Why, Is Just Not So Friendly To “Me” – Sabotaging Self-Care

I like it,

she says, as if that makes all the sense that she needs.

Does reason justify the action?  When action isn’t friendly to Me, do we really want to know the why?

Sometimes in clinic, I feel like a beast.  The other day, I did in fact.  Beautiful Harmony came in and she disclosed that she was drinking a couple of beers a night.  I thought she had stopped her alcohol.  She had told me that some time ago and I had forgotten to ask her about it in many months.

I asked her why, which was my mistake.  What ever her reason was, I already knew I wouldn’t think it made any sense.  I already knew I’d harangue her with teaching, coaching and cheerleading efforts to stop.  I knew when the words were coming out of her mouth that I was going to say things that she didn’t want to hear.  But, who wants a polite doctor?  What a watered down excuse for medical care.  The kind that says,

Oh Harmony, you are drinking.  You understand the risks and benefits and the benefits outweigh the risks for you.  Ok.  I’ll continue to treat you for all the disease processes that are secondary to alcohol, exacerbated by alcohol and I’ll continue to prescribe medications that won’t work while you’re still drinking.

I am not so polite.  Unlucky Harmony.

Harmony, the reasons that you drink alcohol do not do for you what you think they do.  The reasons are not your friend.

We all have a little “Harmony” in us, using reasons for our own sabotage.  As if we needed them.  As if they made sense.

I could die driving to work today.  Let me smoke.

I live with him because I’m lonely.  I know he…

We all battle for and against ourselves.  We are all hoping to do friendly things.  We all hope the unfriendly things will go away or get friendlier.  We have good intentions.  However, when we hear ourselves talking about them, we can get friendlier simply but not worrying about all the reasons that make doing what we want to do feel ok and just go straight to the point.

I like it…

Uh… Stop before getting started on the “why.”

Cathy, who writes The Reinvented Lass, described this so well.  She’s a funny writer and see’s the world with hope.  Check her out.

Questions:  Do you really want to know why?  Is your reason friendly to you?    How do you get past your reasons why?  Please tell us your story.

Self-Care Tip – Don’t be so polite with yourself.

Say Yes to Medication And No To Drugs

Please don’t call them drugs.

Image via Wikipedia

Today I spent eight hours in the company of many neuroscientists.  Smart folk.  People I look up to, want to emulate and learn from.  It was an honor.  We covered different stimulating topics about serving our patients, diagnosing better and the development of our field of practice.  We connected collegially, ate too much chocolate, exchanged cards and talked about each other’s families.  I hope to meet them again soon at future related conferences and continue learning from their experiences and study.

The one thing I do not like about any of these meetings however, is hearing people who know better (if they thought about it) naming our good medications “drugs.”

Drugs.  Yuck.  What do you think of when you hear that word?  I think of stigma, addiction, substance abuse, ruined families, fathers who do not come home, needle marks or powder on mirrors, low-living, illegal behavior, dealers, hepatitis and so much more – very little of which is good.  Drugs.  I cannot number how many patients I have spent oodles amount of time on talking them away from the stigma attached to medications because they thought of them as “drugs.”  Blah.  It is not anyone’s fault but we can start over when ever we want to, so let us.  It is time.

Who thinks of anything that actually improves us when thinking of drugs?  Who thinks of life-saving remedies, disease cures, hope, ability to feel pleasure again, forgotten shame, ability to hold a job, restful sleep, speaking well in public, desire to live restored or a mother who no longer wants to drown her baby?  Do you think of that when you hear drugs?

Let’s get together on this and forget the word that carries so much loaded negative meaning.  It is a disservice to ourselves – physician, scientist, grocer, student, surviving family of a suicide victim, newborn baby, patient and all of us who have any connection whatsoever to disease and treatment.

Drugs.  I think of First Lady Nancy Reagan‘s famous campaign in the 80’s, “Just Say No!”  That is not what we want to say or hear when we write or receive a prescription to treat and to heal what can be healed from a debilitating disease.  Just say yes, please.

Medication.  Not drugs.  A word does matter.  A word carries emotion on it like the smell of cookies baking in the oven or the toilet that was not flushed.  A word can start a war or inspire forgiveness.  Words matter.  Words can be part of what helps us be better friends to ourselves.  Why not use them to our advantage?  Let us change our culture and decrease stigma with this simple word – “medication.”

Maybe when I am able to get together with my colleagues again, maybe next year even, we will be using the word “medication.”  Maybe it will be because of the shift in culture people like you and I can start now.

Self-Care Tip:  Please forget about the misunderstood word, “drugs,” and say yes to medication.  Be a friend to yourself.

Questions:  What do you think of when you hear “drug?”  vs. “medication?”  Is there a difference to you?  To you think it would matter to culture and your “Me” if we used “medication” to refer to prescription therapies?  If so, how?  Please tell me your story.

