It's very cold outside today. I have a headache the size of Texas and I'm coughing like a camel on crack. And because I'm an idiot, I forgot my bottle of Ibuprofen, my scarf, and my gloves at home. By the time I get to work I wish someone would run a Sherman tank across my body from the chest upwards to make the wheezing in my lungs and the pounding in my head stop.
Three patients and two staff meetings separate me from my lunch break. My despondent Italian, who's been feeling a bit more positive. Still, he's worried that feeling halfway good today will just make a bad tomorrow feel even worse. I wonder if this whole friggin' country of Austria doesn't run on this principle.
Then there's Herr H., who is planning on going home for Christmas. Finally. He tried to take his life in August and has been with us ever since, coming up with a new reason once a week to feel miserable so he can stay yet another week. Why? Probably because: See last sentence last paragraph.
Then there is Frau L., my translucent borderline friend whom I left with a box of crayons for the weekend. I open the ring binder she brings to our session and now it's time to gasp: Translucent Frau L., whose entire appearance is so colorless and pale that she might as well be her own ghost, drew two of the most amazingly bright pictures, just playing with the crayons, and she chose the brightest colors you can imagine: neon bright shades of green, purple, blue, yellow, red, and orange. It almost blinds and even kind of hurts me to look at the pictures. Plus she gave the picture a totally cool texture by rubbing the color on the paper surface with her finger. I am shocked. Unfortunately, our session is over, so I don't have time to talk to her about interpreting her drawings, but I ask her permission to show them at our staff meeting. She can hardly believe that I would want to show her pictures to anyone, but she gives me her consent. Later, when I show the pictures and tell my colleagues who drew them, they all sit there in utter shock, quietly mumbling words of disbelief -- especially those who had "handled" Frau L. during her past stays and who had informed me that there wasn't a damn thing we could do to get her to come alive a bit.
Conclusion: NEVER be fooled by a ghost.
Montag, 14. Dezember 2009
Sonntag, 13. Dezember 2009
December 13
Yesterday I mentioned mania as part of bipolar depression. Here we go:
Common symptoms of mania may include:
* Abnormal/excessively high or euphoric feelings
* Extreme irritability or distractability
* Decreased need for sleep
* A marked increase in energy/activity
* Rapid or pressured speech
* Racing thoughts or a feeling that you can't slow down your mind
* You have troubles concentrating or you are easily distracted
* Signs of poor judgment, risk taking, or other bizarre behavior
* An exaggerated belief in one's own abilities or characteristics
* Increased sex drive
* Little or no insight into behavior changes
* In severe manic episodes, you can even have delusions and hallucinations. (But then you're probably hitting schizophrenia or some other psychotic disorder.)
Sounds like fun, huh? Well, it's not.
Bipolar mood disorder (some people still refer to it as manic-depressive illness) is an illness of the brain that afflicts about 1 percent of all people. This mood disorder is caused by extreme mood swings that go beyond the ups and downs of normal moods. It is treatable and manageable, but two-thirds of those with bipolar mood disorder go undiagnosed, folks, and therefore untreated. Why? Because when we go see the doc only when we're depressed, the doc may miss the high episodes.
So, you kind of got to force people to see a doctor during a high episode because people don't have insight into their own behavior and even enjoy their manic phases (reckless shopping, impulsive business decisions, scary driving, lots of sex -- who would not enjoy that? ;-D)
If BMD goes untreated, these folks tend to abuse drugs and alc and they have a much higher suicide risk. Believe me. I see it at work every day. They don't recognize that their emotional problems have a treatable mental illness as their cause. With proper treatment, people with BMD can live a pretty normal and productive life.
So, what else? Symptoms usually start in young adults between the ages seventeen and twenty-five, but they can start any time in life. Even some younger kids have BMD. It's a chronic condition with recurring episodes and requires ongoing treatment. If you don't treat it, it tends to get worse.
More suicide shop talk: About half of all people with bipolar disorder attempt suicide.
