WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


Personality Problems & Self-Hatred After Childhood Trauma

Hieronymus Bosch: "HELL"

Almost a week has passed since I last posted something on the blog. I’ve been engaged in a pitched battle with some of my worst demons. Trying to survive. Living minute to minute. That sort of thing.

Seems like I should check-in with everyone. I haven’t the courage to look at my web-stats, but even though I’m sure the number of visitors is way, way down, I know there are several readers who do care. I want to reassure them I am still kicking, albeit less strongly all the time.

I’m pretty much out of ideas for how to get out of this pit, which mostly is one of very low self-esteem. I don’t mind the anxious, sad, and angry feelings like I used to. But I am sick of my personality and see little chance of change…

About half my therapists have been willing to give me the diagnosis of a personality disorder. Of those, at least two seemed to enjoy slapping me with that accusation. Of the ones who have held back, I suspect there has been a sense of not wanting to further lower my opinion of myself, or further anger me, or somehow make things worse. One psychiatrist said she thought there might be a difference between ‘borderline’ characteristics that are reactive and defensive, but not necessarily integral to the personality, and true BP disorder. That seemed like a nice way of saying that I sure look like someone doomed to eternal conflict with others, but maybe there’s a small chance I can improve.

One of my curses is being so self-aware. I can see all the hostile and counterproductive things I do and even understand why I do them, but I can’t seem to stop. I’m not someone who puts the blame on others or thinks that if only people around me would cooperate I’d be fine. I see myself do and say the most appalling things sometimes, and yet I have no more ability to redirect my actions than I would of turning a train running on a straight track.

The sad thing about so-called ‘borderline personality disorder’ is that it mostly results from childhood abuse. So you get rejected and mistreated as a child, then grow up into a confused and mistrustful adult who invites rejection and mistreatment. The only way I can manage self-forgiveness is to recognize that almost anyone who lived through a childhood as traumatic as mine would turn out just as badly messed up. Perhaps a few abused children escape without major personality flaws, but most suffer with rage, shame, and mistrust. I suspect close to half end up imprisoned, on the street, or dead.

So just surviving, remaining outside institutions, and having one close relationship must be counted as a kind of success. There was a time when I could point to my surgical career to prove I had beaten the odds. But time has mocked that victory. So now I just try to be OK with making it from day to day, sustaining a marriage, and continuing my efforts to improve. I think some would question how hard I try (“If you really wanted to change, you could”), but I know how many years I’ve spent in therapy, how many groups I’ve attended, and how many books I’ve read. I didn’t do those things just to piss off people who tried to help me. I really wanted (want) to improve, but somehow couldn’t get past all the obstacles. Just because I built the many of the barriers myself does not mean they aren’t there.

This was supposed to be a one-paragraph check-in to let others know I’m still alive and fighting. It ended up a rant on my current despair. I hope it somehow helps others feel less alone. At least I feel that way, even if all my readers have long since gone.

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High Emotional Reactivity and Self -Acceptance

http://www.flickr.com/photos/thatguyfromcchs08/2300190277

Just an hour or so ago I participated in a video taped conversation about mental health. When the show gets edited and completed I will post it here on my blog. Tom Wootton invited me to participate as a ‘client’ of his Bipolar Advantage program. Peter Forster, MD, the medical director of Bipolar Advantage, took a seat at the table. Our moderator was Barbara Meyers, who tapes a regular show on mental health, which I highly recommend.

Whew! I got all those links in place for those three!! I respect them all, by the way. They each do unique, good work for the mental health community.

The taping went by fast. Having thought through my answers (I knew the questions in advance), I was shocked when the show came to a close before the end of my question list. I took too long to answer the first three questions, so the last one or two got dropped. Predictably, I ended up feeling bad. Fact is, I’ve never liked cameras. I love to write; I feel OK on a stage; but I get quite uncomfortable when filmed. Even though that has always been true, I did not expect to feel nervous this time, since my general stage fright has reduced so much since my eighteen months of working as a public speaker. No such luck. I ended up feeling just as self-conscious as the first time a stranger shoved a video camera in my face after a movie premier in New York and asked for my reaction to the film.

In fact, my point in writing tonight is the jumpiness of my response, my incredibly high reactivity. In one of my answers on the show I said (I think) something to the effect that sensitive moods can be an advantage (an idea that is a pillar of the Bipolar Advantage concept), giving us a wide range of experience of the human condition. Yet it is hard to believe anything very advantageous comes out of having a gas pedal that gets shoved to the floor at the slightest challenge. Much as I tried to remember breathing, staying relaxed, and visualizing calm scenery, the instant I started talking my mind went into the stratosphere, and I was on autopilot. My emotions have always had hair-triggers, but my moods have gotten even more touchy since my breakdown, followed by nine years of powerful drugs, punctuated by a series of failed enterprises. So tonight became a reminder that I still have the same old issues, waiting to lift their irritating little heads when I reach beyond my comfort zone.

