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.

Find Hope When You Otherwise Must Die – Depression

Jane Eyre

Image by madelinetosh via Flickr

Briggs was crying again.  His wife, who came with him to our first appointment, looked like a peeled fruit beside him.  She was undefended, giving her last layer of self without knowing what would be left.  Briggs was one case of serious depression, but his wife; she was heartbreaking.  Both of them in their own ways would not last long.

It is not unusual in a specialty clinic to work with people such as Briggs who have been around the treatment shops.  Then, finally, in Jane Eyre-style, they appear at my door in the company of death.  They have been through therapies, practitioners and churches, but disease resists treatment.  Everywhere they walk, it is as if Hades (or Neptune) were visiting.  Hope-blossoms wilt as they pass by and those of us who share space, feel like the ground is going to open up and suck us under.  It is not uncommon in specialty-care, to be told, “…I have no strength to go further.”  Like Jane Eyre, they plead, “I must die if….”  (By the way, Charlotte Bronte is the bomb.)

As the person on the other side of this exchange, I have worn down the rainbow of “specialty” options available to offer.  And what are they?

I’m going to write more about those options next, but my questions for you today are:

What has worked for you or your loved one?  Is there any treatment you think is too extreme to consider to get brain health?  Please tell me your story.

Self-Care Tip:  Find your specialty care.

When to Push – Melancholia

Edgar Degas- Melancholy

Effie came to me with many melancholic symptoms.

Melancholia is an interesting word.  It comes from the Greek word for black bile, which is where people used to think sadness came from.  The word melan is familiar to us in words we use today, such as melanin, melanocytes, or melatonin.  All of these having something to do with darkness.

Effie had been feeling dark inside, like a black cloud was hanging over her.  Effie had so many “good” reasons to feel melancholic, as if reasons were needed.  She hurt.  She had other physical problems.  She lost her employment.  She was estranged from her family.  Isolated.

I asked her what she did every day.

Just sit there sometimes.  I just sit there and think about all this stuff.

This wasn’t my first visit with Effie.  We’d worked together for years.  Some of what she was going through, along with the biology, were her psychosocial stressors and learned negative coping skills to stress.  We had been working on these together for a long time but, beyond medications and sleep, Effie had a lot of difficulty working with her directives:

  1. Medication including supplements
  2. Sleep
  3. Connection – groups, church, internet, etc…
  4. Exercise
  5. Lose forty-five pounds to decrease multiple comorbid illnesses she was suffering from.  These comorbid problems secondary to her obesity looped back and worsened her mood.  It was like a brick in her pocket taking her down to the bottom of the sea.

Effie said,

I don’t want to do anything.  I just want to be me.  It doesn’t matter if that is good for me or not.  It just matters that it is who I am now.

Thanks to our work here at FriendtoYourself.com, I felt empowered to pull out the self-care tools and share.

Effie, you need to go to groups.  You need to connect.  If your child told you that she didn’t want to take out the trash because she didn’t feel like it, what would you say?  Maybe, ‘I’m sorry you feel that way.  You still have to do your work!’  Are you going to wait until she wants to?  Do you tell her to just be herself, that it is ok?  Is that nice if you do that?  No.  It is not nice.

Effie explained that she only came to see me because I was the only one who understood her.  She didn’t want to talk to anyone else.  Of course that is flattering but I admit, however reluctantly, that I am not that good.  There are other people out there who know what she’s going through and she’s not meeting them because of her choice to isolate.

Now folks, this is not to say that when someone is depressed, that we should tell them to bucker up and get on with it.  Nor should we say that they are being childish.  We all need to be very very very careful about that.  It’s ignorant and hurtful.  In Effie’s case, however, because I knew her so well, I pushed her a little harder than I had been.  I wasn’t saying she was being childish, so much as I was telling her that she needed to do what was good for her, rather than what she wanted.

Effie wasn’t having fun either way, groups or no groups.  And although medications had helped, they hadn’t helped enough.  As we had seen each other at least once a month, if not more, for about thirty months for this most recent depressive episode, I was as clear as I could be on what had been tried and what hadn’t.  I would not do this in anyone who didn’t have this constellation of factors.  So, I pushed Effie to do something she hadn’t done yet.

Also, we hadn’t spent enough time on the primitive coping skills Effie was using.  What I told her this day was more directed towards getting her away from those.

