United States

by

Just Go To Sleep

Sleep

Image via Wikipedia

A multitude of sins would be forgiven, pills would be forgotten, pain would be diminished, hope would be restored, brain would be healthy if we would but go to sleep.

Questions:  What keeps you from self-indulging when it is time to go to bed but you’d rather not?  What helps you get your restorative brain rest?  Have you noticed that everything is better with sleep?  Would you describe it to us?

Self-Care Tip – Get solid restful sleep.  Be a friend to yourself.

Related articles
by

Emotions and Behaviors Will Get Better As You Heal.

Punch to the Face

Image by Ninja M. via Flickr

Don’t worry.

When you hear that, don’t you think violent thoughts?  Or how about, “Calm down?”  Got to love that.  I have visuals of my back swing.  Sure.  You might call them hallucinations.  I’ve never actually hit someone but I have pulled into ready position.

Here’s the thing though.  After all this on-and-on about taking care of ourselves, I have found myself saying things that get awfully close and I’m looking out.  Pretty soon I’m afraid I’m going to get it.  (I’ve got my eye on you!  And you!)

Here’s what happened.  Augustina was wondering what to do about her best friend.  They had quarreled and then quarreled again.

Naming someone, “best-ie” sounds pubescent but Augustina was no child.  Her best-ie had been her chosen family (as Jackie Paulson reminded us yesterday)  since she was twelve, fat and leaked.  Kids were laughing.  Future Best-ie wasn’t.  That’s the kind of girl she was.  Safe; a light in a house that she had gone toward naturally and that had not been put out by Augustina’s misty self.  Wet face, stained pants, fat neck and pimples – Future Best-ie wasn’t laughing.  And that’s about all it took.  She was her friend.

Why had Augustina and Best-ie quarrelled these thirty-some years later?  This was am apparent mystery to Augustina.  You know those kind of mysteries, when they belong to only one person while everyone else with the answer key is looking on.  It was almost like she was standing there, twelve-years-old and bewildered.  This time though, Best-ie wasn’t on her side.  Or so she thought.

Truth is, Augustina had been mean.  She was not keeping dates, she argued easily and she was more self-absorbed than the color black.  It had been months now and then they quarreled.  Augustina missed all the prodrome, the warnings, the recommendations from family, other friends and including Best-ie to get insight and help.  To Augustina, this quarrel stood alone and she was being misused and misunderstood.

So what do we do?  Do we discuss Augustina’s behavior?  Do we explain her problems?  Maybe.  But only long enough to help her join our treatment team.  Once she’s in treatment, we wait.  We for reasons of self-preservation won’t say, “Don’t worry,” but we will come close.  Why?  Because we know that many of her problems as perceived by others and herself will disappear when her brain illness heals.  Do you believe that?  Where do you think her emotions and behaviors are coming from?

See blog post, There is Less Space Between Emotions And Science.

Questions:  When have you seen maltreatment from others that feels personal to you appear without provocation?  When have you seen someone you trusted change into someone who is mean, angry, selfish and reject you when they never did before?  Did you see the opposite happen when their brain illness was treated?  Please tell me your story.

Self-Care Tip – Calm down.  (Duck!  I see you and I’m outta here!)

Related articles
by

Why Psychiatry?

An American Lady butterfly against a cloud-fil...

Image via Wikipedia

If we have ever seen a psychiatrist, then there has been some point in our lives when someone told us to go or we told ourselves.  I have some questions for you.

How did you hear about psychiatry?

What are your thoughts?

What did/do you understand?

Please tell me your story!

Self-Care Tip – Explore your connection with psychiatry.

Related articles
by

Give Because You Want To, Not Because You Are a Victim To Their Taking

Giving

Self-Care Tip – Give to others because you want to and have so much to give.

People who live in chaos, generally do because they want it. They are the ones who think you are the best one day and are screaming you down in the next. They pit team-members against each other. Without the team-members knowing what happened they are now distrustful of people they used to trust, feeling suspicious and defensive. The people who live in chaos have their own gravitational force for extremes. Extreme behavior finds them. They are suffering. No doubt, but at the same time, they thrive on this in some way. They choose it. Even so, they don’t know their choices and are ever the victim in any crime scene.

I have seen a few amazing life-stories unfold where these habits were reorganized into friendly behavior. It took years but every time I see these people, knowing where they came from, my mouth is open, my soul lays in splayed humility and I have new hope in the Love that heals us.

Clara was one such as this. I’m not going to tell you all of her story but let you know that now she has woven a net of support around her, people she spends time with, peer groups she attends. She takes her medications and doesn’t change the doses without discussing them first with me. She feels pleasure without having to be at an extreme.