Any questions? Ask the Fox. ;-D
Common symptoms of mania may include:
* Abnormal/excessively high or euphoric feelings
* Extreme irritability or distractability
* Decreased need for sleep
* A marked increase in energy/activity
* Rapid or pressured speech
* Racing thoughts or a feeling that you can't slow down your mind
* You have troubles concentrating or you are easily distracted
* Signs of poor judgment, risk taking, or other bizarre behavior
* An exaggerated belief in one's own abilities or characteristics
* Increased sex drive
* Little or no insight into behavior changes
* In severe manic episodes, you can even have delusions and hallucinations. (But then you're probably hitting schizophrenia or some other psychotic disorder.)
Sounds like fun, huh? Well, it's not.
Bipolar mood disorder (some people still refer to it as manic-depressive illness) is an illness of the brain that afflicts about 1 percent of all people. This mood disorder is caused by extreme mood swings that go beyond the ups and downs of normal moods. It is treatable and manageable, but two-thirds of those with bipolar mood disorder go undiagnosed, folks, and therefore untreated. Why? Because when we go see the doc only when we're depressed, the doc may miss the high episodes.
So, you kind of got to force people to see a doctor during a high episode because people don't have insight into their own behavior and even enjoy their manic phases (reckless shopping, impulsive business decisions, scary driving, lots of sex -- who would not enjoy that? ;-D)
If BMD goes untreated, these folks tend to abuse drugs and alc and they have a much higher suicide risk. Believe me. I see it at work every day. They don't recognize that their emotional problems have a treatable mental illness as their cause. With proper treatment, people with BMD can live a pretty normal and productive life.
So, what else? Symptoms usually start in young adults between the ages seventeen and twenty-five, but they can start any time in life. Even some younger kids have BMD. It's a chronic condition with recurring episodes and requires ongoing treatment. If you don't treat it, it tends to get worse.
More suicide shop talk: About half of all people with bipolar disorder attempt suicide.
Any questions? Ask the Fox. ;-D
Samstag, 12. Dezember 2009
December 12
First of all I would like to thank so many of you who have been giving me feedback on the Foxblog. I appreciate all your emails and text messages and I'm glad that some of you have been helped or even inspired, if only in small ways, by some of the stuff they've read on Foxblog.
Let me mention a couple of things about depression. According to statistics published by the World Health Organization,
Mood disorders are much more than just feeling sad. They affect the entire body and cause changes in the body, especially in brain functioning, so that you can't change your mood by sheer willpower. As I've mentioned before, you can't just snap out of depression. Depression always affects our brain chemistry and therefore our thinking, eating, sleeping, concentrating, and just about every other area of our daily life.
There are basically two main flavors of mood disorders: unipolar and bipolar. Unipolar disorders are associated with feeling only sad and empty. Hence, they are called unipolar. Bipolar disorders usually alternate between mania and depression, hence they are called bipolar.
Today I'll describe unipolar depression. Common symptoms are:
* Persistently feeling sad, anxious, empty, worthless.
* Persistently feeling guilty.
* Feeling hopeless.
* You can't feel any joy or pleasure.
* You experience loss of energy and drive (and that would include your sex drive, folks).
* You find it hard to concentrate, remember stuff or make decisions.
* You're restless and irritable.
* You can't sleep well, wake up early in the morning, feel like shit, oversleep and find it hard to wake up.
* Your appetite changes (overeating, undereating).
* Other physical symptoms may include headaches, stomach aches, digestive disorders, or just feeling pain all over.
* You think about death or dying a lot, or even attempt to commit suicide.
In short: Sounds a lot like menopause, huh, girls??? Just kidding.
If you experience many of these symptoms for longer than a couple of weeks, you may be depressed (or menopausal, or both ;-D)
Go get help from a medical doctor or contact your Fox. *grin*
Tomorrow we'll talk about bipolar depression.
Let me mention a couple of things about depression. According to statistics published by the World Health Organization,
- Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44.
- Clinical or major depression is the top cause of disability throughout the world for persons 5 and over.
Mood disorders are much more than just feeling sad. They affect the entire body and cause changes in the body, especially in brain functioning, so that you can't change your mood by sheer willpower. As I've mentioned before, you can't just snap out of depression. Depression always affects our brain chemistry and therefore our thinking, eating, sleeping, concentrating, and just about every other area of our daily life.
