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Three Years Later…

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Today is my blog’s 3rd birthday! Can you believe it? I’ve written 277 posts and still haven’t run out of things to say!

In those 3 books about God that I read this summer, they all said that we have many rebirths in the course of a lifetime, and the beginning of this blog year definitely feels that way. As you know if you’ve been reading my blog, my baby brother had quadruple bypass surgery less than a month ago. What I did not mention at the time is that I am taking care of him, so his heart attack has been a life-changing experience for both of us. While taking on this new role has presented many challenges, in some ways it has simplified my life. My behavior is more intentional; my motivation for everything I do is clear. Many of the things I have realized in this past month relate to themes I have written about over the past 3 years, so I thought I would share some of them.

1. Self-care. I often tell people to treat self-care as though your life depends on it, because it does. Nevertheless, I still struggle with it. It’s hard to go to bed on time, to cook, to go to the grocery store. I still have trouble saying no. Still push myself to the point of exhaustion. But now that I’m taking care of my brother, self-care really does feel like life or death. I have to go to the grocery store and cook healthy meals because if I don’t, he can’t eat. I have to get out of bed, even if I don’t feel like it, because I have to check on him. I have to set limits, or I won’t have the energy to care for him. Like Romeo said in his last post, sometimes it’s better when you don’t have a choice.

2. Mantras. There are so many new things to worry about now that I often feel overwhelmed. Sometimes I can’t fall asleep. I wake up to anxiety attacks. In rare moments of stillness, I cry, thinking about what he went through, wondering how we will make everything work. But in addition to my usual mantras (e.g., everything is going to be OK; I’m doing the best that I can), I have added 2 more: 1) anything is better than him being dead, and 2) if God saved his life, then he’ll help me find a way. And that helps to calm me down.

3. SolitudeI offered to take care of my brother without really thinking about it. At the time, I didn’t realize it meant that he was going to live with me indefinitely. Not that it would have changed my decision. But it’s sort of like suddenly having a child without the 9 months to mentally prepare for it. There was a moment where I mourned the loss of my space, my freedom, but that quickly faded. And surprisingly, I have gained far more than I have lost. I have someone to watch football with. Someone to talk to when I get home, to share my thoughts with. He cares about how my day went, whether I won my tennis match. I don’t dread days when I have nothing planned now, because they’re not as dreadful when you don’t have to spend them alone.

4. FriendshipsMy friends are so awesome. I am so thankful for them. Even though they don’t know my brother, they call and text to ask how we’re doing. They’ve made meals for us. They say prayers for us. They wished me luck on my first day back to work because I was stressed about it. They’ve listened to me cry. They’ve spent hours putting together shelves so that my brother could have space for his belongings. They are taking good care of me, so that I can take good care of Romeo.

5. GratitudeIn my prayers, when I give thanks for all of my blessings, I always do so with some anxiety, knowing that at some point I will lose the things that I am thankful for. What will I do then? Fortunately, hardship and loss have heightened my awareness of how plentiful my blessings are. I am even more aware of what a gift it is to be able to breathe, to feel your heart beat, to walk. (All mindfulness exercises, by the way.)  I’m thankful that I have a job that has vacation days. I’m thankful that every day my brother gets stronger. That he is happier now than he was before the surgery.

If this period of my life marks a rebirth, then my goal in this lifetime is to be more fully aware of what a gift it is to be alive.

No Way Out

Last week I gave you my reflections on my brother’s heart surgery. Today he’s feeling well enough to share what this ordeal was like for him in an effort to share his epiphany: regardless of what you may have to lose in the process, it’s always worth it to choose life.

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In “The Walking Dead” Season 6 debut, former allies Rick Grimes & Morgan Jones share an uneasy reunion. “I’m sorry for all this,” Rick says to Morgan, shyly apologizing for having to lock his old friend into a cell until he can get the man acclimated to the new community he has just joined. Holding no grudges, Morgan replies: “It’s okay. Sometimes it’s easier when you don’t have a choice.”

