Sweaty and Worried – Generalized Anxiety Disorder

Hank had to sing an Italian song for his tests.

His music instructor did not believe that he had been practicing two hours a day. When Hank asked his voice teacher to sign off on those hours, his voice teacher still did not believe him.  He had nothing to feel shame about.  “Then why did I?” Hank wondered.  Card in his hand, signed off, Hank resentfully kicked at the rocks covering the path back to administration.

Looking out over mostly empty hard wooden seating in the music hall, Hank slaughtered the song. Even so, it was still the best performance he had ever done.  His father was there in his stained tie and largeness.  His mother in her too many colors, smiled loudly.  She was tone deaf.  Frank’s shame followed him.  He had practiced.

Hank’s older brother dressed in silk shirts, a big gold medallion, a tuft of hair coming out of his barely suppressed neckline.  When they prayed, Hank heard these smacking noises, and thought, “Pray for my nausea,” hoping they would stop kissing.  His brother always had a girlfriend.  The girlfriend was at his recital.  There were noises.

Everyone was scared Hank’s brother would marry too early and maybe marry for the wrong reasons.  His dad was always like, “Wait, wait!” But with Angie, Dad was like, “Get married now!”  Angie was the best in a long line of noisy kissers.

They asked Hank to sing at their wedding.  They insisted.  His brother, his brother’s girlfriend, his parents – they spoke in harmonics all at once.  “Hank!  You sing like Sinatra! Don’t worry so much! You should sing!”

In a rented tuxedo, Hank sang.  The mike didn’t work.  Aunt Augusta told him to sing louder.  Aunt Augusta didn’t hear well, even if there was a mike.  Hank forgot his words and had to start over.  Sweat filled his shirt and he thought about the dry cleaning.

Hank has never had a girlfriend and he is almost twenty-five.  Standing in front of all those people without the song lyrics, the only words that came to him were, “I am like a sweaty doorknob.”  His brother, facing a battle of his own between his ruffled shirt and his manliness, did not help.  Hank thought, “He is probably waiting for prayer so he can start kissing.”

The second year of college, Hank got caught with pornography.  “Hank!” His mother pulled his ear, towing him while she shook the fisted magazine through the house.  He didn’t listen to her words.  He only listened to his memories asking his music instructor for his signature. Was it as bad as the wedding?  Talking to Sarah or walking across the campus greens were bad. He fingered his worries like a beaded necklace.  He worried a lot.  Worry and shame.  He wished he could have a girlfriend but thought that was a hopeless cause.  Hank was already planning on buying a new magazine before Mom had thrown that one in the garbage.

It is so easy to explain away why Hank is the way he is.  We have heard enough to say, his parents, his brother, his isolation, his treatment from teachers.  We can use these to say, “Who wouldn’t be anxious, worried, down, and isolated, when going through these experiences?”  If we did though, we might miss the generalized anxiety disorder, the medical.  Conceptualizing the medical in this way can be so difficult.  We could call it, “the un-reasons why” we feel and do what we do.  So then we don’t have to deny it.  The un-reasons why don’t have to make sense.  They are un-reasons, after all. We don’t have to deny them by our inherent need to point at the cause and effect, or explain into uselessness the reason we are this way.  We don’t have avoid eye contact just because they can’t be seen.

Hank, like so many of us, is included in the statistics that generalized anxiety disorder, or GAD, is one of the top reasons why we don’t get intimate with others.  The anxiety is distracting.  It isolates us.  It preoccupies our thoughts.  It fills us with self-doubt and develops over time, almost inevitably if not treated, into depression.

Getting by with something as subtle as GAD, or other brain illnesses such as degrees of depression, have potentially devastating effects on what occupies our life-line.  The moments that construct the overall devastation may be explained away by one injustice or another, by what are thought to be personality quirks, or simply by neglect of self. But they could be different. The moments, the otherwise same moments, could be different.  The same rude, distrustful teacher, the rejection from Sarah, the quiet mike – those moments could have been different with the same guy, different only in his brain health.  Brain health makes the sameness different.