There are basically two main flavors of mood disorders: unipolar and bipolar. Unipolar disorders are associated with feeling only sad and empty. Hence, they are called unipolar. Bipolar disorders usually alternate between mania and depression, hence they are called bipolar.
Today I'll describe unipolar depression. Common symptoms are:
* Persistently feeling sad, anxious, empty, worthless.
* Persistently feeling guilty.
* Feeling hopeless.
* You can't feel any joy or pleasure.
* You experience loss of energy and drive (and that would include your sex drive, folks).
* You find it hard to concentrate, remember stuff or make decisions.
* You're restless and irritable.
* You can't sleep well, wake up early in the morning, feel like shit, oversleep and find it hard to wake up.
* Your appetite changes (overeating, undereating).
* Other physical symptoms may include headaches, stomach aches, digestive disorders, or just feeling pain all over.
* You think about death or dying a lot, or even attempt to commit suicide.
In short: Sounds a lot like menopause, huh, girls??? Just kidding.
If you experience many of these symptoms for longer than a couple of weeks, you may be depressed (or menopausal, or both ;-D)
Go get help from a medical doctor or contact your Fox. *grin*
Tomorrow we'll talk about bipolar depression.
Freitag, 11. Dezember 2009
December 11
THE LAW OF THE HARVEST
Herr N., my dear German suicide-victim-gone-artist, left the clinic for an extended stay at at health resort. He took his drawings with him. As a small good-bye gift I gave him a pack of oil pastels and a sketching pad to take to the spa so he would feel encouraged to keep on drawing to access more of his deeply buried feelings. My colleague, M., was so impressed with the rainbow drawing that he asked Herr M.'s permission to scan it and use it for a research paper. Herr M. gladly granted his permission. I also got a copy, which is now hanging in my office. Last week I said that everytime I would walk along train tracks in the future I would think of crowbars. I would like to rigorously amend that statement: Everytime I walk along train tracks I will think of rainbows. If I don't, I will have failed Herr N. -- and the purpose of Christ's Atonement.
Translucent Frau L. was rather happy today. She asked for permission to leave overnight and stay with her boyfriend, which I happily granted her. Since she seemed quite approachable today I pulled out my own pastels, having barely taken them away from Herr N., and set the box in front of her. About 25 different colors.
I tacitly assumed that this might be just as painful for her as it was for me the first time my therapist set a box of colors in front of me. Just the thought of having to choose a color as an expression of my emotional state that very minute had nearly given me a nervous breakdown and I got so upset with my therapist for forcing me into such a self-revealing decision that I quietly started crying, which completely mortified me and I almost ran away in shame and fear.
Fast forward. Now I'm sitting here with Miss Borderline who can barely look into my eyes because she is so scared of life. But she has no problems choosing neon orange to describe her mood right now and it didn't take her longer than 10 seconds and very little prodding from me to grab the neon orange crayon and start drawing some very odd figures. Still, "better than I did after hours of therapy," I said to myself with a very sheepish grin. "And I'm NOT borderline." Okay, my husband and kids would possibly argue that point, but never mind ...
Our time is over. I ask Frau L. if she would like to take the neon orange crayon and the sheet of paper with her over the weekend. She says yes and then suddenly asks for 3 or 4 more empty sheets because she would like to draw more than just one picture, she announces to my surprise. I am dumbfounded (as I have been so often in working with people). So I give her the whole crayon box for the weekend. And another hug. Not to make HER feel good, but to make ME feel good, a token of gratitude, in a way, for my own therapist who "tortured" me into learning to use art as a means of releasing and expressing emotions.
Still, Frau L. appreciated the hug enough and left.
After she closes the door I go to the window and look outside. Gray skies, rain, sleet, mud from the construction site underneath the window. I recall John 4:36:
"And he that reapeth receiveth wages and gathereth fruit unto life eternal: That both he that soweth and he that reapeth may rejoice together."