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Fast forward to August 30, 2016. I’ve missed a couple of days at a new job. Inexplicably, I can never feel fully rested & suffer from painful gas that seems to get stuck in my chest. After weeks of combating my symptoms with sleep, stubborn cardio workouts, & Gas-X—something told me I needed a different approach this time. So I call out sick & plan to see a doctor in order to get an excuse for a couple of days & a prescription for some real medicine. Because of my reference to “chest pains”, the walk-in clinic refused to see me & referred me to the ER instead. “This will be an expensive bottle of Tums,” I thought to myself, the seriousness of my situation not yet setting in. A day later, I’m in a hospital room in my region’s premiere facility for heart surgeries. I’m told I have severe blockage in the arteries feeding my heart. They need to operate on me—TOMORROW. Doctors, nurse practitioners, & everyone who has seen my test results regard me with such astonishment. They wonder aloud how I’d been walking around.

“Oh great,” I think to myself. I’m going to have to call work again. They’re going to think I’m playing hooky.” I must have still been in emotional shock. That night, my stunned older sister calls me & tells me to quit my job—to stop forcing myself through unduly stressful challenges. “They don’t care about you! They don’t appreciate you! They have no idea how valuable you are! You don’t owe them another minute of your time. You hear me? NOT A MINUTE!” She also brought up examples of other people who should have been more concerned with my current crisis than they appeared to be. She wondered why I wasn’t more disappointed.

In hindsight, it was probably because I knew I didn’t have time to be disappointed. It was all happening so fast. I came in for painful gas, maybe some acid reflux, & they offer me open heart surgery instead. My head must have been spinning. But on some level, I knew there was no time to be disappointed or sad—it was time to be strong. Resolved. Focused. That was it. “I’ll be fine,” I reassured the only member of my family who, at that point, seemed to acknowledge the gravity of my current crisis–including me. “I have to go. The nurses just told me I had to take 2 showers with surgical soap; the first one tonight before bed.” It was already past 11 pm. It had been a long day; & the next day would be worse. I rang the nurse to get me unhooked so that I could take this shower with “surgical soap” & about 5 different washcloths intended for different regions of my body.

“Did you sleep well?” The surgeon asked me around the crack of dawn. “Yes I did,” I replied. He was stunned & said so out loud. Truth be told, I didn’t know what I had gotten myself into. And it was probably better that way. Had the details of what was about to happen been revealed earlier, I probably would have escaped! The surgery was nerve-racking. I actually woke up a couple of times after the surgical team had injected me with anasthesia. I saw myself in that horrifying environment under the blue surgical shroud. I had seen things that I had never asked to see. But the aftermath was the worst. I wouldn’t wish my experience on a sworn enemy—not even the Devil himself! I’m sure the Devil deserves punishment; but what kind is not for me to decide. Holed up in bed over the next 3 days in a state of constant discomfort, I realized how the powers both to inflict pain & subdue it are both sacred & require severe checks & balances.

I’m 40. If you saw me on the street, you’d think I look closer to 20. Yet here I was. A “kid” facing “real man” problems. But I’m recovering quickly. My vitals are consistently good. Even in the hospital, the staff seemed surprised at how well I was handling recovery. “If this is what you call ‘good’ I’d hate to see what you call ‘bad.’ “ They’d laugh at me. It was just humbling for me to be so dependent on so many people for so many things.

I always thought of myself as “tough,” but I never really knew for sure. Even after what I went through, I don’t feel tough or brave or strong. In fact, when I think about how severe the pain was & how terrifying everything seemed & how long the discomfort lingered long after the the violent pain had dissipated, I marvel that I got through at all! It took a lot of intervention from my Creator, but also some personal resolve. This wasn’t a challenge that I chose for myself; but once recognized, I was seeing it through. I was strong & brave not because I am all the time, but because I had to be right then.

Like Morgan said, “Sometimes it’s easier when you don’t have a choice.” Yes, well said, Morgan. All life truly is precious. Given everything I’ve had to endure over the last 2 weeks, my life is not only precious, but sacred to me now. That was a choice that I did have to make for myself. But now that I have, I’m as happy on the inside as I’ve been in a long time–maybe ever.

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Strength and Weakness

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In a previous post, I wrote about how using post-apocalyptic strategies to motivate yourself by turning everything into a crisis is not an effective way to manage your psychological resources. If you use shame and fear to motivate yourself–Get up and go to work, you loser! You’re just being weak and lazy!–it may work, but there’s a high price to pay.

Last week my 40 year old brother, the one who struggles with depression and anxiety, had a mild heart attack and had to undergo quadruple bypass heart surgery. They said it was amazing he was walking around at all, given that his arteries were 99% clogged. The only reason he saw a doctor is because he felt guilty for being too weak to go to work and wanted medical evidence to verify that he wasn’t just being lazy.