Clara still has some people in her life who haven’t done this for themselves. Who haven’t worked on themselves and become their own friend and she has been tempted to “save” them at times. Clara just told me the other day,

I am not responsible for the fact that she doesn’t have any one else but me.

Clara has been tempted to stop investing in herself to invest more time caring for those who don’t care for themselves. But she didn’t. She maintains her health and investing in herself and she is still living. She gives to others because she has so much to give. Not because she is a victim to their taking. Clara continues to fight for herself and I respect her. I am learning still about doing this for myself and hope you are too. Out.

Questions: Have you ever seen these kinds of miracles in people’s lives around or in you? What was it like? Please tell me your story.

Related articles
by

Reworking Choices With Your Physician as Part of Your Team

What do you want? 

It is one of my challenges as a physician when someone comes to see me for reasons I’m not able to accommodate.  I can’t validate them.  I can’t tell them what they want to hear.

What can I do?  Help them “realize” that they came to see me for another reason.  Another way to say it is to help them “choose” another agenda.  A part of them realizes their need for help; they came.  A part of them believes I am a person that can help; they came.  A part of them.  A part that I and the patient are responsible to find and shift agendas deliberately or by any wiles possible.

Hands touching

Image via Wikipedia

We are an unusual team in this.  How often do you find another so awkwardly paired?  Yet these are some of my best patient-doctor relationships.

What do you want?

When there is a meeting up, a connection and everyone is working for the same “want,” both presence and movement are natural responses.  It’s like we’re standing still in the moment, senses taking it in, and moving all the while.  The process of moving itself brings pleasure and healing.  It is not always about arriving.  It is not always what we think we want.

Self-Care Tip – Enjoy your re-choices and what you will get from them.

Questions:  Have you every found yourself being “helped” to have a different agenda that improved your presence and movement in your personal journey?  Please tell us your story.

Related articles
by

What Must I Do To Be Happy?

Today, I can’t get my thoughts away from the frolic in temperament-land.

Teacher, what must I do to be happy? 

Who hasn’t asked this?  I remember Nicodemus who asked Jesus,

Teacher, what must I do to be saved? 

A Certified Fresh logo.

Image via Wikipedia

I bet he was wondering, too, about happiness.

I’m not equating happiness with salvation or morality.  I am saying this might have been a parcel of his question.  Happiness is an emotion per our language and cultural definition.  And we have enjoyed our path of discovery in seeing how emotions are tools we use to interpret the world around us.  They are not universal or constant between us.

After I read,

Individualism, a stronger predictor of well-being than wealth,

in R. Fischer, PhD’s Meta-Analysis of Well-Being, I followed my thoughts toward the Jungian Typology of Temperaments.  Remember our pasture and barn people?  The Jungian Typology of Temperaments is our playground where we have a wish-basket equipped with supplies to become any variation we might choose of what our design requests.  Read the article and you might follow a similar path of thought.  Or not.

In case you’re wondering, and per Dr. Q (who is a poor statistician so take this for what it’s worth,) a meta-analysis is a study of studies.  A meta-analysis brings together a number of studies that reflect a population of people and a methodology that is as objective as we can find.  We compare them and through the tools statistics and logic offer, we make a summary conclusion.

If you are familiar with the tomatometer on RottenTomatoes.com, you already have a sense of what a meta-analysis does.  (I love rottentomatoes.com.)  There is more power in the indexed findings of many studies than in just one study.  There is also more power in a fresh tomato than a rotten one.

Questions:

  1. Do you see happiness as something that reflects your condition of spirituality and/or your condition of brain health?  Why?
  2. What do you perceive brings you happiness?  Please tell me your story.
Related articles
by

Our Embrace With Our Powerlessness Stabilizes More Than Our Power

In our growing familiarity with our fears about medication therapies, we are getting to know about control and identity.  Separate those in hopes that will help us bring them together later.

            I don’t want to lose control of my choices to the control of medication.

sugar_frosted

Image by sillydog via Flickr

Jane had pocks on her face from childhood acne.  Kids had bullied her.  She learned to fight.  Jane’s mother had a boyfriend who victimized Jane.  She fought harder.  Not against her mom or her mother’s boyfriend, but against kids.  Jane left her mother’s home when she was fourteen and lived between friend’s houses.  Her story continued to develop.  Jane learned to really fight.  She bloodied herself to get control and she still had her teeth.

Jane had sold marijuana for five years when I saw her.  She had used one to two bowls a day since she was twelve.  It was one of the first things that had given her a sense of control.  Emotions sparking, nerves peeled back and exposed, dilated eyes, afraid and shaking; Marijuana took the peaks and filled in the valleys.