Being a friend to ourselves isn’t always doing what we want.  It is being better to ourselves at least than our enemies.  I don’t know many people I would allow to speak to me, the way Effie was speaking to herself.  We talked about allying ourselves with the bits inside of us that were going in a direction to benefit, and not hurt.  Not collaborating with the parts of us that would further harm us, no.  This part we would name together out loud and drive forward to it deliberately.  We would see together what happens.

All the while, we are still continuing to work with medications and other therapies directed at Effie’s biology.  However, I believe we need to do more. When to introduce different therapies differs depending on the needs and abilities of the individual.  This is how it went for Effie.

Questions:  When have you done something you specifically didn’t want to do, but knew it was friendly to yourself?  How did it turn out and was it friendly after all?  Please tell us your story.

Your Pain is Not Special. It Is Normal.

Self-Care Tip #243 – See yourself as special rather than your pain and know that you will find your normal again.

What is your normal?

When we were kids, we all had a perspective of what normal was.  Let’s say it was “here.”  Let’s imagine we were lovely then, nurtured and emotionally bonded.  We struggled through peer conflicts, social anxiety and rivalry.  We wanted a bike.

Two Sisters

Image via Wikipedia

Then we got a little older.  Maybe our parents divorced.  Maybe, a sibling died.  Maybe we were abused or in an accident and damaged.  Damage changes normal.  What we never would have thought would be acceptable in our lives became acceptable.  We suffered.  We lived.  Life was indiscriminate and ignored our status.  We think there must be a mistake.

What is our normal at one point, filtered through remaining hopes, grew into regenerating fantasies, through real potential and it moved again.  We are older now and more suffering comes.

Where is our normal?  We survive our child, our own dear perfect boy, hanging from a tree.  Normal?  No dear God!  No!  And we continue to live.

Two years.  Two years are what it takes for our biology to catch up to the shock.  Two years are what it takes for us to begin to accept and realize that in this new normal we care again.  We choose it in fact.

People don’t remember his name or talk about him and we can’t remember his eyes.  We are ashamed and lose our breath from panic just trying to see them.  We want to bang our head because we know there is something wrong about feeling normal! Ever! Again! after that.  But we do.

Our normal mutates over financial ruin, abandonment and a growing healthy list of disfiguring illnesses.  We accept them and say yes please.  Live.  We want to live.  This is acceptable.  This is normal.  Our friends die.  Our memory.  We can’t find our teeth.  Our heart stops.  We die and the world finds normal.  The world chooses just like we did.

What we don’t think will ever be allowed to happen while we brush hair, clip our nails and microwave food, happens. We endure these changes.  We find normal again.

What is your normal?

My brother, Vance Johnson MD, is a physical medicine and rehabilitation specialist.  He said that during his residency, close to 100% of spinal cord injury paralysis survivors he worked with wanted to die after their injury.  Many of them would beg him to let them die.  They would cuss at him for keeping them alive.

I leaned very heavily on the studies and data during those times.  It was very hard.

Vance said that what kept him faithful to his task was knowing that close to 100% of them after two years would be glad they were kept alive.

Even the ones who were basically breathing through a straw and that’s all that moved on them; even they wanted to live.  These people found a new normal.

Where is our normal?  We will want it.  We will adapt.  Biology will catch up to our reality.

Remember that your pain is not special.  You are special.  Not your pain.  Pain is normal.

Question:  When this happened to you, how did normal find you despite the rubble?  How does this concept feel to you, that your pain is not special?  Does it make you angry or what?  Please tell me your story.

Check Your Read. Even When You Feel Shame, Bullied and Herded, You Are Free.

Eve covers herself and lowers her head in sham...

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Self-Care Tip #219 – Check your read.  Be a friend to yourself.

I’ve been reading the comments on suicide, thinking and reading and starting who knows how many posts for today, but just couldn’t pull it together.  I spent my time rather drawn to the same words that I hear so many others say as well in clinic, in church, on the street, in the home.  Instead of seeing them find their place in me like I normally do with this kind of crowd, the words kept their space; word-snobs – crutch, selfish, dependent, moral and other words, dusting and reapplying in their reflection.

I had to think, “Why?  Why am I staring like this?”  And so the rest of the day, I perused those thoughts, licked my finger, flick, next, paper-cut and so on.  After all, this is SELF-care I’m talking about, implying I am starting with me.

At last, after rereading yesterdays and past comments, I found the shame I was avoiding.  Why I feel shame about these things isn’t important in this post.  (Maybe another post.  So if you have nothing else to keep you reading, you’ll have that dish to bait you.)

