Blanket statements

So, my TV watching this evening provoked some thoughts; I know, I know, it’s just TV, but still.

1. Glee and the diabetes analogy — great episode overall. I loved the “Unpretty” song, and it’s not the only bit that made me a little teary. I think most of you would guess that I believe homosexual practice to be forbidden in the Bible, but I also firmly believe that gay people are people and should be treated with the same kindness and respect as any other people. I’m really glad this show is dealing with the issue.

However — and keep in mind this is just one thing out of a whole episode — I dislike the diabetes analogy for mental illness and treatment.

The diabetes analogy goes like this: If you had diabetes, you would take insulin. You wouldn’t expect to just snap out of diabetes, or just accept it. You should consider your mental illness the same way — take your medicine. It’s helpful in a limited way — helps with shame, with guilt, with the sense of “I should be able to beat this on my own.” But this analogy does not serve mental illness completely well, and I’m not sure it serves diabetes and other non-mental illnesses all that well, either.

It makes it seem black and white — clear, clean, and tidy; antiseptic, impersonal — thoroughly understood — without nuance, without a variety of diverse factors and contributors, or at least without them being considered significant.

It removes, or at least reduces, any possibility of being the victim (broadly speaking) of any people, and it removes or reduces any possibility of being personally responsible for the illness.

In reality, maybe your past experiences — what you received from others, what you chose for yourself, and the many experiences in which you were both receiver and agent — have a lot more to do both with your diabetes and with your depression.

In the episode, it’s clear that Emma has some past experiences that contribute to her OCD; perhaps in future episodes her therapist will deal with some of that, in addition to the SSRIs she prescribed immediately. Not that I am anti-psychiatry altogether; I take an SSRI myself and believe it helps. Someday I’d like to not need it anymore; and that is not a black and white question. What it is is a question of deciding what shade of gray I want to live with.

I remember attending a seminar about depression, at some Christian weekend conference thing, and being disappointed that it was all about clinical / medical depression, the kind you need medicine and a diagnosis for. I felt vaguely, at the time, that this approach dismissed, made invisible, my kind of depression, which until PPD hit was more about baggage than about neurochemistry. I feel more strongly about that now. I want people to talk more, and more acceptingly and helpfully, about this component of depression and other mental illnesses; perhaps there are some people for whom chemistry is really the only factor, but I suspect not. Even for those who do have chemical imbalances — myself perhaps included, since the SSRI helps me — I suspect baggage has a significant role to play.

I think we should look at medical illness the same way; to look not just at surface symptoms and treatment, but at all the many factors that could be in play, and all the many actions that could be taken. Robertson Davies’ The Cunning Man addresses this idea, among other things.

2. Raising Hope and sleep training

When we were brand-new parents, we, too, thought there were only two approaches to making babies sleep: Cry-it-out, or various attachment methods such as rocking to sleep and bed-sharing. And indeed, these were the only two options mentioned in the show. And, unfortunately (in my opinion), the family went with the cry-it-out option, claiming the attachment option had made their son a wuss. (As if infants are just like adults, and as if the way you deal with an infant will lock you into dealing with them that way forever.)

When I read — in Penelope Leach, I believe — about a middle way, I thought, this should have been obvious! But no one — just about NO ONE — ever talks about it!

The middle way is this: Your baby is somewhere around three months old. (If she is younger, go ahead and rock her to sleep and then put her down. She’s unlikely to wake again soon, and you’re not going to “spoil” her.) She is sleepy, but still a little awake. You’ve had your bedtime routine — story, diaper change, song, cuddle, feeding, whatever. Put her in her crib or moses basket, pat her for a minute, say good night, and leave. If she cries, return in a couple of minutes — do not pick her up, do not start a conversation — just pat her again, reassure her that you’re there, listening and responding, and that it’s bedtime, and leave again. Repeat until she no longer cries when you leave.

You’ll likely have a few really long repetitive nights. But just a few.

With the way my PPD went, and the kind of baggage I’ve got, and other factors, bed-sharing would not work for me. And rocking to sleep stopped working at about this age — she’d wake a half hour later and need to be rocked again. But with this middle way, I felt that I was still showing compassion and respect — indeed reassuring her that we were there and caring.