In fact, because he thought he was just being weak, he tried to overcome his fatigue by drinking Red Bull and forcing himself to do rigorous cardio workouts.Willing himself to commute 2 hours to and from work, to override his anxiety about his job with drill sergeant self-talk. And it almost killed him.

I’m beginning to think that reincarnation isn’t just about life after death. It’s about the opportunities for rebirth, here on earth. That’s why we celebrate the new year. Birthdays and anniversaries. That’s why people who go through personal tragedies often say that the experience saved their life.

Before the surgery my brother felt like his life wasn’t valuable because his depression and anxiety made it hard for him to hold a job. He’s not married and doesn’t have kids. He hasn’t done anything heroic. The thing that he was the most proud of was his physical strength. But right now plugging in the charger to his phone is challenging and leaves him out of breath.

Apparently it’s common to feel depressed after heart surgery, and given that he’s already prone to depression, I was worried about what his mental state would be. Surprisingly, this is the most at peace I’ve seen him. His goals are different now–to give up stressing about the little things, drill sergeant strategies, and other people’s definitions of success. He is more appreciative of the small things, like being able to sit without being in pain. And, perhaps most importantly, he finally understands how strong he is.

This ordeal has been helpful to me, as well. I still struggle with feeling weak and pathetic because I can’t do the things that other people do. My colleagues are able to handle their case load and responsibilities without becoming depressed and suicidal at the end of the term. Our services are in high demand, which is good for job security but not good for setting limits. I feel pressure to push myself beyond what I know I can handle, and I berate myself when I crash and burn.

But to see the undeniable evidence that my brother was insanely mentally and physically tough when he felt weak and irresponsible reminds me that I am strong, too. I don’t need to prove it by pushing myself to my breaking point. Trying to live up to other people’s expectations isn’t worth dying over. I’m going to accept my limits without being ashamed. I’m going to start standing up for myself. I’m going to say no when I know it’s too much.

One of the most valuable lessons that my brother learned from this experience is that you don’t have to train yourself for every possible crisis to prove that you’re strong. You can just have faith that when you need it, you will have the strength to face whatever comes your way. That you already have everything you need to survive.

6 Myths about Antidepressants

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In My Story, I described my lifelong struggle with depression and anxiety and how I suffered for many years before I was willing to go to therapy. It took even longer before I was willing to try antidepressants. And even though the meds helped tremendously, I still went on and off of them for many years because I didn’t like it that I needed them to feel “normal.”

In my work with students, it is very rare that a client enters therapy wanting to take an antidepressant. In helping them decide whether or not to try meds, I tell them to ask me whatever they want about antidepressants. In this Q & A, there several myths that come up repeatedly. So I thought it might be helpful to dispel these myths so that you can form your opinion about antidepressants with accurate information.

Myth #1: Meds are for people who want a quick fix.

Fact: I have rarely, if ever, met a client who wanted to bypass therapy and start with antidepressants. Sometimes they will meet with me for several years before they are open to trying medication. I would hardly call that a quick fix.

Myth #2: I don’t want to take something that is going to artificially make me happy.

Fact: Antidepressants don’t work that way. Think of a person who is depressed or anxious (since they are used to treat both conditions) as someone who has a lowered threshold for stress. The meds help to raise the person’s threshold so that it is in the “normal” range. This means that they don’t get upset over things that used to bother them. And when they do get upset, the feelings aren’t as intense and they don’t last as long. But you still feel depressed and anxious at times.

Ironically, people who make this argument have no problem using other, more addictive drugs that do actually artificially make them happy. Like alcohol. Or marijuana. Or stimulants.

Myth #3: I don’t want to become dependent on antidepressants.

Fact: As I stated above, many people who don’t want to take antidepressants have no problem “self-medicating” with other, more addictive drugs. I would equate taking antidepressants to taking meds for high cholesterol or blood pressure. You’re not dependent on them, but you may be putting yourself at greater risk for harm without them.

Myth # 4: I don’t want the meds to change me as a person.

Fact: When you are depressed or anxious, you are not yourself. You are so focused on your pain that you don’t have the energy to do the things you would normally do. You are necessarily self-focused and therefore cannot focus on other people. You are not fully present. So if anything, antidepressants help to free up more of your energy so that you can act more like yourself.

Myth #5: I don’t want to have to be on meds for the rest of my life.

Fact: Most people don’t have to be on antidepressants for the rest of their lives. Even in my case, my psychiatrist prescribes my antidepressant as needed. Although there are a bunch of supplements that he insists I take for the rest of my life, ironically.