We just don't know HOW our actions, decisions, and choices will influence other people and maybe generations to come. Which "border line" am I going to cross (or not) and where will it take me and the people around me? What am I teaching others, either consciously, by introducing them to, say, art therapy, or unconsciously, by the way I respond to certain people or situations?
Herr N., my dear German suicide-victim-gone-artist, left the clinic for an extended stay at at health resort. He took his drawings with him. As a small good-bye gift I gave him a pack of oil pastels and a sketching pad to take to the spa so he would feel encouraged to keep on drawing to access more of his deeply buried feelings. My colleague, M., was so impressed with the rainbow drawing that he asked Herr M.'s permission to scan it and use it for a research paper. Herr M. gladly granted his permission. I also got a copy, which is now hanging in my office. Last week I said that everytime I would walk along train tracks in the future I would think of crowbars. I would like to rigorously amend that statement: Everytime I walk along train tracks I will think of rainbows. If I don't, I will have failed Herr N. -- and the purpose of Christ's Atonement.
Translucent Frau L. was rather happy today. She asked for permission to leave overnight and stay with her boyfriend, which I happily granted her. Since she seemed quite approachable today I pulled out my own pastels, having barely taken them away from Herr N., and set the box in front of her. About 25 different colors.
I tacitly assumed that this might be just as painful for her as it was for me the first time my therapist set a box of colors in front of me. Just the thought of having to choose a color as an expression of my emotional state that very minute had nearly given me a nervous breakdown and I got so upset with my therapist for forcing me into such a self-revealing decision that I quietly started crying, which completely mortified me and I almost ran away in shame and fear.
Fast forward. Now I'm sitting here with Miss Borderline who can barely look into my eyes because she is so scared of life. But she has no problems choosing neon orange to describe her mood right now and it didn't take her longer than 10 seconds and very little prodding from me to grab the neon orange crayon and start drawing some very odd figures. Still, "better than I did after hours of therapy," I said to myself with a very sheepish grin. "And I'm NOT borderline." Okay, my husband and kids would possibly argue that point, but never mind ...
Our time is over. I ask Frau L. if she would like to take the neon orange crayon and the sheet of paper with her over the weekend. She says yes and then suddenly asks for 3 or 4 more empty sheets because she would like to draw more than just one picture, she announces to my surprise. I am dumbfounded (as I have been so often in working with people). So I give her the whole crayon box for the weekend. And another hug. Not to make HER feel good, but to make ME feel good, a token of gratitude, in a way, for my own therapist who "tortured" me into learning to use art as a means of releasing and expressing emotions.
Still, Frau L. appreciated the hug enough and left.
After she closes the door I go to the window and look outside. Gray skies, rain, sleet, mud from the construction site underneath the window. I recall John 4:36:
"And he that reapeth receiveth wages and gathereth fruit unto life eternal: That both he that soweth and he that reapeth may rejoice together."
We just don't know HOW our actions, decisions, and choices will influence other people and maybe generations to come. Which "border line" am I going to cross (or not) and where will it take me and the people around me? What am I teaching others, either consciously, by introducing them to, say, art therapy, or unconsciously, by the way I respond to certain people or situations?
Donnerstag, 10. Dezember 2009
December 10
On following your feelings:
Herr N., the German with the so amazingly abusive father, was still not granting anyone (including himself) access to his world of emotions. His sessions were really not going anywhere. On Monday, simply following a hunch, I ran to the car during my lunch break and retrieved my oil pastels and a sketching pad. I gave them to Herr N. and asked him if he would be willing to produce some sort of a visual representation of a life without suicide ideations. To my joy my hunch had not been a dud: Mr. N. became totally excited, telling me that had apprenticed as a painter in his youth and had always enjoyed art in his spare time. In the course of his unhappy life he had forgotten all about it.
Today he presented us with 3 pictures. They were mostly happy in nature and showed a positive outlook -- two thirds life, one third death. Two-thirds of a beautiful rainbow originating in a black field. Life arising out of death. And finally Herr N. began to speak about emotions ...
Rule A) Follow your intuition.
