are you doing running away!?”

No. God didn’t say anything about Elijah freaking out. He stayed with him. He followed him. He supported him with basic needs stuff that no one else was able to offer.

And then when Elijah awoke, did Elijah say thank you? No. He did not. He got back to his business of running away. He ran and he ran without as much class or dignity as Forrest Gump. Forty days of running, and he surfaced in the story in a cave at Mount Horeb.

What did God do? God spoke to Elijah. He nurtured him some more and revealed Himself. Elijah came to see that God was with him not because of Elijah’s performance, but because that is who God is.

He loved Elijah, good behavior or bad behavior. Good emotions or bad emotions. God was His constant self. Who loved without transaction.

Elijah had done some damage to God’s reputation by running away. (I’m inferring here…) He’d misrepresented God’s character to the Israelites and acted like Jezebel had more power than God did. And rather than act out in the power He had to set the record straight, God quietly stayed while Elijah needed him, and God understood.

So I looked at Cherry and thought about God who stayed with her, not because of her good behavior, but because God loved her without transaction. Here she, like Elijah, was surfacing from a depression, and God was still with her.

“How can I fix this?” Cherry said.

I felt the shame curl around her like sinister music. Cherry wanted to say that her kids didn’t understand. That she had good reason. That she was victimized by the universe itself in taking her husband. And she was holding on to her rightness while bemoaning her condition.

She did make allowance for her children’s distance on one hand, saying they, of course, were going through it, suffering, grieving, had been abandoned by her. But also there was that hand behind her hip. It gripped the reasons.

Cherry, in any relationship, both sides are always subjectively right. Because their truth and reality is defined by the perceptions of their own mind.

“How can I fix this?”

Tomorrow we’ll start in on our five points to healing relationships. But for today, remember that God attended to Elijah’s physical, emotional, and spiritual needs before addressing his vocational responsibilities.

Our self-care tip is to see who’s staying with you, not because you deserve it or for anything you give in return. He stays because He loves you so much!

Question: Have you ever not been able to do what you knew you were supposed to do because you were too depressed or anxious? Please tell us your story.

Keep on!

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Relationships That Live and Die by what Depression Does

A joyful family scene on a bed, featuring two young children laughing and playing together, with a parent interacting with them, and another adult lying nearby.

Cherry Benton, a 48-year-old mother of four righteously beautiful children was doing so much better. Her medication, like its own kind of knight on a white horse, had given her a rapid response within weeks for her depression, recently a sagging putrefied vegetable that metaphorically stunk her up. No one had wanted to be around her, not even her own cherubs and it broke her heart.

One can be broken hearted and not depressed. They are not synonymous, just neighbors, even if they become housemates again – like when patients self d/c their meds. But that’s another blog post.

In Cherry’s case, her kids had started to avoid her a while ago she now realized. It was like she was coming out of a heavy smog and haze filled space and now looking around, was able to see where she had journeyed. Where had the time gone? She could hardly even remember details but over the past approximate eighteen months she had indeed travelled far. Her kids, from 7 to 13 years old, now looked to Nana for their needs. Nana came when Cherry’s husband, a UPS delivery man, died when a glioblastoma killed him 3 weeks after being diagnosed.

Grief is not the same as depression, even when they become housemates. Depression is multifactorial, with genetic and environmental contributions. And when those environmental factors come together with genetic loading, it can be super hard. Cherry’s father had suicided after the stock market crash in 2008, and she had several family members with a history of severe depression. A cousin hung himself, and an aunt had been on meds for years. Nana was terrified that Cherry’s depression would kill her too. But thankfully Cherry had begun to respond to medication. And it didn’t take long for Cherry to want her kids back! But it’s complicated for kids and mommas. And the days, then weeks, then months, then year(s) when their mom acted like she didn’t care about them, isolated in her room, seemed to cry over the sound of their own tears and didn’t hear them, these add up in the minds of children. “How do I fix this?!” Cherry asked.

You may be wondering when I’m going to get to the 5-steps to healthy relationships, and I will, but first I want to remind you about Elijah… who I’m going to tell you about tomorrow!

For today, self-care tip is going to be about the good old, “you can’t give what you don’t have.” Get well biologically, like getting money in the bank, in order to give to others. You Got this! Keep on!

Question: Has medication helped you or someone you love? How did your relationship survive before meds kicked in? Or did it survive at all? Please tell us your story.

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Why It’s Just So Hard To Take Meds

Adherence is subtle. Adherence is not the same as “compliance.” People are generally good people trying their best with what they understand and what feels right for them.

This matters, because nonadherence might not be defiance—but rather distress.

When someone doesn’t follow a treatment recommendation, it’s not generally because they don’t know they’re supposed to. Nonadherence comes from subtle reasons. “I can’t look at my bottles every day. I feel like trash for taking so many pills.” Needing medication often feels like evidence of personal failure rather than a neutral medical tool. Every time someone looks at the bottles, opens the lids, and swallows the pills, they’re fighting self-stigma. It’s hard to see yourself surrounded by pills and medication bottles.

This is where the daily work of adherence becomes invisible labor rather than willpower. It’s not one decision—it’s an argument you have with yourself over and over.

Consider using a pill box. Put the bottles away. Don’t even look at them until you have to refill the box. At least then you aren’t fighting that inner voice every day that says you are a bad person. That voice affects adherence far more than knowledge. This small tweak quiets self-judgment.

