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What Comes To Me From Others Is a Gift

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Self-Care Tip #246 – Take care of yourself and expect that what comes from others is a gift.

Do you ever ask,

Why does drama follow me?!

It is just darn hard taking care of ourselves (including taking psychotropic medication.)  Much of the rest of the world has difficulty with it too.  Despite our best efforts to go towards what is friendly, we might decide that choosing the company of un-self-cared-for loved ones is more friendly to ourselves than cutting them off.  That is our choice.  If we want them in our lives, we are not able to just take the bits that are friendly.

Some of us are more dramatically affected by this than others.  Wonder about why that is.  I’m wondering if it has to do with our different perspectives of who will take care of us.

Feeling like someone else is going to take care of Me is a trap.  Expecting someone else to find us for love, to expect leadership, to follow without accounting for our steps, to decide without knowing we decided, thinking someone else decided for us – these are traps.

Drama-icon

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What do we expect other people to be for us?  We will interpret the drama we encounter differently when we are our own leader.  If we take care of ourselves and if we come in a state of readiness then we can offer more of these gifts and visa versa.  Gifts are free and as free of agenda as our flawed selves can give.

We embrace our emotional self, our thinking self, our judgmental self, our sensory self, embrace and live ourselves up most fully, and we are most friendly when we do it with the freedom our lives were designed for.

Drama will always come up as long as we think that someone is worth being in our lives.  We will remember that we chose them and can choose quantity of time, the volume, the reception and the degree of connection.  We can choose freely what we will do or not do with them and live and die surrounded inside of ourselves and outside of ourselves by the connections we fought hard for.

Questions:  Why do you think drama is in your life from the perspective of self-care?  Since you’ve been more in tune to being a friend to yourself, has anything happened to the drama in your life?  Please tell me your story.

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Choose Back! …As Long As Life Chooses You.

A Girl On A Footbridge

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Self-Care Tip #241 – As long as life chooses you, it is your right to choose back – so do.

Although I am not a geriatric psychiatrist, I have still been given the pleasure of serving a “golden” few.  What has impressed me has been their willingness to start over.

Starting over takes courage and humility whether it is deliberate or not.  Sometimes fear dances between the lines of all the emotions and intentions. But still, wouldn’t you agree that it takes courage and humility to negotiate fear?

(Enters Hans.)  Hans was seventy-three years old.  He had struggled with brain illness on and off he thinks since he was at least twelve.  There were big spaces of time when his disease exacerbated, and he largely suffered.  But he chose, at this age, to try again for improved brain health.

Is there a time when we start thinking, don’t keep trying to start over?  Maybe in the dying process.  In case you don’t know, the dying process is a specific term.  It means the time when a person is facing impending death.

This area of medicine is not my specialty but I imagine at some point we want to stop with that starting over process, give up, but not in a hopeless way.  In a way that says,

I can stop trying for new anything and sit in the space of what I already have in me…

…Which hopefully includes all the ingredients and interrelations of life.

But how far before that point in life do we consider starting over reasonable?  I’ve heard of kids being told they’re too young to ride a bike, or cut with a knife, or understand the dinner conversation.  No one bobs their head at that.  But find a seventy-three year old who believes that after a lifetime of perceived failure by onlookers or themselves, who still says,

Now let’s give this another go,

…and if it hasn’t been said, it’s been thought,

give it over already!  You’ve hit your seventy-times-seven chances!

It’s like they’re shopping in the teen-ware.  We blink our eyes and angle our heads.  Even the thought of starting over as a real option feels indiscreet.

(Enters Hans.)  Hans is seventy-three.  He is starting over.  Humbly and with courage, he pursues brain health in the face of stigma.

I think I had celebrated my six birthday when my dad asked me if I felt any different from how I felt when I was five.

Yes!  I feel older!

 Then he asked me how old I thought he was.  When I answered some enormous number like, “twenty-two!” he asked,

Does forty-four seem old to you?  

Of course it did!  But I had an intuition that if he was old, than he’d die, so I said a definitive,

NO!  Daddy you’re still young!  You aren’t old!

Now, almost that same age myself, I am in awe of him and the others in their golden or not so golden years (Enters Hans) who believe that as long as life chooses them, they will choose back.  It is their freedom.

Questions:  When all your senses don’t sense pleasure in life, or you feel old and useless, or you feel that you’ve failed too many times, how do you choose to start over?  Who has inspired you and what did they do?  Please tell me your story.

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Being A Student… To Yourself!

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Self-Care Tip #240 – Be a student to yourself.

The PossAbilities Triathlon today was the best.  It was the first triathlon for my young niece.  Doing it with her made it so much more than just a triathlon.  She is someone who works hard on what she loves.

Her father, who is my brother Vance, and I had more time to chat today, thanks to my niece’s excellent pacing.  Vance is a natural teacher as well and he’s been practicing on me our whole lives together.  The fact that we are old now doesn’t change the dynamics much and I think we are both just fine with that.