As Nancy A. Payne, of New York University (NYU) Silver School of Social Work, wrote about treating brain illness,

“There is tremendous satisfaction gained from facilitating the transition from profound illness to equally profound recovery.”

The life-line takes courage to look at.  It takes courage to believe that the effect of our negative thoughts and distorted perceptions could indeed have that pervasively profound effect.  It takes courage to consider that medical treatment can likewise, profoundly change our quality of life.

Hank tried to take his life with a rope before we met.  I’m so glad he didn’t break his neck or die.  He is now well treated and his disease is in remission.  His life-line has changed.Bo-J0zyIEAA_Y3h

Questions:  What are you brave with?  What do you spend your courage on?  Tell us about it.  We gain so much from community and connection.  Keep on.

Self-Care Tip:  Look also at the un-reasons, at the reasons less apparent, at what isn’t seen – look  into those reasons of why we feel and do.

Old and Dying – Why We Are Still Alive

geriatric lady

Sweaty, well-worn, in bike-ware, she was eating comfortably with her friend.  I kept trying not to stare and just had to fight it!  I wanted to imprint her shiny wrinkled yet blooming geriatric status and break down what I saw into categories of self-care moves to grow old by.  She looked really good.

I managed to finish eating at, (Oh my word! Yum! My new binge and bolt location,) Zinc Cafe, without ruining her appetite with a big hug and smooch from crazy-staring-stranger, me.  I almost congratulated myself, it was so hard not to do.  Nevertheless, when walking out I did stop and tell her she was beautiful and that I wanted to grow up to be her.  She bloomed even more, right there and then.  It was swell.  Good food.  Good role-model to remember.

We think it is our best years that people will identify us by.  But they do not just do that.  They think of us as how we are now too.  More importantly is how we think of ourselves – of Me.

It is different for everyone.  Why we want to be here.  Understanding why, is a universal interest.  It is the other side of value in the aging process.

My parents are getting old.  I am.  My patients and their parents are getting old.  We are dying.

My dad is old.  He just turned seventy-nine.  He is not wearing bike shorts.  He is not a blooming geriatric.  But I value him and saying why, well, I realize starts with “Me.”  It is not because of him thirty years ago. It is about his life these last thirty years.  It is about his Me, now.

The present does not prove nor negate the past.  Our value is more than that.

Sometimes I visit community practitioners.   Please visualize that all of this is in the middle of their busy clinic day, racing between exam rooms to meet patient needs.  I am standing at a nurses station perhaps, dressed in something über professional, (to hide the gypsy in me as well as I can.  But if it were you, you would not be fooled by the cut of my lapel!)  I catch the eye of the clinician and receive a strained smile, almost hearing her say, “Come on!  I’m dying here!  I have three patients waiting!”  But generally they do not actually say it, generally.  And sometimes, they are snagged by the magic of connection, take my elbow and draw me away into a private space where they can share their story.  In a matter of moments.

We are skilled at shaving moments here and there.  Skilled at putting as few words into a fat minute that can convey the large concept needed just Now!  We learn this over brow-beating years of managed care medical practice, personal choices, convoluted expectations and need to please – self, other, insurance or what not.  When clinicians share stories, we do it like we are late catching the train to heaven.

From these visits, I get more to my quality of practice.  I get known, and get to know.  Awesome.  It is a newer part of my “work,” that I have been doing this, and I am loving it.  I meet the people who are the other side of our patient’s treatment team.  I meet people who are both human and medical clinicians.  Realness surrounds them.  Life stories come from them.  In a fat minute I hear about their past, gain some understanding of their present and from that, I am given much.  One physician told me of his beloved daughter who suicided, another of her husband’s chronic brain illness and how their family struggles.  I shared how my young cousin hung himself and that part of me who is groping toward that space and time before he died.

To know who we are despite our changing emotions and behaviors, our changing identities, improves our understanding of life value.  Somehow, Dad has known that, without bike shorts.  He continues to mentor me in that.  I do not know about the beautiful geriatric at breakfast, but who is to say she does not know her value?  Not Me.  But I am going to explore my own, for my sake.  I am getting old.

Self-Care Tip:  Look and look some more for why you are valuable.