If a patient is not adherent, the patient, me, and anyone else who is part of the treatment team need to figure out why. Reframe nonadherence as a shared problem to solve, not a personal failure. People are not actually trying to sabotage themselves.

Even when teaching resident clinicians, I ask, “Whose responsibility is it if a patient is not adherent?” The confident answer is, “The patient!” Well, no—not entirely. It’s our responsibility. Ours. Us. If the patient isn’t adherent, there is a good reason why. We just haven’t figured it out yet. That’s our job: to teach, to explore, and to sell hope.

Being right doesn’t change lives. You can have all the facts in the world and still not take the medication. What changes behavior is feeling understood and having agency. Correctness without connection is for the birds.

For example, a lot of nonadherence comes from what patients are hearing outside the office. Family members. Therapists. Friends. “You’re on too many meds.” “Meds are bad.” “Good job! You got away with taking less.” People go home, hear this, and feel like trash for needing treatment. Stigma can live in relationships, not just inside the person.

It helps to name the voice patients carry with them after they leave the office. Naming it helps it lose power.

When that happens, one option is calling the people who are talking in the patient’s ear when they’re not with the provider: a husband, a brother, a parent, a friend. If I call them on my phone, the caller ID, they’re not going to pick up. But if the patient calls them, then they pick up. Here, the voice belongs to someone specific and takes on more shape. Often these are influencers in stigma or bias around treatment. I introduce myself and ask if they have concerns. They might say they think the patient is on too many medications or that medications don’t work. That’s important to know. It may be what the patient has been absorbing and what’s been influencing their ability to adhere to treatment.

Then I say something like, “That’s important. What if we reduce dosages?” Sometimes that’s something we want to do anyway, to keep side effects low and to layer with another class of medication. Lower doses, fewer side effects, and better receptor targeting allow for more comprehensive coverage. Now we’re aligned.

Now the voice in the patient’s ear is part of the plan and has become an advocate.

Adherence isn’t about forcing people. It’s about removing the quiet barriers that make it hard to stay in care. Shame. Stigma. The feeling that something is being done to you instead of with you.

When you and yours join into the discussion early, then you get to declare for yourselves, over and over again, whether the treatment is worth it. Because it is a decision that has to be made again and again. Everyone involved feels agency. No one is victimized by treatments. In order to be my own friend, I have to be that friend even at a biological level.

That’s the work. Not just prescribing, or just taking a pill, but figuring out why someone can’t adhere.

Self-care tip: If something meant to help you feels shaming, change the ritual around it before blaming yourself for not sticking with it.

Question: What part of your self care is hardest to follow because of how it makes you feel about yourself, not because you don’t believe it helps?

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Understanding Medication Nonadherence

“I’m doing really well!” Gene said, and he proceeded to tell me just how well things were going for him.

Gene, a father of three, a husband, and employed full-time, had a life marked by chronic worry and intermittent bouts of depression, occasionally punctuated by panic attacks. We had been working together for several years. During that time, he had experienced some periods of stability.

I was glad to hear how well Gene was doing: exercising regularly, sleeping through the night, performing well both at home and at work, and feeling more agency in his life.

Wonderful, right? Stability is a good thing. But what wasn’t so wonderful was the cycle Gene often found himself in—swinging from severe anxiety to depression, to anxious depression, to what he believed were symptoms of ADHD, and back to anxiety again, a bird in flight without a compass. This pattern played out between his visits. He would come to the clinic one day looking like a shiny penny, only to return in crisis during the next follow-up. Why was he stuck in this cycle? Maybe it was biological—or maybe not. One thing, however, was certain: Gene had a recurring habit of self-sabotage. He loved to self-adjust his medications.

During this particular clinic visit, Gene rushed through his medication list, likely sensing that I wouldn’t be as pleased with him as I was when he had shared his successes at the beginning of our appointment. I noticed him fidgeting as we talked, his eyes darting right, then left. That’s when I knew—without him even saying it—that he had altered his medications again. On his own.

Have you ever been in a relationship with someone you cared about, where their behavior forced you into a confrontation you never wanted to have? Like a friend who drank too much at every dinner party, leaving you no choice but to say, “You have a drinking problem.” Or a child who spent more of your money than agreed upon, and even though you could afford it, you knew it wasn’t good for them, so you had to say, “I can’t give you money anymore.” And it leaves you feeling gutted. You’d much rather be the “Yes-man,” the generous one, rather than the uptight enforcer. You feel misunderstood, even a little resentful, that you were in essence pressed up against the wall without anywhere else to go but into the confrontation. No one thinks about how hard it is for you to have to say “No,” in whatever fashion the situation called for. No one considered that is not something you ever wanted to do. “I don’t want to be this person!”

When someone in your personal life behaves in a way that forces you into uncomfortable confrontations or makes you feel cornered into addressing issues you’d rather avoid, it’s often described as emotional manipulation or manipulative behavior.

This can also be seen as a form of boundary pushing or boundary testing, where the person knowingly or unknowingly disregards your limits, forcing you into a position where you must enforce your boundaries, even if it’s uncomfortable for you. Sometimes, this is referred to as being emotionally strong-armed or coerced into conflict. These situations can make you feel trapped into playing the “bad guy” role, despite your best intentions.

Gene was doing a form of this in our clinical relationship. He’d be in a crisis, call me and I’d see him, reactively rather than proactively. Then Gene would go and play around with his medication dosages and/or stop or start other medications he had at home at will.