Today we talked about teaching directly.  Vance said,

To teach well, first you have to understand what their fears are, and waylay them.  Then you inspire, but you can’t inspire until the fears are examined at some level and trust grows.

Isn’t that lovely?  So my question for us today, is how do we do this for ourselves?  Sure, we want to be humble students as well as educators in the teams we work with involving others.  However, reducing this to the basics of self-care, we finger the idea that this can start right here, where things start and end with “Me.”

Understand our fears and let them lose their power over us.  Then spend our time and energy on what inspires us.  This is how we can teach ourselves and learn from ourselves!  What a delight.

Questions:  What do you think about the idea of being a good teacher to yourself?  Is it ridiculous?  Arrogant?  Possible or not?  How do you teach yourself?  Is it the same as a “doctor-heal-thyself” trap, or as described in this bl0g-post, “teacher teach thyself?”  Is there still self-care potential in this, despite its obvious limitations?  Please tell me your story.

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When Things Get Heated, Remember to Ask Your Friend’s Opinion. You.

Check the Meaning

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Self-Care Tip #237 – When things get heated, get a second opinion with your friend.

What would my friend say?

When in question, ask.  And who is the friend we are referred to here?  The “Me.”

This is a great check point to give ourselves.  Things get heated between her and him, she gets a second opinion.

Barbara had read this blog and tucked something of its fabric away in her blended space between conscious and sub.  Then one day, while zoning out listening to her husband yell and criticize her, she saw herself.  It was as if she split into the participating Barbara and the observing Barbara.  The participating Barbara suddenly didn’t feel so alone.  The word, or more the concept of “friend” came to mind and she put it together.

Now generally when she is in a situation that hurts and bewilders her, she is remembering to ask her friend what she should do.  Asking used to take longer, but now it comes to mind as quickly as the thought of consulting an intimate partner would.

What would my friend say?

Things weren’t peaceful yet in her life, but just asking her friend what she would do has helped Barbara a lot.  Barbara explained to me that if she were with a girlfriend, say Sally, and Sally gets worked over by her husband, Barbara wouldn’t have any problem thinking of what Sally should do about taking care of herself.  Barbara says that being her own friend is almost the same.

And then for me, it clicked.  I can ask my friend.

What should I do?

Question:  When getting hurt by someone, how can you get friendly with yourself in the moment?  Please tell me your story.

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Self-Care As it Affects Your Professional Self

Of the patients waiting at the Out-Patient Dep...

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Self-Care Tip #236 – Think about what self-care is doing for your professional self.

When speaking with managing editor of the Journal of Participatory Medicine (JoPM,) Kathleen O’Malley yesterday, I struggled to explain the presumed simple description of what effect self-care has had over the past many months on my professional self.  I realized that I hadn’t spoken much about that yet.  The words spilled out, messy and ungraceful.  I’d like to say it better so I’m going to try again, and then many more times.  Self-care has helped me be a better physician.

I 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 a friend 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.  Yes.  My quality of practice has definitely improved.

Who isn’t blessed when they see 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 when disease is damaging them, fights hard like my niece did and shows what that fight is worth?  Who doesn’t learn from that?  Who doesn’t want more?  When someone loses their identity to the defacing ravages of disease but still knows who they are, is for me, one of the best places in the world to be.

Working harder on myself personally is working harder to improve myself professionally.  One healthy is another healthy Me.  Self-care has helped me find more pleasure at work because I know I am responsible about how I feel when I’m there.  I take care of myself when I’m there and then I’m able to give more to my patients because of it, including just being present.

Being present is really a lot to get and a lot to give.  I sense this in my kids who want me to see them.  They call out for observation of activities; riding without training wheels, jumping super high, running in fast shoes, building awesomeness.  But those are code.  They want me to see them.  I just can’t do that when I’m self-neglected.  It carries over in all spheres of my life, including the office.  Who wants to consult a physician who is half asleep in the chair?  (Now if I need a nap, I just go all the way and sleep! j/k.)

I know my self-care is participating in the practice of this kind of medicine with you.  I’m hoping to get better saying it.

Questions:  What has self-care done for you in your professional world?  How has it helped you work better as a team-member?  How has it helped you receive better from others who have something to give – such as teach you or give directions?  Please tell me your story.

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Imagine If You Were Your Own Friend, And Take Your Advice

Postcard - Sexy Woman writing a letter

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Self-Care Tip #234 – Imagine if you were your own friend, and take your advice.

Joana Johnson, author of CreatingBrains.com, full-time mom of six, part-time University history teacher, student, wife, confidant, friend and sister-in-law… (no she’s not running for president) …Joana asked me today,

Write a letter to someone you love sharing what you want them to do to take better care of themselves.  You don’t have to give it to them or you can.