Shame comes when implied or direct judgment creeps into our space.  It herds us.  We are bullied and lose our personal boundaries.  It touches and violates.  That is what shame does.  Any time our perception of freedom feels threatened, it is normal to want to defend ourselves.  Separating from stigma is a normal response.

Claiming the shame, however, isn’t forced on us.  It is our choice.  Once we own the shame, then wanting to get away from reminders of it, of course, is natural for anyone.  But jog back and see.  The perception of shame was never forced on us.  We are free.  We are free to feel, to perceive, to believe, to choose or to stop rubbernecking at the sparkling drama.

He made me so mad…!

She really hurt me.

You ruined my life!

I don’t want to take medications because my husband makes fun of me.

I take Prozac but I don’t have mental illness.  I’d be ashamed to…

It is a normal response to not want to be in the space where we feel these things.  That is natural and what many have thought worth fighting for.  But what if our perception, our Sixth Sense, wasn’t getting a good read?  A war might have been avoided.  Our lives might be lived differently.

We really are free, already, to choose.

Question:  How do you see shame affecting your ability to be friendly with yourself?  Or others?  How have different perceptions put you in a place that felt more free and safe?  Please tell me your story.

Starting With Your Own Answers to The Big Questions Leads to Reducing Stigma In Others

Alexander Ostuzhev as Quasimodo, 1925.

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Question:  How do you see the paradigm of spirituality intersecting with the paradigm of biology?

As a psychiatrist who blogs that behaviors come from the brain and not a theater script we voluntarily revise to perform, this is a good question.  As readers, and perhaps subscribers to this same belief, this is a good question.

In church, Bible study, or circle of any kind, there are fewer things that goad me more than listening to descriptions of the moral value in emotions and behaviors.  I have found myself visiting the lady’s room more often, carousing the fellowship hall-kitchen and fridge, or thrusting myself on a poor unsuspecting soul loitering by the door with my fervent uncomplimentary words.  I do this before I stand up and pull rank on the speaker.

(I know.  The words “pull rank” sound just as arrogant, and probably are, but they were said in the heat of the moment.  Please understand that the emotion behind them and including the words came from my brain.)

It wasn’t so long ago that suicides were thought to be the ultimate separation from God.  Oh wait.  That’s still happening isn’t it?  It wasn’t so long ago that anger and sadness were thought to be from separation from God.  Oh wait, they still are.  Ok.  I’ll stop.  This is childish.

The hunched figure of Notre Dame comes to me now, ringing his bell, gazing at Esmerelda – pure heaven in flesh.  He offers up his humble life force, begging to be near her despite his biology.  He is ugly.  He is different.  He is separated by his own beliefs that he is forgotten by God.  His answer to our question is his own isolation.

This pithy topic has no boundaries across the world but yet I reduce it down to Me, one apparently arrogant psychiatrist, kicking up dirt where I stand.  I realize that the best way to protect us from stigma, to help you (again arrogant me swaggers in), is to start with my answer to this marvelous question.  I have to answer it for myself.  I have to start with self-care, spiritual care, relationship care, physical care – I have to start right here with Me.

These kinds of imposed opinions have never been reduced quickly.  We can’t take care of everyone before we take care of ourselves.  We must be patient.  We have the privilege to answer thoughtfully.  It is our freedom.  It is our right.

Self-Care Tip #193 – Answer the big questions in life for yourself, deliberately, and see that a secondary benefit is that it will protect you from the prejudice of others as well as reduce their prejudice.

When You Are Pushed Down, Push Back

A Push and a Shove

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Self-Care Tip #185 – When you are pushed down, deliberately push back with The Force in  you.  Be a friend to yourself.

So much in life pushes down on us.  I am amazed that we push back – considering how awful some of it is.  After 7 years of private practice in psychiatry, I still get caught off guard by some of the particularly horrible stories I am told.  Blinking my own stinging eyes, I look in amazement at the person in front of me.  What I see is this pushing-back Force.

Last week after diagnosing PTSD in Margie, a mother of a murdered son, I could hardly believe that she still chooses life.  She takes care of herself despite.  That’s how amazing she is.  And I’m her psychiatrist!  It’s such an honor.  And thinking about that straining towards life, that thread in us, all of us – I saw that it was the best description of the brilliance and power that is God.  True, sickness can mute our perception of this beautiful thing in us, whether it’s depression or liver disease.  But all of us have seen some of how hard the thrashing against that loss is.