Questions:  What is valuable about you, even though you have lost so much in life?  Why are you still alive?  Please tell us your story.

Related articles

 

Nurse tells her experience – Suicide

Guest Post

by, Leslie Oneil, RN

Nurse extraordinaire!  Person to know.  More.

Nurse extraordinaire! Person to know. More.

In The Ring

I sat at a table in a large meeting room watching Dr. as she stood in front of the room. She stood in front of us with poise…armored with stories, analogies, statistics, and invisible red boxing gloves to match her red dress. She was ready to defend mental illness, and fight for its proper place in medicine and in the spot light where it belongs…right next to the heavy hitters: cancer, heart disease, diabetes.

Dr. delivered the statistics….”1 in 5 people suffer from depression.” She counts the room, “1, 2, 3, 4, depressed. 1, 2, 3, 4, depression.” She continued, “Put all of the depressed people in a room, and look around. 1 in 15 of those suffering from depression will go on to commit suicide.” It’s dramatic. The room was silent. It usually is. I am not comfortable with the topic anymore than I was the first time, but I am getting used to hearing the same phrases, the same statistics, and responding to the same questions from the audience. I am now familiar with the language of mental illness.

Last Friday, as I stood in the middle of the PACU, our eyes met. It felt intense. it was an emergency, and an emergency in behavioral health means…

Then I heard Michael Buffer, the master of ceremonies, in my head. He introduced the statistic to the ring. Dramatic music played, and before I had the chance to raise my gloves, the statistic nailed me…First with a left hook, then went below the belt. I was knocked out. Speechless with my face in my hands. Gloves were off.

 

Your patient committed suicide.

 

No amount of training prepares you. No power point presentation. No book. No doctor.

TKO.

I never even imagined how I would handle the news. I was weak in the knees and shook.

The patient was starting electroconvulsive therapy in 3 days. The patient had just called me. The patient denied any suicidal thoughts. The patient…….It doesn’t stop.

The gravity of what I do hit me. It hit me hard.

As I drove home I thought, “Have I entered a losing battle? I’ve wanted to be a nurse to comfort people, advocate for them, care for them, and try to help improve their quality of life if possible.” If possible are the key words.

Am I okay with, “We did everything we could. Stop. Time of death….”

 

My question to you: “Do you find gratification with the result or with the process?”

You think you know the answer…until you’re in the ring.

 

Leslie Oneil, RN, is a ECT specialist nurse.  She writes at a blog worth following, A Very LOshow.

 

Bank and Book-Keeping

Lathe operator machining parts for transport p...

Lathe operator machining parts for transport planes at the Consolidated Aircraft Corporation plant, Fort Worth, USA (1942). (Photo credit: Wikipedia)

We are like the national bank of our own nation.  If we do not invest and do book-keeping, we get the great depression.  But what does that mean?  What is investing in Me?  What is book-keeping?  “I am not an accountant and I am not good with numbers,” we say.

We are talking about putting it in and seeing into when it is running low.  Putting it in, well, it might be fun, intuitive, the best part of what makes life worth living, or it might feel like working nine to five.

How do we get money in our bank?  We work.  We work jobs we like, and ones we do not.  This is not meant to be a discussion on the employment crisis we are in, but rather our basic needs.   Basic needs, like energy, self-esteem, a desire to live, freedom, the ability to feel pleasure, think about those.

Have we considered them as our entitlement for being human?  Are they a choice?  Investing in me is the big and small, the easy and difficult of practicing accountability to Me.

One of the weaknesses of this primitive analogy is that it piggy-backs a cultural opinion of failure if we find our bank empty.  Without spending time today on that, please accept the premise that emotions and behaviors in this discussion are not moral qualifiers.

The behaviors that bring bank might be any number of things, exercise, diet, marrying God, sleep, taking prescription medication, ECT, using CPAP, avoiding violent content, Love magic, and so forth.  However, to do these things with most success.  Pursue them through the framework gifted to us via genetics, what came to us by way of temperament.  That is style, form, and inspiration.

Temperament provides for us, like a great uncle’s inheritance. Going with that style of personality will tap into what was put aside for us without any work on our part.  It is a fortune each of us have.  This is in compliment to what bank we work for, as described above.