Now imagine what letter with what self-care requests would someone who loved you write to you?

…You’re right.  I’m going to have to talk her into running for president.

And so, I offer this challenge to you.  I wonder after you.  I am sitting in waiting.  Please tell us this part or more of your story.

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Still Interested In Self-Care?

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Self-Care Tip #131 – Start all your efforts and end all your efforts accountably with yourself.

Self-care is:

For many of us, we wonder what self-care is.  Obviously being subjective, it is something unmeasured and changes between us.  It doesn’t interest or make sense to many, depending on their religious biases, culture, temperament and other things.  But others of us, for maybe the same reasons, find self-care to be the place from which our axis swings.  We have together, here at FriendtoYourself.com, through the past eight-plus months, agreed on much of what self-care is and is not.

It is not selfish-care, alone-care, sacrilegious or Godless-care.  It is more than any one thing, for self-care flattens knowledge.  It is not weak but rather courageous.  It brings us to humble accountability for our lives, not erasing our history but still being free to start over any time.  Self-care is living consistent with the belief that the success of our health (emotional, physical, spiritual) begins and ends with Me.

Despite the chorus of boos, we say that we serve God and man better by taking care of ourselves first.  We attack guilt, we stand up to shame, we live as we choose despite stigma and we work harder than we ever have on perhaps the hardest job of our lives.  This is, Self-care.

Are you still interested?

Question:  How do you define self-care?  How is it played out in your life story?  Please tell us.

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Choosing Perspective

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Self-Care Tip #225 – If you can’t choose a better perspective on your own, it might be time to choose it via a medical route.

Feeling trapped?  Overextended?  Used and neglected by others?  It might be true.  But why do we get in these impossible places?

In the Wrinkle In Time by Madeleine L’Engle, towards the end of the story we find ourselves in a room with Charles and It.  Charles is trapped by It.  He has disconnected from his own thoughts and has given himself over to the control of “It.”

Charles’ sister, Meg, comes in and reminds him about Love and that changed the perspective of everything.  It reminded Charles about why he wanted to choose for himself, to have his own thoughts, to love and receive love.  And then, with that, Charles was reconnected with himself again, whole and sharing space with Love.

The changing perspective turned what seemed an impossible bondage into freedom.

When we feel disconnected from our personal journey, impossibly overextended and trapped, remembering our freedom to choose, freedom because of Love can make all the difference.  The perspective shifts.  The impossible becomes possible.  Magic.

Sometimes, choosing is thwarted by brain disease.  When we can’t extricate ourselves, when guilt plagues us, when we feel like things are about us that really aren’t, when the emotion jarring us is inappropriate to the context – we need to use that as a cue to choose to get “free” via medical help.

Questions:  When have you felt trapped?  When you did feel trapped, how did you find your freedom?  Please tell me your story.

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Self-Care Woven and Unravelled Simultaneously for Best Results

Change is good--Kente Cloth Loom

Self-Care Tip #222 – See the different parts of your self-care as independent yet dependent on each other.

One of my truest pleasures would be to teach well.  My temperament is, per Myers-Briggs, designed to be a teacher and I agree that I feel inner congruence when I’m doing just that.

…If you’re feeling your hands closing into a bracing grip, it is probably because you, like many, really don’t want to be schooled – which has happened in my less refined moments, so caution is understood.  This is not what I hope to do here.

After yesterday’s blog-post and comments received, it shows that I have not taught as well as I implied to myself.  Implied intimacy is a danger of any familiar relationship, including with ourselves.  The beauty of you guys, is you help me say things “out loud” decreasing misunderstandings.  You guys are teaching me and I thank you.  So whatever this is we are doing, learning, schooling, teaching or whatever it is that Mr. Rick C. does – what we are doing here together is mucho-much fun.

As we unravel the rug together, we see these threads,

  • emotions and behaviors appropriate to context – yesterday we spoke about guilt
  • emotions and behaviors inappropriate to context – yesterday we spoke about guilt as a symptom of medical illness
  • the magical miraculous beyond our current understanding – before we “see face-to-face” – yesterday Carol Ann mentioned the changing power of God
  • freedom to do self-care and related choices
  • what choice yet remains when other choices are lost either by action or disease
  • (this last one I’m just putting in here to finish the pretty rainbow) – helps me get in the barn where I’m comfortable

The reason I think it’s important to see these together yet apart, as well as we can (through a glass dimly), is that too much of one or another of these, diminishes the results of our self-care intentions.  Don’t mistake this for preaching that one can get too much of God in their lives.  It just isn’t true and not in our best interest to get waylaid.

Questions:  How do you see yourself more effective in your self-care efforts and what has influenced those improvements?  In what way have certain bits of your self-care gotten “too much” attention?  Please tell me your story.

