Tuesday, March 29, 2011

Be You

Last week I listened to the new Lady Gaga song, Born This Way. I mean really listened, to the lyrics and the message. I was so moved by her words about being yourself no matter what. She says early in the song that her mother told her "There's nothing wrong with loving who you are, she said, 'Cause He made you perfect, babe." Oh, if every child in every home heard those words! Lady Gaga refers to a person's skin color and race as well as sexual orientation in her powerful song, telling us all that beliefs about our differences have no foundation. So many of us grow up hating some aspect of ourselves, spending countless years wishing we were different somehow: thinner, blonder, whiter, straighter, it's different for everyone. Does anyone really believe they are perfect the way they are? We are bombarded by messages implying we need to be better somehow, more like the people in the movies or magazines. Articles tell us how we can achieve a better body, ads proclaim we can have whiter teeth and perfect hair, there are even therapists who claim they can change a person's sexual orientation. If all this were true, wouldn't we all be happy? And wouldn't we all look and act exactly the same? Diversity is a word that is used commonly these days. It's interesting because companies want to promote a diverse work force, yet certain groups are routinely discriminated against. Women still earn less than men, people of color are less likely to be top executives and gays aren't allowed to provide benefits for their partners. If we all looked and acted alike, would we all be equal? And would we all be happy, instead of choosing some aspect of ourselves to hate? I don't think there are answers to these questions, but in an age when depression, eating disorders, bullying and suicide are commonplace, I can't help but ponder them. I read a wonderful book recently called "Women Food and God" by Geneen Roth. The book is all about feeling emotions and living in the present instead of trying to change or numb ourselves with food. She makes a case over and over for acceptance of what is, be it the body, the situation, or the pain, and that will set us free. Towards the end of the book, she sums things up in a particularly profound way. "When a diabetic tells me that she can't eat what she wants because what she wants will kill her (and therefore she feels deprived), my response is that what will kill her is wanting another life than the one she had, another condition than the one that is hers." Ok, I'm going to leap here and say that Lady Gaga and author Geneen Roth are saying the same thing in very different ways. Be who you are, don't try to change it. Don't hate it or pick at it or obsess because something about you is different from your ideal. In fact, don't believe there is an ideal because people are born with differences that make us unique and special. The differences should be celebrated, not marginalized or used to create a culture of hatred and fear. So, as I've heard Lady Gaga say: Let your freak flag fly. Rejoice in every aspect of your beauty, because we're all perfect.

Thursday, March 17, 2011

Shhh... Listen!

I am making changes at work, getting ready to begin a new style of treatment. It's been a busy time, and I've been worrying a lot about how this will go. I am also trying to think of a name for my combination of yoga, mindfulness and psychiatry, but I've been frustrated because I can't come up with something that fits. I have been feeling stressed, for sure. This transition at work is coming at the same time as a transition in the weather, and all these changes at once stir the jumbled pot of thoughts in my head. I am thinking constantly!

Our minds are always at work, of course, but sometimes it's easier to see the space between the thoughts. Right now, I feel bombarded by questions. I get up in the morning and ask myself what I should wear, whether I need to wash my hair, what I should eat for breakfast (then think about lunch and dinner), and on and on and on. This goes on in the shower, while I'm driving, even when I'm doing yoga, if I'm completely honest. Oh, that's bad, if my usual quiet place is being disturbed by all this thinking!

So the questions are buzzing around my head, but I find I'm not able to confidently answer any of them. Even the simplest seem beyond me. I doubt myself after I finally grab something to wear, and I'm reading about 4 different books right now. I can say I'm not really getting much from any of them! The questions are constant, but the answers aren't forthcoming. I finally pulled out my journal last night, after inconsistent writing for the last few weeks, and started to explore what's going on here. I realized after some introspection, and literally writing down every question I'm chewing on right now (this took up about 1/2 a page, for crying out loud!), that I'm not finding answers because I'm not stopping to listen for them. One query leads to the next, I'm not breathing or looking for a pause between them to see what comes up. I can't hear my Self respond because of all the chatter.

So as I thought last night about my morning practice, whether I should go to my usual yoga class before work, or practice at home. Then I listened. I didn't get a hard and fast answer, but I recognized that I didn't need to decide right then. In fact, I couldn't possibly know how I would feel in the morning, so I needed to wait. I hate waiting :) but I did it. This morning I woke up and scanned my body and felt achy and stiff. Clearly, not a day for a vigorous practice. I went to the kitchen to look at breakfast options and thought about what I actually wanted to eat, not what was fastest or easiest or what only had a day left before it expires. I felt good after eating, because I paused and realized when I'd had enough, too.

Now, obviously these are the simple questions so far. I'm hoping the listening can go deeper. I am still looking for the right name for my therapy, and I feel like it's there inside me, I just can't hear it yet. I will be sitting more quietly, letting go of the next question while I answer the first one, and maybe the more profound insights can bubble to the top.

Wednesday, March 9, 2011

A.R.C.H.

