Silver Lining Search II

 

Sometimes life gets a little crazy for all of us. . .

At such times we can become totally out of control in regards to what will happen in our lives. Individuals such as fighter pilots, trauma surgeons, or astronauts are trained to feel in control of the situation at all times. The truth is that we only have control of the choices we make in any given situation, nothing more or less.

This is a core principle of addiction in that the addict has deluded them self into believing that they possess some degree of control over their drug of choice. In reality the person is completely out of control and cannot be helped until accepting this fact. My current circumstances seem to have awakened me to certain realities from a personal perspective. Life has so many lessons. I'm beginning to understand the contradiction between myself and the substance abuse community. With the cynicism and animosity sometimes felt, one would find it puzzling why I might continue treating so many patients with chemical dependency. In a sense this sometimes dysfunctional relationship between myself and this group, as a whole, seems to have functioned as a distraction from some of the undesirable realities of my own life. Practicing psychiatry in general requires an ability to detach oneself from ones own emotions. It can become tempting to get caught up in empathizing with others to the point that the empathy can become mistaken for ones own emotions. The two are not even remotely the same.

Empathy and compassion can be sincere and intense but also can be turned on and off with a reasonable degree of control. With ones own grief emotions or other issues this is not so. Certain processes must occur emotionally to reach point B from point A. It has become more aware to me of times when I may have coped with certain personal issues by allowing myself to use my work as a means of distraction or avoidance. Such behaviors, on my behalf, can serve the same purpose for me that the pot or cocaine serves for the addict. By observation of the lack of control in the addict patient's life I suppose it could make it easier to delude myself into the false security of being in control of my own issues and problems. Fortunately, nature has means of shocking us back into reality if we choose to listen.

Yesterday was an interesting day. By necessity my appointments were cancelled and I went to the VA Hospital with my father and finally talked face to face with his doctor. Sitting in the chair opposite the doctor is a totally different experience. It is basically a reality check. Thoughts can no longer be separated from emotions here. Finally, I felt the appropriate emotions and allowed myself to weep some. Just a day before I worked with a young teen who was grieving the death of his dad to a motorcycle accident. His anger was getting the best of him and causing major problems at home. I tried to help him see that crying was a natural and normal part of grief. Though his pain had to be much greater than my own, due to the marked difference in circumstance, I still wondered if I would be able to practice what I have preached. I thought of the many patients that had poured their souls out before me over the past months and somehow me comforting them with words that only faith assured me of any validity. Now I had to drop my shield and feel those dreaded grief emotions. I had to let go of the delusion of being impervious to pain. I suppose this last appointment was more for myself and my family more so than for my father. I was really the one seeking validation from his doctor that it was OK to let go and allow nature to take its course. I needed her to say what I already knew. She did a splendid job of empathizing, compassion, and facilitating. It allowed me to begin the grieving process.

I had some time alone with my father and used it to test some of the things I have said to others when experiencing such times. Many times the therapeutic approaches I use with others are highly intuitively based. I have often wondered if some of the things I say just sound nice and are more palliative than factual. An example might be when I have suggested that the actual words spoken during the dying process to a loved one is much less important than the statement made by the physical presence and intent of the family member present. This has helped patients process guilt feelings. I have suggested other things that are without proof such as the dying person doesn't let go until they decide to and feel content with the good byes. After seeing a chest Xray from last year with the image of a large tumor I sat quietly with my father in the exam room for a while and then later on the walk way outside waiting for the transportation person to return. I observed his cachectic appearance and inability to lift a small bottle of juice to his mouth. I suppose that's when I realized that his physical presence was almost spent and it had to be just will power keeping him alive. I still didn't want to cry but I couldn't hold back the tears and it was good for this to happen.

I probably would be at work today had I not learned of my Uncle Van's unexpected death upon return from the VA. This news overwhelmed me to submission though I really was unable to feel much of anything. Uncle Van was the last remaining sibling of my mother. I always expected he would eventually be the sole survivor but nothing is predicable when it comes to death. I don't wish for any reader to get the impression that I am seeking pity from this journal entry for that isn't the case. This has just been an outlet I sometimes use to process things and I know there are some who find my thoughts resourceful at times. I just record it as I see it.

Sometimes life is very sad and unpleasant but there is always a silver lining if we have the patience to wait and seek. Yesterday, I began to grieve yet I felt a sense of rebirth in many ways. I began to open up and allow others to help me realistically face life more completely. I rekindled some old friendships. I witnessed the peacefulness of a baby bunny walk quietly by my feet as two squirrels played on the tree trunk next to me. I accepted the offer from my nephews' dog to rub his belly as he enjoyed the contact and attention. I wasn't ready for the face licking yet and had to decline that offer. I touched a newborn baby yesterday. I realized from the grief that without it none of these simple things would have much meaning for there would be lack of a valid point of reference. For me personally, the greatest lesson of the past week is to stop hiding behind my work and to learn to live more fully. I wish to thank all who have expressed love through your prayers and concerns. May God bless you.