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If it Matters to You, Even The Hot Shots Say, SELF-CARE BEGINS AND ENDS WITH ME

i i i i i i i i i i i i i i i ! i i i i i i

Self-Care Tip #220 – Take your freedom and be good to yourself.

Free-will keeps cropping creeping climbing clambering up with us.  Go figure.  As usual, Carl pushed buttons and inspired me to remember the lovely word “self-government.”  I was so delighted that not only does the term self-government say it so well, but I felt like I was the first to come up with it.  Then I googled around and found Webster, many countries (possibly yours,) and even our own constitution of the United States (“We the people…”) might have wrinkled time and stolen it from me before I even thought of it (See Einstein and the Fabric of Time.)  Can you believe that!

While calming my unappreciated self, I ran across like-minded David Rigoni’s splendid work at the University of Marseille.  (After reading this, I’m sure he will delight in hearing us named, “like-minded.”)  Dr. Rigoni says,

Folk psychology tells us if you feel in control, you perform better.  What is crucial is that these effects are present at a very basic motor level, a deep level of brain activity.

He and his team studied thirty people over different tasks, using different mediums of examination and deduced that it is better to believe.

If we are not free it makes no sense to put effort into actions and to be motivated.

Dr. Rigoni’s work reminded me of the work of MIT neuroscientist Sebastian Seung.  Some time ago, Dr. Seung gave a wonderful TED conference,

I am my connectome.

Dr. Seung tells us the good news that we are more than our genes.  The connections among neurons are where memories and experiences get stored – not in the genome.

My pleasure grew when I read about the collaborative work from a few schools we’ve heard of – see NYU news.  ….Apparently goals and habits show overlapping neurological mechanisms.

This is all very exciting to our self-government.  I’m sure that we the people would hate to find out that all this time we’ve demanded our freedom – it wasn’t even possible.  But it is – even per the hot-shots of the world. The sophisticated and unsophisticated, in paradigms of thought, Time and Timelessness, learning, beliefs and feelings, in my country and in yours – we continue comfortably and with confidence to say, SELF-CARE BEGINS AND ENDS WITH ME.  (See Ghettysburg Address.)

Questions:  When have you found yourself unable to claim your freedom to be friendly with yourself?  How have you managed to cross the barriers you perceived around yourself or others?  What would you like to tell Carl or Carl?  Please tell us your story.

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Living Where We Feel Safe is Part of Self-Care

Self-Care Tip #213 – Live in safety.  Be a friend to yourself.

In My Fridge

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I love psychiatry because for me it is a safe place.  A place where I am comfortable pushing aside distractions.  The blinking lights disappear and I don’t have to waste myself on B.S.  Some time ago, I told you about how Mom has been when Dad’s been hospitalized in the past.  When she pushed his tubing aside and just got in bed with him to hold him.  All that mattered then was Love.  They didn’t see the clutter any more.  That’s what psychiatry offers.  If we want, we  can come together and be real.  In twenty to forty minutes, we can hune and warp time and find a gravity where we breathe differently.

Chewbacca

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Unfortunately, I have found that the longer I do this psychiatry thing, the worse I am with life otherwise.  Whether I’m with the grocer, dog-trainer, my child’s teacher or person in front of me in the coffee-line – I just don’t graze well.  (See blog-post, “Do You Feel Pleasure.”)  I’m always yelling, “Hit it Chewbacca!” and we’re off at warp speed into asteroids of personal information; perhaps inappropriate to the setting.  (See blog-post, “Using The Force.”)  I hate to think what I’ll become when I’m more thoroughly demented and disinhibited.  These things just get more pronounced with age and soon I’ll just be that crazy Auntie with her bra snapped on top of her bathing-suit in winter yelling at the young kids to turn the music down so we can talk.

The truth is, I’ve never been so wonderful in tinsel-town.  I found home and found that home needs to be a place where we are safe.  In fact, this is true materially in the home we live in.  It starts there and diffuses out.  If at home we are able to speak uncensored knowing we respect others and are respected because we are human, not because we have to earn it, if we can enter our kitchen and not fear temptation from chocolate chip cookies, open the fridge and know as an alcoholic the wife or husband didn’t buy beer, argue and trust that we are loved enough to be a priority, we know the issue won’t be lazily passed up, we know we are safe – then there is a ripple and a ring of safety and another ripple and another ring of safety and soon safety follows us because we just aren’t interested in anything else.  (That was a super-sentence.)  We have found home.

Questions:  How do you define safety?  What feels safe for you?  How do you grow your circle of safety?  Please tell me your story.

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Does What You Live For Make Life Better For You or Worse?

Project 365 June 2008 Mosaic

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Self-Care Tip #212 – Figure out what you are living for and use it to make your life wonderful.

All of us have at least one thing in life that will undo us.  We all have something(s) that we consider worth living for.  For the most primitive to the most cultured, from the most defended to the most vulnerable, we have this (these) soft spot(s).  For me, it is my family.  Many of us might say the same, but there are others of us who have other beauties, treasures, The Pearl (as described by Steinbeck) that they would unravel over.

