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.
All my best to you.
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.
All my best to you.
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?
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.
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.
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?
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.
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!
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.
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.
I feel unlikable
It sounds young
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
Unlikable might be better said
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?
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.
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 :)!
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.
…Continued from yesterday.
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.
Presley couldn’t breath. A truck just drove through his thorax. A monster-hand was closing around his heart. He couldn’t swallow well. Was something stuck in there? Dizziness nearly dropped him, but instead of moving to sit down, like any other normal person would do, he bolted. A fire chased him. He had to escape or he would die. In the bathroom where he found himself, the mirror reflected a sweaty face and crazy eyes. Was he dying? Presley’s phone looked blurry as he dialed, 911.
Please help! I’m having a heart attack!
That was the first time this had happened. After the third visit to the emergency room over the past month, Presley was able to avoid calling 911, although still convinced he was going to die when the next episode hit. He agreed to seek counseling, where he was taught different skills to connect his mind and body, to slow his breathing down, to process, even when he was convinced he was dying. For a time, Presley improved. It was like it never happened. He was almost able to convince himself that it wouldn’t happen again.
This turned over and over, feeling like he was going to die while losing his mind, re-engaging in counseling, thinking he was better, stopping counseling, and then another violent emotional event, thinking for sure, he would die.
It was after his second trip to the ER when he received the recommendation to schedule an evaluation with a psychiatrist. But he preferred to work through this in therapy. Presley didn’t like pills. He wasn’t someone who medicated. An olive-skinned athlete, he lived clean and didn’t believe there was much that healthy living couldn’t cure. And Presley did live clean. He ran fifty miles a week. He ate raw foods. He read his Bible.
After several months of this, his therapist, Dr. Wu, recommended he get a psychiatric evaluation. However, Dr. Wu agreed that he would continue to work with him, whatever Presley chose. (Was this the right thing for Dr Wu to do?) Presley chose, no. No psychiatrist. What would a psychiatrist do to him anyway?! He wasn’t crazy. (Except when he thought he was.)
Presley visited his primary medical physician, Dr. Belinda Jones. It had to be better than seeing a shrink!
Dr. Jones, I don’t want to take meds.
Dr. Jones, cleared him for any medical condition that might be contributing to his events. Only then was she able to convince him to try a “safe antidepressant”, escitalopram. After one pill, Presley had the worst event of his life. He’d never had any experience that was more terrifying. Presley didn’t go back to Dr. Jones, “of course.”
When these emotional tornadoes hit more frequently, he became paralyzed with fear that he would have them in public and be humiliated by them. Presley stopped going to work. If it wasn’t for his rent, he’d never go back. But he had to. So finally Presley agreed to see a psychiatrist. …
To be continued
Questions: What would you tell Presley?
How would you like your physician and/or therapist to handle this, if it were you?
Why is Presley so opposed to taking medical therapies?
Please speak! We need to hear you.
Self care tip: Keep on! 🙂
The bar hummed with the energy of human emotion. It was one of the few places Alfred could still smoke in public. He remembered the first time he was directed to a smoking area in the airport that looked like an enclosure for zoo animals, with glass walls, and positioned in the line of traffic. What in the world?! So Alfred felt unjudged at the bar, and also pumped up.
Alfred got energy from being with people – gravitated to them like a little brother follows his big sister around. If it was the bar, or the smoke break, Alfred got energy if he wasn’t alone. He absorbed every moment, marinated in it no matter how brief. The “moment” was his forever, for however long that moment would last. He was inside the color, flavor, aroma, texture, and song. He noticed. And, Alfred grazed. Amongst ideas, people, choices, and of most anything that came into his field of vision, he chewed it up in that space of time, and then moved on without guilt. Generally people didn’t hold grudges when he moved on. Alfred was just so nice!
When Alfred was in sync with his energy, senses, feelings, and perceptions, and his wife was in sync with her own, she looked at him like he was someone she was interested in. He could make her laugh and play, whereas she was never normally someone who was playful. This was nectar to Alfred’s pollinator.