Much of my jumpiness, I am sure, comes from the trauma of my upbringing. One major source of over-reactivity was my stepmother’s habit of sneaking up on me in my bed at night, and shaking me awake with her hands clenched around my neck. Yes, she really did that. Fairly often, actually. As a variation she would clamp her palm over my mouth. After a while, I learned not to make a noise when she came to get me, and she gradually quit the histrionics of mock suffocation. (After she woke me, the next step was for us to go out back where she could hit me or abuse me however she wanted without my dad awakening–kind of like going to the second location with a serial killer.) Even though I learned silence then, now that I am an adult it is impossible, apparently, for me to keep from shouting if someone wakes me up at night. Even at age fifty, I still awake in full screaming terror if my wife just taps on the door to the guest room. (Sometimes I go to sleep in that room while she reads in bed, and then she comes to get me when she turns out the light.) Thanks, Della (that was the name of my late stepmother), for leaving me with nerves of glass.

So now I contend with this high-voltage response to the equivalent of turning on a AAA penlight. Back in my days as a surgeon (pretty hard to imagine doing that kind of thing now), I had very measured responses to acute situations in the operating room. I think it was because my attention was on high-alert already when I was operating, so there was none of that pounding acceleration from zero to one-hundred-and-ninety that leaves me so disoriented. In the O.R., everything moved at a speed that made sense, and I was able to remain focused and calm come what may (except for one dreadful day that I will no doubt write about eventually, when I ended up quite agitated after a big mistake on a small procedure). The night after a tough case I might lay awake replaying whatever happened. Or the night before I might be sleepless in anticipation of a challenging case. But during the time of the actual work, I stayed in a centered zone.

There is no situation like that now, and I would never dream of trying anything as stressful as surgery again. But despite that caution, I still find ways to demonstrate my limitations to myself and then feel bad about them. I share this because it may be that someone else out there beats himself or herself up like that. Maybe someone else gets embarrassed about nervousness. Maybe someone else can understand.

Sometimes, I am fine with where I am in life. Happy with what sometimes seems like a lot of wisdom (purchased at great price, but mine nevertheless). Lately, I have felt less accepting. Maybe now that I am writing more, I can find my way back to that place of spiritual openness that works so well, that soulful space that is the only worthwhile destination.

That is my goal. Not performance; not looking good on TV; not making a living, even. Just finding connection with whatever it is that embraces me when I let all the expectations go.

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My First Blog Visitors

Yeah! People have actually visited my site. Thank you! I welcome suggestions, by the way. In particular, I don’t want to turn people off with my tagline, and my naive concept of mental harmony as the key to mental health. Works for me, but maybe not for others. Let me know if it’s too much.

I suppose it’s predictable that as people visit, I begin to feel self-conscious. As much as I believe that my history might help others, it also seems presumptuous to say so. Just to fill in a little, my background as a physician both gives me perspective on psychiatry as a field, and makes me feel bad about myself for making the mistake of trusting it too much. It seems like I should have known better than to get so caught up in the medication/therapy cycle, knowing how much it has been to my detriment over the long run. My clinical work was surgical, and I got used to the idea that you could effect improvement with medical care. With psychiatry, however, the results are much less positive and harder to pin down. I know that now, but at first my expectation was that I would take the right drug(s) and all would be well. I should have understood that drugs can help a little but are not enough by themselves. I made more progress once I expanded my sights and began other approaches, including CBT and meditation. Now I suspect the medication step could have been skipped altogether. But I’ll never know for sure.

By the way, I don’t practice medicine anymore. My neck won’t allow me to operate, and besides my mental health is a little too fragile to tolerate the stress. I wouldn’t be blogging and opening up so much if I had any plans to practice again. It would expose me to accusations of ‘physician impairment’, among other things. I imagine that is why psychiatry programs passed on bringing me on board, back when I thought a good plan was to enter the field. I don’t know if they saw the advantage that I did in being both a consumer/client/user/patient and a psychiatrist; but they surely saw the risk.

Maybe I’ll be more useful from the sidelines. It is encouraging to get a few people stopping by. I really do have some strongly held and possibly well-informed ideas about medications and psychiatry. Not only did I go to medical school, by the way, but I also spent time in graduate school studying neurophysiology. So I’ve had ‘fun’ reading about the drugs and their interactions with neurons. Among other things, they are far less ‘selective’ than we are often led to believe.

Well, this is just a rambling post in response to the comments here, and those I read on Beyond Meds, courtesy of Gianna. I’ll reiterate my desire for advice on how to make this blog useful to others. Thank you for stopping by.

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