There are many ways we receive that we do not work for.  Love, for example.  But the choice to receive may not come easy.  The choice to pursue what is freely given to us, to unwrap a gift, to open an envelope that carries our uncle’s will, to receive Love – the choice is ours.  The choice can be as difficult or more so than hours in a sweatshop.

How do we get money in our bank?  We work and we receive.

So this is what “bank” is and book-keeping at FriendtoYourself.com, and maybe it is as interesting as tax season but I thought revisiting it might lend balance.  Keep on.

Question:  What is your bookkeeping activity?  Please tell us some of your story.

Self-care tip:  Work and receive actively.

From a Fellow Commentor – Her Friend Suicided

Anxiety Always

Anxiety Always (Photo credit: Wikipedia)

i woke up this morning to find out that my friend shot herself last night. she texted me, said she hoped i had a good night and said goodbye. she then walked outside and shot herself in the head.  
there are so many emotions i can’t even sort them out.  i don’t know what to feel, i can’t even cry.  why haven’t I cried?  I didn’t hear her stupid text, I didn’t know… I knew she had her demons we all do, but they convinced her to end it.  it’s so finial, so F-ing stupid!!!!!
is this how it ends for us that are so f**ked up in the head?  she wasn’t on meds, would that have even helped?  I don’t know what to think sana. last month i got a phone call from my friend who lives in Fallbrook and she had been dealing with anxiety couldn’t take it anymore, said she didn’t want to feel the anxiety anymore and tried to kill herself.  she was admitted and stayed for 4 weeks.  she’s on so many meds that she’s speaks in a monotone voice.  it’s has really scared me.  
is this how it’s going to be for all of us that deal with fear, anxiety and panic? I need to go for a walk, i feel numb. i feel so pissed off and feel bad that I’m mad. 
i’m scared
didn’t know who else to share this with that would understand
Questions:  Do you?  What do you understand?  Is this how it’s going to be for all of us?  Please tell us your story.  We need to hear.

If You Want To Die, Tell Others.

McCulloch Electric Chainsaw. Photo by Eric Bea...

Image via Wikipedia

Have you been having any thoughts about wanting to die?

You folks know about these questions I must ask. Some people are offended by them. Many people are grateful. Trisha was guarded.

Yes.

I asked,

Did you have a plan in mind on how you would kill yourself?

There was a black pause and then,

I’m not sure I want to tell you that.

I could understand your reluctance Trisha but telling me is a good thing. It helps the ideas lose some of their power. It’s no longer as much of an option when you tell someone than it would be if you kept it a secret, I said.

Ok.

Another black pause and then,

I wanted to use a chain saw.

When it comes to ways of suicide, this one sounded pretty painful.

Ouch! I said to Trisha.

Her response, well, I didn’t expect it.

I hadn’t thought about that! The pain from that would have been nothing compared to the pain I was going through!

Trisha’s words schooled me. I don’t care how many times we talk about the darkness, the hopeless horror and the suffering of some brain illnesses, somehow, I know that I really don’t want to have full knowledge. When having your neck sawed off by your own hands with a chain saw seems like it would feel better than the full body despair, not many others will understand. Trisha wasn’t processing well, true. But the point isn’t her poverty of suicide options. What is the point here. Well, there is one major point to take home and there is a minor. Starting with the minor point – We can’t presume much about others. Moving on…. Major point – Tell people when having thoughts about wanting to die and what those thoughts are. Why? Because it’s friendly to Me. Telling someone isn’t as much about what they’ll do for Me, although once in a while someone may do something right on our behalf. Rather, telling someone is about what the telling process and knowledge of the telling does for Me. It lets us know that we are not alone. We lose some of the magical quality to the suicide plan. It dilutes our conviction to self-harm as a solution.

Question: What else do you think telling someone about thoughts of suicide does for Me? Please tell us your story.

Self-Care Tip: If you have thoughts of wanting to die, tell others.

Resist The Lure of Suicide

Dangerous Risk Adrenaline Suicide by Fear of F...

