Oh, The Holiday Breakdown

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I’m pulling from the archives this week. As we approach another round of holidays, I’m reminded of how lists play a role in the festivities. Even the least organized among us desperately resort to lists to manage survival.

  1. The mom who baked five hundred cookies in 5 hours bullet points a list of the reasons she loves her kids enough to do it, and by the end of the 5 hours, she doubts every one of those reasons.
  2. The unhappy in-laws (or out-laws as they like to be called) conspire over 10 ways to get out of Thanksgiving next year.
  3. The money-conscious come up with penny-pinching techniques;
  4. The time-management disabled brainstorm ideas for cutting activities;
  5. And kids keep count of the number of gifts they have compared to their siblings.

My own holiday list from the archives is my favorite sort of list. The kind that celebrates the epic, holiday breakdown. We’ve all been there.

The Official Guide: How to Lose Your Cool Over the Holidays

Nietzsche’s Playbook

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This is a picture of an Andrew Wyeth. I stared at it, at this particular angle, for a long time; examining it with head tilted, then through the camera lens, then squinting, then wide-eyed. This picture renders paint and canvas invisible. They are no longer the mediators of this curtained scene. It is just me, tucking myself behind the curtain to stare at trails and trees. It is me breathing in the fresh air, no paint residue to stale it. It is me observing the pastoral scene sans canvassed limits.

I would argue that Realism (as a genre) succeeds when it removes the obstacle of the medium (paint, canvas, clay, metal) to reveal the transparent image. Well done, Andrew Wyeth.

I would also argue that we’re attracted to Realism because of this very ability to suspend our disbelief; this art feels true to every fiber of our beings, and we want it to be so. It’s serene, crisp, and lovely. It’s better than believing that we’re observing a flat panel fixed to a matte wall. In literature, we call this suspension of disbelief verisimilitude—when an author helps us ignore his fabrications because he has given us a reason to believe, against our better judgment, that his words are true.

In our daily lives, there’s another name for this phenomenon: functional nihilism. “If I don’t think about it, it doesn’t exist.” This is a suspension of our disbelief through willful ignorance. We are choosing to ignore part of the story.

If I don’t think about the canvas barrier that separates me from Wyeth’s pastoral scene, then it doesn’t exist, and I’m whisked away to a world of my own making, one where I don’t have to leave the wooded shelter…ever. You can see the appeal, here.

Freud would call this denial. But that word is overwrought and misses the juxtaposition of violence and pragmatism. We do violence to our memories by sentencing them to oblivion; and we do it practically as a survival mechanism—so we can function.

The heart-wrenching pain of ending a relationship can turn the best of us into functional nihilists. We want to annihilate the beautiful new beginnings that are now sickening and painful. We also want to crush the painful endings that leave us feeling vulnerable and hurt; because to replay them daily, to allow them to be a part of our moment to moment experience leaves our nerve endings perpetually exposed. Who can function when they are perpetually replaying a traumatic scene?

This pragmatism is enacted without discrimination. We willfully forget embarrassing moments, immoral decisions, and guilty feelings as well as major failures, childhood traumas, and relationship endings. This nihilism also applies to procrastination. If we don’t think about what needs to be done, we aren’t obligated to do it.

As with all of our defense mechanisms, we believe the benefit outweighs the cost. But we are blinded to what that cost is, to ourselves and others. Last year I met a woman who shared that she had gone through a bitter divorce. She was happy to declare that she was now “over it”. Intrigued, I asked how she had accomplished this. “I moved across the country.” She said. “Now I don’t have to think about him anymore.” As I listened to her story it became apparent that she had given up a huge support network, a great job, and an established life to get away from her ex-husband. Sadly, in her attempt to avoid one man, she lost almost everything else. And if the payoff was to forget him, it didn’t work. He consumed most of our conversation.

My heart goes out to this woman. Her story, though a dramatic example, is similar to our own. We are oblivious to what we’re sacrificing in our attempts at annihilation. We may not have moved across country, but we have lost out on meaningful living, nonetheless. As for this woman, whenever we engage in functional nihilism it can’t help but impact our relationships, our work, our sense of well-being–our lives.

If we take a page out of Nietzsche’s Playbook, we will find our nihilism expanding beyond the borders. We will find that, over time, what seemed functional now consumes us.

What are those events, relationships, beliefs that you’ve done violence to? If you’re honest, what have you lost in the aftermath of your annihilation?

So as not to leave us in the abyss, this is only part of the story. We can move beyond functional nihilism to embrace growth and healing. We can overcome our propensity to avoid. When we do, we no longer have to suspend our disbelief, because the healing is tangibly, palpably, and delightfully real.