It reminds me of the concept of scaffolding — the idea that one role of a parent or teacher is to help a child do just a little more than they could do on their own. You’re not doing for or to — you’re doing with, providing just a little more help.

I wish people would talk about this more often. Cry-it-out is NOT the only other option if you can’t or don’t want to bed-share or rock to sleep forever.

Drugs

Last night, I was up with fear; fear about drugs.

1) Thinking about micro-cultures where the use of street drugs is nearly inevitable. Third-worlders running to the cities for good work, not finding any; street kids in any city — when the choice is one meal for a week or one bottle of glue, what really makes sense? And the fact that people drink “alcohols” made with paint thinners and shoe polish and varnish — or anything else that is one part brief mental euphoria or relief and five parts deadly toxins…

Or just the mention on the regional news last night of meth lab trash that can be nearly instantly deadly to anyone unsuspecting enough to breathe close to it. (I didn’t turn off the TV fast enough after the show I was watching. Normally I avoid the news like the plague.)

There is something about all this that terrifies me — how can it be that such situations exist, that such substances exist. And what am I going to do about it, when I can barely keep up with my own puny local life and when so many other causes clamor for attention?

2) Thinking about this Nasonex I’m on, and the Claritin, and occasionally the Benadryl.

Thinking about how I’ve learned enough to be skeptical of everything and everyone, but not enough to have chosen anything or anyone to trust, other than God, and even him I question often enough, and he doesn’t seem to say anything super clear about how to treat allergies.

What is it in Claritin that makes it non-drowsy? Does it contain a stimulant? I don’t want a stimulant. Does Benadryl contain a depressant, or why does it make me drowsy? I don’t mind it making me drowsy when I take it at bedtime. But I don’t want to take it during the day. And if I take Claritin, which lasts 24 hours, then I suppose I shouldn’t take Benadryl at bedtime too. And I have no idea if the Nasonex is helping or not.

I think the neti pot alternative (bulb syringe) is nice, now that I’ve gotten the temperature right. Although it makes me think about other fads regarding cleansing of internal cavities. I bet the nose too is designed to keep itself clean.

Amy seemed worse today; is her Claritin helping her or making things worse? How long do I wait before asking the doctor about that? We put the humidifier in her room tonight and gave her an extra pillow. She had a warm shower, too, and tried the nasal irrigation; she did pretty well with it, at least at first. Wasn’t happy about having to do the other side. It did seem to clear her out at least a little, which is good since she’s not so great at blowing her nose correctly.

It’s funny. I sort of don’t really believe in allergies. Why in the world would anyone’s body react to ordinary normal things in such a way? Surely eating right and getting enough sleep and exercise should cure or prevent all allergies, right? So maybe a long-term prescription for Nasonex is God’s way of challenging yet another one of my precious principles. Just like when I had to quit nursing Amy purely for psychological reasons.

3) Related to 2, what about my Zoloft?

There is a large and vocal community pushing the biological model and the diabetes analogy, and there’s my own experience that suggests that this drug does help stabilize my mood, and yet — at this low dosage — does not remove normal ups and downs and full presence and awareness from my life. Then there’s my friend who has radically reduced her diabetes symptoms by changes in diet and exercise. Although I think she’s got the kind that doesn’t need insulin shots.

Then there’s a smaller and equally vocal community pushing anti-psychiatry, arguing that no drug can resolve distress, and that the psychiatric model does more harm than good by adding drug upon drug in order to deal with side effects and tolerances. And that most therapists seem incompetent at best and retraumatizers at worst.

My experience on this side of the issue is that there are certainly personal-historical roots to some of my distress and that certain kinds of talk therapy have done more work on these roots than drugs have, but that perhaps I’m at a place where I am more to be applying what I’ve learned and less to be seeking more therapy. I have also not experienced being pushed to do more drugs, granted the exception of the psych nurse practitioner who put me on Risperdal — but it was a small dose and after a year I was able to get off it without issues. And I don’t have harmful side effects with Zoloft. In the beginning I had some eye pain, but that’s gone away. The worst thing that still happens is I am a little more easily nauseated, but it’s quite manageable.

And most of these anti-psychiatry folks have been treated at the hands of the incompetent or worse, and have recovered from vast contrary cocktails of ever-changing, ever-increasing drugs.