Our translucent borderline patient, Frau. L., got a royal yelling-at from the doctor on duty yesterday. She had a dental appointment and failed to return to the hospital after her visit to the dental clinic. Apparently she had been out gallavanting around town. Then the psychologist on duty reprimanded her this morning for the same reason. I got her at 11 a.m. She was even more translucent than usual. By order of der Chef we went over her therapy contract one more time and she started to shake. At the end of our session I followed my feelings and did something highly unusual for an Austrian (and even more unusual in a medical setting): I gave her a big hug. And all of a sudden she became a person of flesh and bones, her translucency giving way to a lively skin color. She whispered "Danke!" in my ear and ran out of the room.
Rule B) Follow your intuition.
Herr N., the German with the so amazingly abusive father, was still not granting anyone (including himself) access to his world of emotions. His sessions were really not going anywhere. On Monday, simply following a hunch, I ran to the car during my lunch break and retrieved my oil pastels and a sketching pad. I gave them to Herr N. and asked him if he would be willing to produce some sort of a visual representation of a life without suicide ideations. To my joy my hunch had not been a dud: Mr. N. became totally excited, telling me that had apprenticed as a painter in his youth and had always enjoyed art in his spare time. In the course of his unhappy life he had forgotten all about it.
Today he presented us with 3 pictures. They were mostly happy in nature and showed a positive outlook -- two thirds life, one third death. Two-thirds of a beautiful rainbow originating in a black field. Life arising out of death. And finally Herr N. began to speak about emotions ...
Rule A) Follow your intuition.
Our translucent borderline patient, Frau. L., got a royal yelling-at from the doctor on duty yesterday. She had a dental appointment and failed to return to the hospital after her visit to the dental clinic. Apparently she had been out gallavanting around town. Then the psychologist on duty reprimanded her this morning for the same reason. I got her at 11 a.m. She was even more translucent than usual. By order of der Chef we went over her therapy contract one more time and she started to shake. At the end of our session I followed my feelings and did something highly unusual for an Austrian (and even more unusual in a medical setting): I gave her a big hug. And all of a sudden she became a person of flesh and bones, her translucency giving way to a lively skin color. She whispered "Danke!" in my ear and ran out of the room.
Rule B) Follow your intuition.
Mittwoch, 9. Dezember 2009
December 9
Another session with Signore M., the sad Italian. He just sat there and cried. And cried some more. And kept crying.
He has absolutely no hope for his depression to ever go away again. And that is one of the disgusting side effects of Signore M.'s kind of depression -- you think you will feel this terrible/despondent/sad/hopeless forever.
Fact is: You won't. No system can maintain feeling THAT shitty for very long.
It's good that Signore M. can cry. Lots of people in his condition can't even cry. That presents a by far tougher challenge to the therapist.
It's good to cry. At times we just have to let ourselves cry. For a couple of minutes. Maybe for half an hour or maybe for a week or a month. But at some point in life it just might be time to cry. To let ourselves be totally depressed -- depressed like snot, as one of my missionary companions once so aptly termed this condition.
At some point in life it might be time to be completely depressed like snot. Let my body and soul grieve. Take a break. Keep quiet. Rest for a while. Accept the fact that I have no energy whatsoever. Not try to force things to get better. We live in hectic times.
In all likelihood this condition will not persist. Things will get better. With adequate help and care from internal and external resources I will regain my strength, physically, mentally, emotionally. But first I have to rest and let myself simply be whatever I am.
Sometimes the illness is the cure.
Buona sera.
He has absolutely no hope for his depression to ever go away again. And that is one of the disgusting side effects of Signore M.'s kind of depression -- you think you will feel this terrible/despondent/sad/hopeless forever.
Fact is: You won't. No system can maintain feeling THAT shitty for very long.
It's good that Signore M. can cry. Lots of people in his condition can't even cry. That presents a by far tougher challenge to the therapist.
It's good to cry. At times we just have to let ourselves cry. For a couple of minutes. Maybe for half an hour or maybe for a week or a month. But at some point in life it just might be time to cry. To let ourselves be totally depressed -- depressed like snot, as one of my missionary companions once so aptly termed this condition.
At some point in life it might be time to be completely depressed like snot. Let my body and soul grieve. Take a break. Keep quiet. Rest for a while. Accept the fact that I have no energy whatsoever. Not try to force things to get better. We live in hectic times.