This behavior, where a patient adjusts or changes their medication regimen without consulting their healthcare provider, is called medication nonadherence. More specifically, when patients alter their dosage, skip medications, or stop taking them entirely based on their own judgment, it’s often referred to as self-medication or self-adjustment of treatment.

This behavior can undermine the effectiveness of the treatment and lead to unstable health outcomes, as seen with Gene, where it contributed to his ongoing cycle of anxiety and depression.

“Gene”, I said. “As we’ve discussed many times before, I can’t continue in a patient-doctor relationship with you like this because it’s not good for you. In essence, you are treating me like a dealer. We are not a team.” I did not want to say it but had to. “Gene, if you do this again, we’ll have to terminate our work together.”

Gah! I hate doing that!@#@#^&*%^&*(!!!

There are so many reasons patients do this and it’s not something to be ashamed about. See this post, A Tiffany Diamond Isn’t This Good, to go over reasons for treatment nonadherence. It’s so common that it’s almost normal, but it doesn’t carry a moral value. That’s not to say that it’s not hard on the medical providers, nor harmful to the patient and that’s why it is better to deal with it upfront rather than let it go on and on and on.

Confronting a patient about treatment nonadherence can lead to several positive outcomes, both for the patient and the therapeutic relationship. Here are some key benefits:

  1. Improved Understanding: By addressing the issue, you can help the patient understand why sticking to the prescribed treatment plan is critical for their health. It opens the door for education about the risks of self-adjustment and the benefits of adherence.
  2. Strengthened Trust and Communication: Having an open and honest conversation builds trust. It shows the patient that you’re not just a prescriber but a partner in their care. When patients feel heard and understood, they are more likely to be honest about their struggles, leading to better outcomes.
  3. Identifying Barriers: Confronting nonadherence can reveal why the patient is making these changes—whether it’s due to side effects, misunderstanding, financial issues, or other personal reasons. This insight allows you to address those barriers and adjust the treatment plan if needed.
  4. Tailored Treatment: If the patient feels the medication isn’t working or is causing problems, discussing it allows you to collaboratively adjust the treatment plan in a safe and effective way. This can make the patient feel more in control while ensuring their health is prioritized.
  5. Prevention of Future Health Complications: Addressing nonadherence early can prevent the patient’s condition from worsening. This proactive approach can reduce the likelihood of unnecessary health crises or hospitalizations.
  6. Patient Empowerment: Confronting the issue respectfully and collaboratively can empower the patient to take an active role in their treatment. This can lead to greater self-awareness and better long-term adherence to medical advice.

By having this conversation, the clinician and patient create space for a more individualized approach that acknowledges the patient’s concerns while ensuring their safety and well-being.

Self-Care Tip: Work together with your treatment providers! Be a team :). Keep on!

Questions: What are good reasons you’ve found for treatment nonadherence? We need to hear!

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Where to trust

Sometimes, ok quite often, we feel misunderstood by others and unclear of our paths going forward. We are not alone, dear readers, in this.

This is what Taylor swift says,

“How did I go from growin’ up to breaking down?
And I wake up (Wake up) in the middle of the night
It’s like I can feel time movin’

How can a person know everything at eighteen
But nothing at twenty-two?

And will you still want me
When I’m nothing new?”

I’m thankful for her voice in this.


I am nothing new and my personal value has to be on aught else besides novelty. Nor can it safely be placed in my behaviors and emotions.

It is our life duty to discover where to put our trust. In our own capacity? In identity? Or where? We are vulnerable to our biology one could say. But we are able to trust something someone somewhere. And whether it is fortunate or unfortunate, I can’t hand you trust like a baton.

You got this though.

Sending you readers all my affection. Thank you for joining me in this life journey of being a Friend to Yourself.

Keep on!

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Do I have to stay on medication?

Medication treatment duration is a multi-threaded rug.

Some ask about the effect “wisdom and growth” has on their need for ongoing medication versus growing out of the need for medication therapy. It is normal logic to think that we should behave better and feel better when we know better. This leads many to wonder if it’s time to come off of medication therapy.

Let’s work on this by considering these variables.

  1. Coping skills. 

Coping skills are how we deal with stressors. When something happens to us, like getting yelled at, honked at when driving, or suffering a loss like a break up – our automatic thoughts and actions may be kind or unkind to ourselves. They may serve us well or may not. Coping skills can be intentionally grown, such as through dialectical behavioral therapy, and/or may require medical treatment. Coping skills regress with mental illness. But there are therapies that will improve them, helping our resilience, and helping us choose to continue vs. taper down medications.

  1. Recurrence.

Has the patient had multiple episodes. Multiple episodes of mental illness will signal differently, as compared to a single episode, in regards to risk of relapse.

  1. Genetic loading. 

What’s the family history of mental illness? Genetic loading. Genetic loading. Genetic loading. It tells the story of our biological risks. 

  1. Risks and Benefits.

Weighing the disabling impact the disease processes have on a patient’s life against the risks of medications. Consider the psychic suffering. We suffer and the suffering is real. Compare this to what we don’t like about taking medication. Weigh it and find your balance. Medication may be too “costly” to continue.

  1. Impact of disease process on future brain health. 

Mental illnesses in general are progressive, and the medication therapies not only treat the current symptoms but also are prophylactic (preventative and protective) against further brain insult. The brain now, if mental illness goes on, will be a different brain in ten years. We are fighting for that person too when we fight mental illness. Our future selves.