The thing is, though, we still don’t really know precisely what Zoloft or other SSRI’s do or why that works, or why it works for some and not for others. (It reminds me a bit of how many other times I’ve wanted a more precise and complete line from the nuts and bolts of a thing to the image, model, or analogy of how we understand it in our own experience — like going from the 1s and 0s in computer code to what I see on the screen, or how traveling electrons make the toaster work.) Do we know precisely how other drugs, like Nasonex or Claritin, work? With Bones, sometimes I look aghast at the barbaric and invasive nature of our current medical knowledge and practice.

Then again, I am still quite skeptical of the various alternative approaches to medicine.

And having friends on all sides of all the issues doesn’t help resolve where I should land.

4) Fear itself is a drug. So is food, and sunshine, and health, and rain, and sickness. There are so many factors involved in any one moment of my thought or feeling, it’s mind-boggling. Especially late at night.

I’m afraid of being wrong about anything, especially about anything important, like God, or some drug I’m probably going to take daily for the rest of my life, or what kind of chicken to buy and how much.

I generally try to look at my fears directly and see what the worst case scenario might be, and see that even that won’t destroy me. (And, late at night, I try to remind myself that my fears are always heightened late at night and that generally I have a better perspective in the day. A little voice late at night whispers that the recurrence of the night fears implies the existence of something that I’m avoiding in the day. I try to remind that voice that I am open to facing whatever needs to be faced.)

If my life is shortened by ten years because of medication or incorrect nutrition or not enough sunshine or too much sunshine, is that really such a terrible thing? Might as well add fear to the list of things that could so shorten my life. Fear certainly isn’t going to lengthen it. Healthy concern and research, sure; but not obsessive worry.

If God doesn’t exist, or is not the God of the Bible, most likely that would mean annihilation after death. And it would mean that living my life in faith would have been pitiful. But unless I am absolutely certain that he’s not true, why not hold on to the trust and the hope and the faith? There is good evidence that he’s true — not undeniable, not absolutely proven, but just as much evidence (more, I think) on his side than on the other side(s). So even when I am not solidly convinced, I don’t have to believe the fear that continuing in faith is just a gamble, one of two equal choices in the dark. I can remember that when I have researched and read and thought, I have generally seen that the scales tip decidedly lower on God’s side.

Even when my questioning and fear and doubt is ABOUT God, I can tell him about it in an attitude of faith and trust. I can tell him that while parts of John Piper’s arguments for God’s sovereignty even over evil and sin seem persuasive and even potentially comforting, it still makes me sick to know that some people got raped and sodomized as toddlers, and that others stay alive on glue-sniffing, and that others are tortured, and so on. What good could possibly come from any of that? And good must come from all of it in order for it to fit into God’s good purposes.

Even such little, but chronically recurring things as interpreting when something is good or not. Heard the “That’s good, that’s bad” story or played “Fortunately / Unfortunately” or heard the tale of “The Lost Horse?” Faith tells us that evil is truly evil, but that God’s goodness is sovereign even in the midst of evil, and that all things work together for the good of those who love him and are called according to his purpose (Somewhere in Romans 8). And yet, sometimes I feel like I’m living in “Fortunately / Unfortunately.” The cat visits me late last night, and I could say that God knew I needed distraction and comfort and a warm purring feline visitation would fit the bill nicely. But what if the cat hadn’t come? Would God be any less caring? And if not, what difference does anything make? If I should accept good and evil from the hand of God, like Job, how do I maintain understanding that good is good, evil really is bad, both are in God’s will, and God is always good?

I do think that Christianity’s insistence that evil really is bad is important — vs. philosophies and religions that consider evil and good to be meaningless categories, too subjective. Likewise Christianity’s insistence that God is sovereign, vs. evil and good as peers in the cosmic struggle.

What it comes down to, I think, is that our faith puts goodness primarily in a person and a relationship, and not in events and circumstances.

———

And there you have it: the myriad paths my brain and heart travel when the news mentions meth trash and I’ve just filled a new prescription and people are blogging about decisions and fear and terrible things and I’m likely in the throes of the monthly hormonal upheaval and so all the little bits of thoughts and feelings and concerns and hopes get tossed about again.

DBT and dissociation

I came across a blog post alleging that many survivors of childhood sexual abuse have been further traumatized by therapists applying DBT to them.