Because this is so scary, we might get snared up in where to go banking when we think about this.  We buy more guns, build more storehouses, fill our basement with jugs of water and like Japan, we find ourselves undone by our own preparations.

An interesting statistic is that homes with guns in them have more suicides.  In famine, the rats eat all the grain before we can.  And poor Japan, who had the most amazing defenses against, an unheard of, three simultaneous natural disasters, is leaking cancer.

Pricilla, also, was almost undone.  She’d argued with her husband and she felt fragmented by it.  She felt herself dissolving from the emotional pain and did not even want to recover.  The argument was bad.  The construct of her world precariously balanced moment by moment immobilizing her.  If she moved, she was afraid of which way life would tilt.

Soft spots can be our greatest strengths though.  We can see them as weakening our defense against life’s cruelty, or we can see them otherwise.  When we live defensively, we miss a lot.  Pricilla, I was fortunate enough to witness, chose to go towards her pain, which was in fact going towards what made life valuable to her.  Pricilla wasn’t able to do this until her emotions (what she interpreted her reality with) became more friendly to her.  Her emotions had been awry and she had been a fearful person for a long time.  After working hard on her medical illness through self-care, including medications and other life-style changes, Pricilla became less preoccupied with her ruminating fears.

Pricilla was learning through gene therapy (i.e., medications and lifestyle changes) to use her love for her husband as a strength.  I wonder about those in Japan.  I know we have prayed for them and hurting for them and hoping.

The other day in my children’s Classical Conversations class one of the teachers prayed for the rescue and survival for the citizen’s of Japan.  I prayed for a wonderful death or dying process for those who weren’t going to live.  I don’t think either of us prayed better or braver than the other and I don’t bring this up to qualify prayers.  I say it to highlight how we were holding our soft-spots.  The individual Japanese is at the point in their life’s journey, I imagine, where the life lived till now was a preparation of sorts for how they would hold themselves during this disaster.  How did they defend themselves?  Were their soft-spots their points of vulnerability and weakness, or strength?

Questions:  What do you live for?  Is it empowering to you or does it make you scared?  Please tell me your story.

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You Might Find That You Are A Genius

Did I do the right choice !?

Questions:  What do you do when you are avoiding something?  When you have a job waiting under your nose, what is it that you find yourself using to procrastinate with?

If you see a pattern in what you use to self-sooth with, to avoid with, to divert with and to ease the pain of doing what you don’t want to do, write it down somewhere else.  It’s already written on your heart.  This, with some introspection and purposeful hard work, might be your genius, your natural place of interest and where you are able to feel pleasure and quality of life.  This is an activity, (now hold on – even resting is an activity, so put your hand down,) that is consistent with your hard-wiring – your genes.  Get it?  Genes.  Genius.  That’s why we need to know ourselves to get friendly with ourselves.  Our self-care isn’t too friendly fighting our biology – our temperament.

I noticed this tonight as I was perusing and writing emails when I have to finish up a talk I’m giving tomorrow for the Rotary.  I noticed this when I turned to write my post on this blog before working on that talk I’m giving tomorrow for Rotary.  It’s 8:15 pm.

This post is not glorifying the act of procrastination, avoidance or shirking responsibility.  (Shame on me.  Don’t remember this.  Don’t let this imprint on your minds.)  This post is simply saying, if you are, take a few to use what you’re doing for your self-care.  In the future, you could then choose more actively to do those things that you discovered come so naturally to you.  You might find that you are a Genius!  Wouldn’t that be fun?

Self-Care Tip # 210 – Use whatever comes your way, including procrastination, to teach you about becoming a better friend to yourself.

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Be Willing to Stick Your Toe In The Water of Self-Care – Just Start.

Three Capetian French scholars consulting an a...

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Self-Care Tip #204 – Be willing to stick your toe in the water of self-care – just start.

I’m not interested in medications.

I used to really wonder why anyone would come to me and say this.  Sometimes we would both realized that they didn’t know what a psychiatrist was.  My degrees seemed transparent as they hung so quietly on the wall.

My girlfriend, who’s an Ophthalmologist, loves it when her patients homogenize her work with what optometrists do.   And it wasn’t until I read Madeleine L’Engle did I understand more of the differences between astrology and astronomy by understanding their similarities first.

For the magi, astronomy and astrology were one science, and it is probably a very sad thing that they ever became separated. That is yet another schism which looks for healing…

–Watch for the Light: Readings for Advent and Christmas.

In those cases when my patients don’t know who they came to see, I have tried to bridge the awkwardness with something to put them at ease.

Don’t run for the door.  There’s no cage.  See, the doors unlocked.  There’s no implication that you have to take medication just because you came to see a psychiatrist instead of a psychologist.