  1. Full treatment response.

Even though the patient has been on medication for a long time, what is the current condition of the diseases and the treatment response? Is the patient fully treated? Symptom free? Or does the patient have ongoing symptomatology even if improved from prior to treatment? For example, if the patient’s depression has resolved but they still have symptoms of anxiety then they are at a higher overall risk if medications are stopped. Being better may not be good enough. Or it might.

Self-Care Tip: Staying on medication can be discomfiting but take a turn with your treatment provider to consider.

Question: What is being on medication like for you? Tell us your story if you stopped it or if you chose to stay on it.

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In the mean-time, Waiting for Treatment Response

A crowd of Neuro-receptors fill our brain like a high school mosh pit. It’s noisy and possibly dangerous up there. It’s hard to focus. The negative thoughts are drumming. Medical treatment for depression is the Arthur Murray instructor to our brain-dance. And it takes time.  

When we take medication, the neurotransmitters targeted in our brain have to respond to the neuro-messengers that are the medication. Some receptors downregulate, i.e., decrease in number or activity. Other receptors likewise, upregulate. Again, this takes time. For example, fluoxetine, or Prozac, which came on the market in the late 80’s, is one of our most familiar antidepressants. When we start the medication, (and please don’t call them drugs because no one is panhandling for fluoxetine… Nor are we taking fluoxetine to get a high, but rather to treat a medical illness)… 

When we start fluoxetine, it can take 3-6weeks to start experiencing the benefits. Furthermore, during the first few weeks it is common to feel worse before we feel better. Worse anxiety, worse depression, this is because the receptors are learning a better dance. And it takes time to learn. And learning in this case feels worse before it feels better. 

You ask, what do we do until the medication takes effect? Marvelous consideration. Because here we are, asking for help, and our psychiatrist gives us something that makes it worse. Ummm. 

In the first couple weeks, which can feel like forever, perspective being what it is, a cloudy lens, feeling worse is described by the health of our brain. The brain, from which all emotions, behaviors, and sense of reality come from, takes time to heal.

We come to the psychiatrist by the hair of our chinny chin chin, almost dead inside. We waited, of course, to make the appointment. Waited for our courage to catch up with our disease. And then we waited for an appointment to open up three months later, seemingly forgotten at the train station scanning the crowd for kindness and help to come. And then? Then we receive treatment that takes another month to start, to start I say, not finish, the healing it promised, (a promise that values at about 50-60% of the time to come through. That’s the statistic for fluoxetine to be effective for each of us with our first trial of depression treatment. Thereafter, the likelihood of responding to fluoxetine diminishes after each trial.) 

This is the lighting on the stage for your question, “What do we do in the meantime?” We survive?

It’s too easy to come up with behavioral solutions that if they were to work, they would have already done so during that waiting – ex: 2 months of worsening mood, 2 months to call the psychiatrist, 3 months to get in for your appointment, 1 month for the medication to start working = 8 months. 

You’re not a dummy. But we’ve been advised as if we were by our community. “Feel better.” “Snap out of it.” “Pull yourself together.” “Be strong.” It’s not like you didn’t think of these on your own and were waiting for someone wiser to tell you to get on with life. But, If you are able to, please do get on with it. Go exercise. Sleep better. Eat better. Look at the world with hope.

For the rest of us with melancholia, ie. major depression, the choice left us when we lost brain health. Similar to the alcoholic choosing not to drink, choosing to feel well isn’t a choice. When the medical illness recovers, we gain our freedom to choose those things back. 

During these “8 months” there are some things that can be done however. 

Go to a psychiatric partial hospital program, (“PHP”).  This is a day hospital where you attend for about 6 hours, 5 days a week, for about 4-9 weeks. It’s incredibly supportive. But more than that, PHP teaches dialectical behavioral therapy, (“DBT”), a type of therapy that has been shown to make changes at a cellular level. There are changes to our automatic thoughts, so that when something triggers us, our pre conscious response is more friendly to “Me.”  It’s not a “stick-shift”, but rather increasingly automatic. The key is to work toward brain health. 

Others will collaborate with their psychiatrist to augment fluoxetine, or whichever antidepressant of choice, with another medication that can help pop you out of depression sooner. These treatments are not generally long lasting and don’t treat the underlying illness. Rather they treat the symptoms here and now. Some examples used include stimulants or thyroid replacement therapy. 

In the end, be in a community of support – be it PHP,  outpatient therapy, or NAMI. 

Support is the shell to our drippy egg, while we wait for our medical treatments to take effect. 

Question: Have your efforts in treatment worked out? What’s your story?

Self Care Tip: Don’t give up! Pursue treatment. Your illness is treatable. But in the meantime… be in a community of support. Keep on!

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It is okay to be Wrong …and Fears

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There was an exhale. A ripple out, like dropping eyelids, a wave on a slow shore, turning a shoulder away and the head following; this was how her disclosure soundly rolled through the room.

I failed.

I don’t care how cocky you are, everyone fears. In the brain and body, sometimes, the parasympathetic is dominant and one feels calm. Fear isn’t on the mind. Another time, the sympathetic tone rises and you think, “A bear is chasing me!” Or, “That girl is coming to talk to me!” (It can feel synonymous. Wink.) Yes, that is fear. But the kind of fear I’m talking about here is the one germane to our conscious or even before conscious awareness that we will never be enough. There will always be someone. Smarter Her beat Me in AP Calculus. Someone the boy desires… more. The things like food, shelter, clothing, the money, the votes, the power, and someone other will trump Me. This fear comes from the Amygdala, an almond in the middle of the brain that holds our sensitive selves carefully within it’s tiny shell. Others will argue that it also comes from a magical outside-of-biology-morality. A qualifier or quantifier of personal value. Plink. A widow’s mite drops in; an offering of our small or great selves.