And what brought Jane in to my clinic?  This scraping, scratching survivor?  Weeping, Jane’s pocks folded as her face scrunched up.  Thirty-one years old and she was not in control.  Jane was suspicious of everyone who crossed her path, she couldn’t concentrate and just suffered an at fault motor-vehicle accident when she was ticketed for carrying marijuana.  Jane awaited her trial.

Reader, you see the push-me pull-me in the room.  Was Jane ever in control?  Are any of us?  Our embrace with our powerlessness stabilizes us more than our power.  This was the time in Jane’s life where she was available for help.  This was one of the best times of her life, even if she didn’t know it.  It is the surrender of all that we are, controlled and uncontrolled, to our Higher Power that stabilizes us.  Control comes from the outside in.

But being a friend to ourself isn’t about control.  It is about putting ourselves immediately and ultimately in the care of Love.   What does Love want for us?  To be good to ourselves.

We offer medication therapy (and sobriety) not to put us in control or to take away control.  Assuredly some of our goals will happen.  But still, we offer medication therapy when the benefits outweigh the risks to “Me.”  When it is friendly.  Not to erode us.  See blog-post, Self-Care Works You, Pushes You, Tires You Out Until You Are Happily Spent On Your Friend – You.

Over the past two days, we have asked a lot of questions and gotten insightful, perceptive, inspired and intuitive answers with power to connect us and point toward healing.  We will continue to explore these questions and these answers, as they will continue to influence our relationship with and ability to befriend “Me.”  For today, however, I will bank these Q & A pages and pause Jane’s story.  I send you into blog-post, Are Your Meds Safe?

 

Self-Care Tip #286 – Embrace what your powerlessness offers you.
Related articles
by

To Catch What People Throw At You, Give a Little or You’ll Drop It

Football: Jets-v-Eagles, Sep 2009 - 16

Image by Ed Yourdon via Flickr

Sometimes it doesn’t serve us well to follow our instincts.

When I was little, I don’t know, maybe nine, I remember one of the many times Dad tried to teach me how to throw and catch a football on our front lawn, under the huge tree that seemed to always block me. Dad had played college-ball on scholarship at Duke University where he promptly blew out his knee; one of the many orthopedic problems he’s known. However, he still had his arm and his gentle way of making me feel like he really enjoyed lopping the ball over short distances with me and my awkward hands.

Catch the ball right here, into your arm like you’d cradle a baby.

Nobody needs to try that many times before learning that footballs are hard and pointy and hurt a lot when we catch them wrong. Purposefully putting my body in front of that spinning high-speed object didn’t feel safe.

Get in there and watch it the whole way make contact with you as you catch it.

My eyes were still shut when he said that. I was trying not to cry but I was pretty sure my fingers were going to look differently when I opened them.

Here came more less obvious instruction,

Let your arms and hands give a little, while you catch, closing down on the ball as you let it push you.

People throw all sorts of things at us in the space between “me and thee.” It can hurt to catch and even physically damaging. But counterintuitively, we need to catch like we are cradling a baby, get in there, and give way a little.

This isn’t always advisable but it refers to opportunities to practice presence. Not every interpersonal moment is such an opportunity. Nor will each true opportunity be received naturally or effectively. Those will improve with practice, or perhaps coaching or medical intervention.

The other day, Frida told me with some self-satisfaction about the long hoped for day when she stayed with her daughter during her daughter’s anger, rather than escaping. She gave space for her daughter to throw her pain around. Frida cradled her in her personal space long enough to receive and throw back. For Frida, what she threw back was the next effort of growth. That day we celebrated the presence she was able to offer her daughter and herself.

Now get in there Frida, let it come into you. Give way to some of the momentum or you’ll drop it, and cradle what you catch.

For Frida to do this, she owned her choice to find the presence and to do the work to gain the skill. As I am a medical physician of the brain, you might guess we worked on her illnesses. Frida stayed, received her presence in the company of her daughter – and we celebrated.

Self-Care Tip #284 – Give way to some of the momentum and cradle what you want to be present with.

Related Articles:

Sucking Up to the Boss May Move You Up and Keep You Healthy

by

Grief Can Be Treasured At The Same Time That We Celebrate Life

Self-Care Tip #283 – Find the treasure in your grief while celebrating life.

Today is my daughter’s sixth birthday.  If ever there was a person who doubled the love she received, it is this chid.  She is all passion.  Yes, both ways, but that isn’t to judge.  Just, there is so little I can offer in words to describe her power of self.

They're asleep!

Image via Wikipedia

Tonight, we pushed two twin beds together so she and I could sleep beside each other.  Her sister slept nearby on another twin bed.  Her brother set his bed up in the closet.  (I know.)

If I wasn’t so tired, old and broke, I might be made vulnerable by times like this to having more kids.  Since that’s not going to change, these chubs are what we will stick with.  Happily.