Out of sync, however, Alfred’s wife called him names when they argued. He was “flakey,” or “narrow-minded.” And Alfred, awkward with conflict, developed the habit of escaping during those times. He did not like conflict.
Alfred began to drink a lot more alcohol. After work instead of going straight home, he’d “catch a few beers with the guys”. When entertaining clients he started joining them when he offered alcoholic beverages to his clients, imbibing during work hours. His work performance started to smell sour like his alcohol.
You can see where this is going for Alfred. When he came into my office, he reported his inability to enjoy anything, increasing hopelessness, and now when he left the bar in the evening, his mood regularly plummets, a false weight in the scale of life.
Alfred looked at me with a degree of distrust, expecting judgment. But of course, he was also coming to me for judgment – an evaluation and diagnosis, and then to present a plan for treatment.
The treatment plan was short this day. Go to alcohol rehabilitation. Telling Alfred that there was nothing else we could do for him until he engaged in a rehab, was nerve-racking for me. (I never know how a patient will respond after similar directives like this. Sometimes they are not kind. Especially when talking about their substances or addictions, of any sort.)
Alfred stood up, a bit like a mechanical man, thanked me for his contact referrals, and left. I thought that was the last time I’d get to see him. It’s impossible not to hope for the best.
The deal with brain illness is that the treatments I am able to offer in an outpatient setting are ineffective in this context. Other stuff going into the body hits those brain receptors, turning genes on and off, like Wile E. Coyote in the back country. It would be enabling the mal-behavior if I diverted our focus onto anything else. Even so, like so many in the company of users, it is wilting not being able to offer more.
About two months later, I was completely surprised when Alfred came back sober! He told me he did just what we talked about, and rehabilitated. More surprising though, was his statement,
Thank you for refusing to treat me. You saved my life.
Alfred was still married, and yes, the marriage was still volatile. But he wasn’t plugging his ears and disconnecting from his wife with alcohol. It was a start. And Alfred still had restarts available to him.
We did end up starting psychotropic medication and psychotherapy, with which Alfred continued to heal.
I am humbled by Alfred’s courage to pursue rehab, the path of more resistance, and recognize that I should never underestimate the same courage in others when they present similarly.
Self-care tip: Taking the path of more resistance may bring just what we are hoping for.
Question: What have you done courageously? Where has it taken you? Please tell your story!
Everyone says “Hi” to my dog, Timothy… Way more than to me. Silence.
Is it the springy fluffy hair, I wonder? They walk up, even speed, out of an unseen shadow without inhibition and rub him down. He is pleased every time, to say the least. Do I regret all the painful laser hair removal treatments I got years ago? Hm. I am half Lebanese after all and few really know how much fur I really came with.
Steve came looking for help. I spied him in the hallway before clinic. That’s always a little awkward for some reason. Running into someone out of context. Like we both are caught out of costume and the curtain just pulled up. (Gotcha!)
His strings pulled in, an inner tension, apparent even then. He looked susceptible to emotional or physical attack when we caught each others eye. I could see him wondering if this was “her”, his psychiatrist. What was he expecting?
When patients come in for treatment, it’s comparable to anyone acting on a realization that they’re vulnerable, asking help from a stranger. It can take immense courage.
Part of this understanding is what contributes to the awkwardness of meeting in the hallway, out of context. We are both a little undefended there.
So what would bring a person to do this to themselves? It doesn’t sound pleasant when put this way – vulnerable, asking help from a stranger.
Steve had a wife, kids, a job, a house, and a pet. Inside this bubble, Steve didn’t think he had reasons to feel the way he felt. He looked for them and felt stupid because everyone told him how good he had it. Nor did Steve see reasons to behave the way he behaved. He described his story, a rolling out of his life, like that of a hand stitched carpet. In it, we saw together that he had anxiety then, and then, and then. He had coped well mostly, until he hadn’t. Then he would spend some time falling out of circulation and incurring losses. Then he’d recover and forget. He’d forget that worse patch and redefine the lines around the man. Then again the lines would smudge, he’d get anxious and irritable beyond “control”, grapple within the darkness of the white noise, which panic brings, grapple for reasons why the anxiety came again. His identity would be so threatened, the suffering, the feedback from everyone around him would pull on him, that the lines of his person frightened him into treatment.