But wait. There’s another choker, ring and leash that sparkles around our slender neck; the whole perfectionism culture. This is the psychological influence on what makes us who we are, including our constitution of fear. This is what I wish I gave better to my world, to those I am in contact with. I wish, like Pinocchio, because I believe perfectionism is dishonest and lacks moral fiber. We are made better by our failures rather than worse. And if I were a philosopher, I’d recognize the tiring loop this swings me into… It is a failure to live in shame of my failure to receive the gain that failure brings. Round and round. An ice cream truck sounds music in the distance but I have no change. I’d like to especially tell my kids with my life, my actions, my all – “It is ok to be wrong.” Wrong wrong wrong is just fine. Pause. And then also, “It is ok to not pass, to miss, to play flat notes, to sit alone, to be unchosen, to work hard and fail.”

Beatrice, a graduate of the Medical School of Manila and residency in internal medicine, and later after six years of practice, immigrated to the US of A. She had taken the USMLE Boards Step One, twice and both times, failed. She could not do the training in the states that would allow her to practice here until she passed. In the mean time, her kids back in the Philippines, needed funds to live. Beatrice worked Door-Dash, while she studied and feared.

It would have been clanging “toxic positivity” for me to chirp, chirp, “It takes a lot of failures in order to succeed.” But help me, I wanted to! And forgive me, I have with others. Ugh.

What is the balance? Because there is truth here. All successes are preceded by a large mote of failures, conscious awareness of them or not. However that doesn’t prove that successes will follow. What’s the term in logic that this is in danger of? I think it would be a blend between causal fallacies and a hasty generalization. Sometimes there is just failure. A dump in the mossy monster infested water.

Because we are good psychiatrists, we will shake it down, and dutifully approach fear here with our “bio-psycho-social” paradigm. We have the brain, including the amygdala and it’s influences. We have the psychology of perfectionism. And we have the social of Beatrice’s children’s basic needs to survive.

How do we do self care with all this? If we have enough bank, we go toward the elements, separate and whole, in this paradigm. We pluck away where our suffering calls out to us most. We go forward knowing that whatever it is we are going through, we are not alone. It is common and normal, although unique because we are, each of us, an un-duplicated wonder. We use the reminder this approach offers that things are always more than they seem to our conscious selves and if we give to it, we will weave together a greater hope, with both the good and the bad, all seated at the Thanksgiving dinner table this year.

For Beatrice, we grieve with her the difficulty in her journey. We celebrate her hopes. We encourage without losing honesty. And we give treatment for the biological expression of underlying disease that harms the way she perceives her reality. This is our privilege.

Self-Care Tip: It is okay to be wrong, wrong, wrong. Keep on!

Questions: Would you please tell us about your fear?

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Pastor Venden on suffering

Hello Friends,

This is an audio recording of my pastor of seven years. He is gone now and I miss him.

Tonight, please enjoy one of his sermons and let me know what you think.

youtube.com/watch

All my best to you.

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Daughters

To all the daughters, of any age.

My girlness is triggered. Seeing my daughters grow in femininity is a live matchstick. Woosh! What is this edge and sadness and tears that surprise me; me, the well analyzed adult. Ha!

Where did these thoughts come from, like old dirty  socks from the backside of the dryer? 

My daughters explore their own free rights as well bodied young women. Then flashes explode in my mind, just as unsolicited as the original whistles and lewd comments were. “Hey! Chicky Chicky!” Kissing sounds smack in the air as the men encroach on my space.

My daughter wears a top just so, and suddenly I am 17 years old. My cousin smirks knowingly. “Are you going out to have some fun?” Later I understood he was convinced that because I looked the way I did, I was having sex with multiple partners. 

My daughters pick up on my inconsistencies when I warn them. My somewhat frantic words seem over the top and suppressive. They don’t hear my mom calling me an 8-year old hooker when I walk around the house in underwear. Apparently I was too old. The calendar page had turned and I didn’t notice. Time to wear full attire if my brothers and father were home. It was apparently also time to move my best friend out of my room. I was left alone, listening to the newly roommated brothers on the other side of our shared wall talking and laughing together into the night.

What is this arbitrary line I didn’t see? And how do I explain it and warn my daughters? I’d like to wrap them up in caution tape. “Please be careful my daughters. I love you. Please don’t get hurt.”

It felt like everything reinforced my own vulnerability to that line. “You are not safe,” the line read. “You are not equal.” And I can’t even tell you what it was like becoming a woman in medicine. As I walked along through life, the line progressed too, defining me. “You are just just a woman.”

I have worked so hard to smudge this line throughout my life. So hard. I thought it was as close to a nonissue as it could be while still having a vagina and breasts. This must be why it has been such a surprise when these visceral reactions to my daughters’ development jump up, like turning the crank on the jack in the box. Spring! Cue scary clown in my face. Probably my mother had her own jumping thoughts when she parented me just so. 

I’m sorry, Mom, for judging you. 