My mind is turned toward God by this girl.  I somehow arrive in the moment praying when with her, perhaps for strength and patience or for humility and gratitude.  I learn from her.

Mommy, when I’m scared I talk to Jesus.

Often in times like this, I think of my niece, dead now six years, and how her parents and we wanted what was, what was stripped.  Still grieving and still living the life with us and in us, our braided thoughts and emotions easily lose their flow.

But today I have this clarity.  My niece is gone now six years and ten days.  Today my daughter is six years old.  Today I am sleeping with my three children.  Today I know that this is precious but this is not all we want.  We want what comes after our living years.  We want to let loose to Love the grief and the life; to untangle.  Not more.  Not less.  But we want.  We want what we have, now, although still in the unknown dimension of our forever.

In psychiatry, we are alert to grief that warps the ability to engage in life.  Grief that mars the connections of survivors.  Grief that becomes pathology, brain disease and a medical condition.  This grief disables and, for example, in the case of my daughter’s birthday today, would dissolve my ability to feel pleasure.

It is difficult to gain access to treatment as many of these survivors have ill opinions about medical care.  Such as; fearing medications will mute their connection with the deceased; mute their grief, or in other words, tribute/offering to the deceased; take away the personal punishment for surviving…

Questions:

  • What do you say to these weeping lives?  How can we de-stigmatize medical care for them?
  • How have you been able to treasure your grief and the life with you and in you?
Related articles
by

Choice and Biology – Where Emotions and Behaviors Come From

Three Legged Race

Image via Wikipedia

I left the light on outside, waiting for my husband to come home.  He was gone, though, to a meeting and wouldn’t be back until Friday.  Some bit of automatic thought current made me flip the light switch and before I realized what I’d done, I flushed.

My husband’s eyes aren’t good and he doesn’t see well without a light.  I can.  I don’t “see” so to speak, but somehow I know where things are and can find my way in the dark.  I’m not a bobcat.  I just remember the way things look by the emotions I felt around them.  This is what was happening that night.

I flipped the switch and there he was.  Walking toward the door.  Distracted.  Fitting his key; almost home.  This was all in the moment that it took me to feel happy and then disappointed remembering he was away.

I turned the light off then because I’m not daft.  But it made me think about what sets our behaviors and emotions in motion.  In that moment, finger to the switch, up, anticipation and disappointment – in that moment, I didn’t choose what happened by the cultural definition of choice.  I responded to patterns that many choices I’d made before had laid down.  Tracks in my brain, hedged and maintained by recurring choices, along with design; my emotions and behaviors also an expression of my temperament.  These moved with each other.  But were they moving along the way we generally think of them, like a three-legged race?

Who was leading who?  Trip.  Get up!

One, two, one, two.  Step.  Step.  Step.  Step.  

And in that moment, my layers of choices were counting out with my biology, “One, two!”  There I was, participant and audience.

When we think about where emotions and behaviors come from, culturally we view them as if they are awkwardly related.  As if biology and choice are tied together at the ankles, about to trip each other up.  We call out to them, hoping somehow they might not show the public how little they know of each other’s rhythms.

But you can see the ridiculousness of this.  Choice and biology are in no way separate.  Design forbids it.  The question of where emotions and behaviors come from in itself reveals our confusion.  They come from the same place.

I can hear the concern that this eliminates free-will.  Answer …”But why?”

After these thoughts that night, I turned the light back on.  I preferred how I felt when I thought my husband might arrive soon.  I chose I guess.  What else could I do?

Questions:  What does it mean to you to fuse choice and biology in the discussion of emotions and behaviors?  How does your culture view this?  Does this affect the way you care for yourself?

Self-Care Tip #282 – Don’t deny the choice available to you to feel and behave as you wish, where that wish surfaced from and the tools you use to make them.

Related articles
by

Stop! Don’t Stop! – Affecting Our Practice Of Medicine and Other Agendas

Self-Care Tip #281 – Be aware of how your “Stop!  Don’t stop!” behavior is interfacing with your agenda.

One of the challenges in practicing medicine is the inevitable “Stop!  Don’t stop!” petitions.

stop & go

Image by Joseph Robertson via Flickr

It’s similar in a few ways to being a shoe cobbler who receives clients that don’t want her to use leather.  Ms. Cobbler spends 40-60% of her time with clients persuading them of her capacity to use leather, the objective and subjective evidence behind the use of leather and empowering her clients to wear their leather shoes despite public opinion.

This sounds silly and is not meant to be disrespectful to patients, including myself as a patient of physicians and my own difficulties being a patient.  It is only to describe the forces we are all working with when we work together in medical care – physician and patient.