There Steve was. Timothy at his feet with his puffy furry head in Steve’s lap. Steve asking for help. At the same time as asking for help, he would also refuse, stating caution.
“I don’t want to change myself.
I like being the person who gets things done so well.
I like accomplishing things.” (He thought it was his anxiety that allowed him to do this.)
It reminds me of the, “Stop! Don’t stop!” that I’d tease my brothers with when we were kids.
People think that taking medication changes who they are. Understand that in order for this to be true, that would mean medication changes DNA code.
“Doesn’t it change my brain chemistry?”
Let’s say that were true, that medication changes brain chemistry. Still that isn’t changing your DNA. The DNA is what gives a person “personality,” or, what many of us say, “Who I am.”
After getting laser hair removal, I didn’t change my DNA, but I don’t have as much hair. When my kids were born, I checked, and sure enough, DNA…. They’re gorgeous! Wink. (That’s done with one heavy cluster of eyelashes around my dark Lebanese eye.)
Question: What are your fears about taking medication?
If you have taken medication, how did you see it affected your identity? What happened to who you call, “Me?”
Please SPEAK! We need to hear you. Keep on!
Living with someone like tomorrow might be their last is much harder to do when it is actually the case.
My dad told me, after my nine-year old niece died, that a parent should never outlive their child. When I look at my own children, I know that is true. But with my parents aging process, my dad’s long and difficult past twenty years, and now near end of life condition, I just don’t know how I’d order things, if I could, between us.
When God, (Morgan Freedman,) told the complaining Bruce Nolan, (Jim Carey,) that he could have all of his powers, the audience of “Bruce Almighty” projected both a positive transference and a schadenfreude. Bringing the viewer into the character’s identity is every actor’s aspiration. And we went there. Up. “Yay! Bruce can answer everyone’s prayers with a ‘yes’!” And then down, down, down. The multidimensional disaster’s created by misplaced power, power without wisdom, love, or altruism, was just painful to watch. Power does not God make.
My Dad is dying. Not likely from cancer. Not likely from a failed liver, floppy heart, or baggy lungs. He is just dying. He’s confused on and off. His spine is failing so he can barely walk. He has repeated blood clots. And he’s recently risen out of a deep depression. Rison right into a confused grandiosity, full awkward, awkward like pants ripping when you bend over type of awkward, and inter-galactic soaring thought content.
The first “word” Dad played in Scrabble last week was “vl.” He explained, “vl, like vowel.” …Okay? For thirty minutes Dad played without playing one actual word. I started crying when he finally stopped connecting letters. The letters floated on the board like California will look after the “big earthquake” finally hits and it falls into the ocean. (We’ve all been waiting.) Now he tells me he called and spoke to Obama and Magic Johnson. Reference point. This is bizarre and out of his character. He’s been delirious with waxing and waning level of consciousness for a month and a half. He’s dying. Sheez.
Living well while Dad dies is not easy. Would I use power to restore him to his healthy twelve-year old self, like Elli’s seventy-year old grandfather did, in “The Fourteenth Goldfish,” by Jennifer L. Holm? Would I use power to change the order of death? Would I do anything more or less or different, while my dad is dying?
Power does not God make. I am not God. (Ta-da! It’s out of the box now.) But both of us are watching Dad die. I trust that She, with the power, wisdom, love, and altruism, is living with him well, during this time.
In Life and Other Near-Death Experiences, by Camille Pagán, Libby Miller decides to live, just live, rather than die perfectly. And maybe that’s my answer to this unasked question. Living with someone dying will not be perfect for me.
Self-Care Tip: Live imperfectly to live well, like this is your, his, or her last day.
Question: How do you “live well?”