In all likelihood this condition will not persist. Things will get better. With adequate help and care from internal and external resources I will regain my strength, physically, mentally, emotionally. But first I have to rest and let myself simply be whatever I am.
Sometimes the illness is the cure.
Buona sera.
Dienstag, 8. Dezember 2009
December 8
Today is a holiday in Austria and I didn't have to go to work. However, after having spoken to a number of people, I will respond to their requests to mention a couple of things about mental illness. I might do that on weekends as well.
Understanding mental illness more accurately can help reduce suffering because a lack of understanding increases suffering by victims of mental illness as well as by their loved ones. Even the term mental illness continues to scare people. The term itself can refer to many different kinds of problems, most of which have to do with a certain degree of the brain's ability to function as it should. It's obvious to most folks that a stroke (as a result of a clogged blood vessel in the brain) can reduce the brain's ability to function properly, for example, by causing loss of speech or control over one's motor functions.
But the brain also runs our emotions and thoughts and it processes every bit of information we take in. The causes of mental illness are highly complex and are a consequence of interacting biological, psychological/emotional and environmental factors. Sometimes these causes are genetic, sometimes they are caused by illness or injury, sometimes by stress and trauma, and sometimes the body just doesn't produce enough neurotransmitters to keep the brain functioning properly, or the neurotransmitters are reabsorbed too quickly. I'll talk more about that next time.
The most important thing I would like to mention today is that people who suffer from mental illness can't just "snap out of it." Telling someone with, for example, chronic depression to "snap out of it" is just as ridiculous as telling someone with thyroid malfunction or diabetes to "snap out of it."
The second thing I would like to mention is that there is no need to be scared of taking medication as a part of treatment for mental illness. As mentioned above, if the brain chemistry (regulating neurotransmitter functioning) is a problem, then taking meds to regulate neurotransmitter functioning is like taking insulin if you suffer from diabetes or thyroid hormones for thyroid malfunction. Who in their right mind would think of not taking insulin if the body needs it to stay alive?
Would anyone laugh at a diabetic for taking insulin? Would you stigamatize a diabetic for taking insulin? If my brain needs meds to function properly -- then what is wrong with having that diagnosed and taking the meds to make me feel okay so I can function properly?
Think about it.
Understanding mental illness more accurately can help reduce suffering because a lack of understanding increases suffering by victims of mental illness as well as by their loved ones. Even the term mental illness continues to scare people. The term itself can refer to many different kinds of problems, most of which have to do with a certain degree of the brain's ability to function as it should. It's obvious to most folks that a stroke (as a result of a clogged blood vessel in the brain) can reduce the brain's ability to function properly, for example, by causing loss of speech or control over one's motor functions.
But the brain also runs our emotions and thoughts and it processes every bit of information we take in. The causes of mental illness are highly complex and are a consequence of interacting biological, psychological/emotional and environmental factors. Sometimes these causes are genetic, sometimes they are caused by illness or injury, sometimes by stress and trauma, and sometimes the body just doesn't produce enough neurotransmitters to keep the brain functioning properly, or the neurotransmitters are reabsorbed too quickly. I'll talk more about that next time.
The most important thing I would like to mention today is that people who suffer from mental illness can't just "snap out of it." Telling someone with, for example, chronic depression to "snap out of it" is just as ridiculous as telling someone with thyroid malfunction or diabetes to "snap out of it."
The second thing I would like to mention is that there is no need to be scared of taking medication as a part of treatment for mental illness. As mentioned above, if the brain chemistry (regulating neurotransmitter functioning) is a problem, then taking meds to regulate neurotransmitter functioning is like taking insulin if you suffer from diabetes or thyroid hormones for thyroid malfunction. Who in their right mind would think of not taking insulin if the body needs it to stay alive?
Would anyone laugh at a diabetic for taking insulin? Would you stigamatize a diabetic for taking insulin? If my brain needs meds to function properly -- then what is wrong with having that diagnosed and taking the meds to make me feel okay so I can function properly?
Think about it.
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