Quenn came in reminding me of this.  Quenn was a 32 year-old married mother of three, who complained of trouble swallowing, sleeping and ability to feel pleasure over the past two months.  She had struggled with this after her mother died nine years ago, but the problems went away over the following year.  However nine years-ago, Quenn was not a mother.  Nine years-ago, Quenn could shake, stay in the house with the shades down, silent or crying loudly, not eating lying in bed for days and if she wanted, nine years-ago no one would know.  This time however, Quenn told me she was desperate.

I have to get better!  This time, I’ll do anything!  But please start with something natural.  I don’t want to get addicted!  I’m someone who never does meds.”

Quenn, why are you seeing me?  

This is challenging for everyone.  Together, the physician and the patient work with this influence on their agendas.

My brothers and I used to play a game on each other when we were kids.  Maybe you did this too.

Stop!  No don’t!  Stop!  No don’t! Stop!  Don’t!  Stop! Don’t! Stop! Don’t stop! Stop! Don’t!  Don’t Stop!  Don’t Stop!

And for some reason that was hilarious to us.  I like to remember this when I’m in the office and smile despite being played by the “Stop!  Don’t stop!” behaviors and emotions.

Questions:  How about you?  How are the “Stop!  Don’t stop!” behaviors and emotions playing on your agendas?  Please tell me your story.

Related articles
by

Stigma Can Hack At Us, But We Don’t Have To Lose Our Heads Over It

City of Canterbury budget 2010−2011 072a

Image via Wikipedia

A few days ago we wrote a blog-post entitled “Be A Tall Poppy.”  I had more than one person ask in comments and in person, what the —-! did that mean!

Why a poppy?  Why discriminate against the many other lovely but apparently unapplauded flora of the world?

What does it mean to “be a tall poppy?”

This referenced the “Tall Poppy Syndrome” of Anglosphere nations.  It tells us that culturally people who wear their accomplishments openly and indiscreetly invoke jealousy in others who then correctively cut the “tall poppy’s” down.

No offense to other buds around the globe, but when we say, “Be a tall poppy,” we say be yourself without the “discretion” of hiding your beauty – flaws and desired traits included.

We probably can’t change cultural opinion much if we don’t work with our own feelings of possible social rejection of making these changes in ourselves.  Being a tall poppy means that we will not be reduced by stigma and other forces; we stand tall and live.

In our blog-post Paging A Testimony, Nancy told us about her discomfort with the response of others to the way her improving health demonstrates itself and changes the dynamics of their relationship.  The balance of energy, power and involvement between her and others is in flux.  Her courage of prevailing through can be coined with, “Nancy is a tall poppy.”

Way to go Nancy!  Stand.  Cowing to those negative emotions is the same as cutting the poppy’s head off and stem left short.  Feel the tension, but stand.  Be present with your emotional responses.  Stand tall.

Self-Care Tip #279 – Be present with your emotional responses.  Stand tall.

Related articles
by

Summarizing What You Say About Friendship With Yourself

Friendship

Image by Rickydavid via Flickr

In Summary:

Q1:  What does being “a friend to yourself” mean?

  • self-awareness
  • Acting on that self-awareness
  • Grieving who I wished I was
  • Valuing Me

Q2:  What helps?

  • Knowing where emotions and behaviors come from
  • No self-injury or aggression to others
  • Knowing God
  • Gratitude/self-inventory
  • Support from outside of Me
  • Personal check-points in place to offensively guard again self-sabotage

Q3:  What doesn’t help?

  • Perfectionism
  • Ingratitude
  • Untreated or treatment resistant brain illness
  • Stigma
  • misdirected efforts to feel empowered (such as, preoccupied thoughts = control)
  • isolation
  • habit

Q4:  What helps despite this?

  • Self-forgiveness
  • Realism/Without catastrophizing
  • Tenacity
  • Remembering what your self-care has done
  • Presence

Q5:  What is the relationship between biology and choice when it comes to understanding where emotions and behaviors come from?

  • Biological template determines function
  • Choice is there for using that template
Related articles
by

Guest Post by Richard

Chronic pain

Image via Wikipedia

Guest Post by Richard, who was kind enough to send me his recap on last night’s Self-Care Workshop:

Salient points:

  1.        We are not special by our pain, we are special by who we are.
  2.        I use what I have (am).
  3.        The natural laws stay constant. There are small differences between each person. The divisions are flat.
  4.        Benefit of medical evaluation first to rule out physical causes, then look at outside of medical.
  5.        We inflict the pain not the biology.
  6.        We are in the present, trying to reach goals that will never be completely reached.
  7.        The agenda within, (such as your job.)
  8.        Unwrap and fight for your freedom, illustrated by our national history.
  9.        Stigma is biological.
  10.       Guilt is not always a choice.
  11.       Relinquish opinions of others. Cannot  change how others consider or view us as related to those who knew who we were at a different point in “our story.”  …I guess stigma is in the eye of the beholder?
  12.       The initiation of self-care is a difficult first step.

