Hello, Anxiety. Who are you exactly?

I read an article recently that suggested that when anxiety appears, you have a conversation with it.  Being the eager guinea pig that I am, I decided to give it a try and it was really helpful.  At the risk of revealing my inner crazy, I’m sharing it here.

Me:  I think there are two voices here.  The first is the Judgmental Older Sister.  You obviously need to go first. 

Judgmental Older Sister:  You know when all of this ends badly? I’m going to say I told you so.  I’m going to look at you with disgust and remind you that you knew better.  I’m going to be sorry for you that you are hurting, but I’ll remind you that you could have avoided the pain if you only did the smart thing. 

Disclosure: I have two older sisters and, for the record, neither of them talk in the voice of the judgmental older sister.  It’s just the way I picture this particular voice. Love you, sistas!

Me:  I think what I am unsure about is how will I know when it’s time to REALLY let go?  And will I be able to do it?  That’s the deep essence of my hesitation.  I am not sure about that.  I guess I can say this.  I knew when it was time to let go of my marriage.  And I was able to do it.  Why the hell would that not give me all kinds of confidence about this?  I just made it through the divorce finalization which was hell.  I did it.  I made the decisions that got me through it.  I did it with my eyes wide open.  It wasn’t perfect but it was pretty damn good.  So how can I be unqualified for this?  I  AM smart.  It doesn’t mean I always do the smart thing, because who even knows what that is?  Certainly not me.  I spent a long time doing the “smart” things and it was totally stupid.  It was my best, but if I had to do it over again, I would totally do it differently.  So I’m not looking for the smart thing anymore.  I’m looking for the precise thing.  That’s all I can do. Because smart is too subjective.  It’s too hard to call.  So, Judgmental Older Sister—you are ego personified.  Ego is the real fear—that I’m going to look or feel stupid.  That’s the worst case scenario.  I can handle that.  I do stupid things all the time.  Let it roll.  I can get through that.  Okay, let’s hear from the second voice.

Fear-of-Pain: I just don’t want us to hurt anymore.  Haven’t we been through enough?

Me:  You mean well.  You really do.  I get where you’re coming from.  Pain sucks.  It hurts.  Sometimes it comes and stays a while.  It makes me cry in front of people which can feel awkward.  It makes doing little things seem hard.   But it’s also where all the growth is.  And avoiding the right thing or the true thing to avoid pain never works because pain is there either way.  Pain shows up in the avoiding and it shows up in the embrace.  Pain is on either side of the equation.  It doesn’t matter how you solve it, pain will be there in some measure.  So, my dear Fear-of-Pain voice, you can be present, because, you’re right—pain hurts.  But you can’t drive the car.  You can’t run the show because pain is coming along too, at least for part of the trip, and we have to make room. 

Then I wondered… could I have a dance party with Judgmental Older Sister and Fear-of-Pain?  Is that possible? Does Judgmental Older Sister dance?  She can sit on the side and watch with mild loathing.  Fear-of-Pain will probably only safely sway in the background.  It’s okay—I will dance for all of us.

Rebellion in the sparkling line of costume gems

When I was 17 my mom made me a prom dress.  It’s still one of my favorite pieces she has created, which is saying something because this is a woman who has spent thousands of hours behind a sewing machine.  Since before I was born, she sewed dresses for herself and my sisters and me.  For Christmas, Easter, and summer at the least, every year, she would produce four new dresses.  When we were little, the dresses for my sisters and I were matching.  As we got older we would all go the fabric store to pick out a dress pattern and material so we each got a custom frock. 

I have done a little sewing.  In my 20s I received a sewing machine for Christmas from my mother-  and father-in-law.  I was living in their basement at the time and taking prereqs for PA school.  I saved my Joann’s coupons and bought material and patterns and I began to sew garments for myself.  I got some vintage material from Grandma Hurst that was passed down from her mother, who owned a fabric store at one time.  I made shirts and skirts and dresses. 

Sewing, for me, was an interesting mix of technical ability and creativity.  At times, it was really difficult to understand the pattern instructions and inevitably I would sew a seam in the wrong place and end up picking it out.  Sometimes there were hours of unpicking seams.  Sewing is an exercise in frustration and accomplishment, devastation and creativity, and and mostly perseverance.  Sometimes it’s exhilarating and sometimes it’s intolerable. 