Image by epSos.de via Flickr

Sometimes I wonder, how come other people get to get away without having to deal with this?  Why can’t I get a break?

Heidi wasn’t talking about fair or foul fortune in life.  She was talking about suicide.  Heidi found the suicide idea alluring and promising.  She found life unfair and death a form of equalization.  She reminded me that suicide contagion is a real effect.  I didn’t know this before.  I don’t know when it became an understanding for me, but it was after medical school and definitely after residency.

So much of what I know, came to me outside of those places of learning.  So much of what I know, came from my patients and a settling effect into my specialty of practice.  I have learned, in one way of consideration, too much about suicide.  In that way, I wish I didn’t.

There are good things too, of course.  Suicide is no more moral or amoral than another act in life, it is simply (if one could use such a word with this) and most objectively the last.  I remember commenter Mike J said on December 17, 2011,

Whenever I feel suicidal I remember that I’m going to be dead a long time. As bad as the pain is, I understand but, why rush to get there?  

Life is like pizza or sex, even when it’s bad it’s kinda good.

I know.  Who wants eat bad pizza?!  Sigh.  Each to his own 😉 but you get the meaning – clever man.

Mike J has used this to inoculate himself perhaps to build suicide resistance.  He and you might be interested to know that the CDC takes the risk of “catching” suicide so seriously that they have made formal recommendations for our protection.  In reading them, we find friendly ways to protect ourselves not only from suicide, but also from the contagion of other extreme thoughts that actions such as suicide cluster in; such as self-injury, catastrophizing, all-or-none thinking, and self-flagellation.

Suicide is contagious as a learned behavior, which is part of why it is so confusing for Western Cultures to conceptualize it in any way apart from morality.  Another reason we have a hard time not moralizing suicide is that we still struggle with where emotions and behaviors come from.  (But moralizing emotions and behaviors is for another discussion.)

When I heard Heidi say those words,

Sometimes I wonder…

despite the patients I have known who’ve died by suicide, despite the knowledge gained in clinical practice and despite the diagnosis I had already reported to her insurance carrier – I had an autonomic response.  My skin erupted in goose pimples, breathing sped up and I realized I was afraid.  Despite being a psychiatrist whom our community imagines thinks of who is going to commit suicide next all the time, I am not.  I am not that jaded.  I am affected and I am still taken off guard.  “Heidi,” I thought.  “No.”

Heidi had the “benefit” of media exposure to suicides, media who was promoting suicide contagion through learned behaviors but also as activating her already infirm brain to increase in degree of illness, producing more suicide-thought symptoms.  When I weighed Heidi’s risk of hurting herself knowing her medical condition, I had thought, “Ok.  She’ll make it. We’ll do this and she’ll heal.”  But when the knowledge of news-worthy suicides spread in her, I knew her medical risks might be catalyzed and I knew enough to be afraid.  “No Heidi.”  What to do?

The CDC tells us to turn the copycat-suicide risk upside down by using the  media, which the gypsy in me really likes.  Instead of being silent and afraid, we can describe the help and support available, explain how to find persons at high risk for suicide, and tell about risk factors for suicide.

Today is Christmas and you may be wondering why I am speaking about suicide today.  It is because I’m hoping that by going toward our fears and our places of pain, that they will lose power over us.  I am hoping that on Christmas, which is for some a positive time, that we have a knowledge that Christmas is for others much less.

Furthermore, I am hoping that we know that we and Heidi are up against our illnesses as well as media-poisons.  And most importantly, I hope that we also know that we have power.  We don’t have to be a victim and we are free to choose.  At every level, we are free.  In every paradigm, we are free.  We are free until we do not – AKA, die.

I’ll take it.  I hope Heidi and you do too.

I hope you will speak into the wind if it be windy.  I hope you will look into the flash if you must and I hope you will fight against your own destruction as long as you can choose.   I hope you know that you are free.

Questions:  How do you oppose the lure of suicide, even when you have to oppose it repetitively and against multiple forces?  Please tell us your story.

Self-Care Tip:  When others inappropriately describe suicide and when your thoughts tell you to die, be your own friend by speaking about suicide, even to yourself, with this knowledge.