Question: how do you get loved ones to take the first step or do you?

-Richard

Related articles
by

Positive Emotions and Behaviors are Contagious Too

Chris Sacca, Google special issues

Image by dfarber via Flickr

We are doing a narrative series on understanding where emotions and behaviors come from:

  1. Emotions Are Contagious
  2. Our own Emotional Junk 
  3. Positive Emotions and Behaviors are Contagious Too (today’s post) 

What we’ve covered so far in our series is that we know emotions are contagious and we know that if we take care of our own first, we might not be as “susceptible to contagion” in turn.  Further we were left with the hope that if we do this, we might have the ability to choose to be with people we love even if they don’t do their own self-care and have that connection without personalizing what isn’t about us.  Sigh.  That is nice, isn’t it?

Yesterday, M in his usual gentle way, reminded us that contagious emotions might be effective for spreading more deliberately and more in the positive nature.

 I am encouraged and hopeful. Being peaceful can be contagious too?

Then today I read a tweet about Chris Sacca’s commencement address.

presence -> sleeping well -> breathing *ahhh* -> embracing my weird self -> presence. Thx again @sacca So good.

Well worth my time!  Sacca spoke about being a friend to yourself!  Can you believe it!?  …Ok.  He didn’t say those words or mention this blog, …or me …but he may as well have!  (Wink.)

If you listen, think and process, please tell.   I would love to hear what you get from his speech.

…Did you catch the bit about start overs?!  You know I love that.

Sometimes however, I am a real bore making this “friend to yourself” thing seem so dull and difficult.  And M and Sacca are right!  Peace and happiness are also contagious and a better effort.  To get that, Sacca tells us to do some specific things.  Did you catch them?

Question:  What did Chris Sacca say that you find useful to friendship with yourself? or others?

Self-Care #269 – Positive emotions and behaviors are also contagious and are a better effort for your friend – You.

Related articles
by

Our Patient-Doctor Relationship Improved by Self-Care and Back At You!

NICU Nursery

Image by EMS Shane in Portland via Flickr

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #265 – Use your connections to help yourself and use your self-care to improve your connections (such as your patient-doctor relationship.)

Damaged and premature, my niece was born needing help to live. Now, one year later, I am playing ball with her on the floor. Her intelligent smile, thriving body, and especially the lovely nape of her neck with that baby-curl of hair lipping up makes remembering her near death-dive into life surreal. I don’t want to remember it anyway. But when I can’t help myself, what I like to think of is how my brother and sister-in-law were treated.

The clinicians at UCSD were unbelievable, my brother said. They included him in their decision-making and informed him of medical study results. If you don’t know, if you’ve never been sick or been in a medical setting otherwise, this doesn’t always happen. It isn’t traditional to share medical information directly with patients (such as x-rays, laboratory results, differential diagnoses, and to ask their opinion. Can you imagine?!  “…Um. Yes PLEASE! Can I be your patient!?” Sounds like fantasy.)

I’ve also struggled to collaborate. Hovering over charts and laboratory results, many of us practitioners behave as if our patients were at any moment going to throw us into court. It’s embarrassing, even though the truth is, too many of us clinicians are stalked by litigious intentions, whilst the truly awful practitioners seem to sail away on unsinkable malpractice without pursuit.

I have not enjoyed myself when I’ve done this. When I’ve acted suspicious of the very people I’m meant to team up with, work was not good for me. I don’t think my patients felt comfortable with the doctor-patient relationship either during those times. Hearing my brother talk about how he was treated has emboldened me to engage with more trust in the care I offer patients. Moreso, being friendly to myself has helped me be a better physician.  It’s tail chasing but with productive and enriching effects.

Making a choice to choose trust and transparency with patients and clinicians, even being present with the fear, is self-care although high pressure. With people’s lives on the line, clinicians and patients know mistakes will happen. The self-care will grow our ability to forgive each other.

My journey with self-care has brought me to see people differently. I look at them from the self-care angle. I look for those sticky bits where we can connect and collaborate. I expect things from them. I ally myself with their self-respect, with their intuitive desire to be friends with themselves. I am bored at work when I don’t do this. I am bored at work when my patients don’t do this too. Without self-care for myself and without my patient’s interest in self-care, medical practice becomes everything that the negative reputations advertise about the physician and the patient.

Yes. My quality of practice has definitely improved.

Who isn’t blessed when she sees the courage to face stigma, shame and bewildering illness? Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live, fights hard like my niece did and shows what that fight is worth?

Who doesn’t learn from that? When someone loses her identity to the defacing ravages of disease but still knows she is worth the fight, like PattyAnne, working beside her is one of the best places in the world to be. For Me. It starts and ends with Me.