Related Articles:

Fears of Addiction To Medications For Brain Illness

 

In The Space of Anger, Remember You Are a Friend to Yourself.

The Rage of Achilles (1757)

Image via Wikipedia

Bullying:  Series Continued.

  • #144 Leave Space In Your Beliefs To Grow
  • #163 ”He’s Never Hit Me.” Abuse.
  • #251 Just Ordinary Bullying – The Bully and The Bullied
  • #253 How to Be A Friend To Yourself When Thinking About Your Bully
  • #254 Free To Do Self-Care, Despite Our Bully
  • #255 Bullying That Includes Life-Threatening Behavior.

You are saying this to provoke me!

Paula was angry.  Her hold on her composure was tenuous.  I backed off before she lost her cool.  No one feels good when they do that.  If she felt this way around this mostly unthreatening environment, she must be suffering its effect on her relationships or lack thereof in her other life environments.  No one feels good when they can’t trust themselves.

I am not going to sit here and take this from you!  You are doing this on purpose!

And Paula walked out.  That was it.  That was all I got.  For now, my opportunity to help was over and I was left to wonder after her.

1.  In taking care of ourselves around anger, the first step is to ensure our personal safety.  Deescalate if possible the tension.  But most importantly, do what we must to be safe.  If we have to leave to do that, than we leave and it is over.  I commend Paula for leaving before she acted out on her anger.  That is good coping going on.

For myself, if she had continued to escalate, I could call for help or leave.

2.  The next step, (exclusively per Dr. Q), for those experiencing the anger…  Well there are many, and if it is happening often, should probably include medical interventions along with other considerations of her biopsychosocial self.

For those subjected to the anger, it will be most friendly to themselves to process their own emotional response to the anger-trigger.  “Do I feel angry too?  Do I think I am responsible for her emotions? Do I think what went down here is about me?”  Get our personal out of the stuff that isn’t.  Why make it about us if that isn’t true?  It is another thing if we were poking her with a skewer or had initiated our own emotional diarrhea before she did.  But that just takes us back to step #1.

3.  Finally, for the “victim,” take some time to tease out if we are putting ourselves in a position that isn’t safe repetitively.  “Is there a pattern?  Do we find ourselves in the space of anger or other negative emotions often?  How often?  Do we allow this person to treat us in a negative way that we would never allow anyone else to treat us?”  The answer to that will be telling about our self-friendliness.

Self-Care Tip #259 – In the space of anger, remember you are a friend to yourself.

Questions:  What patterns, if any, do you see in your life, or someone you love re: anger?  What empowers you towards self-care in the space of anger?

Number One Reason For Relapse In Mental Illness

The Sleep of Reason Produces Monsters (etching...

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Self-Care Tip #230 – Remember why you feel the way you do.

Olive was doing well.

How are you doing Olive?

Oh fine.  Just fine,

Olive would say.  And she was.  A sense of rightness filled her when she thought about it.  Right with the world, her garden, her work and even her kids.  She wondered that there had ever been a time when she hadn’t been.

It was almost easy for Olive to forget about why she was better.  Almost, except for her probably thirty seconds of opening the lid, dumping the contents into her hand, tossing them, all of them into her mouth.  One swallow with water and it was over.  Thirty seconds she thought.  I’m doing it for my kids.

Then came the best reason she ever needed.  And despite knowing that she had done this before and had relapsed, something about the rightness of the reason made her feel like the relapse wouldn’t be allowed.  The rightness would keep it away.  After all, she was stopping her medication for her kids.  If she didn’t have medical insurance than she would be a huge burden financially and she would die before doing that to her children.

So quietly Olive stopped.

By stopping medication, many of us have this sense of eliminating the reason we started the medication in the first place.  Take medication.  Disease continues.  Stop medication.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You’re gone.  Turn back.  You reappear.  Turn.  And just like that, you’ve been eliminated.  Even now, remembering it delights me.

Not so cute however, is the number one reason for relapse in mental illness – stopping medication.  For Olive, she turned her head, and hoped her recurrent Major Depressive Disorder would not be there when she turned back around.

How are you Olive?

(Sigh.)  Fine.  Just Fine.  (Sigh.)

But Olive wasn’t.  Even though she knew she had been better on her medications, she couldn’t see any more, how much better.  Her face tightened up, her thoughts wandered and she exploded more.  Self-loathing of course followed and she felt like her suffering was unique to her.  No-one understood her, especially her ungrateful children.  She was doing this for them, just like everything she did through her whole unappreciated life.  This was all wrong.

Is this why I worked all those years and raised them?!