Myth #6: It is more noble to suffer.

Fact: When someone comes to therapy, I assume it’s because they don’t want to suffer. I tell clients that life is full of suffering that they cannot avoid. We will all experience grief, loss, sickness, and crushing disappointments in the course of our lifetime. You will not miss out on your share of suffering. So make it easier on yourself and reduce whatever suffering you can. If there’s a chance that trying an antidepressant will reduce some of your suffering, you might as well give it a shot. You can always change your mind.

 

Everyday Miracles

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Today I read a chapter from Harold Kushner’s book, Nine Essential Things I’ve Learned About Life. The reading was about the importance of helping others as a way to live a meaningful, purposeful life. That wasn’t particularly helpful to me because, if anything, I think I focus too much of my energy on helping others, to the detriment of caring for myself. But it’s still good advice, nonetheless.

There was a section of this chapter that gave me pause, however: his description of the miracles that occur in everyday life. The predictability and reliability of nature. The fact that we can count on the sun to rise and set every day, the waxing and waning of the moon, the changes of the seasons. They happen with such accuracy we know sometimes down to the minute when they will happen. According to Kushner, “a faith system attuned to the natural world celebrates the orderliness that makes our lives livable.”

I’ve had the sense of awe and wonderment about these very things, though not every time they happen. I’m not that mindful. But I guess no one is. Like, when I meditate, I begin by focusing on my breathing, and then I shift my focus to my heart, because for some reason, feeling my heart beat, feeling my pulse throughout my body, makes me acutely aware of the life force that is my heart. How, even when I’m sad, when I’m heart-broken, when I can barely summon the will to live, my heart keeps beating for me, carrying me through life. I know the heart isn’t as immutable as the sun, moon, and seasons, but it fills me with a sense of wonderment and awe, just the same.

In a previous blog post I’ve written about how the weather is a metaphor for our feelings–how it varies from day to day, moment to moment. Some weather conditions are more desirable than others–rain during a tennis match is highly undesirable, for example–but we ultimately accept whatever the current conditions are because we have faith that at some point, the weather will change. Plus, we don’t really have a choice.

We can have the same faith in our feelings, but it does not come as naturally. It takes a lot of practice. When I’m anxious or sad, I’m better able to remind myself that if I wait, at some point my feelings will change. It doesn’t really make the pain go away, but it keeps me from wasting energy on wishing I were feeling something else–a small way I can reduce my suffering in the moment. Perhaps this is a miracle, too–the fact that having compassion for our pain has the power to reduce our suffering.

As I read about these everyday miracles, my Inner Critic was quick to point out my failure to appreciate them. You should be thankful for these things more often! You shouldn’t be taking them for granted! My inner critic often turns practicing gratitude into something that leaves me feeling ashamed and inadequate–as far from awe and wonderment as you can get.

So I’m thinking maybe I’ll practice mindfulness by noticing these everyday miracles more often–to pay attention to the changes of the season, the sunrise and sunset, the waxing and waning of the moon. In practicing mindfulness, there is no expectation that you should feel any particular thing at any given moment; you simply notice what’s there. But even the act of noticing creates an opportunity to experience wonderment and awe. So I’ll try it out and see what happens.

Olympic Dreams and Self-Esteem

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I’ve really enjoyed watching the Olympics over the past 2 weeks. During the Winter Olympics 0f 2014 I wrote a post about my dream of being an Olympic athlete. I didn’t so much care about being the greatest athlete of all time, but I wanted to be a part of the opening ceremonies, live in the Olympic Village (without getting stuck in an elevator for 40 minutes like Del Potro), and exchange pins with other athletes.

During this year’s Olympics I was struck by how many stories there were about gold medalists (usually men) who felt lost, depressed, even suicidal after their success. How they turned to drugs, alcohol, got in trouble with the law, wandered around purposeless, sometimes homeless, not knowing what their next goal should be. Michael Phelps’ story is probably the most surprising one of all. What would the greatest Olympian of all time have to feel depressed about?

This is the myth that continues to haunt us in our search for happiness. We believe that achieving greatness will transform us into someone who we will finally like. It will bestow upon us a sense of self-worth and belonging. We will feel purposeful, useful, and lovable.