But I’m not interested in medication.

Then there are those who know who they came to see.  But they may not know the connection between behaviors, emotions and their brain health.  (Of course there are other reasons to see an MD I’m not covering here.)

I’m not interested in medication.

Who wouldn’t wonder?  Now I realize an MD is good for more than just prescribing, if she wants to be.  I know.  Wild and outrageous idea, right?  So before I educate anyone on my enormous fund of knowledge or my stealth abilities to diagnose and treat, I think about what it is that this someone thought they might get from coming to see me.

(Enters Fatima:)  Fatima came in this way.

I’m not interested in medication.

Fatima wasn’t feeling good.  Her emotions were corrupting her behaviors and quality of life and she was trying to help herself, stretching her toe into the pool of science, slowly.  She had never been a person to jump in and splash.

After speaking with Fatima for some time, we were able to come up with what she felt she needed help with, what she thought might be medical, what she might be willing to try – for now that meant engaging in psychotherapy, starting omega 3’s and vit D, working on her sleep hygiene, trying to get more aerobic exercise in (like a pill) and doing a mood chart.  We decided together that she would see how this goes for her over the next two to four months.  After that, if she wasn’t doing better or better enough, we’d consider a medical intervention.  We’ll see if she’s interested in medication.  Maybe not.  She can choose when she believes she’s making the right choice.

Questions:   What helped you take the plunge into medication therapy?  What held you back?  Or in someone you know?  Please tell me your story.

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Rosa Parks Protesting From the Tower of Babel On The West Coast – We Have Choices in Self-Care

Photograph of Rosa Parks with Dr. Martin Luthe...

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Self-Care Tip #201 – Make a choice that takes care of your inner self and your quality of life.

Dear Sarah McGaugh alerted me yesterday to the #2 emailed article from the New York Time‘s besmirching the intentions of medication prescribing psychiatrists.  Funny thing is, it’s quoting psychiatrists bemoaning their own prescribing practices, victims to managed care and the force of the mighty money mongrel pharma agencies.  You who’ve been reading this blog already know my thoughts on that and might be able to take these boys aside for me and quietly help them learn about self-care.  Politely without whining you know.  You might not get in the New York Times doing it, nor photographed with a furrowed brow.  I’m sorry about that.  Self-care has never been glamorous.

I definitely know where these physicians are coming from when they complain about these qualities in their practices.  The good news is that they don’t have to practice that way if they don’t want to.  Yes they’ll earn less or they won’t.  I don’t know how it will pan out for them.  But they do have choices.  I know many physicians who feel the same way these men do and many others who enjoy working mainly with medication therapy.  It is their choice.

When I was studying on the East Coast, I saw more psychiatrists still using their “couch” skills in psychotherapy.  There were those that viewed West Coast practitioners as the Babelers who were responsible for the fall of the tower that would have should have led them to heaven.  They spoke of the culture of the West Coast psychiatrist.  They questioned periodicals authored by them and wondered if they ever read Kreplin.

Now WHO is this exactly who wrote this?  Never read something without first knowing who wrote it.  What authority do they have on this topic?

Not a bad thing to do as there are a lot of posers out and about, quill fast at work.

I remember my patient Dorinda, divorcing a meany who wouldn’t leave their home.  They had other places they could move out and into, smaller than the one they were in, but neither of them would go.  They both had their reasons.  In our popular New York Time’s article, the psychiatrist explains that he wouldn’t want a cut in pay and asks, “Who would?”  Dorinda and her meany husband would answer, “Not me.”  I would too and agree that probably, so would all of you.  But we do have choices.  I told Dorinda so much and quickly got on her “Meany-list.”  She was nice about it though.

My children learned about Rosa Parks in school a year ago.  They still bring her up at random times,

Mommy, she was a COURAGEOUS woman!  She changed how all the black people were treated.

My five-year old told me Rosa’s age when she started her

Redback and victim

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work leading to desegregation and how long Rosa struggled before she and others were allowed to finally ride public transportation with whites.  She even described how these people protested; united together, refusing to ride public transportation at all until the law changed.  My kids have pretty great teachers at River Springs Charter School.

Maybe, if it’s alright with you, my daughters and their teachers could join you when you talk to these boys about self-care.

Questions:  How do you empower yourself when you feel caught in a web and victimized?  How have you seen others do it?  What do you think about this NYT article?  Please tell me your story.

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Getting or Giving Bad News Without Fear

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I was reading an article on awareness of obesity the other day telling us that many times, people don’t know they are obese until they are told by someone else.  Ouch.  Pass the Band-Aides.  But it aired our need to stay connected, speak up, and listen.  It also prompted me to reflect on mental illness.  How often I’ve sat with someone’s emotions-history in my hands, looked at them and realized they didn’t know.  They were there, emotions bleeding all over the place but didn’t grasp their injury.