Basically, they are told to stuff their feelings related to the abuse, because it’s in the past. No connection allowed to that past self and his or her experiences, even though those experiences are hanging in limbo and can never be metabolized without revisiting them. It’s yet another authoritative voice saying “Shhh! Don’t tell, or you’ll get in trouble.”

Part of the trouble seems to be in the wrong application of the various skills, as if any of them were always universally applicable.

The skill of distraction is overapplied, as if it’s appropriate for all situations, and as if dissociation were not a danger. The skill of temporarily storing overwhelming emotions is likewise misapplied, as if the therapist were conveniently forgetting the “temporarily” part and the need to revisit those feelings at a more safe time and place. The skill of not catastrophising is applied as if there’s no such thing as a catastrophe, instead of only when the distress is NOT a catastrophe. The skill of acting opposite to feelings is misapplied, as if the idea is to hide one’s yucky self or deny one’s yucky feelings, instead of mere impulse control: being able to have one’s feelings, own them, but act according to wisdom instead of impulse. In fact, I remember DBT focusing on emotions being value-less — that even the so-called “negative” emotions are important and have something to say to us. They shouldn’t be pushed aside any more than they should be deliberately sought after.

Some of these skills seem to me clearly intended for distresses that are mild to moderate, not severe. They’re for distresses that recur after you’ve already dealt with the root issue — distresses that you KNOW are based on lies.

Take the half-smile, for example. Of course it’s ridiculous to think that simply smiling will solve all of your sadnesses. But I don’t think that’s the point of the skill. It’s just one small tool. For occasional no-good-reason blues, it’s a great physiological feedback tool. For deep sadnesses, it can be a very small comfort, again purely physiologically, not as if you’re pretending not to be sad. There’s no “should” or “must” about it, and it’s not about denial or stuffing.

Then there’s apparently an idea that using the skills is a matter of instant perfection, and not practice. The blogger writes about people being chewed out for mentioning their distress in group. Yikes! How can you learn distress tolerance if you can’t even mention distress? And again, distress tolerance isn’t the same thing as distress denial or not being bothered by distress at all. It’s about letting each distress be its own true self, neither making it more of a catastrophe than it is, nor minimizing it less than it is. It’s about trusting that the true self can survive, can get through, will not be destroyed by the distress.

It sounds to me like part of the issue is a matter of language and connotations. When a therapist says something like “acknowledge without attaching,” it might mean something very different to their client. Maybe the therapist means “Stay in the present, but allow yourself to feel the feelings that are coming.” Maybe the client hears “The person that experienced those feelings is not, and never was, you.”

Suppose you’re the client and you’re experiencing distress because of something from your past. I think there are at least three possible approaches.

1) You might get sucked into the past moment as if you’re time traveling, reliving it exactly as you did in the past. In this case, there’s no sense of the present moment at all. There’s not enough separation from the past moment to observe it, listen to it, evaluate it, and respond to it. There is only reliving and reacting. I don’t think this approach can solve anything, and it seems clear that it could cause problems in the present.

2) You might push away, deny, or ignore the past moment as if nothing from the past matters anymore. This approach is even less helpful, even though it might preserve a semblance of functioning in the present. The present self grew out of the past self, and so the past DOES matter. Past experiences — especially those that haven’t been fully metabolized — will continue to exert pressure on the present self, causing all sorts of present problems.

3) What seems to me the best approach, in line with how I understand DBT and what I learned in other therapy as well, is to be present while the past moment is speaking. Don’t time travel, and don’t shut your ears. Feel the feelings, experience the experience, mindfully, neither pushing away nor clinging. Listen with compassion. Listen with your present self’s wisdom. See what the past self is saying, what the past self needs from the present self. The only way to metabolize that past moment’s feelings is to feel them — in the present.

You can’t change what happened in the past, but that doesn’t mean it’s safe to ignore the past. Ignoring the past and time-traveling into it are both ways of fighting against reality. Mindfulness is NOT saying reality is wonderful and peachy-keen, but it is accepting that reality is what it is — including the realities that this is the present, and that the past really happened and really matters.

Latest carnival against child abuse

A blog carnival is a collection of posts about a particular theme, gathered in one place. Several of the bloggers I read are survivors of various forms of child abuse, and one or more of them will post a link when the month’s carnival is ready. While I’m not a survivor of abuse, I sometimes read a post or two and usually find there’s a lot to relate to, considering my mental health history; it’s also enlightening, fostering compassion and respect for the survivors, known or unknown, among my friends, and there’s often also good food for thought as a parent.