Building trust in a patient or a clinician starts with us staying connected to others in our personal circle and along the ripples as the circle widens. We have to have a voice and hear their voice and we do this by maintaining a community of people.

Connection is part of self-care for both clinician and patient. In the case of PattyAnne, (yes, she’s still in our story,) she could take an action toward her self-care with the intention of gaining stronger connection to her community and to me. She could ask herself about her intentions. In fact, we both would do better self-care approaching each other this way.

Connection via the patient-doctor relationship is self-care and then back the other way too!

It starts and ends with Me.

Questions: Has your patient-doctor relationship been a friendly part of what you’ve given yourself?  What are some examples or in what ways have other connections you’ve chosen improved your self-care?  How has self-care inversely improved your patient-doctor relationship?  Please tell me your story.

Related articles
by

Self-Care Is Not A Moral Issue

Facial emotions.

Image via Wikipedia

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #263 – Experience, use, observe and interpret emotions, but don’t moralize them.

We sometimes forget about the involved journey to a healthy Me.  Because of this, we become fearful that it means alone-care, apart-from-God-care, selfish-care, excluding experienced-and-professional-input-care and so on.  It’s not.  Self-care is collaborative, yet that doesn’t negate the fact that it must start and end with Me.

When we take care of “Me,” we can connect more with others, including God, have more inside of us to give to others, and have more interest in the world around.  The opposite disables our abilities to do those things.  No one can give what she doesn’t have.

We have this person, “Me,” to take care of.  This “Me” is valuable, of high priority, to be celebrated and cheered on.

Please, shake it off.  Self-care is not a moral issue.  It just is.  It is a choice, a freedom and an opportunity.  It is not about salvation and has no influence on our worth.  It just is.

We are more willing to buy into the, “It just is,” self-care tool when we understand where emotions and behaviors come from – the brain. This biological stance is the evidence for deescalating our drive to moralize emotions and behaviors.  They are not from an aura, a gear we can shift, or any nidus of control outside of our human bodies.  Emotions are how we interpret the world around us.  They are not linked to morality.  Please don’t take them to the pulpit.  If you do, I will still be polite, although breathing through a mask.

Emotions are our interpretive lens for our physical self.

Questions:  How’s the clarity of your lens holding out after considering this part of self-care?  What influence does what you “see” with your emotions have on your ability to befriend yourself?  Please tell me your story.

Related articles
by

Free To Do Self-Care, Despite Our Bully

Demonstration in London supporting Serbia

Image via Wikipedia

Bullying:  Series Continued.  (I didn’t even realize I was writing a series until now!)

  • #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

Bit’s and parts of us are unbelieving in what number of options to self-care that we have, when it comes to being bullied.  I don’t say this lightly about terrors.  Terrors change us irrevocably and hurt to the brink of our own abyss.

The question is, are we free to do self-care even when we are bullied?

Yesterday, Carl in his candid way, said,

Empathy and forgiveness? You gotta be kidding. Do you know what it is like for a twelve year-old to face this…  for an entire school term? Probably not? Cope? Isn’t coping with a chronic negative stimulus as debilitating as being unable to cope….  There may be situations where “book smart” stuff is not applicable because we cannot negotiate with the bully.

Go Serbia

Image by SanforaQ8 via Flickr

We cannot negotiate with the bully.  True, to the degree that Carl said, if I understand him.  (Carl you will surely set me straight soon.)

It is true that people who like to fight, fight well.  People who bully generally will bully better than I can ever defend myself.  They have had a lot more practice.  Have you heard this?  You never want to go up against someone who has nothing to lose because the only one that will lose is you.

When someone is agitated, in psychiatry we learn that it is good not to make eye-contact.  Avert the body.  Keep your voice low and don’t engage as much as possible.  It reminds me of letting the mist of early morning dew expire the coals in the camp fire.  Getting attacked is something we want to avoid.

Early on in my training, I was rounding on the inpatient psychiatry ward.  We often have people who are agitated admitted there and this morning, I remember it was about seven AM on a Sunday….  This particular patient hadn’t slept well.  He wasn’t well-groomed and he scowled.  All the nurses where in another room in a nurses meeting and I didn’t notice he and I were alone in the hallway.  I looked him in the eyes directly.  I didn’t concern myself with tempering my interview.  I was still sleepy myself and wanted to get out of there as quickly as possible to start my Sunday stuff at home.  (I know.  Stellar attitude for a resident-physician, right?)  He grabbed me around the waist and I nearly lost my water!  I screamed at him like a she-dog and he let go.  That was all.  No big deal right?  Well I was ticked at him and at the nurses for not being available.  No one was at the nurses station, which is illegal too.

In truth, I was pretty much an idiot on all accounts.  It doesn’t condone the assault but I have since been better about not negotiating with the bully.  