Um, excuse me ma’am.  Let’s apply some pressure on that and get you some help.

Bloody news like this reminds me of my friend Jack.  He was waterskiing with my brother and I when we were college’ish-age.  Jack was not so capable on the water, although he wasn’t afraid.  As you probably know, three is the perfect number for waterskiing – one to drive, one to hold the flag when the skier is setting himself up, and then of course the skier.  Any more and there are way too many polite smiles and way too much advice for the bobbing body in the water.  Jack was working on his slalom moves, thrilled with his progress and after about the third fall, was still ready for another go.

Hit it!

Our boat, Rosewater, eased him out of the water and he was up.  Jack has a way of celebrating like no other.  He whoops and yells and his whole body joins in.  And so he was in his happy place, up on a single ski, unconcerned with the world at large.  It was lovely.  Until the wake of that other huge boat threw him down and his face slammed into his spectacular single ski.  Up he came and we just looked at him, quietly at first.  Jack paddled up to the boat and wondered if he should try again.

Um, sorry Jack.  Let’s apply some pressure on that and get you some help.

Jack had a huge gash, copiously bleeding all over his face and he had no idea.  He was wet already, cold from the water and didn’t feel a thing.  I still feel the creepies skittering up my arms and chest thinking about it.

When we told Jack, he was a little unbelieving.

Are you sure?  Is it bad?  I think I’m alright.  It’ll wash out and I can try again….

Oh there wasn’t much pleasure in telling him the bloody news.  Generally there isn’t that much pleasure in telling someone they are fat or suffering from mental illness either.  It’s the follow-up to that statement where the fun comes in.  The hope that we link the first punch-line to.  Good news is, …along comes the second punch-line.  Hope.  And presence.  Being with someone where they are at, as they are, and with patience doesn’t mean leaving him in the dark, bleeding out.

The reverse is true of course as well.  If we don’t stay connected with others, we may lose the opportunity to see ourselves through their eyes.  It is an opportunity.  When we are with someone we trust, respect and think see’s us as the precious thing that we are, it is.

Self-Care Tip #195 – Stay connected with others and listen without fear – something good is coming.  Be a friend to yourself.

Questions:  How do you deliver “bad news?”  What is the best way you’ve ever been given “bad news?”  Please tell me your story.

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Goodbyes Are A Way To Connect

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Self-Care Tip #184 – Respond to your goodbyes deliberately to be friendly to yourself.

One of the Regional Centers that I work at is closing their telemedicine clinic.  This means I’ve said goodbye to many beloved patients and their families, whom I’ve worked with since round 2003 I think.  Saying goodbye to people we respect and enjoy is not as casual as we stylin’ people make it look.

Two days ago I said goodbye to my girlfriend of around five-plus years and her family.  Moving far far away makes the flat world feel lumpy and luminous.  I now have all her leftover food and knock-offs she didn’t want to haul across the lengthening world to remind me that she is gone.

Watching parents and/or grandparents age is also an exercise in saying goodbye.  My parents have a hard time making it over to visit on week-ends for all the funerals they go to.  Their calendar sends over that whispering voice that they are growing old.  “Look,” it says.  “See me.  I am aging.  Time is connecting and taking me with it.” Even so, their essence holds its own, apart from Time.  That makes me feel more comfortable.  When that whisper gets louder I may respond differently, I can’t know until then.  But for now, this is good.

“Goodbye” is something that begs a response.  “Oh yes!  Goodbye!  See you later.”  I even say, “See you later” to people I know I have less than one percent chance of running into again.  The word calls to me and I respond.  The word implies a disconnection, but even so, beckons us to connect.  It spreads us over the space of our time shared and into the future apart.  Peanut butter and jelly, it sandwiches us up with the one who says “Goodbye” when we say back, “Until then.”

Today with these people and remembering all the ones I won’t get to see before my contract ends, I feel the pull to respond.  My response can be something deliberate.  It is another bit of something I get to choose.  I hope it will connect me.

Question:  How have you responded to the goodbye’s in your life?  How has it been a connecting force for you?  Please tell me your story.

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

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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.

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Pain Can Be Something More and Better Than Just Pain

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Self-Care Tip #181 – Look for help if your pain never becomes something more than pain.  Be a friend to yourself.

Glee is back!  I’m so glad because it makes great work-out distraction.  Good music, drama, beautiful people, and wonderful ah-ha concepts like,

Use your pain and loneliness to inspire you to make something beautiful.

Can’t remember it verbatim though and I noticed after an hour surfing the web for Mercedes quotes (and getting detoured to all sorts of other fun stuff for grazing) that whoever writes these quotes up didn’t find this one worth it.

Joni Eareckson Tada on the Larry King Show said that when she thanked God for her paralysis, she began to be productive through what paralysis offered.