This month, I just read one of the posts, by Marj AKA Thriver. It’s about working with your inner child. In general, I find myself somewhat sneering at that term — it seems so, sort of, sold out to the psycho-babblers. It reminds me of a cartoon where someone writes to an advice columnist saying “My inner child seems to be missing,” and the columnist replies, “Look for its picture on your inner milk carton.”

And yet, it can really be a helpful and worthwhile concept. I have to not think of my inner child literally, as if there’s a separate and distinct younger me living somewhere between my spleen and my stomach. I have to think of it more metaphorically — thinking about how wounds and other experiences from the past still influence the present self, and how the feelings and thoughts from those times can persist. If the painful moment was not metabolized well at the time, some attention to it in the present can bring healing that was missed before. And usually the healing work does need to be done in a way that the younger self would receive well — this is one of the reasons why just changing the way you think, or giving yourself a lecture, is not always deeply healing.

I find that I already do some of the things Marj discusses.

Singing is a great comfort to me, whether the trouble on my mind is some past hurt, or a spiritual snag (the two are often connected, even if only subconsciously), or some difficulty in the present. Playing dulcimer or another instrument can also be very comforting, especially at times when using my voice does not feel right — when I’m feeling inarticulate, or not able to affirm the lyrics of anything, and so on.

I also love to sit in a comfy place with an afghan, cup of tea, book, knitting, and / or the cat.

During my PPD hospitalization, Mark brought me some of Amy’s presents to open, and one contained the cutest pink stuffed lamb with a little rattle inside. I kept that for myself for quite some time. Likewise the kitty blankie (a blanket square with a cat’s head and paws sewn into the middle), when Amy lost interest in it. That one was especially comforting because a good friend made it for Amy. (I wish I remembered who gave her the lamb — I was diligent about writing thank you notes even in the midst of the PPD, but I forgot to write down for myself a list of who gave what.)

I love swinging. I can’t do very much, or go very high, because the Zoloft makes me a bit nauseated with that kind of movement. I would love to have a porch swing long and wide enough to lie down on, to swing horizontal and sideways, especially if someone or something would swing it for me. Sounds like I wish I had a cradle, eh?

Just being outside, or working with my hands, can be good. Something less mental and more heart / body oriented.

None of these things are failsafe for me, but all are helpful at one time or another.

Several of the commenters on this post talked about how they weren’t really allowed to be kids — no silliness, had to be serious, etc. That’s tough — it continues to be a challenge for me to accurately assess Amy’s maturity level and what appropriate rules and boundaries are for her.

She can’t be silly ALL the time, and while I don’t want to rush her, growing up in independence and maturity IS a major goal of parenting. But I also don’t want to squelch too much. I want to make sure she gets enough time for being silly and ridiculous and even loud. I want to make sure that she knows she’s allowed to be upset or angry or sad or afraid about anything, if that’s how she feels, and that it’s not my place to judge whether her feelings are valid. If it’s how she feels, it’s how she feels.

On the other hand, she needs to learn that there are more and less appropriate ways and times to act on and express her feelings. Mark and I are both getting especially tired of such patterns as top-of-the-lungs screaming when it’s time for bed or nap, and “I can’t — there’s too much!” when it’s time to clean up a lot of toys or a toy with a lot of parts. Or the persistent arguing with us when we ask her to do something. I don’t mind THAT much if she doesn’t cheerfully get up and do whatever we ask whenever we ask it — but I’d rather she didn’t feel the need to voice her displeasure every time, multiple times. We’re working on it all.

———

In the middle of reading over this before publishing, I thought about my hair. Amy has always enjoyed playing with combs and brushes — she tries to brush or comb her hair, or ours, and pretends to give haircuts. The other day I unbraided my hair to let her brush it, and it was glorious. I’d forgotten how much I love to have my hair brushed gently and attentively. Mmm. Did I enjoy that as a child, too? I remember nearly fainting with concentration and anxiety, trying to stand still while having my hair curled… and I remember the pleasure of having my hair washed in the kitchen sink… especially the sprayer held close to my scalp with that perfect temperature water… but I don’t remember brushing or combing much.