Readers, you may not agree with the crystal clear logic that emboldened Olive’s heroic stopping of her medications, but it’s not the only one out there.  This being the number one reason for relapse implies that there are many that seem to make really good sense.  So forget about they specific “why” of why Olive turned, and just know that many of us do.  Many.

Question:  What has helped you stay on your medication when it seemed to make sense not to?  What do you think about people who choose to stay on medications for life?  Please tell me your story.

Please Don’t Say “But”

Christopher Robin in his Disney depiction.

Image via Wikipedia

Self-Care Tip #152 –  Please don’t say “but” to be a friend to yourself.

She wanted to explain why.  Her sons did not hear.  So she explained why to me.  I listened.  What I learned was…

…It is her choice.  Forget about explaining her “why.”  She knows that they can only hear themselves.  If she wants to be in their lives, she has to be with whom they are in this moment, trumpeting her failures, bemoaning their losses.  If she wants to be with them she’ll meet them there in the gutter and remember their value when she smells stench.

If you’re going to be with the sick, you can’t expect them to mop your brow with tender caresses.  Remember yourself.  If you want to be with your sons, than be where they are, apparently breathing fire and your name is the flame.  Still want to be with them?  Don’t explain why then.  Just be with them, like Christopher Robin when Poo was stuck in the tree trunk.  Just stand there until they can get out and be.  Being present.

If you say “but” it means you didn’t hear. “I’m sorry but,” is not saying I’m sorry. “Yes but,” is worse than many more obvious offenses. See the eyes roll? Hear the sighs?  Watch the words fall apart into letters that pile up like a wall in front of whatever it was that was said in the 1st place.

In some such scenarios it can be a first come first serve. Wait your turn to complain. Wait your turn to present your case.  If you didn’t get there first, listen.  And let the air fill up with all the things that someone wanted to say, and don’t open windows.  Just breath.  Just stay and breath and listen to them if you choose to.  If you choose to be a part of that person, where they are now, stay and be and breath.  Another time if and when they can be with you, you can explain the why.  Maybe they will never be able to give you that gift.  But are they worth it to you?

For her, she decides moment by moment.  You can’t give what you don’t have and sometimes she has what it takes to give that gift and sometimes she does not.  When she doesn’t, she isn’t standing beside their bodies stuck in a tree hole.   She’s off taking care of herself like she should be.  They’re still worth it to her.  And in her story, when she’s gone from them it doesn’t equal her abandoning them.  It means she can’t give just then.

For others, being gone may mean that it is not worth it.  That is fair.  It is a free choice to give a gift.  Gifts are free.  Listen or walk away. …But please don’t say “but.” No one will hear you.

And staying present doesn’t mean more than just that.  It doesn’t make you guilty by association.  It doesn’t give you a “go to jail” card.  If you don’t judge yourself that is.  Wow.  What a gift.  Standing present with the one you love.  Even when they are not being nice.  Even when they are not healthy-minded and say all manner of evil against you, still stand beside them, a witness to their value.

Nor does being present turn you into a noodle.  For pity’s sake, it means only what it means to you.  There is love.  And love is stronger than anything. …But please don’t say “but.”  No one will hear you no matter how much you love him.

And that is what this aching heart-mother taught me about presence.

Question:  How has avoiding the “but” in your dialogue affected the reception of what you’ve said?  Or vice-a-versa?

Blog-Jacking – by Rick C.

Hi Everyone… I thought I would kind of write a guest blog today (call it blog-jacking even) DQ did not specifically asked me to do this, however, I do not have any clear recollection of her specifically asking me not to do this either. With this in mind, I would like to let you know about my unique relationship with DQ (I am just going to write DQ because I have a very limited attention span and am likely to have two or three great ideas flow through my brain by the time I type Dr. Sana Johnson-Quijada and then I also start wondering if she has a middle name too and how she fits all those letters into those forms that have the little boxes on them). Anyway… I communicate with DQ on a regular basis and get interesting insight on a variety of topics. This makes me feel unique and special until I realize that most of the people reading this have the same opportunity. Then I kind of ask myself… “What kind of group have I joined?”

To begin, I would like to talk a bit about my psychiatric qualifications. I spent six years attending college. Technically, these were at a community college, but I did take at least one psych course while I was there. In addition, I am an alcoholic and drug addict in recovery who has previously attempted suicide. I take medications for both depression and ADHD. I had to go through a variety of medication to find the right combination because almost every medication I tried made me sweat profusely and/or break out in a rash. As part of my ongoing training, I am going through a nasty divorce which has caused me to be temporarily unable to see my son or live the life that I have become accustomed to. In addition, I have just lost my job of fifteen years due to cutbacks. All of this in the same month that I turned forty and should be free to seek out a quality midlife crisis.