My daughters deserve to figure this out for themselves without my sleeping-thorns waking up all over them. They will do well. My fear will or will not continue to heal. But I pray that either way, I don’t use it against them. And I pray that my fear doesn’t ironically distance us from each other. 

If I were a wizard, I would twitch my nose, chant a marvelous Latin spell, and they would gain the ability to proceed with both the guilelessness and the smarts that would keep them from harm and still give them freedom. But the only magic I have is this clumsy love. 

The differences are real. The double standard is not arbitrary. I misspoke earlier.

Getting accepted to medical school with the many family and friends’ opinions dropping around me like stinky flower petals – “She’s her father’s daughter. That’s why.” A patient mid interview aggressively grabbing me. The failure of messy hair and weight gain. Being passed over for a directorship. 

And then there are all the wonderful realities of being girl…. Many. 

I will stand with you, daughters of mine. I will come when you call. I will shake my fist when you are shattered. I will work on my own self care. I will choose, and choose again, to not trip you. And when you mess up, I will still want you. Every time.

Self-care tip: Work on your own self-care in order to love your loved ones well. Keep on!

Questions: How have you found that the condition of your health – emotional, physical, spiritual – has given you more to give to the ones you love?

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Your False Intuition

The curse of “intuition” in Data Science - Towards Data Science

You can’t listen to your intuition all the time. You have to have a healthy dollop of distrust for your own inner voice. The siren’s song of our inner self to isolate and “do it on your own”, however dulcet and powerful, are dooming.

When Marsha suffered a dramatic loss in the stock market, she became crippled by anxiety and irritability. It had the further outcome of estranging her from her spouse and friends. She spent all her clean, controlled, but lonely time, alone, like a many thorned beautiful rose in a glass vase.

Marsha and I tugged with this concept, like holding onto different ends of a rope. She did not want to go to therapy. She did not want to disrupt her flow.

Sometimes our lives are “in flow,” but it’s not a healthy flow. We are doing some healthy behaviors, such as exercising, getting our sleep, eating well. However despite this, our emotional disease progresses, unchecked by uncomfortable deliberate efforts. Sometimes we are medication adherent even, and yet our behaviors and emotions are not kind to ourselves. We remain in a condition of suffering, isolated; unable to connect to self and others.

During these times, we need to disrupt the flow. It is laminar, even lovely in its quiet arc, that dishonestly soothes. We need in this case, turbulence and a different direction.

If what you are doing isn’t working, add turbulence and do what is uncomfortable. In Marsha’s case, we both laid the rope down, (smile,) and she pursued a day hospital where she worked on changing her automatic thoughts toward those that were kind to herself. When something triggered her, how she responded, and before she even knew she was thinking about it, was healthier.

Question: Have you ever been misguided by your own thoughts? How do you safeguard against an intuition that may not be kind? Please speak and tell us your story?

Self Care Tip: Don’t let your own intuition be your only voice of reason. Be a friend to yourself.

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Science and God Awkwardly Related

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God and science are as awkward together, culturally, as someone walking in on you in the bathroom, mid stream.

People think science and God can’t be related. Like there’s a gap.

My son and I watched, “The Exodus Decoded,” a 2005 documentary, directed and starring Simcha Jacobovici, and James Cameron. In this, the history of the Biblical Exodus is presented through a scientific paradigm.

My son was discombobulated. “Mommy do you believe that!? What do you think? Do you think science explains the miracles God did? I don’t.”
True. He hasn’t had the benefit of decades of higher education to influence his thoughts but irregardless, he is not alone in this.

A pharmaceutical representative I was speaking with explained, “People feel like religion or spirituality are emotion-based whereas science is coming from a field where you have to be objective and unbiased. I think also like you get too much feelings involved, you know? No go.”

Is it like, “God and state,” so is God and science? Like it’s wrong to relate it. Is it not ethical?

Many of us think, mixing these ideas leads to less validity. If that were true, what does it say about who God is? That would be a pretty limp God, who is separated from “one” of His creations with another. Nor is it that kind to “Me”. Me Me Me. Remember? Everything starts and ends with Me here at Friend to Yourself. If keeping science and God separate were true, it increases disconnection in my life. And we are created for connection.

Question: In the words of my son, “What do you think? Do you think science explains God’s miracles?” Or what?

Self-care tip: Allow the gap to fill in between your Higher Power and the explained in your life, however you will. It will improve your self-care.

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PsychU video – Sleep, in the world of Behavioral Health

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God in the Space of Synthetics

Hello Friends!

I’m going to try something a little different today. I’m posting a dictation between a patient of mine and me because I think it has flow and a nucleus. (There are a few small changes made in liberty, and no identifying data.) Let me know what you think of the content.

Psychiatrist:  …And so we were talking about perfectionism, right? 

Patient:  Yes. 

Psychiatrist:  And about how you are not being kind to yourself when you expect yourself to be all healthy.

Patient:  I’m not being kind to myself when I don’t want to take this or that because I don’t do synthetics. (This is what my patient was using to describe medications.)

Psychiatrist:  I like that you used the word synthetics, because I’ve never put it in that perspective with patients, and you did that for me. 

Patient:  Well, there are non-synthetic and there are synthetic. 

There’s body recognizing things, plants, and then there are the synthetics, what the pharmaceutical companies produce. And I’m a very negative pharmaceutical company person. 

Psychiatrist:  Compare that to other inconsistencies in our life. Such as, I’m going to be all-natural, I’m only going to wear hemp.