Carnival Against Child Abuse

Carnival Against Child Abuse

(A blog carnival is a collection of posts from many different bloggers about a particular topic.)

You all know that I work at two things in my parenting that seem to be in tension with one another: maintaining healthy space for myself and my needs, and being a safe, good, loving, compassionate, and respectful mama for my daughter.

You know that each of these things sometimes makes it hard for me to work on the other one. When I am feeling more need for my own space, I can feel Amy as a hindrance. When I am feeling more like an inadequate mama, I can feel myself as the hindrance to both of us. It’s challenging to keep looking for the necessary, the healthy, balance.

Several of the blogs I read are written by survivors of childhood abuse. I found them, or they found me, because we both write about mental health issues.

Reading some of the things they write sometimes renews both sides of my parenting tension. When one of these survivors reminds readers to “Love your inner child,” or posts a painting of a mama holding a child, and another child standing in a corner, with the caption, “Are you holding or ignoring your inner child?” it reminds me first of all to hear the whiny and defensive inner call for more me time and space as the voice of my inner child, and to respond compassionately*. It reminds me secondly to keep hearing the (sometimes unspoken, despite all her chatter) voice of my daughter calling for more together time and space, and to respond compassionately* to her as well.

It’s when one is not feeling well-loved that one gets insecure, defensive, grumpy, inadequate, and so on. I need to love both of us well — me and her. And I need to drink and eat, more and more, how lavishly the Father loves both of us.

*Compassion doesn’t always mean giving what is requested. But even when the answer is “no,” it can be given lovingly, sympathetically, and respectfully.

Gibberish

Why is it that mental illnesses seem to have symptoms that make some sense?

What I mean is, people have hallucinations that actually look like real people or things — they hear voices that say intelligible words — they think thoughts that seem plausible — and so on.

It would be a lot easier, for example, if, when I have a depressive episode, I were to think things like “;sodi[4]1j;ivow34nbd,” or “wave neon boogie plasma,” instead of “I’m a failure because of x,” or “I can’t stand this,” or “So-and-so probably doesn’t like me.”

I wonder what exactly goes wrong in the brain, and how the mind makes sense of it… and I wonder also how exactly the mind and brain relate to and influence each other. And to think that the rest of the body, and even external circumstances, can have such an influence on the mind, too — hormones, what you eat, physical ailments, weather, etc.

(My recent depressive episode seems to be lifting, by the way. This post is just thinking about depression and mental illness in general.)

Lines

Over and over again I realize just how many things in life require people to draw a line, and that everyone draws it in a different place.

I’m still going through and password-protecting the posts with pictures of Amy. Some people won’t use their real names or post even pictures of their adult selves, other people post anything, including their own naked pictures. Some people who post pictures of their kids aren’t aware that someone might misuse those pictures, and others don’t think the risk is a big deal. I still don’t know how I really feel about it all, but using the password protection doesn’t hurt anyone and the pictures are still available to those who want to see them.

Health and mental health — you have to decide to what extent you trust modern medicine, or whatever alternative medicine you prefer, or what you believe about nutrition, or exercise, or spirituality, or any number of other factors that affect health.

I am still rather confused on this stuff, not convinced one way or another about the roots and proper treatments for my depression and anxiety. I do believe that there are multiple factors in both origins and responses. I think drugs are helpful right now, but I still hope I might find a way to live without them. Likewise therapy. Likewise nutrition and exercise. I am trying again to heavily restrict my consumption of sugar and refined flour. I don’t think I have reason to suspect any problems with wheat or dairy, but again I’m not entirely sure.

Where else do we draw lines?

Science in general… who is an authority on what topics… how greenly we live… what we think about self-esteem and the Gospel… what the Gospel implies for how we should live… whether a music album should have any multi-tracking, editing, looping, etc… how authentic does a musician have to be when playing a particular style or genre or tradition… when to speak up and when to stay silent… when to act and when to endure… how to forgive but maintain proper boundaries… what to believe about miracles and gifts of the Spirit in today’s age… how much money to spend and on what… how much to be involved with others and how much to take time for ourselves… how much to care about what other people think… how technologically current to make our homes… what counts as art… what are our real obligations… how much distance can there be between how we act and how we feel… what is good enough… how does a ‘good enough’ philosophy mesh with the Gospel… and so on and so on.