So knowing this, when I look at my black velvet, beautifully tailored prom dress hanging in my closet, I understand a bit of what went into its creation. 

My mom was in a moderate-to-severe depressive episode for about ten years, which covered the entirety of my adolescence.  When I think about that time, it mostly feels quiet.  It was quieter in the house without her laughter and music and the hum of her sewing machine.  There were times when she didn’t function.  Times when she disappeared for days.  Her absences felt ominous and confusing.  But most of the time she was there, doing the driving and shopping and cooking and cleaning, in a quieter way.  Most of the time it wasn’t the activity in the house, but the presence of suffering that felt different. 

I have learned, in a small way, what that might have felt like for her.  There have been nights when I have wondered how I will face the following day—how I can summon the strength to get up and do the few things that must be done.  And I’m in awe that, during this time of darkness, she found the strength and desire to create a graceful, elegant dress for me.  It was a gesture of kindness and love. I see rebellion in the sparkling line of costume gems on the bodice.  An indignant strike against the oppressive darkness.

This is what I learned from my mom: 

To keep moving alongside the fear and the dark. 

To find beauty in it.

And to create in its presence. 

That is how you find the light again. 

It's all delusional anyway

I am a psychiatric PA.  A lot of people get confused by that title.  I am a physician assistant specialized in psychiatry.  I do the same job as a psychiatrist for much less money, and I’d like to think with a little more style!  I diagnose and treat mental illness, primarily with medication.  I have been doing this for 6 years and for half of that time I have worked with the severely, persistently, mentally-ill population.   Most of my patients have schizophrenia, bipolar disorder, substance abuse or some combination of all three.  When I tell people this, I usually get some kind of response like, “I don’t know how you do that. That seems like a really hard group to work with.”  And it is in some ways.  My patients are often dirty and smelly.  They are often high on something or coming down from something or waking up from something.  They struggle with basic tasks.  They get angry easily.  They don’t answer my questions in straight-forward ways.  Sometimes they are violent or threatening.  Sometimes they lie.  And sometimes they are honest. 

One such patient suffers from schizophrenia.  He is usually stoic with limited eye contact when he sits down in my office, but after only a moment he will start to intensely muse about Father Time and the universe and people and places that, I’m pretty sure only exist in his mind.  I’m trying to find out how he is sleeping and whether he is thinking about suicide.  I’m thinking, “Yeah, ok, Father Time… but let’s talk about the important things.” 

And he is probably thinking, “Yeah, ok, sleep…but let’s talk about the important things!" My interviews often feel like a struggle to obtain the information I want without completely dismissing, what to me is complete gibberish, but what to my patient is his pressing reality.  I’ve learned that patients get used to this dance too.  And like me, sometimes it’s frustrating but usually we just roll with it and do our best to play our parts. 

This particular meeting was different.  He started off with a bizarre statement (not so unusual), “Did you know I have AIDS but it doesn’t register?  I have it in my spirit.” 

I think, “Okay, this is how it’s going to go.”  So I look at the report that he completed in the lobby.  It’s called a Common Ground report and it gives the patient a Likert scale to rate various symptoms.  Sometimes psychiatric patients (and really all patients) have a hard time relating their symptoms to their healthcare provider so this is meant to ease the process.  He marked that he was not doing so well at fulfilling responsibilities so I ask him about it. 

“I have trouble remembering to go on walks, wash my plate and the table cloth, and flush the toilet because I spend a lot of time nervous and confused.” The honesty of this statement strikes me.  He continues, “It’s confusing that I know how to understand what I’m going through and still be able to take the pain that I’m going through.”

Heart wrenching. 

This man stabbed himself in the arm a while back in response to some delusional belief.  It became infected but no one noticed and his arm eventually had to be amputated due to the infection.  "Is the pain physical or emotional?" I asked. 

“Emotional,” he replied.

I saw his pain in that moment.  He is living in two worlds, maybe more.  For a moment, he visited me in my reality, but there is pain there so he quickly wandered back into the land of “Mother Nature”, “Father Time” and “alternate universes.” 

This is a dramatic example—and, speaking from the front lines, mental illness is real—but we all get to choose our reality.  Life happens in the mind.  Ultimately, our experiences hold the meaning that we assign to them.  So be intentional with your narrative, friends.  You get to decide if it is a tragedy or the hero’s journey.  You choose the delusion and make it your reality…choose wisely.