In thinking on this amazing force, this thrashing about, this straining against the push of whatever is set at tipping us over, I named it God in us.  And I thought, for all the time I spend on the stuff pushing me around in bad ways, I’m going to more actively team up with the struggle to live.  I’m going to choose to strain and thrash about and move at that chink of space in the dark room as much as I can.  Hopefully I can be brave too, like that mother of a murdered son, Margie.

I can choose to ally myself, with what I want to live for.  I’m going to partner with that Force that keeps me thrashing against the push and be stronger, like you have readers.

After our post on suicide a couple days ago, many of you responded with your own stories about how you were pushed and pushed back.  Karal said,

Like all difficult experiences we face in life, there is the possibility of growth from the ashes.  It requires strength and a willingness to walk through that fire.  Unfortunately for survivors of suicide (i’m referring to those left behind) we’re often chastised into feeling that our grieving, our walking through the fire is both wrong, and  unnecessary.  I totally disagree.  Like you said, caring for people is a choice, and being a friend to yourself means making sense of, or at least peace with, what may never make sense.

Karal is allying herself with that Force to make as much sense of what will always be jumbled.  I’m not going to quote all the rest of the brilliant comments.  Please read them.  They were amazing demonstrations of pushing back in a collaborative way with The Force that makes their lives worth living.  This is active in us at times, and not deliberate at others.  Being better to ourselves, we could more deliberately choose when given the push.  We are not thrashing alone.  Push back.

Question:  How do you deliberately choose your alliances in your life for working against what pushed you down?  How do you define that Force in you that pushes back?  Please tell me your story.

It Is My Choice to Take Care of Someone, Even in The Context of Suicide

Detail of The Death of Socrates. A disciple is...

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I was a teenager I think when a woman in our church suicided.  Dad pointed out the man sitting alone.

His wife just killed herself.

Dad asked me what I thought of suicide.  Imagine.  What a compliment really for a teen, to be asked her thoughts.  Being a “Feeler,” I oozed something empathic I’m sure, but still I only remember what Dad said,

I believe God has a special way of seeing these cases.

This was at a time when culturally most of the western world saw suicide as sin.  It was quite forward for Dad to say what he did again later to the grieving man in the pew.  I did not realize at the time, but now I see that people judged him and his wife for what she did.

Later in psychiatry training, my attending said,

Suicide is the most selfish act anyone can do.  It is the ultimate punishment aimed at those who still live.

I don’t know what you think, but I couldn’t help wondering.  I still do.  I think this may be true for some and not others.  I haven’t had a chance to ask them.  They’re dead.

Suicide is terrifying to a psychiatrist.  We all tremble at the thought.  Statistically we know women attempt it more than men, but men are more “successful” when they do try.  They use methods that are generally more lethal than women.  They don’t get a chance to realize that in a month or a day they will want life again.  Or an hour.  They could have lived.

In the intensive-care unit of a hospital, “unsuccessful” suicide attempts hover in life in a space where their self-injury placed them.  The nurses are kept running between medicines, treatments, physician orders and prayers for these lives that tried to die.  Sometimes, the “chronically suicidal” become familiar patients to this critical care ward and that has it’s effect on those who have spent themselves so heroically to save them.

A nurse once told me angrily about her patient who kept coming back.

I fought for that woman’s life!  I prayed over her!  I worked all night for several nights and didn’t know if she would live until much later.  And then she was transferred out to the step-down ward (to a floor where the patients aren’t in such a life-threatening condition), and that lady probably never knew what I went through to keep her alive.

Then later, she came back, and later again, almost dead but not dead.  She kept trying to kill herself!  Finally, when she was conscious again, I just told her how it is.  ‘Listen!  I fought hard for you!  You better go out there and live!  You better figure out what it is you want and go for it.  Stop trying to die!’

This lady-patient was hurting more than herself.  Suicidal thoughts and attempts are dangerous.

There was a patient who tried to use his bed-sheets as a noose before the nurse lifted his wet body from the door frame.  In the emergency room (ER) he was examined, x-rayed and determined fit to return to the ward.  Alive.  Talking to the ER physician, I learned that the reason most people die when they hang themselves isn’t because of suffocation.  It’s because they break their neck.  Done.  No more chances to choose life.  Even an hour.  My pulse was still beating on me to the rhythm of, “He could have died!  He could have died!”  This time, no broken neck.