In a previous post I wrote about how I had a similar experience after I got my Ph.D. I was expected to get an education beyond college. Preferably medical school, but in one of my few acts of rebellion, I chose clinical psychology instead. Even in my first year of grad school I had fantasies about how smart and accomplished I’d feel after getting my doctorate. Only to find out that instead I felt…exactly the same. Actually, maybe even a little worse. Because if having a Ph.D. didn’t make me feel better about myself, I realized that nothing would. I had nothing left to channel my energy into. No fantasies about how I was just one accomplishment away from achieving my dream of not feeling sucky.

There are other versions of the dream of transformation. They involve six figure salaries, weight loss, a youthful appearance. The perfect job, the perfect spouse, the perfect children. Everything we ever wanted is waiting for us…right after we accomplish this one thing. Oops. Not that one. The next one. Or maybe the next one.

Yesterday on the ride home from our annual Cincy Tennis Tournament trip, I was telling my friend that my job in therapy is to tell my clients over and over again that they are OK, just the way they are. Every week they bring in a different set of problems, different flaws, different confessions, and I say those are all OK, too. You’re still fine. On the one hand, that may seem like a strategy that is too simple to be transformative, but you should try it some time. It’s surprisingly difficult to believe we’re fine the way we are. That’s why change takes so long; we need to hear it all the time. We are never fully confident that we are good enough.

It’s clear that Michael Phelps still enjoys winning gold medals. It’s obviously still a thrill to train to be the best, to see that his hard work has paid off, and to know that he’s still the greatest. But he also seems more at peace about retiring. After all, he is not just the greatest Olympic athlete of all time; he is also a father and a soon-to-be husband. Will he come back to the Olympics in 4 years? Maybe. But if he does, it will be because he loves the competition–not because he is nothing without it.

I, too, think about accomplishing goals differently than I used to before my Ph.D. I’m still competitive and I want to win, but now it is more about the process of getting better than the result of any particular match. I do think that competing hard, playing fair, and executing my game plan say something about my character. But win or lose, when I walk off the court, I’m still the same person I was before the match began. I’m still me.

And I’m becoming increasingly comfortable with that.

Darkness and Light, Part 3

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Now that I am at the end of my summer break, my sleep cycle is officially fully out of whack. I go to bed at 4 am and often wake up after noon. I’m getting better at not berating myself for this because this luxury is about to end in a few days. And because, since I’m a night owl, I feel the best in the wee hours in the morning. This is when I have my moments of clarity. When my demons lose their power to convince me that I suck. Ironically, for me, seeing the light happens in the darkness of night.

It got me thinking about all of the good/bad dichotomies. Darkness and light. Angels and demons. Joy and pain. As I mentioned in a previous blog post, I’ve been reading all these books about God, trying to understand what it means to be good, and the answer seems to be to accept everything about ourselves–even our sins and our vices. I write about acceptance all the time, but I guess in my mind self-acceptance was still something more along the lines of, don’t hate this thing about yourself because it’s a part of you. But it’s still bad. I mean, how can you think of something like depression as good? How can I embrace something that causes me so much suffering?

Although lately I have had a better appreciation of my depression. I pride myself on being mentally tough–on being a warrior. My greatest strength in tennis is not my athletic ability but rather my mind. My determination to not let my opponent get in my head. To fight, even when I’m down 0-6, 0-5. To be able to see what I’ve done well in a loss and to learn from my mistakes.

One of the things I take the most pride in is that players on my team appreciate me as a captain, and continue to be on my team even if we lose every match, because they think I’m positive and encouraging. I mean, I award a Player of the Game and Honorable Mention in matches where we’ve lost 0-5. That is really looking on the bright side. But my bright side would not be possible without my dark side. My mental illness has strengthened my character. It has shaped the parts of me that people admire the most.

If boot camp prepares soldiers for war, then depression is the boot camp for hardship. When I look back on each depressive episode, I realize how strong I was, even though I thought I was weak at the time. How hard I was trying, even though I thought I was being lazy. How much hope I had that things would get better, even though a part of me was telling me to give up–that life was not worth living.

Having said all of this, I can’t say that I have fully embraced my depression. I’m not thrilled when it shows up. But I’m trying to accept it in the way people sign up for the military, knowing that it may cost them their life. Or the way that people choose to get married for richer or poorer, in sickness and health. The way parents choose to have children, knowing the heartache that comes from loving so deeply.

Joy and pain. Angels and demons. Darkness and light. I will choose all of these, because I believe our task in this life is to fully embrace what it means to be human.