Or take it to the point where I’m going to weave my own clothes because it’s really natural and I know exactly what’s in it. Versus saying that I’m moving forward and I’m going to take what science has offered to us. I’m wearing polyester right now. 

Or, I’m willing to take over the counter “herbs” because they don’t have the pharmaceutical stamp on it, or maybe I like that it grows out of the ground. But none of that has been governed. Aside from the “he-said-she-said evidence,” there’s often little science behind some popular over the counter remedies either. 

Let’s consider that perhaps the study data, comparing in a regulated way, one patient with another, defined synthetic agents, and then allowed my body to be its healthier self. It gave us objective data. Numbers. Sure they have their flaws and weaknesses as we learn in statistics that all does. Poke holes in it as you wish, but at least there is a degree of transparency.

Patient:  Maybe for me it’s more trust, because I feel like people are so over-medicated today. And it’s easy to write out a prescription than to really deal with the issue. 

(Me, on the sly: This view, that practitioners prescribe for reasons other than for the medical benefit of the patient, is one that I honor with humility, and stand up and listen when others voice it. Annals fill the internet search engines on it, I’m sure. I will still pick at it a little, I’m a stubborn nubby person like that.

Let us note together that the word, “easy,” in this context isn’t so kind to our person. Taking medication to treat a medical illness is often not easy. It is one of the most courageous acts in someone’s life. And this wonderful lady, who came into my scary office, was a great example of this kind of courage. She wasn’t here doing what was easy. She was giving her emotional entrails a work-over with her psychiatry venture.

This patient, whom I will name hereafter, Lady Courage, was “really dealing” with the issue, in contrast to her self-described mores. Might we suspect the insidious tendrils of “Mister Stigma” shaming her? Yet here she was… Just fabulous!)

Lady Courage: I’m more one that, “Let’s really deal with your issues, and then your mind should come around, everything should come around.” That’s how I view it, because if you don’t fix the underlying problem you’re never going to fix the problem with meds.

Psychiatrist:  Okay. But you’re willing to say there might be some inconsistencies in that right now.

Lady Courage:  Right, no, I’m not … 

Psychiatrist:  It might not be entirely false, but it might not be entirely true. 

Lady Courage:  Exactly. 

Psychiatrist:  We were saying, “I can be healthy but still have disease in my life.” 

Lady Courage:  Yes, that’s true. 

Psychiatrist:  Because I don’t have to be perfect. 

Lady Courage:  Right. And I do find that a little bit hard. But since you put it in that aspect of being, “healthy with disease,” I can see that. I probably never saw that before, because I did always separate the two, either you’re one or the other. 

Psychiatrist:  Wow. 

Lady Courage:  Yeah. 

Psychiatrist:  That’s poignant. Is that how you see God as well? 

Lady Courage:  In what aspect? Like, yeah … Well, you know what? I try to strive to walk in His ways. I haven’t always walked in His way, so I do have guilt about that, but I shouldn’t have that and I know He’s already said He’s forgotten it, He’s washed me clean. So it’s just receiving it for myself. And that just is faith. And I know then it makes me feel like I’m lacking a little faith, but I know I should be stronger. But, yeah, The Word is something that I strive to follow, and it’s hard. 

Psychiatrist:  So do you feel like God is, “either/or,” in the way He looks at you? What about the parts of you that are diseased? 

Lady Courage:  Well, no, yeah, He’s going to heal that. 

Psychiatrist:  But what if He doesn’t right now? What does that mean about who God is?

Lady Courage:  Well, He sent me here probably in hopes that you can help me to heal. He provides these avenues for us, so that we can get healed. 

(Folks! So good! Smile.)

Psychiatrist:  So you somehow think that God enters into the space of the synthetic. 

Lady Courage:  Well, yeah, I guess so, yeah. I do, okay. It’s so contradictory, but in one aspect I do take a thyroid medication that is a synthetic, but I know I have to take that and I understand it and I don’t feel it’s abusive. And I look at my blood work and I know where I’m supposed to be and how much I should be, so I feel confident. But when it comes to things like this that I’m not used to taking, and that don’t show up on labs, and it involves transforming my brain, I’m not really on board with that. 

Psychiatrist:  So when you use the word transforming my brain, I understand you’re saying that it’s making you into something different? 

Lady Courage:  It can alter your brain, yes. 

Psychiatrist:  Okay, so that’s the part I think that’s very scary for people, because they think it’s making them into somebody they’re not. But in reality the medications are there for healing who you already are. So for example, today you feel more like yourself than you did last week. 

Lady Courage:  Well, yeah, last week I was desperate and hurting and losing weight and scared. 

Psychiatrist:  And today you’re closer to who you think your healthy self is. 

Lady Courage:  I think today I’m … Yes, I’m much closer to my healthy self. 

(Q: Closer to who God is creating you to be? Closer to God’s will even?)

Psychiatrist:  In all of these scenarios, at each point we want to think, “What does this say about who God is?” If He or She, (but we will say He to simplify because it’s culturally appropriate,) is kind and loving like you mentioned, then would this belief, X, Y or Z, be true?

Self-Care Tip: Lay out our beliefs next to that standard, that premise in our life. And because we’re a lot crueler to ourselves, then we would allow other people to be, it can rescue us on occasion.

Questions: “What does this say about who God is?” Please speak out!!! …and, Keep on!