The fact that I am laying in bed with my shoelaces in my possession in a nice room that I am free to come and go from as I please over two weeks after the divorce/job loss week most likely indicates that I am totally delusional and only think that I am happy or that I actually am. Either way, I am content in the place that I am at. This, to me, is pretty amazing.

I am grateful for that I have been through all the things that I have been through in my life because they have given me the strength and experience to go through what I am going through. Even though I did not do real well in school, I somehow did well enough with a big corporation that they are willing to give me a severance package that will basically pay me for the next four months as long as I do not get a job or accept one of the positions they have offered me. Basically, a bunch of paperwork and legal terms that say to me “Paid, vacation!”

Being an alcoholic and a drug addict have led me to become involved in a program that connects me with others who have previously tried to use alcohol and drugs as a solution for coping with life. These people are a great source of support and experience. As for the prescribed drugs, I am not even really sure that I need them all the time; however, I sure as heck am glad that I was on them when my “Perfect Storm” kicked off. Oh yeah, as part of my challenging week, I found myself with no place to live and immediate access to very little money. A little rational thought and I realized that I have an amazing amount of airline miles from years of travel. In fact, more than enough to take up residence in a nice beach front condo for the next month.

Why am I sharing all of this? For several reasons — First and foremost, I am newly almost single and think that this is a great way to meet ladies without having to ever think about the awkward point in a relationship where I will have to explain my past. In addition, the fact that everyone here is reading this most likely means that you have experience with challenges like mine and I can always use others that I can relate to. Lastly, I have found out that when I have felt that I have a very unique situation, I am usually wrong and that I am actually just not in a group of people who feel comfortable sharing their experiences. It would be kind of cool if everyone just wore a signs with their three biggest “issues” on them. I have a feeling that if everyone formed a group with only the people who had at least one issue in common with them… we’d all be in the same great big group called life.

Thanks for reading to this point. What do you think about this? Are you female and single or considering becoming that way? Could this really be a worse idea than matchharmoneyfinder.com or whatever it is called? Keep on and be a friend to yourself and stuff.

Oh yeah….DQ, please get better soon because this blogging stuff is cutting into my busy schedule!

 

Afraid of Meds

A colleague told me,

I want to get off my sleep meds because I don’t want to be dependent on anything.

Dependence.  Lazy, pass-the-buck, unimaginative, immoral, chemical abuser.  Maybe even doctor-shopper depending on who is speaking.  When someone says it, before we talk about medication use, biology, etc… we need to know what is behind that word.  Working with the tip of an iceberg of prejudice might sink us before navigating much treatment.  Even physicians after 25+ years of education and more of medical practice, find it hard to shed these cultural prejudices about psychotropics (medications used in psychiatry).  What does the word dependence mean to you?

To psychiatrists, substance dependence means that the body has become accustomed to something.  We don’t get as much physical or emotional boost we used to using a substance, such as to nicotine, alcohol, illicit drugs, or prescription medications.  We now need more to get the same effect we would have gotten before with less amount.  It includes physical and emotional cravings – like sweating, shaking and yearning.  A lot of time is spent to do whatever it takes to get it.  Can’t cut back.  Keep doing it even though spilling into personal and professional space.  Keep using even though aware body and mind are worse for it.

Was this a description of my “dependent” colleague?

How about abuse?  Substance abuse is when we do dangerous, mean, and/or irresponsible things when using.  Was he hitting his wife when he was under the influence of a sleep medication?  Was he taking sleep medications when he was at work because he liked how they made him feel?  Driving with them?  You get it.

This guy is no dummy.  Yet he felt guilt and shame about appropriately using a medication for a medical reason.

I was seeing a woman for the first time in my clinic.

“Doctor is this medication going to make me addicted?”

We spoke about her fears.  Turns out, she thought her medication would prejudice the world against her.  Change her personality.  Make her crave it if she ever wanted to stop.  Steal from her geriatric mother and eventually, who knows?  Panhandling?  Now how am I supposed to work with that?  How she ever got the courage to come and see me in the first place with all that on her back, must be pure grit.

So here’s the dirt.  Some medications have no dependency risks.  Some medications do.  Some people abuse any medication they can get their hands on.  There are rave parties where there is a kitty – a bowl full of whatever pills anyone in attendance donates to.  They take them out randomly and swallow to get whatever surprise awaits them.  Is one class of medication more often abused than another?  Yes.

As a prescribing physician, I have sworn to not intentionally do any harm.  As a patient, you contract with me to take your medications as prescribed and safely. We’re in this together.  We will talk about any recommendations and you will hear the risks and benefits to treatment.  You will decide.  There is no conspiracy to turn Americans into bad citizens through psychotropics.

Self Care Tip #52 – Find out where your fear is coming from.  Be a friend to yourself.

Question:  What are your fears about psychotropics?  Agree or disagree with this post?