It is however sometimes impossible to take what hurts and let it fuel our fires.  Sometimes it’s just a cold lump of coal.  Sometimes, we aren’t adaptable.

Luckily we aren’t sitting in a cave during the ice-age and can trust that a bear won’t come and eat us when we are wounded.  But there are other predators.  In my line of work, I could call disease process a preying force.  It takes over more and more cells, space, grey matter, consuming bits of our identity and changing our ability to cope with stress.

It’s easy for people to say, “Turn your pain into energy for creativity,” as if it were a volitional option for you like it was a choice for them.  Or we call it bits of morality; maybe a fourth of an inch on the rim of our gold crown we get in heaven.  Those of us who care about that crown look at our shoes, apologize and promise to try harder.

It is not easy to explain these apologies and inactivity to someone who has never been immobilized by mental illness.  Even those of us who have experienced it first hand have a hard time remembering the real texture of what we went through once it is passed.  Illness can be so awful that even our subconscious shudders when turned back to remember.  It is no wonder that we find it difficult to explain.

However, it doesn’t have to be this way.  If we aren’t able to adapt, aren’t elastic and sit stunned in the presence of pain, immobile to the newness that it can offer – recognize this as a flag to turn towards medical help.

Question:  What was/is your story when you weren’t able to adapt well to stress?  When you didn’t adapt well, what helped/helps you hope for more?  How did you find it?  Please tell me your story.

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Dad Is In The Hospital. My Reality.

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Self-Care Tip #179 – Get inside your reality and be with Love.

When I was eight my family left me at Grandma’s farm for the summer.  There’s not much more inland to go than Iowa.  If the United States of America were a house, Iowa would be perhaps it’s cellar; full of smells, goods and it is a great place to play.  I played a lot that summer – as well as stepping in a cow-pie or two, riding tractors with Grandpa Jack cutting hay, pulling on cow tits and seeing the milk come out to shoot right into the cat’s mouth.  And I gathered eggs from pecking feisty chickens that would scare the bravest of any Coasters (those of us from the East and West.)  Grandma was no-nonsense and didn’t waste much time on coaching.

Just stick your hand in there and take the eggs.

As an eight-year-old you haven’t known real fear until you face down a mother hen in a musty unlit poop filled coup, and reach under her feathered skirts for eggs.

That summer Dad came to get me early.  I was really happy to see him.  Uncle Mel and my cousin Dougy had been in a motorcycle accident.

Dad is an orthopedic surgeon and since my summer in Iowa,  Dad has called motorcycle helmets, “brain-buckets.”  He’s seen a lot of them in emergency rooms, so he knew what his brother had looked like.  Dougy was in a hospital bed being introduced to his now forever useless arm.  I came in shy, because Dougy was so cute.  I was thinking about what he thought of me.  I know.  I did.  Despite my diva-self, despite the horror and grief, Dougy gave me a brilliant white-boy American smile.  I hid under Dad’s arm where I didn’t have to look but could still hear Dad’s voice.  I think I may have even whined.  I’m still embarrassed.

These days, unfortunately I rarely get to see Dougy, but when I do, I still want to hide under Dad’s arm as if he’d remember me there.  I wonder if he remembers Dad’s voice.

Today, Dad is in a hospital bed with a blood clot the size of a rattle-snake crawling up his leg, fighting for his right to walk, let alone live.  It is his voice, or maybe the bed, that brought Iowa back to me.

Cousin Patty was crying at Uncle Mel’s funeral.  She wouldn’t go up to the casket, just sat and cried.  I was a little bummed my cousins weren’t interested in me.  It was who I was at eight years old.

Grandma, who left me unsupervised to gather eggs from angry-chickens, cried and asked me for more kisses.

They taste like brown-sugar!  Give me some more.

Dad’s hands now have Grandma’s same wormy veins, raised over blotched ecchymosis (purple patches from leaking blood vessels into the skin); begging to be touched.

I went to see her with my brother Cam before she died.  She was delirious.  But I trusted her so.  I laid beside her in her hospital bed and looked up for a shoe she told me was stuck in the ceiling.  I thought, “There just might be one and these people don’t believe her.”  I was miffed.  Now I realize I was mostly angry because Grandma was dying.

The farm is gone and I wish I had the metal tub Grandma bathed me in outside on the lawn.  But I do have this connection in me to all she gave, the people who came from her and her showing me how to live and die.

If she was still alive and knew Dad was in this danger, she’d say, “Rob, I’m praying for you.  I Love you.”  And unlike my emotives, that would be about it.  She was from Iowa, you know.

This is my reality.  Dad is in the hospital.

Self-care includes being in our reality.  Sometimes it’s too much for one person to handle.  People need Love.  The reality of the world and of the individual is that we need Love.  We are better to ourselves and others when we can be inside our reality.

Telling you about this is my self-care.  This is part of my Love story.

Question:  What is yours?  Please tell me your story.