In an interview with Kitty and Michael Dukakis, journalist Katia Hauser explores the benefits and risks of electroconvulsive therapy (ECT) in treating depression. Kitty shares her first hand experience with ECT and the ways it changed her life, and Michael provides the perspective of a family member.
Muscled and gorgeous, he came in, like dessert, main course, and appetizer. Some people just carry themselves that way. It doesn’t work if they dress low, chest hair accentuated by opened buttons and glimmering chains. It doesn’t work if it’s their agenda, checking to see if you noticed, a finger hovering over the acoustic applause button. No. Attire must be intact, normal, not baptized in cologne. In fact, attire must be worn as if it is completely a non-issue. Attitude of a jack-rabbit, who never thought about his muscled legs. Those legs just hop because that’s what they do. That is the kind of attitude-ingredient to this kind of presence-recipe.
How would a mother name such a son? How could she know he would turn out this way? Greg is an essential name for this elixir to work, as essential as “Fabio” is to its destruction. Everything else may have been in place, developed over years, like a bonsai tree groomed under the tender ministration of Father Time, and caboom! “Fabio.” The bonsai becomes a paint-can-frosted Christmas tree. Greg’s mother named him ‘Greg’, in fact, because it was the dullest name she could think of, not wanting him to grow up to be anything like the sort of philandering infidel his good-for-nothing pig father “Fabio” was. Greg told me this. I didn’t come up with it. He knew it because his once beautiful mother, who worked seventy hour weeks, told him whenever he messed up, “I named you Greg! This is not supposed to happen!”
In came Greg, after three years of absentia. And it was like I had just seen him yesterday. His mother couldn’t believe that the name Greg would hold such a man, an addict. Yep. Greg hadn’t seen me for three years for a reason. There I was. Chirpy as ever.
Greg! Where you been?
Whenever a patient comes to see me, I believe in him or her. I believe. In part, because I believe in Me. I believe in my value. Wink. But I also believe in them because I believe in Love, and because I’m simply wired to. There are more reasons why we behave and feel the way we do, more than colors in your crayon box. It’s not just a moral issue, biology, or an adjustment to our human condition. Heck. His name may have even had something to do with it. “Greg,” is quite a name. But I did believe, more than I disbelieved, that he hadn’t been in to see me for reasons other than relapse. Maybe his primary doctor was filling his meds, and he was so stable he didn’t need psychiatry anymore! Yah! That’s it!
(This is inside information folks. You can’t tell anyone. My patients can’t know this about me. It could ruin my career! I don’t want them to be any more afraid of disappointing me than they already are. It’s hard enough to be honest in these places, and I do my darndest not to project my Pollyanna-agenda’s on them. They don’t deserve that. They deserve the hard-earned poker-face I screw into place when my heart gets broken. I purchased it with ten-years of my life from some magic spiders I quested in a cliff off distant shores. Bargain.)
Greg! (I said,) It’s great to see you!
Every patient wants to please their doctor. And every doctor wants to please their patient. And we all get our hearts broken at some point.
I was really glad to see Greg, after all. And he was looking good. But then I noticed he had more weather in his face, some clouds, lines, and gutters. And I noticed he wasn’t as glad. He had an aura of melancholy and self-loathing rolling off of him.
His little boy was with him, too, (Fabio. …J/K! Gotcha! Good ‘ol “cycle.”)
Greg sat there, thunder in his sorrow shaking his frame, and we reviewed his story. You may know Greg’s story. Greg may be your friend too. Or brother, husband, dad, or You. And you know the high from this addiction feels better than everything, until it doesn’t.
The best line ever spoken in this context is, “Relapse is part of Recovery.” That is from the God of Hope. That is what makes sense in every illness, like Charles Dickens is to literature, timeless and universal content, man. When Bob reaches for that doughnut, when Harriet rolls the dice at Pechenga, when Fabio uses porn rather than intimacy in a meaningful relationship, when Myrtle has to pull over on the freeway in a panic attack, this is when we ask, “Why am I alive?” and demand to start over for that answer.