Regardless of our culture, we are not the judges of these people who want to die.  Regardless of our emotions, their emotions before, any previous conflicts, regardless, we cannot measure their final act by degrees or intentions.

We fight together for their lives and they may or may not know about what that does to the rest of the world.  When we don’t want to fight for them any more, we should change jobs.  It is our choice, each of us.  Whether we are fighting as professionals or as a wife, brother, friend, volunteer or the hired tutor, we fight for their lives because we choose to.  If we cannot keep it up without judging, shaming, accusing the suicidal, we need to own that and take care of ourselves first.  “Can’t give what you don’t have.”

The truth is, suicidality is hard for everyone.  It is hard in ways and in people that aren’t talked about, such as the nurses or the x-ray tech who is the first to find the cervical fracture (broken neck) on film.  It is hard for the church parishioners, the person separated by seven-degrees or the grocer.  Suicidality is hard for all of us.  We give what we choose to give and remember to say, “I can’t control that,” when we can’t.  It is our choice.

Self-Care Tip #182 – Taking care of someone is your choice, even in the context of suicide.  Be a friend to yourself.

Question:  How has suicide touched your life?  Please tell me your story.

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

You Should Be Living

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

Bridget told me,

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

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

I just hate myself!

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

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

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

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

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

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

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

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

What Are You Getting From Pain?

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

guardian.co.uk – Lucian Freud

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

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

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

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

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

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

 

Early portraits by Lucian Freud

Your firstborn dies.

You were cruel in a debase way.

You develop mental illness.

Your divorce is ugly.

You father commits suicide.

You have a disabled child, and then another.

You’re paralyzed.

You prostituted yourself for drugs.

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

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

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

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

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

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

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

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

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

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

When You Are Hurting, Remember Why You Want To Live, And Live For That

 

greaterlearning.org

Self-Care Tip #133 – When you are hurting, remember why you want to live, and live more purposefully for that.

My daughter has a viral upper respiratory infection.  She is laying on the floor in her sleeping bag that has the stuffed puppy dog head for a pillow.  She just wants to be near me today while I work.  She wakes up and coughs, I check her out and dose her if she’s febrile.  She goes back to sleep.  Awakens.  Trundles up to drink some mango juice, water, eat 3 noodles, comes down again and lays there, pink in the cheeks, red eyes and chafed upper lip.

Sometimes when one of the kids is sick they stay home if I’m here.  It usually stresses me out but I’ve been getting better at believing more that we can take what comes and still get the work done.  Today, in-between patients, I laid down beside her.  Face-to-face.  She leaned in, opened her eyes and smiled!

She is one of the most delicately framed little people I know.  My nuclear family has never had small bones so this must be from someone on my husband’s side.  My daughter swung that tiny arm, warm with fever over my neck, put her face on mine, and fell asleep.

Lying there, thinking I’m so glad I could do this for her, suddenly felt wrong.  It flip-flopped over in my mind and I realized that I was glad.  But for me.

Having her near me while I work is a connecting force.  To both of us but maybe more for me.  My family has been exchanging this virus for 2 weeks now.  It hasn’t been hell but it has not been a delight.  Yet here I find myself delighted.  I wonder how long I’m going carry this gladness around.

Come what may in this world, it is these surprising moments that convince us about the rest.

In psychiatry, I’m required to ask each patient if they have thoughts of wanting to die.  Then I ask, “What do you want to live for?”  That catches some people off guard and I’ve gotten looks that could defend anyone in war.  But we aren’t at war and eventually they tell me why they want to stay alive another day.

At some level we all answer that question even if indirectly.  Everyone suffers.  If I were asked, my daughter’s smile would be on my list.

I am often amazed by good things that come out of bad.  Knowing that, gives hope.  But it also gives purpose and we can choose to angle ourselves more purposefully towards that rather than passively.  We can choose to live for the reasons we think worth living for.

My husband prays, “God please turn my posture toward you today.”  I’ve always loved that.

Question:  Why do you want to stay alive?  What are you living for?  Please tell me your story.

The Great Lie.

One of the great lies of mental illness is that, “If things weren’t so stressful, I wouldn’t feel so bad.”  Look inside ourselves now and see them.  All the numbered and ranked stressors we tick off to explain how we feel and/or behave.  How about someone we love.  Do we tell them, “Of course you feel that way!  Look at all you’re going through!”