To My Clients About Your Meds

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Dear Esteemed Clients,

This letter, although personalized, is for all students/consumers of Psychiatric medications. It is written with the demoralized patient in mind and heart.

I’m attending a Psychopharmacology conference this week. Not because I love the world of diagnosis, medication, and clinical treatment (although it has an essential place), but because I want to understand you and your medications. I know your medication management can feel more like a high stakes poker game than a streamlined science. You wait for the river to turn up aces and you get twos instead. That is, you hope the benefits will outweigh the side effects, but your current cocktail of tapering, titration, or cross-tapering leads to yet another bad withdrawal effect.

I also know that you suffer the side effects in silence. You tolerate restlessness, sleeplessness, weight gain, mood fluctuations etc., because you think this round of medication is the best it’s going to get, OR because you don’t know how to communicate your symptoms. I want you to know, I hear you. And, you don’t have to settle.

Your doctors are stretched thin in a system where more hours are spent doing administrative work than face to face with patients. And you feel it, acutely. You feel the sterility of baring your soul with their backs turned because they’re typing furiously at the details of your medical confession. You feel their harried pace as you’re pushed in and out of offices. You feel your brain shut down as you’re pressured to share all pertinent diagnostic information in 2.5 minutes. Your doctors have a near impossible task, and so do you.

I hear you. I’m at this conference because I want to better serve you and your pursuit of medication management. I, too, am tired of the many complexities of collaborating with other professionals, and I’m tired of how that affects my ability to advocate for you. I believe there’s a better way, and I’m determined to find it.

So here’s what I want you to know:

1–Self-advocacy is essential. It’s easy to assume your doctor is all-knowing and there’s a great chasm between their expansive knowledge and your limited understanding. But you know your body better than anyone else. You know when something doesn’t feel right. You know when it does. Please advocate for yourself if you know something is wrong. Ask questions; give feedback; keep working at it until there’s a manageable solution.

2–A lot can be done to manage side effects. If your side effects feel debilitating, speak up. You don’t have to settle. It may be a simple tweak, or an added booster medication that can make all the difference.

3–Data is a doctor’s gold mine. Create a medication timeline with dates, symptoms, and previous medications prescribed, and side effects. This will provide a reference point for you, me, and other important providers. The more exact data you can give to your doctor, in simple format, the better he or she can eliminate months of trial and error. And don’t forget to tell your doctor about all vitamins and supplements, because they may interact with your medications.

4–Journal your treatment. After you start a new medication, jot down some brief, daily notes about experienced symptoms and changes. What do you feel physically, and what do you feel emotionally? You can use ratings on a simple scale, and there are even forms you can fill out, if you prefer. This will provide practical information to help you dialogue with your doctor and it will help your practitioner more accurately assess the efficacy of treatment. And if you’re concerned that your medication isn’t working, you’ll have data to support that conclusion. Data that will help them avoid other medications that could result in similar side effects.

5–Avoid the “medication dump”. The Psychiatrist’s worst nightmare is the patient who abandons their medication due to initial side effects without a plan and without communicating with them first. Valuable time is lost when you start a medication, go off of it due to side effects, but don’t see your doctor for another six weeks. That’s six weeks of continued suffering to then end up back at square one. This is demoralizing, among other things. IF your side effects feel unbearable, don’t suffer in silence. Call your doctor. If you can’t reach them, talk to your pharmacist. Many insurance companies also have a hotline for 24-hour consultations with a Nurse Practitioner or doctor. That hotline is another immediate option in case of emergencies.

I hope this list empowers you to make a paradigm shift: narrowing the gap between “omniscient” practitioner and “fragile” patient. Much can be done to increase collaboration, limit side effects, and establish a healthy, working relationship with your doctor. And this, of course, applies not only to psychiatric medication but all facets of your healthcare as well.

As I absorbed the myriad of psychopharmacology data this week, I was reminded that in spite of having a nearly impossible task there are Doctors in this world who care and are fiercely committed to your well-being. So am I. They’re listening; I’m listening. Talk to us.

With Your Health In Mind,

Amy

The UnCola

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I’m attending a Psychopharmacology conference this week; that is, a conference where you learn current best practices in Psychiatric medication management. In short, the intellects are expansive and the humors are dry–like, scorched desert dry. But I digress.