Grief Revisited

   

Last night I dreamed of . . .

being Gomer Pyle in the Marines going through basic training. The Sergeant really let me have it for not being up to snuff. I'm sure these dreams of late are representative of current real life struggles that cannot be avoided. It was more difficult than usual working with grieving patients this past week after seeing that dreaded look of death in my fathers' eyes last Sunday. For the first time the denial I have clung to weakened as I felt a little shock. He really is dying and there is nothing I can do about it. I placed him in his hospital bed and tried to adjust it to make him feel more comfortable. My mother spoke to me about concerns of a business nature but it was very hard to concentrate or think clearly. I have seen that look several times before in patients I treated in the hospital and they always died. It is an ominous sign but the exact time of death cannot be predicted with any certainty.

Less than a year ago I had an idea for a post entitled Three Old Men but I never wrote it, I suppose because of the painful emotions I didn't want to feel. The piece was about two of my uncles and my father who were all on the last pages of their lives. Uncle J.C had suffered a severe debilitating stroke as he entered his late eighties. Uncle Milt was diagnosed with terminal lung cancer as was my father. Uncle J.C. lived until December. Uncle Milt died yesterday. My father's fate hasn't been sealed yet but it wouldn't have surprised me if he had been the one to pass yesterday. Uncle J.C. will be remembered for his stories and laughter, uncle Milt for his colorful prayers at Roberts Chapel. My father's obituary isn't due yet. I write of these things to facilitate my own grief and feel that this forum is as appropriate as any.

I feel blessed in being skilled at helping others grieve and have had a bit of practice doing so. It's so much harder being the one who must grieve. I've grown to realize that in this life the only escape from grief is your own demise. Parents grieving a child is the ultimate loss for which no words can appropriately comfort. Allowing them to verbalize their feelings and encouraging them not to hold back can be helpful. I met with a father today whose son would have turned 18 yesterday had he not accidentally overdosed on drugs provided by peers. For 18 months he has sunken deeper into the abyss of dysfunction. His wife grieves as deeply but has been able to cope more effectively by allowing herself to feel the anger and sublimating through her work. The husband seems to have given up and has provided very little in his efforts for her to work with. She fears coming home one day and finding him dead. He just can't seem to respond. Their marriage is in big trouble. This type of situation causes me to feel frustration and helplessness. His noncompliance with medications and choice to smoke pot instead are a bad sign. He numbs himself to the point that her threats to leave him barely registered. The grief he feels becomes frozen until the drug effect wears off then the emotions return at an amplified intensity. All I can do is try to facilitate communication between the couple and insist that he follow my treatment instructions. I can only hope for the best for it is not possible to follow him home and hold his hand.

Sometimes a loved one remaining alive can cause more grief than a premature death. Generational curses among families is a real entity. I spoke with a morbidly obese profoundly unhappy relatively young mother today. Her plight saddened me as she went more deeply than usual into some of her issues. Due to abuse issues among the preceding generation her mother had always been cruel to her in a relentless manner despite persistent efforts to win her mothers' love. Though obviously mentally ill, her mother never received any treatment and was a survivor of incest and abuse herself. As a child, the patient was blamed by her mother for her biological father abandoning her mother. After being informed by the patient's mother of her pregnancy, this trophy man cursed the young woman telling her he didn't want children after which he left never to be seen again. Throughout her childhood she was repeatedly reminded of how she had ruined her mothers' life. She found her only soothing comfort in food and eventually reached a weight of over 400 lbs. She has battled valiantly to shed weight but her progress has been marginal. Gastric bypass has not been recommended due to airway concerns and other health risks. A recent argument with her uncle resulted in him calling her a big fat bitch. She lamented that the bitch part was tolerable but the fat part seared like a hot knife. Even though he approached her later to request her baby sitting services he never apologized for his words just as her mother has never apologized for any of her many put downs. A couple of her kids have adopted the pattern of mental cruelty they have observed.

Helping her understand how abuse is passed down from generation to generation seemed helpful. I reiterated how such families seem to have the one or more chosen to break the cycle of abuse. These chosen ones are usually abused and ridiculed, even seemingly persecuted at times, but what makes them different is they make a conscious decision not to become abusers themselves as is the more common pattern. Though referred to as weak by many, such individuals are usually quite the opposite. They will make a special effort to ensure that their children or grandchildren never feel the pain of sexual, physical, or emotional abuse that they themselves may have felt. I view such individuals as heroic and incorporate into their therapy a means of rebuilding self esteem and terminating their inner quest to discover the source of their constant pain. The true source of their insanity lays within their circumstances which awaited them long before their birth. Those who successfully endure the pain long enough to find the light of truth can have a rebirth and rebuild a life with a functional support system as they learn who they really are.