Because major depressive disorder (MDD) is mainstream enough, I’ll use it as an example.  Who, when they are down, doesn’t look for reasons why?  Say there is an additive effect of stressors such as home conflicts, financial duress, and poor sleep.  Since these events, you haven’t felt pleasure, you’ve felt sad and depressed.  You aren’t motivated or interested in your usual.  And where you normally would seek people out when you felt down, to get more energy, now you just want to be alone.  And so on.  You are able to say that you started feeling this way progressively since triggered with those stressors about 3 months-ago.  Before that you were “fine.”

Many people in your life, have told you that you are just going through a bad spell.  You have believed them but say, “Even if this is a bad spell, if it goes on much longer I think I’d rather die.”  Your best friend responds, “Anyone would be depressed if their boss was that evil!”

My answer, “No.”  Feeling down is appropriate to stress when it doesn’t disrupt your life for more than two weeks at this level.  And it is never normal to want to die.  Everyone has stress but not everyone responds to stress in the same way.  Not everyone if put under your same triggers would develop MDD.

Would you have developed this disease if you weren’t put under these stressors?  I can’t say.  We develop illnesses for many reasons.  One of the many reasons is external stress.  A hypothesis supporting this is that stressors trigger our genes for MDD much like we know cancer genes can be turned on by stress.  However, we do not have a direct correlation to the stressors as being entirely causal events.

Even if it were, none-the-less, we are left with the disease process in progress.  It is not an adjustment reaction to stress.  It is medical illness.

Feeling this way is not normal for what you are going through.  Telling yourself that it is, that is the great lie.

Self-Care Tip #118 – Don’t believe the lie if what you’re going through is affecting your function in life.  Be a friend to yourself.

Question:  What whispering lies are you struggling against?  Please tell me your story.

Pebbles to Diamonds

 

yourloosediamonds.com

Self-Care Tip #117 – Notice, you got diamonds out of stones!  Be a friend to yourself.

Cindy replied to yesterday’s post (that had some discussion on functional mental illness,) “I understand Miranda’s feelings completely.  Some days it’s all I can do not to down tools and scream ‘What about ME?’”

That is one of the lovelies that these illnesses bring to us.  In our honest moments, we can, like Cindy did, perceive our own traits that resemble them.  Perhaps, if we are lucky, that will lead to empathy, one of the great human experiences.  To be able to put yourself in the hypothetical place of someone else.  To imagine what they think and feel.  “If I were in your shoes…” and so forth.  If you’d like, read more on this at this post.

Illness is often considered a step in the dyeing process.  Others see it as part of the living process.  Of course, it is both.  We are all on level ground when it comes to having been born, coming into life, and knowing we will equally die.  Illness reminds us of our like-natured frailty and of course the opposite – resilience.  Whether seeing our own illness or someone else’s, we have this privilege of being blessed this way.

My Dad used to tell me a story (author unknown) when I was little.  It’s been a long time but I remember it this way.

Three travelers were walking when they heard a voice telling them to bend down, pick up pebbles and put them in their pockets.  The voice told them further that in the morning they would be both happy and sad.  The travelers did but not equally.  Some pockets were more full than others.  In the morning when they awoke, their stones had turned to diamonds.  Whoever gathered many stones were happy even though all of them wished they picked up more stones.  But whoever gathered few, well, they were not happy.  They still had diamonds but the comparison soured them and they finished their journey full of “what if” thoughts and not thoughts about the obvious.  They got diamonds out of stones!

We are all similar, with the opportunity to say thanks in seemingly off times, such as mental illness.

Question:  What have your “stones” turned into?  Please tell me your story.

When Suicide Almost Made Sense

Hello world. Please comment.

nancy says:
November 17, 2010 at 8:01 am (Edit)
I could write a book….but suffice it to say, to the day she died, my mother never even told her best friend that I had had a breakdown and was on medication, my sister said I couldn’t possibly be a Christian and be mentally ill, people at church have told me that they actually walked across pews to avoid talking with me when I was sick, and, even though I’m off all medications but Klonopin and seeing a therapist only every three or four months “just to keep in touch”, I can’t go anywhere or meet anyone new without feeling as if I’m wearing a sign saying “Mentally Ill” around my neck. My attitude about people with emotional problems? God bless them…and I pray that they have a really good connection with HIm. It (and the love of my family) is the only thing that kept me alive.

Question: aside from the obvious nausea and anger that stigma and prejudice bring on, what do you have to say? Please tell me your story.