I was trying desperately to catch up my continuing ed credits this weekend, and came across an entire month of articles devoted to ethics. Contributions were written by bioethicists, people serving on hospital ethics committees, and even some ethics policy-writers. It was really interesting stuff, because I haven't had to think about some of these issues in a while. The most interesting one for me was written by George Blackwell, PsyD, and it was about how to de-escalate conflict in tense situations. The author was coming from a perspective of helping a hospital team agree on a solution to an ethical dilemma, but the concept he explained seems pretty universally helpful. I tried to Google this and see where it originally came from, but had no luck. I will simply say I did not come up with this beautiful idea, and give thanks and credit to the person who did!

The concept is the ARCH principle. It stands for "Acceptance, Respect, Curiosity and Honesty." It begins with "accepting every person where they are, as they are." We respect a person's right to their own opinion, and show curiosity about how they came to it. Then we open an honest discussion that still follows the other principles. I think it's pretty clear how this could be useful in daily interactions. There are as many different opinions as there are people in the world, eventually we will come up against someone with whom we disagree. My usual tactic is to allow them to speak, maybe make a comment or two, and let the discussion drop because I don't like conflict. Later I'm left feeling empty because I didn't speak my mind. I have seen other tactics that work even less well, where someone starts shouting and calling names to show their disagreement. Neither of these methods results in a fruitful meeting of the minds, and they both leave someone feeling bad.

If we follow these principles, however, we can have a discussion and not end up angry or upset, hopefully. I accept that another person has a different background than I do, and have come by their beliefs in a different way. Right now, we disagree. I respect that they have an opinion, perhaps even a strong one, and they are entitled to it. I show curiosity by asking questions about how they came to this conclusion, trying to learn more about them and their belief-system to be more informed. This in turn shows them I'm interested, and willing to listen. We can discuss things calmly because everyone feels safe in this kind of environment. When we come to points of disagreement, I can honestly say that I understand they have a different opinion, I respect that, but then explain my views, without using language that is harmful. In an ideal situation, they would afford the same ARCH principles toward me. We may never agree on everything, but we will both have learned more about each other, and about another point of view. That kind of knowledge allows me to interact with others in a more intelligent way in the future, too.

I think this principle correlates really well with yogic philosophy. In the Yoga Sutras of Patanjali, the yamas are the first limb of Ashtanga Yoga. They describe the ways we should relate to others in the world. The first 2 of the 5 yamas are ahimsa (non-violence) and satya (truthfulness). The usual "rule of thumb" is that ahimsa, or non-violence, trumps all the others. So, if our honest truth is hurtful, we do not speak it. The ARCH principle gives a simple and modern perspective on these ancient concepts that really speaks to me. We have multiple interactions with people every day, from our family members to our co-workers to the people in line at the grocery store. Reminding ourselves to accept each one of them where they are is a great way to begin any conversation. That alone sets a positive tone for the rest of the interaction, even if there is no disagreement.

Tuesday, March 1, 2011

Take Care

I saw a woman yesterday who has a familiar story. She told me about her busy full-time job, her family obligations, her health concerns and all the pressures in her life. We discussed her symptoms, which included poor concentration, tension in the neck and shoulders, irritability and difficulty sleeping. I gently explained that all of her symptoms are classically related to stress.

The human body is programmed to respond to stressful situations in a way that allowed us to survive in ancient times: we recognize a threat and our body gears up for fight or flight. Of course, millions of years ago, we were fighting or fleeing from wild animals. That's rarely the kind of stress we face today. But, our bodies cannot differentiate the threat of attack by tiger or a deadline at work. The physiologic response is the same in either case. A lot of people feel they are under constant pressure, so their sympathetic nervous system (that of the fight or flight response) is always firing. The body is flooded with stress hormones like epinephrine and cortisol which help us to move fast and escape danger, at the expense of mental concentration, rest and digestion. We end up burnt out, finally exhausted physically, but with the mind still racing ahead, worrying about the next day.

So what is the remedy to daily pressure when we can't escape the stresses? We have to work and take care of family, after all. However, too often the priorities are out of sync with our own best health. My patient listed all of her obligations, and said she had no time to get help for herself. She was doing everything for everyone else, including things that could be delegated, and choosing to put herself in last place. I talked to her about reducing the stress response with proven remedies, such as talk therapy, yoga, meditation and massage. I could see her getting anxious trying to insert even one of these things into her schedule. After some problem solving, she was able to come up with a few things she could delegate, or allow to go undone for a day so she could find an hour here and there. She agreed to start meeting with a therapist right away. That's always a good outcome, because I know she'll feel better just having taken the step to put herself first for a change. All too often, though, I will see a patient like this for a follow-up and find out they haven't called the therapist or scheduled the massage or attended the weekly yoga class. And they aren't feeling better.

Why is it so easy to put ourselves behind every other obligation in life? I know from experience, if I'm not healthy and relaxed, everything else I undertake suffers. I bet you've noticed the same thing in your own life. I often say goodbye to people in conversation or email with the words Take Care. We throw this phrase around in casual conversation, and I often say it without thinking what I really mean. Today I recognize when I tell you to take care, I mean put yourself first, thinking of your own physical and emotional needs. So take care, please, and notice the difference you feel in your day.