DREAMS 2

Much can be learned from dreams. . .

Freud once wrote a book entitled The Interpretation of Dreams. Actually I've never read it but have stumbled on many of its principles through different encounters along the way. Our dream life is much like the vacation home of the mind. Some philosophers have pondered whether the reverse is true or not. If you've ever seen Ashton Kuchner in The Butter Fly Effect it becomes easier to entertain this idea. This movie I consider the horror version of Ground Hog Day.

In real life our dreams are believed to possibly serve the practical purpose of allowing us a place where we are allowed to be completely insane in a way that is unacceptable during the waking hours. Most of our repressed drives and suppressed thoughts are free to express themselves while we dream. It is really the emotion felt during the dream that has value and not so much the plot occurring, as many are tempted to become more enthralled by. One can dream of war and kill thousands then wake up and go to work as if nothing happened as that repressed aggressiveness returns to the abyss of forgotten memories. Having such a dream doesn't mean the person is a violent killer in the least. More likely it represents an opportunity to let off steam from repressed emotions of anger internally or from an external stimuli such as the unacceptable thought of wanting to punch the boss or other individual causing conflict in the persons life.

Everyone dreams whether the dreams are recalled or not. This has been pretty much proved through studying the rapid eye movement stage of sleep in research and clinical labs. In essence, many of the bad dreams are representative of taking out the garbage of the subconscious mind. Without the existence of dreaming we would probably act out those emotions in the waking world which would not be a good thing. If you don't accept that idea then try stressing out someone who has been sleep deprived for several days and see if that person isn't more likely to react in a more irritable and hostile manner than a person who has received their nightly eight hours of sleep. I work with many Post-traumatic Stress people who characteristically have nightmares to the point they sometimes resist or avoid going to sleep at night. It is my belief that if the patient can ever reach a point where they are willing to endure the fear and discomfort and challenge those dreams they can, in theory, conquer the dreams and realize the therapeutic value of purging their subconscious mind of these toxic emotions and fearful drives. This of course is a process that takes time and is best done while in psychotherapy. People in bereavement often have pleasantly euphoric dreams of the loved one being alive. In this case awakening is when the trauma is felt as they re-aclimate and realize the loved one is no longer a physical part of their life.

I have found that no dream can be considered too crazy. In fact, the crazier the dream the more creative the dreamer for dreams are not meant to have boundaries or make sense. I have had some repulsive and repugnant dreams but learn to throw them back just as a fisherman returning an undesirable catch to the water. Those bad dreams actually make us thankful to be finally awake. Like everything else in our reality dreaming relies on balance. If 100% of our dreams were good who would want to ever get out of bed and much productivity would be lost. So bad dreams may have value from an evolutionary standpoint just as certain positive envisionary dreams. Someone had to dream certain things for them to ever have been developed. The initial dreamers of the airplane, the telephone, and the television were likely looked at as being totally insane the first time they spoke of such ideas but had they not had the courage to dream of such things these luxuries would not be a part of our waking reality today.

This entry was inspired by an intense recurring dream that visited me last night involving being in a play. Drama played a major part of my younger life and helped me to develop and  explore many different characteristics within myself and among others. By nature, I'm introverted and tend to live inside my head majority of the time. But as most introverts are aware of we are more creative than our extroverted counterparts because they rely on having to hear themselves talk and participating in an active way to maintain their self esteem and productivity. We introverts tend to work on stuff inside our heads until a brilliant idea is born and it isn't until that idea is presented to others that we are given credit for having much intelligence. Okay, maybe that's an over simplification but I think the point was made. Without further digression, I dreamed this dream of being in a play at a whole 'nother level of chaos last night. The play had no name, the auditorium was unfamiliar, I knew no lines, knew none of the characters, the plot was not known, the setting continuously changed, I was always on stage at the wrong time, the cues were always off, retreating to the backstage area was useless because the drapes would always reveal me to the packed auditorium. Early in the dream I felt confident I could improvise and wing it. My unknown fellow actors would or could not respond and I continued to look increasingly like a complete idiot. This dream may have lasted ten minutes in reality but to me the perception was that it was going on for hour after hour. I tried so hard to awaken myself after entering that state of awareness of it being a dream. The inability to awaken myself seemed to intensify the helplessness and sense of embarrassment.

In such a dream, over time, I have developed the ability to try and influence the outcome, so I tried to see and interact with some of the people in the audience. I also made the curtains close so the act could be restarted. The restart was more chaotic than the initial take. I waited for the audience to start heckling and booing which surprisingly didn't happen, at least not before I finally awakened. I'm not going to make any interpretive attempts of this dream here but I wanted to document it before it vanishes from my memory. I know it will return at some later night as it has for years. I feel fear while experiencing the dream but I don't fear experiencing the dream because I recognize it has value in helping me sort out fears in my waking life.