I’ve asked that question fifty-plus times a week for fourteen-some years, and every time I ask it, I listen for an answer. I’m curious too. We all are, right?! It’s a marvelous question. Every time I ask, I wonder about the magic that keeps this beautiful creation in our community. I listen, because every answer is something that crescendos into the room, the words explosive, the best part of the atom.
I have a daughter. She needs me.
My dogs. Nobody loves me more than my dogs.
I want to know what it is to live without this.
I’m too scared to die.
I just don’t know why.
Oops! Wait. “I just don’t know why,” isn’t good enough. Figure it. Finger it. Cradle it, and answer. What do you want to stay alive for? Because this thing! This thing is part of your recovery. Another day will come.
Greg left our appointment with options for treatment and a commitment to treatment. I’ll see him again and he’s one of the reasons I love life. Can’t wait.
Self-care Tip: Answer the question and start over.
One of the difficulties we have in talking to psych patients is realized with the dawning truth that we are not curing anyone. Working in those conditions of not curing, you both, patient and psychiatrist, have to come to terms with each others’ agendas. The physician says, “(‘I’m a failure.’) I can’t cure anything.” Now eye contact is even tough.
“If I don’t look them in the eye, some other emotion will surface and they’ll stop crying.”
Rachel was crying and crying hot and hard in the emergency room. She was unable to stop the lava flow. It was bewildering to her. The people around her shifted their gazes. Those who didn’t, looked angry instead, as if to say, “Pull yourself together, Woman!”
Psychiatrists have the advantage perhaps to these others in the lobby and receiving rooms and gurney shelves. Supposedly psychiatrists can grip and tug at the corner of the large sweater that is human behavior and say, “Emotions and behaviors come from the brain.” They can imagine, if not entirely believing at a visceral to cognitive level, that the person they observe is responding to symptoms of what is happening biologically, at a cellular level. When they are tempted to avert their eyes, or look back impatient with the messy emotions, they can say, “This is medical.” Impatience with emotional chaos from psychiatrist to patient, is equivalent to the ER doc saying to the trauma patient, “How dare you bleed in a public area?”
When someone cries on the medical unit, you may hear, “Nurse! Call the psychiatrist! There’s an emotion on the ward!” Later when things are calm, I walk out and they say, “Doctor! You’re amazing! What did you do?”
“Well, I bit off the head of chicken and sacrificed a goat on the patient’s chest. Then I said, take this pill and everything will be as it should.”
Luckily I have several chins now, and when I gesticulate, their quiver contributes to me looking very capable. As if I could cure something. I don’t know much about art history but, The Thinker, a bronze sculpture by Auguste Rodin, is probably what that Frenchman’s psychiatrist looked like when they both came to terms with the fact that psychiatrists don’t cure anything. (Heresy.) At least he got to get nude while he did it.
Talking to psychiatric patients can be that difficult.
There are studies on patient satisfaction that demonstrate that patients don’t like us when they think we give them bad news.
You see the predicament here, don’t you? So, some of the difficulty the world at large may be having with talking to psychiatric patients is that we have distorted perceptions of good and bad news. We may have difficulty with our own humanity, frailty, infirmity, and seeing it out there “without a scarf on” for decency, is a hard reminder.
We will never be cured of so many things. All of us. And the best we can hope for…
What is the best we can hope for?
(We are all gluttons and all hope for many unpublishable things but please! Just humor me.)
Say: “I hope to be healthy with disease.” There. Now we will all speak better to each other. It all starts and ends with Me.
Questions: Have you ever had difficulty talking to a psychiatric patient? Have others had difficulty speaking with you? Why do you think that is? What could help? Please tell us your story.
Self-Care Tip: Hope to be healthy with disease.
(I bet Carl D’Agostino could make an excellent cartoon with this rich irony to work with! That’s right Carl! You heard me! Maybe a blue ribbon with a hole in it?… Ah heck. I’m sticking with practicing psychiatry and leaving the toons to you!)