That probably wasn’t exactly what Carl was talking about but it is related.  It is by no means a full year of negative harassment, but when responding to the concept of not being able to negotiate with the bully, I don’t know at what point in degrees of trauma experiences that becomes true for us.  Perhaps it isn’t a matter of qualifying them or quantifying them.  Perhaps more depends on the victim.  I don’t know.  Do you?

What I do know, is that Carl and I are both partly wrong.  We can.  I don’t know about then.  We can now.  We are free even from those molesting monsters because of who we are.  We were created free and those horrors can’t extinguish that bit of us.  We are free not because of the protection or lack of protection we’ve lived in life.  We are free.

We don’t claim to know all the innumerable forms of suffering out there.  That is not what this self-care engages with.

Questions:  How do you find yourself free at this time in your life, despite it all?  How do you describe your freedom, even with your bully?  How have you seen others in this context?    Please tell me your story.

Self-Care Tip #254 – Free yourself from your bully.

Additional Resources:

Related Articles
by

The Testimony of The White-Headed People – Connection and Aging

Once again, I find myself in a café.  This doesn’t happen often enough for me.  But here,Almond paste tart with chocolate mouse and blueberries

I am

at the wonderful le Croissant Bakery, indulging not only in the quiet of my private thoughts, not only in my delectable chocolate croissant with coffee, but also in the ambiance.

Here, there is this completely lovely group of white-headeds, maybe ten of them at a table, sharing the treasured community of each other.  None of them walk completely upright.  One is wearing his oxygen tubing with tank in tow.  The ladies are coiffed irregardless of their folding skin and thin hair.  Fruit tart

I am

so blessed to be in their community, testifying to me that aging doesn’t have to be done alone.  Flourless Chocolate cake with Ganache inside

I am

sure, 100% sure, that none of them are aging as they dreamed.  Each of them have outlived many loved ones and the ground they walk on has changed many many times.  They have, each of them, learned to walk again after suffering the type of loss that put’s any of us in bed.

I am

blessed.  This collection of café moments they have together does not account for these losses.  This does not resolve their ongoing conflicts or pain.

But none of them,

Almond paste tart with chocolate mouse and blueberries

I am

100% sure, did not let those things keep them from having this moment together today.

All this sureness without having checked my notes with them?  Yes.

I am.

Crumbs on a Plate

Image by rockbadger via Flickr

by

Sleep Does Not Lose As Gracefully As He Lets Us Think

Cougar sleep

Image via Wikipedia

Self-Care Tip #244 – Sleep when the day is over, and play another time.  Be a friend to yourself.

Sometimes it is hard to let the day end.  Michael told me that he was having trouble sleeping.  I asked him to tell me more and heard him describe fun-filled hours of movies, computer, phone-calls and late-night snacks that were disturbing his sleep-initiation.  Just listening to him, I felt a yearning catch spark in me to have the freedom to be spontaneous again.  You might know what I mean.

The opportunities to be spontaneous have shrunken up as our choices have brought us expanding fillers for time, attention, money, energy, emotion, personal resources and magic.  It is no wonder that letting the day end meets reluctance.  Those last few hours that sleep called shot-gun for are ours with less fist than big brother used to stage.  Sleep doesn’t put up much fight …at first.  At first, it concedes to us.  It lifts it’s chin casually until given turn.  However, much like the loan shark, sleep will never go unpaid.  It will take it’s due.  Maybe just not tonight.  Maybe you won’t hear about it until later.  And there are no promises that it won’t take by force, from one part or another of our body, our brain, our beauty, our emotions – debts are not forgotten here.

Michael says, as if he were the victim here,

It takes most people about thirty minutes to fall asleep.  But me!  It takes me hours to.  

We started talking about sleep hygiene and Michael just wasn’t interested.  I asked him to simply read about it and just see what he thought he might be able to start with.  One change maybe that he thought was tolerable.

These negotiations are sometimes best when the patient feels like they came up with the idea.  Michael is going to read about this and hopefully become his own advocate.  He will hopefully “sell” it to himself with the information both from facts but also from experience.  It’s no accident that Costco sets up samples at ever turn of their superstore.  Nor that we can never seem to leave without spending at least $100 in cash – not credit!  Cash!  (Argh.)  Maybe Michael will sample and decide to sleep rather than play at night.  He might have to “taste it” to believe and choose for himself.

Spontaneity will always lure us, dangle her jangly jewelry, give her side-ways glance and make us long for those midnight hours to open up in playful company.  However, sleep is not as gracious as it seems.  Don’t be fooled.

Question:  Do you consider sleep hygiene important to self-care and why?  How do you see it related to you being a friend to yourself?  Please tell me your story.

Related Articles