I want to better advocate for my clients by understanding the professionals who prescribe their medications and the barriers to success in prescription and medication management. I have many and varied thoughts on this topic, which is what led me to the conference in the first place. I’m excited to share those thoughts, and more excited to withhold until I invest the time to learn first (and to challenge my own assumptions). In the meantime, musings on a fun fact I learned today:

The drink known as 7 Up formerly contained Lithium–a drug prescribed in the treatment of Bi-Polar Disorder as a mood stabilizer. It was removed in the 1950’s when we became aware of Lithium’s side effects. With the nefarious beginnings of 7 Up AND Coke, it leads me to speculate about the main ingredient in all soft drinks (aka. sugar) eventually being banned as a neurotoxin. There’s irony in soft drinks being taken down not by the usual nefarious culprits, but by an ingredient oft-used as a metaphor for a sweet disposition and whitened innocence. Will soft drinks be enveloped in a sticky, sweet demise? If so, infamous songs referencing sugar will take on a whole new meaning.

Until then, enjoy your refreshing UnCola (as it was once named), and think of me while I navigate the world of dry humors.

The Time Traveler’s Guide

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Twice a year we get to participate in the mystical journey of time travel, springing forward or falling backward in space, also known as Daylight Saving.

For all you grammar geeks, here’s a logophile’s take on those semi-annual time shifts:

“The official spelling is Daylight Saving Time, not Daylight SavingS Time.

Saving is used here as a verbal adjective (a participle). It modifies time and tells us more about its nature; namely, that it is characterized by the activity of saving daylight. It is a saving daylight kind of time. Because of this, it would be more accurate to refer to DST as daylight-saving time. Similar examples would be a mind-expanding book or a man-eating tiger. Saving is used in the same way as saving a ball game, rather than as a savings account.

Nevertheless, many people feel the word savings (with an ‘s’) flows more mellifluously off the tongue. Daylight Savings Time is also in common usage, and can be found in dictionaries.

Adding to the confusion is that the phrase Daylight Saving Time is inaccurate, since no daylight is actually saved. Daylight Shifting Time would be better, and Daylight Time Shifting more accurate, but neither is politically desirable.”  (source)

Apparently Counting Crows got it right; maybe we should take a cue from their playbook and refer to the fall backward phenomenon not errantly as Daylight Saving Time, but as musician-inspired Daylight Fading Time (DFT?).

For many, in spite of the ribbon-wrapped extra hour of sleep, daylight fading brings an unfortunate down side: Seasonal Affective Disorder.  As the darkness creeps in earlier and earlier through the winter months, many are plagued with depressive symptoms including lack of motivation or loss of interest, fatigue, tearful affect, irritability, and sadness.  See NAMI’s description for more.

You may already know seasonal mood changes have been linked to vitamin D deficiencies and are often treated with light exposure therapy and/or vitamins.  What you may not be aware of is some of the changes in “activities of daily living” (as we say in counselor speak) that accompany daylight-fading time.  These scheduling changes come with the natural rhythms of the winter season and couple with plummeting moods.  The combination of winter and the holidays creates the perfect storm for depression.

Let’s look at a typical scenario.  Margaret is a 55 year-old mother of three.  She glances at the calendar this morning, mug in hand, and almost spills coffee all over herself when she sees Nov. 1st.  Her initial association is accompanied by swirling thoughts and frantic internal checklists.  She’ll run to the mall later to find Macys already lit with Christmas lights and red-toned boxes, taunting her about unchecked items.  If we observe her life from November through February, we’ll find a common theme.  The chaos, cold, darkness, and disruption leave her primed for depression.

There are the obligations: parties, school events, and family gatherings.  And there are the accompanying details: what to bring, who to call, and booking travel dates.  There are the physiological changes: less exercise (due to cold weather and time commitments), a diet higher in sugars and fats, and less exposure to sunlight, along with stress carried in the body.  There are increased financial pressures and disrupted routines with extra hours at the office and schedules ubiquitously wrapped around vacation time.

During winter we may have to work doubly hard to avoid plummeting emotions.  Like swimming upstream, the winter months leave us swimming against a current of emotions furiously attempting to sweep us into depression.

Every year I find myself setting goals to counteract this.  Every year there are sneaky stressors that threaten to pull me down anyway.  I would prefer to avoid the work of planning for the winter months.  And yet, the work of planning is easier than the inevitable emotional and physical fallout when I don’t.

As daylight fades, at the very moment I’m posting this, consider the work that will go into preventing a slope into depression.  And consider the work that will go into counteracting it if you don’t.  If it’s inevitable that you’ll face the fading sunlight, how can you prevent the darkness from becoming internal?

 

Your fellow time traveler.