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Patients who see me think God has not heard them

Hi friends. This is unedited. Something unedited really doesn’t have a right to be published online. Ah well. We are all rebels here. Give me your thoughts, mark up for your edits. We need to hear from you.

People come and say, I prayed God would heal me, I did everything right, but I didn’t get better. So I finally came to you. It was my last effort. I’ll do anything. I can’t live this way.

Then we sat together and explored what was happening here.

God is a better psychiatrist then I am, but it is a miracle every time that S/He uses me to answer prayer.

See what God is doing.

I’m grateful I am given these years as I am able to grow in understanding that my job is not as much to see, what can I do. Rather, watch and participate in what God is doing.

Remember Gideon.

The Israelites from Abraham till Jesus came, wondered and wandered around, thinking about what their destiny was. When they got Saul as king, they lost vision of seeing what God can do. Then they broke up into different kingdoms and got more kings. Then they were conquered over and over and they waited to get their victory. Then Jesus came. And showed us that His kingdom was one of love. Could we say, in some ways, it was a disappointment?

I’ve been disappointed at various times of my wandering and wondering how I fit in. Now I am very slowly learning that it isn’t about me.

Do not limit what God can do. Do not squeeze God down to the confines of our own minds.

Ellen White says that we will spend all of eternity learning about the character of God. That’s a lot of content. That a lot of interest.

If we think about all the scholars of scripture; jesuit’s, ravi’s, pastors, people with photographic memories, the wisdom of Solomon, it doesn’t touch all that is waiting there in that space of eternity for us. We are just getting a toe into what will capture our attention for eternity; what will give us purpose, motivation, interest, a wanting to live and connect with self and others for a space of existence that has no parameters to time.

Self care tip: it’s more than Me

Please speak out and tell us your thoughts.

Keep on

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Four Horsemen – Lovin’ Better




So good. I want to practice this in my home.
More and more I see that I love because God loves me first.
This is a good place to start in living in a love relationship.
Keep on!
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Unlikable: Me Too

Poem:

I feel unlikable

It sounds young

Immature

It sounds like I’m fishing

But I feel unlikable and it is what it is

I can list my attributes

And do also remember

What others have said

In their own throws of comparisons

It is disconnected though

Me talking to myself

An echo in a cavern

Otherwise quiet

Unlikable might be better said

Disconnected

And I was created for connection

I’ll never survive any pilgrimage on my own

I’m designed to say, “Me too”

But just this

Improves my sense of company

I can’t know why

Writing it out

Makes me think of you reading it

And saying something back

Selfcare Tip: Look for connection. You are not alone.

Question: What improves your connection? Will you tell us an example of a time you turned it around; went from feeling alone to then connected?

Keep on!

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Self-Stigma and MYTH

What is it like when people talk with you, a psychiatric patient?

How do all the areas we are contending with in stigma affecting your interaction with others? – Demonic possession, shame, violent tendencies, weak character, and poor moral choices?

We want to hear from you. Some stories please.

One patient told me that her parents were angry at her teachers when they were advised to consult with a psychiatrist for my patient’s depression. Her parents were so angry, in fact, that they removed her from her private school and enrolled her somewhere else.

I wanted to ask my patient, let’s call her Brianna, how people speak to her now that she has finally engaged in treatment, as an adult! How do her parents reconcile it? How does her church speak to her?

Briana is among many who suffer at stigma, but her best approach would be to ask how she, first speaks to herself, a psych patient. Does she have biased self talk? We need to start with “Me.”

What are the common myths? Get the myths out there.  Some of what the community says are true myths and some are not myths.

  • Time consumption.
  • Danger
  • Treatment skepticism – no recovery, there’s less hope for them
  • Punishment from God for evildoers.
  • Demonic possession
  • Danger
  • I am lessened by my affiliation with the mentally ill

The patient is sick after all. We agree. Brain illness and all that. This is Brianna’s identity; her emotions and behaviors paint what she and others see. Perhaps, Briana identifies herself as someone with depression; someone who went over her church and parents directives. That takes a chunk of courage to do. 

 

Self Care tip: Discuss and discover the self stigma we have about our mental illness.

Questions – as listed above :)!

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False Thoughts about Getting Healthy

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Think of walking in a rainstorm. Your clothes and hair hang heavily. They provide no protection. They offer no remedy. You take a hand towel out of your bag and try to mop up your icy wet face. Wring it out and continue to wipe. 

This is like choosing to do all the psychosocial efforts in your life, but missing the biological. Until you treat the underlying illness, much of our efforts to heal are like using a hand towel to dry off in the rain storm. We think that we can get better without medication. Or, we may reject other treatment options, like ECT or TMS. We think false thoughts. 

It’s not healthy to take pills. 

I’m better than that. 

All I need is God. 

My parents would be upset, so I shouldn’t. 

If my work found out, I’d lose my job. So I shouldn’t. 

THC is better. 

Exercise is better. 

Some of these are entirely false. But some are just partly false, encased in a disconnected truth. This “rain and the hand towel” idea is not an analogy meant to minimize or bring shame to those who choose not to engage in treatment. It is not meant to talk down. Please forgive me for the crudeness and limitations. It is just meant to crack open this idea.

Yesterday, Louise commented that her physician told her taking sertraline, or Zoloft, was like taking “a vitamin for my brain”. That clicked for her! Vitamins were ok.

Question: How has your physician helped you get past not wanting to take treatment? How could your provider do better with this?

Self-care Tip: Allow healing with medical treatment for medical disease.

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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.